bluuebunny/crossref_metadata_2025 huggingface dataset:
1764. Collaboration between Public Health and Healthcare Partners to Attack the Rising Menace of Candida auris: The Michigan Experience
Authors: Brennan Brenda M , McNamara Sara E , Stier Elisia , Malani Anurag , Pogue Jason M , Ressler Adam M , Eckel Seth , Coyle Joseph , Bagdasarian Natasha
Published: November 2023

Background

Candida auris is an emerging fungal pathogen with high rates of morbidity and mortality. In May 2021, the Michigan Department of Health and Human Services (MDHHS), detected its first case of Candida auris and has since seen a rapid increase in southeast MI. There is currently no C. auris screening guidance developed for states. MDHHS Surveillance for Healthcare Associated and Resistant Pathogens (SHARP) Unit convened a multidisciplinary group from acute care facilities to collaborate on the development of guidance to rapidly assess, screen, and isolate patients entering healthcare facilities in efforts to slow the spread of C. auris.

Methods

The MDHHS SHARP Unit invited individuals representing infection prevention, infectious diseases, antimicrobial stewardship/pharmacy, lab, and epidemiology to participate. The purpose was to engage healthcare partners by providing updates on epidemiology, surveillance, antifungal susceptibilities, lab capacity, and containment/prevention activities in the state. Facilities were able to share best-practices and collaborate with public health to develop pragmatic recommendations that could be implemented within facilities across the region.

Results

Approximately 60 attendees representing MDHHS and 6 large healthcare systems, providing 63% of patient care in MI, met twice in early 2023 to draft C. auris screening guidance that can be customized to the specific facility. The document walks through how to develop a surveillance plan and includes guidance definitions, a Screening Assessment Flowchart, a Screening Assessment Checklist, and an Epidemiologically-linked Health Care Contact Screening Flowchart. The guidance went through an iterative process with feedback from healthcare partners.

Conclusion

MDHHS collaborated with healthcare partners to develop C. auris screening guidance that is evidence-based, easy-to-reference, and adaptable across facility-types. Previous regional approaches, such as the Michigan CRE Surveillance and Prevention Initiative, have proven to be substantially more effective at stemming the spread of multidrug resistant organisms. Michigan will continue these successful collaborations and apply this approach for future emerging pathogens.

Disclosures

jason M. Pogue, PharmD, AbbVie: Advisor/Consultant|Entasis: Advisor/Consultant|Ferring: Advisor/Consultant|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Qpex: Advisor/Consultant|Shionogi: Advisor/Consultant
1767. Ventilation in Non-Healthcare Congregate Settings: Capacity-Building Assessments to Reduce COVID-19 Exposure Risks, California 2022 – 2023
Authors: Wiegand Jared G , Peerless Kyle T , Stepp Robert , Ullman Elon , Greenberg Taria , Stainken Cameron R , Armatas Christina , Cummings Kristin J , Chung Wendy M
Published: November 2023

Background

Optimizing indoor air quality has been increasingly recognized as a cornerstone strategy to minimize aerosol transmission of SARS-CoV-2, particularly in non-healthcare congregate settings. Expertise often is lacking within local health departments (LHDs), to provide ventilation guidance to such facilities.

Methods

We offered non-regulatory ventilation assessments by state industrial hygienists (IHs) to 58 LHDs. Interested LHDs selected 1-2 non-healthcare congregate facilities, prioritized by: administrator interest, whether they were publicly funded, or had past COVID-19 outbreaks. We requested on-site participation of LHD and facility staff. State IHs presented educational material at pre-visit meetings and during the visits. Findings were collected systematically, and recommendations shared in reports and post-visit debriefings. Participants completed post-visit surveys.

Results

We visited 25 facilities in 19 counties, including 8 homeless shelters, 7 jails, 8 schools, 1 campground, and 1 behavioral health facility. Most (68%) were not operating heating, ventilation, and air conditioning (HVAC) systems continuously and air dampers were closed or obstructed in 4 (16%) facilities. Half of facilities had insufficient HVAC maintenance. Only 7 (28%) facilities used Minimum Efficiency Reporting Value (MERV) 13 filters. Of residential facilities, 3 (19%) had medical isolation spaces equipped with dedicated air handlers. Of non-correctional facilities, 11 (61%) used portable air cleaners. No facilities had implemented staff training on ventilation measures. In post-visit surveys, LHDs reported gaining a better understanding of actions that facilities can take to improve ventilation practices, which could also be generalized to other settings.

Conclusion

State IHs can have an important impact in bolstering public health workforce knowledge of principles of ventilation assessments. Common inadequacies in ventilation practices may occur in a variety of non-healthcare congregate settings, increasing the risk of SARS-CoV-2 transmission and outbreaks in vulnerable persons. Demonstrative site visits can effectively provide practical training to LHDs and inform the development of tools to build public health capacity to guide under-resourced settings.

Disclosures

All Authors: No reported disclosures
1784. Prevalence of Community-onset Group A Streptococcal Infections across 10 Regional Midwestern Hospitals
Authors: Kuo Tiffany D , Bolon Maureen K , Malczynski Michael , Qi Chao , Zembower Teresa
Published: November 2023

Background

Group A Streptococcus (GAS) is a bacterium that can cause infections, including strep throat, skin and soft tissue infections, and necrotizing fasciitis. As of December 2022, a global outbreak of GAS infections has been noted among the pediatric population. Northwestern Memorial HealthCare (NMHC), containing ten regional hospitals, noticed a sharp increase in community-onset GAS infections affecting both children and adults. This study examines the epidemiological and clinical features of GAS infections among patients presenting to our medical system.

