bluuebunny/crossref_metadata_2025 huggingface dataset:
799. Unstable Housing, Daily Drug Use, and Transactional Sex are Associated with Viremia in Transgender Individuals Living with HIV
Authors: Garrett Grace , Eyasu Rahwa , Cover Amelia A , Davis Ashley , Harfouch Omar , Ebah Emade , Bijole Phyllis , Gannon Catherine , Wang Vivian , Spikes Michelle , Imani F N U , Jones Miriam , Masur Henry , Kottilil Shyam , Kattakuzhy Sarah , Rosenthal Elana S
Published: December 2022

Background

In the United States, HIV is highly prevalent among transgender individuals, but factors contributing to viremia in this population are poorly understood. We aimed to assess factors associated with HIV viremia among transgender people living with HIV (PLWH).

Methods

PATCH is a longitudinal natural history study of transgender individuals in Washington, DC. Participants complete laboratory assessments, as well as surveys assessing demographics, behaviors, and mental health. Patients whose HIV viral load was >200 copies/mL at screening were considered viremic. Fisher’s exact test was used for statistical analysis.

Results

Of 62 enrolled participants, 35(56%) were HIV+, the majority of whom were prescribed antiretroviral therapy (31, 89%) and had an undetectable viral load (25, 71%). Of PLWH, 35(100%) were assigned male at birth, 34(97%) were Black, and the median age was 37 years. PLWH were predominately stably housed (24, 69%), with 9(26%) reporting daily drug use or more, and 16(46%) reporting transactional sex within a year.

When comparing PLWH who were viremic versus those virally suppressed, viremic PLWH were less likely to be prescribed antiretroviral therapy (60% vs 100%, p=0.004), and more likely to have unstable housing (60% vs 25%, p=0.04), use drugs daily or more in the last month (60% vs 12%, p=0.007), and engage in transactional sex in the last 12 months (80% vs 32%, p=0.02). HIV viral suppression was not significantly associated with number of sexual partners within the last 12 months or always using condoms during any type of sex (p >0.05).

Conclusion

In this cohort of transgender PLWH, we found moderate rates of HIV viremia associated with chaotic life factors such as daily drug use, unstable housing, and engaging in transactional sex. In addition, we found low rates of consistent condom use despite multiple sexual partners, regardless of viral load. Comprehensive care programs that improve access to ART, address substance use disorders and facilitate housing may serve to improve treatment outcomes and reduce risk of HIV transmission in this population.

Disclosures

Shyam Kottilil, MD, PhD, Arbutus Pharmaceuticals: Grant/Research Support|Gilead: Grant/Research Support|Merck: Grant/Research Support|Regeneron Pharmaceuticals: Advisor/Consultant|Silverback Therapeutics: Advisor/Consultant|The Liver Company: Advisor/Consultant|Yufan Biotechnologies: Advisor/Consultant Elana S. Rosenthal, MD, Gilead Sciences: Grant/Research Support|Merck: Grant/Research Support.
801. IDSA Featured Oral Abstract: 25 Years of Varicella Vaccination Program in the United States: Health Impact during 1995–2019
Authors: Marin Mona , Leung Jessica W , Lopez Adriana S , Melgar Michael , Anderson Tara C , Curns Aaron T , Dooling Kathleen L
Published: December 2022

Background

In 1995, the United States was the first country to introduce universal childhood varicella vaccination. High vaccine coverage was attained among young children, ≥ 90% since 2007. In 2007, the policy was changed from 1-dose to a 2-dose program. We describe the impact of 25 years of the U.S. varicella vaccination program on varicella disease nationally.

Methods

We reviewed published data and analyzed overall and age-specific trends for rates from the pre-vaccine period (1990–1994) through 2019 for varicella incidence using National Notifiable Diseases Surveillance System data, hospitalizations using National Inpatient Sample data, and deaths using National Center for Health Statistics data. We present trends in persons aged < 50 years, which captures most varicella burden and avoids misclassified herpes zoster in older people. Outbreak (≥ 5 varicella cases epidemiologically linked) characteristics were assessed for 1995–2019 and were informed by published data and analysis of surveillance data reported to CDC.

Results

Within the 10 years of the 1-dose program, varicella incidence, hospitalization, and mortality rates declined dramatically (71%–90%) vs. pre-vaccine. However, limited transmission continued in school settings which informed the change to a 2-dose policy. By 2019, declines reached > 97% for incidence and 94% and 97% for hospitalizations and deaths, respectively. The greatest decline occurred among persons aged < 20 years, born during the varicella vaccination program, with 99%, 97%, and > 99% reduction in incidence, hospitalizations, and deaths, respectively. The 2-dose program further reduced the number, size, and duration of outbreaks vs. the 1-dose program; over the entire program, the proportion of outbreaks with < 10 cases increased from 28% to 73%.

Conclusion

The varicella vaccination program significantly reduced varicella morbidity and mortality in the U.S. Twenty-five years into the program, pediatric varicella hospitalization has become a rare event and varicella deaths in persons aged < 20 years are practically eliminated in the U.S. Annually, > 3.8 million cases, 10,500 hospitalizations, and 100 deaths from varicella are now prevented in the United States due to the varicella vaccination program.

Disclosures

All Authors: No reported disclosures.
874. Diagnostic Stewardship of Gastrointestinal Multiplex PCR Panels in Hospitalized Children
Authors: Cotter Jillian , Stokes Claire , Tong Suhong , Dominguez Samuel R
Published: December 2022

Background

The introduction of multiplex gastrointestinal panels (GIP) led to increased rates of children with stool testing, high rates of negative results, and no change in clinical outcomes for most children. We aimed to reduce overall stool testing and stool testing with negative results by 20%.

