bluuebunny/crossref_metadata_2025 huggingface dataset:
2016. CLABSIs in the Time of COVID
Authors: Espiritu Maria Rosa Velasquez , Dundas Mary , Chen Donald S , Keller Marina
Published: December 2022

Background

With the COVID-19 pandemic, acute care facilities experienced an initial increase in hospital-acquired infections, most notably Central Line-Associated Bloodstream Infections (CLABSIs). Interestingly, the positive correlation between COVID-19 and CLABSIs appeared to wane post surge. We sought to define the pre and post-pandemic CLABSI rates.

Methods

Single-center, retrospective review of the CLABSIs reported to the National Healthcare Safety Network (NHSN) for the five years previous to COVID and through to the First Quarter of 2022. Our center is a quaternary care, level 1 trauma center in New York, which serves a highly ill critical care population, including solid organ and bone marrow transplants, acute leukemias, and patients requiring extracorporeal membrane oxygenation (ECMO).

Results

Between January 2015 and December 2019, our Medical Intensive Care Unit (MICU) reported 15 CLABSIs with an overall Standardized Infection Ratio (SIR) of 1.007. During the second winter surge of COVID, we saw a sharp rise in CLABSIs. Between October 2020 and March 2021, our MICU reported eight CLABSIs, with an overall SIR of 4.601 and a p-value of 0.0005 (CI 2.137 – 8.737), representing a statistically significant increase (p-value 0.0019) in comparison to prior years. Of these patients, seven had COVID. All patients received high-dose steroids. The average number of days between hospital admission to CLABSI was 16.38 days, and mortality was 87.5%. Since that spike in CLABSI, we have reported seven CLABSIs in NHSN for a SIR of 2.026. After 2019 patients with CLABSI tended to be younger and had a higher Body Mass Index.

Conclusion

We reported a spike in CLABSIs in our adult medical Intensive Care during the second wave of COVID-19 that affected the Northeast United States in the winter of 2020/2021. Despite experiencing a sharp rise, our CLABSI rates are returning to pre-pandemic low levels even during subsequent surges in COVID-19, including the recent Omicron surge. It remains to be determined if the improvements in infection control measures, differences in the patient illness severity, and/or variations of COVID management have contributed to the stabilization of the CLABSI rate.

Disclosures

All Authors: No reported disclosures.
2020. Disinfection of Needle-less Connectors Using UVC Light
Authors: Rasooly Julia , Banaei Niaz , Fourkas Michael , Schears Gregory
Published: December 2022

Background

Nearly 50% of post-insertion catheter-related infections are due to microbial ingress from needleless connectors (NC), widely used devices which connect to the end of catheters or infusion sets and enable access for injection of medications and attachment of infusions. Infections arising from NC could result in central line associated bloodstream infection (CLABSI). The clinical guideline for disinfecting NC is to wipe the hub of the NC with a 70% alcohol and to manually scrub the connector surface for at least 15 seconds. Unfortunately, multiple studies have found low compliance with the 15 second disinfection scrub.

Methods

In this study, we investigated the efficacy of 1 second of ultraviolet light-C exposure in the reduction of the 3 most common CLABSI associated organisms: Staphylococcus aureus, Candida albicans, Candida auris, and Methicillin-resistant Staphylococcus aureus (MRSA). We tested a total of 30 NC samples for each organism with 3 positive controls and 1 negative control.

Results

The log reductions were 5.68, 5.05, 4.41, and 6.38 for S. aureus, C. albicans, C. auris and MRSA, respectively.

Growth of Candida albicans with and without UV-C exposure for 1 second.

The figure shows the observed growth of Candida albicans from the surface of the connector with and without UV-C exposure for 1 second, displaying no growth on the agar plate for samples that were exposed to 1 second of UV-C disinfection.

Log reduction of tested organisms after exposure of UV-C for 1 second.

Table 1 displays the overall log reduction of tested organisms after 1 second of UV-C exposure. The results are shown for positive control concentration and log reduction for the test organisms Staphylococcus aureus, Candida albicans, Candida auras, and Methicillin-resistant Staphylococcus aureus.

Conclusion

Our findings demonstrate greater than 4 log reduction of common CLABSI-associated organisms with 1 second of UV-C exposure, which we believe would decrease CLABSI rates, increase aseptic technique compliance, and reduce disruption in hospital workflow.

Disclosures

Julia Rasooly, MS, Puracath Medical, Inc: Board Member|Puracath Medical, Inc: Stocks/Bonds Michael Fourkas, MS, Puracath Medical, Inc: Grant/Research Support Gregory Schears, MD, Puracath Medical, Inc: Advisor/Consultant|Puracath Medical, Inc: Stocks/Bonds.
2021. Efficacy of Chronic Antimicrobial Suppressive Therapy in Ventricular Assist Device Infections
Authors: Teran Nicholas S , Russo Hannah , Rizwan Sohail M , Phe Kady
Published: December 2022

Background

Ventricular assist devices (VAD) prolong life expectancy or serve as a bridge to heart transplant in end stage heart failure but are not without risks. These patients are at high risk for device-related infections with a propensity for relapse. Indications and efficacy of chronic antimicrobial suppression (CAS) to prevent relapse are not well defined.

Methods

We conducted a retrospective study of all adult patients with VAD infections at our institution between 1/1/2013 and 10/31/2020. VAD-specific or VAD-related infections were defined by the International Society for Heart and Lung Transplantation criteria. Patients were stratified by receipt of CAS or no CAS after completing index infection treatment. Relapsed infections were defined as those recurred at the same site caused by the same organism seen in the index infection. Time-to-relapse infection was defined as the time in days between the index infection and first relapse. The primary outcome was CAS efficacy measured by time-to-relapse in VAD-specific or -related infections.