Methods

NMHC is an all 11-hospital system. This study focuses on the 10 regional hospitals and excludes the inpatient rehabilitation hospital. Across the health system NMHC has more than 132,000 inpatient admissions annually. All GAS infections resulted through the emergency department and inpatient locations across NMHC were extracted from the electronic medical record (EMR) between December 2022 and March 2023. Clinical and microbiological data, possible exposure source, and outcomes were determined through the EMR.

Results

261 GAS infections resulted across NMHC (Figure 1). Of those 261 cases, 116(44.4%) were less than 18 years of age (Table 1). In addition, 106(40.6%) patients were hospitalized due to their GAS infections. The GAS source for hospitalized patients could not be identified for 82(77.4%) cases, while 12(11.3%) were infections secondary to injury. Thirty patients admitted to the hospital were placed in intensive care units. Ten of the hospitalized patients, age 56 and older, died. Furthermore, 9(90%) patients died due to septic shock and 1(10%) to acute respiratory failure. All deaths were attributable to GAS infections.

Table 1: Clinical and Microbiological Characteristics

Conclusion

This observation of community-onset GAS infections demonstrates a high prevalence among both pediatric and adult populations. The severity of disease and increased mortality are more predominant in the adult population.

Disclosures

All Authors: No reported disclosures
1790. Characteristics of Patients with Mpox Treated with Tecovirimat during the 2022 Outbreak in Puerto Rico
Authors: Gonzalez Hector J Melendez , Rodriguez Melissa Marzan , Gerena Iris Cardona
Published: November 2023

Background

In June 2022, the first case of Mpox, was diagnosed in Puerto Rico, followed by a sharp increase in cases that peaked in August 2022. In total, 108 cases were confirmed during this period. Throughout this time period, Tecovirimat (Tpoxx) was already available upon request to the Puerto Rico Department of Health (PRDoH). In this report we aim to describe the clinical characteristics and outcomes of all the patients in Puerto Rico who received Tecovirimat.

Methods

A cross sectional study was conducted to describe clinical and epidemiological profile of Mpox patients who received Tecovirimat. We use the data collected from our institution (PRDoH), who was responsible for the approval, delivery and monitoring of Tecovirimat prescription during the outbreak. The analysis period ranges from August 2022 to November 2022. Univariate analysis was conducted, including the median and percentage, to provide a summary of the distribution of the variables of interest.

Results

We present the clinical characteristics of 27 male patients who received Tecovirimat for a diagnosis of Mpox during the outbreak in Puerto Rico. Most patients were treated during August and September (85%), followed by October and November 2022 (15%). Most received treatment in outpatient settings at private clinics (63%) followed by government clinics (37%). Of the patients that required Tecovirimat, 67% had human immunodeficiency virus (HIV) and the median age was 32 years. Prior immunization with smallpox vaccine was reported by two patients, while 70% were not immunized and the immunization status of 22% was unknown. The most common indications for Tecovirimat prescription were genital structure involvement (67%), severe pain (37%), oral cavity involvement (22%), proctitis (19%), and immunosuppression (11%). Only two patients received Tecovirimat while admitted to an acute care setting. No severe adverse events or deaths were reported among these patients, and there were no suspected cases of Tecovirimat resistance.

Conclusion

This study provides relevant clinical information on the use of Tecovirimat in patients with Mpox during the outbreak in Puerto Rico. These findings may have important implications for the clinical management of future outbreaks of Mpox and other related infections.

Disclosures

Iris Cardona Gerena, MD, Valneva: Honoraria
2885. Increased incidence of fluconazole-resistant Candida parapsilosis bloodstream infections in Atlanta, Georgia 2021
Authors: Witt Lucy S , Misas Elizabeth , Farley Monica M , Thomas Stepy , Jenkins Emily N , Fridkin Scott , Chow Nancy A , Lockhart Shawn R , Lyman Meghan
Published: November 2023

Background

Since 2020, outbreaks of fluconazole-resistant Candida parapsilosis (FR-CP) infections have proliferated around the world. An increase in FR-CP bloodstream infections (BSI) in the Atlanta metropolitan area in 2021 was identified during routine surveillance through the Georgia Emerging Infections Program supported by the Centers for Disease Control and Prevention (CDC). We describe the genomic relatedness and epidemiologic associations between resistant and susceptible isolates.

Methods

Active laboratory- and population-based surveillance for candidemia was conducted in Atlanta during 2018-2021. Fluconazole susceptibility testing of CP isolates was performed at the CDC in accordance with CLSI breakpoints. Whole-genome sequencing was completed on 82% of all viable CP isolates from 2021. Clinical and epidemiologic data was abstracted from medical records. Bivariate analysis was performed using Wilcoxon-rank sum and chi-squared (or Fisher’s) test as appropriate.

Results

A total of 60 confirmed cases of CP BSI were characterized in 2021. Incidence of CP BSIs increased along with the proportion of FR-CP isolates in 2020-21(Figure 1). FR-CP isolates were genetically closely related (0-39 SNPs), and all contained the Y132F substitution in the Erg11 gene (Figure 2). FR-CP BSI (n = 19) were more common in patients who were admitted to a long-term acute care hospital (LTACH) in the last 90 days (p= < 0.01) and those who were mechanically ventilated in the 30 days prior (p=0.02). FR-CP was less common in patients who were in a short-term acute care hospital at the time of diagnosis (p=0.01) or who had a malignancy (p=0.03) (Figure 3). Patients with FR-CP isolates interacted most frequently with a unique set of healthcare facilities as compared to susceptible isolates (data not shown).Figure 1.Rate of incident Candida parapsilosis bloodstream infections by year with percent of fluconazole-resistant isolatesFigure 2.Neighbor-joining phylogeny of Candida parapsilosis, isolates from 2021.

