bluuebunny/crossref_metadata_2025 huggingface dataset:
2067. Missed Opportunities for Confirmatory HIV Testing at a Midwestern Medical Center
Authors: Paetz Olivia R , Sayles Harlan R , Fey Paul D , Bares Sara H
Published: December 2022

Background

The currently recommended HIV testing algorithm begins with a 4th generation antigen/antibody (Ag/Ab) combination immunoassay, which allows for early detection of HIV. However, this assay’s high sensitivity can result in false positives that must be distinguished from acute infections via an HIV nucleic acid test (NAT). At our medical center, HIV NATs are recommended in the lab report for anyone with a positive p24Ag component on the screening assay, but they are not done reflexively by the lab as it requires a different blood tube. Thus, difficulties arise in obtaining the NAT, such as providers failing to order the test or patients failing to return for another blood draw, jeopardizing the diagnosis of early HIV.

Methods

We conducted a retrospective chart review of adult patients at a Midwest academic medical center with a positive p24Ag on the HIV-1/2 Ag/Ab combination assay between Jan. 1, 2017 and Feb. 21, 2021. We assessed if appropriate confirmatory testing was performed, identified barriers to missed opportunities for confirmatory testing, and used t-tests and Fisher’s exact tests to evaluate differences between those who did and did not receive confirmatory testing.

Results

Of 37 people with a positive p24Ag on the HIV Ag/Ab immunoassay, 6 (17%) did not have an HIV NAT performed within 30 days of their positive screening test. Of these 6 cases, the ordering provider did not acknowledge the need for a confirmatory test in 3 cases, the patient did not return for the test in 1 case, and other factors prevented follow-up in 2 cases. Of those who had an HIV NAT ordered, 7 (23%) had a positive HIV NAT. Younger age was significantly associated with completion of appropriate confirmatory testing (p=0.05), but other factors including sex, race, insurance status, having a primary care provider, specialty of ordering provider, encounter location, and test indication were not.

Conclusion

Our review identified multiple missed opportunities for confirmatory HIV testing following a positive p24Ag component on the HIV screening test. Provider lack of knowledge/awareness of the need for appropriate testing was the most common barrier. A quality improvement initiative will be undertaken to minimize future risk of missed opportunities for confirmatory testing.

Disclosures

Paul D. Fey, PhD, BioFire: Advisor/Consultant|BioFire: Grant/Research Support|Merck: Grant/Research Support Sara H. Bares, MD, Gilead Sciences: Expert Testimony|GSK ViiV Healthcare: Grant/Research Support|Janssen: Grant/Research Support.
2068. Molecular and Clinical Features of New HIV-1 diagnoses in Northern Dominican Republic
Authors: Sanchez Martha C , Lerebours Alain , Darpolor Josephine , Manne Akarsh , Novitsky Vladimir , DeLong Allison , McCarthy Meghan , Carlo Dominique , Solomon Matthew , Rodriguez Claudia , Kantor Rami
Published: December 2022

Background

Surveillance of transmitted drug resistance (TDR) and molecular epidemiology of newly diagnosed persons with HIV can impact care and prevention and inform efforts towards ending the HIV epidemic. Both interventions are not routinely available in the Dominican Republic (DO).

Methods

During 10/2019-4/2021, we attempted to enroll all newly HIV-diagnosed antiretroviral naïve adults (≥18 years) presenting at the regional hospital in Santiago, DO. Demographic, clinical and laboratory data were collected, and blood samples obtained for partial pol genotyping. Subtyping and resistance interpretation were done with Stanford Database tools. Maximum likelihood phylogenies were inferred by RAxML and clusters were defined as clades with bootstrap support of ≥0.8. Extended phylogenetic analyses included ∼1,500 publicly available Caribbean sequences. Demographics and TDR were compared by cluster status using Fisher Exact or Wilcoxon rank sum tests.

Results

Of 100 HIV-diagnosed participants (mean age 40 years; 61% male; 84% heterosexual; 50% never tested prior), 56% were hospitalized, 48% tested via doctor advise and 28% for feeling sick. Available CD4 count was < 200 cells/µL in 49% (43/87) more prevalent (vs CD4 >200) in heterosexuals (93% vs 7% in gay/bisexuals; p=0.003). Genotyping from 68/100, were 29% HIV-1 subtype B, 69% B-containing recombinants and one HIV-1 subtype C. TDR was in 12% (95% CI: 5-22%), all to NNRTIs (K103N and Y188L most common; two with multiple mutations). Six identified clusters included 25% of participants, 92% from downtown Santiago. Individuals in the largest 6-member cluster met partners online and were gay/bisexual. Participants in clusters had higher TDR (24% vs 8%, p=0.100), were younger (34 vs 43 years, p=0.01), and were gay/bisexual (41% vs 8%, p=0.003). In extended phylogenetic analyses participant sequences clustered with other DO sequences, as well as some from Haiti.

Conclusion

In this snapshot of new HIV diagnoses in the DO, findings of high AIDS at diagnosis, particularly in heterosexuals, high TDR, more clustering in gay/bisexual younger individuals, and existing non-local-only transmission networks, should inform focused surveillance and prevention strategies to disrupt HIV transmission and improve care.

Disclosures

All Authors: No reported disclosures.
2084. Importance of the Primary Care Physician in HIV PrEP Adherence During a Pandemic
Authors: Daudelin Isaac , McCarty Bret , Ahmad Chaustre Shawn K , Finkel Diana
Published: December 2022

Background

In 2015 emtricitabine-tenofovir (PrEP) was approved for use as a pre-exposure prophylactic medication for preventing HIV infections. In 2017, WHO declared PrEP to be an essential medicine, gaining widespread acceptance for outpatient care. In 2020, the COVID-19 pandemic disrupted the healthcare system, with several studies showing lower rates of PrEP prescriptions during the pandemic particularly among Black and Latinx groups.

