bluuebunny/crossref_metadata_2025 huggingface dataset:
1280. Real-World Comparison of HIV-ASSIST with Expert Opinion in Selecting Antiretroviral Therapy for Complex Patients
Authors: Tang Michael E , Hill Lucas , Yin Jeffrey , Abulhosn Kari , Wooten Darcy
Published: December 2022

Background

HIV-ASSIST is an online, clinical decision support tool that helps HIV clinicians select antiretroviral (ARV) regimens for patients with HIV by accounting for individual patient characteristics. Concordance between HIV-ASSIST recommendations and expert opinion has been reported to be as high as 89% in treatment-experienced patients. We evaluated the utility of the HIV-ASSIST tool for a heavily treatment-experienced, complex patient population at the University of California, San Diego (UCSD) by comparing regimens recommended by HIV-ASSIST with regimens recommended by HIV experts.

Methods

We identified 14 patients through a routine HIV drug resistance teaching conference at our clinic. Each case was reviewed by 5 HIV clinical experts who independently recommended an ARV regimen. A consensus “best” regimen was agreed upon among the 5 experts for each patient. Consensus regimens were compared for concordance to the top 5 regimens recommended by the HIV-ASSIST tool. HIV-ASSIST regimens were also reviewed to determine if any were high or moderate risk for virologic failure due to patient or resistance characteristics, or drug-drug interactions (DDIs).

Results

The patients analyzed were medically and psychosocially complex, with a high rate of multi-class resistance (Table 1). Expert-recommended regimens were concordant with one of the top five regimens recommended by the HIV-ASSIST tool for 4/14 (28%) patients (Table 2). We further classified 20/70 (29%) regimens as high risk for virologic failure and 12/70 (17%) regimens as moderate risk for virologic failure (Figure 1). Table 2.Expert-recommended consensus regimens compared to the top 5 HIV-ASSIST regimens for 14 patients with HIV and a history of drug resistance, multimorbidity, and polypharmacy.Figure 1Classification of HIV-ASSIST regimens by HIV clinical experts as either acceptable, moderate risk or high risk for virologic failure.

Conclusion

Compared to prior reports, we found lower concordance between ART regimens recommended by HIV experts vs those recommended by the HIV-ASSIST tool in patients with HIV drug-resistance and/or complex comorbidities and potential DDIs. Moreover, several HIV-ASSIST regimens were considered at risk for virologic failure. We recommend caution in using the HIV-ASSIST tool for complex patients with significant drug resistance.

Disclosures

Lucas Hill, PharmD, AAHIVP, Gilead Sciences: Speakers Bureau.
1286. Telehealth Utilization and 2-year Outcomes among People with HIV at a Midwestern Clinic
Authors: Labisi Titilola , Regan Nichole N , Arroyo Monica , Fadul Nada
Published: December 2022

Background

Telehealth platforms such as video and telephone visits serve as mechanisms for HIV care delivery during the COVID-19 pandemic. While telehealth may be instrumental in HIV care, its utilization, sustainability, and impact on patients’ outcomes remain an area for further research. Hence, we compared people with HIV (PWH) utilizing telehealth services to those receiving in-person clinic services at Nebraska's largest HIV clinic in Omaha.

Methods

HIV Care visits were classified into telehealth and in-person visits. We defined telehealth users as PWH who have utilized telephone or video visits at least once between April 2020 to March 2022. Clinical and demographic comparisons between both groups were made. We conducted bivariate analyses and descriptive statistics for associations and proportions of visit type, viral loads (VL), and completed visits.

Results

A total of 4,473 visits were completed among 1,308 unique patients (172 telehealth users versus 1136 in-person). Telehealth utilization was significantly higher among patients from cities other than Omaha (< 0.001) and those with income levels above the Federal Poverty Line (FPL) (0.001). Telehealth users made up 73.3% of missed appointments and 50% of canceled visits. Telehealth users were significantly more likely to have undetectable VL than in-person visit users (0.018). In addition, patients who were ≥ 45 years were significantly more likely to have undetectable VL than younger patients (< 0.001).

There was no association between gender, race, or year of HIV diagnosis and visit type. Notably, transgender patients (n = 18) did not use telehealth.

Overall telehealth utilization dropped from 64% of our total visits in April 2020 to 5% in March 2022.

Conclusion

In our patient population, telehealth users were more likely to have undetectable VL, live far from the clinic, and have income levels above the FPL than in-person visit users. However, telehealth users were more likely to cancel or miss their medical appointments. Our data also suggest a low preference for telehealth among transgender people. Future studies should develop strategies to improve rates of completed visits among telehealth users, promote telehealth use among transgender men, and sustain the utilization of telehealth beyond the pandemic.

Disclosures

All Authors: No reported disclosures.
1293. Calling Attention to Pre-Exposure Prophylaxis (PrEP) for Women: A Novel Social Media Educational Campaign for Potential PrEP Users and Clinicians
Authors: Avraamides Christie , Blackstock Oni , Symowicz Jaime
Published: December 2022

Background

We designed and implemented an educational campaign using social media to provide information about HIV risk and prevention to Black heterosexual women (BHW) to promote PrEP awareness and enhance their relationships with clinicians.

Methods

In July and August 2021, 3 physician social media influencers who are Black women with large Black audiences shared content focusing on sexual health and PrEP on Instagram and TikTok with links to 2 surveys. An accredited webcast for clinicians followed in October 2021. It incorporated key points from the surveys and covered integrating HIV prevention into the routine care of BHW and addressing misconceptions about PrEP.

