bluuebunny/crossref_metadata_2025 huggingface dataset:
1980. A Case Series of Serratia Marcescens Endocarditis in Persons Who Inject Drugs
Authors: Cook Julia Christine , Anderson Matthew B , Barnes Erin W
Published: December 2022

Background

Serratia marcescens is a gram-negative bacillus that is widespread in the environment and has been recognized as a rare cause of infective endocarditis (IE), particularly in persons who inject drugs (PWID). The literature consists of a 19 person case series in the 1970s followed by just a handful of case reports and small case series. At AHWFB (Atrium Health Wake Forest Baptist), we have noticed an increasing number of severe infections, including IE, with Serratia marcescens in PWID.

Methods

We conducted a retrospective chart review of all cases of Serratia grown from sterile culture sites in the AHWFB system between 8/1/2016 -10/31/2021. Charts were reviewed to confirm status of injection drug use in the 3 months prior to admission, ≥18 years old, and possible or definite IE by Modified Duke’s criteria.

Results

Twenty two participants were included in the study. The median age was 29.5 years. Eighteen (90%) were white and 16 (73%) were female. Sixteen (73%) had injection of opioids and 3 (14%) had injection of stimulants clearly indicated. Ten (45.5%) had stimulant use documented but the route was not clear. Nineteen (95%) had evidence of active or resolved HCV infection. The median duration of bacteremia was 2 days. Two cases of IE involved the aortic valve, 8 mitral, 3 pulmonic, and 10 tricuspid. Four (18%) of the participants had prosthetic valve IE. Nine (41%) of the participants had a history of previous IE episode. Eighteen participants had evidence of septic emboli: 10 pulmonary, 7 cerebral, and 5 major arterial. In terms of disposition, 4 (18%) patients died, 4 left against medical advice, 12 (54%) remained at a facility for the duration of their antibiotics. One patient was transferred to another facility and one was discharged to complete antibiotic therapy via peripheral IVs in an infusion center. Two patients expired before a final antibiotic regimen could be determined. Ten participants were treated with beta lactam monotherapy, 1 with fluoroquinolone monotherapy, and 9 with dual therapy with a beta lactam and fluoroquinolone.

Conclusion

Serratia marcescens, a rare cause of IE, has been found in a population of PWID in a North Carolina hospital system. More research is necessary to understand why this unusual infection is clustering in this population and the optimal treatment regimen.

Disclosures

All Authors: No reported disclosures.
1987. One-Year Mortality and Reoperation Among Patients with Infective Endocarditis After Transcatheter or Surgical Aortic Valve Replacement
Authors: Papamanoli Aikaterini , Abboud Alan , Muncan Brandon , Parikh Puja B , Skopicki Hal A A , Kalogeropoulos Andreas P
Published: December 2022

Background

Treatment of severe aortic valve stenosis with transcatheter aortic valve implantation (TAVI) was initially developed for older patients at high surgical risk. However, with improving technology and experience, indications for TAVI have expanded to include younger patients and those at moderate surgical risk, leading to increasing use of TAVI as an alternative to surgical aortic valve replacement (SAVR). As a result, post-TAVI infective endocarditis (IE) is increasingly common. Data on post-TAVI IE in comparison to post-SAVR IE outcomes are limited.

Methods

Using data from the TriNetX Research Network, we identified (1) a cohort of patients who underwent TAVI between 1/1/2016 and 12/31/2020 (CPT procedure code 1021150) and developed IE (captured with ICD-10 codes I33, I38, or I39) after the procedure; and (2) a propensity score-matched cohort of patients who underwent SAVR (CPT procedure codes 1006141, excluding any associated transcatheter procedures) and developed IE. Both cohorts were required to have at least 1 week follow-up, i.e., deaths within 7 days of IE were excluded. We matched the cohorts for demographics and clinically relevant background characteristics. We used Kaplan-Meier estimates for 1-year mortality and aortic valve reoperation and Cox proportional hazards models to compare event rates.

Results

We identified 616 patients with post-TAVI IE and 616 matched patients with post-SAVR IE. The baseline characteristics of the cohorts were well balanced, as indicated by standardized mean differences < 0.1, Table 1. The Kaplan-Meier 1-year mortality between 7 days and 1 year (as deaths before 7 days were excluded) was 20.9% in the TAVI cohort (117 events) vs. 13.0% in the SAVR cohort (72 events), HR 1.66 (95%CI 1.24-2.22; P=0.001), Figure 1. Reoperation for the aortic valve by 1 year was uncommon in both groups, with 12 and 10 events in the TAVI and SAVR groups, respectively (2.0% vs. 1.4%; HR 1.49, 95%CI 0.61-3.65; P=0.56).

Baseline Patient Characteristics After Matching

Figure 1

One-year survival post infective endocarditis after transcatheter aortic valve implantation (TAVI IE) or surgical aortic valve replacement (SAVR IE). Deaths within 7 days of infective endocarditis diagnosis were excluded.

Conclusion

In this comparative, propensity-matched cohort study, 1-year mortality after an episode of IE was significantly higher among TAVI recipients vs their SAVR counterparts. Repeat aortic valve procedures were uncommon in both groups. Prospective studies are needed to elucidate the causes of excess mortality among TAVI recipients.

Disclosures

All Authors: No reported disclosures.
2355. Prison as a Driver of Recent Transmissions of Multidrug-Resistant Tuberculosis in Callao, Peru
Authors: Utpatel Christian , Zavaleta Milagros , Rojas-Bolivar Daniel E , Mulhbach Andreas , Picoy Janet , Portugal Walter Jose J , Esteve-Sole Ana , Alsina Laia , Miotto Paolo , Bartholomeu Daniella , Sanchez Jorge , Alarcon Jorge O , Niemann Stefan , Huaman Moises A
Published: December 2022

Background

Peru has one of the highest rates of multidrug-resistant tuberculosis (MDR-TB) in the Latin America region, with Callao being one of the hot spots. We sought to identify resistance patterns and key drivers of recent MDR-TB transmission in Callao, Peru.

