bluuebunny/crossref_metadata_2025 huggingface dataset:
1914. Characteristics of Hospital Onset SARS Cov-2 Infections Before and After the Emergence of The Highly Transmissible Variant B.1.1.529 In a Comprehensive Cancer Center
Authors: Dib Rita Wilson , Spallone Amy , Khawaja Fareed , Bartek Jalen , Cantu Sherry , Dvorak Tanya , Feldman Adina , McMurry Hilary , Nahavandi Leila , Nguyen Kim , Odom Crystal , Hankins Amy , Gravis Linda , Chemaly Roy F
Published: December 2022

Background

SARS-CoV-2 B.1.1.529 (Omicron) variant was first identified in November 2021 in South Africa and was notable for its increased transmissibility and rapid spread worldwide. In the United States, this variant led to a surge in COVID-19 cases by December 2021. As a result, we experienced a steep rise in cases among patients and employees at our institution starting December 22nd, 2021. Therefore, we compared the incidence and characteristics of hospital-onset COVID-19 (HO-COVID-19) in our cancer patients prior to and during the surge of the Omicron variant.

Methods

We identified HO-COVID-19, as per the CDC definition, from our infection control surveillance database, and additional contact tracing information was reviewed to determine the possible sources of HO-COVID-19. Whole-genome sequencing studies were conducted randomly on nasopharyngeal swabs of patients and employees who had COVID-19 during the study period.

Results

Twenty-six HO-COVID-19 infections were identified from the beginning of the pandemic (February 2020) through February 2022 (Table 1). Only 17 cases occurred over 22 months from the beginning of the pandemic through early December 2021 (Figure 1). These HO-COVID-19 occurred during the 3 COVID-19 surges that were epidemiologically attributed to the variants seen prior to Omicron. Among these 17 patients, 12 (70%) were symptomatic, 9 (53%) had a link to an infected employee, 7 (41%) died during their hospitalization (3 of the deaths were attributable to COVID-19), and 10 (59%) recovered and were discharged. Over 6 weeks (from December 22nd, 2021, through February 1st, 2022), 9 HO-COVID-19 were discovered during the Omicron variant surge (Figure 1). Six (67%) of these patients were symptomatic, 8 (89%) had a link to an infected employee, 2 (22%) died (1 death was attributed to COVID-19 ), and 7 (78%) recovered and were discharged. Table 1.Characteristics and demographics of patients with hospital-onset COVID-19.Abbreviation: PCR, polymerase chain reaction; HOCI, hospital-onset COVID-19 infections.Figure 1.Bar chart of nosocomial COVID-19 cases graphed against line graphs of COVID-19 infections diagnosed weekly among patient and employee at MD Anderson Cancer Center between March 2020 through February 2022

Conclusion

The Omicron variant surge led to marked increases in HO-COVID-19 despite the continuous adoption of enhanced infection control practices, testing on admission, and daily symptoms screening of patients and employees.

Disclosures

Roy F. Chemaly, MD/MPH, Karius: Advisor/Consultant|Karius: Grant/Research Support.
1919. Implementation of Hydrogen Peroxide Vapor (HPV) Decontamination of N95 Respirators for Reuse During COVID-19 Pandemic
Authors: Havill Nancy L , Martinello Richard A , Kenney Patrick , Bragg Cherie , Epright Jacqueline , Cintron Margaret , Solla Italo , Israel Scott
Published: December 2022

Background

To ensure an adequate supply of N95 respirators in response to the global shortages caused by the COVID-19 pandemic, we evaluated and implemented hydrogen peroxide vapor (HPV) to reprocess disposable N95 respirators. Previous work performed by our team showed that HPV was effective in eradicating viable viruses from experimentally contaminated N95 respirators and that they retained their breathability and filtering efficiency for 3 cycles of HPV disinfection.

Methods

A multidisciplinary team worked by performing experiments and PDSA cycles to develop the ultimate process. Key processes and stakeholders were identified and engaged in operations decisions.

Results

The respirator reprocessing program was successfully implemented. One of the critical components for its success was the implementation of a Personal Protective Equipment (PPE) liaison program which was developed to create a process and local, unit-level champion for the collection of used N95s and to educate the staff on the program and provide guidance per the hospitals’ PPE policy. A courier system was implemented for the collection, transport and delivery of bulk containers of respirators between facilities. Facility Services designed and constructed a centralized respirator reprocessing center to include a receiving location, a negative pressure decontamination area to sort and stage the respirators on racks, two HPV reprocessing rooms and a clean room to receive the reprocessed N95s and to repackage and label for distribution. Standard operating procedures, staff training and competencies, and logs for documentation were created.

Within 18 weeks (March 13, 2020 through July 2020), nearly 32,000 N95 respirators were reprocessed and packaged for redistribution utilizing the 2 HPV disinfection rooms and 5 full time employees. As built, there was capacity to reprocess 5,000 respirators per day and evaluated by the U. S. Food and Drug Administration (FDA) led to the issue of an Emergency Use Authorization.

Conclusion

This scalable program enabled YNHHS to ensure an adequate supply of respirators for the safety of staff during the COVID-19 pandemic and global shortages of PPE. A multidisciplinary team and leadership commitment to provide resources for space and personnel were critical for program success.

Disclosures

All Authors: No reported disclosures.
1921. Leveraging Bluetooth Low-Energy Technology to Improve Contact Tracing in Healthcare Settings during the COVID-19 Pandemic
Authors: Guillamet M Cristina Vazquez , Rjob Ashraf , Zhang Jingwen , Hamauon Reshad , Dai Ruixuan , Wang Ruiqi , Candell Jeff , Kwon Jennie H , Bailey Thomas , Lu Chenyang , Fraser Victoria J
Published: December 2022

Background

COVID-19 rapidly evolved into a global pandemic. Contact tracing with isolation and quarantine contribute to epidemic control but they are time consuming, costly and may be incomplete. We set out to assess the usability and performance characteristics of Bluetooth Low-Energy (BLE) wireless technology for indoor localization applied to contact tracing in healthcare settings.