Results

The social media campaign reached over 171,000 followers and garnered 3,700 engagements, 62,441 total views, and 1.4 million impressions. Among the 171 comments, common themes included women not realizing that they could use PrEP and appreciation that the posts advocated for their health.

In total, 41 Black women responded to the surveys. 64% said they would be extremely/moderately comfortable talking with a provider about HIV prevention and PrEP (N=14). 89% would be extremely comfortable asking their provider for PrEP if they thought they needed it, but their provider did not offer it (N=9). However, some respondents still felt uncomfortable because they didn’t know what questions to ask, were embarrassed to ask questions, or were afraid of being seen as promiscuous.

To date, the webcast had 767 participants (75% in primary care and OB/GYN), and matched pre/post-test data were available for 49 learners. Learners’ confidence in their ability to integrate HIV prevention into the routine care of their BHW patients increased (53% moderately/very confident at baseline vs. 74% at post-test). Learners were more likely to ask their BHW patients about the risk behaviors of their partner(s) when taking a sexual history (51% very/extremely likely at baseline vs. 78% at post-test).

Conclusion

These results highlight the educational needs of BHW and illuminate needed improvements in clinician-patient dialogues about sexual health. Although Instagram and TikTok are known for brevity of content, they were effective in informing BHW about PrEP use for women and taking charge of their sexual health.

Disclosures

Jaime Symowicz, PhD, Gilead Sciences, Inc: Unrestricted educational grant for the educational initiative described in the abstract.
1295. Cross-sectional survey on education of clinical infectious diseases and antimicrobial resistance in pharmaceutical department in Japanese universities
Authors: Koizumi Ryuji , Tanaka Chika , Endo Mio , Fujitomo Yumiko , Tsuzuki Shinya , Asai Yusuke , Ono Akane , Muraki Yuichi , Kitahara Takashi , Ohmagari Norio
Published: December 2022

Background

Pharmacists play an important role in infection control and antimicrobial stewardship teams in hospitals and the community. The need for education on antimicrobial resistance (AMR) and clinical infectious diseases (CID) is increasing. However, the status of Japanese pharmaceutical education on CID and AMR is unclear.

Methods

We conducted a nationwide cross-sectional survey of pharmaceutical department in Japanese universities between February and March 2022. Data on the following were collected using questionnaires: 1) basic information; 2) number of faculty members with experience in CID; 3) lecture times for CID and AMR; 4) self-evaluation of CID and AMR education; and 5) the most important issues in CID and AMR education. Descriptive analyses were conducted.

Results

Among the 74 participating universities, 44 (59.5%) universities responded. The median number [IQR] of faculties of infectious disease education was 7 [4–12], and clinical faculties was 3 [1–6]. Twenty-seven (62.8%) of the universities had faculties with clinical experience in infectious diseases. Lectures time for CID and AMR varied among the universities.

Respondents indicated that CID and AMR lectures were insufficient, compared to microbiology basic lectures. Additionally, insufficient lecture time and specialists were the most common responses as the most important issues in CID and AMR education.

University background and questions regarding CID and AMR lectures (N=44)

Boxplot of lectures time for clinical infectious disease and antimicrobial resistance education

Self-evaluation of clinical infectious disease and antimicrobial resistance education

Conclusion

This study revealed that educational status and resources for CID and AMR education varied widely, and that practical lectures on CID and AMR may be insufficient. We suggest that the entire core curriculum and resources, including the number of faculties, needs to be examined and improved.

The most important issues in clinical infectious disease and antimicrobial resistance education.

Disclosures

All Authors: No reported disclosures.
1302. Interactive Case-based Antimicrobial Stewardship Education Program to Pharmacists at a Large Community Health System
Authors: Wilde Ashley M , Swingler Elena A , Song Matthew , Moore Sarah E
Published: December 2022

Background

Education on antimicrobial stewardship (AMS) is one of the several elements outlined by the Center for Disease Control for hospital antibiotic stewardship programs. However, the Infectious Diseases Society of America guideline on implementing antimicrobial stewardship notes that passive education should not be a sole method for training as the effects are often short lived. AMS education strategies beyond didactic lectures and written material distribution are needed.

We sought to describe the implementation of an interactive, case-based AMS educational program targeting pharmacists across a multi-hospital community health system licensed for over 1,500 beds.

Methods

Each month, a custom patient case was drafted by an infectious diseases trained pharmacist to highlight a common AMS principle encountered in practice. These topics were broadly categorized into appropriate empiric antibiotic selection, treatment plan modification, and identification of non-infectious clinical syndromes. A specific question with multiple choice answers was drafted. The case was disseminated to all hospital pharmacists via email using Microsoft Outlook. Pharmacists were prompted to use the voting buttons to select the correct answer (Figure 1). After a week, results of the survey was shared with the entire pharmacist staff along with information on the primary teaching point and detailed explanations for why each answer was correct or incorrect.

Example Voting Buttons for Case-Based Education

Results

A total of eleven AMS cases were disseminated to 88 hospital pharmacists involved with direct patient care. Average number of responses per case was 27 (31%), range 17-41 (19%-47%). Average number of correct responses for each case was 74%, range 26%-100%. The highest rates of correct responses came from cases focusing on empiric antibiotic selection (87%), followed by identification of non-infectious clinical syndromes (73%). The lowest rate of correct responses were found with treatment plan modification cases (65%).