Methods

We engaged stakeholders and implemented multi-modal interventions including 1) education and development of a clinical pathway to guide testing, and 2) electronic medical record (EMR)-based testing changes including built in stool testing restrictions with optional approval process (Table 1), and quantification of stool caliber in the EMR by nursing using the validated Bristol Stool Scale (BSS). We included all hospitalized children who had stool testing performed at a large children’s hospital over 30 months (2018–2020). Outcomes included the rate of stool tests and negative stool results per 10,000 patient-days. We evaluated rates of BSS documentation and GIPs performed for children hospitalized for > 96 hours as process measures. Balancing measures included the percent of ordered tests that were restricted, and percent of initially restricted tests that were approved. We compared the rate of actionable results (bacteria or parasite identified) between initially restricted but ultimately approved tests and non-restricted tests.

Results

There were 2,001 tests performed for 1,982 encounters (Table 2). After interventions, we found special cause variation with a 29% sustained decrease in the rate of stool testing and a 28% decrease in the rate of negative stool results (Figures 1,2). The rate of use of BSS was 81% and was sustained. There was a 33% decrease in the number of GIPs performed for children hospitalized for >96 hours. 34% of ordered stool tests per month were restricted, and this did not change over time. 56% of initially restricted tests were ultimately approved with no change over time, and these tests had a lower rate of actionable results compared to non-restricted tests (25 vs 34%, p=0.02).

Conclusion

Education coupled with EMR-based testing restrictions resulted in reduced rates of overall stool testing and low-value stool testing. Sustained ordering of restricted tests over time suggests that EMR-decision support is needed and likely cannot be removed.

Disclosures

Samuel R. Dominguez, MD PhD, BioFire Diagnostics: Advisor/Consultant|BioFire Diagnostics: Grant/Research Support|Karius: Advisor/Consultant|Pfizer: Grant/Research Support.
876. Suggested Empiric Therapy for CoNS Identified by BioFire BCID2 – Making Mountains Out of Molehills?
Authors: Ryu HaYoung , Yu Diana , Lewis James S
Published: December 2022

Background

Coagulase-negative Staphylococci (CoNS), including mecA-positive Staphylococcus epidermidis (MRSE), are among the bacteria identified by BioFire blood culture identification (BCID2). After transition to BCID2 on 31 March 2021, our institution began providing a suggested empiric antimicrobial therapy (EAT) comment with rapid diagnostic results, whereas no suggestions were given with the prior platform. Limited data exist on the impact of EAT suggestions on antibiotic use when likely contaminants such as CoNS are identified.

Methods

This was a single center, observational, pre- and post-intervention study of patients aged ≥ 18 years with CoNS in the blood between 1 April 2020 and 30 September 2021. Patients with compromised immunity, intravenous drug use, polymicrobial cultures, or MRSE-active therapy use for a documented infection were excluded. Primary outcome was the rate of initiation or discontinuation of MRSE-active agent in response to the rapid diagnostic result. Secondary outcome was healthcare resource utilization such as Infectious Diseases consultation and delayed discharge.

Results

A total of 174 patients were included (pre-BCID2, n=93; post-BCID2, n=81). For all CoNS rapid diagnostic results, no significant difference was noted in MRSE-active agent initiation (33.3% vs. 37.0%, p=.90) and discontinuation (61.3% vs. 48.4%, p=.31). A subgroup analysis of S. epidermidis was performed with 64 and 46 patients in pre- and post-BCID2 groups, respectively; in the latter, BCID2 identified 31/46 (67.4%) as MRSE. In this subgroup, empiric MRSE-active agent was significantly less likely to be discontinued if EAT suggestion was reported with results (68.4% vs. 31.2%, p=.03). This change was not seen if Staphylococcus species were identified as the suggestion was to withhold EAT. There was no difference in healthcare resource utilization.

Conclusion

Providing EAT suggestion with BCID2 result for S. epidermidis unexpectedly encouraged continuing empiric MRSE-active agent for likely contaminants. In contrast, suggestion to withhold treatment had no impact on EAT use for other CoNS. The reason for this difference is unclear, but may be a result of the highlighted methicillin resistance in the BCID2 result reporting which is specific to S. epidermidis.

Disclosures

James S. Lewis, PharmD, FIDSA, Cidara: Advisor/Consultant|Merck: Advisor/Consultant|SeLux Diagnostics: Advisor/Consultant.
1518. Bacteremia due to Non-Staphylococcus aureus Gram-positive Cocci and Risk of Cardiovascular Implantable Devices Infection
Authors: Chesdachai Supavit , Baddour Larry M , Sohail Rizwan , Palraj Raj , Madhavan Malini , Tabaja Hussam , Fida Madiha , Lahr Brian D , DeSimone Daniel C
Published: December 2022

Background

Cardiovascular implantable electronic devices (CIED) infection carries significant morbidity, mortality, and financial burden. Bacteremia in patients with CIED increases risk of CIED infection. While several investigations have examined Staphylococcus aureus bacteremia and risk of CIED infection, data regarding non-S. aureus gram-positive coccal (non-SA GPC) bacteremia in patients with CIED has been both limited and dated. The current study examined the clinical characteristics of patients with CIED who developed non-SA GPC bacteremia and their proclivity of CIED infection.

Methods

We reviewed all patients with CIED who developed non-SA GPC bacteremia at Mayo Clinic between 2012–2019. Cases with a left ventricular assist device, non-hospitalization, and contaminated blood culture were excluded. The 2019 European Heart Rhythm Association International Consensus Document was used to define CIED infection.