Methods

Consented healthcare workers (HCW) from 2 designated COVID-19 wards (one intensive care unit (ICU) and one medical ward) were equipped with coin-sized BLE- emitting beacons. The signal was captured by small embedded computers (anchors) placed at designated locations, time-stamped and transmitted to an edge server via secure Wi-Fi where data were stored and real time contact algorithms were run (Fig.1).

We developed experiments mimicking clinical scenarios and tested indoor localization during observed clinical activity for 6 months. We constructed our algorithms based on room structure (e.g. open spaces vs computer rooms) and activity characteristics (e.g. rounding in a large group vs 2 healthcare workers sitting together). We used 1) radio fingerprint localization where an initial virtual radio map was developed, 2) semantic localization which carries additional information such as proximity to a computer to define indirect transmission via fomites, and 3) clustering contact tracing to identify individuals rounding together. Close contact was defined as per the CDC guidelines. Fig. 1System configuration

Results

Consent rate was 43.3% with 187 HCW enrolled in the study. Consent rate was higher in the ICU and among attendings. All participants were compliant with wearing the beacons for the duration of the study. The performance characteristics for contact tracing using fingerprinting methods were AUROC 0.93, AUPRC 0.96, sensitivity 0.9, specificity 0.77 with F1 score of 0.89 and overall accuracy of 0.85. The clustering contact tracing registered a sensitivity of 0.86, specificity 0.89, F1 score 0.91 and accuracy 0.87. Computation time necessary to generate a list of close contacts as per specified criteria was less than 30 minutes.

Conclusion

We have developed and tested a reliable and accurate, low-cost and easily deployable system based on BLE technology to improve contact tracing among healthcare workers.

Disclosures

M Cristina Vazquez Guillamet, MD, AUPH: Stocks/Bonds|BNGO: Stocks/Bonds|OCGN: Stocks/Bonds|SESN: Stocks/Bonds.
2348. Distinct cerebrospinal fluid immune proteins mark neurosyphilis
Authors: Catalano Allison A , Yoon Jennifer , Farhadian Shelli F , Fertuzinhos Sofia , Gisslen Magnus , Zetterberg Henrik , Marra Christina M , Walsh Hannah L
Published: December 2022

Background

Neurosyphilis (NS) is increasing in prevalence in the U.S. but remains challenging to diagnose, particularly in asymptomatic cases. Uncovering central nervous system (CNS) specific immune pathways may shed light on disease pathogenesis and potential biomarkers.

Methods

Paired cerebrospinal fluid and blood were collected from participants with syphilis without neurological symptoms from 2013–2019. Participants were categorized as NS if CSF VDRL was positive and matched by RPR and date of enrollment to participants without neurosyphilis (non-NS), defined by VDRL negative and CSF WBC < 5/uL. Paired CSF and plasma were run on a 71-plex chemokine/cytokine array, high-sensitivity (SIMOA) ELISA for markers of neuronal and astrocyte injury, and ELISA for neopterin, a marker of intrathecal macrophage/microglial activation. Comparisons between NS and non-NS were made using T-tests and Wilcoxon rank-sum tests, with p-values adjusted (FDR) for multiple comparisons.

Results

24 participants were enrolled with characteristics as in Table 1. HIV status, age, race/ethnicity, and plasma RPR values did not significantly differ by group. Six cytokines were significantly (p< 0.05, FDR < 0.10) different in the CSF in NS compared to non-NS, including MIG/CXCL9, IP-10/CXCL10, macrophage-derive-chemokine (MDC), IL-8/CXCL8 and BCA-1/CXCL13, which was previously recognized as elevated in NS (Figure 1B). Neopterin, but no neuronal or astrocyte markers, was elevated in the CSF of NS versus non-NS (p < 0.001) (Figure 1A). After adjusting for multiple comparisons, there were no significant differences between markers in plasma of NS vs non-NS. Differences between NS and non-NS groups were not affected by HIV status.

Conclusion

There is a distinct and compartmentalized CNS immune response occurring in individuals with NS, as indicated by elevated markers of CNS inflammation and of key chemoattractants, the CXC family of proteins. Elevation of neopterin, but not neuronal injury markers suggest asymptomatic disease elicits an immune response without incurring neuronal damage. These immune biomarkers can provide insight into neuroinflammatory processes during asymptomatic NS and should be explored as potential CSF biomarkers of NS.

Disclosures

Magnus Gisslen, MD, PhD, Amgen: Honoraria|AstraZeneca: Advisor/Consultant|AstraZeneca: DSMB membership|Biogen: Honoraria|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Honoraria|GlaxoSmithKline/ViiV: Advisor/Consultant|GlaxoSmithKline/ViiV: Honoraria|MSD: Advisor/Consultant|MSD: Honoraria|Novo Nordic: Honoraria|Novocure: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Sanofi: Honoraria.
1927. Use of a SARS-CoV-2 Strand-specific Assay to evaluate for Prolonged Viral Replication among Hospitalized Patients. Tertiary Care Center, California 2020–2022
Authors: Ferguson Jessica , Contreras Anez Gustavo A , Tompkins Lucy S , Shepard John , Rosenthal Ayelet , Subramanian Aruna , Pinsky Benjamin A , Salinas Jorge
Published: December 2022

Background

Determining if a patient with SARS-CoV-2 remains infectious is an infection control challenge in healthcare settings; specially, among critically ill or profoundly immunosuppressed patients. We use an assay that detects minus-strand RNA as a surrogate for actively replicating SARS-CoV-2. We report positive strand-specific assays in relationship to time since admission and describe patients with a detectable strand-specific assay >20 days since admission.