Conclusion

This case-based AMS education program leveraged existing technology to provide engagement across a large and geographically diverse pharmacist staff, provide opportunity to apply stewardship concepts, and assess staff pharmacist knowledge on general AMS principles.

Disclosures

Matthew Song, PharmD, BCIDP, Merck: Stocks/Bonds|ObsEva: Stocks/Bonds.
1305. PrEParing for success: An intervention to increase HIV prevention awareness among internal medicine residents.
Authors: Torres Mario A , Ojeda-Martinez Hector , Cluzet Valerie , Mazurkiewicz Rebecca
Published: December 2022

Background

PrEP (Pre-Exposure Prophylaxis) is a strategy that involves a combination of antiretrovirals medications aimed to reduce HIV transmission among at-risk individuals. The purpose of this quality improvement project is to increase internal medicine residents' knowledge and prescribing of PrEP.

Methods

We administered an anonymous paper survey to internal medicine residents at all stages of training at our suburban community hospital in the Hudson Valley, NY in the summer of 2021 during the academic half-day of their ambulatory block rotation. The survey consisted of questions about the residents’ demographics, PrEP knowledge, and previous prescribing of PrEP. Following the survey participants were given a 1-hour lecture by the authors on sexual history and PrEP including indications, available options, dosing, monitoring, side effects, and access to the therapy. Six months later we reissued the same survey to the residents. Surveys were analyzed using descriptive statistics.

Results

All 74 eligible residents completed the survey. Out of the 74, 35 (47.3%) identified as male and 40 (52.7%) identified as female. Medical school graduation year range between 2007 to 2021. Only 69 residents completed the post-survey. To Q1 “which medications are FDA approved to be used as PrEP,” 40 (54.05%) answered correctly prior to the intervention, whereas 51 (73.91%) did after. When they were asked Q3 “How effective was PrEP at reducing the risk of contracting HIV through sex,” 21 (28.38%) responded correctly, which improved to 46 (66.67%) after. To the other knowledge-based questions there was no significant improvement (see table). The number of people who reported prescribing PrEP increased from 2 (2.7%) to 7 (10.14%).

PrEP survey Pre and Post results

Conclusion

Although experiencing this educational intervention did not improve long-term retention of knowledge among the participants, there was a substantial increase in the number of residents who prescribed PrEP. One of the limitations that can contribute to these results; is the short time frame between the intervention and post-survey. These findings demonstrate the need for early introduction of this topic into medical school and residency program curricula.

Disclosures

All Authors: No reported disclosures.
1308. Virtual ID Fellowship Interviewing & DEI: A Win for Everyone?
Authors: Schultz Sara K , Clauss Heather , Matt Brionna
Published: December 2022

Background

Graduate medical education programs shifted to an all-virtual recruitment in 2020. There is little published on the impact of this shift on the demographics of applicants, particularly in a field such as infectious disease where there are typically fewer applicants than available spots. Program directors were forced to make a radical change to their typical recruitment process. This study illustrates a single-center experience with virtual ID fellowship interviewing.

Methods

Using the Program Director Work Station on Electronic Residency Application Service (ERAS), we reviewed our program specific data from 2018-2021. We extracted the total number of applicants, the self-identified race/ethnicity of the applicants, their medical school type (US MD grad, DO grad, Non-US grad), their sex, and their location. We used simple descriptive statistics to identify trends and comparisons from in-person interviewing (2018 and 2019) and virtual interviewing (2020 and 2021).

Results

The number of virtual ID fellowship applicants to our program increased in 2021 by 24% compared to in-person applicants in 2019 (123 vs. 99). This exceeds what a program would expect from the 13% nation-wide increase in ID applicants in 2021 as there were a record 404 total applicants compared to 356 total applicants in 2019 We also saw an increase in Black or African American applicants; 13 Black applicants in 2021 compared to 2 Black applicants in 2019. We saw a stable rate of applicants who self-identified Hispanic, Latino, or of Spanish origin; 18 in 2019 and 17 in 2021. as Notably, we also saw an increase in geographic diversity of our applicants as we drew applicants from 22 states in 2019 (Figure 1a) and 35 states in 2021 (Figure 1b). Additionally, in 2020 we matched two applicants from geographically distant states (Ohio and Colorado) and in 2021 we matched one (Mississippi). Figure 1aFigure 1b

Conclusion

Virtual interviewing was advantageous for our infectious disease fellowship program at Temple University. We saw a 24% increase in applicants, had more Black applicants and more geographic diversity in our applicants. Furthermore, we were able to recruit these applicants into matched fellows.

Disclosures

All Authors: No reported disclosures.
1311. Associations Between Microbiological Diagnoses and Clinical Outcomes in Children with Acute Hematogenous Osteomyelitis: A Retrospective Cohort Study
Authors: Enderle Madison , Gallizzi Gina , Hu Nina , Yonts Alexandra B , Martin Benjamin D , Hamdy Rana F
Published: December 2022

Background

Acute hematogenous osteomyelitis (AHO) affects about 2-13 children per 100,000 in developed countries each year. Staphylococcus aureus is the most common causative pathogen of AHO and, due to antibiotic resistant strains of this species, a microbial diagnosis is often desired. Blood and bone cultures may identify causative pathogens and determine antibiotic susceptibilities but obtaining bone cultures carries risks. The benefit to patients of having a pathogen identified is disputed and further research is required to address this question. The objectives of this study were to determine if length of stay differs between culture-negative and culture-positive patients and to determine if odds of receiving 3 or more unique antibiotics differs between culture-negative and culture-positive patients.