Results

A total of 160 patients with CIED developed non-SA GPC bacteremia during the period. Ninety (56.2%) patients had CIED infection, with 60 (37.5%) classified as definite and 30 (18.8%) possible. This included 41/64 (64.1%) patients with coagulase-negative Staphylococcus (CoNS), 30/41 (73.2%) patients with Enterococcus, 13/19 (68.4%) patients with viridans group streptococci (VGS), and 6/36 (16.6%) patients with other non-SA GPC. The odds of CIED infection (with 95% CI) for CoNS, Enterococcus, and VGS bacteremia were 8.9 (3.2–24.6), 13.6 (4.5–41.6), and 10.8 (2.9–40.0) -fold higher, respectively, as compared to other non-SA GPC. Among those with infected CIED, 51 (56.7%) patients underwent complete device extraction after a median of 6 (IQR 3.5–10) days. In an unadjusted analysis of patients with CIED infection, the reduction in one-year mortality following device removal was not statistically significant (HR 0.59, 95% CI 0.26–1.33, p=0.198).

Conclusion

The overall prevalence of CIED infection following non-SA GPC bacteremia was higher than previously reported, particularly that due to CoNS, Enterococcus, and VGS. Further study with a larger cohort is needed to demonstrate the survival benefit from CIED extraction in patients with infected CIED due to non-SA GPC.

Disclosures

Larry M. Baddour, M.D., Boston Scientific: Advisor/Consultant|Botanix Pharmaceuticals: Advisor/Consultant|Roivant Sciences: Advisor/Consultant|UpToDate, Inc.: Royalty payments - authorship duties Rizwan Sohail, M.D., Aziyo Biologics: Advisor/Consultant|Boston Scientific: Advisor/Consultant|Medtronic: Advisor/Consultant|Philips: Advisor/Consultant|Philips: Honoraria Malini Madhavan, M.B.B.S., Biosense Webster: Advisor/Consultant|Biotronik Inc: Advisor/Consultant|Boston Scientific: Grant/Research Support|Convatec: Advisor/Consultant.
1519. Increased incidence of colorectal cancer in Veteran Health Administration hospital patients with pyogenic liver abscess: A matched cohort study
Authors: Kidder Ian , Goto Michihiko , Suzuki Hiroyuki
Published: December 2022

Background

Colorectal cancer (CRC) remains the third leading cause of death in the United States (US), and incidence has increased among patients < 50 years of age over the last few decades. Although many patients with early CRC remain asymptomatic, infections such as Streptococcus gallolyticus bacteremia, can be an early finding. There is increasing evidence that pyogenic liver abscesses (PLA) may also be associated with CRC. However, studies of US populations remain limited.

Methods

We retrospectively evaluated patients with a diagnosis of PLA at Veteran Health Administration hospitals across the US from 2003 to 2020. For each case, up to three uninfected controls matched for age (+/- 5), gender, and healthcare facilities at the time of index infection from the outpatient population were selected. PLA patients and matched controls were followed for ten years. Our primary outcome was a new diagnosis of CRC after index infection. Stratified cumulative incidence function plots with Gray’s test for equality were used to examine CRC incidence. Then we used Fine-Gray sub-distribution hazard regression models with interaction terms using the logarithm of time to estimate cause-specific time-dependent hazard ratios (HRs) for CRC incidence while accounting for mortality.

Results

We compared 8,294 PLA patients to 23,111 matched controls. Median age was 65.7 in PLA patients and 66.0 in matched controls. The median number of colonoscopies was ten in PLA patients and five in matched controls over the study period (p < 0.001). Our analysis revealed a 1.9% incidence of new CRC in the liver abscess group, compared to 0.8% in the matched cohort (p < 0.001, Figure 1). The multivariate sub-distribution hazard regression model showed higher time-dependent HRs of CRC up to two years from diagnosis of PLA but not higher afterward (Table 1).

Incidence of colorectal cancer (CRC) in patients with liver abscess (dashed yellow line) compared to patients with no liver abscess (solid blue line). Our analysis revealed a 1.9% incidence of CRC in patients with liver abscess compared to 0.8% in the matched control cohort.

Conclusion

We found a significantly higher incidence of CRC for patients with PLA, especially during the first two years from diagnosis, although some of our findings may be explained by increased screening around the time of diagnosis. We believe our findings support the importance of CRC screening after the diagnosis of PLA.

Disclosures

Michihiko Goto, MD MSCI, Merck & Co.: Grant/Research Support.
1523. Association between Self-reported Masking Behavior and SARS-CoV-2 Infection Wanes from Pre-Delta to Omicron-Predominant Periods — North Carolina COVID-19 Community Research Partnership (NC-CCRP)
Authors: Tjaden Ashley H , Gibbs Michael A , Runyon Michael S , Weintraub William , Taylor Yhenneko , Edelstein Sharon
Published: December 2022

Background

Wearing a face mask is a primary public health method to reduce SARS-CoV-2 transmission. We assessed the association between self-reported mask use and risk of COVID-19 infection during three periods of the pandemic.

Methods

We performed a nested case-control analysis within the NC-CCRP of adults ≥18 years who completed daily syndromic surveillance surveys from April 2020 through February 2022, comparing self-reported cases to controls who never self-reported a positive test. We matched up to 10 controls to each case on calendar time of self-reported positive test and corresponding daily survey entry. Not wearing a mask was defined as responding “no” at least once in the ten days preceding the match date to “In the last 24 hours, have you worn a face mask or face covering every time you interacted with others (not in your household) within a distance of less than 6 feet?” Conditional logistic regression models of risk of COVID-19 infection were adjusted for demographics, vaccination status, and recent known exposure to COVID-19. We tested any days not wearing a mask during the Pre-Delta (July 1 2020-June 30, 2021), Delta (July 1– November 30, 2021), and Omicron (December 1, 2021 – February 28, 2022) periods.

