bluuebunny/crossref_metadata_2025 huggingface dataset:
1511. Influenza antiviral use in patients hospitalized with laboratory-confirmed influenza in the United States, FluSurv-NET, 2015 – 2019
Authors: Tenforde Mark W , Cummings Charisse N , Sutton Melissa , Kim Sue , Maslar Amber , Alden Nisha B , Spina Nancy , Price Andrea , Monroe Maya , Rothrock Gretchen , McMahon Melissa , Talbot Helen , Openo Kyle P , McMullen Chelsea L , Billing Laurie M , Garg Shikha
Published: January 2021

Background

Antiviral therapy is recommended for all patients hospitalized with influenza to reduce morbidity and mortality. We used data from the population-based Influenza Hospitalization Surveillance Network (FluSurv-NET) to evaluate trends in influenza antiviral use in patients hospitalized with influenza over 4 seasons in the United States.

Methods

We included cases residing within the FluSurv-NET catchment area and hospitalized with laboratory-confirmed influenza from October 1 – April 30 during 2015-16 through 2018-19 seasons. For 2015-16 and 2016-17, chart abstraction of demographic and clinical characteristics and antiviral use was performed on all cases; for 2017-18 and 2018-19, all patients < 50-years and an age-stratified random sample of older adults were sampled. Data were weighted to reflect the probability of selection. We assessed the frequency of treatment, by season and age group, and evaluated trends by season using the Cochran-Armitage test. Among those receiving antivirals, we used multivariable logistic regression to assess the association between the days from symptom onset to admission and receipt of early (0-2 days from symptom onset) versus late (> 2 days) treatment, adjusting for age, sex, race/ethnicity, and underlying medical conditions.

Results

Over 4 seasons, we sampled 62,182 patients; 54% female and 63% non-Hispanic white. Overall, 92% of patients received antivirals, increasing from 86% in 2015-16 to 94% in 2018-19; use increased by season in all age strata (p < 0.001) [Figure]. Most received oseltamivir (99%); in 2018-19, 2% received baloxavir. Of those who received antivirals, 38% received early treatment. The median days from symptom onset to admission was 1 day (interquartile range [IQR] 1-3) for those who received early treatment and 4 days (IQR 3-6) for those who received late treatment. Ninety-three percent who received antivirals started within 1 day of admission. For each additional day from symptom onset to admission, the adjusted odds of late treatment was 8.56 (95% confidence interval: 7.83-9.35).

Figure. Weighted percentage of hospitalized patients receiving influenza antivirals by influenza season and age strata, FluSurv-NET, 2015-16 through 2018-19.

Conclusion

In patients hospitalized with influenza, most received antiviral treatment within 1 day of admission. However, a majority had delays from symptoms onset to initiation, due to late presentation of illness.

Disclosures

Melissa Sutton, MD, MPH, CDC funding (Emerging Infections Program) (Grant/Research Support) Sue Kim, MPH, Council of State and Territorial Epidemiologists (CSTE) (Grant/Research Support) Nisha B. Alden, MPH, CDC (Grant/Research Support)
1513. Medically Attended Respiratory Syncytial Virus Hospitalizations (RSVH) and All-Cause Bronchiolitis Hospitalizations (BH) Among Children Aged ≤ 24 Months at RSV Season Start With Higher-Risk Congenital Heart Disease (CHD) Before and After the 2014 American Academy of Pediatrics (AAP) Policy
Authors: Fergie Jaime , Gonzales Tara , Suh Mina , Jiang Xiaohui , Fryzek Jon , Howard Ashley , Bloomfield Adam
Published: January 2021

Background

In 2014, the AAP stopped recommending palivizumab for use in children with hemodynamically significant CHD (hs-CHD) aged 12 to 24 months at the RSV season start. This analysis investigates the impact of the 2014 AAP policy on the contemporary burden of RSVH and BH in children with CHD for whom palivizumab immunoprophylaxis is no longer recommended.

Methods

All children with CHD aged ≤ 24 months at the start of the RSV season and hospitalized for RSV or BH during the 2010-2017 RSV seasons (November-March) were studied. RSVH and BH were defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM codes. As there are no ICD codes for hs-CHD, we evaluated the effect of the guidance on higher-risk CHD as defined by ICD codes.1 Frequency and characteristics of RSVH and BH and disease severity (including intensive care unit [ICU] admission and mechincal ventilation) for these children before and after the 2014 AAP guidance using the Children’s Hospital Association’s Pediatric Health Information System® (PHIS) data set were described. SAS version 9.4 was used for statistical analysis of this data, with z-tests method used to determine statistical significance.

Results

RSVH significantly increased after 2014 for all higher-risk CHD children aged ≤ 24 months (3.4% [1992 RSVH CHD/59,217 RSVH] before the 2014 guidance and 4.0% [1798 RSVH CHD/45,470 RSVH] after; P< 0.0001) and for the subgroup of children aged 12 to 24 months at the start of the RSV season (0.5% before the guidance and 0.8% after; P< 0.0001). Disease severity as measured by ICU admissions in the 12 to 24 months subgroup also significantly increased after the 2014 guidance (0.2% before the guidance and 0.3% after; P< 0.0001). Mechanical ventilation usage was not statistically significantly increased after the 2014 guidance (P=0.188). A similar pattern of results was found for BH.

Conclusion

RSVH, BH, and associated disease severity significantly increased among higher-risk CHD children aged 12 to 24 months, within the PHIS health system, after the 3 RSV seasons following the 2014 AAP RSV immunoprophylaxis recommendations.