Methods

Data were retrospectively abstracted from medical records of pediatric patients with a clinician’s diagnosis of AHO admitted to Children’s National Hospital (CNH) between January 1, 2010 – June 30, 2020. Baseline characteristics, treatment, and outcomes were described. For culture-negative and culture-positive AHO patients, length of stay and odds of receiving 3 or more unique antibiotics were compared using multiple linear regression and multiple logistic regression, respectively.

Results

Of 367 included patients, 210 had a positive culture result about 83% of which were identified as S. aureus. Culture-negative patients were associated with a 6.45-day shorter length of stay compared to culture-positive patients, adjusting for age, peak C-reactive protein (CRP), and surgery (p = 0.02). Culture-negative patients had 0.196 times the odds of receiving 3 or more unique antibiotics than culture-positive patients, adjusting for age, peak CRP, and surgery (95% CI: 0.114, 0.336).

Conclusion

Among AHO patients admitted to CNH, being culture-negative was associated with shorter length of stay and lower odds of receiving 3 or more unique antibiotics.

Disclosures

All Authors: No reported disclosures.
1325. Macrolide versus Non-macrolide in Combination with Steroids for the Treatment of Lobar or Segmental Mycoplasma Pneumoniae Pneumonia Unresponsive to Initial Macrolide Monotherapy
Authors: Bae Eunha , Kang Hyun Mi , Kim Ye Ji , Jeong Dae Chul , Kang Jin Han
Published: December 2022

Background

Mycoplasma pneumoniae (MP) is one of the most common causes of bacterial pneumonia in children. In the recent decade, macrolide-resistant MP (MRMP) has been increasing in proportion, leading to children unresponsive to initial macrolide therapy. The purpose of this study was to evaluate the outcomes of children with lobar or segmental MP pneumonia unresponsive to initial macrolide therapy, who received non-macrolide (NM), macrolide plus steroids (M+S), and non-macrolide plus steroids (NM+S) according to the 2019 guideline during the 2019-2020 Mycoplasma epidemic in South Korea.

Methods

This was a retrospective cohort study of children below 18 years old, admitted during the 2019-2020 MP outbreak for lobar or segmental MP pneumonia. The inclusion criteria were as follows: 1) sputum or nasopharyngeal swab MP PCR positive, 2) no history of pneumonia within one month of positive MP PCR, 3) lobar or segmental pneumonia on chest x-ray, and 4) initial treatment with macrolide monotherapy. Children that were unresponsive to the initial 3-5-day macrolide monotherapy were divided into 3 groups depending on the next regimen: NM, M+S, and NM+S group. Their outcomes were assessed.

Results

During May 2019 to March 2020 MP epidemic, a total 190 patients that fit all of the inclusion criteria were included as study participants. Of these, 16.8% (n=32/190) were responsive to initial macrolide monotherapy and 83.2% (158/190) were unresponsive. Of the 158 patients unresponsive during the initial 5-day macrolide therapy, 8.2% (n=13) were switched to a NM, 75.9% (n=120) were added steroids (M+S), and 15.8% (25/158) were switched to a non-macrolide plus steroids (NM+S). Treatment success rates were 46%, 81%, and 100% in the NM, M+S, and NM+S groups, respectively (P=0.001). Compared to patients in the NM+S group, those in the M+S group were 8.0 (Confidence interval [CI], 1.3-61.7; P=0.046) times more likely to have prolonged fever ≥4 days after the switch in treatment regimen compared to patients with NM+S, and 10.7 (CI, 1.5-108.7; P=0.046) times more likely in the NM group.

Conclusion

In patients with severe mycoplasma pneumonia with failure of response to initial macrolide therapy, a non-macrolide antibiotic plus steroid combination had the highest treatment success rate and shorter duration of fever.

Disclosures

All Authors: No reported disclosures.
1327. Nontyphoidal salmonella infection in children and adolescent; A retrospective, multicenter study in Korea
Authors: Shin Je Hee , Lim Sung Min , Choi Joon-sik , Kim Ji Hong , Ahn Jong Gyun , Kang Ji-Man
Published: December 2022

Background

Non-typhoidal salmonella (NTS) infections usually have a self-limiting course, but can cause invasive NTS (iNTS) diseases, including bacteremia, meningitis, osteomyelitis or other focal infection. However, information on NTS infections in children is scarce in Asian countries. We investigated the differences in clinical features and antimicrobial susceptibility patterns of NTS infections in Korean children.

Methods

From November 2006 to May 2021, we collected NTS cases isolated from patients under the age of 20 at three Severance Hospitals (Sinchon, Gangnam, and Yongin) in Korea. All NTS cases were extracted through the Severance Clinical Research Analysis Portal. NTS cases isolated from the genitourinary tract were excluded. Clinical data were collected through chart review.

