bluuebunny/crossref_metadata_2025 huggingface dataset:
1626. Group B Streptococcus detection rate and clindamycin resistance among reproductive-age women and early-onset sepsis in neonates in Korea from 2003 to 2022
Authors: Sung Ji-Hee , Kim Doo Ri , Choi Suk-Joo , Oh Soo-young , Kim Yae-Jean , Roh Cheong-Rae , Shin Areum
Published: November 2023

Background

Group B Streptococcus (GBS) is the leading cause of early-onset sepsis (EOS) in neonates and intrapartum penicillin prophylaxis is recommended for pregnant women with GBS colonization to prevent vertical transmission. For pregnant women with penicillin allergy, clindamycin is recommended. In this study, we retrospectively examined the GBS detection rate and clindamycin resistance rate among Korean women of reproductive age and EOS in neonates in the last 20 years from a single center.

Methods

From 2003 to 2022, microbiologic studies on genital/rectal swab pairs from females of reproductive age (15-49 years) were reviewed. Among the total number of tests, the number of GBS positive results were extracted and GBS detection rates per year were calculated. Multiple tests from the same person within a year were counted as once. Among the GBS isolates, the clindamycin resistance rate was calculated. The total study period was divided into two periods (period 1 for 2003-2012 and period 2 for 2013-2022) by 10 years and GBS detection rates and clindamycin resistance rates were compared (Chi-square test). EOS caused by GBS in neonates was investigated among all neonates who received sepsis work-up within 3 days after birth.

Results

For the past 20 years, a total of 14,571 women were tested 16,879 times and GBS was isolated in 1,054 tests (6.2%). GBS detection rate increased from 1.7% (101/6,066) in period 1 to 8.8% (953/10,813) in period 2 (p< 0.001, OR 5.708, 95% CI 4.638-7.025). Among the GBS isolates, clindamycin resistance rates were 29.7% (30/101) in period 1 and 41.1% (392/953) in period 2 (p=0.026, OR 1.654, 95% CI 1.059-2.583).

In a separate database, among 9,280 neonates who underwent blood culture or CSF culture studies within 3 days after birth, 9 patients were diagnosed with EOS by GBS and 4 patients died within 30 days.

Conclusion

Close monitoring is needed on the epidemiology of increasing GBS detection rate and clindamycin resistance rate in GBS isolates from Korean women of reproductive age.

Disclosures

All Authors: No reported disclosures
2077. Utility of a Real-Time Spatiotemporal Mapping Surveillance System in Detection of Healthcare-Associated Acute Respiratory Viral Infection Clusters in a Tertiary Healthcare Institution
Authors: Venkatachalam Indumathi , Philip Edwin , XY Sim Jean , Chow Weien , Cai Yiying , Graves Nicholas , Whiteley Sean , Arora Shalvi , Auw Maybelle , Chuanwen Tiang Daniel , Leng Neo Siow , Meng Cheong Joseph Kin , Wei Hong Wei
Published: November 2023

Background

Transition to endemic COVID-19 has been associated with a rise in community respiratory viral infections (ARIs) with a corresponding increase in healthcare-associated ARIs (HA-ARIs) (Figure 1). 4D-Disease Outbreak Surveillance System (4D-DOSS) is a real-time spatiotemporal mapping surveillance system being developed to detect healthcare-associated infection clusters. We aimed to assess 4D-DOSS’s utility in detection of HA-ARI clusters.

Methods

4D-DOSS is a system that integrates and maps clinical, laboratory and patient movement data onto a digital twin of the hospital’s physical space. In addition to a virtual mapping replica of Singapore General Hospital, a 2000-bedded tertiary hospital in Singapore, it constitutes detailed healthcare cloud architecture and surveillance algorithms.

Respiratory specimens from inpatients with ARI symptoms are tested for 16 human respiratory viral pathogens via a respiratory virus multiplex PCR (RV16) panel. HA-ARI constitutes first positive sample beyond the maximum incubation period of the corresponding virus (from admission date). Earlier positive test is categorized as community-associated ARI (CA-ARI). Two or more patients with spatial temporal overlap of three-days or less, during the infectious period (7-days) of an index patient are deemed a HA-ARI cluster.

Results

Incidence of HA-ARI, as per 10,000 patient-days was 7.4 pre-COVID-19 pandemic (Jan 2018 to Dec 2019), 1.5 during pandemic (Jan 2020 to Dec 2022) and 6.4 during transition to endemicity (Jan 2023 – April 2023). Between September 2018 and December 2018, one influenza cluster of ten inpatients (Nov 2018) was identified in the proof-of-concept version of 4D-DOSS. There were four HA-ARI clusters during the Jan 2020-Dec 2022 COVID-19 pandemic phase. 19 HA-ARI clusters were identified between Jan 2023-April 2023.

Conclusion

4D-DOSS can detect HA-ARI clusters and has potential to trigger an alert-response process for more effective infection prevention. It enables study of infectious disease transmission kinetics in real-time.

