bluuebunny/crossref_metadata_2025 huggingface dataset:
P-1338. Don't You Forget About Me: Older Patients with Substance Use Disorder -- Have We Left Them Behind on Screening?
Authors: Yu Diana , Streifel Amber C , Varley Cara D
Published: January 2025

Background

Oregon has seen increasing incidence of sexually transmitted infections [e.g. HIV, syphilis, gonorrhea, chlamydia (GC/CHL), hepatitis C (HCV)], as well as outbreaks associated with vaccine preventable infections [e.g. hepatitis A (HAV), B (HBV)]. Limited data are available on routine screening and vaccination rates despite guidelines expanding screening, especially in high-risk patients such as those with substance use disorder (SUD). This study aims to determine rates of screening in persons with SUD.Table 1.Patient Demographics by Year of First Consultation

Methods

Single-center, retrospective cohort study in Portland, Oregon, USA. Patients aged 12-100 years with an Addiction Medicine consultation between January 1, 2015-March 31, 2024 were included. Data abstracted included patient demographics, payor status, and laboratory results for GC/CHL, syphilis, HAV, HBV, and HCV, and HIV. Chi-squared test was used to analyze differences in testing rate testing by age group.Table 2.Screening Rates and Results by Age Group

Results

A total of 5630 patients met inclusion criteria (Table 1). For GC/CHL screening, 887 patients had testing; 32 and 24 of 1228 tests were positive, respectively. For syphilis screening, 2364 patients were tested; 260 of 3539 tests were reactive. HAV serology was performed in 1566 patients; 694 were immune, 596 non-immune, 2 with active infection, and 274 were IgM negative at initial testing. There were 3998 tests for HBV; however, 2709 were incomplete panels (e.g. missing HBVsAb). Of the 903 patients with a full panel, 264 were immune, 92 had prior infection, 11 with acute/chronic infection, and 536 non-immune at initial testing. 4206 HCV tests were performed in 3043 patients with 632 new or recent diagnoses during the study period. 4603 HIV screening tests were performed in 2728 patients, with 13 new diagnoses. Patients aged 55 years and older were less likely to receive testing (Table 2).

Conclusion

Despite guidelines recommending frequent screening in high-risk patients, it appears to be limited at this institution. Furthermore, screening tests revealed several opportunities for healthcare intervention (e.g. vaccination) thus efforts should be made to secure access to testing. Future directions should include ordersets to ensure proper testing and follow through of results, as well as education and feedback to providers of screening results.

Disclosures

All Authors: No reported disclosures
P-1346. Identification of aminoglycoside 6′-N-acetyltransferase type Ib small molecule inhibitors using mixture-based combinatorial libraries and structure-activity relationship studies
Authors: Sklenicka Jan , Tran Tung , Magaña Angel J , Ramirez Maria Soledad , Donow Haley , LaVoi Travis M , Mamun Yasir , Chapagain Prem , Santos Radleigh , Pinilla Clemencia , Giulianotti Marc , Tolmasky Marcelo
Published: January 2025

Background

The aminoglycoside 6′-N-acetyltransferase type Ib [AAC(6’)-Ib] confers resistance to amikacin and other relevant aminoglycosides in Gram-negatives. To identify small molecule inhibitors of AAC(6’)-Ib that would overcome resistance, we utilized a strategy incorporating mixture-based combinatorial libraries, scaffold ranking, and positional scanning, followed by structure-activity relationship analysis. After identification of pyrrolidine pentamine by scaffold ranking, we isolated a compound substituted by two S-phenyl groups, an S-hydroxymethyl group, and a 3-phenylbutyl group at the R positions (compound 2700.001) (Fig 1). Herein, we describe a structure-relationship analysis of this compound.

Figure 1

Chemical structure of compound 2700.001

Methods

Initial inhibition assessment was done by measuring OD600 of A. baumannii A155 cultures at a single dose of compound. Checkerboard assays were done in triplicate, with each dose combination tested twice. The data were processed to eliminate any antibacterial effect exerted by the inhibitor.

Results

Single substitution of functionalities at R positions along the core scaffold of compound 2700.001 showed that position R5 is the most tolerant to changes. The replacement of 3-phenylbutyl by 4-phenylbutyl resulted in compound 2700.003, equally active to 2700.001. Modifications at all other locations produced weaker inhibitors, while truncations of the scaffold resulted in inactive compounds. Testing compounds with double or triple substitutions confirmed the critical role of the S-phenyl group at position R1. No compounds with higher inhibitory activity were found. Using molecular docking, the relationship between ΔG (Kcal/mol) values for each compound and inhibitory activity was studied, with results indicating a significant correlation.

Conclusion

Using mixture-based combinatorial libraries, the scaffold ranking approach, and the positional scanning strategy, we identified an inhibitor of AAC(6’)-Ib that can overcome resistance to amikacin in Gram-negatives. Furthermore, structure-activity relationship studies led to the identification of a second inhibitor, while also giving direction for further improvements to the molecule toward developing stronger inhibitors.