Results

Among 3,901 cases and 27,813 date-matched controls, there was a significant interaction between mask use and time period (p< 0.001). Prior to July 2021, the odds of a reported SARS-CoV-2 infection was 66% higher (aOR=1.66, 95% CI=1.43 – 1.91) among participants reporting at least one day not wearing a mask compared to those who reported no days (1592 cases, 11717 controls). During the Delta-predominant period, the results were similar (aOR=1.53, 95% CI=1.23 – 1.89; 659 cases, 4649 controls). This association was attenuated during the Omicron-predominant period, where the odds of a reported SARS-CoV-2 infection was 16% higher (aOR=1.16, 95% CI=1.03 – 1.32; 1563 cases, 10960 controls).

Conclusion

While the effect of not wearing a mask remains significant, during the Omicron-predominant period we observed a decrease in the association between self-reported mask wearing and risk of SARS-CoV-2 infection. The increased transmissibility of Omicron, pandemic fatigue, and increasing population immunity are possible contributing factors.

Disclosures

Michael S. Runyon, MD, MPH, Abbott Laboratories: Grant/Research Support|Roche Diagnostics Operations, Inc: Grant/Research Support.
1538. Socioeconomic Risk Factors for Multidrug Resistance in Enterobacterales
Authors: Brown Dylan , Henderson Heather , Ruegsegger Laura , Moody James , van Duin David
Published: December 2022

Background

Multidrug resistance (MDR) in Enterobacterales is common; the impact of socioeconomic status (SES) on MDR prevalence is unclear.

Methods

Data from 2014–2021 was obtained from UNC Hospitals for all cultures with Enterobacterales growth (N=90129). ZIP-code level socioeconomic data for North Carolina was sourced from the 2020 5-Year American Community Survey and combined into an SES factor score assigned to each ZIP code (N=790). Prevalence ratios from generalized linear models were used to compare the relative MDR occurrence between SES quartiles.

Results

A significant inverse relationship between MDR and SES was observed (16%, 16.5%, 19.5%, and 20.7% MDR in the highest, medium-high, medium-low, and lowest quartiles, respectively; Table 1). The prevalence of MDR in Enterobacterales from patients residing in lowest-quartile ZIP codes was 32% higher (Table 1) relative to those from the highest quartile. This effect was significant across all measured antibiotic classes, with the largest absolute difference in penicillins (40.1% and 50.6% in the highest and lowest quartiles, respectively), and the smallest in aminoglycosides (5.6% and 7.3%; Figure 1). Temporally, the lowest quartile had the highest prevalence of MDR in all measured years.

Conclusion

Our findings show that in North Carolina from 2014–2021, MDR was consistently more prevalent in Enterobacterales from patients residing in lowest-quartile ZIP codes. These data emphasize the need to address the societal causes for disparities in clinical outcomes and can inform further study of the relationship between SES and MDR.

Disclosures

David van Duin, MD, PhD, Achaogen: Advisor/Consultant|Actavis: Advisor/Consultant|Allergan: Advisor/Consultant|Astellas: Advisor/Consultant|Entasis: Advisor/Consultant|Karius: Advisor/Consultant|MedImmune: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Neumedicine: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Qpex: Advisor/Consultant|Roche: Advisor/Consultant|Sanofi-Pasteur: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|T2Biosystems: Advisor/Consultant|Tetraphase: Advisor/Consultant|Utility: Advisor/Consultant|Wellspring: Advisor/Consultant.
1540. Clinical severity across five viral diarrheal pathogens in infants and young children Global Enteric Multicenter Study (GEMS)
Authors: Cates Jordan , Tate Jacqueline E , Parashar Umesh D , Mirza Sara , Nasrin Dilruba , Farag Tamer H , Panchalingam Sandra , Sur Dipika , Faruque Abu S G , Breiman Robert F , Jahangir Hossain M , Mandomando Inacio , Onyando Richard O , Nataro James P , Levine Myron M , Kotloff Karen L
Published: December 2022

Background

Viruses are a leading cause of pediatric diarrheal illness, resulting in over 200,000 childhood deaths annually worldwide. Rotavirus is the most common viral cause of moderate-to-severe diarrhea in low to middle-income countries, but adenovirus 40/41, norovirus, sapovirus, and astrovirus are increasingly recognized as important contributors to the global viral gastroenteritis burden. Comparisons of clinical severity between these five viruses among infants and young children are currently limited.

Methods

The objective of this analysis was to describe the clinical severity of rotavirus, adenovirus 40/41, norovirus, sapovirus, and astrovirus among children enrolled in the Global Enteric Multicenter Study (GEMS). Stool samples from children younger than 5 years of age with moderate-to-severe diarrhea at four sites in Africa and three in Asia were tested by enzyme immunoassays (rotavirus, adenovirus) and multiplex reverse transcriptase polymerase chain reaction (norovirus, sapovirus, astrovirus). A modified Vesikari score (MVS) to assess clinical severity was calculated based on symptoms and clinical characteristics.