Disclosures

Sean Whiteley, BSc (IT), Axomem: Board Member|Axomem: Fees received for service and software licenses Maybelle Auw, MBBS, Axomem: Work for company that received fees for service and licensing
1637. Safety Evaluation of the Novel Oral Polio Vaccine Type 2 during a National Supplementary Immunisation Activity in Uganda, a Multipronged Approach: January–March 2022
Authors: Nsubuga Fred , Gilani Zunera , Tobolowsky Farrell A , Longley Ashley T , Greene Sharon A , Ntale Ismail , Hellen Ndagije , Kisakye Annet , Ampaire Immaculate , Kyabayinze Daniel , Gidudu Jane F
Published: November 2023

Background

Data from clinical trials show that novel oral poliovirus vaccine type 2 (nOPV2) is safe. However, nOPV2 is under emergency use listing, and continued vaccine safety monitoring is required to support licensure and World Health Organization (WHO) prequalification. In January 2022, Uganda introduced nOPV2 in a national supplementary immunization activity (SIA) in response to a circulating vaccine derived poliovirus outbreak, vaccinating 9.8 million children < 5 years old. We sought to identify and characterize safety events following nOPV2 vaccination

Methods

We evaluated the safety of nOPV2 following the SIA in Uganda using a multi-pronged approach: 1) routine passive surveillance for adverse events following immunization (AEFI), 2) active hospital-based surveillance for adverse events of special interest (AESI) 3) active acute flaccid paralysis (AFP) surveillance, and 4) active, cohort event monitoring (CEM) among a nationally representative sample of 2000 households in 200 enumeration areas for 42 days following administration of the nOPV2 vaccine. The national AEFI committee conducted causality assessment for all reported serious AEFI and pre-specified AESI conditions using global guidelines.

Results

During 14 January–11 March 2022, 1,157 adverse events were identified: 43 (3.7%) from passive surveillance, 5 (0.43%) from hospital-based surveillance, 157 (14%) from AFP surveillance, and 952 (82%) from CEM. The most commonly reported adverse events identified through CEM 0-3 days post-vaccination were fever (n=377, 40%), diarrhea (n=147, 15%), and malaise (n=107, 11%). Through all surveillance systems, 171 events underwent causality assessment. Among these 7 (4%) were classified as vaccine product-related reactions (1 acute disseminated encephalomyelitis, 1 encephalitis, 1 fever, 3 gastro-enteritis, and 1 painful lower limbs), 101 (59%) were classified as coincidental events, and 63 (37%) were downgraded.

Conclusion

The majority of identified serious AEFI were classified as coincidental events. No unexpected safety signals were identified among children < 5 years old during the nOPV2 SIA in Uganda. This evaluation provides critical data to contribute to the vaccine’s safety profile and informs recommendations for use, pre-qualification, and licensure.

Disclosures

All Authors: No reported disclosures
1642. Vancomycin AUC24 Estimation Using First Order Pharmacokinetic Methods in Pediatric Patients
Authors: Wallace Katie L , Burgess David , Olney Katie B , Brandon Hope
Published: November 2023

Background

The 2020 guidelines for the monitoring of vancomycin emphasize the importance of timely assessment of AUC24 for both efficacy and safety in pediatric patients. However, real-world data supporting the feasibility of vancomycin AUC24 in pediatric patients using first-order equations is lacking.

Methods

This is a single-center, retrospective cohort study of hospitalized pediatric patients (< 18 years) receiving intravenous (IV) vancomycin between 1/1/2020 and 8/20/2022. Patients were included if they received at least 24 hours of IV vancomycin with peak and trough concentrations obtained in the first 96 hours of therapy. Patients with baseline renal dysfunction were excluded. First-order equations were utilized to estimate Ke, Vd, Cl, and AUC24.

Results

Overall, 219 patients (68% male, 87% Caucasian, 24% critically ill, median age of 6 years (IQR 1-12)) met inclusion criteria. Of the total patients, 9% were neonates (age ≤ 28 days), 11% were infants (age 29 days to < 1 year), 58% were children (age 1 to 12 years), and 22% were adolescents (age 13 to 17 years). The pharmacokinetic parameters for each group are outlined in Table 1. The estimated AUC24 was within the therapeutic range of 400-600 mg*hr/L for the majority of patients. However, when comparing age groups, adolescents had the lowest (53%) while neonates had the greatest (79%) percentage of patients within the therapeutic range

Conclusion

Our results reinforce the variability in vancomycin PK seen across pediatric age groups, confirming the need to tailor empiric dosing regimens by patient age. For patients with AUC24 outside the therapeutic range, more patients had SUPRAtherapeutic rather than SUBtherapeutic AUC24. In response to results of this study, institutional empiric vancomycin dosing will be decreased for all age groups outside the neonatal group to better align with the 2020 guideline recommended AUC24 of 400 - 600 mg*hr/L for pediatric patients.

Disclosures

Katie B. Olney, PharmD, BCIDP, The Society of Infectious Diseases Pharmacists (SIDP): Grant/Research Support
1644. Quantifying Empiric Vancomycin Overuse in Two Tertiary Care Pediatric Intensive Care Units
Authors: Chiotos Kathleen , Newland Jason , Starnes Luke , Meyahnwi Didien , Same Rebecca G , Lautenbach Ebbing , Szymczak Julia E , Gerber Jeffrey S
Published: November 2023

Background

Vancomycin is among the most commonly prescribed antibiotics in US children’s hospitals. When used empirically for sepsis, vancomycin primarily targets methicillin-resistant Staphylococcus aureus (MRSA). We aimed to quantify empiric vancomycin overuse among critically ill children with suspected sepsis.

Methods

We performed a cross sectional study including all episodes of suspected sepsis in two tertiary care pediatric intensive care units (PICUs) between 11/2020 and 10/2022. Suspected sepsis was defined as collection of a blood culture and administration of one or more broad spectrum antibiotics within 12 hours. Episodes with prior broad-spectrum antibiotic use or transfers from an outside hospital within 7 days were excluded, as were episodes occurring within 14 days of a preceding sepsis episode. The frequency of MRSA among episodes of suspected sepsis was calculated based on the results of sterile site, respiratory, and wound cultures collected within 24 hours of the sepsis episode. MRSA history was defined as a positive clinical or screening culture or PCR within 6 months before the suspected sepsis episode. As a secondary analysis, we quantified the frequency of any vancomycin-requiring organism (Table 1).

