bluuebunny/crossref_metadata_2025 huggingface dataset:
2660. Evaluating Risk for Bacterial Vaginosis Utilizing an Unsupervised Machine Learning Approach
Authors: Rodriguez Violeta , Pan Yue , Salazar Ana , Fonseca Nicholas , Raccamarich Patricia , Klatt Nichole R , Weiss Deborah Jones , Alcaide Maria L L
Published: November 2023

Background

Clustering methods using machine learning may be useful for identifying variables predicting clinical outcomes. Despite the need to better understand risk behaviors of Bacterial Vaginosis (BV), the most common cause of abnormal vaginal discharge linked to STI and HIV acquisition, machine learning methods have not been used to better understand BV. This study used an unsupervised machine learning algorithm, sidClustering and random forests, to identify clusters of risk behaviors of BV.

Methods

Participants were 402 cisgender women recruited in Miami, Florida, aged 18-45 (median age=31); over half of them were black (56%) and non-Hispanic (43.8%). Participants completed measures of demographics characteristics, sexual and medical history, and intravaginal practices (IVP), and underwent collection of vaginal samples. BV was diagnosed using Amsel or Nugent criteria; abnormal vaginal flora was defined as Nugent score of 4 or above. sidClustering and random forests were used to identify clusters and the most important variables in classifying clusters associated with BV; 135 behavioral variables (including substance use and number of partners) were subjected to analysis.

Results

We identified 4 clusters explained most of the variation in behaviors, and variables were ranked by importance in distinguishing these clusters. Results showed that clusters associated with BV were composed of women who 1) engaged in IVP primarily using water and fingers (Cluster 1: n = 108 (26.9%)], 2) engaged in IVP using multiple methods [water, rags, etc.; Cluster 2: n = 127 (31.6%)]; 3) engaged in a combination of IVP and other risk behaviors [Cluster 3: n = 119 (29.6%)]; and 4) those who did not engage in IVP but engaged in other high-risk behaviors [Cluster 4; n = 48 (11.9%)]. Clusters were related to abnormal vaginal flora (p < .001). Cluster 2, the cluster with most frequent IVP, had the highest prevalence of BV (64.9%, compared with Cluster 1 (38.0%), Cluster 3 (50.4%), and Cluster 4 (39.6%).

Conclusion

Machine learning methods may be particularly useful in identifying specific clusters of high-risk behaviors, and in developing interventions intended to reduce BV and IVP, and ultimately to reduce the risk of HIV infection among women.

Disclosures

Maria L L. Alcaide, MD, Discidium Biosciences: Board Member|Gilead: Honoraria|Merk & Co: Honoraria|Senhwa Biosciences: Honoraria|Virology Education: Honoraria
2665. Health Care Provider Characteristics Associated with Anal Cancer Screening in an Academic Medical System
Authors: Gore Daniel , O’Donoghue Ashley , Dechen Tenzin , Zerillo Jessica A , Multani Ami , Krakower Douglas
Published: November 2023

Background

Anal cancer disproportionally affects persons living with HIV (PWH), sexual and gender minorities, and those with gynecologic cancers, condyloma acuminata, and solid organ transplantation. While expert guidance on anal cancer screening exists for PWH, there are no national guidelines for screening any of these populations. We analyzed clinician characteristics associated with anal cancer screening among providers who care for high-risk populations at an academic medical center including infectious disease (ID) specialists, primary care providers (PCPs), and obstetrician/gynecologists (OBGYNs).

Methods

We retrospectively reviewed medical charts for patients with HIV, gynecologic cancers, condyloma acuminata, solid organ transplantation, and sexual or gender minority status at Beth Israel Deaconess Medical Center and two affiliated clinics from 01/01/2015 - 08/01/2022. We extracted provider specialties, clinic locations, patient panel demographics, and dates of anal cytology and human papillomavirus (HPV) screening tests. We used chi-squared tests to identify provider factors associated with screening.

Results

Of 1,093 providers, at least one anal cytology test was performed by 93.8% (75/80) of ID providers, 55.2% (376/681) of PCPs, 28.3% (41/145) of OBGYNs, and 24.1% (45/187) of other providers (p < 0.001); among screeners, anal HPV co-testing was performed equally across specialties (54.2%, p = 0.23). Providers were more likely to screen if they cared for PWH (91.8% with 10-49 PWH vs 3.7% for no PWH, p < 0.001), majority cis-men (55.2%, p=0.003), or majority publicly insured patients (51.8%, p < 0.001). Providers were less likely to screen if they cared for majority cis-women (40.9%, p< 0.001) or majority privately insured patients (24.0%, p< 0.001). Screening practices did not differ by the racial composition of providers’ patient panels (p=.21).

Conclusion

While many ID specialists performed anal cancer screenings, other providers were less likely to screen. Providers caring for many PWH, cis-men, or publicly insured patients were more likely to screen. Additional research is needed to clarify screening guidance and optimize screening practices for all higher-risk populations, especially non-PWH groups.