Methods

Cross-sectional study including clinical specimens identified as MDR-TB strains in Callao, Peru between April 2017 and December 2019. DNA was extracted for whole genome sequencing and data used for phylogenetic classification, clustering, and resistance causing mutation analyses. Recent transmission was defined based on an isolate-to-isolate distance of ≤5 (D5) single nucleotide polymorphisms (SNPs). We used logistic regression models to analyze the relationship between MDR-TB clustering and epidemiologic factors including age, sex, history of diabetes mellitus, HIV infection, illicit drug use, known TB contact, prior TB disease, and imprisonment.

Results

171 unique MDR-TB strains were included; 93% were assigned to lineage 4 and 7% to lineage 2. The most prevalent sublineage was 4.3.3 LAM (57%), followed by 4.3.4.2 LAM (10%) and 4.1.2.1 Haarlem (9%). In the dominant 4.3.3 LAM sublineage, concomitant resistance was common, including resistance mutations to pyrazinamide (92%), ethambutol (22%), ethionamide (23%), and quinolones (10%); 4 isolates harbored bedaquiline resistance mutations. Seventy-four percent of 4.3.3 LAM isolates were D5-clustered, with 53 (30%) isolates within a single dominant cluster. Male sex (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.5 – 8.9), drug use (OR, 4.9; 95% CI, 1.9 – 12.7), and current or prior history of imprisonment (OR, 12; 95% CI, 3.3 – 43.5) were associated with the dominant D5 cluster in unadjusted analyses. History of imprisonment remained independently associated with the dominant D5 cluster in multivariate analyses (adjusted OR, 8.9; 95% CI, 1.6 – 50.6). History of imprisonment was also independently associated with being part of any D5 clusters in multivariate analyses (adjusted OR, 4.8; 95% CI, 1.2 – 20.3).

Conclusion

History of imprisonment was linked to current MDR-TB transmissions, indicating an important role of prisons in driving the MDR-TB epidemic.

Disclosures

Moises A. Huaman, MD, MSc, Gilead: Grant/Research Support|Insmed: Grant/Research Support.
2008. Real-World Experience of Administration of Bezlotoxumab in an Outpatient Infusion Center Upon Discharge in Recurrent Clostridioides difficile patients
Authors: Bradley Logan , Bland Christopher M , Jones Bruce M
Published: December 2022

Background

Bezlotoxumab is a humanized monoclonal antibody administered as single IV infusion that binds to Clostridioides difficile toxin B. It is currently recommended as a co-intervention in the updated 2021 IDSA guidelines for patients with recurrent C. difficile infection (CDI) in the last 6 months in addition to standard of care (SOC) antibiotics (vancomycin or fidaxomicin) to decrease CDI recurrence. Due to logistical issues and cost restrictions, administration is difficult as part of the inpatient stay. This case series evaluated a novel practice of discharging patients to receive bezlotoxumab immediately upon discharge from our not-for-profit community health system.

Methods

This was a retrospective chart review of all adult patients who received an outpatient infusion of bezlotoxumab after discharge between June 2019 and January 2022 for recurrent CDI. CDI was defined as ≥ 3 loose stools within 24 hours and a positive stool test for toxigenic C. difficile. The primary objectives were to evaluate the safety of bezlotoxumab in the outpatient setting and the rate of recurrent CDI at 12 weeks and 1 year. Recurrent CDI was defined using the same parameters as initial infection.

Results

Ten patients received bezlotoxumab in the outpatient setting after discharge and were included. Of the 10 patients, 2 were immunocompromised, 6 had at least stage 2 chronic kidney disease, and 4 required dialysis. All patients had > 1 previous CDI in the past 6 months, ranging between 1-6 with the average being 2.4. The average time to infusion was 9.8 days after starting SOC antibiotics and 80% of patients received treatment within 24 hours of discharge. No patients reported adverse reactions during treatment. One patient with a previous diagnosis of heart failure was readmitted for a heart failure exacerbation 69 days after receiving bezlotoxumab. Two patients and 4 patients experienced CDI recurrence within 12 weeks and 1 year of infusion, respectively.

Conclusion

Discharging patients to receive bezlotoxumab as an outpatient infusion is a safe and effective way to treat recurrent CDI logistically and may offer a financial advantage to institutions to shift costs to an outpatient payment model. Recurrence rates compared to phase III trials of bezlotoxumab were similar at 12 weeks (20% vs. 16%).

Disclosures

Christopher M. Bland, PharmD, FCCP, FIDSA, BCPS, biomerieux, Inc.: Honoraria|Merck Pharmaceuticals: Advisor/Consultant|Merck Pharmaceuticals: Honoraria Bruce M. Jones, Pharm.D., FIDSA, BCPS, AbbVie: Advisor/Consultant|AbbVie: Honoraria|La Jolla: Honoraria|Melinta: Advisor/Consultant|Paratek: Honoraria|Regeneron: Honoraria.
2014. Central Line - Associated Bloodstream Infections and Their Increase With the COVID-19 Pandemic at Veterans Affairs in San Antonio, Texas
Authors: Chandramohan Divya , Ford Delvina , Beck Erica , Garza Lauren N , Reveles Kelly R , Cadena Jose
Published: December 2022

Background

Coronavirus disease-19 (COVID-19) has been associated with an increase in healthcare-associated infections (HAI). This increase is likely multifactorial (i.e. higher hospitalization rates, COVID-19 and post-COVID-19 complications, lower staffing, delayed care among others). The objective of this study was to determine the association between COVID-19 hospitalization rates and central line- associated blood stream infections (CLABSI).