Methods

We use a 2-step rRT-PCR specific to the minus strand of the SARS-CoV-2 envelope gene. The strand-specific assay is used to evaluate for infectivity in asymptomatic patients with a positive admission screening or pre-procedural test or if ongoing replication is suspected (critical illness or profound immunosuppression). We retrieved strand-specific test results for patients hospitalized at Stanford Healthcare during August 2020–March 2022. We describe clinical characteristics for patients with a detectable minus strand-specific test >20 days since admission.

Results

A total of 774 strand-specific tests were collected from 624 hospitalized patients. A total of 523 patients had only one test (84%) and 101 (16%) had ≥2 tests. The test positivity rate varied by time since admission: 19% in tests performed 0–5 days, 28% in 6–10 days, 22% in 11–20 days, and 41% in those >20 days since admission. Among 35 patients tested >20 days since admission, 13 (37%) had ≥1 detectable minus strand-specific test. Most were male (n=8, 62%) and mean age was 59. Of 13 patients with a detectable assay, seven (54%) had prolonged viral replication with persistent symptoms and detectable minus strand assays for >20 days from symptom onset. Of these seven patients, four had a transplant (3 lung, 1 liver), 1 ovarian cancer, 1 CAR-T cell therapy, and 1 ESRD without immunosuppression. The remaining eight patients with a detectable assay >20 days since admission had illness onset while hospitalized.

Conclusion

Among hospitalized patients with SARS-CoV-2 infection, we found a varying positivity rate according to the timing of testing, possibly reflecting different indications for the test. The strand-specific assay may help assess for infectiousness in profoundly immunocompromised patients.

Disclosures

Aruna Subramanian, MD, Gilead Sciences: Grant/Research Support|Regeneron, Inc: Grant/Research Support.
1930. Answering the Call: Inpatient Vaccination for SARS-CoV2 Infection in an Academic Hospital
Authors: Albrecht Benjamin , Green Sarah B , Moran Peter , Corkish Morgan E , Tilton Carrie , Rizzo Ashley , Hurtik Micheal , Ukpabi Chidozie , Vastakis Litsa , Mohammed Othman , McGraw Kristen , Metzger Nicole , Mohorn Phillip L , Francois Christele , Brown Mary , Thompson Terry , Sexton Mary Elizabeth
Published: December 2022

Background

While the available SARS-CoV2 vaccines are up to 94% effective at preventing COVID-19-related death or invasive mechanical ventilation, only 76% of the United States population aged ≥18 years have received a primary series and 49% have received a booster. Vaccine administration has been complicated by changing schedule recommendations, packaging in multi-dose vials, and federal reporting requirements that may have limited the locations offering vaccines. We therefore implemented a pharmacy-based initiative to provide SARS-CoV2 vaccination to patients admitted to an academic health center, in order to encourage vaccination when patients had presented for other care.

Methods

A pharmacy committee developed a protocol for administering the three authorized SARS-CoV2 vaccines to interested inpatients while minimizing vaccine waste, monitoring for safety events, and providing next dose education. Associated training included multidisciplinary education on requirements related to vaccine Emergency Use Authorization (EUA) status. While developing the protocol, the vaccine committee utilized a temporary procedure to administer vaccines once weekly through review by antimicrobial stewardship pharmacists during August 2021. The protocol went live in September 2021 for inpatient and emergency department sites, with subsequent tracking of the number of doses ordered (stratified by vaccine type and dose number) and number administered.

Results

From August 3 2021 to March 25 2022, a total of 389 vaccine orders were placed with 302 doses (78%) administered, including 126 Moderna (48 first, 20 second, 15 third, 42 booster, and 1 undesignated), 165 Pfizer/BioNTech (80 first, 24 second, 41 third, 14 booster, and 6 undesignated), and 11 Janssen COVID-19 vaccine doses. Only 18 vaccine orders were placed on patients in the ED, with 14 (78%) of those doses administered. Of the 87 vaccine orders not administered, 6 were placed but not given, and 81 were placed and then discontinued.

Conclusion

With multidisciplinary collaboration, SARS-CoV2 vaccination can be performed in inpatient and ED settings. However, orders should be monitored for protocol compliance and order discontinuation, as these may increase potential for waste.

Disclosures

All Authors: No reported disclosures.
1936. COVID- 19 Vaccination in an Inner City HIV Clinic
Authors: Nagarakanti Sandhya , Bishburg Eliahu
Published: December 2022

Background

Patients (pts) living with HIV (PLWH) are more likely to be hospitalized and experience increased rates of death from COVID-19. Vaccination has been shown to reduce hospitalization and death. Vaccination rate for general population in the state of New Jersey is 74.9%. We sought to analyze vaccination rates and its effects in an HIV outpatient clinic.

Methods

Retrospective review in an outpatient HIV clinic, study period 12/01/2020 - 12/30/2021. Data was collected on demographics, CD4 count, HIV Viral loads (VL), type and number of vaccines received, incidence and outcome of COVID-19 infection. Student t-test used for comparison.