Results

We identified 1859 suspected sepsis episodes. Of these, 1135 (61%) received empiric vancomycin for a median of 3 days (IQR 2,3). MRSA was identified in 37 (2%) and any vancomycin-requiring organism was identified in 101 (5%). Among 1790 episodes with no history of MRSA, 1080 (60%) received empiric vancomycin and MRSA was identified in 17 (< 1%). MRSA was infrequent in community onset sepsis (21/1324 episodes, 2%) and in patients without central lines (18/1397, 1%) (Table 2). The proportion of episodes receiving empiric vancomycin differed between the two centers (70% vs 44%, P< 0.01), as did the proportion with a history of MRSA (3% vs 5%, P=0.03), whereas identification of MRSA (1% vs 0.9%, P=.77) did not.

Conclusion

Vancomycin was administered to 61% of critically ill children initiated on broad-spectrum antibiotics, but MRSA was identified in just 2%. Reducing empiric vancomycin overuse for community onset sepsis and in patients with no history of MRSA or central venous catheter is an actionable target for antimicrobial stewardship efforts in the PICU.

Disclosures

Jason Newland, MD, Moderna: Grant/Research Support|Pfizer: Grant/Research Support
1651. Utility of Staphylococcus aureus Nares Screening in Hospitalized Children with Osteomyelitis
Authors: Sands Ashley , Iacono Denise E , Hagmann Stefan
Published: November 2023

Background

Antibiotics with activity against methicillin-resistant Staphylococcus aureus (MRSA) are frequently started empirically in children diagnosed with osteomyelitis. At our institution clinicians increasingly obtain at time of admission a PCR-based staphylococcal nares screen (SNS) which can differentiate methicillin-sensitive Staphylococcus aureus (MSSA) and MRSA. We aimed to evaluate the utility of SNS for antibiotic optimization in pediatric inpatients with osteomyelitis.

Methods

A retrospective chart review was conducted of children (< 20 years) admitted for osteomyelitis (January 01, 2021 to December 31, 2022) who had a SNS and a clinical culture (i.e. site of infection or blood) performed as part of their diagnostic work up.

Results

A total of 36 children were included, median age (range) of 8.5 years (0-19). Etiologic diagnosis was established in 52.8% (n=19), most infections were with MSSA (n=12), followed by MRSA (n=4), and MRSA/MSSA (n=1). The prevalence of nasal MRSA and MSSA colonization was 8.3% (n=3) and 47.2% (n=17), respectively. The sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive values (NPV) of the SNS test to predict a MRSA and a MSSA infection were 40.0%, 96.8%, 66.7%, 90.9%, and 75.0%, 66.7%, 52.9%, 84.2%, respectively. When including only patients with site specific cultures (n=25), SE, SP, PPV and NPV of the SNS test to predict MRSA and MSSA infection were 40%, 100%, 100%, 86.9%, and 70%, 60%, 53.8%, 75.0%, respectively. Of those whose SNS test was negative (n=16), infection with MSSA was found in some (n=3) but none had documented MRSA infection.

In about half (15/32, 46.9%) anti-MRSA therapy was discontinued during the hospitalization, de-escalation solely in response to a negative MRSA SNS occurred in some (n=3, 20.0%).

Conclusion

We found that children with osteomyelitis have a disproportionate high rate of nasal colonization with MSSA which was also the primary etiologic cause for the infection in this cohort. The SNS was noted to show a high NPV for MRSA infection which may help encourage clinicians to de-escalate potentially toxic anti-MRSA therapy in a timely fashion, especially in non-critical patients. Further prospective study is warranted.

Disclosures

All Authors: No reported disclosures
1652. Impact of the 2022-2023 Amoxicillin Shortage on Antibiotic Prescribing for Acute Otitis Media: A Regression Discontinuity Study
Authors: Khazanchi Rohan , Brewster Ryan , Butler Alex , O’Meara Daniel , Bagchi Devika P , Michelson Kenneth
Published: November 2023

Background

On October 28th, 2022, the U.S. Food and Drug Administration (FDA) announced a national shortage of amoxicillin powder for liquid suspension. The extent to which drug shortages affect prescribing patterns has been poorly described. To characterize the causal impact of the amoxicillin shortage, we performed a quasi-experimental analysis of antibiotic prescribing for uncomplicated acute otitis media (AOM).

Methods

We retrospectively analyzed encounters for children < 18 years old diagnosed with AOM from May 15th, 2022 to April 14th, 2023 at an urban children's health system. Exclusion criteria included a prior episode of AOM within 30 days, presence of concomitant respiratory infections (sinusitis, pharyngitis, pneumonia, and conjunctivitis), and penicillin or amoxicillin allergy. We used a sharp regression discontinuity design with logistic regressions to evaluate the causal impact of the FDA shortage on the odds of being prescribed amoxicillin, amoxicillin-clavulanate, cefdinir, other antibiotics, or no antibiotic.

Results

We identified 3076 encounters with 1677 (54.5%) occurring after the amoxicillin shortage (Table 1). The mean patient age was 4.1 years (SD 3.5), and most patients were male (n=1695, 55.1%), Hispanic (n=1252, 40.7%), and seen in the emergency department (n=1900, 61.8%). The most prescribed antibiotics were amoxicillin (n=1662, 54.0%), amoxicillin-clavulanate (n=671, 21.8%), and cefdinir (n=263, 8.6%).

The odds of being prescribed amoxicillin decreased by 91% after the FDA shortage declaration (OR 0.09 [95%CI 0.07-0.12]) (Fig. 1A). The odds of being prescribed amoxicillin-clavulanate or cefdinir increased 7-fold and 9-fold (7.90 [5.59-11.31] and 9.25 [5.27-17.17]), respectively (Fig. 1B/1C). Management without antibiotics (0.82 [0.55-1.23]) and prescriptions for other antibiotics (1.73 [0.96-3.19]) did not significantly change (Fig. 1D/1E).Table 1.Encounter Characteristics for Patients Diagnosed with Acute Otitis Media During the Pre-Shortage (May 15, 2022 - October 27, 2022) and Shortage (October 28, 2022 - April 14, 2023) PeriodsFigure 1.Regression Discontinuity Plot of Antibiotic Prescriptions Before and After the FDA Amoxicillin Shortage Declaration (October 28, 2022).

