bluuebunny/crossref_metadata_2025 huggingface dataset:
2120. Respiratory Viral Infections in Patients with Hematologic Malignancies
Authors: Cardenas Jorge Luis , Raja Mohammed , Camargo Jose F , Morris Michele I , Natori Yoichiro
Published: December 2022

Background

Respiratory virus infections (RVI) are an important cause of pneumonia with increased risk of morbidity and mortality in patients with hematologic malignancies (HM) especially after stem cell transplantation. However, data on RVI in this population without stem cell transplant is still lacking. Here we aim to look at trends of RVI in HM population.

Methods

We conducted a retrospective cohort study of adult patients with HM diagnosed with RVI at our institution. We analyzed data from multiplex qualitative PCR-based respiratory viral panel (RVP) samples taken from January 2016 to June 2020. Lower respiratory tract infection (LRTI) was defined as abnormal chest radiography with positive RVP.

Results

Fifty-seven unique episodes were analyzed out of 54 patients. Thirty (52.6%) were females and the most common underlying malignancy was Non-Hodgkin’s Lymphoma (21, 36.8%). Median age was 61 (range 23-92) years old and 44/57 (77.1%) patients received chemotherapy within 30 days prior to RVI. Patient characteristics are summarized in Table 1. Most common viruses included Rhinovirus/Enterovirus (25, 43.8%), Influenza A/B (14, 24.5%) and RSV A/B (7,12.2%), respectively. Out of 39 patients who underwent chest imaging, 13/39 (33.3%) had evidence of LRTI. Out of 45 cases diagnosed as outpatients, 11/45 (24.4%) required hospital admission. ICU admission and mechanical ventilation were required in 5/57 (8.7%) and 2/57 (3.5%), respectively. Bacterial and fungal co-infection were seen in 1 (Pseudomonas spp) and 3 (Aspergillus spp.), respectively. Of note, only 1/57(1.8%) died at 30 days after RVI diagnosis.

Conclusion

Only one third developed LRTI after RVI in HM patients with very low 30-day mortality. However, we still found several bacterial and fungal co-infections. Thus, adequate diagnosis for RVI and co-infections with proper treatment should be required. Further studies with larger sample size are still needed.

Disclosures

All Authors: No reported disclosures.
2122. The Impact of HHV-6 DNAemia on hematopoietic cell transplant (HCT) recipients at high risk for CMV reactivation in the era of Letermovir
Authors: Srinivasan Krithia , Spallone Amy , Khawaja Fareed , Sassine Joseph , Aramburo Oscar Morado , Febres-Aldana Anthony J , Rondon Gabriella , Ramdial Jeremy , Shpall Elizabeth , Ariza-Heredia Ella , Chemaly Roy F
Published: December 2022

Background

Letermovir (LTV) has reduced non-relapse mortality (NRM) in allogeneic hematopoietic cell transplant (allo-HCT) recipients by reducing the rate of clinically significant cytomegalovirus infections (CS-CMVi). The impact of LTV prophylaxis (PP) on other infections is unclear. We investigated the effects of LTV on human herpes virus 6 (HHV6) DNAemia in HCT recipients with or without CS-CMVi and studied the interaction of HHV6 DNAemia with CS-CMVi and its impact on NRM.

Methods

We performed a single center, retrospective cohort study from March 2016 to December 2018 of consecutive allo-HCT recipients who are CMV recipient seropositive (R+) with or without LTV prophylaxis. Baseline characteristics and infectious complications data were collected. Outcomes of interest was NRM at 100 days, 24 weeks and 48 weeks post allo-HCT. Univariate analysis was performed to identify risk factors for HHV6 reactivation within the first year including CS-CMVi and risk factors for NRM at 48 weeks post transplant. A logistic regression was performed to identify independent risk factors for HHV6 DNAemia and NRM at 48 weeks. Patients with relapse were excluded from NRM analysis.

Results

A total of 539 allo-HCT recipients were included in our analysis; 124 (23%) with and 415 (77%) without LTV PP. HHV6 DNAemia was identified in 111 (21%) allo-HCT recipients within the first year of transplant, where CS-CMVi occurred in 241 (45%) (table 1). Risk factors for HHV6 DNAemia included African American race, underlying ALL, Haploidentical or cord HCT, marrow or cord source of stem cells, use of Post-cyclophosphamide, and CS-CMVi. On multivariate analysis, CS-CMVi was the only independent predictor of HHV6 reactivation (Adjusted OR: 1.69) (table 1). Independent predictors of NRM on logistic regression included CS-CMVi (OR: 1.67, CI 95% 1.03-2.62), and age > 40 years (OR: 2.21, CI 95% 1.24-3.95), and matched related donor allo-HCT (OR: 0.36, CI 95% 0.18-0.70) as a protective factor (table 2).

Conclusion

HHV6 DNAemia is strongly associated with CS-CMVi, which is probably a reflection of poor T cell recovery post HCT such as Haploidentical or Cord blood HCT. Furthermore, CS-CMVi was associated with NRM whereas HHV6 DNAemia was not. Larger studies are needed to better elucidate this interaction.