Results

A total of 83 patients were included with a documented VAD-specific (n = 68) or VAD-related (n = 15) infection. Driveline (n = 66) and bloodstream (n = 13) infections were the most common VAD-specific and VAD-related infections, respectively. For the index infection, all patients received antimicrobial treatment and 16.4% required incision and drainage. Staphylococcus aureus was most frequently isolated in 46 cases. Oral minocycline was the most commonly utilized agent in 22 of 47 patients receiving CAS. Agent-specific CAS efficacy was unable to be assessed due to the small sample. In patients who received CAS, 57% experienced a relapse infection compared to 81% in patients not receiving CAS (p = 0.03). The median time to relapse was 151 days (IQR 78-247) and 57 days (IQR 36-114) in the CAS and non-CAS groups, respectively (p < 0.01).

Conclusion

The incidence of relapse infection in the setting of CAS was lower compared to those not receiving CAS. Patients receiving CAS were relapse-free for a significantly longer duration. Larger studies are warranted to assess if one agent confers a benefit over another.

Disclosures

M. Rizwan Sohail, MD, Aziyo Biologics: Honoraria|Boston Scientific Corporation: Honoraria|Medtronic: Grant/Research Support|TRYX: Grant/Research Support.
2029. Risk factors for a Central Line Associated Bloodstream Infection Amongst Hospitalized Patients with COVID
Authors: Fontana Lauren , Galdys Alison , Wang Qi , Ross Jennifer , Menier Terra , Dobbins Ginny , Alsaker Brady
Published: December 2022

Background

Central line associated bloodstream infections (CLABSI) are serious healthcare associated infections. During the COVID pandemic, we observed an increased incidence of CLABSIs in our healthcare system. We sought to identify risk factors for CLABSI among patients with COVID.

Methods

We performed a single-center, matched case-control study in patients admitted between Mar 2020 and Dec 2020 who were 1) diagnosed with COVID based on laboratory results or diagnosis code, and who were 2) at risk for developing a CLABSI based on the presence of a central line for ≥3 days. Cases were those diagnosed, based on National Healthcare Safety Network criteria, with CLABSI; controls were patients not diagnosed with CLABSI. Cases and controls were 1:4 matched based on age at admission (+/- 5 years) and COVID diagnosis date (+/- 45 days). Descriptive statistics were calculated for continuous and categorical variables. For comparisons, p values are from generalized estimating equations accounting for clustering by case-control matches. All analyses were performed in SAS version 9.4 (SAS Institute Inc., Cary, NC). Approval was granted by our institutional IRB.

Results

Characteristics of the patients who were diagnosed with COVID and at risk for developing a CLABSI are presented in table 1. Compared to patients with COVID and no CLABSI, patients with a CLABSI were more likely to be of a non-white race (p=0.0435). A longer length of stay was observed among CLABSI patients, (p=0.0011) and patients with CLABSI were less likely to be discharged to home (p=0.0084). There was a non-statistically significant trend toward a history of diabetes (p=0.0554), receipt of corticosteroids (p=0.052) and receipt of tocilizumab (p=0.0952) among CLABSI patients.

Conclusion

Patients hospitalized for COVID who developed a CLABSI had longer hospitalizations and were less likely to be discharged home. Race other than white was a risk factor for CLABSI among patients with COVID. The relationships between race, racism, and CLABSI should be further explored.

Disclosures

All Authors: No reported disclosures.
2030. Risk Factors for Recurrent Percutaneous Nephrostomy Tube Infections in Patients with Gynecological Malignancies
Authors: Szvalb Ariel D , Marten Claire A , Cain Katherine E , Taylor Jolyn , Huang Steven Y , Viola George M
Published: December 2022

Background

Percutaneous nephrostomy tube infections (PCNIs) are complex, affect quality of life, necessitate implant exchanges, and increase health care costs. Here, we analyzed risk factors for recurrent PCNIs in patients treated with our standardized institutional algorithm.

Methods

At our institution, we prospectively evaluated consecutive patients with gynecological malignancies who developed PCNIs between July 2019 to September 2021. All patients were treated using our institutional algorithm for PCNI, which consists of obtaining blood cultures plus urine analyses and cultures from each percutaneous nephrostomy tube (PCN); utilizing ultrasound or abdominal pelvic computed tomography scans to rule out obstructive hydronephrosis, pyelonephritis, or renal abscess; exchanging the PCN once patients are receiving concordant antimicrobial therapy; and having patients complete an adequate course of targeted antimicrobials. Thereafter, patients were followed up until reinfection, routine PCN exchange at 3 months, being lost to follow-up, or death.

Results

We treated 100 patients. Their median age was 54 years; 53% were White. The most common malignancies were cervical (61%), ovarian (23%), and endometrial (13%), with 60% being metastatic. To analyze the risk factors for developing a recurrent PCNI, patients were placed in 3 different groups: those reinfected with the same organism (19%), reinfected with a different organism (17%), and not reinfected (64%). Overall, there were no differences among the patient groups regarding demographics, comorbidities, clinical presentation, infection timing, PCN exchange (Table 1) or microorganisms encountered (Table 2). However, patients with prior radiation therapy or pelvic fistulas (urinary-vaginal-rectal or their permutations) had higher rates for developing a recurrent PCNIs with the same organism (P< .002).