Disclosures

Douglas Krakower, MD, Gilead: Grant/Research Support|Merck: Grant/Research Support|U. North Texas Health Sciences Center: Funding for mentoring|UAB: Advisor/Consultant|UpToDate, Inc.: Royalties|Virology Education: Honoraria
155. Use of MRSA PCR and Antimicrobial Stewardship Intervention to Limit Anti-MRSA Therapy in Respiratory Tract Infections at a Community Teaching Hospital
Authors: Politis Paula A , Chen Alice , Oravec Michael J , England Matthew , Tan Michael , File Thomas M
Published: November 2023

Background

Patients admitted to the hospital with respiratory tract infections (RTIs) who are at risk for MRSA are often treated empirically with anti-MRSA agents such as vancomycin or linezolid. While pre-treatment respiratory culture is recommended, it is not always feasible. An alternate, more easily obtainable test is the MRSA nasal PCR, which is used to detect nasal colonization. While a positive nasal MRSA PCR cannot determine MRSA pneumonia, a negative MRSA PCR result strongly correlates with lack of MRSA pneumonia providing a useful antimicrobial stewardship tool for de-escalation or avoidance of empiric anti-MRSA therapy. Our Antimicrobial Stewardship Program (ASP) routinely follows patients admitted with RTIs and provides recommendations for appropriate therapy based on culture and test results, including the MRSA PCR. The purpose of our quality improvement project was to assess the practice and clinical impact of reduction of specific MRSA therapy associated with a negative nasal MRSA PCR.

Methods

We performed a retrospective review of patients admitted to our institution with MRSA PCRs performed for the purpose of RTI workup from November-December 2022. We compared patients with negative MRSA PCRs (not detected or MSSA) with and without ASP intervention and assessed differences in patient characteristics and outcomes. If ASP intervention occurred, intervention and acceptance data was collected. Characteristics were compared using descriptive statistics.

Results

Shown in Table 1 and 2. There was no significant difference in age, sex, duration of MRSA therapy, SCr, length of stay, or readmission between groups. When looking at ASP intervention for 1. discontinuation of MRSA therapy or 2. ordering/collecting MRSA PCR, a total of 73 interventions occurred with a 100% acceptance rate. This encompassed 34% (52/155) of patients on MRSA therapy with a negative PCR result.

Conclusion

While no significant difference was found between groups in terms of duration of MRSA therapy, the slightly shorter duration in the non-ASP group was likely due to prior discontinuation of MRSA therapy thus not necessitating ASP intervention. Those with slightly longer duration received ASP intervention which led to discontinuation of unnecessary MRSA therapy.

Disclosures

Thomas M. File, Jr., MD, MSc, MACP, FIDSA, HealthTrackRx: Advisor/Consultant|NAbriva Therapeutics: Advisor/Consultant|ThermoFisher Scientific: Advisor/Consultant
2670. Sexual Health Evaluation Among People Tested for Mpox in an Urban Health System
Authors: Jones Joyce , Garneau William , Dashler Gaby , Kwon Nathan , Gilliams Elizabeth , Hamill Matthew M , Rudolph David , Keruly Jeanne , Klein Eili , Hansoti Bhakti , Gebo Kelly
Published: November 2023

Background

The predominant mode of transmission in the 2022 mpox outbreak was sexually associated. Best practices for mpox evaluation include a sexual history, an anal and/or genital exam and STI testing. We hypothesized that the quality of clinical evaluation (QoC) for mpox varied by clinical setting.

Methods

A retrospective chart review was conducted on all patients in the Johns Hopkins Health System (JHHS) who tested for mpox from June 15 through December 15, 2022. Outcome measures included three QoC metrics (record of sexual history, anal and/or genital exam and concomitant STI testing). Fisher’s exact test was used to compare the frequency of QoC indicators by location of mpox testing (emergency department/urgent care [ED/UC], HIV/sexual health clinic [HIV/SH] or non-HIV/SH outpatient clinic [non-HIV/SH]).

Results

Of 269 patients tested for mpox, median age was 37 years, 48% were Black, 8% Latino, 71% assigned male sex at birth, 2% transgender women and 25% living with HIV (Table 1). Location of mpox testing was ED/UC (n=165), HIV/SH (n=50), or non-HIV/SH (n=54). Rates of mpox diagnosis and documentation of a sexual history, anal and/or genital exam and concomitant STI testing varied by site and were statistically significantly different (Table 2). HIV/SH had the highest rate of mpox test positivity (58%) and were most likely to meet these QoC indicators (96%, 78% and 82%, respectively) followed by ED/UC (74%, 50%, 57%, respectively) and HIV/SH clinics (68%, 32%, 30%).

Conclusion

In a high-volume tertiary care health system, only 50% of individuals tested for mpox had a documented anal and/or genital exam and 57% had concomitant STI testing. QoC indicators for mpox evaluation were highest in clinics where sexual health assessments are routine (HIV/sexual health), intermediate in ED/urgent care settings and lowest in non-HIV/sexual health settings. These findings support other studies that demonstrate a lack of consistent sexual health evaluation among individuals at risk for STIs. Strategies that decrease barriers to completed sexual history, exam and STI testing should be explored including audio-computer assisted patient report of sexual history, patient self-collection of STI testing and provider training.

Disclosures

Matthew M. Hamill, MBChB, PhD, Roche diagnostics: Honoraria Kelly Gebo, MD, MPH, Pfizer: Advisor/Consultant|Spark HealthCare: Advisor/Consultant
2672. Understanding the Barriers to Sexual Health in Middle Eastern Immigrant Women
Authors: Kazanji Noora , Masri Hana , Power Laura
Published: November 2023

Background

Sexually transmitted infections (STI) are often considered taboo in the life of women living in the Middle East and North Africa (MENA), and few studies have evaluated how to raise awareness of sexual health (SH) for these women. There are no studies that have aimed to understand if social norms, stigmas, and misconceptions surrounding seeking SH care continue for women who have immigrated to the United States (US) from MENA countries. The primary goal of this study is to determine existing cultural barriers to seeking SH care among US-living women who have emigrated from MENA or whose parents have emigrated from MENA.