Disclosures

Jaime Fergie, MD, AstraZeneca (Speaker’s Bureau)Sobi, Inc. (Speaker’s Bureau) Tara Gonzales, MD, Sobi, Inc. (Employee) Mina Suh, MPH, International Health, EpidStrategies (Employee) Xiaohui Jiang, MS, EpidStrategies (Employee) Jon Fryzek, PhD, MPH, EpidStrategies (Employee) Adam Bloomfield, MD, FAAP, Sobi, Inc. (Employee)
1515. Nationwide trends of invasive pneumococcal disease in Spain for the period 2009-2019
Authors: de Miguel Sara , Domenech Miriam , Sempere Julio , González-Camacho Fernando , Yuste Jose
Published: January 2021

Background

Introduction of pneumococcal conjugate vaccines (PCV) is an effective measure to control the invasive pneumococcal disease (IPD) although the emergence of non-vaccine serotypes is of great concern worldwide.

Methods

This study includes national data from IPD cases affecting pediatric and adult population for the period (2009-2019). Data contain 25341 laboratory-confirmed clinical isolates of Streptococcus pneumoniae causing IPD in Spain.

Results

The overall reduction of IPD cases by serotypes included in PCV13 was 88% for children and 67% in adults with a constant increase of IPD cases by serotype 8 in adults since 2015. In children, serotypes 24F (12%), 8 (10%) and 3 (9%) were the most frequent in 2019 whereas in adults, serotypes 3 and 8 accounted for 37% of IPD cases. IPD cases in adults by additional serotypes covered by the 23-valent polysaccharide vaccine (PPV23) have risen constantly within the years, increasing from 19% in 2009 to 52% in 2019. IPD cases by Non-vaccine types in adults (not covered by PCV13 or PPV23) show a moderate increase from 14% in 2009 to 24% in 2019.

Conclusion

Emerging serotypes are observed in Spain with the rise of serotype 24F in children and 8 in adults as a worrisome event.

Disclosures

Jose Yuste, n/a, GSK (Consultant)MSD (Consultant, Research Grant or Support)Pfizer (Consultant)
1516. Outbreak of SARS-CoV-2 among Migrant Farm Workers in North Florida
Authors: Nasser Khalil , Tabon Vanneza , Jayaweera Dushyantha , Elias Tiffany , Jasti Kavya , Talati Raja , Ramgopal Moti
Published: January 2021

Background

Migrant farmworkers have been identified as a vulnerable population for Severe Acute Respiratory Syndrome Novel Coronavirus-2 infection (SARS-CoV-2). The objectives of this study were to detect the SARS-CoV-2 infection (COV19) status among 262 migrant farmworkers in North Florida.

Methods

This is a retrospective analysis of the information gathered from migrant workers referred by the Florida Dept. of Health for evaluation. Due to the urgency of returning to Mexico, subjects with which COV19 was detected were reevaluated for detailed medical history. Therefore, subjects that tested negative were later released following CDC guidelines. COV19 status was determined using an RNA qualitative nucleic acid amplification test (NAAT) from nasopharyngeal swabs collected over a three-day period. Variables collected include demography, symptoms, temperature, comorbidities, medication use, and vaccine status. Statistical significance for categorical variables was assessed using χ 2 test or Fisher’s exact test where appropriate. Remaining variables were assessed using basic descriptive analysis.

Results

From the 262 subjects tested, 6 missed the follow up visit and data was unavailable. All were Mexican males, age 18-67 years, with positivity rate of 35.1%. Among the 92 (+) subjects, the average age was 34.1 years and 34.5 among the 164 (-) subjects, (p=< 0.77). The symptoms and temperatures are in Table 1. Three of the 92 COV19 (+) subjects were hospitalized, non-ICU and made an uneventful recovery. 59.8% of COV19 (+) subjects were asymptomatic. Among the 92 (+) subjects, 20.7% reported using acetaminophen within the last 60 days. The most common reported comorbidity was being a former smoker or current smoker, at 12.0% and 4.3% respectively.

Conclusion

The COVID-19 pandemic has highlighted migrant workers as a vulnerable population with astronomical COV19 rates, compared to others in FL (14/100,000). They are impoverished, uneducated, undocumented, uninsured and employed to perform arduous physical labor and it is essential to provide basic healthcare to prevent the spread of COV19.

Disclosures

All Authors: No reported disclosures
1517. Outcomes of Influenza Infection among Vaccinated and Un-Vaccinated Patients presenting to a Suburban hospital in Perth, Western Australia (WA), 2019 Southern Hemisphere Influenza Season
Authors: Otome Ohide , Fysh Ed , Shariar Afsin , Yuan Andrew Chin Hock , Brownell Phoebe , Abu-Sharifa Aysha , Bailey Claire , Hall Victoria , Courtney Aiofe Tarrant , O’Reilly Marese
Published: January 2021

Background

Influenza season started in April, earlier than any previous season. WA immunization registry showed a higher than average vaccine uptake. By October 22,770 cases and 80 influenza related deaths were recorded (in 2018: 3,679 cases and 13 deaths). We aimed to characterize clinical presentation and outcomes of laboratory confirmed Influenza, comparing vaccinated with unvaccinated controls.Hypothesis; vaccination would result in less severe disease and better outcomes. Primary objective: length of stay (LOS); Secondary objective: prevalence of severe respiratory illness, ICU admission and death.

Methods

Retrospective study, April to October 2019. Eligible patients had a telephone-based questionnaire for clinical and immunization data verification. Excluded; < 18 years; deceased; dementia; nursing home and unable to consent. Continuous and categorical data of cases (vaccinated) and controls (unvaccinated) were compared using Mann-Whitney U test (non parametric), student t-test (parametric). Correlation and multilinear regression analyses were undertaken to determine the effects of vaccination status and identified confounders on the primary outcome. Based on previous average LOS (5 days, SD 1.5) the sample required to detect a difference of 1 day with 80% power was 70 patients. This study was approved by the SJGHC HREC.