Branch length indicates the number of SNPs and taxa nodes’ color indicates fluconazole-susceptible/resistant phenotype; no-circle taxa indicate the reference isolate. External orange squares flag isolates with the mutation Y132F in the Erg11 gene.Figure 3.Characteristics of patients with Candida parapsilosis infections in Atlanta, GA 2021 by fluconazole susceptibility

Conclusion

Overall rates of Candida parapsilosis BSIs in Atlanta increased in 2020 during the COVID-19 pandemic and highly related isolates of FR-CP emerged in 2021, associated with significant recent past exposure to LTACHs and mechanical ventilation. Network analysis is underway to further evaluate patterns of transmission that may inform infection prevention efforts.

Disclosures

All Authors: No reported disclosures
1791. Use of pathogen genomics to monitor global emergence of extensively drug-resistant Salmonella Serotype Typhi
Authors: Mikanatha Nkuchia M , Fu Yezhi , Yin Xin , Carr Christopher E
Published: November 2023

Background

Whole-genome sequencing (WGS) has transformed surveillance and outbreak detection. However, its use to complement resource-intensive epidemiologic investigations of emerging pathogens is limited. Here using WGS data of S. Typhi, we investigate the global spread of an emerging pathogen.

Methods

We used NCBI pathogen detection to search for SNP clusters of ceftriaxone-resistant S. Typhi (CRT) reported in the US and the National Antimicrobial Monitoring System (NARMSNOW) to analyze antibiotic-resistant trends of S. Typhi.

Results

Pathogen Detection Outbreaks of CRT infections were first reported in the US in 2018. We found that the US CRT isolates formed two distinct clusters linked to travel destinations, having close genetic relatedness with those found in Pakistan or Iraq. Specifically, three US CRT isolates (linked to travel to Iraq) only differed from 10 Iraq isolates (2021-2022) by an average of 3 SNPs (Figure). Further, two US CRT isolates (linked to travel to Pakistan) only differed from one Pakistan isolate (2022) by an average of 5 SNPs.

NARMS Now

Using 2012-2022 NARMS Now data, we analyzed trends in decreased susceptibility to ciprofloxacin (DSC) and resistance to ≥3 antibiotics recommended for treatment (MDR) among S. Typhi. We also compared the resistance trend pre-pandemic and after 2020. Our analysis included a total of 3,633 S. Typhi isolates. The percentage of DSC isolates increased from 68.5% (2012) to 85.1% (2022), while the percentage of MDR isolates increased from 8.9% to 20.1%. The 3-year (2017-2019) pre-pandemic DSC average was 77.5% and 80.5% after (2020-2022). For MDR isolates, it was 12.4% and 21.8%.

Close genetic relatedness between three US outbreak associated ceftriaxone-resistant Typhi strains (linked to travel to Iraq; highlighted in red) and 10 strains isolated in Iraq (highlighted in red).

Note the strains are collected in different years. The single nucleotide polymorphism (SNP) tree is automatically generated in the NCBI Pathogen Detection database when sequencing data are submitted to the database. The average SNP distance for the red highlighted isolates in the tree is three (SNP distance range 0∼9).

Conclusion

The SNP clusters indicate the likely international spread of resistant S. Typhi strains in travelers. Resistance to ciprofloxacin is increasing as is resistance to multiple antimicrobials. Travel restrictions imposed during the pandemic did not appreciatively alter resistance trends. These findings indicate the need for global cooperation in addressing antimicrobial resistance and emerging pathogens.

Disclosures

All Authors: No reported disclosures
1792. SARS-CoV-2 Genomic Surveillance System Development as a Model for Other Emerging Pathogens in Texas
Authors: Rai Saroj , Milleron Rania , Lee Rachel , Hanson Blake M , Hardy Marlisa , Boerwinkle Eric , Kubin Grace , Pont Stephen J , Shuford Jennifer A
Published: November 2023

Background

Texas is the second largest state in the country and has significant geographic and demographic diversity placing it at the forefront for identifying and responding to emerging infectious diseases. Therefore, it is critical to establish pathogen surveillance programs with statewide reach and local impact to meet public health needs. The Texas Department of State Health Services (DSHS) partnered with the University of Texas Houston School of Public Health (UTSPH) to create a statewide SARS-CoV-2 variant surveillance monitoring network project (the Network). This Network can be a model for monitoring other emerging pathogens in Texas.

Methods

A network was formed among DSHS, six academic centers, two commercial laboratories, and one public health laboratory for high throughput SARS-CoV-2 sample procurement, sequencing, and analysis for Texas. The program developed sample procurement and sequencing capacity across the state and electronic genomic data reporting to DSHS. Partners were selected based on expertise and area of geographic need. Protocols were established to meet high data quality and reporting standards. Working committees and shared data visualization tools were established to ensure collaboration among partners. The steering committee and workgroups were established to support network activities and enable DSHS to monitor epidemiological dynamics and transmissibility and respond to SARS-CoV-2 variants across each public health region.

Results

The Network has successfully established a state-wide system for sample collection, whole genome sequencing, reporting and analysis of data. At a regular cadence, the six academic centers acquire SARS-CoV-2 samples, sequence them in their respective labs and report the corresponding sequence or test data to DSHS and UTSPH. As of April 21, 2023, a total of 17,257 samples have been collected (Figure 1) and a total of 14,080 samples have been sequenced (Figure 2).