Methods

From April 2021 to August 2021, 18 semi-structured interviews were conducted in women who emigrated from MENA or whose parents emigrated from MENA. We used thematic content analysis to identify the main themes and subthemes around barriers to seeking SH care. We then developed a conceptual model to depict how different themes interact to influence attitudes and beliefs towards SH care of MENA immigrant women.

Results

The primary themes that emerged were (a) reduced knowledge about SH resources and STI, (b) judgement, (c) lack of discussion in the community and household, (d) circumvention, and (e) call to action. The subtheme of cultural expectation of abstinence before marriage was a cross-cutting theme brought up by 16 of the 18 participants. One of the subthemes within the theme of judgement was the preference to seek SH care outside the community. Participants felt there was a barrier with discussing SH concerns with physicians who are of the same community due to the perception of judgement from that physician with whom the participant identifies. Call to action highlights several solutions shared by participants to reduce barriers to SH care.

Conclusion

We identified several themes underlying barriers to SH care for MENA immigrant women living in the US. We hope this project will fuel future research and policy efforts to raise awareness of SH in this vulnerable population. Appropriate and targeted interventions will ultimately help to prevent morbidity and mortality from diseases of SH in these women.

Disclosures

All Authors: No reported disclosures
2674. Disparities in Mpox Care: Use of the Social Vulnerability Index to Predict Mpox Infections
Authors: Leonard Michael , Fairman Robert , Polk Christopher , Inman Michael , Passaretti Catherine , Sampson Mindy
Published: November 2023

Background

The 2022 mpox outbreak disproportionately impacted minoritized populations especially in the US South, where 60% of infections were in Black men. Social vulnerability may explain some of the disproportionate disease burden as minoritized populations are at higher risk for infections such as mpox. The goal of this study is to examine what social vulnerabilities predict mpox infection.

Methods

We performed a retrospective chart review of all patients tested for mpox between July 24 and September 28, 2022 within the largest healthcare system in the Carolinas. Demographic information, medical and sexual history, and patient geocoding was obtained from extracted data. Patient location was then joined to the CDC and Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) data at a census tract level. Logistic regression models predicting mpox test results were then constructed.

Results

Of 319 individuals tested for mpox during the study period, those who identified as Black, men who have sex with men, having multiple sexual partners, and those known to be living with HIV were more likely to test positive for mpox (p< 0.001, see Table 1). In assessing the social vulnerability sums, there were statistically significant differences in the household composition and disability sum of those who tested positive for mpox (mean=1.6952, std=.0663) and those who did not (mean=1.8495, std=.5712, p=.0349), as well as a statistically significant difference in the means of minority status and language sum (p=.0001). Being in a census tract that is 90th percentile for multi-unit housing (p=.0003), as well as a census tract that is in the 90th percentile for unemployment (p=.0393) are associated with testing positive for mpox, but overall SVI was not predictive of mpox diagnosis (see Table 2).

Conclusion

Being diagnosed with mpox primary occurred among those who are Black, men who have sex with men, and those living with HIV. Though some social vulnerabilities predicted mpox diagnoses, overall, social vulnerability did not predict mpox diagnoses.

Disclosures

Christopher Polk, MD, ViiVHealthcare: Job change to work for ViiV as Medical Director
2675. Concurrent HIV and Sexually Transmitted Infections in People with Mpox in Guatemala City
Authors: Marroquin Hugo , Farfán Alvaro J Mazariegos , Pinzón Rodolfo , Samayoa Johanna
Published: November 2023

Background

High rates of HIV and sexually transmitted infections (STIs) among people with mpox have been reported. Guatemala has the highest number of mpox cases reported in Central America. Data on this topic in the region is lacking. We report the prevalence of STIs and HIV in people evaluated for mpox at Hospital Roosevelt in Guatemala City.

Methods

We conducted a cross-sectional analysis of confirmed mpox cases with outpatient care at our institution between July 2022 and January 2023. Sociodemographic and clinical data was retrospectively collected. This analysis includes new diagnoses of HIV, syphilis, chlamydia, gonorrhea, mycoplasma genitalium infection and herpes virus simplex (HSV) infection. Diagnoses were confirmed by serology or nucleic acid amplification tests. Rates of HIV/STIs were assessed and association with sociodemographic, behavioral and clinical characteristics was analyzed through non-parametric statistical tests.

Results

Sixty participants with mpox were included. All cis-gender male, 34 (56.6%) younger than 30 years old, 52 (86.6%) were residents of Guatemala City, 57 (95%) men who have sex with men (MSM), 51 (85%) had above secondary education, 36 (60%) with known HIV-positive status. Recent participation in group sex was reported in 9 (15%) participants and inconsistent or no condom use in 49 (81.6%). Among participants with known HIV-positive status 34 (94.4%) had CD4 count > 200/µL and 32 (88.9%) had a HIV viral load < 200 copies/ml. Two previously undiagnosed HIV infections were detected. Overall, 27 new STIs were found in 20 (33.3%) participants (5 had more than one STI). Comparisons between participants with concurrent STIs and those without are shown in Table 1. Nine cases of syphilis were detected. Eighteen STIs involved mucous membranes (oropharyngeal, genital or anorectal). Rates by site are shown in Table 2.