Conclusion

The amoxicillin shortage had an immediate, sweeping impact on prescribing patterns. To mitigate future clinical, economic, and antimicrobial resistance consequences, the FDA should increase oversight of manufacturers responsible for critical medications, require supply issue resolution timelines, and incentivize antibiotic production to mitigate their low profitability.

Disclosures

Kenneth Michelson, MD, Moderna: Stocks/Bonds|Pfizer: Stocks/Bonds
1659. Prokinetic Antibiotic Agents in the Neonatal Intensive Care Unit: Ripe for Antibiotic Stewardship Efforts!
Authors: Magers Jacqueline , Prusakov Pavel , Storey Michael , Sanchez Pablo J J
Published: November 2023

Background

Intolerance to enteral nutrition among infants in the neonatal intensive care unit (NICU) may lead to the use of prokinetic agents to improve gastric emptying and feeding tolerance. Two such oral prokinetic agents are erythromycin and amoxicillin-clavulanate that have been used in cases of dysmotility due to intestinal failure. However, dosing strategies vary and the recommended duration of therapy has not been determined. Moreover, the use of these oral antibiotics in the NICU may fall under the radar of neonatal antimicrobial stewardship programs. Our objective was to quantify their use in the Level 4 outborn NICU at Nationwide Children’s Hospital, Columbus, OH in order to inform antibiotic stewardship efforts.

Methods

This was a retrospective cohort study of all infants who received enteral erythromycin or amoxicillin-clavulanate in the NICU. The number of doses of each antibiotic was obtained from the Nationwide Children’s Hospital Pharmacy database. Pertinent clinical, laboratory, and outcome data were obtained.

Results

From January 1, 2022 to April 30, 2023, 15 infants in the NICU received ≥1 dose of erythromycin ethylsuccinate and 19 infants received ≥1 dose of amoxicillin-clavulanate enterally. Erythromycin was always used to improve motility while amoxicillin-clavulanate served as a prokinetic agent in 53% of infants in whom it was prescribed. Demographics and reason for initiation are provided in Table 1. The median (IQR) doses per patient for erythromycin was 64 (28, 125; dosing interval varied from every 6 to every 8 hours) and for amoxicillin-clavulanate was 50 (9, 105) doses per patient (majority of doses were given on a BID schedule).

Characteristics of infants who received prokinetic agents in the NICU

Conclusion

Enteral erythromycin and amoxicillin-clavulanate have not been the target of antimicrobial stewardship programs. These antibiotics may contribute to dysbiosis and adverse events in NICU infants. An automatic stop time with a time-out when ordered in the electronic health record may be a viable strategy to reduce overutilization of these antibiotics.

Disclosures

Pavel Prusakov, PharmD, Merck & Co: Grant/Research Support|Merck & Co: Employee Michael Storey, PharmD, MS, CSL Behring: Advisor/Consultant|Sarepta Therapeutics: Advisor/Consultant
1682. Clinical Characteristics and Outcome of Acinetobacter Bacteremia in Children
Authors: Gashgarey Deema , Alsuhaibani Mohammed , Alhajjar Sami , Alyabes Ohoud Abdulrahaman , Alhuthil Raghad
Published: November 2023

Background

Acinetobacter is a gram-negative bacterium that can cause several infections, particularly in hospitalized and immunocompromised patients. Invasive Acinetobacter infection in pediatrics can lead to significant morbidity and mortality. This study aims to investigate Acinetobacter bacteremia clinical characteristics and outcome in pediatric patients.

Methods

This is a retrospective study conducted in a tertiary-care center in Riyadh, Saudi Arabia, including pediatric patients (0-14 years) with a confirmed blood culture of one of the Acinetobacter species from January 2015 to December 2022. Medical charts were reviewed for demographics, clinical data, and outcomes. IRB approval number (2231132).

Results

Forty-two pediatric patients with Acinetobacter bacteremia were identified. The median age was 10.5 [interquartile range (IQR): 2-48] months, and 25 (59.52%) were males. Over half of the episodes were hospital-acquired infections 26 (61.90%). The most reported subspecies were Acinetobacter calcoaceticus–Acinetobacter baumannii complex 34 (81.13%), then Acinetobacter lwoffii 4 (9.52%). Polymicrobial infection was found in 15 patients (35.71%), most commonly Enterococcus faecalis 4 (26.67). The antimicrobial susceptibility showed that all isolates were susceptible to Colistin, and (68%) to Cefepime and Meropenem. Most of the patients were previously hospitalized 32 (76.19%), exposed to antimicrobial therapy 26 (61.90%), and underwent invasive procedures 23 (54.76%) one month prior to the bacteremia episode. The median duration of treatment was 15 days [IQR: 12-21]. Two patients (4.76%) had relapse (while on treatment), and two (4.76%) had recurrent infection. The overall 14-day crude mortality rate was (11.90%). Interestingly, non-survivors were significantly younger than survivors (median age: 2 [IQR: 1-2] vs. 18 [IQR: 3-48] months respectively.

Conclusion

Acinetobacter spp. are important emerging nosocomial pathogens. Most of the mortalities were associated with younger age. Previous hospitalization, prior antimicrobial therapy, and invasive procedures were common features for mortality in this study. Further multi-centers studies might be needed to investigate the mortality related risk factors.