Methods

We conducted a retrospective study in acute care unit hospitalizations in a Veterans Affairs (VA) hospital in San Antonio, Texas from October 2017 to December 2021. Individuals over 18 years of age admitted with a new diagnosis of COVID-19, determined by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction (PCR) were included in the study. CLABSIs were defined by the National Healthcare Safety Network (NHSN) criteria for laboratory confirmed bloodstream infections. Pearson correlation was used to determine correlation of CLABSI and COVID-19 disease hospitalization rates. CLABSI rates were also compared pre-COVID-19 (Oct 2017-Feb 2020) to COVID-19 (Mar 2020-Dec 2021) periods using the chi-square test.

Results

During the study period, a total of 0.69 CLABSIs per 1,000 central line days occurred in the pre-COVID-19 period compared to 1.98 per 1,000 in the COVID-19 period (p=0.004). There was a significant correlation between CLABSI and ICU COVID-19 hospitalization rates (R=0.459; p=0.001) as well as CLABSI and acute care COVID-19 hospitalization rates (R=0.341; p=0.014). During the COVID-19 period only, there continued to be a significant correlation between CLABSI and COVID-19 ICU hospitalization rates (R=0.426; p=0.048).

Conclusion

CLABSI rates significantly increased during the COVID-19 period compared to the pre-COVID-19 period and CLABSI rates were significantly correlated with COVID-19 ICU and acute care hospitalizations. Accounting for this variable allows us to factor in impact of post-COVID-19 related complications and association with CLABSI rate. We urge for careful implementation of HAI prevention strategies during the pandemic. Awareness of anticipated increase is important in allocating resources essential for prevention of HAIs.

Disclosures

All Authors: No reported disclosures.
2017. Comparison of California Acute Care Hospital Central Line-Associated Bloodstream Infection Incidence by Hospital Location Before and During the COVID-19 Pandemic
Authors: Brenes Lizette , Magro Monise , Mitsunaga Tisha , Epson Erin
Published: December 2022

Background

Central line-associated bloodstream infection (CLABSI) incidence among acute care hospitals (ACH) and in some patient care locations such as critical care (CC) units increased substantially nationwide during the COVID-19 pandemic. We compared California ACH CLABSI incidence by location before and during the pandemic to identify locations with high burden to inform targeted prevention efforts.

Methods

Using California ACH (n=327) CLABSI standardized infection ratio (SIR) data from the National Healthcare Safety Network, we compared incidence during the second halves of 2019 (2019H2) and 2020 (2020H2) to evaluate early pandemic changes, and during 2019 (pre-pandemic) and 2021 (pandemic) periods by hospital type, location type (e.g., CC), and patient care location (e.g., medical CC), excluding rehabilitation units. A mid-P exact test was applied to compare SIRs between study periods.

Results

ACH CLABSI SIR increased statewide from 2019H2 to 2020H2 by 50.8% (0.65 to 0.98) and from 2019 to 2021 by 34.3% (0.67 to 0.90). Community hospitals < 125 beds had the highest SIR and percentage increase in 2021 as well as 2020H2. Of 9 location types and 58 patient care locations, CC units and medical and medical-surgical CC had significantly higher SIR in both comparisons (2020H2 versus 2019H2 and 2021 versus 2019); wards and medical wards in 2020H2 only, and step-down units and adult step-down in 2021 only. Trauma CC SIR was significantly higher only in 2020H2 compared to 2019H2, while surgical CC SIR was significantly higher in 2021 compared to 2019. Respiratory CC had the highest SIR (2.99, 95%CI 2.14-4.08) in 2021, but was not significantly higher when compared to 2019 (1.06, 95%CI 0.21-3.41).

Conclusion

We observed an overall statewide increase in hospital CLABSI incidence, especially in CC locations, during the pandemic. Although the SIR increase relative to pre-pandemic was smaller in 2021 than in 2020H2, with some exceptions, most locations had persistently higher incidence. We will further assess associations between CLABSI incidence and antimicrobial resistance, device insertion dates, and hospital COVID-19 burden. We will use our findings to guide public health support for hospital infection prevention programs to reduce their CLABSI incidence.

Disclosures

All Authors: No reported disclosures.
2027. Popliteal Peripherally Inserted Central Catheter (PICC) Use in Neonates
Authors: Shahoud Fadi , Rathore Mobeen H
Published: December 2022

Background

PICCs are widely used in the neonatal intensive care unit (NICU). PICCs play an essential role in providing IV access to maintain administration of fluids, parenteral nutrition (TPN), and antibiotics to premature neonates. Multiple anatomical sites can be used for PICC placement. Complication rates vary depending on the PICC insertion site. There are few published data on the use of Popliteal PICCs (P-PICC) in neonates.

Methods

We retrospectively reviewed charts of all neonates admitted to a Level III NICU between 1/1/2016 and 12/31/2020 and underwent PICC placement.

Demographic data, number of days with PICC (dwell time), and complications were gathered. Complications included infectious and mechanical. These data were compared between P-PICC and non-Popliteal PICCs (NP-PICC) using Chi-square (C), t-test (T), and Mann-Whitney U test (MW).

Results

A total of 1241 PICCs were inserted in 784 neonates: 126 (10.2%) were P-PICCs and 1115 (89.8%) NP-PICCs.

The average dwell time for P-PICCs was 15.4 days compared to 14.2 days for NP-PICCs (p=0.24).

P-PICCs were more likely to have complications (11.5%) compared to NP-PICCs (8.7%) (p= 0.039.). Infectious complications for P-PICCs (5.5%) compared to NP-PICCs (3.2%) were significantly higher (p=0.048). For mechanical complications there was no significant difference between P-PICCs (11.5%) vs NP- PICCs (8.7%); (p = 0.17).