Results

Of 163 eligible, 83 completed the questionnaire. 8 were excluded. 75 underwent analysis (50 vaccinated and 25 unvaccinated). Median age was 75 (23-83) and 63 (33-70) respectively (p< 0.01). 76% vs 48% reported >1 comorbidity (p =0.02). 10% vs 0% were admitted to ICU (p =0.16). Higher vaccination uptake was seen in older patients and those with comorbid conditions. There was a strong correlation (Spearman r= 0.54 (0.34 to 0.68, p< 0.001) between age and length of stay, but none was found between comorbidity or vaccination and length of stay. Neither age (p >0.05), comorbidity status (yes/no; p=0.99), vaccination status (p=0.61) nor any combination of these variables were significantly associated with a dichotomised outcome of acute hospital stay > 3 days.

Conclusion

Vaccination with the 2019 influenza vaccine had no significant effect on hospital length of stay, mortality or critical care requirement in patients admitted to hospital with influenza.

Disclosures

All Authors: No reported disclosures
1524. Sex Differences in Influenza: The Challenge Study Experience
Authors: Giurgea Luca , Cervantes-Medina Adriana , Han Alison , Czajkowski Lindsay , Baus Holly , Memoli Matthew J
Published: January 2021

Background

Our understanding of the impact of biological sex on influenza-associated disease and the mechanisms that underpin it is still incomplete. Further investigation of sex-linked effects on influenza pathogenesis and clinical outcomes may help tailor vaccine strategies. Animal studies have shown female mice experience more symptoms than male mice during influenza infection. Similarly, human females of reproductive age have higher rates of influenza and influenza-related hospitalizations. However, data is sometimes conflicting and may be confounded by other important differences in baseline characteristics. Human challenge studies have demonstrated the importance of NAI titers as a correlate of protection and may also provide an ideal opportunity to study sex differences in a homogenous group of participants controlled for confounders.

Methods

Data from 168 volunteers who underwent Influenza A/California/04/2009/H1N1 challenge studies affiliated with NIAID’s LID Clinical Studies Unit were compiled to compare differences between sexes. Participants were included in the analysis if they received a challenge dose of virus of 107 TCID50 and were excluded if they had received any vaccines or experimental therapy during the study period.

Results

Baseline differences between male and female participants were observed in NAI titers but not HAI titers or age. Outcomes of interest included presence of viral shedding/duration which were similar among sexes. However, symptom number and duration were higher among female participants (p=0.008 and p=0.045 respectively). Ongoing data analysis also shows females have lower post-challenge NAI titers than males.

Conclusion

Female participants in our H1N1 challenge studies had more symptoms and a longer duration of symptoms compared to their male counterparts. Differences in NAI titers may potentially explain the observed relationship between sex and symptoms associated with influenza.

Disclosures

All Authors: No reported disclosures
1527. Incident Sexually Transmitted Infections among Southern Men Who Have Sex with Men Living with HIV in the Era of Biomedical Prevention
Authors: Gravett Ronnie M , Cleveland John D , Overton Edgar T , Marrazzo Jeanne , Marrazzo Jeanne
Published: January 2021

Background

Sexually transmitted infections (STI) and HIV disproportionately affect men who have sex with men (MSM) in the U.S. Deep South. The South also continues to bear the majority of incident HIV in the U.S.; concomitantly, STIs have increased among MSM in this region. HIV virologic suppression effectively prevents sexual transmission of HIV (treatment as prevention, TasP), but STIs occur commonly in MSM living with HIV despite this. Here, we describe the incidence of gonorrhea and chlamydia in MSM living with HIV in the context of their viral load (VL) management from 2016 to 2019.

Methods

We analyzed data from adult MSM living with HIV from 2016-2019 in HIV care in Birmingham, AL. Eligible MSM were prospectively enrolled in the CFAR Network of Integrated Clinical Sites (CNICS) and had documentation of at least one HIV viral load and one STI test (gonorrhea or chlamydia at any anatomic site) in the same calendar year. Demographic data is presented by year. STI incident rates were calculated by year by viral load (VL) category, suppressed (VL < 200 copies/ml) and unsuppressed (VL ≥ 200 copies/ml), with incident rate ratios (IRR) and 95% confidence intervals for comparing suppressed VL to unsuppressed VL.

Results

The study cohort included 943, 1084, 1080, and 1106 MSM in each year from 2016-2019, respectively. Of these men, 551 (58%), 623 (58%), 639 (63%), and 676 (61%) were Black or African American with a median age (years) of 46, 45, 44, and 43 from 2016-2019. Most had VL < 200 (79%, 81%, 82%, and 80% from 2016-2019). There were 100, 131, 139, and 168 men with positive GC or CT results per year from 2016-2019. The annual incident rates per 100 person years (PY) for MSM by suppressed and unsuppressed VL as well as IRR are presented in Table 1; the IRR ranged from 3.00-4.34 through the study period. Figure 1 shows incidence rate by VL category.

Figure 1. Incidence Rate by Viral Load Category. PY, person years.

Conclusion

In this cohort, incident bacterial STIs were common and increased each year in this analysis for both groups, reflecting national STI trends. MSM with suppressed VL had higher bacterial STI incidence rates and higher risk for incident STI compared to MSM with unsuppressed VL. Novel approaches to STI prevention, such as pre- and post-exposure prophylaxis or vaccines, are necessary to alter the STI epidemic in this population and limit its impact on HIV transmission.