Disclosures

All Authors: No reported disclosures
1686. Bacteremia associated with intravascular catheter colonization with Gram-negative rods in children
Authors: Hisano Hina , Shoji Kensuke , Matsui Toshihiro , Kato Hiroki , Fukui Kana , Kano Motohiro , Yamada Yuji , Gocho Yoshihiro , Ishiguro Akira
Published: November 2023

Background

Patients with Staphylococcus aureus colonization of an intravascular catheter, but without bacteremia, had a 14% chance of developing subsequent S. aureus bacteremia after removing the central venous catheter. However, information on the frequency and outcomes of subsequent bacteremia due to Gram-negative rods (GNRs) is limited, particularly in children.

Methods

We conducted a single-center, retrospective, case-control study. Clinical information including age, sex, immune status, bacterial culture results from both catheter tips and the blood, and outcomes were extracted from electronic medical records. Patients were included if the central venous catheter tip culture was positive for GNRs, but the concurrent blood culture (within one day before or after catheter removal) was negative. Subsequent bacteremia was defined as bacteremia caused by the same organism(s) as the catheter tip culture within six months of catheter removal. Clinical characteristics were compared between patients with and without subsequent GNR bacteremia.

Results

During the study period, 49 cases < 18 years of age that were positive for central venous catheter tip culture but negative for concurrent blood cultures were identified. Median (interquartile range) age was 0 (0-4.5) years and male sex was 44.9%. Pseudomonas aeruginosa was the most common isolate (n=18, 36.7%), followed by Escherichia coli (n=8, 16.3%) and Klebsiella spp. (n=8, 16.3%). Subsequent GNR bacteremia developed in 6 (12.2%) patients. The median (range) days between catheter removal and the occurrence of subsequent GNR bacteremia was 16.5 (3-35) days. The median age and the proportion of immunocompromised cases were higher in patients with subsequent bacteremia than in those without subsequent bacteremia (8 years vs 0 years, P=0.011 and 6 [100%] vs 21 [48.8%], P=0.027, respectively). The presence of antibiotic treatment at catheter removal was similar between these two groups (n=4 [66.7%] vs n=25 [58.1%], P=1.0).

Conclusion

The frequency of subsequent GNR bacteremia in children was 12.2%. Immunocompromised patients may be at higher risk for developing subsequent GNR bacteremia.

Disclosures

Kensuke Shoji, MD, PhD, AstraZeneca K.K.: Honoraria|Gilead Sciences, Inc.: Honoraria|KYORIN Pharmaceutical Co.,Ltd.: Honoraria|Meiji Seika Pharma Co., Ltd.: Honoraria|Nippon Becton Dickinson Company, Ltd.: Honoraria|Novartis Pharma Co., Ltd.: Honoraria|Viatrs, Inc: Honoraria
1714. Incidence of Sexually Transmitted Infections in Youth with HIV Pre-COVID and COVID Era
Authors: Khan Firdous , Loerinc Leah , Scheel Amy , Gillespie Scott , Camacho Andres
Published: November 2023

Background

Adolescents and young adults (AYAs) living with HIV have high rates of co-sexually transmitted infections (STIs). During the COVID pandemic, STI prevention strategies including access to testing and treatment facilities, availability of public health practitioners and healthcare workers, and condom availability may have decreased. The aim of this study was to determine if differences in STI incidence for first infection and re-infection existed between the pre-COVID and COVID eras in a cohort of AYAs living with HIV in Atlanta, GA.

Methods

Retrospective chart review was conducted for all patients aged 13-24 at the Grady Ponce and Family Youth Clinic in Atlanta, GA. Two eras were identified: a pre-COVID era from 1/1/2009 – 12/31/2019 and a COVID era from 1/1/2020 – 6/30/2021. Patients could be followed in both eras, where follow-up for first and recurrent STI incidences were reinitiated at the start of the COVID era. STIs recorded included gonorrhea, chlamydia, human papillomavirus, syphilis, trichomonas, herpes simplex virus, lymphogranuloma venereum, hepatitis C, bacterial vaginosis, and chancroid. First and recurrent incidence rates for any STIs were reported.

Results

Our sample included 766 sexually active AYAs with HIV. The mean age of first observation was 18.91 (±2.86) years. 72.3% of our patients were male and 90.7% were black. 721 patients were included in the pre-COVID era and 583 (80.9%) had at least one STI. 337 patients were included in the COVID era, and 158 had at least one STI (46.9%). The overall first STI incidence rate increased from 42.47 to 58.67 per 100 person-years from the pre-COVID to the COVID era (p< 0.001). Gonorrhea, trichomonas and syphilis had significantly higher rates during the COVID era (Table 1). The recurrent STI incidence rate for any STI also significantly increased from 121.50 to 169.85 per 100 person-years (p< 0.001) (Table 2).

Conclusion

Our study demonstrated significantly higher incidence rates of first and recurrent STIs in AYAs living with HIV in the COVID era compared to the pre-COVID era. Reallocation of resources during pandemics should emphasize continuation of existing STI prevention programs to avoid secondary clinical and economic adverse effects of increased infections.

Disclosures

All Authors: No reported disclosures
1744. Next generation sequencing (NGS) optimization of Oral Polio Vaccine samples
Authors: Carrington Yuan J , Zhou Frank , Tzou Philip , Xiao Mingze , Leary Sean , Altamirano Jonathan , Maldonado Yvonne A
Published: November 2023

Background

As wild poliovirus is eradicated, preventing circulation of vaccine-derived poliovirus is top priority. Our lab developed real-time multiplex PCR and deep sequencing methods to detect and characterize OPV strains directly from stool samples. This method requires gel purification of PCR product created from viral RNA in stool samples. However, gel purification causes significant genetic material loss and is time consuming. Here, we explore combinations of different purification and NGS methods to optimize sequencing.

Methods

554 OPV positive samples from a previous study were used. 991 isolates were identified: 268 serotype 1 (S1), 405 serotype 2 (S2), and 318 serotype 3 (S3). PCR amplicons created from viral RNA in stool were run through a 0.08% agarose gel to identity presence of the ∼3.5kb amplicon of interest. Amplicons then underwent 1 of 4 purification methods (Table 1) with those yielding DNA >10ng/ul sequenced using 1 of 2 NGS techniques (Miseq vs Nextseq).