Conclusion

Patients with prior radiation therapy and underlying pelvic fistulas have an increased risk for reinfection with the same pathogen. Therefore, further studies should be performed to mitigate this increased risk of recurrent infections with more frequent PCN exchanges or, more invasive procedure such as ureteral embolization, sclerosis, or ligation to dissociate the upper and lower urinary tracts.

Disclosures

All Authors: No reported disclosures.
2036. Dual VIM-producing Proteus mirabilis, Including a Novel VIM-75, Among Elderly Patients in a Medical Center from Hungary: Report from the 2020 SENTRY Antimicrobial Surveillance Program
Authors: Deshpande Lalitagauri M , Burián Katalin , Csányi Ilona Dóczi , Castanheira Mariana
Published: December 2022

Background

Nonsusceptibility of Proteus mirabilis to imipenem allows this pathogen evade surveillance for carbapenemases. Metallo-beta-lactamases of the VIM family are widespread among Enterobacterales in Europe. We identified an outbreak of P. mirabilis carrying 2 VIM enzymes among elderly patients from a medical center in Hungary.

Methods

A total of 16 P. mirabilis isolates were received from Hungary during 2020 as part of the SENTRY Antimicrobial Surveillance Program. Isolates were susceptibility tested by the CLSI reference broth microdilution method. Carbapenem-nonsusceptible isolates were submitted to whole genome sequencing, screened for resistance mechanisms, and evaluated for core genome multi-locus sequence typing (cgMLST).

Results

Among the 16 P. mirabilis isolates from Hungary, 5 carbapenem-nonsusceptible, multidrug-resistant isolates (3 from urinary tract infections and 1 each from bloodstream infection and pneumonia) were identified from patients 66-92 years old. Four of these 5 isolates were listed as community acquired. All isolates were resistant to ceftriaxone (MIC, > 8 mg/L), cefepime (16- > 32), imipenem ( > 8), gentamicin ( > 16), levofloxacin (16- > 32), nitrofurantoin ( > 64), trimethoprim/sulfamethoxazole ( > 4), and plazomicin ( > 128), but susceptible to meropenem (0.25-0.5) and ertapenem (0.03-0.25). Isolates carried blaVIM-4 and blaVIM-75 on a class 1 integron within IS26 and separated by aac(6’)-IIc. IS26 was located on a compound plasmid carrying other resistance-encoding genes, including armA. The integron structure is identical to the blaVIM-4 and blaVIM-1-carrying integron described from a Vibrio cholerae isolated from a seagull in France in 2015 (KR262557). blaVIM-75 is a single amino acid variant (Q60R) of blaVIM-1. All isolates carried mutations in the QRDR (gyrA_S83I, parC_S84I). Based on cgMLST analysis, these 5 P. mirabilis isolates were highly similar, with only 7-19 SNPs detected.

Conclusion

The outbreak of multidrug-resistant P. mirabilis isolates carrying blaVIM-4 and blaVIM-75 in a Hungarian medical center is a cause of concern. Surveillance should be performed to understand the spread of and treatment options for infections caused by carbapenem-nonsusceptible P. mirabilis.

Disclosures

Lalitagauri M. Deshpande, PhD, Melinta: Grant/Research Support|Pfizer: Grant/Research Support Katalin Burián, MD, JMI Laboratories: Grant/Research Support Ilona Dóczi Csányi, MD, JMI Laboratories: 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.
2044. In Vitro Activity of Omadacycline Against 14,000 Bacterial Isolates from the United States by Infection Type (2020-2021)
Authors: Huband Michael D , Pfaller Michael , Streit Jennifer M , Sader Helio S , Castanheira Mariana
Published: December 2022

Background

Omadacycline (OMC) is a novel tetracycline class (aminomethylcycline) antibacterial FDA approved for treatment of acute bacterial skin and skin structure infection (ABSSSI) and community-acquired bacterial pneumonia (CABP) caused by indicated organisms. OMC is active against bacterial isolates expressing resistance to tetracycline, penicillin, fluoroquinolones, macrolides, and vancomycin. This study has been funded in whole or in part by Federal funds from the U.S. Department of Health and Human Services, Biomedical Advanced Research and Development Authority (BARDA) within the Office of the Assistant Secretary for Preparedness and Response, under Contract No. 75A50120C00001.

Methods

14,000 bacterial clinical isolates were collected from 31 medical centers in the USA (2020-2021) in the SENTRY Surveillance Program. Isolates were collected from the following infection types: bloodstream (24.1%), pneumonia in hospitalized patients (22.6%), skin and skin structure (SSSI; 22.4%), urinary tract (15.9%), intraabdominal (5.5%), community acquired respiratory tract (8.3%) and other (1.2%). Identifications were confirmed by MALDI-TOF. Susceptibility testing of OMC and comparators was conducted according to CLSI M07 (2018) and M100 (2022) guidelines. OMC MIC results were interpreted using FDA breakpoints (BPs).

Results

OMC demonstrated potent in vitro activity against S. aureus (MIC90, 0.12 mg/L; 99.0% susceptible [S]) from SSSI, including 98.0% of MRSA (Table). From RTI, 99.6% of MSSA were S. 97.6% of S. lugdunensis and 95.5% of S. anginosus group isolates from SSSI were susceptible to OMC. All S. pyogenes and E. faecalis (including vancomycin-resistant [R]) isolates from SSSI were S to OMC. 99.8% of S. pneumoniae isolates from RTI were S to OMC, as were 100% of penicillin-R and tetracycline-R strains. H. influenzae susceptibility to OMC was 99.8%. Susceptibility of E. cloacae and K. pneumoniae isolates from all infection types to OMC was 88.9% and 90.4%, respectively.