P-PICCs were more likely to be placed in lower birth weight and lower gestational age neonates compared to NP-PICC group (p< 0.001).

Conclusion

There was a significant increase in overall complication rate in P-PICCs compared to NP-PICCS. This difference was primarily due to a higher number of infectious complications. The increased complication rate may have been driven by the lower gestational age and birth weight of the neonates. Additional data are needed to confirm this finding.

Disclosures

All Authors: No reported disclosures.
2045. IVAC Plus in the Time of COVID-19: An Imperfect Metric?
Authors: Spears Camille , Ford Delvina , Martinez Jose , Reveles Kelly R , Beck Erica , Garza Lauren N , Hoffmann Ann , Hoskins Serene , Cadena Jose
Published: December 2022

Background

Prior to the COVID-19 pandemic, the incidence of infection related ventilator associated complications plus possible ventilator associated pneumonias (IVAC+) was decreasing; however, as the number of COVID-19 hospitalizations increased, so did the number of IVAC+. Our goal was to investigate if there was a relationship between these two occurrences.

Methods

This was a retrospective study at the Audie Murphy VA Hospital (ALMVA) from October 2017 to December 2021. ALMVA is a level 1A facility with 232 beds and an active bone marrow transplant program in San Antonio, Texas. This study included acute care COVID-19 hospitalizations per 10,000 bed days of care and IVAC+ per 1000 ventilator days. Monthly acute and intensive care COVID-19 hospitalization rates were correlated with IVAC+ rates using Pearson correlation for the overall study period and in the subgroup of COVID pandemic months (Mar 2020-December 2021).

Results

During the overall study period, COVID-19 hospitalization rates were significantly associated with IVAC+ rates: acute care correlation 0.86 (p< 0.01) and intensive care correlation 0.33 (p=0.04). During the COVID-19 pandemic months, acute care COVID-19 hospitalizations but not intensive care COVID-19 hospitalizations, were correlated with IVAC+ (correlation 0.90, p< 0.01 and correlation 0.21, p=0.53, respectively). There were 0 IVAC+ before the pandemic months and this rose to 14 during (0 per 1000 ventilator days and 3.05 per 1000 ventilator days, respectively). All but 2 cases of IVAC+ had COVID-19.

COVID-19 Hospitalizations and IVAC Plus, October 2017 to December 2021

A sharp increase in COVID-19 hospitalizations correlated with a rise in patients meeting criteria for IVAC Plus.

Conclusion

The natural history of COVID-19 disease has presented challenges for IVAC+ monitoring. COVID-19 can cause persistent fevers and worsening oxygenation, and antibiotic use is common during periods of clinical deterioration. These factors can fulfill criteria for IVAC+. In this study, each IVAC+ case was traced for safety bundle compliance. These bundles were followed, along with conservative fluid management, low tidal volume ventilation, and sedation breaks. Patients met NHSN criteria for IVAC+ despite these measures and most had COVID-19. Given the common occurrence of IVAC+ in COVID-19 patients, futures studies are needed to define if IVAC+ are preventable in this population and whether IVAC+ surveillance has any value among COVID-19 patients.

Disclosures

All Authors: No reported disclosures.
2054. Trends in Incidence and Epidemiology of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection, 2005–2020
Authors: Biggs Holly M , Jackson Kelly A , Nadle Joelle , Petit Susan , Ray Susan M , Lynfield Ruth , Como-Sabetti Kathryn , Bernu Carmen , Dumyati Ghinwa , Gellert Anita , Tracy Marissa , Schaffner William , See Isaac
Published: December 2022

Background

Methicillin-resistant Staphylococcus aureus (MRSA) is a serious antimicrobial resistance threat; prevention efforts have focused primarily on healthcare-associated MRSA infections. We assessed progress in MRSA bloodstream infection (BSI) prevention during 2005-2020.

Methods

MRSA BSI data were from CDC Emerging Infections Program’s active, population-based surveillance for invasive S. aureus in 17 counties in 6 states (sites). A case was defined as isolation of MRSA from a blood culture in a resident of the catchment area. Cases were considered hospital-onset (HO) if the culture was obtained > 3 days after hospitalization, healthcare-associated community-onset (HACO) if the culture was obtained in an outpatient setting or ≤ 3 days after hospitalization in a patient with ≥ 1 prior major healthcare exposures, or otherwise community-associated (CA). Annual incidence was calculated per 100,000 census population for each epidemiologic classification.

Results

MRSA BSI incidence decreased from 32.2 (per 100,000 population) in 2005 to a nadir of 15.7 in 2016, then increased during 2017-2019 to 17.0 and decreased in 2020 to 16.4. (Figure 1). HACO comprised > 50% of all cases throughout 2005-2020 and mirrored the pattern of overall rates. HO rates decreased from 9.2 to 2.3 during 2005-2013 and fell below CA rates starting in 2012; rates were lowest during 2017-2019 (1.8-2.1) and increased in 2020 to 2.4. CA rates remained 3.0-4.6 throughout the surveillance period; during 2015-2019, rates increased from 3.0 to 4.0, then in 2020 decreased to 3.4. All sites saw decreases in overall MRSA BSI rates by > 50% during 2005-2020, and HACO rates in 2020 were at least 50% of total rates for each site. However, the relative proportion of CA and HO rates during 2020 varied by site (Figure 2), with CA MRSA BSI more than twice as common as HO MRSA BSI in two sites. Figure 1.Incidence rates of methicillin-resistant Staphylococcus aureus bloodstream infection, by epidemiologic classification, in 6 Emerging Infections Program sites, 2005–2020Figure 2.Ratio of incidence (per 100,000 population) of community-associated (CA) to hospital-onset (HO) methicillin-resistant Staphylococcus aureus bloodstream infection, in 6 Emerging Infections Program sites, 2020

Conclusion

MRSA BSI rates fell by more than half during the 15-year surveillance period, reflecting substantial declines in HACO and HO cases; however, the recent plateau suggests a need for additional preventive measures that restore previous progress. Increased focus on CA MRSA BSI prevention may be needed in some areas depending on local epidemiology.