Results

We included 635 pts, median age 53years (range 33-84), males 316 (49.7%), transgender 3 (0.48%). African American 568(89%), Hispanic 52 (8.1%), Caucasian 12 (1.9%), Asian 3(0.5%). HIV risk factors were heterosexual 451(71%), male having sex with male 122(19.2%), intravenous drug use 8(1.25%). CD4 > 200 cells/mm3 in 587 (92.4%), HIV VL < 200 copies/mL in 562 (88.5%). Two doses COVID vaccine was received by 442 (69.6%) pts. BNT162b2 (Pfizer) in 192 (43.4%), mRNA-1273(Moderna) in 181(40.9%), Ad.26.COV2.S (J & J) in 43(9.7%), unknown in 25 (5.7%). Booster dose in 126 (28.5%). Incomplete immunization in 7(4.4%). Vaccination in men 217/316(68.7%) vs. women 224/316 (70.8%) (p=NS). COVID-19 infection was diagnosed in 67(10.6%); 49(73%) were unvaccinated vs. 18 (27%) vaccinated; 14 received 2 doses and 4 were boosted (p< 0.05); 15 pts were hospitalized for COVID-19, 13/15 (86.7%) unvaccinated vs. 2/15 (13.3%) vaccinated (p< 0.05). CD4 was > 200 cells/mm3 in 46/49(94%) in unvaccinated vs. 16/18 (88.8%) vaccinated pts (p=NS); HIV VL < 200copies/mL in 46/49 (94%) unvaccinated vs.17/18(94%) vaccinated and infected (p=NS). One unvaccinated pt. expired.

Conclusion

In our outpatient HIV clinic, PLWH had vaccine acceptance rates similar to the general population. More unvaccinated became infected and hospitalized than vaccinated pts. There was no difference in CD4 and HIV VL in COVID infected pts who were vaccinated vs. unvaccinated pts.

Disclosures

All Authors: No reported disclosures.
1959. Lower B-Cell Responses Rather Than Circulating Antibody Titres Are Associated With SARS-CoV-2 Infection Post Third Dose COVID-19 Vaccination
Authors: Byrne Joanne , Gu Lili , Negi Riya , Garcia-Leon Alejandro , Alalwan Dana , Gaillard Colette Marie , Saini Gurvin , Leamy Kelly , Reynolds Bearach , O’Gorman Tessa , Kenny Grace , O’Broin Cathal , Feeney Eoin R , Yousif Obada , Cotter Aoife , de Barra Eoghan , Horgan Mary , Landay Alan , Doran Peter , Gautier Virginie , Mallon Patrick
Published: December 2022

Background

Which components of the immune response to SARS-CoV-2 vaccination best protect against subsequent infection remains unclear. We explored SARS-CoV-2 specific antibody and B-cell responses post 3rd dose vaccine and their relationship to subsequent SARS-CoV-2 infection.

Methods

In a multicentre prospective cohort, adult subjects provided samples before and 14 days (d14) post 3rd dose vaccine with Pfizer-BioNTech 162b2. At 18-22 weeks post vaccine, subjects self-reported SARS-CoV-2 infection (confirmed by PCR or antigen test). We used electrochemiluminescence assays to quantify antibodies to SARS-CoV-2 spike subunit 1 (S1), subunit 2 (S2) and receptor-binding domain (RBD) in plasma (reported in WHO IU/mL). In a subset of subjects, we assessed SARS-CoV-2 specific differentiated B-cell (plasma cell) and memory B-cell responses from peripheral blood mononuclear cells. Unstimulated plasma cells, and memory B cells stimulated with R848 and IL2, were seeded on plates coated with RBD or full Spike antigen and antigen-specific responses measured by ELISpot (Mabtech ELISpot, Sweden). We compared between group differences by Wilcoxon signed rank or Mann–Whitney tests. Data are median [IQR] unless specified.

Results

Of 133 subjects (age 43 [32-50], 81.2% female (table 1), 77 subjects in the B-cell subgroup (table 2)), 47 (35.3%) reported SARS-CoV-2 infection post 3rd vaccine. Antibody titres, plasma cell and memory B-cell responses all increased significantly at d14 post 3rd vaccine (Table 1 & 2, all P< 0.001). Although d14 antibody titres did not differ in those with and without subsequent infection (table 1), those reporting subsequent infection had significantly lower d14 RBD-specific plasma cells and a lower proportion of RBD-specific memory B-cells (Figure 1a-b, both P< 0.05). Similar results were observed with full-spike-specific memory B-cell responses (Figure 1d). The differences persisted when the non-infected group was restricted only to those reporting a confirmed close contact (n=26).

Conclusion

Infection following 3rd dose vaccine is associated with lower d14 circulating and memory B cell responses, but not antibody titres, suggesting B-cell responses better predict protection against subsequent SARS-CoV-2 infection.

Disclosures

All Authors: No reported disclosures.
1967. Receipt of Influenza Vaccination as Predictor of COVID-19 Vaccination among United States Veterans
Authors: Oda Gina , Sharma Aditya , Lucero-Obusan Cynthia A , Schirmer Patricia , Holodniy Mark
Published: December 2022

Background

Vaccine hesitancy has been a major barrier during the COVID-19 pandemic. Surveys administered to assess vaccine acceptance have indicated several factors associated with individual’s intention to receive COVID-19 vaccination, including risk perception, concern for side effects, political orientation, male sex, and having received an influenza (flu) vaccine. However, it is unknown whether these factors predict receipt of vaccination. We sought to determine factors that predicted COVID-19 vaccination in the Veterans Health Administration (VHA).

Methods

We extracted COVID-19 vaccine status among Veterans with any VHA outpatient or inpatient visit from 12/01/2020 - 12/01/2021 from the VHA Corporate Data Warehouse. To ensure participants were engaged in ongoing VHA care, deceased individuals, and those with no visits in the prior year were excluded. We estimated association of proportion of years of VHA care in which influenza vaccine was received in the preceding 5 years with COVID-19 vaccination by logistic regression, adjusting for age, sex, and rurality of home address.