Disclosures

Gabriella Rondon, MD, Omeros: Advisor/Consultant Elizabeth Shpall, MD, Adaptimmune: Advisor/Consultant|Affimed: License agreement|Axio: Advisor/Consultant|Bayer Helathcare Pharmaceuticals: Honoraria|Fibroblasts and FibrioBiologics: Advisor/Consultant|Navan: Advisor/Consultant|NY Blood Center: Advisor/Consultant|Takeda: License agreement Ella Ariza-Heredia, MD, MERCK: Grant/Research Support Roy F. Chemaly, MD/MPH, Karius: Advisor/Consultant|Karius: Grant/Research Support.
2148. No Device, But Still a Problem: A Five Year Review of Healthcare Associated Bloodstream and Urinary Tract Infections in a Children’s Hospital
Authors: Schafenacker Amanda , Gornick Wendi , Huff Beth , Singh Jasjit
Published: December 2022

Background

Central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) continue to be the focus of external reporting of healthcare associated infections based on CDC-NHSN criteria. As facilities decrease CLABSI and CAUTI, we sought to understand our non-central line bloodstream infections (NCLABSI) and non-catheter urinary tract infections (NCAUTI).

Methods

We retrospectively reviewed total healthcare associated bloodstream infections (HABSI) (NCLABSI + CLABSI) and healthcare associated urinary tract infections (HAUTI) (NCAUTI + CAUTI) from July 1, 2016 to June 30, 2021 at our 334-bed quaternary care Children’s Hospital. CLABSI and CAUTI were both defined using CDC-NHSN criteria. Epidemiologic and microbiologic data, total antibiotic days related to infection, and mortality were analyzed for each subgroup.

Results

In a 5-year period, 255 patients were identified with HABSI and HAUTI; 164 were HABSI (26% NCLABSI, 74% CLABSI) and 91 were HAUTI (79% NCAUTI, 21% CAUTI). While our NCLABSI, CLABSI, and CAUTI infections per fiscal year (FY) have remained relatively stable, our NCAUTIs have increased since FY17 (Figure 1). Total antibiotic days for NCLABSI versus CLABSI and for NCAUTI versus CAUTI were similar (Figure 2). Staphylococcus aureus was the predominant pathogen in all HABSIs (16% CLABSI, 31% NCLABSI). Pseudomonas aeruginosa was seen in 15% of CLABSIs but in no NCLABSIs. P. aeruginosa was seen in both CAUTI (32%) and NCAUTI (11%). Escherichia coli was the predominant pathogen in NCAUTI (39%) (Figure 3). There were 2 NCLABSI (5%), 16 CLABSI (13%), 2 NCAUTI (3%) and 2 CAUTI (11%) patient deaths during hospitalization.

Conclusion

Our data shows that non-device related healthcare associated infections are a significant proportion of our total healthcare associated infections, comprising one quarter of HABSIs and three quarters of HAUTIs. In addition, P. aeruginosa, typically an important pathogen in device-associated infections, also contributes to non-device associated infections. We feel that total HABSI and HAUTI may provide more objective measures to report. Infection prevention measures to decrease NCLABSI and NCAUTI also need attention.

Disclosures

All Authors: No reported disclosures.
2149. Risk of dental abnormalities after tetracycline exposure in children: A retrospective, population-based study in Korea, 2003-2015
Authors: Kim SeoJung , Kim Eun Hwa , Lee Myeongjee , Shin Je Hee , Lim Sung Min , Jung In Kyung , Ahn Jong Gyun , Kang Ji-Man , Kang Chung-Min , Baek Jee Yeon , Lee Ji Young
Published: December 2022

Background

Despite its clinical usefulness, the use of tetracycline antibiotics (TCs) in children has historically been limited because of the risk of permanent tooth discoloration and enamel deformity, although age restrictions have varied across countries (e.g., contraindicated under 8 years of age in Taiwan, USA, and Canada, and under 12 years of age in Korea and UK). We explored whether the incidence of dental abnormalities in Korean children with a history of TCs use differed by age. Furthermore, the relative risk compared to the TCs non-exposed group was calculated.

Methods

From 2002 to 2015, 1 million standard sample subjects data was provided from National Health Insurance Service in Korea. Children younger than 18 years were included and divided into groups A (0-7 years), B (8-12 years), and C (13-17 years). Subjects in 2002 were excluded for wash-out, as were those diagnosed with dental abnormalities within 6 months after TCs prescription. For comparison, 1:4 matching between the TCs exposure and non-exposure groups was performed according to age and gender.

Results

Among 14,831 individuals included as study subjects (487 (3%) in group A; 1,695 (11%) in group B; and 12,649 (85%) in group C), 201 (1.4%) were diagnosed with dental abnormalities. The 5-year cumulative incidence of dental abnormalities after exposure to TCs in the group A was 4.7%, which was significantly higher than that of the control group C (0.9%; p< 0.0001), but that of group B was 1.3% and not significantly different from that of group C. In the risk analysis of dental abnormalities according to exposure of TCs, there was no significant difference (adjusted RR=1.03, 95%CI=0.71 to 1.50 in group A; adjusted RR=1.13, 95%CI=0.76 to 1.69 in group B; adjusted RR=1.18, 95%CI=0.97 to 1.43 in group C). Fig 1.Cumulative incidence rate and relative risk analysis.A. Cumulative incidence rate of dental abnormalities after TCs exposure by age group (p = <.00001). B. Relative risk analysis by TCs exposure and age group.Abbreviation; TCs: tetracycline and its derivatives.

Conclusion

Korean children aged 0-7 years who were exposed to TCs had a higher cumulative incidence and relative risk of dental deformities compared to the 13-17-year-old group but not the 8-12-year-old group. No significant increase in dental abnormalities was observed with TCs exposure among pediatric age groups.

Disclosures

All Authors: No reported disclosures.
2171. Clinical Characteristics and Outcomes of Immunocompromised Patients with Enterococcal Pneumonia
Authors: Ajaka Leama , Day Shandra R , Hebert Courtney , Colburn Nora , Liscynesky Christina
Published: December 2022

Background

Although Enterococcus species can colonize and cause infection in multiple body sites, it is considered a rare cause of pneumonia (PNA). The study objective was to describe clinical outcomes in immunocompromised patients with PNA and Enterococcus in respiratory cultures to better elucidate the pathogenic role played by Enterococci.