Conclusion

The network of public, academic and private partners has effectively met the need for SARS-CoV-2 sequence surveillance in this large and diverse state. With this established infrastructure in place, expanding to study other emerging pathogens in Texas is feasible.

Disclosures

Saroj Rai, PhD, MPH, Novartis: retirement in form of stock|Novartis: Stocks/Bonds
1797. Pneumococcal Vaccination in Veterans 65 years and older with Pneumococcus in the Veterans Health Administration (VHA) since November 2021
Authors: Schirmer Patricia , Lucero-Obusan Cynthia A , Oda Gina , Holodniy Mark
Published: November 2023

Background

Pneumococcal infection is a vaccine-preventable illness caused by Streptococcus pneumoniae. In October 2021, the Advisory Committee on Immunization Practices updated pneumococcal vaccine guidelines in all adults >65 years and for adults 19-64 years with certain medical conditions or risk factors. Pneumococcal vaccination among patients >65 years is a national VHA performance measure. We reviewed vaccine status in patients >65 years with pneumococcal infection since guidelines changed.

Methods

Demographics, pneumococcal vaccination in relation to time of infection and laboratory testing (culture, molecular and urinary antigen) during 11/1/2021-4/11/2023 were retrieved from VHA data sources. Patients aged >65 years with pneumococcus were evaluated and compared to VHA’s electronic quality measurement (eQM) for national pneumococcal vaccination rates.

Results

1,128 cases (1,108 unique patients) were identified (Table 1). 20 patients had recurrent infections. Median age was 74 years (IQR 69-77) with non-Hispanic Blacks (14.1%) slightly overrepresented compared to VHA’s Black population (12.7%); primary infection sites were pulmonary (68.4%) and blood (23.5%). 1,006/1,128 (89.2%) of cases in patients >65 years had at least 1 pneumococcal vaccine. VHA’s national pneumococcal vaccination of patients >65 years for fiscal years 2022-23 was 65.3%-65.9% per eQM. Of cases not vaccinated, 22.1% were non-Hispanic Black patients. Median time of vaccination before infection was 4.7 years (IQR 2.8-6.5). Most recent vaccination prior to infection for the overall cohort and those with recurrent infections was 23-valent pneumococcal polysaccharide vaccine (PPSV23) (56.5% and 57.9% respectively). In addition, 108/1,128 (9.6%) cases were vaccinated after their pneumococcal infection (17/108 were not previously vaccinated). 71/108 (65.7%) vaccines given after illness were 20-valent pneumococcal conjugate vaccine (PCV) (PCV20).

Conclusion

In VHA patients >65 years with pneumococcal infection, nearly 90% had had at least 1 pneumococcal vaccine which was mainly PPSV23 and given on average almost 5 years before infection. VHA could target non-Hispanic Black patients with pneumococcal vaccination efforts and ensure providers are utilizing PCV20 or PCV15+PPSV23 vaccines.

Disclosures

All Authors: No reported disclosures
1799. Patients Who Inject Drugs (PWID) and Unstable Housing are Associated with Invasive Group A Strep Infection: A retrospective collaboration between two large, quaternary care hospital systems in Philadelphia
Authors: Loeven Nicole , Altneu Eric , Spivack Stephanie , Halpern-Cohen Virginie , Dyer Kelly , Sullivan Kaede Ota , Epstein Shara , da Silva Daniel Teixera , Meisner Jessica , Schultz Sara K
Published: November 2023

Background

Invasive infections involving Group A Streptococcus (iGAS), defined as infections beyond simple skin and soft tissue infection or pharyngitis, are rising nationally. We report an increase in incidence of iGAS at two urban, quaternary care health systems that contain 6 hospitals in the city of Philadelphia.

Methods

All blood, sterile fluid, and tissue cultures that yielded Streptococcus pyogenes were identified using the laboratory information systems at the Temple University Health System and the University of Pennsylvania Health System. Two cohorts were compared: cases diagnosed between January 1, 2019 and December 31, 2019, and between January 1, 2021 to December 31, 2021. We excluded 2020 data to avoid analysis of disease incidence when hospital admission patterns may have been highly biased due to COVID-19 pandemic. Electronic health records were reviewed and data pertaining to demographics, month of infection, culture site, HIV status, HCV status, housing status, and injection drug use were abstracted. Descriptive statistics were used to summarize findings.

Results

In 2021, there were 301 unique cases of iGAS (148 involving bacteremia) compared to 169 in 2019 (with 70 cases of bacteremia). This represented an overall increase in iGAS of 178% and a 211% increase in cases involving bacteremia. Of the cases in 2021, 210 (69.8%) were PWID compared to only 54 (32%) in 2019, a 388% increase. In 2021, 7.5% of patients had a diagnosis of HIV compared to 8.9% in 2019, but a large percentage did not have an HIV test (37% in 2019 and 19% in 2021). HCV Antibody positivity was 52.3% in 2021 versus 26.6% in 2019. Housing instability was recorded in 151 cases (50.2%) in 2021 and 31 (18.3%) in 2019, a 487% increase.

Table 1

Demographic and clinical characteristics of iGAS cases in 2019 and 2021

Table 2

Age and Sex data in PWID

Conclusion

From 2019 to 2021, there was an increase in iGAS infections among an adult population in a large metropolitan city. We noted a 178% total increase in iGAS during our study period, with a 388% increase among PWID and 487% increase among those unstably housed. As the overdose crisis continues, public health practitioners and medical providers should be aware of the increase in iGAS when providing empiric treatment for PWID with infections and utilize local and national resources to report and manage cases.