Methods

Medical records at Rutgers New Jersey Medical School (NJMS) were queried for PrEP prescriptions from 2017-2021. All duplicate entries, and all patients prescribed emtricitabine and tenofovir as part of HIV treatment were removed. Years 2017-2019 were defined as “pre-pandemic” and years 2020-2021 were defined as “pandemic.”

Results

Average annual prescriptions for PrEP at NJMS decreased by only 13% (157 to 137 p=0.53) for all ages and 25% (29 to 22 p=0.38) for adolescents and young adults (ages 16-24) (AYA) from pre-pandemic to pandemic years. The annual number of AYAs who had their PrEP prescribed by the Division of Adolescent and Young Adult Medicine practice (DAYAM) remained the same during the pandemic while the annual number of AYAs who had their PrEP prescribed by the Infectious Disease practice (IDP) decreased by over 50% (p = 0.07). PrEP prescriptions for trans-identifying individuals (over 90% prescribed by the IDP) increased by 15% (p = 0.58).

PrEP Prescriptions for Adolescents and Young Adults

All PrEP Prescriptions at Rutgers NJMS

Conclusion

Despite the national decline in PrEP prescriptions during the COVID-19 pandemic, NJMS experienced a non-statistically significant decrease in PrEP prescriptions despite serving a majority Black and Latinx population who have elsewhere suffered the most disruption in healthcare during the pandemic. At NJMS, the IDP provides primary care for trans-identifying individuals, and DAYAM provides primary care for AYAs. Average annual PrEP prescriptions for trans-identifying individuals increased and AYA PrEP prescriptions by the DAYAM remained the same throughout the pandemic emphasizing the key role primary care physicians have in PrEP access during the pandemic and may play a significant role in the strong continuation of PrEP program provided at NJMS throughout the pandemic.

Disclosures

All Authors: No reported disclosures.
2099. Clinical frailty scale as a predictor of mortality of pulmonary infections in patients with hematological malignancies
Authors: Ortiz-Martínez Yeimer , Fajardo-Rivero Javier , Cadena-Sanabria Miguel , Figueroa-Pineda Claudia , Ruiz-González Carlos , Saul Zane
Published: December 2022

Background

Due to the poor outcomes reported in older patients with hematological malignancies (HM) and pulmonary infections, there is a need to identify patients at high risk of mortality.

Objective: This study aims to find the association between frailty and mortality in patients above 65 years of age with HM hospitalized with pulmonary infections.

Methods

A cross-sectional, retrospective study was conducted on the clinical data of 64 HM older patients with pulmonary infection hospitalized in a tertiary university hospital in Bucaramanga, Colombia, between January 2015 and December 2020. Patients were assessed using Clinical Frailty Scale (CFS) and were divided into three groups: CFS 1–4 fit; CFS 5–6 frail and CSF 7–9 severely frail. The association between frailty and in-hospital mortality was the primary outcome. All statistical analyses were performed using Stata/IC 14.0.

Results

The number of participants classified as fit, frail, and severely frail was 21 (32.8%), 22 (34.3%), and 21 (32.8%), respectively. 48.4% were women, and the mean age was 75.4 ± 6.85 years. A total of 45 patients (70.3%) died during hospitalization. We found a significantly higher in-hospital mortality rate among frail (23.8% vs. 90.9%; p < .001) and severely frail patients (23.8% vs. 95.2%; p < .001), when compared to fit patients. After multivariate analysis, high CFS score was an independent risk factor for mortality, OR was 6.8 (1.40–32.97, p = .001) for frail and 14.4 (1.76–117.32 p = .013) for severely frail compared to fit patients, after adjustment for sex, type of HM and the presence of comorbidities. Table 1Baseline characteristics of study participants.Image 1Kaplan-Meier survival estimate for mortality for patients ≥65 years with hematological malignancies and pulmonary infection.

Conclusion

Clinical Frailty Scale (CFS) could be used as a potentially useful tool in predicting mortality of pulmonary infections in elderly patients with HM. These results could suggest that the use of this score extends beyond evaluating the degree of frailty and could predict adverse outcomes and help decision making in complex clinical scenarios.

Disclosures

All Authors: No reported disclosures.
2102. Common co-occurence in the respiratory tract of Mucorales with Gram-negative rods in patients with hematologic malignancy and sinopulmonary mucormycosis
Authors: Egge Stephanie L , Wurster Sebastian , Axell-House Dierdre B , Jiang Ying , Miller William R , Kontoyiannis Dimiitrios P
Published: December 2022

Background

Mucorales (MCR) and Gram-negative rods (GNR) commonly infect patients (pts) with hematological malignancies (HM); however, their co-occurrence is understudied.

Methods

We retrospectively reviewed the records of 63 pts with HM and sinopulmonary MCR (proven or probable, EORTC/MSG criteria) at MD Anderson Cancer Center (Houston, TX) from 2008-2016. Co-occurrence was defined as a culture positive for GNR taken from sinuses or the lungs within 90 days (d) of a positive Mucorales culture or histology demonstrating Mucorales spp.

Results

Ninety percent of the 63 pts with MCR had leukemia or myelodysplastic syndrome (54% AML) and 10% had lymphoma/myeloma. Sixty-eight percent had undergone hematopoietic stem cell transplant. Sixty-seven percent were neutropenic at the time of MCR diagnosis. Thirty-five percent had received > 600mg of prednisone within 30 days (d) prior to MCR diagnosis. Thirty-five percent were admitted to the ICU during the time of MCR treatment. MCR pts had sinusitis (42.9%), pneumonia (38.1%) and disseminated sinopulmonary disease (19.0%). Nearly all pts (92%) received empiric antimicrobials with activity against Pseudomonas prior to collection of their positive fungal cultures. Twenty-three pts (37%) had concurrent detection of GNRs (Pseudomonas in 10, Stenotrophomonas in 8) in samples from the sinopulmonary tract. Eight of 23 co-isolations of GNRs and Mucorales (35%) were found in same-day samples. Demographic and clinical characteristics of pts with and without co-occurrence of GNR were comparable. Pts with co-occurrence had less frequently received antibiotics with activity against Stenotrophomonas 7 (30.4%) vs 23 (60%, p=0.024). Ninety-day all-cause mortality was high and comparable in pts with (83%) and without (78%) GNR detection (p = 0.75).