Disclosures

Ghinwa Dumyati, MD, Pfizer: Grant/Research Support William Schaffner, MD, VBI Vaccines: Advisor/Consultant.
2056. Trends in the Rates of Multidrug-resistant Bacteria Commonly Associated with Healthcare in U.S. Acute Care Hospitals, 2019-June 2021
Authors: Kazakova Sophia V , Baggs James , Wolford Hannah , Rose Ashley , Natalie McCarthy , Olubajo Babatunde , Jernigan John A , Reddy Sujan
Published: December 2022

Background

Several studies demonstrated an increase in hospital-onset (HO) infections during the COVID-19 pandemic. We examined trends in the rates of multidrug-resistant (MDR) infections among acute care hospitals in the United States (U.S.) for bacteria commonly associated with healthcare: methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum cephalosporin resistance in Enterobacteriaceae suggestive of extended-spectrum beta-lactamase production (ESBL), vancomycin resistant Enterococcus (VRE), MDR Pseudomonas aeruginosa, carbapenem resistant Enterobacteriaceae (CRE), and carbapenem-resistant Acinetobacter species (CRAB).

Methods

We measured incidence of clinical cultures yielding the bacterial species of interest among hospitalized patients in a dynamic cohort of hospitals submitting data to the Premier Healthcare Database Special COVID-19 Release during 2019-June 2021. Community-onset (CO) cultures were obtained ≤ day 3 of hospitalization; HO were obtained ≥ day 4. We determined monthly hospital-specific rates for each species. We used generalized estimating equations (GEE) multivariable negative binomial regression models adjusting for hospital characteristics to examine trends.

Results

From 2019-June 2021, the overall number of hospitals contributing data was 318. Rates for each pathogen are shown in Figures 1 and 2. All pathogens’ HO rates were significantly higher in 2021 compared with 2019. The rates of ESBL, VRE, and CRE were also significantly higher in 2021 when compared to 2020 (Table 1a). For CO rates, we found that MRSA rates decreased significantly during the study period, while ESBL, VRE, and CRE increased with varying degree of significance (Table 1b). Rates of CO MDR Pseudomonas and CO CRAB did not significantly change.

Conclusion

Our study confirmed that the rates of several MDR infections increased during the COVID-19 pandemic through June 2021, especially HO infections. CO MRSA was the only pathogen with consistent and significant decline. As infections caused by MDR pathogens represent a serious threat to patient safety, further study of factors contributing to the emerging trends may inform prevention strategies during a pandemic.

Disclosures

All Authors: No reported disclosures.
2361. Timing of antiretroviral therapy prior to diagnosis of cryptococcal meningitis
Authors: Chang Bickey , Wele Abduljewad , Atoma Bethlehem , Kagimu Enock , Muzoora Conrad , Musubire Abdu , Boulware David R , Meya David
Published: December 2022

Background

Cryptococcal meningitis (CM) is the most common cause of meningitis in adults in Sub-Saharan Africa (SSA), causing significant morbidity and mortality in people living with HIV. Early initiation of antiretroviral therapy (ART) after cryptococcal diagnosis is associated with increased mortality. With increasing access to ART in SSA, an increasing proportion of CM patients are now presenting on ART, and outcomes remain unclear.

Methods

We performed a retrospective study of 724 participants with positive CSF cryptococcal antigen in four clinical trials performed in Uganda from June 2017 to February 2022. We compared survival outcomes based on ART experience at the time of CM diagnosis. We had implemented structured ART interruption when ART had recently been initiated (< 2weeks).

Results

Sixty-one percent (445/724) of participants were ART-naïve at the time of CM diagnosis. Compared to those receiving ART, those ART-naïve had lower CD4 counts and higher Cryptococcus colony forming units (CFUs)/mL on quantitative CSF culture (p< 0.001). However, the two-week mortality between ART-naïve and ART-experienced groups did not statistically differ (16.6% vs. 16.8%, Hazard Ratio = 0.97 (95%CI, 0.67–1.40) as well as for ten-week mortality (25.4% vs. 26.2%, Hazard Ratio = 0.98 (95%CI, 0.73–1.31)). Further stratification of ART-experienced participants by length of ART experience (< =2 weeks vs. >2 weeks prior to diagnosis) and ART continuation status (ART continued vs. discontinued if ART started < =2 weeks prior to diagnosis) demonstrated no statistically significant difference between the groups for two- or ten-week mortality.

Conclusion

Cryptococcal diagnosis after ART initiation is now increasingly common. In this study, we found no significant mortality differences between ART-naïve and ART-experienced participants at 2 weeks and 10 weeks. Accounting for length of ART experience did not change these short-term mortality outcomes. One potential limitation of our study is different CM treatment regimens were used across clinical trials.

Disclosures

All Authors: No reported disclosures.
2062. Impact of Indeterminate HIV Test Results on Efficacy of Emergency Department Routine HIV Screening
Authors: Aguilera Elizabeth A , Del Bianco Gabriela P , Rodriguez Gilhen , Perez Norma , Heresi Gloria , Murphy James , Prater Samuel J
Published: December 2022

Background

In 2019, 36,801 new HIV cases were reported in the United States. Emergency Department routine HIV testing is crucial to identify new asymptomatic HIV infections. Early diagnosis followed by prompt antiretroviral therapy decreases morbidity and mortality and reduces HIV transmission. The Emergency Department (ED) at Memorial Hermann Hospital (MHH) - Texas Medical Center (TMC) in Houston, Texas, implemented an ED-routine HIV screening program in June 2017. At times, the testing for HIV yields indeterminant results. Consequences of indeterminate HIV tests include individuals unaware of their HIV infection status transmitting infection and not receiving antiretroviral therapy.