Disclosures

Sara K. Schultz, MD FACP FIDSA, AbbVie: Advisor/Consultant
1808. Burden of infectious diseases and bacterial antimicrobial resistance in China, 2019: a systematic analysis
Authors: Zhang Chi , Liu Yi-Qi , Zhao Hong , Wang Gui-Qiang
Published: November 2023

Background

Whether on a global scale or within China, the issue of bacterial antimicrobial resistance (AMR) has become a pressing concern. This study aimed to comprehensively investigate the disease burden of infectious diseases and AMR in China.

Methods

Data on infectious diseases and AMR were collected by the Global Antimicrobial Resistance Burden study 2019 database. Our analysis steps consisted of 5 broad components: estimating the disease burdens of the total and 12 infectious syndromes by age and sex; describing the burden caused by 43 pathogens; calculating the burden caused by bacterial AMR in two scenarios (AMR associated deaths, AMR attributable deaths), respectively; estimating the AMR burden of 22 bacteria; calculating the burden of AMR by 22 bacteria and 19 antibiotics combinations.

Results

In 2019, there were an estimated 1.3 million (95% UI 0.8-1.9) infection-related deaths in China, accounting for 12.1% of the total deaths for that year. Males were 1.5 times more affected than females. Bloodstream infections was the largest fatal burden syndrome, associating with 521392 deaths (286307-870583), followed by lower respiratory infections (373175 deaths), and peritoneal and intra-abdominal infections (152087 deaths). These five leading pathogens were S aureus, A baumannii, E coli, S pneumoniae, and E spp., which were associated with 41.2% (502658/1218693) of all infection-related deaths. The pathogens of different infectious syndromes exhibit significant heterogeneity. In 2019, 602561 deaths were associated with bacterial AMR, including 145465 deaths attributable to bacterial AMR. Six leading pathogen-drug combinations were responsible for more than 0.5 million deaths in 2019: macrolides resistance S aureus, fourth-generation cephalosporins resistance A baumannii, carbapenems resistance A baumannii, third-generation cephalosporins resistance A baumannii, aminopenicillin resistance E coli, macrolides resistance S pneumoniae.Figure 1:Number and rate of deaths by pathogens in China, 2019. (A) Number; (B) Rate per 100000 populationFigure 2:Number of deaths associated with bacterial antimicrobial resistance by pathogen-drug combination in China, 2019

Conclusion

This study provides the comprehensive assessment of the burden of infectious diseases and bacterial AMR in China. The annual death toll of 1.3 million infection-related deaths, including 600000 deaths related to antibiotic resistance, requires sufficient attention.

Disclosures

All Authors: No reported disclosures
1809. Seroprevalence of Tick-borne Diseases including Alpha-gal Allergy and Associations with Musculoskelatal Symptoms in a Population-based Cohort in Central North Carolina
Authors: Zychowski Diana , Alvarez Carolina , Rodgers Haley Abernathy , Giandomenico Dana , Boyce Ross M , Nelson Amanda E , Commins Scott
Published: November 2023

Background

The incidence of ehrlichiosis, spotted fever rickettsioses (SFR), and Alpha-gal syndrome (AGS) is high in North Carolina (NC). Post-infectious sequelae secondary to ehrlichiosis or SFR are uncommon, however patients often attribute persistent musculoskeletal symptoms, including arthralgia, to prior tick-borne exposure. It is uncertain if these symptoms represent long-term complications from SFR or ehrlichiosis, or non-anaphylactic AGS via the development of IgE to galactose alpha-1,3-galactose (alpha-gal IgE). Utilizing a population-based cohort, we sought to examine the potential association between prior exposure to Ehrlichia, Rickettsia and alpha-gal, and chronic musculoskeletal symptoms.

Methods

A total of 488 Individuals from the 2017–2018 Johnston County Osteoarthritis study – a longitudinal, probability-based cohort – completed questionnaires regarding health status and environmental exposures, underwent physical assessment, and had serological testing for Rickettsia, Ehrlichia chaffeensis, and alpha-gal IgE. Multivariable models were used to estimate associations of interest for this cross-sectional study.

Results

The overall weighted point prevalence for Ehrlichia IgG was 8.6% (95% CI: 5.9–11.3%), Rickettsia IgG was 17.1% (95% CI: 12.6–21.5), and alpha-gal IgE > 0.1 IU/mL was 19.6% (95% CI: 15.3–23.8) in Johnston County, NC. Only one individual had antibodies to Rickettsia, Ehrlichia, and alpha-gal IgE > 0.1 IU/mL. Forty percent of participants had detectable alpha-gal IgE > 0 IU/mL, while only 2.5% self-reported a diagnosis of alpha-gal allergy to red meat. Only alpha-gal IgE was associated with knee pain, aching and stiffness (PAS) (IDR 1.3, 95% CI: 1.09-1.56). Antibodies to Rickettsia, Ehrlichia, and alpha-gal were not associated with symptomatic radiographic knee osteoarthritis (OA).

Conclusion

Despite only 17% of individuals recalling a tick bite in the past 5 years, 52% had either i) alpha-gal IgE > 0 IU/mL; ii) positive Rickettsia IgG antibodies; and/or iii) positive Ehrlichia IgG antibodies, together, suggesting high levels of tick exposure. Positive Ehrlichia or Rickettsia tick-borne serologies did not predict OA or PAS within this population. Further investigation into extraintestinal manifestations of AGS is needed.