Results

Among 3,305 viral diarrhea cases, rotavirus had the highest median MVS (9 [interquartile range [IQR: 7,11]) followed by adenovirus 40/41 (8 [IQR]: 6,10]); sapovirus and astrovirus had a similar MVS distribution to norovirus (7 [IQR: 6, 9]). The proportion of patients experiencing > 3 episodes of vomiting was high for those with rotavirus (66.3%) and adenovirus 40/41 (55.7%); astrovirus (40.8%), sapovirus (40.0%), and norovirus (35.9%) patients also experienced substantial episodes of vomiting. A high proportion of cases with adenovirus 40/41 (54.0%) and rotavirus (46.3%) experienced ≥ 7 episodes of diarrhea within 24 hours. While hospitalization or intravenous fluids were required most frequently for patients with rotavirus (42.1%), the proportion was also high in those with adenovirus 40/41 (30.6%).

Conclusion

These findings demonstrate the clinical severity of viral diarrheal pathogens besides rotavirus, in particular adenovirus 40/41, warranting the continued development of vaccines and therapeutics to prevent morbidity and mortality due to viral enteric pathogens.

Disclosures

All Authors: No reported disclosures.
1163. Age, Poverty and Inequity are Key Determinants of Dengue Severity in Colombia
Authors: Acevedo-López Doménica , Cardona-Ospina Jaime A , Molton Mia , Collins Matthew H , Rodríguez-Morales Alfonso J , Álvarez-Amaya Valeria , Díaz-Henao William , Ramírez Daniel , Rojas-Gallardo Diana , Castañeda Camilo
Published: December 2022

Background

Age has been a major risk factor for death and complication due to dengue infection (DENV). Although antibody-dependent enhancement (ADE) has been proposed as an explanation, other variables could shape disease outcomes. We aimed to analyze the role of age as a risk factor for disease severity across departments (ﬁrst administrative level), and epidemic years in Colombia considering poverty and inequity indexes.

Methods

We conducted a retrospective study analyzing DENV epidemiological data from Colombia between 2012 to 2017, and monetary poverty, extreme poverty, and GINI indexes. Total cases, incidence, incidence of severe DENV, mortality, case- fatality rates (CFR), and complication rates (CR) were calculated for each department and year. The effect of age, department, year of infection, monetary poverty, extreme poverty, and GINI on CR and CFR was evaluated by using a generalized additive model.

Results

After adjustment, age (p< 0.001), GINI (p< 0.001), monetary poverty (p< 0.001), and extreme poverty(p< 0.001) indexes were signiﬁcantly associated with the CR, but age was the only variable signiﬁcantly associated with CFR (p< 0.001). Our results revealed a ﬁrst peak of CR in patients younger than 5 years old, the second peak in patients between 27 to 34 years old, and a third peak after 45 years old.

Conclusion

Our work has important implications for future designing of human cohorts analyzing the risk of complications in adults and provides evidence for improving clinical DENV risk assessment. Our ﬁndings are consistent with similar observations linking ADE with severe DENV in childhood and suggest protective antibody decay during adulthood. The interplay of biological and socioeconomic factors shaping clinical outcomes in DENV is complex and should be further analyzed

Disclosures

All Authors: No reported disclosures.
1166. Botulism poisoning fatalities linked to home-canned food products - Tajikistan, 2021
Authors: Shoeva Sakina M , Aminov Safarali , Dzhurakhon Azizov , Horth Roberta , Zhakipbayeva Bakhytkul
Published: December 2022

Background

Botulism is a rare but fatal illness often caused by consumption of foods containing Clostridium botulinum neurotoxins. We investigated an outbreak among people having attended a family dinner in Kushkiya village, Tajikistan in December 2021.

Methods

We interviewed dinner participants using a structured questionnaire to collect clinical, demographic, and prior 48-hour food histories. We abstracted data from medical records. A case was defined as a person who attended the event with symptoms clinically compatible with botulism.

Results

Thirteen people attended the dinner event. Of these, 10 (77%) were classified as a case. Case-patients ages ranged from 2 to 40 years old; five were children < 12 years old. All case-patients had muscle weakness, dizziness, dry mouth, nausea, and vomiting. Two had abdominal pain, five had symmetric paresis, two had shortness of breath, and two had double vision. Median time from dinner event to development of symptoms was 22 hours (range 17-30 hours). Four patients (40%) were hospitalized in serious condition, including two children in comas. Four patients died (40%). Deaths occurred on average 48 hours after the dinner (range 41-55 hours). All ten cases had eaten homemade canned salad. Two other dinner participants ate the canned salad, but did not get sick. The canned salad was made of tomatoes, onions, garlic, and oil. It had been prepared in September 2021. Due to limited capacity for botulism testing in Tajikistan diagnostics were not performed. The infectious disease hospital did not have botulism antitoxin in stock upon patient admission. Deceased patients had not received antitoxin. On the third day after exposure, botulism antitoxin (A, B, C and E) was given to 9 dinner participants; all of whom survived.

Conclusion

The high case fatality rate highlights the need to increase clinician awareness of botulism, educate and improve their ability to provide emergency and respiratory care, and ensure stocks of anti-botulinum serum in health facilities. Additionally, improved national diagnostic capabilities to detect botulism and identify toxin types can help identify sources. Lastly, public health messaging may help increase safe food preparation practices.

Disclosures

All Authors: No reported disclosures.
1173. Increased risk of dementia in patients after Scrub typhus: a nationwide, population-based study in Korea
Authors: Kim Jooyun , Park Dae Won , Seo Gi Hyeon , Jeon Ji Hoon , Seok Hyeri , Choi Won Suk
Published: December 2022

Background

Scrub typhus causes systemic vasculitis and can lead to complications ranging from pneumonia and acute renal injury to meningitis or encephalitis. In South Korea, it occurs not only in rural areas but also in urban areas, and especially high in older people. We hypothesized that patients with scrub typhus are predisposed to increased risks for developing dementia.