Different Purification Methods Used Prior to NGS

Results

Gel purification: 42/126 (33.3%) S1 and 45/121(37.2%) S2 banded amplicons had a DNA concentration of >10ng/ul, as required for NGS. DNA purification: 449/450 (99.8%) S2 (259 banded) and all 318 (100%) S3 (170 banded) amplicons had concentrations >10ng/ul. S1 (n=145) samples had a higher mean coverage (MC) of 2850.02 than S2’s (n=208) MC of 792.56 and S3’s (n=217) MC of 256.78. Also, Nextseq (n=315) had a higher MC of 1486.78 than Miseq’s (n=255) MC of 648.99. Table 2 shows the MC for each purification and NGS method grouping and Graph 1 shows each grouping’s sample Ct value graphed against MC. 5/71 (7%) non-banded amplicons yielded sufficient sequencing coverage. There was a negative correlation between increasing Ct and coverage and a weak positive correlation between DNA concentration and coverage.

Coverage of OPV Positive Samples by Purification and NGS Methods

Ct Value Against Mean Coverage of Samples by Serotype and Purification and NGS Method Groups

Conclusion

DNA-purification methods (DPM) retain more DNA than gel-purification methods (GPM), therefore capturing a wider range of data. GPM may cause data loss and misrepresentation from reduction of sample size and variety, particularly of samples for within host variation analysis. However, the DNA retained via DPM were not OPV-specific, causing a need for a higher amplicon input volume to than GPM for the same coverage. DPM of band-producing samples with a Ct value of < 34 followed by Nextseq may be most optimal for NGS.

Disclosures

Yvonne A. Maldonado, MD, Pfizer: Grant/Research Support|Pfizer: Site Investigator, DSMB member
1745. Respiratory Syncytial Virus Surveillance of Child Care Attendees, Family Members, and Child Care Providers
Authors: Chedid Khalil , Shope Timothy , Hashikawa Andrew , Wang-Erickson Anna , Williams John V , Martin Emily T
Published: November 2023

Background

Respiratory syncytial virus (RSV) is a leading cause of severe respiratory illness among young children. In the U.S., a third of these children attend child care centers (CCC), where RSV can spread rapidly and be transmitted to family members. The study objective was to determine the incidence of RSV in CCC attendees and their household contacts.

Methods

The prospective cohort enrolled students (< 6 years old), their household contacts and child care providers (CCP) at six CCC in Ann Arbor, MI from May 2021 to March 2022. Participants completed a symptom diary and weekly nasal swabs. RT-PCR was used to detect RSV. Incidence rates were calculated using Poisson regression.

Results

A total of 2,342 swabs were collected during 19,121 person-days from 32 students, 13 household child contacts (7 of whom were also students), 45 household adult contacts, and 10 CCP. The incidence rates per 10,000 person-days (95% CI) for total vs. asymptomatic cases were 10.2 (4.2, 24.5) vs. 2.0 (0.3, 14.5) for students, 8.4 (2.1, 33.7) vs. 4.2 (0.6, 30.0) for child contacts, and 5.4 (2.2, 12.9) vs. 1.1 (0.2, 7.6) for adult contacts, respectively. Twelve people tested positive for RSV: 5 (15.6%) were students, 2 (15.4%) were child contacts, 5 (11.1%) were adult contacts, and none were CCP. Semiquantitative cycle threshold was comparable between samples from asymptomatic and symptomatic cases. Three students, 1 child contact and 3 adult contacts had serial positive swabs for a single illness. Asymptomatic cases were detected in 1 (20%) student, 1 (20%) adult contact, and 1 (50%) child contact. Suspected transmission events were observed in 3/24 (12.5%) households with documented infection. All cases were detected between 9/6/21 and 1/17/22, coinciding with RSV circulation in Michigan during the study period.

Conclusion

This study demonstrates the continued presence of RSV in CCC, including during times of increased disease mitigation, and transmission between children and household contacts may have occurred. Asymptomatic infection was detected, albeit at lower rates than symptomatic infections. Given the incidence of RSV detected, our findings underscore the importance of implementing additional surveillance and infection prevention policies in CCC to mitigate the impact of RSV on vulnerable populations.

Disclosures

Khalil Chedid, MPH, MD, PHD, Merck: Grant/Research Support Timothy Shope, MD MPH, Merck: Grant/Research Support Andrew Hashikawa, MD, Merck: Grant/Research Support Anna Wang-Erickson, PhD, Merck: Grant/Research Support John V. Williams, MD, Merck: Grant/Research Support|Quidel: Board Member Emily T. Martin, PhD, MPH, Merck: Grant/Research Support
1749. Clinical Characteristics and Enteric Viral Detection Among Children with One Vomiting Episode in the Absence of Diarrhea
Authors: Johnson Jacob D , Amarin Justin Z , Stopczynski Tess , Hayek Haya , Qwaider Yasmeen Z , Hamdan Olla , Stewart Laura S , McHenry Rendie , Hall Aron J , Payne Daniel C , Wikswo Mary , Dunn John R , Spieker Andrew J , Chappell James , Halasa Natasha B
Published: November 2023

Background

Clinical presentations and etiologies of acute gastroenteritis (AGE) are variably captured by current definitions. Nonspecific presentations of AGE, such as a single vomiting episode within 24 hours without diarrhea, are common. We described clinical characteristics and viral detection among children presenting with one vomiting episode without diarrhea, comparing them to those presenting with multiple episodes or those who were asymptomatic.