Methods

39,288 adults who presented to ED MHH –TMC from June 2017 to March 2022 with a Glasgow score > 9 were tested using an Opt-Out protocol for HIV infection. Testing comprised a screening assay (HIV 4th Generation (GEN) ADVIA Centaur TM Ag/Ab COMBO (Siemens)) followed by a confirmatory test (GenniusTM HIV1/HIV2). A second confirmatory test is performed if screening and first confirmatory tests yield conflicting (indeterminant) results (HIV1 RNA PCR or a repeat 4th GEN test).

Results

824 (2.0 %) patients tested positive for HIV infection; 94 (0.2%) yielded indeterminate test results. 61 (64.8%) of the patients with indeterminate findings received confirmatory testing; 37 (39.4%) before leaving the hospital (35 HIV negative, 2 positive). Of the 57 (60.1%) who left the hospital before confirmatory testing, 24 (42.1%) were traced and tested (21 HIV negative, 3 positive). 33 (35.1%) were lost to follow-up (11 of whom were reported homeless or in unstable housing).

Conclusion

The primary cause of failure to follow up testing on patients who tested indeterminant during an ED visit is a loss of contact with the patients after leaving the ED. In turn, failure to link these patients to HIV care relates to a failure to complete confirmatory testing before completion of the hospital visit. Therefore, the quantitative results presented will enable the assessment of the best deployment of resources in capturing those patients currently lost to follow-up.

Disclosures

Norma Perez, DO, Theratecnologies, Inc: Advisor/Consultant.
2064. Incidence and Risk Factors for Microscopic Hematuria in a US Military HIV Cohort
Authors: Wachs Stephanie , Xu Xiaohe , Daniels Colton , Sunil Thankam , Telu Kalyani , Colombo Rhonda E , Lalani Tahaniyat , Berjohn Catherine M , Ganesan Anuradha , Agan Brian , Okulicz Jason F , Lindholm David A
Published: December 2022

Background

Microscopic hematuria (MH) is a common finding on screening urinalyses in persons living with HIV (PLWH); however, a study in the pre-HAART era revealed that a complete urologic evaluation was generally non-diagnostic in young males with a benign history and normal renal function. Recent studies have shown a decreased incidence of hematuria in PLWH in the HAART era. We performed a nested case-control study in the prospectively enrolled US Military HIV Natural History Study (NHS) to evaluate characteristics of PLWH with and without MH.

Methods

We evaluated male participants diagnosed with HIV and enrolled in the NHS Jan 2007 to Dec 2019. MH cases were defined as having at least one urinalysis with ≥5 RBCs/hpf. We used descriptive statistics to compare cases and controls with respect to demographics, comorbidities, and laboratory findings to determine risk factors for MH. Cox regression models evaluated for independent associations with the development of MH since HIV diagnosis.

Results

Of 829 included participants, 142 (17.1%) had MH, of whom 87 (61.3%) had only one MH event. Cases had a shorter mean duration of study follow-up but more analyzable urinalyses per participant. There were no significant differences between cases and controls in demographics, CD4 count nadir, time from HIV diagnosis to HAART initiation, or inclusion of tenofovir disoproxil fumarate (TDF) in initial regimen. On univariate analysis, more cases had a history of urinary tract infection (UTI) or a hypertension diagnosis through the time of incident MH compared to controls, but were less likely to have proteinuria or pyuria at the time of MH. Cox regression models revealed that a history of UTI increased the hazard for MH (HR 2.07, p < 0.05). In contrast, the presence of proteinuria (HR 0.42, p< 0.01) and TDF use (HR 0.56, p< 0.05) decreased the hazard for MH compared to controls.

Conclusion

A history of UTI, though not concurrent pyuria, was associated with an increased hazard for MH. The use of TDF in the initial HAART regimen and the presence of proteinuria were protective against hematuria. Future studies are needed to clarify these findings; however, they provide reassurance that in a young, otherwise healthy cohort, MH is typically self-limited and unrelated to intrinsic renal pathology, comorbidity, or HIV-related factor.

Disclosures

All Authors: No reported disclosures.
2362. Adoption and Utilization of Social Media among Adult and Pediatric Infectious Diseases Divisions and Fellowship Programs in the United States and Canada
Authors: Ryder Jonathan H , Mowrer Clayton , Van Roy Zachary A , Lyden Elizabeth , Lyden Elizabeth , Lyden Elizabeth , Cawcutt Kelly , Marcelin Jasmine R
Published: December 2022

Background

Social media (SoMe) is used by 72% of US adults. The utility of SoMe for infectious diseases (ID) has been highlighted by the COVID-19 pandemic. Adoption and utilization of SoMe by ID divisions is not well characterized.

Methods

We conducted a systematic search strategy for US and Canadian ID fellowship/division SoMe accounts – specifically Twitter, Facebook (FB), and Instagram (IG) – in November-December 2021. We collected data from program websites, SoMe accounts, and NRMP and FREIDA databases. Primary outcome was ID SoMe account prevalence. Secondary outcomes included measures of SoMe characteristics, adoption, and activity comparing adult and pediatric programs. We reported descriptive statistics.