Conclusion

OMC demonstrated potent in vitro activity against staphylococci, streptococci, E. faecalis, H. influenzae, E. cloacae, and K. pneumoniae isolates, including drug-resistant strains, regardless of infection type.

Disclosures

Michael D. Huband, BS, AbbVie: Grant/Research Support|Melinta: 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 Helio S. Sader, MD, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|Melinta: Grant/Research Support|Nabriva Therapeutics: Grant/Research Support|Pfizer: 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.
2360. Serum Cholesterol Variability and Mortality in PLWH On Lipid-Lowering Therapy
Authors: Drechsler Henning J , Ayers Colby , Bedimo Roger
Published: December 2022

Background

In people living with HIV (PLWH), consistent use of lipid lowering therapy (LLT) is associated with lower all-cause mortality and use of tenofovir disoproxil fumarate (TDF) with reduced serum cholesterol (C). In the general population, high cholesterol variability (CV) is independently associated with all-cause mortality. We explored the relationship between consistency of LLT/TDF exposure, cholesterol variability, and mortality in PLWH.

Methods

In a cohort of 15,860 PLWH who achieved undetectable viremia on ART between 2001 and 2011 we used multivariable Cox modeling, stratified by prevalent cardiovascular disease (CVD) to identify predictors of mortality and built multi-level marginal structural models for different LLT/TDF exposure levels based on percentage of days covered (PDC) over the past year, categorizing exposures into low (PDC < 50%), high (50–93%), and consistent (≥94%). The latter two were further subdivided into single and dual exposures for a composite LLT model where we explored effect sizes before and after inclusion of time-updated absolute C values and its 1-year coefficient of variation (CoV). We also examined the relationship between consistency of LLT/TDF use and C variability in a mixed linear model.

Results

During a median follow-up (f/u) of 4.3 years, there were 2,269 deaths. For 43% of f/u time patients were exposed to TDF, for 13% to non-statin LLT, and for 17% to statins. The hazard ratio (HR) of death for consistent use was 0.38, 95% confidence interval (CI) 0.32–0.45 for TDF, 0.40 (CI:0.28–0.58) for non-statin LLT, and 0.50 (CI:0.40–0.63) for statins (Fig 1). In the composite model, increasing LLT intensity was inversely associated with mortality risk but low C and high CV remained strong independent predictors of death. High HDL C values were protective (Table). The effect sizes for high LLT intensity and high HDL-CV moderately decreased when they were modeled jointly. Compared to unexposed patients, HDL CoV was significantly lower during consistent LLT exposures but higher for patients with low LLT exposure (Fig 2).

Conclusion

In PLWHA, intensity of LLT exposure is inversely related with all-cause mortality. The highest LLT intensity levels were associated with the lowest HDL-CV. This could serve as a partial explanation for the lower mortality.

Disclosures

Roger Bedimo, MD, Gilead Sciences: Advisor/Consultant|Janssen: Advisor/Consultant|Merck & Co.: Advisor/Consultant|Merck & Co.: Grant/Research Support|ViiV Healthcare: Advisor/Consultant.
2057. A Social Network Strategy for HIV Self-Test Kit Distribution through PrEP Program Clients
Authors: Doblecki-Lewis Susanne , Butts Stefani , Kanamori Mariano , Johnson Ariana , Rodriguez Edda L
Published: December 2022

Background

HIV testing allows care engagement of people living with HIV and PrEP for those who test negative. Social network strategy (SNS) interventions may facilitate distribution of HIV self-test (ST) kits to individuals who do not routinely test for HIV. The University of Miami pre-exposure prophylaxis (PrEP) program offers low-barrier PrEP/HIV prevention services through mobile and static clinics in Miami-Dade County. Current PrEP clients may be ideal distributors of HIV ST kits and PrEP information within their social networks.

Methods

Study activities occurred in Miami from November 2021 to March 2022. At PrEP visits, participants (n = 96) were given Ora-Quick oral fluid ST kits for distribution to their social network members. Participant surveys included demographics, feelings of closeness to network members, history of PrEP conversations, and intention for future PrEP conversations. Descriptive statistics included mean and range for continuous variables and frequencies for categorical variables. Network visualizations were constructed using UCINet and NetDraw. Bivariate and regression analysis, conducted in R, assessed the relationship between demographic characteristics of the client and the proportion of network members who discussed PrEP and plan to discuss PrEP in the future between and across networks.

Results

A network visualization displays clients (n=96) and their social networks (n=426). Clients and network members were a majority male (84.7%) and of Hispanic/Latinx ethnicity (78.8%). Within and between network analysis indicated that networks differed significantly in reported closeness and frequency of PrEP discussions (F = 2.97; p-value 0.01, F = 17.45; p < 0.03, respectively). Age and average reported closeness of the ego were independently and jointly associated with an increase in the likelihood of future PrEP conversations (estimate = 0.02; p-value < 0.01; estimate = 0.24; p –value < 0.01, respectively). Figure 1:PrEP Discussion & Closeness

Node color reflects PrEP discussion and node size reflects client reported closeness

Conclusion

We demonstrate the feasibility of disseminating HIV ST kits and PrEP information through SNS. Emotionally closely linked networks, with similar characteristics (i.e., age) may be most effective for this SNS strategy.