Conclusion

Over a third of heavily immunosuppressed pts with sinopulmonary MCR harbor GNRs in their respiratory tract, most commonly Pseudomonas. Although no impact on survival outcomes was seen in a background of high mortality, pathogenesis studies are needed to understand the mutualistic interplay of GNR and Mucorales spp. and their influence on host responses.

Disclosures

William R. Miller, MD, Entasis Therapeutics: Grant/Research Support|UpToDate: Royalties - Topic Contributor Dimiitrios P. Kontoyiannis, MD, ScD, PhD (hon), AbbVie: Advisor/Consultant|Astellas Pharma: Advisor/Consultant|Astellas Pharma: Grant/Research Support|Astellas Pharma: Honoraria|Cidara Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria|Merck: Advisor/Consultant.
2103. Comparison of Antibiograms Across Solid Organ Transplant Services Within a Medical Center
Authors: Kim Annie , MacDougall Conan
Published: December 2022

Background

Antibiograms summarize localized antimicrobial susceptibilities and are used to guide empiric antibiotic therapy. Antibiograms for subpopulations may offer more meaningful clinical data, especially in immunocompromised hosts who may be at higher risk for multidrug-resistant organisms. However, population-specific antibiograms are uncommon. The purpose of this study is to evaluate whether service-specific antibiograms provide more useful information than hospital-wide antibiograms.

Methods

This is a retrospective, single-center study that included bacterial isolates from all body sites collected between 2017-2020. Antibiograms were created in accordance with the Clinical and Laboratory Standards Institute guidelines, with susceptibilities reported as a percentage and a 95% confidence interval. A combined solid organ transplant (SOT) antibiogram and individual antibiograms based on the transplanted organ (heart, lung, liver, and kidney) were compared to a hospital antibiogram with a difference of ≥ 10% considered clinically significant.

Results

In the combined SOT antibiogram, Escherichia coli, Klebsiella aerogenes, and Klebsiella pneumoniae susceptibilities were lower for antibiotics such as ceftriaxone, ceftazidime, and ciprofloxacin compared to the hospital antibiogram. Overall susceptibilities for Pseudomonas aeruginosa in the SOT antibiogram were comparable to that of the hospital antibiogram; however piperacillin-tazobactam susceptibilities were substantially lower among lung and heart transplant patients. Among Staphylococcus aureus isolates, clindamycin susceptibilities were similar between the SOT antibiogram and hospital antibiogram. This was a result of lower susceptibilities among lung transplant patients, offset by greater susceptibility in liver, kidney, and heart transplant patients.

Conclusion

Clinically significant differences were seen in susceptibilities for several antibiotics against gram-negative and gram-positive pathogens in various transplant antibiograms. The combined SOT antibiogram minimized substantial between-service differences. Through population-specific antibiograms, providers may be able to improve empiric antibiotic therapy selection for their patient population.

Disclosures

Conan MacDougall, PharmD, MAS, Merck: Advisor/Consultant.
2116. Long-term (2-year) outcomes and complications of COVID-19 in solid organ transplant (SOT) recipients
Authors: Burack Daniel , Pereira Marcus R , Verna Elizabeth
Published: December 2022

Background

The long-term complications of COVID-19 infection in the general population include mortality, re-infection, secondary infection, persistent organ dysfunction, and symptoms of long-COVID. The prevalence of these outcomes and impact on graft function in solid organ transplant (SOT) remain uncertain. We aim to describe these complications in a large series of SOT with COVID-19 with 2 years of long-term follow up.

Methods

We retrospectively studied all adult (age >18) SOT from a single center hospitalized with SARS-CoV-2 diagnosed by nasopharyngeal swab between 3/10-5/30/2020. Patients with early mortality within 28 days were excluded. Outcomes including mortality, allograft rejection, allograft failure, secondary infections, COVID-19 re-infections, post-COVID complications (oxygen requirement, chronic renal or cardiac dysfunction), and symptoms of long-COVID were analyzed. Re-infections were characterized by severity and likely variant based on local variant predominance.

Results

117 SOT recipients were hospitalized with COVID-19 in the study period. 94 survived the first 28 days and were followed for a median of 751 (742-760) days post-infection. 9 (9.57%) died within 1 year of infection and 14 (14.9%) within 2 years. 21 (22.3%) had ≥1 episode of allograft rejection and 21 (22.3%) had allograft failure. 11 (9.4%) were re-infected with COVID-19 at a median of 603 (389-642) days following initial infection, of whom 2 (18.2%) were hospitalized and 0 died. 43 (45.7%) had secondary infections and 18 (19.1%) with multi-drug resistant organisms. 32 (34.0%) developed new chronic kidney disease or end-stage renal disease, 25 (26.6%) had new cardiovascular disease, and 8 (8.51%) had a prolonged oxygen requirement following infection. Of reported long-COVID symptoms, fatigue (26, 27.7%), dyspnea (18, 19.1%), and cough (11, 11.7%) predominated with 25 (26.6%) having >1 symptom.

Conclusion

In this large cohort of SOT recipients hospitalized during the first wave of the COVID-19 pandemic, long-term 2-year follow-up showed high rates of mortality, allograft rejection, allograft failure, secondary infection, organ dysfunction, and symptoms consistent with long-COVID. Ongoing study of the impact of these complications will be crucial to improving outcomes in SOT recipients.