Methods

We performed a population-based cohort study, in which persons aged between 60∼89 years, used the Health Insurance Review and Assessment database of South Korea between 2009 and 2018. The case definition of scrub typhus was based on the ICD-10 diagnostic code and prescription of doxycycline more than three days. Dementia was defined as patients with the code in expending benefit coverage or patients with the ICD-10 codes, examination codes and drug codes. The control group was selected as stratifying by age and gender at a ratio of 1:5 to the number of the case group in study population.

Results

During the observational periods, Of 76,073 patients had diagnosed with scrub typhus, 5,026 excluded due to diagnosed with scrub typhus during window period, with dementia or died before index date, 71,047 patients were included as case group. 355,235 patients were included as controls. During a mean follow-up of 5.6±2.9 years, 14,089 (19.8%) patients with previous scrub typhus and 61,807 (15.2%) controls had been developed dementia. Scrub typhus was significantly associated with dementia (adjusted hazard ratio [aHR], 1.12; 95% confidential interval [CI], 1.10-1.15, P< 0.001). Of dementia classification, the risk of Alzheimer dementia was significantly higher in the case group (17.8% vs 15.2%; aHR, 1.15; 95%CI, 1.13-1.18, p< 0.001), however, there was no significant difference in the risk of vascular dementia (2.1% vs 2.2%; aHR, 0.98; 95%CI, 0.83-1.16, p=0.82).

Cumulative incidence of dementia during the follow-up period by the history of scrub typhus

It shows in both groups dementia incidence increased over time and the case group had higher incident dementia compared with control group.

Conclusion

History of scrub typhus infection in elderly was associated with increased risk for dementia, especially Alzheimer’s dementia. Our results suggest that prevent measures of dementia could be improved by preventing and treating scrub typhus.

Disclosures

All Authors: No reported disclosures.
1176. Metagenomic Next-Generation Sequencing of Nasopharyngeal Swabs in Acute Febrile Illness in Cambodia
Authors: Yek Christina , Lay Sreyngim , Chea Sophana , Bohl Jennifer , Oum Mengheng , Ly Sokna , Sath Ratanak , Ahyong Vida , Tato Cristina , Seng Heng , Ly Sovann , Lon Chanthap , Manning Jessica
Published: December 2022

Background

There is growing recognition of metagenomic next-generation sequencing (mNGS) as a valuable diagnostic tool capable of providing unbiased pathogen detection, but data on performance in low-resource settings remains scant. Here, we use mNGS of nasopharyngeal (NP) swabs taken from subjects in Cambodia to identify potential pathogens causing acute febrile illness.

Methods

Febrile subjects aged 2 months to 65 years were enrolled in a cross-sectional study conducted across 4 tertiary hospitals in Cambodia. NP swabs were collected at hospital presentation. Depending on reported symptom constellations, sera was also taken in a subset of subjects for comparison of mNGS results. RNA was isolated from biosamples, converted to cDNA libraries, and sequenced on a NextSeq2000 (Illumina). Raw sequence reads were stripped for host reads and aligned to NCBI nucleotide and protein databases using a cloud-based bioinformatics platform (CZID).

Results

NP swabs were collected from 97 subjects between April 2020 and June 2021. Subjects were predominantly male (53.6%) and young (median age 3 years [IQR 1-25]). Pathogens were identified in 42 (43.2%) NP swabs; of these, 26 (61.9%) were respiratory viruses including 9 rhinovirus, 7 coronavirus (1 SARS-CoV-2), and 5 respirovirus cases. Co-infection was identified in 3 subjects with coronavirus and respirovirus (N=2) and coronavirus and rhinovirus (N=1). Of subjects with paired sera and NP samples (N=61), 18 (29.5%) had positive NP swabs but negative sera, 7 (11.5%) had negative NP swabs but positive sera, 12 (19.7%) had positive NP swabs and sera, and 24 (39.3%) had negative NP swabs and sera. Pathogen hits correlated in NP swabs and sera in 10 of 12 subjects, including six subjects with chikungunya.

Conclusion

mNGS can be successfully implemented in low-resource settings to identify emerging pathogens and common respiratory pathogens, including co-infecting pathogens, from NP swabs of febrile patients. mNGS may also be able to detect chikungunya from NP swab alone, raising the possibility of non-invasive diagnostics for infections associated with high viremic states.

Disclosures

All Authors: No reported disclosures.
1177. Mind the GAPP: Global Arrivals and Pre-treated Patients screening at a children’s cancer center
Authors: Mukkada Sheena , Max Anita , Denzin Tessa , Gadir Ghussai Abd El , Adderson Elisabeth , Hakim Hana , Hayden Randall , Maron Gabriela , Wolf Joshua
Published: December 2022

Background

Clinical and laboratory evaluation for infectious diseases prior to initiation of cancer-directed therapy creates opportunities for risk assessment, infection prevention and targeted treatment. The need may be greater for patients from outside the United States (US) where the epidemiology of infectious diseases may differ. We created the Global Arrivals and Pretreated Patients (GAPP) program to address this need at a referral hospital for children with cancer and blood disorders.

Methods

Patients accepted for treatment at our hospital are referred to GAPP for the following reasons: 1) residence in the continental US for 1 year or less, 2) travel outside the continental US within 3 months of referral 3) hospitalization outside the continental US, or 4) clinician request. GAPP evaluation includes review of history and laboratory studies, and recommendations for screening tests and management.