Conclusion

At least one STI was detected in a third of the mpox cases with syphilis being the most frequent. Almost half of STIs cases involved the anorectal site. People with previously known HIV-positive status had a significantly higher rate of STIs. HIV/STI care is key to an appropriate mpox management.

Disclosures

All Authors: No reported disclosures
2676. Development of the World's First Automated Phenotypic Antibiotic Susceptibility Test System for Neisseria gonnorrhoeae
Authors: Newton Mitchell D , Puttaswamy Sachidevi , Isakson Andrew , McPeake Jared , Hadfield Ted , Swiger Roy
Published: November 2023

Background

With the increasing prevalence of antibiotic resistance of Neisseria gonorrhoeae (NG), clinical reliance on empiric treatment is no longer an option. Providing clinicians with fast, accurate, susceptibility results for directed patient treatment of NG cannot be ignored anymore. Here we describe the development of the world’s first phenotypic automated Antibiotic Susceptibility Test system specific to NG. The system is reliable, seamlessly integrates into existing sample workflows, and provides full customization. This yields a user-friendly device for rapid and actionable patient treatment.

Methods

The system consists of Hardware; Software & Firmware; and Consumables that are single-use disposable. The system allows the growth of fastidious Neisseria gonorrhoeae while continuously monitoring for growth or lack thereof in the presence of antibiotics in real time, displaying reports via a user-friendly interface. The samples tested include QC strains and challenge strains of N. gonorrhoeae along with select isolates across multiple antibiotics of relevance at multiple concentrations. All testing has been done in parallel with the phenotypic broth dilution method for verification in-house and/or compared against expected or published results.

Results

The results of the analysis of gonococcal strains are generated in as little as four (4) hours and are based on phenotypic and broth dilution methodology. We show (a) results from analysis of quality control strains, and CDC/FDA Antibiotic Resistance (AR) Bank and (b) a demonstration of easy integration using clinical laboratory sample workflow. In 100% of cases, our method produced a clear selection of the MIC and corresponding S/I/R interpretations allowing for calculated Categorical Agreement.

Conclusion

This data demonstrates not merely the feasibility but realizability of an automated, phenotypic AST for NG. The results here demonstrate that it is possible to make informed treatment decisions for cases of gonorrhea.

Disclosures

All Authors: No reported disclosures
2678. Prevalence of gonorrhea, chlamydia and syphilis among males living with HIV attending the Antiretroviral Clinic, Hospital Santo Tomás, Panamá, November 2021-March 2022
Authors: Rodriguez Cristel , Rodríguez Ana Belén Araúz , Gabster Amanda , Jhangimal Monica , Henostroza German , Pascale Juan Miguel , Castillo Jorge , Martinez Alexander , Ortiz Alma
Published: November 2023

Background

Prevalence of gonorrhea, chlamydia and syphilis is unknown among people living with HIV (PLHIV) in Panama. Owing to the asymptomatic course and syndromic management of these infections, etiological diagnosis and epidemiological surveillance are often missed. The aim of the study was to determine the prevalence of Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and syphilis in HIV positive men, that receive care in the Infectious Diseases Clinic at Hospital Santo Tomás.

Methods

A cross-sectional study was conducted among male PLHIV who attended the antiretroviral therapy clinic for a routine clinical care during March and April 2022. Written consent was obtained from all participants. Blood samples were taken for syphilis screening using a rapid lateral flow test and consecutive RPR on all positive samples. First flow urine, as well as provider-collected oropharyngeal and participant-collected anal swabs were taken from the patients for PCR CT/NG testing. Statistical analysis was carried out using SPSS version 22.0 software. Chi-square test and odds ratio were done at 95% CI using significance level of p < 0.05.

Results

A total of 221 male PLHIV were included. The prevalence of CT/NG at any anatomical site was 20.3%, 13.5% for CT and 9.0% for NG. The anatomical site with the highest prevalence was the rectal site, with a prevalence of 12.2% for CT/NG. Neisseria gonorrhoeae had a prevalence of 5.4% in oropharyngeal samples. An antibody syphilis test was positive in 51.1% of the patients. Logistic regression analysis revealed that men that reported to have had sex with another male in the past year was a risk factor for CT/NG positivity at any site(AOR = 4.95, 95% CI 1.46-16.76, p 0.004). Overall, 91.4 % of the patients had good acceptance for auto collection of the rectal sample among the study group.

Conclusion

There is a high prevalence of CT/NG, especially at the rectum site, and high prevalence of syphilis among HIV male atients in the antiretroviral clinic at the Santo Tomás Hospital in Panama. Most individuals with an STI w tested for, reported to be asymptomatic for these infections. Public health strategies need to be implemented to increase the screening and appropiate treatment with this population.

Disclosures

All Authors: No reported disclosures
2682. Opt-Out Syphilis Screening in an Urgent Care Center Increases Recognition and Treatment of Asymptomatic Syphilis Infection and Uptake of HIV Pre-Exposure Prophylaxis
Authors: Sweitzer Stephanie F , Sharp Joseph , Gruen Judah
Published: November 2023

Background

Atlanta, Georgia has an extremely high burden of both HIV and early syphilis. This syndemic is driven by a complex set of structural factors that result in striking healthcare inequities, further burdening communities with low access to primary care. These populations may instead utilize emergency departments and urgent care centers (UC) for medical care. UC visits represent a crucial opportunity for recognition and treatment of syphilis as well as connection to HIV prevention services. We describe a novel pilot of a universal, opt-out syphilis screening program offered to all adults in the Grady Urgent Care Center in Atlanta.