Methods

We conducted population-based surveillance of children presenting to Monroe Carell Jr. Children's Hospital at Vanderbilt as part of the New Vaccine Surveillance Network (12/01/2012–01/30/2016). Eligible children were aged >14 days and < 18 years, had ≥1 vomiting episode or ≥3 episodes of loose stool within 24 hours, and presented within 10 days of symptom onset. Additionally, we recruited asymptomatic children and collected stool samples within 5 days of enrollment. We tested stool samples by enzyme immunoassay for rotavirus and by reverse transcription polymerase chain reaction assays for rotavirus (confirmatory), norovirus, sapovirus, and astrovirus. We restricted our analysis to children without diarrhea. For comparisons, we used Pearson’s χ2 test and the two-sample t-test with unequal variances for categorical and continuous variables, respectively.

Results

Our final study population included 180 children with one vomiting episode, 853 children with multiple episodes, and 1,255 asymptomatic children. Demographic and clinical characteristics of the children are compared in Table 1. At least one virus was detected in 32 children with one vomiting episode (17.8%; reference), 364 children with multiple episodes (42.7%; p < 0.001), and 212 asymptomatic children (16.9%; p = 0.77). Norovirus was the most common virus detected across all three groups, and children with one vomiting episode were more likely to present with fever than those with multiple episodes.

Table 1

Clinical characteristics and viral detection among children presenting with one vomiting episode without diarrhea, those presenting with multiple episodes without diarrhea, and those who were asymptomatic.

Conclusion

Viral detection in children presenting with one vomiting episode was comparable to that in asymptomatic children and considerably less frequent than in children with multiple vomiting episodes. Our findings suggest that one vomiting episode without diarrhea is not a comparatively strong indicator of viral acute gastroenteritis.

Disclosures

Natasha B. Halasa, MD, MPH, Merck: Grant/Research Support|Quidell: Grant/Research Support|Quidell: donation of kits|Sanofi: Grant/Research Support|Sanofi: vaccine support
1766. An Integrated Infectious Disease and Critical Care Staffing Model for Clinical Care of Special Pathogens
Authors: Busch Lindsay M , Harris Gavin , Ockers Sandy , Kraft Colleen S
Published: November 2023

Background

The Serious Communicable Diseases Unit (SCDU) at Emory University Hospital (EUH) is a special pathogen treatment biocontainment unit. Medical care is led by Infectious Disease (ID) specialists with an interdisciplinary group of nurses, infection preventionists, laboratorians, and consultants. In the 2014 Ebola Virus Disease (EVD) outbreak, the SCDU treated four EVD patients, one critically-ill requiring mechanical ventilation and dialysis. Critical care (CC) services were provided through consultation by CC staff, requiring just-in-time (JIT) training in high-level personal protective equipment (PPE) and real-time adaptation of standard operating procedures (SOPs) to meet biocontainment needs. The care provided was successful: all patients survived and no serious PPE breaches or provider exposures occurred. However, these events revealed the need for a comprehensive plan for SCDU CC services.

Methods

SCDU-CC physician liaison and lead advance practice provider (APP) positions were created to implement SCDU CC in conjunction with the Emory Critical Care Center (ECCC). Previous CC services were reviewed and revised.

Results

An integrated staffing model of ID-CC co-management was proposed. CC provider roles were codified: participate in regular high-level PPE training/verification and procedural simulation; attend quarterly interdisciplinary trainings and monthly provider meetings; maintain high quality patient care per ECCC standards. Following unit activation, the SCDU-CC liaisons and lead APP construct a JIT CC schedule. APPs provide 24hour in-house coverage in 12hour day/night shifts. Depending on patient number/acuity, physician coverage consists of in-house day coverage with night home call or 12hour day/night shifts. CC co-manages with the ID physician.

Conclusion

CC delivery in the SCDU has been improved after 2014. CC services were previously deployed ad hoc, with simultaneous need for JIT high-level PPE training of new personnel, urgent patient assessment, and modification of SOPs for biocontainment. We developed an integrated staffing model to provide ID-CC co-management within the SCDU.

Disclosures

All Authors: No reported disclosures
2883. Comparative outcomes following Candida bloodstream infections in patients with left ventricular assist devices (LVAD)
Authors: Mansoor Armaghan-e-Rehman , Krishnan Gayathri , Zuniga-Moya Julio C , Sinclair Dorothy , Spec Andrej , George Ige
Published: November 2023

Background

Left ventricular assist devices (LVAD) are an important management strategy for end-stage heart failure, however they carry a risk of infection. This study examines attributable outcomes of LVAD presence in patients presenting with Candida bloodstream infection (Candidemia).

Methods

1233 patients with candidemia admitted to Barnes Jewish Hospital between January 2010-December 2021 were retrospectively included, of whom 39 had an LVAD at the time of infection. Demographics, comorbidities, microbiologic data, and risk factors for infection were analyzed. Outcome measures included 30 and 90-day mortality, need for mechanical ventilation, and dialysis. Risk factors for candidemia, and outcomes following infection were compared between patients with and without LVAD presence.

Results

Candidemic patients in the LVAD cohort were more likely to be male (77%) compared to the non-LVAD group (54%) (Table 1). Patients with an LVAD were more likely to have central venous access (p-value 0.04), and to have received extracorporeal membrane oxygenation (ECMO) prior to infection (67% vs 46%, p-value=0.01). There were no statistically significant differences in rates of parenteral nutrition, abdominal surgeries, liver disease or malignancies between the two cohorts. C. parapsilosis was the most common causative species in patients with LVAD (38% in LVAD group vs 16%) followed by C. albicans compared to the non-LVAD cohort (24% in LVAD group vs 39%). Patients in both groups had similar rates of mechanical ventilation, and hemodialysis need. HeartMate2 was the most common LVAD strategy in 21 patients (54%). Two patients required LVAD exchange as part of treatment.