Disclosures

Marcus R. Pereira, MD, Hologic: Grant/Research Support|Merck: Grant/Research Support|Moderna: Grant/Research Support|Shire/Takeda: Grant/Research Support|Takeda: Advisor/Consultant|Union Therapeutics: Advisor/Consultant Elizabeth Verna, MD, Salix: Grant/Research Support.
2125. Determinants of Placental Transfer of HSV-specific Antibodies and the Impact of SARS-CoV-2 Coinfection
Authors: Mahant Aakash Mahant , Estrada Fatima , Aguilan Jennifer , Sidoli Simone , Herold Betsy , Herold Betsy
Published: December 2022

Background

Primary versus recurrent herpes simplex virus 1 or 2 (HSV-1 or HSV-2) infection during pregnancy carries a higher risk of neonatal herpes. Murine and clinical studies demonstrate that antibody dependent cellular cytotoxicity (ADCC) provides greater protection against disseminated neonatal disease. To quantify relative transfer of HSV specific Abs with different functions and targets and whether SARS-CoV-2 coinfection modified transfer, we conducted a prospective cohort study of mother-infant dyads prior to and during COVID-19.

Methods

Total and HSV lysate, glycoprotein D (gD) and glycoprotein B (gB)-specific IgG, IgG1 and IgG3, nAbs and ADCC were quantified in paired 3rd trimester maternal and cord blood. IgG1 and IgG3 subclass and gD or gB-specific Abs were isolated by column purification and glycan profiles were assessed using mass spectrometry. The pre-COVID study population included 21 term and 15 preterm dyads who were HSV seropositive and the pri-COVID cohort included 25 HSV seropositive term dyads whose mothers were also SARS-CoV-2 PCR and COVID Ab positive at delivery.

Results

HSV-specific Ab and neutralizing Ab transfer ratio (TR) were higher in term compared to preterm pre-COVID dyads (all p< 0.05), but the ADCC TR was < 1.0 for both groups. To determine if the low ADCC TR reflected antigenic target, subclass and/or glycans, we enriched for anti-gD and anti-gB specific and IgG1 and IgG3 Abs. The anti-gD Abs were exclusively IgG, had only neutralizing activity and had glycans associated with FcRn binding. In contrast, anti-gB Abs were both IgG1 and IgG3; had both neutralizing and ADCC activity and expressed glycans associated with both FcRn and FcγRIIIa binding. There was no significant difference in HSV-specific IgG TR in pre-COVID vs COVID dyads (0.42) but the nAb TR was lower (p=0.018) and ADCC TR higher (p< 0.001) in COVID compared to pre-COVID patients. Placental immunohistochemistry showed an increased colocalization of FcRn and FcγRIIIA in SARS-CoV-2 positive mothers, which would favor transfer of ADCC Abs.

Conclusion

Defining the determinants of ADCC transfer has implications for future vaccine and monoclonal Ab strategies to prevent/treat neonatal herpes. We speculate that increasing the transfer of ADCC may be a key element in providing immune protection

Disclosures

Betsy Herold, MD, Viracor (Eurofins): Advisor/Consultant|X-Vax, Technologies: Advisor/Consultant|X-Vax, Technologies: Grant/Research Support|X-Vax, Technologies: Serve on Scientific Advisory Board for X-Vax, Technologies and receiving reserach funding for related worl. Betsy Herold, MD, Viracor (Eurofins): Advisor/Consultant|X-Vax, Technologies: Advisor/Consultant|X-Vax, Technologies: Grant/Research Support|X-Vax, Technologies: Serve on Scientific Advisory Board for X-Vax, Technologies and receiving reserach funding for related worl.
2156. Impact of Asymptomatic Upper Respiratory Viral Shedding in Pediatric Cardiothoracic Surgical Patients
Authors: Fischer Laura J , Castera Mark R , Chin Hannah , Lee Junghyae , Simonsen Kari
Published: December 2022

Background

Intraoperative and postoperative complications associated with symptomatic upper respiratory infections in young children are well-documented; however, asymptomatic upper respiratory viral shedding is frequent and may be prolonged. Necessary pediatric cardiac surgical procedures could be delayed with recognition of asymptomatic viral shedding. This study aimed to assess if a positive preoperative respiratory viral panel PCR (+ RVP) impacted postoperative length of stay in the pediatric intensive care unit (PICU) or hospital and assessed for an association among + RVP and adverse clinical events.

Methods

Patients < 3 years old presenting to a freestanding children’s hospital for cardiothoracic surgery from March 2018-March 2020 were enrolled. Within 24 hours before surgery, an RVP via nasopharyngeal swab for PCR was collected from subjects. Chart review was completed after hospital discharge. Mean difference between RVP status and length of stay for PICU and hospital was assessed with an independent, two group, sample t-test. Logistic regression was used to test association between RVP status and adverse clinical events (VAP, SSI, prolonged fever, ventilator use, or antibiotics), adjusted by complexity of surgical procedure using the Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) score.

Results

There were 95 subjects included, approximately 50% female, 75% Caucasian; 39% had + RVP (Table 1). There was no statistical association between RVP status and length of PICU (p=0.35) or hospital stay (p=0.28) (Table 2). Odds ratio for extubation in the operating room was significantly associated with +RVP, though small sample size and wide confidence intervals limit generalizability of this observation (Table 3). There were no clinically significant associations between RVP status and adverse events. Table 1.Subject DemographicsTable 2.Mean Difference in Length of Stay by RVP StatusTable 3.Odds Ratios of Clinical Adverse Events by RVP status

Conclusion

This limited, single-center study suggests that preoperative RVPs in pediatric cardiac surgery candidates identified asymptomatic viral shedding in 39%, though provided no detectable clinical benefit. Larger studies are needed to fully explore specific adverse clinical events and individual viral pathogen impacts. Institutional policies requiring preoperative RVP screening for pediatric cardiac surgery should be discouraged.