Results

We identified 5,700,590 Veterans with outpatient/inpatient visits during the study period, with median age 66 years, of whom 5,131,617 (90%) were male. A total of 3,704,617 (65%) received at least 1 COVID-19 vaccination. Individuals who received influenza vaccination during each year in care had more than 4 times the odds of receiving COVID-19 vaccination than those who never received influenza vaccination. (Table 1). Age groups 50-64 years had twice the odds, and years 65-74 and over 75 had 3 times the odds of receiving COVID-19 vaccination versus those 18-49, while Veterans living in rural and highly rural areas had lower odds of receiving COVID-19 vaccination versus those in urban areas. Table 1.Multiple logistic regression analysis of predictors of COVID-19 vaccination among Veterans cared for in the Veterans Health Administration, December 2020 – December 2021. N=5,700,590

Abbreviations: aOR = Adjusted Odds Ratio, CI = Confidence Interval.

1 Proportion of years in care influenza vaccine received was calculated by dividing the total number of years a Veteran received influenza vaccine by the total number years the Veteran received care for the 5 years prior to the study time period.

2 VHA uses the Rural Urban Commuting Areas (RUCA) system to define rurality (RURAL VETERANS - Office of Rural Health (va.gov)

Conclusion

Influenza vaccination on a regular basis (i.e., annually) was strongly linked to receipt of COVID-19 vaccination, indicating that prior influenza vaccine acceptance predicted COVID-19 vaccination. Public health efforts to reduce vaccine hesitancy (including targeted messaging to younger individuals, and those in rural areas) are important to increase vaccine acceptance in preparation for the next pandemic, as well as to decrease annual disease burden.

Disclosures

All Authors: No reported disclosures.
2353. Distance and Time to Clinic Are Associated with Increased Risk of Detectable HIV-1 Viral Load at a Peripheral Health Center in Rural Western Uganda
Authors: Hendren Cate , Ndizeye Ronnie , Mumbere Nobert , Rubinstein Rebecca J , Baguma Emma , Muhindo Rabbison , Goel Varun , Shook-Sa Bonnie E , Ntaro Moses , Siedner Mark , Mulogo Edgar , Boyce Ross M
Published: December 2022

Background

Antiretroviral therapy (ART) improves the health of people living with HIV (PLHIV) and reduces HIV transmission. While availability and efficacy of ART have improved in sub-Saharan Africa (SSA), access remains a challenge. Travel burden, measured as travel time, distance, and cost, has been posited as a potential barrier to ART. For example, a previous study at a large, urban referral center in Uganda showed GPS-measured distance was associated with clinic absenteeism. However, others suggest that PLHIV are willing to travel farther for HIV care because of stigma or for higher quality care. Less is known about the effect of travel burden in rural settings where transportation infrastructure is sparse, and there are few transportation options. Therefore, the objective of this study funded by the IDSA GERM Program was to explore potential associations between distance- and time-to-clinic in a highland area of rural western Uganda with HIV outcomes including viral suppression.

Methods

We enrolled 129 adult participants receiving care at the Bugoye ART clinic. Using a handheld GPS device, we mapped routes between participants’ home and clinic recording trip distance, time, and mode of transportation. We abstracted clinical outcomes from participant medical records. Modified Poisson regression with robust error variance was used to estimate risk ratios of associations between main exposures (e.g., distance to clinic, time to clinic) and primary outcomes (e.g., detectable viral load, missed an ART dose, and history of opportunistic infection [OI]).

Results

Distance and time to clinic were significantly and positively associated with probability of detectable viral load. In adjusted analyses, for every 10-km increase in distance, participants were almost twice as likely to have detectable viral loads (PR: 1.95 [95% CI 1.12, 3.41]). For every 10 additional minutes spent traveling, risk of viral non-suppression increased by almost 40% (PR=1.39 [95% CI 1.08, 1.78]). Neither distance nor time to clinic was associated with increased risk having missed an ART dose or history of OI.

Conclusion

These results suggest travel burden may adversely affect achievement of 90/90/90 goals, and novel, decentralized ART distribution mechanisms may be required.

Disclosures

All Authors: No reported disclosures.
1984. Implementation of an integrated infectious disease and substance use disorder team for the treatment of severe injection-related infections
Authors: Seo Grace , Hervera Belén , Bartholomew Tyler , Chueng Teresa A , Chueng Teresa A , Suarez Edward , Forrest David , Hernandez Salma , Rodriguez Allan , Tookes Hansel , Doblecki-Lewis Susanne , Serota David P
Published: December 2022

Background

Hospitalizations for severe injection drug use-related infections (SIRIs) are characterized by high costs, frequent patient-directed discharge, and high readmission rates. Beyond the health system impacts, these admissions can be traumatizing to people who inject drugs (PWID), who often receive inadequate treatment for their substance use disorders (SUD). The Jackson SIRI team was developed as an integrated infectious disease/SUD treatment team for patients hospitalized at a public safety-net hospital in Miami, Florida in 2020. In order to facilitate implementation of this team, we conducted a qualitative study of patients and providers to identify barriers and facilitators to the team’s success.

Methods

Participants were patients with history of SIRIs (n=7) at the Jackson Memorial Hospital (JMH) and healthcare providers (HCPs) (n=8) at JMH. Semi-structured qualitative interviews were performed with a guide created using the Consolidated Framework for Implementation Science (CFIR). Interviews were transcribed and double coded by study team members using determinants adapted from the CFIR.

Results

Key barriers to SIRI team success included: 1) complexity of SIRI and SUD care requiring multidisciplinary teams and resources; 2) lack of resources for PWID experiencing homelessness, financial insecurity, and uninsured status; 3) stigma and lack of knowledge around addiction and medications for SUD; and 4) suspected understaffing and underfunding for the team. Facilitators of team success included: 1) holistic, integrated care being more efficient and effective than fragmented care; 2) the team’s advocacy for PWID as a means of institutional culture change; 3) provision of close post-hospital follow-up for an often-abandoned population; 4) non-judgmental, harm reduction-oriented approach; and 5) addressing diverse needs such as housing, insurance, and psychological wellbeing.