Methods

A retrospective chart review was performed on all patients 18 years and older who had a rapid plasma reagin (RPR) test collected from 9/1/21 to 12/31/21. Demographic data, syphilis diagnosis, syphilis treatment, and HIV testing and serostatus were abstracted from the electronic health record. Patients with reactive RPRs were contacted by a physician for diagnosis and potential syphilis treatment, sexual health counseling, and referral for HIV pre-exposure prophylaxis (PrEP) or HIV care.

Results

From 9/1/21 to 12/31/21, 5794 patients were triaged and 1381 underwent RPR screening (23.8%). Eighty (5.8%) had reactive RPRs, and 42 (52.5%) had active syphilis infection. Of those with active syphilis, 39 (92.9%) received treatment, and 35 (83.3%) completed treatment. Among all undergoing RPR screening, 37 (2.7%) were living with HIV. Of those who were not previously diagnosed with HIV, 1279 (93.9%) underwent concurrent HIV testing. Among all undergoing RPR screening, 41 expressed interest in PrEP, and 7 completed PrEP clinic intake. Of those with reactive RPRs, 16 expressed interest in PrEP, and 6 completed PrEP clinic intake.

Syphilis Testing and Treatment Among Patients 18 Years of Age and Older Who Had an RPR Collected in the Grady Urgent Care Center, 9/1/2021-12/31/2021

HIV Testing and PrEP Among Patients 18 Years of Age and Older Who Had an RPR Collected in the Grady Urgent Care Center, 9/1/2021-12/31/2021

Conclusion

Routine, opt-out syphilis testing was used to identify a substantial number of patients with active syphilis and connect a majority to treatment, underscoring the need for universal syphilis screening in this setting. It also provided an opportunity to deliver sexual health counseling and offer PrEP, although few patients completed PrEP clinic intake, suggesting that a more targeted approach to PrEP referral may be more effective.

Disclosures

All Authors: No reported disclosures
2684. Characteristics of mpox patients treated with Tecovirimat: a single center review
Authors: Vargas Robert , Fernandez Jennifer , Taylor David , Green Tondria , Won Sarah Y , Sha Beverly E , Guarin Laura Hernandez , Shankaran Shivanjali
Published: November 2023

Background

The 2022 mpox outbreak disproportionately affected men who have sex with men (MSM), and communities of color. Tecovirimat, which was FDA-approved for the treatment of smallpox in 2018, was made available to treat mpox via an Expanded Access Investigational New Drug protocol through the Centers for Disease Control (CDC). This retrospective chart review describes the demographics and characteristics of patients treated with tecovirimat at a single academic hospital in Chicago, IL.

Methods

The charts of patients with suspected or confirmed mpox infection who received tecovirimat were retrospectively reviewed. Demographics, HIV status, mpox vaccination, presentation and outcome were collected.

Results

Tecovirimat was prescribed to 22 patients. The average patient age was 38 years (26-55 years), 73% were nonwhite: 10 identified as Black and 6 as Hispanic. 91% were MSM, and 9% identified as heterosexual. 55% (12/22) had a known diagnosis of HIV: 42% (5/12) of this cohort were not on antiretroviral therapy, and 3 had a CD4 count < 200. 73% of all patients had at least 1 additional sexually transmitted infection (STI), the most common were syphilis (7/22), gonorrhea (3/22) and/or chlamydia (3/22). 16 patients had not received any doses of the vaccine. 64% had > 10 lesions, and 68% had systemic symptoms of headache, fevers or myalgias. 10 patients were treated as outpatients, 12 needed hospital admission and one needed an ICU stay for IV tecovirimat. Follow-up was available for 16 patients; all but two completed their treatment. Only one person stopped tecovirimat due to mild gastrointestinal side effects. Other than one patient who took > 6 months to recover, symptoms had completely resolved at a median of 18 days (8-30 days) from positive test result.

Conclusion

At our institution, patients receiving tecovirimat were predominantly MSM and nonwhite. A majority had other STIs and/or had a diagnosis of HIV, emphasizing the importance of STI testing, and providing a potential opportunity to reengage people in HIV care. The retrospective nature of our study limits assessment for treatment efficacy. However, tecovirimat was well tolerated, with only one person having mild side effects. This suggests that tecovirimat may play an important role in the management of patients with mpox infection.

Image 1. Example of mpox lesions Image 2. Example of mpox lesions

Disclosures

All Authors: No reported disclosures
2685. Impact of Education and Clinic Site Champion on Extragenital Testing for Sexually Transmitted Infection
Authors: Cunningham Victoria , Smith Hayden L , Hurdelbrink Jonathan , Sittig Katherine , Veach Lisa A
Published: November 2023

Background

Over the last several years sexually transmitted infections (STIs) have been on the rise in the United States. A potential area for improving the diagnosis of STIs is appropriate testing of extragenital (EG) sites (i.e., throat or rectum). These sites may serve as a reservoir for infection and lead to increased transmission if not identified and treated. Prior studies have shown that in men who have sex with men, genital testing alone misses >70% of STIs. In other patient groups, this may range from 10-40%. The aims of this project were twofold: to determine the proportion of patients receiving EG STI testing, and to observe the effect of a two-phase educational intervention on EG site testing.