Disclosures

Scott Commins, MD, PhD, Genentech: Advisor/Consultant|Revivicor: Grant/Research Support|Up to Date: Honoraria
1810. Noma (Cancrum oris): World Health Organisation's latest neglected tropical disease?
Authors: Braimah Ramat O , Butali Azeez , Mossey Peter , Wendy Thompson , Taiwo Abdurrazaq , Coker Modupe , Bala Mujtaba , Ibikunle Adebayo , Abdullah Shafiu , Bello Abubakar
Published: November 2023

Background

Noma, also known as cancrum oris, necrotizing ulcerative stomatitis or gangrenous stomatitis, is a rapidly progressive and often fatal infection of the mouth and face. This disease predominantly affects children between the ages of 2 and 6 years old in poorly developed countries around the world where adequate nutrition, sanitation and cleanliness are lacking. Northwest Nigeria has a particularly high prevalence of the Noma.

Noma starts as gum disease and, without effective treatment (including antibiotics), around 90% die within two weeks and as such noma eminently fits the definition of a neglected tropical disease (NTD). The World Health Organization (WHO) has described 5-stages of the disease to include: Stage 1 (Acute Necrotizing Ulcerative Gingivitis), Stage 2 (Edematous), Stage 3 (Gangrenous), Stage 4 (Scarring) and Stage 5 (Late sequelae).

Stage 1 noma - Acute necrotizing ulcerative gingivitis (necrotizing periodontal disease)

Stage 1 noma - Acute necrotizing ulcerative gingivitis (necrotizing periodontal disease)

Stage 2 noma – Edema

Methods

This study describes the patients who presented at hospitals in Sokoto, Nigeria between 2014 and 2022. Data were collected at Usmanu Danfodiyo University Teaching Hospital, Noma Children’s Hospital and State Specialist Hospital. The data are supplemented with exemplar images of cases which presented in each stage of noma.

Stage 3 noma - Gangrenous

Stage 4 noma – Scarring

Results

Since 2014, a total of 1,147 patients have been admitted. 165 (14.4%) patients presented with Stage 1 noma and were enrolled in the Ambulatory Therapeutic Feeding Centre (ATFC) (Figure 1). 125 (10.9%) patients presented with Stage 2 or 3 noma(see Figure 2)and were admitted to Inpatient Therapeutic Feeding Centres (ITFC). 845 (73.7%) patients presented with Stage 4 or 5 noma (see Figure 3) had various surgical interventions.

One case of twins both presenting with noma was seen. One presented with Stage 3 noma and the other was in Stage 4 . Just 11 (1.0%) cases were adults, all of whom presented with Stage 3 noma.

Stage 5 noma – late sequelae

Conclusion

Noma represents a major health inequality and has a relatively high prevalence in Nigeria. While previous studies have identified possible risk factors, there is a paucity of knowledge about the etio-pathogenesis, prevention and treatment of each phase. The designation of noma as a neglected tropical disease would focus attention on the condition and would release funding for further research to address these knowledge gaps.

Disclosures

All Authors: No reported disclosures
1813. A Retrospective Review of the Safety and Efficacy of Dalbavancin at Ireland's Largest Acute Medical Hospital
Authors: Conlon Peter , Bannan Ciaran , Kelly Mary , Williamson Claire
Published: November 2023

Background

Dalbavancin is second-generation lipoglycopeptide antibiotic. It is licensed in Ireland and the United States for the management of acute skin and soft tissue infections. International colleagues report treatment success in its use for patients who are unable to stay in the hospital for prolonged periods and not suitable for OPAT [1]. We reviewed the use of Dalbavancin at St James's Hospital Dublin, which is the largest hospital in Ireland with over 700 acute beds. We are located in Dublin’s inner city which experiences significant socio-economic deprivation.

Methods

We used the electronic patient records at St James's Hospital to capture all uses of Dalbavancin from August 2018 to September 2022.

We established baseline demographics, indication, microbiological characteristics if there was oversight by ID/micro, safety, and treatment outcomes.

Results

< We identified 23 patients who met the inclusion criteria

Base demographic:

The most common indication was endovascular infection (35%) and skin and soft tissue infection (35%). (Figure 1)

Most patients were not bacteremic. Staph aureus was the most common organism identified on blood culture (figure 2)

322 hospital bed were saved which equates to 257,600 euro

0 patients had an adverse drug reaction

100% of cases were discussed with micro or ID

Conclusion

Dalbavancin is a safe and effective drug. It is another tool that can be used when caring for patients who are experiencing unstable housing and challenging social circumstances. Our experience has found 0 adverse events, 69% of patients experienced treatment success (this increases to 88.8% if we exclude those lost to follow up). This is an important finding considering on 17% of indications were considered ‘on label’.

Dalbavancin can save money on hospital beds and also reduces non-recyclable plastic associated with repeated doses of IV antibiotics.

Disclosures

All Authors: No reported disclosures
1814. Retrospective Study of Skin and Soft Tissue Actinomycosis in an Urban Pediatric Academic Medical Center
Authors: Demirhan Salih , Orner Erika , Szymczak Wendy , Lee Philip J , Aldrich Margaret
Published: November 2023

Background

Actinomyces species are known colonizers of human mucosal surfaces but are rarely associated with disease in immunocompetent hosts. Pediatrics studies are limited to case reports. This retrospective study aims to describe the characteristics of skin and soft tissue actinomycosis (SSTA) and the frequency and risk factors of recurrence in pediatric patients.

Methods

We conducted this study of patients aged ≤21 years with Actinomyces growth in abscess cultures obtained under sterile conditions between January 2019 and December 2022 (Figure 1). Patient demographics were collected using the EMR, and all patients had at least a one-year follow-up period in which to ascertain recurrence.