Conclusion

Integration of infectious disease and substance use disorder treatment is a promising approach to managing patients with SIRIs; however, success depends on institutional buy-in, holistic care beyond the medical domain, and an ethos rooted in harm reduction.

Disclosures

Susanne Doblecki-Lewis, MD, MSPH, Gilead Sciences: Grant/Research Support.
1985. Infective Endocarditis in Enterococcus faecalis Bloodstream Infection: Prevalence, Risk Factors, and Patient Outcomes
Authors: Engers Drew , Siddiqui Madiha Naqsh , Abunayla Ali , Jagarlamudi Rajasekhar
Published: December 2022

Background

A substantial proportion of gram-positive infective endocarditis (IE) is caused by Enterococcus species, which renders significant mortality risk. Recent European studies have attempted to identify clinical variables beyond Duke’s criteria and develop risk assessment tools. This study aimed to evaluate the prevalence of IE in our patient population with E. faecalis bloodstream infection (BSI), risk factors predictive of IE, and clinical outcomes.

Methods

This retrospective cohort study included adult, hospitalized patients with E. faecalis BSI in 1 tertiary and 3 community Michigan hospitals from January 1, 2018 through December 31, 2020. The primary objective was evaluation of comorbidities, clinical variables, and a previously validated NOVA (N-number of positive blood cultures, O-origin unknown, V-valvular heart disease, A-auscultation of cardiac murmur) scoring system for their association with IE using bivariate analysis and logistic regression. The secondary aim was to describe the mortality and readmissions rates with E. faecalis BSI and IE.

Results

We identified 167 patients with E. faecalis BSI, 65% were female, and the mean age was 71.6 (standard deviation +/- 14.8). Echocardiography was done in 68.2% of patients. There was evidence of IE in 11.9% of cases. The origin of infection was community acquired in 93.4%, an unknown source in 5.4%, and monomicrobial infections in 73.6% of patients.

The comorbidities of valvular heart disease (50% with IE vs. 20.4% without IE, p=0.01) and a cardiac implantable electronic device (CIED) (35% with IE vs. 11.5% without IE, p=0.01) were associated with IE. Community acquired origin, an unknown source of infection, and NOVA scores were not associated with IE status. Patients with a CIED were more likely to have IE, with an odds ratio of 3.45 (95% confidence interval 1.06 to 11.17; p=0.04). The 30- and 60-day mortality rates were 16.7% and 19.7% with E. faecalis BSI. The 30- and 60-day readmission rates were 19.1% and 28.1%. Mortality and readmission rates did not differ among patients based on IE status.

Conclusion

This study revealed a significant IE prevalence of 11.9% in patients with E. faecalis BSI. Of the many previously identified risk factors for IE, patients with valvular heart disease and a CIED had the greatest risk for IE.

Disclosures

All Authors: No reported disclosures.
1991. Q fever endocarditis is on the rise
Authors: Alahmad Mohamad Alhoda Mohamad
Published: December 2022

Background

Q fever is a reportable zoonotic febrile bacterial infection caused by Coxiella burnetii. In patients who are symptomatic, acute manifestations with hepatitis, pneumonia or fever represent the majority. Elderly men and immunocompromised populations usually present with chronic disease, usually infective endocarditis (IE). Herein, we study the inpatient prevalence of Q fever.

Methods

We used Nationwide Readmissions Database (NRD) and included hospitalizations of adults (≥18 years old) with a diagnosis of Q fever between January and November 2016-2019. Survey procedures were applied to accommodate for complex sampling design of NRD. Chi-square and means least-square were used for categorical and continuous variables, respectively. Jonckheere-Terpstra test was used to study the trends over the years. SAS 9.4 was used for data mining and analysis.

Results

A total of 1,289 hospitalizations with a diagnosis of Q fever were included, among which 172 (13%) cases had a concurrent diagnosis of infective endocarditis. The mean age of patients was 58 years, a third were female. Our analysis demonstrated that infective endocarditis was the most common cardiac complication associated with Q fever (96%) followed by pericarditis and myopericarditis (5 and 4% respectively). There is a trend of an increase in cases of inpatient Q fever with or without endocarditis over the years (from 30 and 165 cases in 2016 to 50 and 401 cases in 2019 respectively, p-value 0.04). Although there was no significant increase in mortality or 30-day readmission between patients with or without endocarditis, patients with IE had longer inpatient stays (mean of 19 vs. 11 days, p-value < 0.001) and subsequently higher hospital charges (mean of $242,615 vs. $136,989, p-value < 0.001).

Q fever trend from 2016-2019 (%).

Increase in percentage of inpatient cases of Q fever with and without endocarditis across the years (cases in a year/ all cases in 2016-2019).

Q fever trend from 2016-2019.

Increase in the number of inpatient cases of Q fever with and without endocarditis across the years.

Conclusion

Physicians should be aware of an increasing trend of hospitalized patients with Q fever. Further studies are needed.

Disclosures

All Authors: No reported disclosures.
1993. Serratia is a rare cause for Infective Endocarditis of the Tricuspid Valve
Authors: Talib Samer I , Raoof Nazar , Kovacs Jonathan , Raoof Natalia , Khashan Abdallah , Daliparty Vasudev , Poudel Srijana
Published: December 2022

Background

Serratia marcescens is a Gram-negative motile bacillus that is a facultative anaerobe and non-lactose fermenting. Serratia can be isolated from water, soil, plants, and the intestinal microbiome. Serratia produces a unique Identifying reddish pigment called prodigiosin. Serratia is responsible for only 0.14% of infective endocarditis cases, with a mortality rate of 85%.

Methods

A 37 YO female with a history of Intravenous heroin abuse was admitted with fevers and dyspnea. Vital signs were BP 76/50, HR 140, RR 26, temp 102 F, and SpO2 98% on room air. She was toxic-appearing.