Disclosures

Kari Simonsen, MD, MBA, MedImmune: Grant/Research Support|Melinta Therapeutics: Grant/Research Support|Pfizer: Grant/Research Support.
2157. Low Interferon-γ and Interleukin-13 Levels in the Respiratory Tract are Related to Life-threatening Respiratory Syncytial Virus Infection in Previously Healthy Infants.
Authors: Ferolla Fausto M , Toledano Analía , Caratozzolo Ana , Talarico Laura B , Acosta Patricio L , Theiler Graciela , Yfran Eduardo W , Matute Javier , Mascardi Normando , Neira Pablo , Contrini María M , López Eduardo L
Published: December 2022

Background

The mechanisms of interindividual susceptibility to respiratory syncytial virus (RSV) are not clearly understood. Viral load (VL), an exaggerated immune response or T-helper 2 (Th2) bias were postulated as playing a role in the severity of RSV infection. We aimed to analyze VL, cytokine profiles and their association with life-threatening disease (LTD).

Methods

Prospective cohort study including previously healthy full-term infants < 12 months old, hospitalized with a first RSV infection in 2017-2019. Nasopharyngeal aspirates were performed on admission to assess VL (by qRT-PCR) and cytokines levels (using a Bioplex panel). Cytokines were grouped according to their functional classification: proinflammatory (TNF-α), regulatory (interleukin [IL]-10), Th1 (interfereron-γ [IFN-γ]), Th2 (IL-4, IL-5, IL-9, IL-13) and Th17 (IL-17a). Patients were defined to have LTD when required admittance to the intensive care units and ventilatory support.

Results

One hundred and nineteen patients were studied, 68 (57%) were male; median age was 3 months. Nineteen (16%) infants developed LTD, with no significant differences in socioeconomic, pregnancy and infant variables compared with other RSV cases. Virus subtypes were not related to LTD (p= 0.77). VL was not associated with LTD (p= 0.51). Patients with LTD had significantly lower levels of IFN-γ (mean 0.08 pg/ml [standard deviation -SD- 0.06] vs. 0.32 pg/ml [SD 0.4]; p= 0.001) and IL-13 (mean 0.03 pg/ml [SD 0.04] vs. 0.05 pg/ml [SD 0.07]; p= 0.02), fig 1. IFN-γ and IL-13 inversely correlated with days of hypoxemia (p< 0.001 and p= 0.002, respectively). VL, IFN-γ and IL-13 did not correlate with duration of symptoms before admission. No relationship was observed between IFN-γ, IL-13 and age, sex or breastfeeding. In 102 (86%) samples, IL-4 was under the limit of quantitation. TNF-α, IL-5, IL-9, IL-10 e IL-17a were not related to LTD.

IFN-γ and interleukin-13 levels according to clinical outcome.

Conclusion

To our knowledge, this is the first study to relate low IL-13 levels to LTD in previously healthy infants. Patients with LTD had 4-fold lower levels of IFN-γ. The severity of RSV infection may be the result of a deficient immune response rather than a higher viral load or an overactive immune response. These findings provide additional evidence for the development of preventive and therapeutic strategies.

Disclosures

All Authors: No reported disclosures.
2158. Monitoring of Varicella specific T-cell mediated immunity in pediatric allogenic hematopoietic stem cell transplant recipients
Authors: Kim Gahee , Lee Sanghoon , Lee Jina
Published: December 2022

Background

Varicella-zoster virus (VZV) infection is known to occur in 13-55% of patients within the first year after hematopoietic stem cell transplant (HSCT). The dynamics of recovery of VZV-specific T cell- mediated immunity (CMI) and its role for prevention and control of VZV reactivation are rarely reported in pediatric allogenic HSCT recipients.

Methods

From April 2019 to February 2020, subjects aged younger than 19 years who underwent allogenic HSCT with at least 1 year of follow up at Asan Medical Center Children`s Hospital were prospectively enrolled. All of them underwent VZV-specific enzyme-linked immune absorbent spot (ELISPOT) assays just before HSCT and then at 1, 3 months following HSCT. Extension study, which measures VZV-specific CMI before and after VZV vaccination at 24 months post-HSCT, is currently underway.

Results

A total of 32 HSCT recipients with a median age of 11years were enrolled. 37.5% underwent haploidentical HSCT and VZV R+ were in 78.1%. Antiviral prophylaxis was applied to all HSCT recipients, of which 65.6% were applied up to 365 days after HSCT. During this study period, only 1 patient (3.1%) experienced herpes zoster at 23 months following HSCT, whose VZV-specific ELISPOT assay showed 0, 1, and 0 spot-forming cells (SFC)/2.0x105 cells before HSCT, 1 and 3 months following HSCT, respectively. The presence of VZV-specific CMI ≥ 1 SFC/ 2.0 × 105 cells was observed in 62.5 % before HSCT, 65.6 % at 1 month, 59.4 % at 3 months, and 70% at 24 months after HSCT, respectively. However, only 18.8 % ,12.5 % and 21.9 % recovered VZV-specific CMI with ≥ 5 SFC/ 2.0 × 105 cells at 1, 3 and 24 months following HSCT. Meanwhile, all the 4 recipients who got the 1st VZV vaccination at 24 months following HSCT showed recovery of VZV-specific CMI with ≥ 5 SFC/ 2.0 × 105 cell. Recovery of VZV-specific CMI after HSCT was not associated with VZV serostatus, chickenpox history, type of HSCT, conditioning regimens, and GVHD.

Conclusion

Only a few pediatric allogenic HSCT recipients recovered VZV-specific CMI with ≥ 5 SFC/ 2.0 × 105 cell up to 2 years following HSCT. In addition, the association between VZV-specific CMI and VZV reactivation could not be analyzed because no one experienced VZV reactivation within 1 year after HSCT. More long-term large-scale multicenter study is mandatory to supplement these parts.