Methods

Phase I (Jul-Dec 2021) included four urgent care clinics within a Midwest health system. Retrospective baseline data was ascertained for all adults receiving STI testing for Chlamydia trachomatis (CT) and Neisseria gonorrhea (GC) at these clinics. Next, all four clinics received access to an educational presentation regarding the importance of EG testing for STI detection. Two of these clinics served as pilot sites for the implementation of patient self-collection kits. Data was compiled for all adults undergoing STI testing at these clinics for a 6-month period. Phase II (Jul 2022-Mar 2023) involved further expansion and utilization of a site champion at several family medicine clinics including on-site promotion of multi-site testing and patient self-collection. Educational materials as in Phase I were provided to site champions

Results

Phase I baseline data indicated that less than 1% of samples from patients receiving STI testing were obtained from EG sites. There was a small increase in EG site testing after the educational intervention and implementation of self-collected swab kits (Table 1). Phase II data showed an increase in EG testing after the utilization of a clinic site champion and the sharing of testing data in family medicine clinics (Table 2).

Conclusion

Rates of STIs have reached an all-time high in the United States. EG infections serve as potential sources for STI transmission. Adequate multi-site testing is necessary. Implementation was most effective when a clinic site champion was identified, and clinic testing data was provided to them.

Disclosures

All Authors: No reported disclosures
2687. Tetracycline Resistance in Neisseria gonorrhoeae Isolates Among Transgender Women and Men Who Have Sex with Men — eGISP and SURRG, 2018–2021
Authors: Wondmeneh Sarah , Learner Emily , Schmerer Matthew W , Harvey Alesia , Mauk Kerry , Quilter Laura A , St. Cyr Sancta
Published: November 2023

Background

Doxycycline, a tetracycline analog, is being considered for use as post-exposure prophylaxis (PEP) to reduce bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (MSM) and transgender women. Pre-existing tetracycline resistance may contribute to the varied effectiveness of doxycycline in preventing Neisseria gonorrhoeae (GC). We examined trends in tetracycline resistance (TetR) and tetM plasmid-mediated high-level tetracycline resistance (TetHLR) among GC isolates collected from MSM and transgender women through national sentinel surveillance.

Methods

Genital (urethral, urine, vaginal or endocervical), pharyngeal and rectal GC isolates were collected from MSM and transgender women during 2018–2021 at 12 Enhanced Gonococcal Isolate Surveillance Project (eGISP) and 8 Strengthening the U.S. Response to Resistant Gonorrhea (SURRG) sites. We determined overall prevalence of TetR and TetHLR (minimum inhibitory concentration, MIC ≥2 µg/mL and MIC ≥16 µg/mL, respectively) among MSM and transgender women by anatomic site of infection and described annual trends among MSM.

Results

Among 10,853 isolates collected from 8,667 MSM, overall TetR prevalence was 31% (genital: 31%, pharyngeal: 32%, rectal: 29%), and annual TetR prevalence decreased during 2018–2021 (Table 1). Overall TetHLR prevalence among MSM was 13% (genital: 13%, pharyngeal: 12%, rectal: 12%) and annual TetHLR prevalence for genital and pharyngeal infections increased during 2018–2021. Among 108 isolates collected from 89 transgender women, overall TetR prevalence was 23% (genital: 19%, pharyngeal: 23%, rectal: 25%) and TetHLR prevalence was 9% (genital: 0%, pharyngeal: 10%, rectal: 12%), though numbers were small.

Conclusion

Approximately 1/3 of GC isolates collected from MSM and 1/4 of GC isolates collected from transgender women were tetracycline resistant. Prevalence of tetracycline resistance was similar across anatomic sites. Providers should continue to follow recommended screening and treatment guidelines for gonorrhea among persons using doxycycline as STI PEP. Additionally, given high levels of TetHLR, enhanced tetracycline resistance surveillance is needed with implementation of doxycycline as STI PEP.

Disclosures

All Authors: No reported disclosures
157. Implementation of multidisciplinary diagnostic stewardship for Clostridioides difficile infection during the COVID-19 pandemic at a small Japanese hospital
Authors: Sasaki Yasuhiro , Yano Masataka , Umehara Ayumi , Tagashira Yasuaki
Published: November 2023

Background

Clostridioides difficile infection (CDI) is a common, healthcare-associated infection. However, its incidence has reportedly declined in the United States owing to the COVID-19 pandemic. On the other hand in Japan, testing for CDI has been infrequent, suggesting that this disease may be underdiagnosed. The present study examined the implementation of multifaceted, diagnostic stewardship for CDI in a small Japanese hospital during the pandemic.

Methods

The following interventions were introduced at Tama-Nambu Chiiki Hospital, a small community hospital in Tokyo: 1) criteria for CDI testing were added to the hospital's guidelines; 2) clinical pharmacists and nurses assessed the need for CDI testing in patients with nosocomial diarrhea and made recommendations for CDI testing to physicians; 3) a tutorial on CDI testing was given to physicians, nurses, and pharmacists; 4) data on the density of CDI testing and the CDI incidence in the hospital were provided to healthcare workers every three months. The outcomes were CDI testing frequency and the CDI incidence per 10,000 patient days. Segmented regression in interrupted time-series analysis (ITSA) was performed before the pandemic (2018/04-2020/03), after the pandemic (2020/04-2022/03), and after the intervention (2022/04-2023/03).