Results

One hundred four patients met inclusion criteria; median age 19 (IQR 17-20) years, 68.3% female, 46.2% Black and 47.1% Hispanic. Body mass index (BMI) was > 25 in 59.8% of patients. Actinomyces turicensis (n=47) was the most commonly isolated subspecies and 71.2% of Actinomyces cultures were monobacterial. Clindamycin and trimethoprim-sulfamethoxazole were the most commonly used antibiotics. Only 7 patients had consultation with pediatric infectious diseases. Patients who had a prior abscess at the same anatomic site made up 29.8% of the study cohort and 33.7% had documented recurrence after the first SSTA episode, within median 10 (IQR 6-16) months after initial episode (Figure 2 and Table 1). Monobacterial culture growth (85.7% vs 63.8%, p=0.02), patients with BMI >25 (75% vs 52.6%, p=0.04) and patients with prior abscess in the same area (51.4% vs 18.8%, p=0001) were significantly higher in patients with recurrent actinomycosis (Table 2). In univariate analysis, monobacterial growth (OR= 3.4, 95% CI 1.2-9.9), BMI >25 (OR=2.7, 95% CI=1.1-7.0) and prior abscess (OR=4.6, 95% CI=1.9-11.2) were associated with increased odds of recurrence.

Conclusion

Our findings suggest that patients with SSTA were generally adolescents with elevated BMI. Monobacterial culture growth, BMI >25, and prior abscess in the same area were significantly associated with recurrence. High recurrence rate, suboptimal antibiotic utilization and very low rates of consultation with infectious diseases suggest that providers should be informed and updated regarding this rare but difficult to treat infection.

Disclosures

All Authors: No reported disclosures
1822. Assessing Trusted Sources and its Impact on Healthcare Accessibility for Safe Return to K-12 Schools in an Underserved Population
Authors: Agha Humza , Shelley Jamee T , Reyes Sydney A , Reyes Summer M , Walsh Tyler , Watterson Tremayne , Torres Ana V , Bonty Brittany T , Evans Christina , Prater Jasmine , Hayes Samantha , Malone Sara , Lai Albert , Fritz Stephanie A , Newland Jason , Neidich Julie A , Lackey Ian T
Published: November 2023

Background

Participants of a COVID-19 school-based testing program in predominantly Black schools were asked to complete the NIH’s Common Data Elements (CDE) survey to help understand the demographic and social determinants of health of our testing population. The objective of this study was to assess if those completing the CDEs were reflective of our overall testing participants and to identify the trusted sources of these individuals

Methods

All testing participants were offered the opportunity to complete a 150 question CDE survey after being enrolled in the testing portion of the study. Descriptive statistics described race/ethnicity, socioeconomic status, and vaccination status. Geospatial mapping utilizing addresses of participants was used to assess social vulnerability index among testing and CDE participants. Response options for trusted COVID19 source questions were given in a 5-point Likert scale, with answers ranging from “A great deal,” to “Not at all.”

Results

A total of 477 CDE surveys were submitted among 2581 participants. When comparing the total participant population with the CDE respondent population, we see disparate numbers among Black and White participants (Fig. 1). Additionally, those completing CDEs were in lower SVIs (Fig. 2). Analysis of trusted sources for COVID19 information showed that 80% of White CDE respondents trusted their doctor/healthcare provider “a great deal,” as compared to 26% indicating “not at all” for Faith Leader. 51% of Black CDE respondents trust their doctor/healthcare provider “a great deal,” as compared to 25% indicating “not at all,” for the US Government. (Fig. 3)

Testing population vs. CDE population by race

This graph shows our overall testing population and CDE population by race.

Mapping testing population vs. CDE population SVI

The addresses of our overall testing population and our CDE population were geospatially mapped against CDC's 2018 Social Vulnerability Index (SVI).

CDE trusted COVID19 sources by Race

Responses from our testing population that completed CDEs based on trusted sources

Conclusion

CDE respondents did not reflect our testing participants. Additionally, the most trusted sources among the population completing the CDEs were doctors/healthcare providers, and not as much faith leaders. While these data are important, they do not reflect the testing participants in our underserved community and need to be interpreted with caution. Use of CDEs are important but care needs to be taken when reporting the results.

Disclosures

Albert Lai, PhD, Johnson & Johnson: Stocks/Bonds Jason Newland, MD, Moderna: Grant/Research Support|Pfizer: Grant/Research Support
1827. Patients with Serious Injection Related Infections (SIRI) have Limited Access to Community-based Infection Prevention and Treatment in Alabama
Authors: Bradford William , Gagnon Kelly , Bassler John R , Eaton Ellen
Published: November 2023

Background

The University of Alabama at Birmingham Hospital (UABH) provides a large percentage of tertiary care for Alabamians, including treatment of serious injection-related infections (SIRI). Because patients with SIRI frequently utilize our hospital and emergency department, we hypothesized that persons who inject drugs (PWID) in AL have limited access to community-based infection prevention and treatment, including addiction and harm reduction services, that is associated with their rural residence.

Sociodemographics, healthcare utilization, infection type, and substance use outcomes of participants.

Methods

We conducted a retrospective cohort study of patients hospitalized with SIRI at University of Alabama at Birmingham (UAB) Hospital (2016 to 2021). We queried sociodemographics, healthcare utilization, infection, and substance use outcomes (table 1). We used a standardized telephone survey, to identify and characterize the community services for PWID in AL. We then categorized the distance between self-reported residence, using zip code, and two locations: UAB hospital and community services. Using geospatial mapping, we then evaluated patients’ driving distances to these sites.

Results

A total of 383 patients with SIRI met inclusion criteria (table 1). We identified 98 sites providing community services (HIV, harm reduction, addiction) for PWID in AL. Patients residing in a community at intermediate distance from UAB (defined as 15-50 miles) had the most limited access to services. They were also significantly more likely to be white, uninsured, rural, have an established diagnosis of opioid use disorder (OUD).