Disclosures

All Authors: No reported disclosures.
2166. Timely Antiviral Therapy for Influenza-Associated Hospitalizations in Pediatric Solid Organ Transplant Recipients in the United States
Authors: Amarin Justin Z , Haddadin Zaid , Spieker Andrew J , Godown Justin , Halasa Natasha B , Dulek Daniel
Published: December 2022

Background

Pediatric solid organ transplant (SOT) recipients are at high risk of complications from influenza and those with documented or suspected influenza should receive antivirals as soon as possible. We aimed to compare outcomes between pediatric SOT recipients who did or did not receive timely antiviral therapy for an influenza-associated hospitalization (IAH).

Methods

We linked the Pediatric Health Information System (PHIS) and Scientific Registry of Transplant Recipients (SRTR) databases and queried the merged database for single SOT recipients < 18 years old who were transplanted between 1/1/2006 and 6/1/2016 and had at least one IAH within 3 years. We excluded children who contracted influenza or died during the transplant encounter and those who did not have follow-up data. We defined “timely” antiviral therapy as the receipt of antivirals no more than 2 days after hospitalization and compared the outcomes of children who did or did not receive timely antiviral therapy using Pearson’s χ2 test or the two-sample t-test with unequal variances, as appropriate.

Results

Of 12,419 children, 379 (3.1%) had at least one IAH. The most common organ transplant was kidney (n=133 [35.1%]). Of 270 children (71.2%) who received antivirals, 225 (83.3%) received them within 2 days of hospitalization. Oseltamivir was the most frequently administered influenza-specific antiviral (n=268 [99.3%]). The outcomes of children who received timely antiviral therapy and those who did not are compared in Table 1. The proportion of children who received timely antiviral therapy increased over the study period from 33.3% in 2007 to 100% in 2019 (Figure 1). Table 1Outcomes of pediatric SOT recipients who did or did not receive timely antiviral therapy.Figure 1Proportions of pediatric SOT recipients who did or did not receive timely antiviral therapy.

Conclusion

Timely influenza-specific antiviral therapy was associated with better outcomes in pediatric SOT recipients with IAH. Importantly, more than one-third of children did not receive timely antiviral therapy. Further studies are needed to identify and address barriers to timely antiviral therapy.

Disclosures

Natasha B. Halasa, MD, Quidel: Grant/Research Support|Quidel: equipment donation|Sanofi: Grant/Research Support|Sanofi: HAI testing and vaccine donation Daniel Dulek, MD, Eurofins/Viracor: Grant/Research Support.
2177. Institutional Prevalence of Drug-Resistant Pathogens in Community-Acquired Pneumonia
Authors: Ding Helen , Loomis Jordan , Ortwine Jessica , Mang Norman S , Wei Wenjing , Prokesch Bonnie C , Shah Nainesh , O'Connell Ellen
Published: December 2022

Background

Community-acquired pneumonia (CAP) is a leading cause of hospitalizations and plays a major role in mortality. The previous Infectious Diseases Society of America (IDSA) definition of healthcare-associated pneumonia (HCAP) was found to be neither sensitive nor specific for identifying drug-resistant pathogens including methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PsA) as a cause of CAP, and use is no longer supported by current guidelines. The 2019 IDSA guidelines for CAP management emphasizes the need for clinician understanding of local epidemiology data to guide selection of appropriate treatment. The primary objective of this study was to determine the prevalence of MRSA and PsA CAP at our institution.

Methods

This was a retrospective observational study of patients admitted to our 870-bed public hospital with a CAP or HCAP diagnosis within 48 hours of admission between March 2016 and March 2021. The primary outcome of prevalence of CAP caused by MRSA or PsA was determined by comparing the number of blood and adequate sputum cultures with MRSA or PsA to total reviewed cases. Secondary outcomes included the percentage of initial antibiotic regimens involving a broad-spectrum agent, percentage of initial broad-spectrum regimens de-escalated within 72 hours if indicated, and duration of CAP antibiotic treatment.

Results

A total of 220 patients were included. MRSA or PsA was isolated in 1.36% of adequate sputum cultures collected (n=3/35) and in no collected blood cultures (n=0/208). The local prevalence of CAP caused by MRSA or PsA among the analyzed sample was 1.36% (n=3/220) (Table 1). MRSA nares screening tests were completed in 10% of cases, 4.5% of which were positive (n=1/22). Secondary end point results are presented in Table 2.Table 1.Prevalence of MRSA and PsA in CAP Based on Culture DataTable 2.Secondary Outcome Data

Conclusion

The overall prevalence of CAP caused by MRSA or PsA among admitted patients is low at Parkland Hospital. Further research is needed to identify local risk factors associated with CAP caused by drug-resistant pathogens.

Disclosures

All Authors: No reported disclosures.
2181. Outcomes of Patients with Community Acquired Pneumonia Using the Pneumonia Severity Index Versus the CURB-65 as Severity Assessment Tool in Routine Practice of Emergency Departments
Authors: Kaal Anna G , de Hoek Linde op , Hochheimer Davinia T , Brouwers Corline , Joost Wiersinga W , Snijders Dominic , Rensing Katrijn , van Dijk Christel E , Steyerberg Ewout W , van Nieuwkoop Cees
Published: December 2022

Background

The Pneumonia Severity Index (PSI) and the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB-65) score can assess the severity in patients with community acquired pneumonia (CAP). We compared the clinical performance of both prognostic scores according to clinical outcome and admission rates.

Methods

A nationwide observational cohort study was conducted using claims data from adult patients presenting to the emergency department (ED) with CAP in 2018 and 2019. Dutch hospitals were divided into three categories: ‘CURB-65 hospitals’ (n=25), ‘PSI hospitals’ (n=19) and hospitals using both (‘no-consensus hospitals’, n=15). Main outcomes were number of hospital admissions, intensive care unit (ICU) admissions, length of hospital stay, and all-cause 30-day mortality. Multilevel logistic and Poisson regression analysis were used to adjust for potential confounders, including age, gender, comorbidities, medical specialism, and type of hospital.