Results

Of 243 ID programs in the US and Canada, 170 (70%) are adult and 73 (30%) are pediatric with 222 (91.4%) programs in the US. Twitter, FB, and IG accounts were found for 70 (31.5%), 14 (6.3%) and 14 (6.3%) US programs, respectively (Table 1); 2/21 (9.5%) Canadian programs had a SoMe account (Twitter). Twitter accounts were associated with larger programs and higher match rates (Table 2). SoMe activity and engagement before and during IDWeek 2021 is in Table 3. More adult programs had Twitter accounts (37.3% vs 17.2%, p=0.004), but utilization was similar between adult and pediatric programs. Most Twitter posts were educational (1653/2859, 57.8%); FB primarily promotional (68/128, 53.1%); IG mostly social (34/79, 43%). COVID-19 related posts were found in 821/2859 (28.7%) Twitter posts, 33/128 (25.8%) FB posts, and 5/79 (6.3%) Instagram posts. FB was the earliest adopted SoMe platform for ID, but Twitter and IG have more recent growth. The rate of Twitter account creation increased from 0.35 accounts/month prior to March 2020 (COVID pandemic declaration) to 1.95 accounts/month after March 2020. 71.4% (10/14) of IG accounts were created after March 2020.

Conclusion

SoMe remains underutilized across all ID divisions, but COVID-19 and virtual recruiting may have influenced recent account creation (Figure 1). Twitter is the most frequently used ID program SoMe platform in comparison to FB and IG, and use increased during IDWeek. ID divisions should embrace the digital and SoMe space with benefits for recruitment and amplification of their trainees, faculty, and specialty.

Disclosures

Jasmine R. Marcelin, MD, Pfizer/Mayo Clinic Global Bridges: Honoraria.
2080. Differences in Hormonal Measures Among Transgender Individuals Assigned Male at Birth Switching from Tenofovir Disoproxil Fumarate/Emtricitabine to Tenofovir Alafenamide/Emtricitabine for Pre-Exposure Prophylaxis
Authors: Patel Nimish , Blumenthal Jill , Burke Leah , Chow Karen , Pacheco DeeDee , Stanczyk Frank , Morris Sheldon
Published: December 2022

Background

There are concerns among transgender (TG) individuals about the effect of changing pre-exposure prophylaxis (PrEP) products on hormone concentrations. The objective of this study was to compare hormone concentrations among TG individuals assigned male at birth (AMAB) who switched from tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) to tenofovir alafenamide/emtricitabine (TAF/FTC) for PrEP.

Methods

An observational cohort study was performed among a subset of TG individuals AMAB enrolled in a clinical trial evaluating TAF/FTC for PrEP. Inclusion criteria for this study were ≥18 years old, TG identity, HIV negative, use of both TDF/FTC and TAF/FTC for ≥12 weeks, and availability of stored blood samples for hormone measurement while on both medications. Estradiol, testosterone (total and free) and sex hormone binding globulin were quantified at two time points: once while on ≥12 weeks of TDF/FTC and after ≥12 weeks on F/TAF. Median hormone concentrations were compared using related-samples Wilcoxon Signed Rank Test.

Results

Thirty participants met inclusion criteria with mean age of 35.9 ± standard deviation 9.7 years. There were 20 (67%) participants who identified as TG female. The remaining identified as gender non-conforming. Most participants self-identified as either Caucasian (40%), Hispanic or Latino/a/x (33%), Black (13.3%) or Asian (13.3%). Gender affirming therapy was used by 20 (67%) participants. The median (interquartile range, IQR) duration of TDF/FTC use before switching to TAF/FTC was 48 (15 – 60) weeks. Hormone values during TDF/FTC and TAF/FTC by use of gender affirming therapy is displayed in the Figure.

Hormonal Values Before and After Switching PrEP Products, by Use of Gender Affirming Therapy

Conclusion

Switching to TAF-based PrEP was not associated with significant changes in hormone values among TG individuals AMAB.

Disclosures

Nimish Patel, PharmD, PhD, Gilead: Grant/Research Support Jill Blumenthal, MD, Gilead: Grant/Research Support Sheldon Morris, MD, Gilead: Grant/Research Support.
2100. Epidemiology and Risk Factors for Invasive Fungal Infections Among Patients with Hematological Malignancies In Colombia
Authors: Ortiz-Martínez Yeimer , Fajardo-Rivero Javier , Mendoza-Herrera Tania , Figueroa-Pineda Claudia , Ruiz-González Carlos
Published: December 2022

Background

Invasive fungal infection (IFI) is a potentially lethal complication in patients with hematological malignancies (HM). However, studies are scarce in this population, especially in developing countries. The aim of this study was to investigate the prevalence, epidemiology, predictive factors, and outcomes of IFI in patients with HM hospitalized in non-HEPA-filtered rooms (resource-limited settings) in a reference center in Colombia.

Methods

A cross-sectional, retrospective study was conducted on the clinical data of HM patients and pulmonary infection hospitalized in a tertiary university hospital in Bucaramanga, Colombia, between 2015 and 2020. The primary outcome was proven/probable IFI according to the EORTC/MSGERC criteria. A descriptive and group comparison analysis were performed between patients with IFI and patients with non-fungal infections. The main risk factors for the development of IFI were identified by multivariate stepwise logistic regression analysis. Table 1Statistically significant variables in the univariate analysis of patient characteristics compared between patients with invasive fungal infection and patients with non-fungal infection.Image 1Associated factors to develop invasive fungal infections (IFIs) in patients with HM. The graph shows the variables showed statistically significant difference in the multivariate analysis.