Methods

A retrospective, descriptive observational study was conducted on immunocompromised patients with Enterococcus spp on lower respiratory culture from January 1, 2015 to September 22, 2021 with clinical PNA. Data was collected on patient demographics, microbiologic details including bacteremia, other potential infectious causes of PNA and clinical outcomes.

Results

116 cases of immunocompromised patients with PNA and Enterococcus spp on respiratory culture were identified. Two patients also grew Enterococcus spp on pleural fluid and 1 on lung tissue. Vancomycin-resistant Enterococcus grew in 41/116 (35%) cases. Six (5%) patients had a bloodstream infection due to Enterococcus spp and a central line was present in all cases. In 52/116 (45%) cases there was growth of another organism, and 61/116 (53%) cases had an alternative infectious cause for PNA, whether it was a typical respiratory bacterial pathogen, viral illness, or invasive fungal infection. In 55 (47%) cases, there was no alternative infectious cause of PNA identified; 44 (80%) of these patients received an antibiotic active against Enterococcus spp and of these, 30 (68%) were clinically improved after 14 days. Overall mortality was high with 52/116 total cases (45%) in which the patient was alive after 90 days. In 25 cases patients did not receive antibiotic therapy active against Enterococcus and 28% were alive at 90 days.

Conclusion

Enterococcus spp should be considered a significant pulmonary pathogen in immunocompromised hosts in the appropriate clinical context. At our institution, the majority of immunocompromised patients with a monomicrobial pulmonary infection with Enterococcus were treated with targeted antibiotics. Further studies should evaluate outcomes of and indications for targeted treatment of pleuropulmonary Enterococcus.

Disclosures

All Authors: No reported disclosures.
2176. In Vitro Evaluation of Delafloxacin Activity Against Contemporary US Isolates from Cystic Fibrosis Patients Hospitalized with Pneumonia: Results from the SENTRY Antimicrobial Surveillance Program (2019-2021)
Authors: Shortridge Dee , Streit Jennifer M , Huband Michael D , Castanheira Mariana
Published: December 2022

Background

Delafloxacin (DLX) is a broad-spectrum fluoroquinolone antibacterial approved in the US for the treatment of community-acquired bacterial pneumonia (CABP) and acute bacterial skin and skin structure infections. DLX is indicated to treat CABP caused by multiple pathogens, including methicillin-susceptible Staphylococcus aureus (MSSA) and Pseudomonas aeruginosa (PSA). S. aureus (SA) and PSA are common pathogens causing pneumonia in cystic fibrosis (CF) patients. In this study, the in vitro susceptibilities of DLX and comparator quinolones were determined for clinical isolates from US CF patients collected during 2019-2021.

Methods

Isolates from CF patients hospitalized with pneumonia were consecutively collected at 17 US medical centers participating in the SENTRY Surveillance Program. Sites submitted 1 isolate per patient per infection episode. Isolate identification was determined at each site and confirmed using MALDI-TOF at JMI Laboratories. Susceptibility testing was performed according to CLSI broth microdilution methodology. FDA interpretive criteria were used for DLX, and CLSI (2022) criteria were applied to comparators.

Results

A total of 115 SA, including 72 MSSA and 67 PSA, were submitted. Susceptibilities (%S) to DLX, levofloxacin (LEV), and moxifloxacin (MOX) for MSSA are shown in the table. As MOX does not have breakpoints for PSA, ciprofloxacin (CIP) was tested. Against all SA, %S was 73.9%, 67.0%, and 67.0% for DLX, LEV, and MOX, respectively. DLX had the highest %S against MSSA (94.4%). The %S to LEV and MOX was 87.5% and 87.5%. DLX was also more active than comparators against PSA, with DLX 68.7%S, while LEV was 43.3%S and CIP was 50.7%S.

Conclusion

DLX had good activity against recent CF isolates from US hospitals, and had the highest percent susceptibility of the quinolones tested against MSSA and PSA. These in vitro data suggest that DLX could be a useful therapy when coverage of both MSSA and PSA is needed.

Disclosures

Dee Shortridge, PhD, AbbVie: Grant/Research Support|JMI Laboratory: Employee|Melinta: Grant/Research Support|Menarini: Grant/Research Support|Shionogi: Grant/Research Support Jennifer M. Streit, BS, MT(ASCP), Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Shionogi: Grant/Research Support Michael D. Huband, BS, AbbVie: Grant/Research Support|Melinta: Grant/Research Support Mariana Castanheira, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support.
2188. A Quality Improvement Initiative for Influenza Diagnosis and Treatment within Health Systems Serving American Indian/Alaskan Native Patients
Authors: Mera Jorge , Montgomery Roger , Stephens David , Leston Jessica , Carter Jeffrey D , Douglas Bonnie , Simone Laura , Molloy Leah
Published: December 2022

Background

This project aimed to identify practices, knowledge and confidence in diagnosing and treating influenza in health systems serving American Indian/Alaskan Native communities and to provide education to support alignment with IDSA guidelines.

Methods

Anonymous baseline surveys were completed electronically by healthcare professionals (HCPs) from Cherokee Nation Health Services (CNHS) and the Northwest Portland Area Indian Health Board’s teleECHO program. Responses informed a 2-part series of live virtual educational trainings featuring pre- and post-program surveys and team-based action planning.