Results

A total of 837 isolates were identified from 637 patients. 22 patients were excluded, and a 615 patients were included in the study. The median age at NTS infection was 4.6 years (IQR, 2.4-7.9 years), and those under 5 years of age accounted for 54.1% of all cases. The male to female ratio was 1.6:1 and approximately 15.8% (n=97) had at least one comorbidity. By clinical diagnosis, enterocolitis was the most common with 543 cases (88.3%), followed by bacteremia without local sign in 11 cases (1.8%), osteomyelitis in 7 cases (1.1%). The iNTS group (n=68) did not have any significant differences in age of onset, presence of fever, white blood cells, absolute neutrophils, and C-reactive protein levels, but the frequency of diarrhea (67.6% vs. 89.9%, p<0.001) was less than the non-invasive NTS group (n=547). Extra-intestinal symptoms were more common in the iNTS group than in the non-invasive group (30.9% vs. 14.3%, p=0.003), and the length of hospital stay (8.65±6.4 days vs. 5.13±3.3 days, p=0.001) were significantly longer in the iNTS group. Notably, 2 out of 7 patients with NTS osteomyelitis showed a poor clinical response even with cefotaxime-sensitive antimicrobial susceptibility results. Antimicrobial susceptibility pattern between the group was shown in Figure 1.

Antimicrobial susceptibility pattern between the group

Conclusion

Children with iNTS infection showed a relatively severe clinical course compared to children with non-iNTS infection. Further studies on the epidemiology and characteristics of invasive NTS infection are needed.

Disclosures

Joon-sik Choi, MD, MS, Ministry of Trade, industry and Energy, Republic of Korea: Grant/Research Support.
1332. Population structure and genomic analysis of pediatric Streptococcus pyogenes clinical isolates in the United States, 2020 – 2022
Authors: Ozer Egon A , Gatesy Samuel W , Patel Ami B , Guzman-Cottrill Judith A , Fleming-Dutra Katherine E , Chochua Sopio , Beall Bernard , Jaggi Preeti , Inguglia Christine L , Katsogridakis Yiannis L , Shulman Stanford , Tanz Robert R , Rippe Jason
Published: December 2022

Background

Streptococcus pyogenes (GAS) is the major cause of bacterial pharyngitis in children. GAS can cause conditions ranging from asymptomatic pharyngeal carriage to invasive infection. We compared the genomic characteristics of GAS pharyngeal and invasive isolates from U.S. children.

Methods

We cultured GAS from throat swabs collected from children aged 3–18 years with acute GAS pharyngitis, diagnosed by rapid antigen or molecular test, and from a convenience sample of asymptomatic children during 1/2020 to 3/2022 in Chicago, IL; Atlanta, GA; Portland, OR; Phoenix, AZ. We collected invasive isolates in Chicago. Whole-genome sequencing (WGS) was performed on the Illumina MiSeq for species confirmation, isolate typing, and virulence and antimicrobial gene identification. Reference-based read alignment was used for whole genome phylogenetic analysis.

Results

Of 1144 collected throat swabs, 684 were from children with pharyngitis and 460 from asymptomatic children. 13 invasive GAS isolates were collected. GAS were cultured from 359 pharyngitis and 20 asymptomatic swabs. Of these, 371 GAS isolates could be recovered and underwent WGS. Thirty isolates (8%) were either low-quality sequences and/or identified as species other than S. pyogenes and were excluded. Whole-genome phylogenetic analysis of 341 GAS (215 pharyngitis, 13 asymptomatic, 13 invasive) identified 25 related clusters and 8 singletons (Figure 1). Virulence gene complements within given emm types were generally concordant with recently published CDC strain data. The most frequently identified resistance genes were tetM and ermB. 281 isolates (82%) carried no antibiotic resistance genes. Some clusters were significantly more represented at certain sites within apparent geographically defined clusters of nearly indistinguishable isolates (Figure 1): cluster 1 in Chicago, emm type 3; cluster 14 in Phoenix and Portland, emm 28, 12; and cluster 15 in Atlanta, emm 89. No major genomic factors were significantly associated with asymptomatic vs pharyngitis vs invasive presentation. Figure 1:Whole genome phylogenetic tree of pediatric GAS isolates

Maximum likelihood phylogenetic analysis based on whole-genome alignment of 371 Group A Streptococcus isolates. Tip colors represent cluster assignments based on genetic similarity. Inner ring represents geographic location of GAS isolation. Outer ring represents patient presentation: asymptomatic colonization, symptomatic pharyngitis, or invasive infection.

Conclusion

Pharyngeal and invasive GAS in children within individual clonal complexes are co-included in closely related clusters, with evidence of close transmission within individual sites

Disclosures

All Authors: No reported disclosures.
1333. Prognostic Factors Associated with Complications of Acute Hematogenous Osteomyelitis in Children
Authors: Clemente Adriana Sarmiento , McNeil Jonathon C , Hulten Kristina G , Vallejo Jesus G , Kaplan Sheldon L
Published: December 2022

Background

The clinical presentation and management of acute hematogenous osteomyelitis (AHO) in children can vary significantly. Scores to predict acute complications utilize prolonged fever after antibiotics, bone abscess, suppurative arthritis, disseminated infection and delayed source control. By contrast, elevated CRP after 48-96 hours of therapy, disseminated disease and bone debridement are predictive of chronic complications. Such scoring systems have undergone limited validation. We examined factors associated with acute and chronic AHO complications at our center to identify other variables that may enhance published scores.