Results

In 201 patients, the prevalence of proven/probable IFI was 21.39% (43 cases). The most common IFI was caused by Aspergillus spp. (41.8%), followed by Candida spp. (34.8%), Mucor spp. (6.9%), Penicillium spp. (4.6%) and Cryptococcus neoformans (4.6%). The lung was the most commonly affected site (n=34; 81.3%); four patients (9.3%) developed fungal sinusitis and disseminated IFI, respectively. In-hospital mortality was 86% (37/43). Multivariate logistic regression analysis (area under the ROC curve=0.90) showed that antibiotic use ≥3 weeks (OR, 4.11; 95% CI, 1.26-13.31; p< .001), history of pulmonary infection (OR, 5.75; 95% CI, 1.41-23.39; p< .001) and neutropenia duration ≥21 days (OR, 5.88; 95% CI, 1.26-19.86; p < .001) were independent risk factors for the development of IFI and mould-active prophylaxis (OR: 0.20; 95% CI: 0.060–0.705; p=0.012) was significantly associated with a lower occurrence of IFI.

Conclusion

HM patients in resource-limited settings have a high prevalence of IFI with an elevated mortality. The use of mould-active prophylaxis is associated with a significantly lower occurrence of IFI. Cost-effective strategies for prevention and early diagnosis of IFI are required to improve survival in patients with HM.

Disclosures

All Authors: No reported disclosures.
2112. Incidence and outcomes of infections in liver transplant recipients during the first year post-transplant.
Authors: Alpizar-Rivas Rodolfo M , Palli Rohith , Croix Michael , Prasad Paritosh , Gupta Purba , Chuang Sally
Published: December 2022

Background

Despite the use of antimicrobial prophylaxis in liver transplant recipients (LTR), infection remains the most likely cause of death (18.94%) in the first year. There is limited data describing the characteristics, & infections of LTR while hospitalized in the first year post-transplantation. We aimed to review the incidence and outcomes of infections in LTR in the first year post-transplant during hospitalization or re-hospitalization. Graph 1.Y-axis; Number of cultures collected, X-axis; type of organism dived over time.

Site of bacterial infection Table 1.Number of bacterial infections divided by site/system, involved compared to timing of infection.

Methods

We performed a single-center retrospective cohort study at The University of Rochester. Electronic medical records of 298 first time adult LTR between 03/5/2011 and 04/01/2020 were reviewed. Demographic and comorbidity data was obtained at time of transplant. Microbiologic data and outcomes were obtained during the first year post-transplant. We compared mortality between those with infection and those without using log-rank survival analysis.

Graph 2. Y-Axis; Number of patients with diagnosed viral infection. X-axis virus divided over time.

Results

160 (53.7%) patients suffered at least 1 infection while hospitalized in the first year post-transplant. There were 178 bacterial infections in 130 patients of which 115 were intra-abdominal (table 1). The most common organism was Enterococcus sp. (n=102), 65 were vancomycin resistant (VRE). The most common site of fungal infection was abdominal (n=13) and the most common organism was C. glabrata (n=9). The most common viral infection was CMV at 7-12 months although other viral infections occurred between 1-6 months (graph 2).

In a univariate chi-square model, bacterial infection at any time was associated with all-cause mortality in the first year (CI 1.7-8.9 p-adj= 0.002). Fungal infection between 2-6 months was also associated with increased mortality (CI 2.7-12.2 p-adj= 0.0005).

Conclusion

Bacterial infections are the most common type of infection in LTR and occur more frequently during the first 6 months. Bacterial infection at any point was independently associated with increased mortality in the first year post-transplant. The most common organism was Enterococcus with a high rate of VRE which should be taken into consideration for empiric coverage at our institution. Fungal infection between 2 to 6 months was associated with increased mortality. We observed that early bacterial and fungal infections are markers of poor prognosis.

Disclosures

All Authors: No reported disclosures.
2117. Outcomes and Risk Factors Associated with Development of Pneumonia in Lung Transplant Recipients in the Year After Transplant
Authors: Gallagher Jason C , Roesch Torey , Giurintano Julie , Atwater Abby , Dinh Anya , Groninger Liesel , Hoang Julie , Shif Jennifer , Tanasy Erin , Wagner Jamie , Bandres Maria , Burnell Jacqueline
Published: December 2022

Background

Lung transplant patients (LTPs) experience considerable infection-related morbidity and mortality, including from pneumonia. Our institution performs the highest volume of lung transplants in the US, providing an opportunity to describe the scope and impact of pneumonia in LTPs.

Methods

We conducted a retrospective cohort study of all patients who received a lung transplant at our institution from late 2017 to early 2020. Patient records were reviewed from the pre-transplant period to 1-year after transplant for data pertinent to comorbidities, transplantation characteristics and complications, donor organ cultures, immunosuppression, prophylactic and therapeutic antibiotic regimens, pathogens, and outcomes. Cases of pneumonia were reviewed using standard criteria. The primary outcome was 1-year survival.

Results

320 patients received lung transplants and 121(38%) developed pneumonia. Characteristics are in Table 1.

Pneumonia developed a median of 66 days after transplant (IQR 15-142). Most frequent pathogens ( >10 cases) were P. aeruginosa, S. aureus, and K. pneumoniae. The most common viral cause was RSV (5 cases). Patients with pneumonia had significantly lower 1-year survival rates than those without (100/120, 83.3% vs 186/199, 93.5%; p=0.004). Number of readmissions were higher in patients who had pneumonia (mean 3 ± 2.58 vs 2.04 + 3.18, p< 0.001). Bronchial stents (p< 0.001), past medical history of atrial fibrillation (0.003), and donor lung culture positive for E. coli (0.007) were independent risk factors for the development of pneumonia. Prophylaxis with piperacillin/tazobactam (0.032) prophylaxis with ciprofloxacin (0.008) were protective.

Conclusion

Pneumonia occurred within the first year of transplant in 38% of LTPs and was associated with lower survival.

Disclosures

Jason C. Gallagher, PharmD, Merck: Advisor/Consultant|Merck: Grant/Research Support|Qpex: Advisor/Consultant|Shionogi: Advisor/Consultant|Spero: Advisor/Consultant.