Results

Baseline surveys were completed by 247 HCPs. 149 attended the 1st meeting, and 90 attended the 2nd. For outpatient influenza diagnosis, 72% of baseline survey respondents reported primarily using rapid antigen testing, and 11% reported using molecular testing. Similarly, 15% of learners in the live meetings correctly identified rapid molecular assay as the guideline-recommended test, which improved to 72% afterwards. All 9 CNHS outpatient health centers switched from rapid antigen to molecular testing for influenza diagnosis after the training. Influenza treatment decision-making was assessed using a case vignette. For a patient at high risk for complications with flu-like symptoms but stable for outpatient care, 23% of learners in the live meetings correctly chose to start antiviral treatment immediately, which improved to 54% after the program, and more learners felt confident applying diagnostic test results to treatment, from 31% before to 68% after the training. Learner confidence also improved from 19% feeling confident in selecting antiviral treatment and 33% feeling confident in identifying high risk patients before the program to 60% and 70% afterwards, respectively. Action plans prioritized by the HCPs included: patient engagement (61%), reviewing guidelines and data (57%), improving patient adherence to treatment (50%), and developing criteria for immediate antiviral treatment (50%).

Conclusion

Knowledge and confidence in influenza management improved after the training, as did system-wide alignment with IDSA-recommended diagnostic testing. Studies evaluating the clinical impact of this activity is warranted.

Disclosures

Jorge Mera, MD, FACP, Abbvie: Grant/Research Support|Gilead Sciences: Grant/Research Support|Gilead Sciences: Received one time honorarium for participating as a panelist in a COVID-19 Webinar|Merck: Grant/Research Support.
2191. Children with severe human rhinovirus lower respiratory tract infection
Authors: Kim Doo Ri , Kim Kyung-Ran , Park Hwanhee , Cho Joongbum , Huh Hee Jae , Lee Nam Yong , Kim Yae-Jean
Published: December 2022

Background

Human rhinovirus (HRV) infection can also cause lower respiratory tract infections (LRTIs). We aimed to investigate the proportion and characteristics of severe HRV infection among children under 5 years who were hospitalized due to HRV LRTI.

Methods

The medical records were reviewed retrospectively in patients hospitalized caused by HRV LRTI from January 1, 2016 to December 31, 2020, at Samsung Medical Center, Seoul, Korea. Patients who were older than 90 days and younger than 5 years old were included. Patients with co-infection of other respiratory viruses or bacteria were excluded. Patients with cancer were excluded.

Severe HRV LRTI was defined as the following: need for high flow oxygenation, mechanical ventilation, or intensive care unit (ICU) admission.

Results

A total of 116 cases were identified. The median age was 17 months (range, 3-56 months), and their median hospital days were four days (range, 2-31 days). Of 116 cases, 18 cases (15.5%) showed a severe course. The median age was younger in severe group compared to non-severe group (9.5 months vs. 19.5 months, p=0.001). In 18 patients with severe HRV LRTI, 11 (11/18, 61%) had underlying diseases; bronchopulmonary dysplasia and bronchiolitis obliterans accounted for the largest proportion (7/11, 63.6%). Six patients (6/18, 33.3%) required mechanical ventilation. Of note, there were seven previously healthy children (7/18, 38.9%) were diagnosed with severe HRV LRTI. Of those seven, three were diagnosed with asthma later during follow-up.

When 116 cases were divided into previously healthy (n=61) and underlying disease (n=55) groups, severe course of HRV LRTI was observed in 11% and 20%, respectively (p=0.205).

There was no fatal case.

Conclusion

HRV can cause severe LRTI in certain pediatric patient, especially with underlying diseases and young-aged children. One out of ten hospitalized children even without previously diagnosed underlying diseases, showed severe course of HRV LRTI.

Disclosures

Doo Ri Kim, MD, Korean Society of Pediatric Infectious Diseases: Grant/Research Support Yae-Jean Kim, MD, PhD, Janssen: Grant/Research Support|Korean Society of Pediatric Infectious Diseases: Grant/Research Support|Ministry of Trade, Industry and Energy: Grant/Research Support|MSD: Grant/Research Support.
2203. Involvement of Respiratory Viruses in Community-Acquired Alveolar Pneumonia (CAAP) in Children < 5 Years in Southern Israel, Before and During the COVID-19 Pandemic
Authors: Danino Dana , van der Beek Bert Adriaan , Ben-Shimol Shalom , Avni Yonat Shemer , Greenberg David , Dagan Ron
Published: December 2022

Background

Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) and to a lesser extent, parainfluenza and influenza viruses have been associated with pneumonia in young children. In contrast, adenovirus (AdV) and rhinovirus (RhV) are usually not associated with pneumonia. We aimed to evaluate the involvement of the four pneumonia associated viruses (grouped as PAV) in pediatric CAAP, before and during the COVID-19 pandemic.

Methods

CAAP incidence and viral activity surveillance in southern Israel in children < 5y and virological detection methods were described previously (Danino. CID 2022, https://doi.org/10.1093/cid/ciab1014). We reviewed the period of Jan 2016 - Mar 2022. Most cases of COVID-19 in children < 5y occurred during Dec 2021 - Mar 2022 (Figure 1); Over 95% of children admitted for respiratory disease were tested for COVID-19 (PCR). Since AdV and RhV activity was previously not associated with CAAP and tended to be equally involved in mixed and single infections, the current analysis was done for the four PAV only.