Results

Between March 21, 2019 and May 2, 2022, 35 patients were evaluated; 9 (26%) with solid or CNS tumors, 25 (71%) with hematological malignancies and 1 (3%) with immune thrombocytopenic purpura. Of these, 20/35 (57%) were from Latin America, and 10/35 (29%) from Eastern Europe. Most patients (29/35 [83%]) were seen within 2 weeks of arrival to the institution. Evaluation prompted isolation precautions in 2/35 (6%) for communicable respiratory illness and in 4/35 (11%) for ESBL-producing organism on perianal screen. Additionally, 13 patients were under-immunized (mostly non-immune to hepatitis B [7/35, 20%] or varicella zoster virus [8/35, 22%]), and 9/35 (26%) had an exposure-related risk. Finally, parasitic infection prompted specific management in 4 patients; 3/35 (9%) had positive serology for Toxoplasma gondii requiring appropriate prophylaxis, and 1/35 (3%) was treated for cryptosporidiosis.

Conclusion

Screening new arrivals to the US prior to administration of immunosuppressive therapy is feasible and may identify risk factors for illness during therapy as well as opportunities for infection prevention, immunization, and treatment or suppression of existing infections. Providers focusing on acute hematologic or oncologic illness may otherwise miss this quality improvement opportunity in a patient group at high risk of poor infectious outcomes.

Disclosures

Randall Hayden, MD, Inflammatix: Advisor/Consultant|Quidel Corporation: Advisor/Consultant|Roche Diagnostics: Advisor/Consultant|T2 Diagnostics: Advisor/Consultant Gabriela Maron, MD, Astellas Inc,: Grant/Research Support|SymBio Pharmaceuticals: Grant/Research Support Joshua Wolf, MBBS, PhD, Karius: Grant/Research Support|Merck: Participation in industry sponsored research.
1178. Opportunities and Challenges to Emergency Department-Based HIV Testing Services and Self-Testing Programs: A Qualitative Study of Healthcare Providers and Patients in Kenya
Authors: Aluisio Adam , Bergam Scarlett , Ogory Agot , Ngila Beatrice , Sugut Janet , Bosire Rose , Bukusi David , Kinuthia John , Guthrie Kate , Katz David , Farquhar Carey , Mello Michael
Published: December 2022

Background

Young people in Sub-Saharan Africa, especially males, have been insufficiently engaged through HIV Testing Services (HTS). In Kenya, younger persons are often treated in emergency departments (EDs) for injuries, an interaction where HTS and HIV self-testing (HIVST) can be leveraged. Data from stakeholders on ED-HTS and HIVST is lacking and needed to understand opportunities and barriers for HIV testing and care, and inform program implementation.

Methods

Between December 2021 and March 2022, 32 in-depth interviews (IDIs) were conducted with 16 male and 16 female patients who had been treated in the Kenyatta National Hospital (KNH) ED, half of whom had been HIV-tested. Six focus-group discussions (FGDs) were also conducted with 50 nurses, doctors, HIV testing counselors, and administrators working in the ED. All transcripts were double-coded and thematically analyzed using Dedoose software and a parallel inductive and deductive coding approach which allowed for capture of both a priori and emergent themes.

Results

Patients and providers agreed that ED-HTS are facilitated by friendly staff, patient education, high perceived HIV risk, and confidentiality. However, ED-HTS is limited by burdens on staff, resources, time, and space, as well as severity of patient injuries limiting ability to consent to or prioritize HIV testing. These limitations provide opportunities for ED-HIVST: particularly the ability to test at a comfortable time and place, especially when provided alongside sufficient HIV and testing education, contact with healthcare providers, and psychosocial support. Barriers for ED-HIVST where identified and as patients’ concerns about HIVST accuracy and mental health impacts of a positive test, as well providers’ identified barriers on their concerns for loss to follow up and inability to complete confirmatory testing.

COM-B Model

Application of the COM-B Model of Behavior Change to ED-HIVST Acceptability in Kenya

Conclusion

ED stakeholders are receptive to HTS and HIVST, and patients desire the opportunity to use HIVST. Potential challenges—such as psychological effects of testing positive, worries about access to follow-up care, and confusion about how to self-administer testing, may be addressed through programming designed to promote education, access and ensure follow-up mechanisms.

Disclosures

All Authors: No reported disclosures.
1188. Efficacy of Copper Impregnated Self-Sanitizing Surface Against Clostridioides difficile Spores
Authors: Ashby Landon , Navarathna Thanuri , Coppin John David , Chatterjee Piyali , Williams Marjory D , Bennett Morgan , Choi Hosoon , Hwang Munok , Xu Jing , Nelson Richard , Allton Yonhui , Jinadatha Chetan
Published: December 2022

Background

Clostridioides difficile (C. diff) is one of the most common causes of healthcare-associated infections (HAIs), leading to increased hospital stay, cost, and mortality. Elimination of C. diff spores is difficult as they are resistant to kill by common hospital grade disinfectants. Copper impregnated self-sanitizing surfaces (SSSCu) provide continuous reduction of vegetative pathogens, potentially lowering the risk of infections, but their efficacy on C. diff spores has not been previously evaluated.

Methods

Control (no copper) and copper coupons containing 20% copper-oxide were inoculated with varying C. diff spore loads ranging from 105 to 107 spores, prepared using environmental protection agency protocol, with or without 5% fetal bovine serum (FBS) soil load. After 4 hours of contact time, the C. diff spores were recovered and tested for viability. The efficacy of copper (log10 kill) was estimated using a Bayesian linear multilevel model.