Results

Of the 51.241 included patients with CAP at the ED, 21.233 were treated in CURB-65 hospitals, 17.389 in PSI hospitals and 12.619 in no-consensus hospitals. The 30-day mortality rate was 8·6% in CURB-65 hospitals versus 9·7% in PSI hospitals. Adjusted odds ratios (aORs) for 30-day mortality were lower in CURB-65 hospitals than in PSI hospitals (aOR 0·88, 95% confidence interval (CI): 0·82-0·95, p = 0·002). The admission rates in CURB-65 and PSI hospitals were similar (77·2% and 79·9%, aOR 0·81, 95% CI:

0·64-1·02). No-consensus hospitals had slightly higher admission rates on average compared to the CURB-65 and PSI hospitals combined (78·4% and 81·5%, aOR 0·79, 95% CI: 0·62-1·0).

Conclusion

The routine use of CURB-65 for risk assessment in CAP patients presenting to the ED in the Netherlands is associated with lower 30-day mortality. After further confirmation, the CURB-65 may be recommended over the use of the PSI.

Disclosures

W. Joost Wiersinga, PhD, AstraZeneca: Honoraria|GSK (DSMB): Honoraria|Pfizer: Honoraria|Sobi: Honoraria.
2185. Pulmonary Non-Tuberculosis Mycobacteria (NTM) Infections in Adult Patients at a Tertiary Care Hospital in Saudi Arabia
Authors: AlMahasnah Reem , AlMohaizeie Abdullah , AlRajhi Abdulrahman , AlMaghrabi Reem , AlThawadi Sahar , AlFattani Areej
Published: December 2022

Background

Burden of Non-tuberculous Mycobacteria (NTM) disease is increasing in both developed and developing countries. Local data is needed to guide our understanding of the epidemiology and outcome of NTM management in our population. The main objectives of the study are to describe management of patients with NTM infection and determine treatment outcomes in adult patients. Also, to explore the epidemiology of mycobacterial species associated with pulmonary NTM.

Methods

A 10-year (2010-2020), retrospective cohort study was conducted at a tertiary care hospital in Saudi Arabia. All patients with positive NTM culture were screened. Adult patients (≥ 18 years old) diagnosed with pulmonary NTM disease and received treatment for ≥ two months were included. Clinical data was collected from the patient’s chart using standardised form. The primary end points were overall cure rate (clinical, microbiological, and radiological cure), recurrence, relapse, and re-infection rate. The secondary end points were mortality and hospital admission rate for NTM infection. The Chi-square test was used to compare parameters. Univariate then multivariable logistic regression were used to model the effect of the outcome.

Screening of patients with positive Non-tuberculous Mycobacteria culture for eligibility

Results

Forty-five patients met the study inclusion criteria. 60% were male with a median age of 53. The most common comorbidities were malignancy and bronchiectasis. NTM species were Mycobacterium simiae (35%), Mycobacterium avium Complex (27%), and Mycobacterium abscessus (18%). Overall cure rate was 95%, with 85%, 85% and 74% of microbiological, clinical, and radiological rate achieved, respectively. Greater number of patients were treated before the recent pulmonary NTM guideline. Regimens were based on general treatment for NTM infection with clarithromycin, ethambutol, and rifampicin utilized the most. 69% of regimens were adjusted after speciation. The median duration of treatment was 36 weeks. Relapse, recurrence and reinfection rate was 20%, 9%, and 2%, respectively. NTM related hospital admission rate was 34%.

Baseline characteristics of Patients with Pulmonary Non-tuberculous Mycobacteria (n=45)

Primary and secondary outcomes

Clinical Presentation, diagnosis and treatment of Patients with pulmonary Non-tuberculous Mycobacteria (n=45)

This table is showing the clinical course of all patients included in the study with subgroup analysis per each specie of Non-tuberculous Mycobacteria

Conclusion

Pulmonary NTM disease in our patients was mainly due to three species in 80%. High overall cure rate and low recurrence rate were achieved. The findings of this study will serve as a guide for the management of pulmonary NTM disease in Saudi population.

Disclosures

All Authors: No reported disclosures.
2215. Pre-pregnancy STI Counseling and HIV Testing Among Married Women: PRAMS 2016-2019
Authors: Jang Eun Ji , Gjelsvik Annie , Amanullah Siraj
Published: December 2022

Background

Chlamydia, gonorrhea, and syphilis are one of the most reported and curable sexually transmitted infections (STIs) in the US, but rates continue to rise. STI during pregnancy can lead to perinatal infections. The best time to address this is at pre-conception. This study aims to examine health care visit practices among women before pregnancy and compare pre-pregnancy STI counseling and HIV testing rates among married women.

Methods

We utilized the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016-2019, a population-based survey of postpartum women. Mothers self-reported if any health care worker talked to them about STIs or tested for HIV during any health care visit in the 12 months before pregnancy. Marital status was obtained from birth certificate records. Multivariable logistic regression analysis was performed adjusting for age, race, Hispanic ethnicity, education, insurance, income, and previous live birth.