Methods

A retrospective chart review was conducted of all children 6 mo-18 years with AHO and with acute symptoms of < 14 days at Texas Children’s Hospital from January 2012 through December 2020. An acute complicated course was defined as treatment failure within 6 weeks of starting antibiotics, > 2 bone debridements, prolonged admission ( >14 days) and acute avascular necrosis. Chronic complications included growth arrest or limb leg discrepancy, pathologic fracture, avascular necrosis, chronic osteomyelitis or frozen joint. Statistical analysis was completed using STATA 17.

Results

418 patients met the inclusion criteria. 106 (25.4%) had an acute complicated course. 51 (13.5%) of 377 followed had a chronic complication. Clinical factors associated with acute and chronic complications were very similar. Factors associated with either an acute complicated course (Figure 1) or chronic orthopedic complications (Figure 2) included: older age, tibia involvement, infection due to S. aureus/MRSA, presence of multifocal or disseminated infection, DVT, fever > 48 hours of antibiotic therapy, admission laboratory values including higher absolute neutrophil count (ANC) and higher CRP, ICU admission, associated suppurative arthritis, bacteremia, bone abscess, surgical debridement and delayed source control.

Conclusion

In children with AHO, risk factors for acute and chronic complications are highly similar. Older age, tibia involvement, MRSA, higher ANC and bacteremia were linked to complications in our population and will be assessed in current clinical scoring systems which may help guide management.

Disclosures

Jonathon C. McNeil, MD, Agency for Healthcare Research and Quality: Grant/Research Support|Allergan: Provided reagents for unrelated research|Nabriva: Site investigator for multicenter clinical trial Kristina G. Hulten, PhD, Me-med: Grant/Research Support|Pfizer: Grant/Research Support Sheldon L. Kaplan, MD, MeMed: Grant/Research Support|Pfizer: Grant/Research Support.
1336. Six-Year Clinical Experience of Pediatric Murine Typhus in Houston, TX
Authors: Taylor Margaret G , Bocchini Claire
Published: December 2022

Background

Murine typhus is a flea-borne rickettsial disease endemic to gulf states. It shares clinical features of Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C). We sought to explore the six-year experience with murine typhus among children living in Houston, TX.

Methods

We conducted a retrospective chart review to identify clinical and laboratory features of children with murine typhus from January 2015 to July 2021. Cases were identified by positive Rickettsia typhi serology with single IgG >=1:256, single IgM >=1:128, or increase in IgG from 1:64 to 1:28 in convalescent sera.

Results

162 cases of pediatric murine typhus were identified. Most cases (85, 52.5%) occurred in the summer. There was a bimodal distribution of age, with peaks at 4 and 17 years (Figure 1). Most children (96, 59.3%) required hospitalization; 11 were admitted to intensive care, and 3 required intubation. All children had fever; the mean duration of fever at presentation was 8.9 days (+/-2.9). Only 67 (41.4%) had a combination of fever, headache, and rash (Table 1). 64 (39.5%) had documented flea or opossum exposure. The most common laboratory abnormalities were elevated serum liver transaminases, hypoalbuminemia, thrombocytopenia, and hyponatremia (Table 1). Cardiac abnormalities were not uncommon: 20/59 (33.9%) had an abnormal electrocardiogram, 5/50 (10.0%) had troponin >0.04 ng/mL, and 4/50 (8.0%) had b-type natriuretic protein >100 pg/mL (Table 1). Most children (149, 92.0%) were diagnosed based on positive initial serological testing. Nine (5.6%) received intravenous immunoglobulin for a diagnosis of KD before typhus was diagnosed. The median duration of hospitalization was 3 days (IQR 2,5), and most children were treated with doxycycline (146, 90.1%). Figure 1.Histogram of age at time of murine typhus diagnosis.Table 1.Clinical and Laboratory Features of Children Diagnosed with Murine Typhus.

Conclusion

Murine typhus is a common cause of prolonged unexplained fever in children living in endemic areas and shares clinical features of KD and MIS-C. Cardiac abnormalities are not uncommon, and severity of illness can range from outpatient to intensive care. Lack of flea or opossum exposure or lack of headache or rash does not rule out infection. Therefore, a high index of suspicion is warranted, and initial serology testing may accelerate diagnosis in children with prolonged fever.

Disclosures

All Authors: No reported disclosures.
1651. In vitro synergy test and clinical outcome of antibiotics combination regimens for carbapenem-resistant Acinetobacter baumannii
Authors: Baek Jin Yang , Kim Hyemee , Kang Yu Ri , Kang Sujeong , Huh Hee Jae , Lee Nam Yong , Ko Jae-Hoon , Cho Sun Young , Kang Cheol-In , Chung Doo-Ryeon , Peck Kyong Ran , Huh Kyungmin
Published: December 2022

Background

Acinetobacter baumannii is one of the leading etiologic agents of serious hospital-acquired infections. A. baumannii is characterized by a high rate of carbapenem resistance, which often leads to treatment failure and poor outcome. Combination regimens of antibiotics are often used, but their clinical benefit and optimal target are yet unclear.

Methods

We selected carbapenem-resistant A. baumannii (CRA) isolates from the patients who received antimicrobial treatment for bloodstream infection (2012–2018) or pneumonia (2019–2020) and survived for ≥5 days. In vitro synergy was tested using checkerboard method and time-kill assay for colistin (COL) and tigecycline (TGC) with the following antibiotics: meropenem (MRO), ampicillin/sulbactam (A/S), minocycline (MIN), ciprofloxacin (CIP), and with each other. Clinical information was collected to compare the patient outcome between those who were treated with combination regimens with in vitro synergy and those who were not.