Results

CAAP incidence dynamics closely resembled the four PAV (grouped) activity dynamics (Figure 2A, 2B) with very low activity during the expected peak in winter 2020-2021, but with an off-season resurgence from spring 2021. Even though most CAAP episodes during the pandemic coincided with peak COVID-19 rates, only 9 CAAP episodes were COVID-19 positive (7 in 2022, of which 5 were RSV positive). Out of 3,430 CAAP episodes 55% were tested for PAV, of which 61% were positive, with similar rates before and during the pandemic. RSV was the most common involved virus, followed by hMPV. The virus distribution in CAAP during the entire period reflected their activity in the community (Figure 2C). Unlike pre-pandemic years where all four PAV appeared almost simultaneously, in 2021 PAV resurged sequentially, resulting in successive involvement in CAAP episodes, suggesting a causative association.

Conclusion

1. SARS-CoV-2 was only rarely involved in CAAP in young children. 2. PAV were involved in 61% of CAAP episodes in children < 5y with predominance of RSV and hMPV. 3. The atypical dynamics imposed by the COVID-19 pandemic suggests a causative association between PAV and CAAP.

Disclosures

All Authors: No reported disclosures.
2213. Increased Early Syphilis Detection and Treatment in an Urban Emergency Department During the COVID-19 Pandemic
Authors: Lipps Ashley , Malvestutto Carlos , Koletar Susan L , Dick Michael , Lindsey Sommer E , Bazan Jose A
Published: December 2022

Background

Many people at risk for sexually transmitted infections (STIs) utilize the emergency department (ED) for evaluation and treatment of STI-related complaints. Syphilis testing rates in the ED have historically been low. Following the implementation of a joint ED and Infectious Disease (ID) multidisciplinary quality improvement initiative designed to increase syphilis testing in this setting, we sought to evaluate the demographics and clinical outcomes for patients diagnosed with early syphilis in the ED.

Methods

A retrospective chart review of patients with positive syphilis test results from ED encounters at the Ohio State University Wexner Medical Center East Hospital between 1 January 2019 and 31 December 2021 was performed. Demographic and clinical information was obtained for patients diagnosed with early syphilis (primary, secondary or early latent syphilis).

Results

Since 2019, we have observed a significant increase early syphilis cases identified in our ED despite stable rates of testing (Figure 1). There were 55 cases of early syphilis, 3 with neurosyphilis (NS) at the time of diagnosis (Figure 2). Most cases were men (38/55; 69%), Black/African American (44/55; 80%), and symptomatic (48/55; 87%). Nine of 55 patients (16%) had HIV co-infection, 2 were new diagnoses at time of syphilis diagnosis. Most patients (44/55; 80%) completed appropriate treatment. Of the symptomatic patients, 17/45 (37%) received presumptive treatment in the ED (3 cases of NS excluded). Of those who received treatment after discharge from the ED, the median time to treatment completion was 3 days (range 0-30), with 11/24 (46%) returning to the ED for treatment. Figure 1.Figure 2.

Conclusion

As a result of a collaborative ED/ID STI testing initiative established at our institution, we have observed a significant increase in the number of symptomatic early syphilis cases identified in our ED between 2019 and 2021, with most patients completing treatment in a timely manner. This data show that the ED is an important and feasible setting for syphilis diagnosis and treatment when appropriate support systems are in place, including established communications with ID colleagues.

Disclosures

Carlos Malvestutto, MD MPH, Gilead Sciences: Advisor/Consultant|Viiv Healthcare: Advisor/Consultant Susan L. Koletar, MD, Gilead Sciences: Grant/Research Support.
2219. Syphilis Diagnosis and Treatment Practices in the Ambulatory Setting of a Large Vertically Integrated Healthcare Organization: An Opportunity for Infectious Diseases Physician Engagement
Authors: Gwiazdon Matthew , Matheu Michelle M , Seibert Allan M , Stanfield Valoree K , Kumar Naresh , Stenehjem Edward A
Published: December 2022

Background

Sexually transmitted infections (STIs) continue to increase in the United States. Syphilis management may challenge busy outpatient clinicians and diagnostic delays have been described. To better understand syphilis treatment practices and identify targets for improvement in our organization, we characterized outpatient encounters associated with a positive syphilis test.

Methods

Intermountain Healthcare (IH) is an integrated healthcare system with 23 emergency departments (ED), 34 urgent care (UC), and >100 primary care (PC) clinics. Protocols favor treponemal testing as the initial screening test. All positive treponemal tests associated with a positive non-treponemal test in the ambulatory setting were routed to an electronic inbox within the electronic health record (EHR) and reviewed by a team of Infectious Disease (ID) clinicians from May 1st 2021 – January 31st, 2022. Positive results originating from ID or HIV-trained primary care clinicians were excluded. Each encounter was assessed for staging and treatment plans based on CDC guidelines as well as HIV pre-exposure prophylaxis (PrEP) and HIV treatment eligibility.

Results

119 encounters were reviewed. Patients 30-44 years old were most likely to have a positive test (50, 42.0%). PC (63, 52.9%) and UC (24, 20.2%) accounted for the most positive tests. 102 (85.7%) positive tests were from white patients, consistent with racial demographics of Utah. Only 40 (33.6%) encounters could be clinically staged after chart review by an ID clinician. Of these, 17 (42.5%) were determined to be staged and treated inappropriately by the treating provider. 54 (45.4%) encounters could not be staged and required further testing or more clinical history to determine the significance of positive test. 18 (15.1%) patients could possibly have benefitted from PrEP evaluation and one new HIV diagnosis was referred to ID clinic.

Conclusion

Our exploratory analysis revealed many syphilis cases unable to be staged on chart review and opportunities to improve care. Strategies such as prospective audit and feedback or eConsults may be insufficient and clinical evaluation may be necessary to stage syphilis infection. Syphilis care improvements in our system may be a future target for ID physician engagement and novel stewardship strategies.