Disclosures

Susanne Doblecki-Lewis, MD, MSPH, Gilead Sciences: Grant/Research Support.
2063. Implementation of a Rapid HIV Screening Program in the Emergency Department
Authors: Geringer Matthew , Lajeunesse Brooke A , Bettger Caitlin , Markelz Elizabeth , Arroyo Cazurro Miguel A , Trueblood Wesley E , Okulicz Jason F
Published: December 2022

Background

Guidelines recommend that human immunodeficiency virus (HIV) screening be performed for all patients evaluated for sexually transmitted infections (STIs). The current practice for STI evaluation in the Brooke Army Medical Center (BAMC) emergency department (ED) is to defer HIV testing to Primary Care Managers (PCMs), however PCM follow-up and HIV screening may not occur. This project evaluated HIV screening practices before and after implementation of rapid HIV testing in the ED.

Methods

The pre-intervention period (Aug – Oct 2021) included usual practice in the BAMC ED followed by the post-intervention period (Dec 2021 – Feb 2022) after implementation of rapid testing with the Determine™ HIV-1/2 Ag/Ab Combo test. ED providers were educated to include HIV rapid testing for patients with STI complaints. Patients with Neisseria gonorrhea/Chlamydia trachomatis (GC/CT) tests ordered in the ED pre-intervention (n=303) and post-intervention (n=268) were selected for chart review and demographic, clinical, and laboratory data were used to assess HIV screening practices.

Results

A similar proportion of patients in the pre-intervention period presented with an STI chief complaint (13.5% vs. 17.2%), tested positive for GC/CT (13.5% vs. 10.8%), and received empiric treatment for GC/CT (38.3% vs. 34.3%) compared to the post-intervention period (Table 1). HIV screening in the ED significantly increased both overall (4.3% vs. 19.8%; P< 0.001) and in the subgroup treated empirically for GC/CT (9.7% vs. 30.4%; P< 0.001, Table 2). Among patients treated empirically for GC/CT who did not receive HIV screening in the ED, PCM follow-up was low in both the pre- and post-intervention periods (20.7% and 34%, respectively; P< 0.001) and HIV screening was not commonly performed by PCMs during those visits (6.2% vs. 8.4%, respectively; P=0.350).

Conclusion

STIs are considered biologic markers of HIV risk, including acquisition and forward transmission. Implementation of a rapid screening protocol in the ED resulted in a nearly 5-fold increase in HIV screening, however HIV screening by PCMs remained low. Although rapid HIV testing can be a useful tool, continued education and training of ED providers and PCMs is also needed to improve uptake of HIV screening.

Disclosures

All Authors: No reported disclosures.
2070. Risk Factors Affecting PrEP Offering and Uptake Among At-Risk Youth in an Area of High HIV Prevalence
Authors: Stillman Jared , Coughlin Emily , Espinosa Claudia M
Published: December 2022

Background

New HIV cases are steadily reported in our community among at-risk youth despite the availability of highly effective pre-exposure prophylaxis (PrEP). Although providers regularly offer PrEP during sexually transmitted disease (STD) screening visits, PrEP utilization rates remain low among those patients. The primary outcomes of this study are determining the rates of PrEP offering and uptake in high-risk individuals seeking care for STD screening at local youth clinics and whether these rates differ by demographic factors.

Methods

A retrospective chart review was conducted on 218 charts of patients ages 18 - 24 years with risk factors for HIV infection who sought care at a youth clinic in Tampa, FL between 2018 and 2020. PrEP offering and utilization rates were compared across demographic and risk factor variables using Chi-square tests for categorical variables and Mann-Whitney U tests for continuous variables.

Results

Of 218 patients, 86 (39.4%) were offered or had a documented discussion of PrEP at their visit but uptake occurred only in 22 (10.1%). Factors associated with offerings are depicted in table 1. Factors associated with uptake are depicted in table 2. Age at first visit, insurance type, level of education, and employment did not significantly impact PrEP offering or uptake. Additionally, there was no significant difference in PrEP uptake associated with race or ethnicity.

PrEP Offerings

Demographic characteristics associated with offering and uptake of PrEP among young people screened for STD in a high prevalence of HIV area

PrEP Uptake

Demographic characteristics associated with uptake of PrEP among young people screened for STD in a high prevalence of HIV area

Conclusion

This study highlights differences in offering and uptake of PrEP among young adults with a high risk of acquiring HIV living in a high prevalence of HIV area. Males and MSM are offered more PrEP and also use it more. Black patients are less likely to be offered PrEP. These differences emphasize the need for interventions to improve the rate of PrEP discussions among female and black patients at risk for HIV and to improve adherence to PrEP among young individuals at risk of HIV infection. Interventions targeting these demographics may lessen disparities and incidence of HIV in the community. Moving forward we will continue to investigate additional data collected on PrEP compliance at 6mo and at 12mo follow-ups among our patient population. Future studies with qualitative data identifying barriers to use PrEP will provide important information on this topic.

Disclosures

All Authors: No reported disclosures.
2364. FACEing Infectious Disease Fellows: Growing and Culturing Clinician Educators
Authors: Welford Elliott , Jagannath Anand D , Wooten Darcy
Published: December 2022

Background

Infectious diseases (ID) fellows are increasingly interested in clinician-educator (CE) careers. However, dedicated structured curricula for subspecialty fellows are uncommon due to limiting factors such as time, resources, and faculty expertise. At the University of California San Diego, we recruited fellows and faculty across several Internal Medicine subspecialties to develop a Fellow As Clinician Educator (FACE) course. We taught a core CE skillset and assessed its effects on self-reported confidence, content knowledge, and scholarly productivity.

Methods

Principles from the Kern model were used to structure and build curricular content (Figure 1). Validated medical education survey methodology was used to create a survey to assess fellows’ confidence in 10 medical education domains. Content knowledge of foundational medical education principles was assessed using multiple choice questions. Fellows answered the survey and content questions before and after the course. Differences in self-reported confidence and content knowledge were assessed using paired, two-tailed t-tests. Medical education scholarly projects completed within one year of the course were also tracked.