Labs: WBC 26000(4,000 – 11,000 /uL) with 14% bands, Hb 5.6 (12.6 – 17.0 g/dL), PLT 15*10^3(150-372*10^3/uL), creatinine 2.5 (0.50 - 1.60 mg/dL), lactic acid 15.8 (0.5-2.2 mmol/L). We started vancomycin, piperacillin-tazobactam, and norepinephrine for septic shock. A transthoracic echo showed a large mass on the tricuspid valve, and a transesophageal echo depicted it as vegetation. Blood cultures grew Serratia. She underwent excision of anterior and posterior tricuspid valve leaflets with reconstruction and ring annuloplasty. She reported washing her syringes with tab water and reusing them again. Serratia has a predilection for left-side heart valves even in the IVDU population but this patient presented with a tricuspid valve endocarditis.

Results

Serratia is a rare cause for IE in the ICE study; out of 2.761 definite IE cases identified over five years, only forty-nine instances were due to gram-negative bacilli. Of those, only four cases were due to Serratia. The clinical presentation of Serratia includes constitutional symptoms, new-onset murmur, and cutaneous and neurologic manifestations. Serratia produces multiple pathogenic factors allowing Serratia to result in valvular destruction and perivalvular complications, and distant septic emboli metastasis.

Conclusion

Serratia is sensitive to third and fourth-generation cephalosporins, monobactams, carbapenems, fluoroquinolones, and aminoglycosides. Treatment is complex due to the production of AmpC B-lactamase, which hydrolyzes third and fourth-generation cephalosporins. The 2005 IDSA suggested a combination of B-lactam and an aminoglycoside for Serratia endocarditis, and these are not guidelines but merely recommendations.

Disclosures

All Authors: No reported disclosures.
1999. Cefpodoxime for Spontaneous Bacterial Peritonitis Prophylaxis: Incidence of Breakthrough Infection
Authors: Sung Peter , Lee Tiffany , Simonds Lauren
Published: December 2022

Background

Guidelines recommend use of fluoroquinolones and sulfamethoxazole-trimethoprim (SMX-TMP) for spontaneous bacterial peritonitis (SBP) prophylaxis based on data demonstrating a decrease in one-year incidence of SBP. Our institution frequently utilizes cefpodoxime for its favorable safety profile despite the lack of robust clinical experience. We sought to compare rates of breakthrough SBP with the use of cefpodoxime compared to previously reported incidence rates with the use of SMX-TMP and fluoroquinolones.

Methods

This is an IRB-approved, retrospective, single-center cohort analysis. The electronic medical record at the Hospital of the University of Pennsylvania was utilized to identify cirrhotic patients newly started on cefpodoxime for SBP prophylaxis from March 1, 2016, to December 31, 2020. The primary endpoint was the incidence of breakthrough infections within 1 year in patients who received cefpodoxime for primary or secondary SBP prophylaxis. Secondary endpoints included 1-year all-cause mortality and any microbiologic data from suspected or confirmed SBP during the study timeframe. Descriptive statistics were utilized to analyze baseline characteristics and collected data points.

Results

Overall, 90 patients met inclusion criteria within our timeframe. The study population consisted of mostly men (65.6%) with a mean age of 59 years. The majority of patients were taking cefpodoxime for primary prophylaxis (66.7%). A large proportion of the patients also had diabetes (44.4%). Alcohol use (53.3%) was the most common cause of cirrhosis, and the mean MELD score was 20.3. Breakthrough SBP occurred in 4 (4.4%) out of 90 patients within 1 year of cefpodoxime initiation. Of the 19 patients who completed a full year of cefpodoxime, 1 (5.2%) patient experienced breakthrough SBP. Microbiologic data was significant for the growth of Citrobacter spp., Streptococcus spp., Enterococcus spp., and Candida glabrata. One patient experienced culture-negative SBP. All-cause mortality at one year in our study was 41.1%.

Conclusion

Cefpodoxime is a viable option for primary or secondary prophylaxis of SBP based on comparable rates of breakthrough infection. Cefpodoxime does not frequently appear to encourage colonization and infection with resistant gram-negative pathogens.

Disclosures

All Authors: No reported disclosures.
2001. Clinical management changes after positive multiplex gastrointestinal pathogen panel testing for evaluation of diarrhea
Authors: Mackow Natalie A , Eiffert Samantha R , Kinlaw Alan C , Kooken Banks W , Miller Melissa B , Bartelt Luther A , Ciccone Emily J
Published: December 2022

Background

IDSA guidelines for diarrhea include pathogen-specific management. Compared to non-molecular tests, multiplex gastrointestinal pathogen panels (GIPPs) may allow for more timely and cost-effective diagnoses and care. However, this has yet to be definitively demonstrated. Our objective was to determine the impact of positive GIPP results on clinical management, including antimicrobial use.

Methods

We performed a retrospective study of patients with diarrhea and a positive GIPP result (xTAG Gastrointestinal Pathogen Panel, Luminex) at an academic, tertiary-care medical center from January-December 2018. We excluded immunocompromised patients (solid organ or stem cell transplant, HIV with absolute CD4 count < 200 cells/µL, primary immunodeficiency, and immunosuppressive medications including biologics). We collected patient and clinical data via electronic medical record review. Our primary outcome of interest was change in antimicrobial usage.

Results

A total of 2,333 GIPP tests were performed of which 266 (11.4%) were positive. Of 193 patients who met inclusion criteria, 34% were tested in an emergency room, 38% in outpatient clinics, and 29% on inpatient wards. Of these, 55% were men, 65% were white, and the median age was 31 years (interquartile range, IQR 5-56). The median turnaround time from GIPP collection to result was 31 hours (IQR 24-53). The most frequently identified pathogens were norovirus, Salmonella, and Campylobacter (Figure 1). In 43% of patients, results led to one or more management changes including antibiotic discontinuation (8%) and antibiotic initiation (25%). Antibiotics were most often discontinued for norovirus (Figure 1A) and started for Campylobacter (Figure 1B). Other management changes occurred in 13% of patients, including avoidance of further diagnostic testing and isolation precaution change. The median turnaround time did not differ for GIPPs that were (30 hours; IQR 22-50) or were not (32 hours; IQR 25-56) associated with management change.