Disclosures

All Authors: No reported disclosures
1532. Demographics and Population Epidemiology of Mycoplasma genitalium infection: Correlation to Co-Infection and prior STI history
Authors: Kostera Josh , Santiago Jose
Published: January 2021

Background

Despite reports in the past few years that Americans are having less sex, the US Centers for Disease Control and Prevention (CDC) recently reported in 2019 that sexually transmitted infection (STI) cases are at an all-time high in the United States. The CDC report included statistics on confirmed cases of Chlamydia trachomatis and Neisseria gonorrhoeae, but did not include data for Trichomonas vaginalis and Mycoplasma genitalium. Although Trichomonas vaginalis and Mycoplasma genitalium are generally recognized agents responsible for STI’s, there is limited prevalence data in the United States.

Methods

Herein we present STI prevalence and socio-demographic epidemiological data associated with patients enrolled in a multicenter STI study using the automated multiplex qualitative CE marked assay, Alinity m STI. The enrolled study population reflected a diverse number of participants with an approximately equal male to female ratio, prior STI history, single and married, education levels from primary to post-graduate, as well as different ethnicities.

Results

Participants in this study population who have previously been diagnosed with an STI had an overall Mycoplasma genitalium prevalence rate that was approximately double those who have not been previously diagnosed with an STI. Furthermore, the co-infection rate for Mycoplasma genitalium and Trichomonas vaginalis was as high as 2.5% for vaginal swab specimens with an overall Mycoplasma genitalium prevalence of 11.6%. The overall prevalence of Trichomonas vaginalis in women was 12.3%. Neisseria gonorrhoeae had the lowest overall prevalence in men and women at 2.4%, and Chlamydia trachomatis at had an overall prevalence of 9.8%.

Conclusion

Mycoplasma genitalium infections are generally asymptomatic in both men and women that contributes to up to 35% of non-chlamydial non-gonococcal urethritis in men and linked to cervicitis and pelvic inflammatory disease in women. Left untreated or not accurately diagnosed, STIs can cause significant, serious long-term health consequences including sexual, reproductive, and psychological well-being that present an extensive challenge and burden to public health in the United States.

Disclosures

Jose Santiago, PhD, Abbott (Employee)
1533. Galapagos Islands: structuring of an HIV clinic in a captive territory
Authors: Jaramillo Ana Maria M Gomez , Teran Enrique
Published: January 2021

Background

Galapgos contributes 0.11% of the HIV cases in all Ecuador. There is a social and biological distinction, especially considering that the islands receive 245,000 tourists/year from all over the world, which also includes sex tourism by the LGTBI community. In 2016, the HIV Clinic project began in the Santa Cruz hospital, as an initiative carried out by a specialist in Internal Medicine.

Graphic 1. Distribution by type f case notification at the diagnosis of PLWHA at the Galapagos Islands

Graphic 2. Distribution by gender of PLWHA at the Galapagos Islands

Methods

An initial descriptive analysis of the variables was performed, frequency tables were used for the qualitative variables. For the quantitative variables, measures of central tendency (mean, median, mode). The analyzed data correspond to the period between 2016 to 2019.

Graphic 3. Impact of HIV Clinic on viral load value of the PLWHA at the Galapagos Islands

Graphic 4. Impact of HIV Clinic on CD4 cell count of the PLWHA at the Galapagos Islands

Results

The 43.1% of cases correspond to HIV+ and 58.8% of AIDS. 67.3% of PLWH are men and 32.7% are women. All cases occur due to unprotected sex (100%). 64% of HIV+ and 40.6% of AIDS patients report homosexual intercourse. Of the AIDS cases, 58.8% are in the A2 to C2 CDC category, and have less than 200 CD4+. The most frequent opportunistic infection in this group is Oropharyngeal Candidiasis (16.7%) followed by tuberculosis of any location (16.7%) and Pneumocistys jirovecii pneumonia (3.3%). 93.1% of patients receive ART, the remaining 6.9% corresponds to loss of follow-up. Thus, since the creation of the unit, a positive impact on the evolution of viral load as well as the values of CD4+ count can be seen. This would be related to the fact that PLWHA controls have been more frequent and are given in the context of a special care unit for their pathology.

Conclusion

We can conclude that the behavior of HIV infection in the Galapagos Islands has a distribution in vulnerable groups as in the continental Ecuador. It is important to mention that the diagnosis of HIV is late in the insular region. The creation of an HIV clinic strategically located on the island of Santa Cruz has significantly improved the status of infection in PLWH, however, large population and qualitative studies are needed to determine other factors related to the quality of life of these patients and the behavior of the infection in this population.

Disclosures

All Authors: No reported disclosures
1534. Gonorrhea Testing and Ceftriaxone Resistance in the Department of Veterans Affairs (VA), 2010-2019
Authors: Schirmer Patricia , Lucero-Obusan Cynthia , Oda Gina , Holodniy Mark
Published: January 2021

Background

Gonorrhea (GC) infections caused by Neisseria gonorrhoeae are an ongoing public health issue and have shown resistance to nearly all antibiotic classes, including cephalosporins which are a CDC recommended treatment. We investigated national GC testing and Ceftriaxone resistance in VA.

Methods

GC cases identified from VA data sources from 1/1/2010-12/15/2019 by either molecular laboratory testing or GC culture with sensitivity testing. Patients were reviewed for positive results, whether culture testing was performed after 2 positive molecular GC results in < 90 days, and sensitivity patterns.