Results

Thirteen fellows from ID (7), Geriatrics (3), and Pulmonary/Critical Care (3) participated in this course. Eleven (85%) completed both pre and post-course surveys. Confidence in giving an effective lecture, teaching on the wards and clinic, giving a chalk talk, giving feedback, and achieving career success as an educator increased significantly after the course (p< 0.05, Figure 2). Content knowledge in giving a lecture and teaching clinical reasoning increased significantly after the course (p< 0.05, Figure 3). Nine fellows participated in medical education scholarship in the year after the course with curriculum development, manuscript publication, and abstracts representing the areas of greatest participation (Figure 4).

Conclusion

The FACE course successfully utilized multidisciplinary faculty to teach and improve fellows’ confidence in and content knowledge across multiple core medical education domains and increased scholarly output. Future directions for this course will include formal evaluation of participants’ teaching skills and CE career trajectories.

Disclosures

All Authors: No reported disclosures.
2105. Early-onset and Late-onset BK Polyomavirus-associated Nephropathy: A 10-year Retrospective Analysis
Authors: Thiandech Vichitra , Kantachuvesiri Surasak , Bruminhent Jackrapong
Published: December 2022

Background

Polyomavirus-associated nephropathy (BKVAN) is one of the serious causes of allograft dysfunction and allograft loss in kidney transplant (KT) patients. Most of the patients were diagnosed with BKVAN within the first year after transplantation but some more cases of BKVAN occur later. A study focused on the differentiation between early and late-onset BKVAN is needed.

Methods

We conducted a retrospective cohort study among KT recipients at Ramathibodi Hospital between January 2010 – December 2020. The incidence of early-onset (diagnosed within 1 year) and late-onset (diagnosed after 1 year) BKVAN, as well as composite kidney allograft outcomes, were compared.

Results

From 1032 KT recipients, 645 (62.5%) were screened for BK viral infection. BKVAN was diagnosed in 83 (12.8%) patients. Of those, 46 (55.4%) and 37 (44.6%) were diagnosed with early-onset and late-onset BKVAN, respectively. Composite kidney allograft outcomes of GFR decline≥ 40% from baseline, graft loss or death were greater in early-onset BKVAN compared to late-onset BKVAN (7.5 vs 5.52 per 1000 person-months; hazard ratio 0.47; 95%CI, 0.23-0.95; P=0.037). In multivariate analysis, female gender and living-related kidney transplantation (LRKT) were independently associated with late-onset BKVAN compared to early-onset BKVAN. The more advanced the BKVAN diagnosis, the worse the allograft outcome occurs, even with optimizing immunosuppressive drugs and adjunctive therapy.

Conclusion

BKVAN could occur later after one-year post-transplantation, although relatively better composite kidney outcomes were observed compared to early-onset BKVAN. Female individuals who underwent living-related KT should be considered for BK virus preemptive monitoring beyond one year to detect this late-onset BK virus infection.

Disclosures

All Authors: No reported disclosures.
2108. Evaluation of Bezlotoxumab for the Prevention of Recurrent Clostridioides difficile Infection in Patients Living With Cancer at a Large Comprehensive Cancer Center
Authors: Peña Jaime A , Vuong Nancy N , Okhuysen Pablo C , Munsell Mark F
Published: December 2022

Background

Bezlotoxumab is a fully human monoclonal antibody that binds and neutralizes Clostridioides difficile toxin B. Administration of bezlotoxumab along with standard of care antibiotic (SoC) treatment of C. difficile infections (CDI) is associated with lower rates of CDI recurrence (rCDI). We aimed to determine the real-world incidence of rCDI in patients with cancer within 12 weeks after receiving bezlotoxumab.

Methods

This is a retrospective, single-center, descriptive study of patients with cancer that received bezlotoxumab from Jan 2018 through Oct 2021 at a large cancer center. rCDI was defined as a clinical illness associated with a positive stool nucleic acid amplification test with or without a confirmatory toxin assay for which CDI SoC was prescribed.

Results

A total of 131 patients were included in the study (median age of 63 years, 47% male, 77% Caucasian, 21% ICU admission), with 31% having one or more CDI episodes ≤ 6 months prior to receiving bezlotoxumab. The most common primary cancer type was leukemia (36%) followed by a solid organ tumor (35%), lymphoma (21%), and myeloma (8%). Cytotoxic chemotherapy or immune checkpoint inhibitors were prescribed within 6 months in 78% of cases and 60% of patients were given antibiotics not related to CDI. Fidaxomicin was most frequently administered as SoC (56%), followed by oral vancomycin (44%) with or without intravenous metronidazole. Within 12 weeks following bezlotoxumab treatment, rCDI occurred in 14 (10.7%, 95% Cl 5.4% to 16.0%) patients. Using univariate analysis, patients with rCDI were more likely to have received levofloxacin before and during bezlotoxumab treatment (86% versus 47%; OR 6.76, 95% CI 1.45 - 31.56, p=0.009).

Conclusion

In this real-world study, the rate of rCDI following use of bezlotoxumab during SoC antibiotics was comparable to that seen in clinical trials. Use of levofloxacin as prophylaxis for prolonged neutropenia in hematologic malignancies was associated with significantly higher rates of rCDI in patients that received bezlotoxumab. Our study suggests that neutropenia and antibiotic induced dysbiosis are risk factors for rCDI despite bezlotoxumab administration.