Presence of an LVAD did not significantly impact 30-day (31% in LVAD group vs 35%, p-value=0.62) or 90-day mortality (38% in LVAD group vs 41%, p-value 0.77). Within the LVAD cohort, 90-day mortality was associated with a shorter time duration from LVAD placement to candidemia.

Conclusion

In patients presenting with Candidemia, presence of an LVAD did not impact 30 or 90-day mortality. A shorter time from LVAD placement to infection was associated with poorer outcomes.

Disclosures

All Authors: No reported disclosures
1787. Association of Lifestyle Factors with Sepsis Incidence: A Population-Based Cohort Study in South Korea
Authors: Lee Eun Hwa , Lee Kyoung Hwa , Han Kyung-Do , Song Young Goo , Hoon Sang
Published: November 2023

Background

Sepsis, a critically-ill syndrome that can cause damage to multiple organs, is a leading cause of death worldwide with significant healthcare costs. However, there was no large-scale study to evaluate the association of daily modifiable lifestyles with the risk of sepsis, which will be very important that the occurrence of sepsis can be sufficiently prevented by individual volition and effort.

Methods

A retrospective population-based cohort study was performed to assess the association between the incidence rate (IR) of sepsis and alcohol consumption, tobacco smoking, and physical activity. Clinical data from health checkup arranged by the Korean National Health Insurance System (NHIS) were obtained from individuals 20 years or older in 2009 (n=4,234,415). The final 3,837,953 patients were analyzed, excluding personnel with sepsis during the 1 year before and after the checkup and patients with missing data. The NHIS claim data of all patients in the cohort were followed up until December 31, 2019. The primary outcome was the occurrence of sepsis as defined by the ICD-10 codes (A02, A32, A40, A41, A42, B37, R57, and R65). Lifestyle factors were collected through health-related behavior questionnaires in the health checkup.

Results

During a median 9.32 years of follow-up, 78,188 sepsis cases were identified. The multivariate model, which adjusted for age, socioeconomic status, body mass index, diabetes mellitus, hypertension, and dyslipidemia, revealed that smoking was independently associated with a higher risk of developing sepsis in both male (adjusted hazard ratio: 1.29, 95% confidence interval: 1.26-1.32, P< 0.0001) and female (1.48, 1.40-1.56, P< 0.0001). Heavy drinking was associated with a higher IR in female (1.33, 1.18-1.51. P< 0.0001), but a lower IR in male (0.95, 0.92-0.97, P< 0.0001). The individuals who engage in regular exercise have a lower risk of developing sepsis in both male (0.94, 0.92-0.96, P< 0.0001), and female (0.89, 0.86-0.91, P< 0.0001) compared to those who reported physical inactivity.

Conclusion

This study suggests that lifestyle factors such as smoking, drinking, and regular exercise may play a role in the incidence of sepsis, and that modifying these factors may have potential benefits for preventing or reducing the incidence of sepsis.

Disclosures

All Authors: No reported disclosures
1789. Comparison of influenza vaccine effectiveness estimates from the US Influenza Vaccine Effectiveness Network and Electronic Health Record Source Population Data, 2021-2022
Authors: McLean Callie , Chung Jessie R , Gaglani Manjusha , Nowalk MaryPatricia , Martin Emily T , Tartoff Sara , Wernli Karen , Belongia Edward , Grijalva Carlos G , Flannery Brendan
Published: November 2023

Background

The COVID-19 pandemic led to increased respiratory viral testing for patients presenting with acute respiratory infection (ARI). Electronic health record (EHR) data from these visits can be used to assess influenza and COVID-19 vaccine effectiveness (VE). We compared VE data from participating healthcare institutions with VE against medically attended influenza among systematically tested patients actively enrolled in the US Flu VE Network.

Methods

During the 2021-2022 influenza season, seven sites in the US Flu VE Network identified medically attended episodes of ARI in ambulatory settings based on ICD-10 diagnostic codes and clinical influenza and SARS-CoV-2 testing. Influenza status was determined from the clinical test results. Vaccination status was extracted from the EHR. During the same period, patients with ARI presenting at ambulatory clinics were actively enrolled and tested for influenza. VE and 95% confidence intervals (CI) were estimated comparing the odds of vaccination among influenza-positive versus influenza-negative patients using logistic regression models controlling for age, site, and calendar time.

Results

During the 2021-2022 season, 220,162 medical visits for ARI with clinical testing were identified; 2% of tests were influenza positive, 26% were SARS-CoV-2 positive and 73% were negative for both. Overall, 34% of influenza positive and 42% of influenza negative patients had received influenza vaccines; VE using EHR data was 34% [95% CI 29-38]. Among 6,260 enrolled patients, 7% tested positive for influenza, 34% were SARS-CoV-2 positive and 62% were negative for both. Overall, 42% of influenza positive and 59% of influenza negative patients had received influenza vaccines. VE using enrolled patient data was 36% [95% CI 20-49]. VE using EHR data was 35%, 34%, and 6% for patients aged 6 months-17 years, 18-49, and 50+ years versus 40%, 32%, and 10% for enrolled patients.

Conclusion

EHR based influenza VE estimates were similar to estimates from the US Flu VE study. Through continued widespread clinical testing, EHR-based platforms may present opportunities to assess VE in sub-groups with insufficient sample size in active surveillance.

Disclosures

MaryPatricia Nowalk, PhD, RDN, Merck & Co.: Grant/Research Support|Merck & Co.: Honoraria|Sanofi: Grant/Research Support Emily T. Martin, PhD, MPH, Merck: Grant/Research Support Edward Belongia, MD, Seqirus: Grant/Research Support Carlos G. Grijalva, MD, MPH, AHRQ: Grant/Research Support|CDC: Grant/Research Support|FDA: Grant/Research Support|Merck: Advisor/Consultant|NIH: Grant/Research Support|Syneos Health: Grant/Research Support