Results

Of the the162,558 surveyed women, only 66.1% had any health care visit within 12 months pre-pregnancy (Figure1). Among those with a health care visit and STI screening response (n=104,256), approximately 70% of women reported never receiving pre-pregnancy STI counseling or HIV testing. Puerto Rico and D.C. had the highest pre-pregnancy screening rates while Utah had the lowest (Figure 2). Married women were less likely to receive pre-pregnancy STI counseling (OR 0.6: 95% CI 0.56, 0.64) or HIV testing (OR 0.65: 95% CI 0.61, 0.69) compared to unmarried women (Figure 3). Other risk factors for missing pre-pregnancy STI screening were older age, having more education, private insurance, higher income, and previous live birth. Black and Hispanic women were 2-3 times more likely to receive STI screening compared to White women. Figure 1:Any health care visit and visit type within 12 months before pregnancy (n=162,558)Figure 2:Pre-pregnancy STI counseling and HIV testing across 43 states, DC, NYC, and PR (n=104,256)Figure 3:Adjusted odds of receiving pre-pregnancy STI counseling and HIV testing among recent mothers, PRAMS 2016-2019 (n=104,256)

Conclusion

Married women were less likely to receive pre-pregnancy STI counseling and HIV testing. Our study highlights the lack of preconception care among women who recently gave birth. Marital status, demographics, and socioeconomic factors continue to affect a woman’s likelihood of receiving STI screening. Risk-based, selective STI screening creates gaps and missed opportunities to address STIs before pregnancy. Universal screening should be adopted for all women regardless of their preconceived risk or assumptions.

Disclosures

All Authors: No reported disclosures.
2217. Sexually Transmitted Infection (STI) Therapy Compliance Pre and Post Centers for Disease Control and Prevention (CDC) STI Treatment Guideline Update
Authors: Sunagawa Shawnalyn , Baack Krysta , Gomez Leigh , Nichols Heather , Lewis Terese , Zeger Wesley
Published: December 2022

Background

In December 2020, an update to the CDC STI Guidelines was published for the treatment of uncomplicated Neisseria gonorrhoeae (GC) and the common co-infection of Chlamydia trachomatis (CT). These prescribing changes reflect goals of antimicrobial stewardship and antimicrobial susceptibility. Previous studies assessed guideline prescribing adherence; however, there is no current literature to assess the impact of these updates. The results will be used to further evaluate the impact of the 2021 CDC STI Treatment Guidelines on prescribing patterns in the Emergency Department (ED).

Methods

This study was a single-center, retrospective cohort study which included patients treated for an STI (GC/CT) in the ED at an academic medical center between February 1, 2020 and August 31, 2021, > 19 years of age, and discharged from the ED. The primary endpoint is to determine if the updated guidelines contributed to a reduced incidence of appropriate guideline directed therapy for ED treatment of STIs. Secondary endpoints include ED patients still in need of STI treatment 30-days post-ED discharge, ED patients lost to follow-up within 30 days post-ED discharge and repeat ED visit for STI within 30 days.

Results

A total of 1049 patient encounters were screened for inclusion with 338 patient encounters in the Pre-CDC update cohort (PRE) and 346 patient encounters in the Post-CDC update cohort (POST). Results for the primary outcome indicate a statistically significantly reduced incidence of appropriate guideline directed therapy for ED treatment of STIs (PRE = 98.2% vs POST = 62.7%, p< 0.0001). Results for the secondary outcomes were not statistically significant.

Conclusion

The update to the CDC STI Treatment Guidelines led to decreased guideline directed therapy prescribing in an academic medical center ED. There was no difference in ED patients still needing treatment, lost to follow-up, or repeat ED visits for STI within 30 days post ED discharge.

Disclosures

All Authors: No reported disclosures.
2231. Assessing Clinical Cure of Empiric Piperacillin-Tazobactam for ESBL Urinary Tract Infections (ACCEPT-UTI)
Authors: Stefanos Sylvia , Gant Jessie , Kermeen Sydney , Sakaan Sami , Samarin Michael , Gelfand Michael S , Cleveland Kerry O , Hobbs Athena L V
Published: December 2022

Background

While literature supports use of carbapenems over piperacillin-tazobactam (TZP) for extended spectrum beta-lactamase (ESBL) bacteremia, data is limited regarding the use of TZP for ESBL urinary tract infections (UTIs). The objective of this study is to determine if patients have similar clinical outcomes when empirically treated with TZP versus carbapenems for ESBL UTIs.

Methods

This IRB-approved, retrospective, non-inferiority study evaluated adult patients admitted to a 5-facility healthcare system from January 1, 2016 to June 30, 2021. Patients who received a carbapenem or TZP empirically for at least 48 hours with a urine culture positive for an ESBL, urinary symptoms or leukocytosis, and isolate susceptibility to the empiric antibiotic of choice were included. The primary outcome was clinical success within 48 hours defined as resolution of temperature (36-38 °C), resolution of symptoms or leukocytosis (WBC < 12 x103/μL) in the absence of symptoms, and the absence of readmission for an ESBL UTI within 6 months. Secondary outcomes included time to clinical success, hospital length of stay (LOS), and 30-day all-cause mortality.

Results

A total of 223 patients were included with 123 (55%) patients receiving TZP and 100 (45%) patients receiving a carbapenem. Patients were predominantly female (65%) and Caucasian (52%) with a median (IQR) age of 70 (58, 81) years. Baseline characteristics were similar between the groups with no difference in complicated cystitis (60%), pyelonephritis (27%), or concomitant bacteremia (25%) (Table 1). There was no difference in the primary outcome of clinical success between the carbapenem and TZP group (60% vs 59%, respectively; p=0.92). Additionally, there was no difference in median (IQR) time to clinical success [39 (21, 52) vs 40 (25, 57) hrs, p=0.53], median hospital LOS [7.0 (5.1, 10.6) vs 6.8 (4.7, 9.2) days, p=0.12], or 30-day all-cause mortality (4% vs 2%, p=0.72) between the carbapenem and TZP groups, respectively (Table 2).

Conclusion

In this large, multi-center study, we found no difference in clinical outcomes in patients with UTIs caused by ESBL-producing organisms treated empirically with TZP versus carbapenems. Clinicians could consider using TZP in patients with ESBL UTIs susceptible to TZP.

Disclosures

Michael S. Gelfand, MD, AbbVie: Expert Testimony|La Jolla: Expert Testimony Kerry O. Cleveland, MD, AbbVie: Honoraria|Cumberland: Honoraria|Merck: Honoraria|Pfizer: Honoraria.