Results

The frequency of CDI testing tended to increase before the pandemic (+0.16/10,000 PD, P=0.28) but decreased significantly after the pandemic (-0.79/10,000 PD, P=0.02), then increased significantly immediately after the intervention (+29.6/10,000 PD, P< 0.01). Similarly, the incidence of CDI increased significantly before the pandemic (+0.23/10,000PD, P=0.02) but decreased significantly after the pandemic (-0.45/10,000PD, P=0.01). Implementation of the intervention resulted in an immediate, significant increase in the CDI incidence (+6.8/10,000PD, P< 0.01).

Conclusion

Multifaceted, diagnostic stewardship involving multiple specialists was effective in improving CDI testing, suggesting that appropriate testing can contribute to the accurate diagnosis of CDI.

Disclosures

All Authors: No reported disclosures
2689. Utility of Bronchoalveolar Lavage for Diagnosis and Management of Pneumonia in Immunocompromised Children
Authors: Green Amanda M , Flerlage Tim , Hijano Diego , Abraham Afreen
Published: November 2023

Background

Determining the etiology of acute respiratory illness (ARI) in immunocompromised children is challenging. The wide variety of infectious and non-infectious causes makes it difficult to optimize empiric antimicrobial treatments, leading to broad, lengthy antimicrobial courses with potential antimicrobial overuse, increased side effects, and interruptions to chemotherapy treatments. The diagnostic yield and safety of bronchoalveolar lavage (BAL) in these patients has long been debated.

Methods

We conducted a retrospective chart review of BAL procedures performed on immunocompromised children with ARI at St. Jude Children’s Research Hospital between 2017-2021. Microbiological and molecular study results were reviewed, including next generation sequencing (NGS) studies obtained from BAL, upper respiratory, and blood specimens within 7 days of the BAL. Etiology determined by the clinical team, changes in antimicrobial clinical management, and adverse events following the BAL were collected.

Results

82 BAL procedures from 57 patients are presented. The most common underlying diagnosis was hematologic malignancy, and 39 (48%) had undergone hematopoietic cell transplant. BAL identified one or more potential respiratory pathogen in 62.2% of ARIs, including viruses (54%), bacteria (48%), and fungi (37%). Of the 12 patients with BAL NGS, 8 (67%) identified likely respiratory pathogens, 5 (42%) correlated with other testing, and 3 (25%) were unique to NGS. 58 (71%) of BALs led to a change in antimicrobial management, either by discontinuation of broad-spectrum antimicrobials (65%) or narrowed antimicrobial regimen (41%). In 7 (12%) patients with suspected infectious etiology, BAL confirmed alternate etiology and avoided initiation of antimicrobials. 12 (15%) of patients underwent new intubation, and 22 (27%) had increased ventilatory requirements within 24 hours of BAL. No patients required new ICU transfer due to the procedure.

Conclusion

BAL is a valuable, well tolerated procedure that can aid in the diagnosis of pulmonary disease in pediatric immunocompromised patients. These preliminary findings highlight the benefits of BAL and its potential impact on decision making and clinical management, including avoiding antimicrobial overuse.

Disclosures

All Authors: No reported disclosures
2695. Lung Transplant Recipients With High Risk Cytomegalovirus Mismatch Donors Managed Using A Multimodality Regimen: A Five-Year Study
Authors: Banga Amit , Kanade Rohan , Bollineni Srinivas , Kaza Vaidehi , Mohanka Manish , Timofte Irina , Lawrence Adrian , Torres Fernando
Published: November 2023

Background

Lung transplant (LT) recipients with high risk cytomegalovirus (CMV) mismatched donors (recipient negative, donor positive or R-/D+) have been found to have worse early and late outcomes. In our institution, high risk CMV mismatch patients are managed in a protocolized manner consisting of proactive utilization of antiviral agents (ganciclovir/valganciclovir) and immune augmentation with CMV immune globulin.

Methods

We reviewed our institutional LT database. The study group consistent of all patients who underwent single or bilateral lung transplant between January 2012 to December 2016 (n=319). The CMV serostatus of both recipients and donors was reviewed and patients were classified into two groups: High risk CMV mismatch (R-/D+): n=82 (25.7%) and non-high risk CMV mismatch (n=237). We compared patient demographics, co-morbidities, pre and port-transplant variables among the two groups. Three-year survival was analyzed as the primary outcome variable. With three-year survival as the dependent variable, we analyzed the association of CMV status with survival using multivariate logistic regression analysis.

Results

There was no difference in the baseline and post-transplant characteristics of LT recipients with and without CMV mismatch donors. Overall one-year and three-year survival was 89.96% and 72.7% respectively. Recipients transplanted with CMV mismatch status and managed with a proactive CMV prophylaxis protocol experienced similar one one-year (92.7% vs 89%, p=0.4) and three-year survival (73.2% vs 72.6%, p=1.0) as the non-CMV mismatch recipients.

After adjustment for demographics, comorbidities and post-transplant course, CMV mismatch was not associated with three-year survival. Post-LT development of AKI the only independent variable to be independently associated with three-year survival (adjusted OR: 2.1, 1.13-3.87; p=0.019). Kaplan Meier analysis (see Fig) showed very similar survival curves for recipients with and without CMV mismatched donors.

Conclusion

Use of a proactive multimodality CMV prophylactic regimen consistent of antiviral agents (ganciclovir/valganciclovir) and immune augmentation with CMV immune globulin may improve outcomes among high risk CMV mismatch LT recipients.