Disclosures

All Authors: No reported disclosures.
2220. Trends in Follow-up Testing among Patients Positive for Chlamydia and Gonorrhea in the Veterans Health Administration (VHA), 2013-2019
Authors: Schirmer Patricia , Sharma Aditya , Lucero-Obusan Cynthia A , Oda Gina , Holodniy Mark
Published: December 2022

Background

Chlamydia (CT) and gonorrhea (GC) infections are an ongoing public health issue. CDC recommends testing patients with CT/GC for other sexually transmitted illnesses (STIs) and repeating CT/GC testing 3-12 months later. We described repeat testing and testing for other STIs among GC/CT cases in VHA.

Methods

Molecular laboratory testing for CT/GC during 1/1/2013-12/31/2020 was retrieved from VHA data sources. Patients were evaluated for syphilis, HIV, and repeat CT/GC testing within one year after a positive GC or CT test. Differences in characteristics of CT/GC positive patients associated with receiving recommended testing were assessed using the chi-squared test.

Results

41,630 of 1,005,762 (4.1%) CT results (36,138 unique patients) and 17,649 of 1,013,198 (1.7%) GC results (14,598 unique patients) were positive; mean age of positive CT/GC patients were 31.5 and 40yo respectively with the largest percentage of cases in the 25-34yo group. Repeat testing within 91-365 days after a positive result were 32.6% and 34.5% for CT and GC, respectively (Table 1-2). Of CT/GC positives receiving repeat testing, 9% of CT and 15% of GC were again positive. HIV testing was performed for 72.4% and 65.5% CT and GC first positives, respectively, while syphilis testing was completed for 66.5% and 60.5% CT and GC, respectively (Table 3-4). In CT and GC patients tested for other STIs, HIV was positive in 2.1% and 5.9%, and syphilis was positive in 4.1% and 11.3%, respectively. Compared to 25-34yo patients with CT or GC, those < 25 had higher odds of inappropriate repeat testing (i.e., retested < 91 days, or not retested within 365 days after positive) but had lower odds of not being tested for HIV and syphilis. CT/GC positive females had lower odds of not being tested for HIV and syphilis.

Conclusion

In VHA, nearly 2/3rds CT/GC patients had inappropriate repeat testing, nearly 1/3rd were not tested for HIV/syphilis and up to 15% remained positive for CT/GC, suggesting testing practices and treatment could be improved to better align with current CDC recommendations. STIs not identified and treated appropriately can have serious individual and public health consequences. VHA providers may benefit from additional education on CDC recommended STI guidelines.

Disclosures

All Authors: No reported disclosures.
2244. Prescribing Patterns of Urinary Tract Infections in Patients Discharged from the Emergency Department
Authors: Tan Jorden , Kue Kenneth , Kale-Pradhan Pramodini , Delgado George , Giuliano Christopher , Johnson Leonard B
Published: December 2022

Background

Urinary tract infections (UTIs) are one of the most common infections in the emergency department (ED). The risk of treatment failure and readmissions to the ED may be increased with inappropriate antibiotic regimens. The purpose of this project is to determine the proportion of patients receiving guideline-based therapy (GBT) for UTI discharged from the ED.

Methods

Single-center, retrospective cohort study of adult patients diagnosed with an UTI or pyelonephritis from July 1-December 31, 2020. The primary outcome was to describe the proportion of patients discharged from the ED who received GBT for UTI. Secondary outcomes were to define the proportion of patients readmitted within 30 days, describe the reason for readmission, and compare 30-day readmission rates in patients who received GBT versus non-GBT.

Results

Of 370 patients screened, 68 were excluded primarily for inpatient admission. Of the 302 patients included, 172 (57%) received GBT and 130 (43%) received non-GBT with no significant difference in Charlson Comorbidity Index (p= 0.48) between groups. Fifty two of 302 patients (17.2%) were readmitted within 30 days; 31 (60%) from GBT and 21 (40%) from non-GBT (p=0.632). Of the 52 readmissions, 14 (26.9%) were related to the UTI and returned for either persistent symptoms (11 patients) or development of sepsis (3 patients).

Readmissions related to persistence of UTI and development of sepsis were not significantly different between GBT and non-GBT, 9 patients and 5 patients respectively (p=0.92).

Conclusion

The majority of prescribed antibiotic therapy did conform to GBT for UTI. However, 30-day readmission rates were not significantly different between groups.

Disclosures

All Authors: No reported disclosures.
2245. Urinary tract infections in the elderly population in Japan; long hospital stay, high medical costs, and decline in the activities of daily living scores
Authors: Akiyama Yutaro , Saito Sho , Tsuzuki Shinya , Mezaki Kazuhisa , Ohmagari Norio
Published: December 2022

Background

Japan has one of the most aging societies in the world. Urinary tract infection (UTI) is a common disease in the elderly, and the incidence of hospitalization owing to UTI is increasing with the aging population. Here, we examined the length of hospital stay, differences in the Barthel index (BI), activities of daily living score (ADLs) at admission and discharge, and medical costs of UTI in elderly patients.

Methods

We retrospectively included hospitalized UTI patients in our center between January 1, 2013 and March 31, 2019. The inclusion criteria were as follows: (1) urine culture positive for Escherichia coli (over 104 colony forming units/mL) within 48 h of admission, and (2) the presence of at least one of the following: fever ≥ 38°C, costovertebral angle tenderness, suprapubic tenderness, and dysuria at the time of admission. We classified the enrolled patients into four groups according to age: young adults (20–64 years), pre-old (65–74 years), old (75–84 years), and super-old (≥ 85 years). Patient characteristics were compared across groups using the Mann–Whitney U test, Fisher’s exact test, and Kruskal-Wallis test. The Bonferroni corrected P < 0.05 was considered statistically significant.