Results

10,642 of 644,968 (2%) GC molecular results were positive with annual number of positive cases (1,365 to 3,225), number of tests performed (97,636 to 164,085) and percent positive for GC (1.4% to 2%) increasing over the time period studied. 2,358/10,642 (22%) of positive molecular test results had repeat testing < 3mo with 351 (15%) positive on repeat testing which is concerning for possible resistance. 2,624 GC cultures were performed with 2,179 (83%) positive. 1,480/2,179 (68%) positive GC culture tests had some sensitivity testing performed. Culture testing remained stable with 287 in 2010 to 289 in 2019 with percent positive ranging from 78-89%. Of the 351 patients with repeat positive GC molecular testing done < 3mo from their positive molecular test, only 18 (5%) had GC culture testing performed proximal to the second positive test. Among all cultured isolates, resistance to Ceftriaxone was noted in 1 sample in 2017 in Missouri (also intermediate resistance to Tetracycline) and 1 in 2019 in New Jersey (also resistant to Penicillin, Tetracycline, and Ciprofloxacin).

Conclusion

In VA, GC infections have increased from 2010 to 2019 and GC culture testing has remained stable despite increasing molecular testing. Only 2 samples were identified with Ceftriaxone resistance. However, the low percentage of GC culture testing after persistent positive molecular testing in VA could mask treatment failures and possible resistance. Culture testing with sensitivity testing should be increased in VA in cases where patients may have resistance to initial treatments (i.e., – repeat positive testing less than 3 months after a positive test).

Disclosures

All Authors: No reported disclosures
1535. Impact of Defunding Family Planning Health Centers on Gonorrhea and Chlamydia Cases in Iowa: A Spatiotemporal Analysis
Authors: Srinivas Megan L , Yang Eileen , Tang Weiming , Tucker Joseph
Published: January 2021

Background

Fifteen states have defunded family planning health centers (FPHCs), causing thousands to be left without health services. This has accelerated in the COVID-19 era. FPHCs provide low-income individuals in rural areas with essential primary care services, including sexually transmitted infection prevention, testing, and treatment. The purpose of this analysis is to use spatiotemporal methods to examine the impact of FPHC closures in Iowa on the reported number of gonorrhea and chlamydia cases at the county level.

Methods

This analysis investigates the association between FPHC closures and changes in the number of gonorrhea and chlamydia cases between 2016 and 2018. Iowa implemented defunding policies for family planning clinics, resulting in four FPHC closures in June 2017. 2016 pre-closure STI incidence rates were compared to 2018 post-closure rates. Gonorrhea and chlamydia rates in the four Iowa counties with clinic closures were compared to the 95 Iowa counties without closures. T tests were used to compare changes in reported gonorrhea and chlamydia rates in the two settings. Linear regression modeling was used to determine the relationship between clinic closures and changes in gonorrhea and chlamydia cases.

Results

The gonorrhea burden in Iowa increased from 83 cases per 100,000 people in 2016 to 153.8 cases per 100,000 people in 2018. The four counties with clinic closures experienced a significantly larger increase (absolute 217 cases per 100,000 population) in their gonorrhea rate compared to counties without FPHC closures (absolute 121 cases per 100,000 population). There was also a significant relationship between clinic closures and increasing gonorrhea rates (p = 0.0015). Over the three-year period, there was no change in chlamydia rates (p = 0.1182). However, there was a trend towards counties with more FPHC closures having a higher number of chlamydia cases (p = 0.057).

Conclusion

Despite the fact that many STI diagnoses are made and reported by FPHCs, our data suggest that clinic closures may have contributed to an increase in gonorrhea and chlamydia cases. This is consistent with delayed diagnoses and missed opportunities for providing essential STI services to vulnerable and under-served rural residents. Legislative action is urgently needed to curtail this trend.

Disclosures

All Authors: No reported disclosures
1537. Incidence, Reinfection, and Discrepancy Between Site Positivity and Reported Sexual Practice of Sexually Transmitted Infections in HIV-Positive Adolescents and Young Adults in Atlanta, GA
Authors: Loerinc Leah , Scheel Amy , Jordan-Thompson Sierra L , Gillespie Scott , Camacho-Gonzalez Andres
Published: January 2021

Background

HIV-positive adolescents and young adults (AYAs) are disproportionately affected by sexually transmitted infections (STIs). Despite national recommendations, STI screening remains low. Incomplete screening in addition to inconsistent reported sexual practices may lead to missed infections. This study aimed to determine the incidence and reinfection rates of co-STIs in HIV-positive AYAs and the discrepancy between site positivity and self-reported sexual history in this group.

Methods

Retrospective chart review was conducted for all patients aged 13-24 at Grady Ponce and Family Youth Clinic in Atlanta, GA from 2009-2018. Data were collected on demographics and STI events. STIs included gonorrhea (GC), chlamydia (CT), human papillomavirus (HPV), syphilis, trichomonas, herpes simplex virus (HSV), lymphogranuloma venereum (LGV), hepatitis C (HCV), bacterial vaginosis (BV), and chancroid. First STI incidence and incidence of reinfections were calculated by dividing new cases over corresponding person follow-up time.

Results

621 sexually active HIV-positive AYAs were included. The mean age at first observation was 18.7 (±3.29) years. 72.1% of patients were male, 92.3% were Black, and 79.7% were horizontally infected. 83.7% of patients had at least one STI during the study period. The overall first STI incidence rate was 35.8 per 100 person-years with HPV, GC, CT, and syphilis as the most common STIs reported (Table 1). The overall recurrent incidence rate was 72.1 per 100 person-years with GC, CT, and syphilis as the most common recurrent infections (Table 1). Of all GC and CT infections, the majority were rectal (48.7% and 49.9%, respectively) (Table 2). Only 65.8% of patients with rectal GC and 68.5% with rectal CT infections reported recent receptive anal sex (Table 3).