Results

A total of 72 isolates were selected. When combined with colistin, MRO showed the highest rate of synergy (20.8%), followed by A/S (16.7%), and MIN (13.9%). No antibiotics showed synergy with TGC in >10% of the tested isolates. Most isolates with positive checkerboard test also tested positive with time-kill assay for COL (97.6%), but not for TGC (20.0%). Among 57 patients with monobacterial infection caused by the tested CRA isolates, nine (15.8%) received combination regimens with in vitro synergy. All patients received colistin, and carbapenem was the companion antibiotic in all patients in the synergistic combination group. There was no significant difference in all-cause 30-day mortality (55.6% vs 33.3%, p=0.266), treatment response, and microbiologic response. Multivariable analysis also demonstrated no significant difference in mortality by synergistic combination regimen (adjusted odds ratio, 4.59; 95% confidence interval, 0.73–33.88).

Conclusion

Checkerboard method showed an excellent concordance with time-kill assay for COL-based combinations, but not with TGC-based regimens. However, combination regimens with a proven in vitro synergy were not associated with better outcomes.

Disclosures

All Authors: No reported disclosures.
1355. An Acute Care Hospital’s Outbreak Response to Measles in an Afghan Refugee Population
Authors: Lapian Becky , Levorson Rebecca E , Downes Barbara L , He Lucy , Peninger Michelle , Peninger Michelle , Peninger Michelle
Published: December 2022

Background

The disruption of massive refugee evacuations in the fall of 2021 had subsequent downstream effects on the health care systems affected by such sudden human evacuations. Our 923-bed tertiary care facility in the Washington, D.C. metropolitan area admitted several refugees with acute measles infection. Gaps in surveillance for identifying infectious pathogens in our emergency department were identified and mitigation strategies were implemented in order to more rapidly identify suspected subsequent cases. Partnership with our local and state health departments were imperative in successfully identifying exposed persons, evaluating risk factors and administering post-exposure prophylaxis for at risk exposed persons.

Methods

Infection Preventionists identified exposed patients and team members, based on shared air spaces and time to include two hours after the infectious patient had left the area or had been placed on proper precautions. Following CDC and local health department guidance, over 500 charts of exposed patients were reviewed by a multidisciplinary team of physicians, nurses, pharmacists, and infection preventionists.

Results

Over 90 patients met criteria for and received post-exposure prophylaxis. 10 visitors, also refugees, were also given post-exposure prophylaxis. Standard operating procedures for hospital based measles exposure were further solidified through this exposure procedure. Written and verbal communications were updated for team members, patients and the community. No secondary cases of measles were seen in the hospitalized patients or in the community at large over the following 28 day observation period after last exposure. Numerous more cases of measles were noted in the refugee population evacuated over the following several weeks until MMR vaccination was widely distributed.

Conclusion

Consideration of infectious diseases in refugees with significant infectious exposure burden is imperative during times of massive refugee evacuations. Vaccination of refugees during evacuation and prior to resettlement is imperative. Evaluation for highly contagious diseases such as measles must be forefront in clinicians’ minds when encountering massive refugee evacuations.

Disclosures

All Authors: No reported disclosures.
1358. Establishing Genomic SARS-CoV-2 Surveillance at the National Level: Germany, 2021
Authors: Oh Djin-Ye , Hölzer Martin , Paraskevopoulou Sofia , Trofimova Maria , Hartkopf Felix , Budt Matthias , Wedde Marianne , Richard Hugues , Haldemann Berit , Domaszewska Teresa , Reiche Janine , Keeren Kathrin , Radonić Aleksandar , Calderón Julia Patricia Ramos , Smith Maureen Rebecca , Brinkmann Annika , Trappe Kathrin , Drechsel Oliver , Klaper Kathleen , Hein Sascha , Hildt Eberhard , Haas Walter , Calvignac-Spencer Sébastien , Semmler Torsten , Dürrwald Ralf , Thürmer Andrea , Drosten Christian , Fuchs Stephan , von Kleist Max , Kröger Stefan , Wolff Thorsten
Published: December 2022

Background

The COVID-19 pandemic has demonstrated the importance of pathogen genomic surveillance. At RKI, the German National Institute of Public Health, we established the Integrated Molecular Surveillance for SARS-CoV-2 (IMS-SC2) network to perform SARS-CoV-2 genomic surveillance.

Methods

SARS-CoV-2 positive samples from laboratories distributed across Germany regularly undergo whole-genome sequencing at RKI. This surveillance instrument enables (i) almost-real-time monitoring of SARS-CoV-2 genomic diversity and evolution, (ii) in vitro assessment of vaccine coverage against emerging variants and (iii) genome-based estimates of SARS-CoV-2-incidences.

Results

We report the results of our analyses of 3623 SARS-CoV-2 genomes collected between 12/1/2020 and 12/31/2021. All variants of concern were identified, at ratios equivalent to those in the 100-fold larger German GISAID sequence dataset from the same time period. Lineage distributions fluctuated over time, covering the rise of the Alpha and Delta, as well as the emergence of Omicron. Phylogenetic analysis confirmed variant assignments. Multiple mutations of concern emerged during the observation period. To model vaccine effectiveness in vitro, we employed authentic-virus neutralization assays, confirming that both the Beta and Zeta variants are capable of immune evasion. The IMS-SC2 sequence dataset facilitated an estimate of the SARS-CoV-2 incidence based on genetic evolution rates. Together with modelled vaccine efficacies, Delta-specific incidence estimation indicated that the German vaccination campaign contributed substantially to a deceleration of the nascent German Delta wave.