Results

This study enrolled 393 cases, including 112 (28.4%) young adults, 72 (18.3%) pre-old, 130 (33.2%) old, and 79 (20.1%) super-old. The lengths of hospital stay were 10.8, 17.9, 17.2, and 21.6 days in young adults, pre-old, old, and super-old, respectively (P < 0.05). Differences in the BI were 1.2, 4.2, 5.2, and 5.2 in young adults, pre-old, old, and super-old, respectively (P < 0.05). However, no significant differences in these values were noted among the pre-old, old, and super-old groups. The medical costs were 6,054, 8,310, 10,129, and 12,577-USD (1USD = 128 yen) in young adults, pre-old, old, and super-old, respectively (P < 0.05). Nevertheless, a comparison of the medical costs per day showed no significant differences among the groups.

Conclusion

UTI in elderly patients were associated with ADLs decline, longer hospital stays, and higher medical costs than those in younger patients; however, no significant differences were found among those aged ≥ 65 years.

Disclosures

Sho Saito, MD, PhD, DAIICHI SANKYO: Grant/Research Support|EVEC: Grant/Research Support|EVEC: Patents obtained through collaborative research|SHIONOGI: Grant/Research Support|Takeda: Advisor/Consultant.
109. Seroprevalence of Protective Antibodies against Varicella, Hepatitis-A and Dengue among Indian Children, Adolescents and Adults
Authors: Verma Sanjay , Baig Mirza Zubair , Rawat Ankita , Kapoor Rajesh , Rawat Amit , Suri Vikas , Suri Vanita
Published: December 2022

Background

Varicella, Hepatitis-A and Dengue cause significant disease burden in our country. Estimation of age-wise seroprevalence of antibodies against these diseases not only help us in understanding age-specific incidence rates and susceptibility, but also help policy makers in deciding need and timing of vaccination. None of these vaccines are part of current national immunization program in India, yet.

Methods

In this observational cross-sectional study, apparently healthy children (9-12 years), adolescents (15-18 years) and adults (25-30 years) attending OPD of a tertiary care hospital in Northern India over two-year period (July 17- June 19) were enrolled after taking informed written consent, and their 3-ml venous blood sample was collected. Ethical clearance was obtained from Institute Ethics committee, before enrolling subjects. Serum was tested for IgG antibodies using specific commercial ELISA kits. Those who received received Hepatitis-A or Varicella vaccination in past were excluded from enrollment.

Results

Out of total 240 subjects (M:F=117:123) enrolled, 75 were children, 75 adolescents and 90 adults in specified age groups. Mean age in these three groups were 11.04, 16.52 and 26.53 years respectively.

In our study, antibodies (IgG) against Varicella were >12 U/ml (seroprotective) in 36% (27/75), 74.6% (56/75), 64.5% (58/90) in children, adolescent and adults in specified age groups, respectively. Similarly, the antibodies (IgG) against Hepatitis-A were >10 U/ml (seroprotective) in above three groups were 68% (51/75), 85.3% (64/75), 95.5% (86/90). For dengue IgG antibodies also, seropositivity rates in above three groups were 37.3% (28/75), 62.7% (47/75), 53.3% (48/90).

Conclusion

Large proportion of children, adolescents and adults remain susceptible to Varicella and Hepatitis-A infection in India. Early childhood vaccination with Varicella and Hepatitis-A vaccines should be a part of National Immunization Programme in India, as a part of preventive strategy.

Our study also showed a large proportion of children, adolescents and adults remain seronegative for Dengue antibodies in various age groups. Therefore, if currently available dengue vaccine (Dengvaxia) has to be used in our population, it can only be used after individual screening.

Disclosures

All Authors: No reported disclosures.
111. Influenza and Pneumococcal vaccination rate in a cohort of adults with chronic comorbid conditions in Colombia.
Authors: Serrano-Mayorga Cristian C , Ibáñez-Prada Elsa D D , Fuentes Yuli V , Lozada Julian , Bustos Ingrid G G , Mendez Lina , Crispin Ana M , Reyes Luis Felipe F
Published: December 2022

Background

Lower respiratory tract infections (LRTI) are the leading cause of mortality and morbidity worldwide. Elderly and patients with comorbid conditions are at higher risk of developing LRTI and systemic complications. Therefore, the Centers for Disease Control and Prevention (CDC) and the United States National Center for Immunization and Respiratory Diseases (US-NCIRD) recommend that patients older than 19 be vaccinated for influenza annually. Patients older than 65 or with comorbid conditions (of any age) should be vaccinated for the pneumococcal vaccine. Low-middle-income countries like Colombia do not have strong policies for adults to get vaccinated. According to CDC recommendations, this study aims to determine the vaccination rate in a Colombian cohort. Figure 1.

Panel A illustrates patients’ distribution of influenza vaccine in the cohort, while Panel B shows the distribution of pneumococcal vaccine

Methods

This is the description of a prospective cohort of patients with chronic comorbid conditions between 2020-and 2022 in Bogotá, Colombia. We compared the number of patients vaccinated against Influenza and S. pneumoniae, according to CDC recommendations, to determine the adherence to international guidelines.