Table 1: First and recurrent incidence rates of any STI and individual STIs per 100 person-years

Table 2: STIs by site, all infections

Table 3: Reported exposure history vs. STI site positivity

Conclusion

Our study demonstrates disproportionately high incidence and reinfection rates of co-STIs in HIV-positive AYAs. Furthermore, many patients did not report exposure at their site of infection. If screening is done based off reported exposure history alone, many infections may be missed. Our data support the urgent need for increased STI screening in this population, including routine extragenital testing for GC and CT even without reported exposure at these sites.

Disclosures

All Authors: No reported disclosures
1539. Pilot Study of Sexual Networks and Sexually Transmitted Infection Risk in a Military Population
Authors: Rahman Nazia , Robles Roberta Lugo , Magno Nicholas , Hsieh Hsing-Chuan , Waggoner Sandra , Kao Tzu-cheg , Smith Realisha , Lalani Tahaniyat , Garges Eric
Published: January 2021

Background

In the U.S., military members experience a higher incidence of sexually transmitted infections (STIs) than the age and gender-adjusted general population, placing a costly and preventable burden on the military health system (MHS). These increased rates are likely due to differences in both individual and network level risk factors. To assess the feasibility of a survey examining the impact of sexual network risk factors on risk, a survey assessing STI individual and network level risk factors to include a 90-day sexual partnership inventory was piloted at a single military medical center.

Methods

A sample of 50 military beneficiaries completed a computer-assisted self-interview (CASI) cross-sectional egocentric survey administered on a tablet. Demographical and clinical data were captured from the electronic medical record. Non-parametric statistics were used to analyze the data.

Results

45 of 50 subjects (90%) completed the survey. 40 (88%) subjects completed at least one partnership survey and reported 1 to 20 partners per subject. Respondents were mostly active duty (91.8%) and had been active duty for less than five years (68.2%). Common risk behaviors were explored and included meeting partners online (68.75%) and having partners who use drugs (48.94%) or are heavy drinkers (44.68%). Partnership inventories suggest sexual concurrency and disassortative mixing on age, racial and ethnic groups, and military service.

Conclusion

While previous studies demonstrate that service members will complete sexual risk behavior surveys, this pilot egocentric partnership study demonstrates their willingness to provide detailed information on risk behaviors as well as detailed information on sexual partnerships. While we report on statistically significant associations, these may be subject to bias due to the underlying characteristics of the source population. As a result, these data will not likely be reflected in the full study population. 80% of pilot subjects completed the questionnaire and submitted at least one partnership survey, indicating the possibility of gathering more diverse individual sexual risk questionnaires from active duty service members. Based on these data, a multisite study of sexual networks was implemented in the MHS and is currently under analysis.

Disclosures

All Authors: No reported disclosures
1542. Provider Uptake of Extragenital Screening for Gonorrhea and Chlamydia in Active Duty Air Force Members with Incident HIV Diagnosis
Authors: Lamb Christian C , Yabes Joseph , Hakre Shilpa , Okulicz Jason
Published: January 2021

Background

The prevalence of Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) is much higher at extragenital anatomic sites among men who have sex with men (MSM) with HIV infection. National guidelines recommend that all MSM with HIV infection undergo screening for extragenital sexually transmitted infections (EG-STIs), however uptake is low in many primary care settings. We evaluated EG-STI screening by primary care providers (PCPs) for US Air Force (USAF) members with incident HIV infection.

Methods

All USAF members newly diagnosed with HIV infection who received initial HIV specialty care with Infectious Disease (ID) providers at Brooke Army Medical Center from 2016-2018 (n=98) were included. A retrospective chart review was conducted to evaluate STI screening performed by PCPs within 1 week of HIV diagnosis compared to screening at entry into ID care. Demographic, clinical, laboratory and behavioral risk data were collected. STI screening included GC/CT EG-STIs, urethral GC/CT, syphilis, and hepatitis B and C.

Results

Patients were predominantly male (97.9%) with a median age of 26 (IQR 23, 32) years at HIV diagnosis (Table 1). A previous history of STIs was reported in 53 (54.1%) patients and the majority of males self-identified as MSM (66.3%) or bisexual (22.5%). The median time from HIV diagnosis to ID evaluation was 26 days (IQR 9, 33). PCPs performed any STI screening in 61 (62.2%) patients (Table 2). EG-STI screening was conducted in 3 (3.1%) patients overall and in (3.4%) MSM/bisexuals. A total of 31 (31.6%) patients had missed STIs; the majority due to EG-STIs of the rectum (71%) and pharynx (21.9%). All EG-STIs would have been missed by urethral GC/CT screening alone.

Table 1

Table 2

Conclusion

EG-STI screening uptake was low among PCPs evaluating USAF members with incident HIV infection. Underutilization of EG-STI screening can result in missed infections and forward transmission of GC/CT. Barriers to low uptake need to be explored. Continued education and training of PCPs may be necessary to improve uptake of EG-STI screening.

Disclosures

All Authors: No reported disclosures
1545. Three Site Testing for Sexually Transmitted Infections for People Living with HIV in One Southeastern Ryan White HIV/AIDS Program Clinic: First Year of Experience
Authors: Geba Maria , Powers Samuel , Williams Brooke , Dort Kathryn R , McQuade Elizabeth T Rogawski , McManus Kathleen A
Published: January 2021

Background

For comprehensive care, it is recommended that people living with HIV who are sexually active have annual multisite testing for gonorrhea and chlamydia. Appropriate testing is defined by testing at all sites of sexual exposure (urogenital, pharyngeal, rectal). In the first year of 3 site testing at our HIV clinic, we aimed to describe (1) the rate of appropriate sexually transmitted infection (STI) testing, (2) the factors associated with STI diagnosis, and (3) the percentage of extragenital STIs that would have been missed with only urogenital testing.