Conclusion

For patients with SIRI receiving care at UAB Hospital, the proximity of their residence to UAB was associated with access to community services, with those 15 to 50 miles away being most limited. Although this group has access to care when hospitalized, the results highlight the lack of community care available in their hometowns. Clinicians should anticipate this gap in care and arrange for telehealth and other accessible options; integrated infection and addiction telehealth services may help bridge this care gap. More research is needed to understand how the residence of PWID may impact post-hospital ID and addiction outcomes.

Disclosures

Ellen Eaton, MD, MPH, Gilead: Grant/Research Support|Gilead: Honoraria
1843. Exploring Cisgender Women's HIV Pre-Exposure Prophylaxis (PrEP) Needs and Preferences Across Settings: the Roles of Social-Structural Factors
Authors: Kerrigan Deanna , Yonamine Kimi , O’Rourke Allison , Karver Tahilin Sanchez , Davis Wendy W , Metzner Aimee A , Oglesby Alan , Garris Cindy , Scott Rachel , Moriarty Patricia , Taggart Tamara , Barrington Clare , Gomez Hoisex , Perez Martha , Donastorg Yeycy
Published: November 2023

Background

Cisgender women (CGW) account for 48% of new HIV infections globally and 18% of new HIV infections in the United States (US) but comprise only 8% of daily oral PrEP users in the US. Social-structural factors including stigma, gender norms, and medical provider bias have been linked to daily oral PrEP inequities among CGW. These factors influencing PrEP utilization merit further attention as additional options emerge, including long-acting (LA) injectable PrEP.

Methods

PrEP preferences, barriers, and facilitators to uptake were explored through 60 in-depth interviews with CGW with indications for PrEP (n=40), and HIV and reproductive healthcare providers (HCPs) (n=20) in Washington, DC, US and Santo Domingo, Dominican Republic (DR) in 2021 and 2022 (Table 1). CGW in the DR were female sex workers (FSW), while those in DC were seeking reproductive health services. Thematic content analysis was employed.

Results

Participants noted low awareness of PrEP, particularly LA PrEP, among CGW across settings and indicated this may be in part due to ongoing emphasis on PrEP for men who have sex with men and transgender women compared to CGW. In DC and the DR, PrEP was often seen as a potential empowerment tool by CGW to address social-structural constraints, gender-related pressures and responsibilities, and inequitable partner dynamics. The perceived need for and preferences regarding daily oral vs. LA injectable PrEP was mixed among CGW in DC due to varied self-assessment regarding PrEP as a priority and some CGW’s comfort with pill taking. LA PrEP was described by some CGW as a means to improve adherence and reduce stigma associated with pill taking. FSW in the DR were particularly interested in LA PrEP as they found it more compatible with their work. Suggested facilitators of PrEP uptake noted across settings included financial and logistical support (transport, childcare) and HCP training on CGW’s PrEP needs.

Conclusion

Tailored CGW-centered awareness campaigns and sensitivity training for HCPs related to PrEP options for CGW are needed. Access to LA PrEP for FSW is critical given the disproportionate impact of HIV on this community and their work-related PrEP preferences. Interventions must address social-structural factors among CGW to support equitable PrEP uptake.

Disclosures

Aimee A. Metzner, PharmD, AAHIVP, ViiV Healthcare: Full-time employee (salary/benefits/etc.)|ViiV Healthcare: Stocks/Bonds Alan Oglesby, MPH, GlaxoSmithKline: Employment|GlaxoSmithKline: Stocks/Bonds Cindy Garris, MS, GSK: Stocks/Bonds|ViiV Healthcare: Employee Rachel Scott, MD,MPH,FACOG, Gilead Science: Grant/Research Support|ViiV/GSK: Grant/Research Support
1846. Quality of Life Impairment and Difficulty to Work Associated with Post-COVID Syndrome: A Cross-Sectional Study
Authors: Kochuparambil Jose J , Raju Jomel
Published: November 2023

Background

Following SARS-CoV-2 virus infection, patients may suffer from long-lasting symptoms regardless of disease severity. Preliminary results show limitations in health-related quality of life (HRQoL). The aim of this study is to evaluate the change in the quality of life of COVID-19-infected patients depending on the duration of the infection and the accumulation of symptoms.

Methods

The study population consisted of patients (18–65 years) presenting to the Post-COVID outpatient clinic of the tertiary care hospital in India, between March and October 2022. The HRQoL was assessed by the use of the RehabNeQ and the SF-36. Data analysis was descriptive with frequencies, means, and/or percentages. In addition, a univariate analysis of variance was performed to show the dependence of physical and psychological HRQoL on specific factors. This was finally tested for significance at an alpha level of 5%.

Results

Data from 318 patients were analyzed, most of whom had 3–6 months of infection (56%) and 5–10 symptoms persisted (60.4%). Both mental (MCS) and physical sum score (PCS) of HRQoL of the COVID-19 infected population were significantly lower than those of the normal population without a history of COVID-19 infection (p < .001). The number of remaining symptoms (MCS p = .0034, PCS p = .000) as well as the perceived ability to work (MCS p = .007, PCS p = .000), influenced the HRQoL.

Conclusion

The HRQoL of patients with Post-COVID-syndrome is still reduced months after infection and so is their occupational performance. In particular, the number of symptoms could have an influence on this deficit, which would need to be further investigated. Further research is needed to detect other factors influencing HRQoL and to implement appropriate therapeutic interventions.

Disclosures

All Authors: No reported disclosures