Disclosures

All Authors: No reported disclosures
2700. Reducing the Dose of Mycophenolate in Solid Organ Transplant Recipients Diagnosed with SARS-CoV-2 Infection Increases the Risk of Severe COVID-19
Authors: Gillcrist Marion , Waller Stephen , Taylor Ryan M , Bahr Nathan C , Cibrik Diane M , Shah Zubair , Eid Albert
Published: November 2023

Background

Most of the available COVID-19 outcome data in solid organ transplant (SOT) recipients does not suggest a higher mortality rate in the SOT population. Though theoretically immunosuppressive medications might be associated with worse outcome, its immunomodulatory effect might be beneficial.

Methods

We retrospectively analyzed the effect of dose-reduction of mycophenolate, tacrolimus, and prednisone on the severity of COVID-19 in SOT recipients diagnosed with COVID-19 at the University of Kansas Medical Center between January 1, 2020 and December 31, 2022. Severe COVID-19 was defined by development of hypoxia while the patient was on room air during a 21-day period following COVID-19 diagnosis. To evaluate the effect of dose changes after the diagnosis of COVID-19 on the odds of developing severe COVID-19, we subset our data based on whether patients were taking mycophenolate (n = 449), tacrolimus (n = 537) or prednisone (n = 386) at the time of diagnosis. Within each subgroup, we fit a logistic regression model with severe COVID-19 as the response variable and adjusted for the relevant immunosuppressant and a set of covariates (age, sex, race, body mass index, hypertension, diabetes mellitus, prespecified time period of COVID-19 diagnosis during the pandemic, chronic heart disease, chronic lung disease, malignancy, end stage renal disease, cirrhosis, smoking, receipt of COVID-19 vaccine, and receipt of SARS-CoV-2 monoclonal antibodies).

Results

In our SOT population, 570 patients were diagnosed with COVID-19 (458 kidney, 73 liver, 54 heart, 43 pancreas, and 8 lung recipients). The median patient age was 54 years, 59% were male, and 70% were white. After adjusting for other covariates, a mycophenolate dose-reduction of < 50% was associated with an odds ratio of 2.01 (95% CI: 1.03 - 3.90; p = 0.04) for developing severe COVID-19. Similarly, decreasing the dose of mycophenolate by ≥ 50% was associated with an odds ratio of 2.65 (95% CI: 1.09 - 6.41, p = 0.03) for developing severe disease. Tacrolimus dose reduction did not increase the risk of severe COVID-19, nor did a dose increase or decrease of prednisone.

Conclusion

A mycophenolate dose reduction when a SOT patient is diagnosed with COVID-19 should be discouraged, especially if the patient has mild disease.

Disclosures

All Authors: No reported disclosures
2704. Real-world safety and effectiveness of letermovir for preventing cytomegalovirus (CMV) disease in patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT): Final results of post-marketing surveillance (PMS) in Japan
Authors: Fukuda Masaki , Hattori Junko , Ohkubo Rika , Watanabe Asuka , Maekawa Shinichiroh
Published: November 2023

Background

CMV is one of the most common opportunistic infections in patients undergoing allo-HSCT. Letermovir is an inhibitor of CMV DNA terminase that is approved for CMV prophylaxis in patients undergoing allo-HSCT. We report the final results of a PMS that collected data on its safety and effectiveness of letermovir in real-world clinical practice after its approval in Japan.

Methods

The case report forms were drafted in part by the Japanese Data Center for Hematopoietic Cell Transplantation using data elements in the Transplant Registry Unified Management Program and sent to individual HSCT centers to decrease the burden of reporting. Patients who underwent HSCT and started letermovir between May 2018–May 2022 at one of 136 centers in Japan were registered in the PMS. Safety data collected in the PMS included adverse events (AEs)/adverse drug reactions (ADRs), which were assessed by the physicians. Clinical effectiveness outcomes were the development of CMV disease, CMV antigen status, and use of preemptive therapy within 48 weeks of starting letermovir. The database was locked on October 5, 2022.

Results

Overall, 932 patients who underwent HSCT were registered, of which 821 were included in safety analyses. ADRs occurred in 11.33% of patients and serious ADRs occurred in 3.05%. The five most common ADRs were nausea (1.58%), renal impairment (1.46%) and acute graft versus host disease (0.61%), CMV test positive (0.61%), and hepatic function abnormal (0.61%). AEs related to renal disorders occurred in 6.67% and 4.30% of patients treated with intravenous and oral letermovir, respectively. AEs related to cardiac disorders occurred in 3.05% of patients treated with oral/intravenous letermovir. Of 670 patients eligible for the effectiveness analyses at Week 48, CMV antigens were detected in 38.36% (Figure 1).

Conclusion

This final analysis PMS in Japan provides further evidence supporting the effectiveness and long-term safety of letermovir for CMV prophylaxis in patients undergoing allo-HSCT in real-world settings.

Disclosures

Masaki Fukuda, MSD K.K.: Grant/Research Support|MSD K.K.: Salary provided by MSD K.K. Junko Hattori, PhD, MSD, KK: Grant/Research Support|MSD, KK: Salary Rika Ohkubo, PhD, MSD K.K.: Grant/Research Support|MSD K.K.: Salary provided by MSD K.K. Asuka Watanabe, n/a, MSD K.K.: Grant/Research Support|MSD K.K.: Salary provided by MSD K.K. Shinichiroh Maekawa, n/a, MSD K.K.: Grant/Research Support|MSD K.K.: Salary provided by MSD K.K.