Methods

Participants were > 14 years old with > 1 in-person medical visit at the Ryan White HIV/AIDS Program clinic in 2019. We collected demographics, reported sexual activity, and STI test dates and results. Controlling for number of sites tested, a log-binomial model was used to estimate the association of different characteristics with an STI diagnosis.

Results

For this cohort (n=857; Table 1), 44% reported sexual activity, 34% reported no sexual activity and 22% had no sexual activity information recorded. Of 1185 STI tests performed for 491 participants, 51 STIs were diagnosed in 33 participants. One STI was diagnosed for a female (0.7%). Overall, 68% (253/375) received appropriate urogenital testing, 63% (85/134) received appropriate pharyngeal testing and 69% (72/105) received appropriate rectal testing. For male participants with > 1 STI test (n=347), Hispanic ethnicity was associated with an STI diagnosis (Table 2). Of those with concurrent extragenital and urogenital tests, 96% of people with an STI (n=26) were positive at only an extragenital site.

Table 1: Study Participants’ Characteristics

Table 2: Factors Associated with Being Diagnosed With a Sexually Transmitted Infection for Men Living With HIV: Frequencies and Results of Univariable and Multivariable Log-binomial Model

Conclusion

Nearly a quarter of participants had no sexual activity information recorded in the year, which is an area for improvement. Despite newly adopting 3 site testing, appropriate extragenital and urogenital testing rates were similar and were high compared with national averages. There was no obvious clinician/patient bias against extragenital testing. Hispanic male participants’ higher STI diagnosis rate may point to more condomless sex in this population. Based on the identification of many infections exclusively at extragenital sites, we likely missed STIs previously. This highlights the importance of 3 site testing availability and testing at all appropriate sites.

Disclosures

Kathleen A. McManus, MD, MSCR, Gilead Sciences, Inc (Research Grant or Support, Shareholder)
1548. Association of bacterial colonization in ulcerative lesions of the diabetic foot together with the cicatrization process
Authors: Loveras Alexander A Ozoria , Espinal Jacques Paré , de luna David , Acevedo Noemi
Published: January 2021

Background

In 2018, a review of the scientific literature identifed biofilm studies in the past 3 years. Wherein, the role of the biofilm in the progression of the diabetic foot ulcer with the presence of biofilm is reviewed. As a result, tissue sampling is more effective than transcure, Levin, and aspiration.

A study in Cuba evaluate the effectiveness of a new proposal for antimicrobial treatment in patients with diabetic foot infection in 2017. The method used was a experimental type of two groups. The control group, was treated with the treatment scheme proposed in the Comprehensive Care Program for the patient with diabetic foot ulcer (PAIPUPD). Instead, the other experimental group was treated according to the scheme based on the local microbial map. They used a random distribution. Using the Wagner classification, there were patients classificate with a grade of W2 (13% of patients), W3 (66%) and W4 (12%). The most frequent germs found were Staphylococcus aureus, Escherichia coli and Enterobacter sp. The experimental group required less days with hospitalization.

Methods

This is an observational study of primary source with a non-probability sample with 58 patients. Adult patients diagnosed with type 2 diabetes mellitus, with diabetic foot, Wagner classification 1, 2 and 3, who attended the healing area of the Institute of Diabetes of Santiago were included. After identifying the colonized pathogen, its cicatrization process was evaluate for four weeks.

Results

Of the total sample, 12.07% belonged to Wagner 1, 43.1% to Wagner 2 and 44.83% to the Wagner 3 classification. In the case of the Wagner 3 group, S. aureus and Pseudomona aeruginosa were present in 6 cases. Despite the infectious processes detected by the culture, the patients showed a successful cicatrization process after four weeks of evaluation.

Graph 1: Isolated Microorganism Vs Wagner’s Degree (n=60)

Graph 2: Gram positive microorganism vs. healing process per week in patients with diabetic foot (n=22)

Graph 3: Gram-negative microorganism vs. healing process (n=33)

Conclusion

During the four weeks of clinical evaluation, more than 88% of patients progressed positively to clinical recovery, regardless of the type of bacteria colonized and/or their resistance to antibiotics.

Disclosures

All Authors: No reported disclosures
1549. Association of Skin Infections with Sharing of Injection Drug Preparation Equipment among People who Inject Drugs
Authors: Jawa Raagini , Stein Michael , Anderson Bradley , Liebschutz Jane M , Stewart Catherine , Keosaian Julia , Barocas Joshua A
Published: January 2021

Background

Sharing needles and injection drug preparation equipment (IDPE) among people who inject drugs (PWID) are well-established risk factors for viral transmission. Shared needles and IDPE may be a reservoir for bacteria and serve as a nidus for skin and soft tissue infections (SSTI). Given the rising rates of SSTIs in PWID, we investigated the association of needle and IDPE sharing on history and incidence of SSTI in a cohort of PWID.

Methods

Active inpatient PWID were recruited to a randomized control trial of a risk reduction intervention aimed at reducing bacterial and viral infections. A subset of participants (N=252) who injected drugs were included in the analysis. The primary dependent variable in this cross-sectional cohort study was self-reported incidence of SSTI one year post-hospitalization. We assessed three self-reported independent variables from baseline enrollment: 1) sharing needles, 2) sharing IDPE, and 3) sharing needles or IDPE and compared these groups separately to persons who reported not sharing via univariate and multi-level Poisson regression model estimating the adjusted effect of baseline sharing on incidence of SSTI during follow up.