Results

The cohort was composed of 810 patients. The median [IQR] age was 63 [53-62] and the most common comorbidities were 52.2% [423/810] arterial hypertension, 21.7% [176/810] coronary disease, 19.0% [154/810] congestive heart failure, and 17.4% [141/810] chronic kidney disease. According to CDC recommendations, 808 patients should have been vaccinated against influenza (Figure 1A), but only 31.7% [256/808] were immunized last year. Also, 17.8% [144/810] of the whole cohort were 65 years old and should have received the quadrivalent flu shot. Moreover, 86.4% [700/810] patients meet the criteria for pneumococcal vaccination (Figure 1B), but only 11.9% [83/700] received at least one shot.

Conclusion

Vaccination rates in our cohort of adult patients with chronic comorbidities were meager. Therefore, these patients are at higher risk of developing LRTI complications. More robust vaccination programs for adults are required in Colombia.

Disclosures

All Authors: No reported disclosures.
129. LiaX, a Member of the LiaFSR System, is Essential for Cell Envelope Adaptation System in Enterococcus faecium
Authors: Cecilia Tran Truc , Panesso Diana , Zhao Audrey , khan Ayesha , Axell-House Dierdre B , Shamoo Yousif , Arias Cesar A
Published: December 2022

Background

Daptomycin (DAP) is an important antibiotic for enterococci. Our previous studies identified LiaX as a surface-exposed protein that is a mediator of cell envelope homeostasis in Enterococcus faecalis (Efs) upon exposure to DAP via activation of the LiaFSR system. LiaX encodes for a soluble protein with an N-terminal of α-helices, and a C-terminus which is β-pleated sheets. Its role in E. faecium, a species of clinical relevance, remains unknown. In this work, we aim to elucidate the function of LiaX of E. faecium (Efm).

Methods

We used the commensal strain of Efm TX1330RF (DAP minimum inhibitory concentration [MIC] 3 μg/ml), its ΔliaR derivative (TX1330RFΔliaR [DAP MIC 0.125 μg/ml]) and targeted the liaX gene for mutagenesis. Using the PheS* counterselection system, we aimed to create a truncation or in-frame deletion of liaX. Mutants were characterized by determination of DAP MIC and visualization of anionic phospholipid domains by 10-N-nonyl-acridine orange (NAO). The nisin-controlled expression vector, pMSP3535, was used to express LiaX from Efm (LiaXTX1330RF) in Efs host OG1RFΔliaX, which lacks liaX. Expression of LiaX of Efs (LiaXOG1RF) was used as a control.

Results

In the presence of liaR, we were unable to create truncation or in-frame deletion of liaX after many attempts. In Efm TX1330RFΔliaR, we successfully created an in-frame deletion of liaX, TX1330RFΔliaRliaX (DAP MIC 0.125 μg/ml). NAO staining of all strains of TX1330RF, TX1330RFΔliaR and its ΔliaX mutant showed localization of anionic phospholipid domains at septa of the cells. Interestingly, multiple attempts to complement liaR in TX1330RFΔliaRliaX were also futile. NAO staining of Efs OG1RFΔliaX demonstrated that anionic phospholipid microdomains redistributed away from septa. Expression of LiaXOG1RF in Efs OG1RFΔliaX successfully restored microdomains to septal and polar regions of Efs while expression of LiaXTX1330RF did not show any significant difference in the fluorescence staining compared to its parental host (Efs OG1RFΔliaX).

Conclusion

Our findings suggest that LiaX has divergent functions as a mediator of cell envelope homeostasis in enterococci and may be essential in the Efm redponse to DAP. Efforts to elucidate its role in DAP resistance in Efm are ongoing.

Disclosures

Cesar A. Arias, MD, PhD, Entasis Phramceuticals: Grant/Research Support|MeMed Diagnostics: Grant/Research Support|Merck: Grant/Research Support.
132. Carbapenem-resistant Enterobacteriaceae colonization in a Neonatal Intensive Care Unit in Bogotá, Colombia: Characterization and clinical outcomes
Authors: Londono-Ruiz Juan Pablo , Alvarez-olmos Martha Isabel , Medina-ramos Diana Carolina , Troncoso-Moreno Gloria Amparo , de la Hoz-Valle Jose Antonio
Published: December 2022

Background

Carbapenem-resistant Enterobacteriaceae (CRE) infections is a global public health problem, especially among vulnerable populations. Studies exploring these outcomes in neonates colonized with CRE are scarce. The aim is to explore differences in clinical outcomes between CRE-colonized versus CRE-non-colonized neonates.

Methods

A retrospective, observational, and longitudinal cohort study was performed for surveillance of CRE colonization in the neonates admitted between 2018-2021 to NICU in Bogotá, Colombia.

Results

From 462 clinical records, 21 (4,5%) were CRE colonized neonates. We found a difference in median gestational age to birth (34 weeks in CRE-colonized vs 37 weeks in non-CRE colonized p 0,018), any previous antibiotic therapy (71% vs 25% p 0,005), carbapenem use before admission (19% vs 1,6% p 0,01), CRE isolation in any sterile fluid during sepsis episodes (14% vs 0% p 0,004), use of empiric carbapenem therapy in sepsis episodes (42% vs 6,3% p 0,0003), empiric therapy for CRE infection (28% vs 6,3% p 0,01), and hospital length of stay (22 vs 11 days p 0,007). We did not find difference in sepsis episodes (66% vs 39% p 0,058) and mortality (4,8% vs 7,9%) among both groups.

Conclusion

Gestational age, prior use of any antibiotic or carbapenems, CRE isolation in sterile fluid during sepsis episodes, and higher length of stay were more frequently identified among CRE-colonized neonates versus CRE non-colonized neonates.

Disclosures

All Authors: No reported disclosures.