Disclosures

Pablo C. Okhuysen, MD, AstraZeneca: Stocks/Bonds|Beam Therapeutics: Stocks/Bonds|Biontech: Stocks/Bonds|Deinove: Grant/Research Support|Ferring: Advisor/Consultant|Glaxo Smith Kleine: Stocks/Bonds|Johnson and Johnson: Stocks/Bonds|Melinta: Grant/Research Support|Merck Sharp & Dohme Corp: Grant/Research Support|Moderna: Stocks/Bonds|Napo Pharmaceuticals: Advisor/Consultant|Napo Pharmaceuticals: Grant/Research Support|Novavax: Stocks/Bonds|Pfizer: Stocks/Bonds|Summit: Advisor/Consultant|Summit: Grant/Research Support.
2113. Infectious endocarditis in patients with hematologic malignancy at the University of Wisconsin
Authors: Scolarici Michael J , Berman Leigh R , Saddler Christopher , Smith Jeannina
Published: December 2022

Background

Infective endocarditis (IE) is a highly morbid complication of blood stream infections (BSIs) involving neutrophil and platelet activation. Patients with hematologic malignancies have frequent BSIs but a low incidence of IE. We sought to evaluate the microbiology of BSIs and rates of IE in hospitalized patients with hematologic malignancies.

Methods

Patients admitted to the University of Wisconsin Hospital hematology ward between 2018 and 2020 were included if blood cultures obtained grew Streptococcus spp., Staphylococcus spp., Enterococcus spp., Streptococcus-like bacteria, and fungi. Two investigators recorded patient demographics, BSI microbiology, and hospital course. Using the Duke’s criteria each BSI was classified as definite, possible, or rejected cases of IE. Cases of possible IE were reviewed for evidence of missed IE within 90 days of hospital admission based on readmission with repeat positive blood culture and new signs or symptoms of IE. Definite cases were reviewed by two additional investigators to corroborate cases of IE.

Results

Our study included 101 unique patients with hematologic malignancy: 35.6% female, mean age 58.4, and 10.9% had multiple BSIs during our study period. Of 111 distinct BSIs, 82.6% were neutropenic, 37.4% community acquired, and 21.7% polymicrobial. Of 129 positive blood cultures, 41.0% isolated Streptococcus spp., 5.4% Staphylococcus aureus, 17.8% other Staphylococcal spp., 7% Enterococcus faecalis, 9.3% other Enterococcus spp., 9.3% Gamella spp., and 4.7% Candida spp. Of 111 BSI, 2 were classified as definite cases, 39 as possible, 70 as rejected. After further review, only 1 was considered a true cases of IE and they were not neutropenic. The 90-day survival rate for all patients was 76.2%.

Conclusion

We found a very low incidence of IE in our study. Low rates of IE in our population aligns with previous reports showing rare cases of IE in neutropenic and malignancy patients with BSIs and raises questions about the utility of invasive IE workups in neutropenic patients with hematologic malignancies. Further studies are needed to identify patient or microbiologic factors that can be used to guide appropriate use of transesophageal echocardiography to evaluate IE in patients with hematologic malignancy.

Disclosures

All Authors: No reported disclosures.
2118. Patient Characteristics and Clinical Outcomes of Leptotrichia spp. Bacteremia
Authors: Ranganath Nischal , Challener Douglas , Schuetz Audrey , Stevens Ryan W , Shirley Joshua D , Shah Aditya
Published: December 2022

Background

Leptotrichia spp. are anaerobic, gram-negative bacilli that are part of the normal oral and intestinal microbiota. Although traditionally considered non-pathogenic, these bacteria can result in invasive infections including bacteremia in immunosuppressed patients, particularly those with neutropenia. There are limited published data to inform best management strategies in those with Leptotrichia bacteremia.

Methods

All cases of Leptotrichia spp. bacteremia between January 2012 and 2022 at our tertiary academic medical center were retrospectively reviewed to determine patient risk factors, clinical outcomes, and antimicrobial susceptibilities. Descriptive statistical methods were used. Antimicrobial susceptibilities were performed by agar dilution.

Results

26 cases of Leptotrichia spp. bacteremia were identified (Figure 1). The mean patient age was 55 years (SD 17), with 9 female patients (35%). All 26 patients were immunocompromised, predominantly due to hematologic malignancy (69%) or hematopoietic stem cell transplant (23%) (HSCT). 25 of 26 patients were actively neutropenic, with a median duration of neutropenia of 21 days (13-26) (Table 1). The most frequent sources of Leptotrichia bacteremia were gastrointestinal translocation (60%), followed by catheter-related infection (35%). 10 patients had polymicrobial bacteremia (38.5%). The primary antibiotics utilized to treat Leptotrichia bacteremia included metronidazole (42%), piperacillin-tazobactam (27%), and carbapenems (19%). Overall, the mean duration of treatment was 11 days, with a 60-day all-cause mortality of 19% (Table 1) with no cases of microbiologic relapse. In the 22 clinical isolates evaluated for susceptibility, Leptotrichia spp. were largely susceptible to metronidazole, penicillin, ertapenem, and piperacillin-tazobactam, but uniformly resistant to moxifloxacin (Table 2). Figure 1:Leptotrichia spp. identified as cause of bacteremia in 26 patientsTable 1:Baseline characteristics of patients with Leptotrichia bacteremia (n=26) between January 2012 to January 2022Table 2:Antimicrobial susceptibility profile of the Leptotrichia spp. (n=22)

Conclusion

Leptotrichia spp. may be a rare cause of bacteremia in neutropenic hosts, particularly those with underlying hematologic malignancies and HSCT. The pathogen has a favorable susceptibility profile to penicillins and carbapenems, but has high degree of resistance to fluoroquinolones.