Results

Participant characteristics: 37.9 years [mean]; 58% male; 90% primarily inject opioids, 43% inject with others, 13% shared IDPE only, 50% shared needles or IDPE. In general, persons who shared IDPE only compared to those who did not share were younger, more likely female, more likely Caucasian, were less likely to primarily inject opioids, and had a higher mean on the knowledge scale. We found no significant differences of prior self-reported SSTI. Adjusted for those randomized in the behavioral intervention arm for skin cleaning, persons who shared needles only and needles or IDPE had a higher incidence of SSTI compared with persons who did not share (IRR 1.90, 95% CI1.03-3.51, p=0.04; IRR 2.14, 95% CI 1.23-3.72 p=0.007). Persons who shared IDPE only did not have a statistically significant higher incidence of SSTI compared with persons who did not share (IRR 1.3, 95%CI 0.89-1.95 p=0.157).

Conclusion

In this cohort of hospitalized active PWID, we found a significant association between baseline sharing of needles or IDPE but not IDPE only with incidence of self-reported SSTI.

Disclosures

All Authors: No reported disclosures
1551. Cat Scratch Disease as a Mimicker of Malignancy: Rare and Elusive
Authors: Dhal Udit , Tarrand Jeffery , Kontoyiannis Dimitrios P
Published: January 2021

Background

Cat scratch disease (CSD) mimicking malignancy has been the subject of scattered case reports. To that end, we reviewed patients (pts) with CSD at MD Anderson Cancer Center (MDACC), focusing on the clinical overlap of CSD presentation with that of malignancy.

Methods

We retrospectively reviewed all pts diagnosed with CSD at MDACC (11/2015-1/2020). CSD was diagnosed based on Bartonella henselae serology, animal exposure and biopsy findings consistent with the diagnosis. We collected data on CSD epidemiology, signs, symptoms, laboratory findings, histopathology, radiological studies, treatment used, outcome and the malignancy mimicked. We also reviewed the published cases of CSD mimicking malignancy (1952-2020).

Results

We identified 11 such pts; 1 (9%) was male and 5(45%) were ≤ 18 years old. No pt had a prior history of malignancy. All but 1 pt reported an exposure to cats. Only 2/11 (18%) had fever, and none of the pts had skin lesions or hepatosplenomegaly. All pts had lymphadenopathy; 2/11 (18%) had only inguinal lymphadenopathy. PET scan was performed for 3 pts and revealed only enlarged lymph nodes. Several malignancies were considered as initial diagnostic impressions, including sarcoma (n=3), lymphoma (n=2), breast cancer (n=2). Serum Bartonella IgG titer was ≥ 1:512 in 9/11(82%) pts with 3 pts (28%) positive for IgM. 8 pts had a biopsy and non-necrotizing granuloma was the most common finding, present in 4. Azithromycin was used in all 8 pts that were treated. Nearly all pts improved or had resolution of symptoms with one pt having persistent fever and lymphadenopathy. Literature search identified 33 cases of CSD that mimicked malignancy (10 for breast cancer, 10 for lymphoma, 6 for sarcoma with 1 each for lung, pancreatic, parotid and 4 others).

Conclusion

Although there was a probable referral bias in the CSD pts at MDACC, CSD should be included in the differential diagnosis of malignancy. Although publication biases are probable, literature review also supports the notion that atypical CSD rarely can simulate a variety of malignancies.

Disclosures

Dimitrios P. Kontoyiannis, MD, Amplyx Pharmaceuticals (Consultant)Astellas Pharma (Consultant)Ciadara Therapeutics (Consultant)Gilead Sciences (Other Financial or Material Support, Honoraria)Mayne Pharma (Consultant)Merck & Co (Consultant, Honoraria)Pharma (Consultant)United Medical (Other Financial or Material Support, Honoraria)
1552. Clinical Outcomes and Healthcare Costs of Inpatients with Tetanus in Korea in 2011–2019
Authors: Bae Sohyun , Chang Hyun-Ha , Jung Sook In , kim Shin-Woo , Kim Yoonjung
Published: January 2021

Background

We aimed to investigate the recent trend of clinical outcomes and medical costs of inpatients with tetanus, which is a rare, vaccine-preventable but extremely grave disease, in Korea, in 2011–2019 for the first time.

Methods

From January 2011 to October 2019, this study examined 49 patients with tetanus admitted in 2 national university hospitals in Gwangju and Daegu of South Korea. Patients’ medical records were retrospectively reviewed to determine the clinical factors and medical cost for tetanus management.

Results

The mean age was 65.3 ± 16.1 years and 32 (65.3%) of them were female. All patients (100.0%) had generalized tetanus, and 5 (10.2%) died during admission. The median duration from symptom onset to hospital visit was 4 days. Trismus (85.7%) was the most common symptom, and wound of the lower extremities (24.5%) was the most frequent presumed entry site of toxin. Only 6 (15.0%) patients were operated for wound management. The median hospital stay was 39 (9; 49) days. Furthermore, 32 (65.3%) needed mechanical ventilation, and 20 (40.8%) patients developed aspiration pneumonia. The median total healthcare cost was 21,072 KRW(Korean Republic Won) (17,560 USD(United States Dollar); 1 USD = 1200 KRW) per person. After discharge, 35 (79.5%) patients fully recovered without any disability.

Conclusion

Tetanus remains a grave disease that requires long duration of admission and huge medical cost in Korea. The completion rate of 3-time tetanus toxoid (Td) or tetanus toxoid, acellular pertussis and diphtheria vaccine (Tdap) vaccination was low; thus, the medical staff needs to establish more medical advice or policies to the general population of Korea

Disclosures

All Authors: No reported disclosures