Conclusion

This example illustrates that pathogen genomics enables a proactive approach to controlling a pandemic as the virus evolves. Molecular and genomic SARS-CoV-2 surveillance will be crucial during the post-pandemic future, informing public health policies including vaccination strategies. Of note, the IMS-SC2 infrastructure can be adapted to many other pathogens, serving as a blueprint for future efforts to increase genomic pathogen surveillance.

Disclosures

All Authors: No reported disclosures.
1361. Lyme Borreliosis (LB) is a Significant Disease Burden in Germany: Estimated LB Incidence after Adjusting for Under-ascertainment by Public Health Surveillance, 2021
Authors: Olsen Julia , Brestrich Gordon , Pilz Andreas , Halsby Kate , Kelly Patrick , Malerczyk Claudius , Angulo Frederick , Stark James H
Published: December 2022

Background

Lyme borreliosis (LB), the most common tickborne disease in Europe, is endemic in Germany. Nine German states (with 42% of the German population) conduct LB surveillance with mandatory notification by clinicians and laboratories but an analysis of outpatient claims estimated that only one of every six LB cases in these states were reported. We estimated the LB incidence after adjusting for under-ascertainment of public health surveillance.

Methods

Nationally representative studies estimated the prevalence of antibodies against Borrelia burgdorferi sensu lato in adults and children in Germany. Published estimates of the asymptomatic proportion and the duration of antibody detection were used to estimate the number of LB cases from seroprevalence data in states that conduct LB surveillance. The number of estimated LB cases were compared to the number of surveillance-reported cases to derive under-ascertainment multipliers for adults and children. The derived multipliers were applied to the number of reported cases in 2021 to estimate the number and incidence of LB cases in the states that conducted surveillance in 2021. A sensitivity analysis evaluated the impact of different antibody durations.

Results

Using a 50% asymptomatic proportion and 10-year antibody duration, the estimated number (population-based incidence) of LB cases in states that conducted surveillance was 128,870 (408/100,000) in 2021. Since there were 11,051 reported cases in these states, these data indicate there were 12 LB cases in 2021 for every reported case in these states. Using 20-year or 5-year antibody duration, the estimated number (incidence) of LB cases in the states that conducted surveillance was 64,935 – 259,740 (204 - 816/100,000) in 2021, respectively.

Conclusion

Incidence of LB in states that conduct surveillance in Germany is higher than reported. Under-ascertainment of LB cases in states that conduct surveillance is even greater than that estimated in a claims data analysis of medically-attended LB cases. Enhancements of LB surveillance, including expanding nationwide, would facilitate further elucidation of the true LB disease burden in Germany. Disease prevention efforts, including availability of an efficacious vaccine, are needed to address this important public health problem.

Disclosures

Julia Olsen, BS, Pfizer: Employee Gordon Brestrich, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Andreas Pilz, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds|Pfizer: Stocks/Bonds Kate Halsby, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Patrick Kelly, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Claudius Malerczyk, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Frederick Angulo, DVM PhD, Pfizer: Employee|Pfizer: Stocks/Bonds James H. Stark, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds.
1368. Stakeholders Perceptions on Barriers and Facilitators to Opt-Out Infectious Diseases Care in Jails
Authors: Smyth Emma M , Lodolo Laura , Ngassa Yvane , Beckwith Curt , Wurcel Alysse Gail
Published: December 2022

Background

Despite national guidelines on infectious disease testing and vaccination in prisons, there is heterogeneity in operationalization. Previous literature has shown that using the “opt-out approach” to infectious diseases testing increases equitable access. Although opt-out testing is endorsed by national guidelines, there is little research on the acceptability from key stakeholders in jail healthcare. Additionally, perspectives on using the opt-out approach to vaccination are unknown.

Interview Themes

Themes and quotes that came out of semi-structured qualitative interviews.

Methods

We developed an interview guide based on the Theoretic Domains Framework. Guided by the 7Ps framework for stakeholder engagement, we conducted semi-structured interviews with key stakeholders in jail healthcare, including people incarcerated in Hampden County jail, clinicians working in jail and community settings, corrections officers, and representatives from public health, government, and industry. All persons eligible to receive a stipend were offered $50 for participation. Interviews were offered in the jail in English and in Spanish.

Results

Between July 2021—March 2022, 48/108 (44%) of people approached agreed to be interviewed including 13 incarcerated men. Most stakeholders agreed that infectious diseases testing and vaccination in jails are essential tools for mitigating the spread of disease. Major themes that emerged from stakeholder interviews included confusion about the wording of the “opt-out” approach, reluctance to operationalize “opt-out” testing because of concerns for coercion, and concern that it gives people any “easy out” from taking the test or vaccines. People who supported the operationalization of opt-out testing were more often stakeholders from the community, including public health experts, researchers, and clinicians.

Conclusion

Although “opt-out” testing is evidence-based, we found that key stakeholders who work and are incarcerated in jails did not understand the concept and did not support implementation. Our work is further evidence that successful implementation of public health strategies requires vetting from all key stakeholders in jail healthcare, especially people working and incarcerated in jail when developing strategies to improve healthcare.

Disclosures

Curt Beckwith, MD, Gilead Sciences, Inc: Grant/Research Support.