Results

After 4 hours, the copper coupons, at mean initial spore load (6.67 log10) and no soil load, had a mean 1.21 (95% uncertainty interval: 1.13 - 1.31) log10 reduction compared to control coupons. With soil load, the treatment effect of copper decreased by 0.50 (95% uncertainty interval: 0.37 - 0.64) log10. Also, for each additional standard deviation (SD) increase in initial spore load there was a 0.59 (95% uncertainty interval: 0.47 - 0.72) log10 decrease in the treatment effect of copper. The soil load in combination with increasing initial spore load further decreased the treatment effect of copper by an additional 0.19 (95% uncertainty interval: 0.01 - 0.38) log10 for each SD increase in initial spore load.

Conclusion

Copper coupons can substantially reduce C. diff spores after 4 hours by 50%-97% depending on the initial spore concentration and presence or absence of organic material. Higher initial spore loads or excess organic material may prevent the spores from coming in contact with the copper-impregnated surface thus decreasing the kill efficacy. Continuous sporicidal effect of copper-impregnated surfaces might prevent transmission of spores and help reduce HAIs. Further studies are needed to evaluate the efficacy on C. diff HAI rates.

Disclosures

Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing.
1192. Containment of Sustained Transmission of Drug-resistant Acinetobacter baumannii by Pulsed-Xenon Ultraviolet Disinfection of the Patient Room in the Intensive Care Unit
Authors: Morikane Keita , Yakuwa Jun , Nakane Masaki
Published: December 2022

Background

No-touch environmental disinfection has been highlighted in the last decade to control transmission of multidrug-resistant Gram-positive organisms including MRSA and VRE, but its effectiveness to control gram-negative bacteria has not been well examined. Also, its effectiveness outside the US healthcare setting is seldom reported.

Methods

This study was conducted in the intensive care unit (ICU) of Yamagata University Hospital, a 637-bed tertiary referral hospital. Sporadic acquisition of two drug-resistant Acinetobacter baumannii (2DRA) began in late 2013. Despite various infection control practices including hand hygiene promotion and intensified manual terminal cleaning, transmission of this pathogen continued. In February 2018, pulsed-xenon ultraviolet (PX-UV) disinfection was added. The study periods were defined as follows: the baseline period (August 2016 to January 2018, intensified manual cleaning) and the intervention period (February 2018 to December 2021, addition of PX-UV). Throughout the study periods, all patients were regularly screened for 2DRA to detect acquisition of those pathogens in the ICU.

Results

The incidence of newly acquired 2DRA significantly declined over time (4.45 per 1,000 patient days in the baseline period to 1.20 in the intervention period, relative risk (RR): 0.27, 95% confidence interval: 0.12-0.61). Notably, horizontal transmission of 2DRA was completely contained, not only in the ICU but also throughout the hospital (Figure).

Newly acquired 2DRA events (all wards, monthly)

Conclusion

Adding PX-UV after through manual terminal cleaning is effective in controlling acquisition of 2DRA in the ICU patients and led to termination of transmission of 2DRA in our hospital. The effectiveness of PX-UV in controlling gram-negative MDROs in the non-US healthcare settings is suggested.

Disclosures

All Authors: No reported disclosures.
1201. Reduction of Methicillin-Resistant Staphylococcus aureus Surface Microbial Burden and related Healthcare Associated Infections with the implementation of an Advanced Photocatalytic Oxidation Technology in a Medical-Surgical Intensive Care Unit
Authors: Stowe Caitlin , Lambert Beth Ann , Berthelot Lori , Baumgarten Katherine , Leger Nattie
Published: December 2022

Background

Methicillin Resistant Staphylococcus aureus (MRSA) bacteria have been long established as a major cause of infections. MRSA infections occurring in blood or other sterile sites are associated with poorer health outcomes and an increased risk of mortality, especially when acquired in a healthcare setting. The ongoing COVID-19 pandemic has not only stymied reduction efforts but has precipitated increases in invasive HO-MRSA infections, with increases seen of 12-34% in national MRSA standardized infection ratios in 2020 compared to 2019. The facility had seen similar increases of HO-MRSA infections, defined as a positive culture on or after the 3rd hospital day, despite no change in clinical practice.

Methods

A prospective study was conducted in a 22 bed Medical-Surgical Intensive Care Unit from November 2021 to March 2022. 50 surface samples were collected from surfaces throughout the unit including two nurses’ stations, physician charting area, and 5 areas in 7 patient rooms. The advanced photocatalytic oxidation (aPCO) equipment was then installed in the HVAC ductwork throughout the ICU and activated. Sampling was then repeated every four weeks during the study period. The facility’s normal disinfection protocols were unchanged. HO-MRSA infections attributed to the unit were also tracked during the study period. Changes in MRSA surface burden were calculated using a repeated methods ANOVA with post hoc analyses as appropriate. Rates of HO-MRSA infections per 1,000 patient days were compared using the chi-square test.

Results

There was a 98% statistically significant decrease in MRSA surface burden from the baseline to final post-activation test. The average colony forming unit count (CFU) went from 427 to 3 CFU/100cm2 during the same time. HO-MRSA infections also had a statistically significant decrease when compared to the same time frame a year prior and the immediate 6 months prior to the study. Figure 1Average MRSA Surface Reduction

Conclusion

The aPCO technology resulted in a reduction of MRSA on frequently touched surfaces in a high-traffic ICU. Corresponding decreases in HO-MRSA cases were also seen. This study highlights a novel aPCO technology and its efficacy at reducing microbial burden and healthcare-onset MRSA infections despite no change in practice and through the continued COVID-19 pandemic.

Disclosures

Caitlin Stowe, MPH, CPH, CIC, CPHQ, VA-BC, ActivePure Medical: Employee|PDI Healthcare: Employee.