Conclusion

Positive GIPP results can prompt changes in antimicrobial treatment in non-immunocompromised patients with diarrhea. Future efforts will evaluate the appropriateness of these management changes.

Disclosures

Melissa B. Miller, PhD, Abbott Molecular: Grant/Research Support|Agena Biosciences: Board Member|ArcBio: Grant/Research Support|Cepheid: Board Member|Luminex Molecular Diagnostics: Board Member|QIAGEN: Board Member|QIAGEN: Grant/Research Support|Sherlock Biosciences: Advisor/Consultant|Talis Biomedical: Board Member|Thermo Fisher: Honoraria|Werfen: Board Member.
2007. Multidirectional Transmission of Clostridioides difficile in Families with Young Infants
Authors: Clayton Jason , Golonka Gregory , Maruskin Lynn , Jencson Annette , Hailes Jennifer , Cadnum Jennifer , Donskey Curtis , Toltzis Philip
Published: December 2022

Background

Infants frequently excrete toxigenic C. difficile asymptomatically during their first year of life. Prior studies have demonstrated an association between acquisition of community acquired C. difficile infection in adults and contact with an infant, suggesting the latter is a reservoir of the organism. To probe this possibility further, we aimed to examine how frequently C. difficile is transmitted from infants to otherwise healthy adult caregivers.

Methods

Families presenting to a suburban pediatric clinic for their infants’ 4-month well-child visit were recruited. Consenting parents were instructed to mail soiled diapers every 2 weeks to a research laboratory with experience cultivating C. difficile, until their baby was 8 months old. Parents were requested to concomitantly send soiled toilet paper, or a rectal swab via a moistened wipe, from themselves. Samples were cultured for C. difficile by direct plating on selective media plus using a more sensitive broth enrichment method. For family groups with C. difficile colonization, PCR ribotyping was used to determine the relatedness of selected baby and parent isolates.

Results

To date 17 families have submitted at least 1 set of samples. Follow up has ranged from 2 to 16 weeks (median 8). In 15/17 families, at least 1 sample was positive for C. difficile: in 4/15 only a parent was positive, in 3/15 the baby plus 1 parent were positive, and in 8/15 all family members were positive. There were no families in which only the baby yielded the organism. The index was the mother in 6/15 families, and the baby in 3/15 families; in 6/15 families, the baby plus >/= 1 parent were initially positive simultaneously. Excretion tended to be prolonged in infants (up to 16 weeks) whereas positivity was more transient in the adults. Isolates from 10 families in which the baby and at least 1 adult were positive for C. difficile were subjected to ribotyping; in 8/10 families the baby’s ribotype was concordant with >/= 1 adults’.

Conclusion

C. difficile colonization is common among healthy household members caring for an infant. Longitudinal observation suggests that transmission is multidirectional, with the organism passed from adult to baby and from baby to adult.

Disclosures

All Authors: No reported disclosures.
2011. Use of Biofire®Filmarray gastrointestinal panel on clinical decision making and infection control in a General Pediatric Department.
Authors: Savvidou Parthena , Kourti Maria , Tsiatsiou Olga , Michailidou Elissavet , Zarras Charalambos , Antachopoulos Charalambos , Roilides Emmanuel , Iosifidis Elias
Published: December 2022

Background

The new Biofire® Filmarray Gastrointestinal Panel (BFGI-BioMérieux, France) offers advantage against conventional cultures of gastrointestinal tract specimens with rapid detection and a broader pathogen identification. Aim of this study is to evaluate the use of BFGI and compare detection of pathogens in GI samples with conventional cultures in hospitalized children with gastroenteritis.

Methods

A retrospective study was conducted in a General Tertiary level Pediatric Department from Jan 2020 to Apr 2022. Children were included if an appropriate GI tract specimen was obtained for clinical evaluation and was assessed by BFGI. Results were compared with conventional cultures. Demographic, clinical, laboratory data, treatment and the effect of the BFGI on clinical decision making were analyzed.

Results

Fifty-eight children were included, 27(46%) females, with mean age 5.1 (IQR 9.35). Thirty-one (53%) had an underlying condition, or a prolonged hospital stay. All children had diarrhea, 44% had fever and 25% had vomits. The most common pathogens were Norovirus (8/58), Campylobacter (7/58) and Enteropathogenic Escherichia coli (EPEC, 6/58), followed by Clostridium difficile, Rotavirus and Salmonella spp. Five of the Norovirus cases were detected within a 10-day period, in children that were hospitalized for other reasons, indicating an intrahospital outbreak. In five patients there was a co-infection with 2 or more pathogens. In 35 patients a stool culture (salmonella and shigella) was performed. All cultures were negative. In 20 (57%) patients, culture results were in accordance with a negative BFGI, but in the rest 15 (42%) patients the PCR detected at least one pathogen. Only 17 patients were treated with antimicrobials, because of age < 3 months or the severity of disease/ comorbidities. A macrolide was prescribed in all campylobacter cases (clarithromycin, 57%, azithromycin, 43%).

Conclusion

In this cohort of hospitalized patients with gastroenteritis, BFGI offered a rapid and more precise result, in comparison to cultures. It helped recognize a norovirus outbreak in the department and improve the infection control measures. Finally, it assisted the clinical decision making leading to more rational and targeted antibiotic administration.

Disclosures

All Authors: No reported disclosures.