Disclosures

All Authors: No reported disclosures.
2131. Performance of Dried Blood Spot (DBS) for the Diagnosis of Congenital Cytomegalovirus (cCMV) in a Single Center: A Real-World Experience
Authors: Del Valle Penella Ana P , Rochat Ryan H , Miller Jerry A , Demmler-Harrison Gail J
Published: December 2022

Background

The newborn DBS has been used for the retrospective diagnosis as well as a screening method for cCMV. We aimed to assess the sensitivity and specificity of this test compared to traditional methods, for the diagnosis of children suspected to have cCMV in the first 21 DOL.

Methods

In this single-center retrospective cohort study, all patients (N= 304) with a request for DBS testing between 2013 and 2021 were reviewed. Those with a DBS available for testing, a medical record at our institution, and at least one diagnostic test for cCMV obtained within the first 21 days of life (DOL) were included for review (N=86).

DBS were requested from the Texas State Health Department and sent to the Center for Disease Control for testing by DNA CMV PCR.

DBS results were compared to patients whose diagnoses were made via traditional testing with at least one accepted method (urine culture, urine PCR, blood PCR and/or saliva culture) obtained within the first 21 DOL. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated.

Results

Of the 86 patients included, 59 had a diagnosis of cCMV established by conventional testing, with 50 of them having a positive DBS and 9 a negative result. DBS had a sensitivity of 84.7%, specificity of 100 %, positive predictive value of 100 % and a negative predictive value of 75%.

Those patients with a true positive DBS had a higher median level of viremia by CMV blood PCR (6487 IU/ml vs 471 IU/ml, p= 0.012) when compared to those with a false negative result.

All patients with cCMV and congenital hearing loss had a positive DBS (N=15). A significant difference was noted in the median viremia levels of those patients with cCMV with congenital hearing loss vs those with cCMV without congenital hearing loss (17,547 IU/ml vs 3,175 IU/ml, p=0.012)

Of those cCMV patients that developed late onset hearing loss (N=9), 8 had a true positive DBS and 1 had a false negative result.

Conclusion

DBS could be useful in the diagnosis of cCMV, and its performance may be related to the level of CMV viremia at birth. DBS appears to be able to accurately identify those patients with congenital hearing loss and those who will develop late onset hearing loss. Future studies are needed to determine the best population that can be identified by this test.

Disclosures

Ryan H. Rochat, MD, PhD, MS, Merck Sharpe & Dohme: Grant/Research Support Jerry A. Miller, MS, PhD, CPH, Merck: Grant/Research Support Gail J. Demmler-Harrison, MD, Elsevier: Book royalties|Merck: Grant/Research Support|Microgen: Advisor/Consultant|Microgen: Grant/Research Support|Moderna: Advisor/Consultant|UpToDate Wolters Kluwer Health: Royalties.
2136. Development of Recombinant Rotavirus Vaccine Carrying Herpes Simplex Virus 2 Gene Based on Reverse Genetics Technology
Authors: Kawamura Yoshiki , Komoto Satoshi , Fukuda Saori , Kugita Masanori , Tang Shuang , Pieknik Julianna , Enya Yasuko , Ihira Masaru , Nagao Shizuko , Krause Philip , Taniguchi Koki , Yoshikawa Tetsushi
Published: December 2022

Background

Herpes simplex virus type 2 (HSV-2) can cause genital herpes, which reduces the patient's QOL associated with pain. In addition, genital herpes can increase the risk of human immunodeficiency virus infection. Vaccine development has been attempted for many years, but it has not yet been put into practical use. Meanwhile, rotavirus (RV) is one of the major viral causes of severe gastroenteritis in infants and young children worldwide. Currently, two live attenuated vaccines are widely used to prevent severe RV infection in children. We have developed entirely plasmid-based reverse genetics systems of RV, which allowed the generation of recombinant reassortant RV containing a foreign gene.

In this study, we sought to develop simian RV (SA11), in which HSV-2 glycoprotein D (gD2) gene was inserted by reverse genetics system, as a herpes vaccine, and evaluated its immunogenicity in mice.

Construction of HSV-2 protein expressing rotavirus as a vaccine inducing mucosal immunity

Methods

Artificially synthesized gD2 DNA fragment was inserted into T7 expression NSP1 plasmids (pT7/NSP1-gD2). Using the plasmid, recombinant SA11-gD2 virus (rSA11-gD2) was generated. gD2 protein expression in infected MA104 cells was verified by Western blotting. rSA11-gD2 was orally inoculated into BALB/c suckling mice twice two weeks apart and into eight-week-old mice three times apart four weeks. Diarrhea score was evaluated for seven days after first inoculation in suckling mice. Serum IgG and IgA titers against RV and gD2 were measured by ELISA.

Results

Insertion of the gD2 gene and synthesis of gD2 protein were demonstrated by sequence analysis and Wester blotting analysis, respectively. Diarrhea occurred after the first inoculation of rSA11-gD2 in suckling mice. Although IgG and IgA antibodies against RV were induced, gD2 antibody was not detected in convalescent sera in the suckling mice. Meanwhile, in the eight-week-old mice inoculated with three times of rSA11-gD2, significant increases in not only IgG and IgA against RV but also IgG against gD2 were demonstrated.

Conclusion

Simian RV containing gD2 gene, which was developed by the reverse genetics, induced IgG antibody against gD2 in orally inoculated mice. This strategy can be used to develop genital herpes vaccine.

Disclosures

All Authors: No reported disclosures.