Disclosures

All Authors: No reported disclosures
P-1352. Epidemiology and Clinical Profile of Infections Caused by Carbapenem-resistant Gram-negative Bacilli Identified by a Rapid Molecular Method in a Referral Hospital in Nicaragua
Authors: Zúniga-Gaitán Josué , Marenco-Avilés Sunaya , Gavarrete-Rivas Kevin , Porras-Cortés Guillermo D
Published: January 2025

Background

Bacterial resistance is a public health problem and resistance to carbapenems has a special connotation and it is important that each institution and country establish the characteristics of these infections. The objective of this study was to determine the epidemiology, clinical profile, and outcome of infections caused by carbapenem-resistant microorganisms in a referral hospital in Nicaragua.Figure 1.Prevalence of Carbapenemases Detected by Xpert Carba-R and Types of Carbapenemases in Clinical Samples

Methods

An ambidirectional cohort study was carried out between January 2019 and November 2023 at the Dr. Fernando Vélez Paiz Hospital (Managua, Nicaragua) including all patients with infection and a clinical sample that had been processed directly by the Xpert Carba-R® rapid diagnostic molecular method to detect carbapenemases of the NDM, KPC, VIM, IMP, and OXA-48 type. Patients of the Surgery, Orthopedics, Internal Medicine, and Critical Care Department were included. The clinical data were obtained from the hospital's electronic medical record system.Figure 2.Number of Carbapenemases Detected by Patients

Results

A total of 346 patients with infectious processes had their clinical samples processed directly by Xpert Carba-R®, and 56 (16.1%) had a carbapenem resistance gene detected (Figure 1). By type of infection, resistance to carbapenems was 36% in ventilator-associated pneumonia, 34% in intra-abdominal infection, and 30% in surgical site infection. NDM carbapenemase was present in 91.1% of patients, and KPC in 27% (Figure 1). More than one type of carbapenemase was found in 26.8% of patients. In 4% of the patients 3 types of carbapenemases was found. (Figure 2). The most frequently identified bacterium was K. pneumoniae (36.4%), followed by E. coli (16.9%) (Figure 3). Mortality in patients with carbapenem resistance was 58.9%. Risk factors for mortality were infection with the presence of two carpanemases, requiring mechanical ventilation on admission, presence of shock on admission, Charlson index ≥ 3 points, among others (Table 2).Figure 3.Gram Negative Bacilli Identified in Clinical Samples with Carbapenemases Detected by Xpert Carba-R

Conclusion

The prevalence and mortality associated with the presence of carbapenemases detected by the molecular method used were high. The most prevalent carbapenemase was NDM. Different factors were associated with mortality, including shock on admission, invasive devices (eg: vascular catheter), patient comorbidities, and the presence of 2 different types of carbapenemases in the infection.Table 1.Risk Factors for Mortality in Patients with Infection with Gram Negative Bacilli Resistant to Carbapenems Detected by Xpert Carba-R

Disclosures

All Authors: No reported disclosures
P-1354. Carbapenemase Gene Detection in Clinically Significant Pseudomonas aeruginosa Isolates from A Tertiary Care Health Center: A Prospective Study
Authors: Kumar Deepak , Chaudhary Monika , Gadepalli Ravisekhar , Vaishnavi meruvu Hari , aggarwal alisha , Tak Vibhor , Bohra Gopal Krishna , Meena Durga Shankar , Midha Naresh Kumar , Samantaray Subhashree , Solanki Hitendra Pal , Kothari Nikhil , Bhatia Pradeep , Garg M K
Published: January 2025

Background

Pseudomonas aeruginosa is a leading pathogen causing widespread hospital acquired infections worldwide. As WHO has also designated Carbapenem resistant Pseudomonas aeruginosa as one of three Critical Priority Pathogen, we decided to conduct a study on the Pseudomonas aeruginosa isolates to find out the presence of carbapenemase genes using RT-PCR and to find out the relation between the phenotypic assessment of carbapenem resistance with genotypic detection of carbapenemase genes.

Methods

Total 41 patients were included in this prospective observational study done for 6 months from 1st July 2023 to 31st December 2023. Pseudomonas aeruginosa isolates from the patients with age >18 years, ICU admission for more than 48 hours and absence of any coinfection were included and those patients with polymicrobial infections and multisite infections were excluded. Isolates were obtained from the blood, respiratory and pyogenic samples and antimicrobial susceptibility was done by VITEK for various antimicrobials and broth microdilution for colistin. The bacterial colony was used for DNA extraction using Bacterial Genomic DNA Extraction Kit in accordance with the manufacturer’s instruction. Multiplex RT PCR was done to detect genes blaVIM, blaNDM, blaKPC and blaIMP.

Results

Out of 41 isolates, as depicted in figure 1, blaIMP was most common gene found in 26(63.41%), followed by blaNDM in 20(48.7%) isolates. Combination of blaNDM and blaIMP was found in 12 (29.2%) and blaNDM with blaKPC in 3(7.3%) patients. As shown in table 1 even in isolates which were found pan sensitive to all antimicrobials in VITEK were also harboring genes for carbapenemase. blaIMP was found in 9(69%) of these isolates out of 13 pan sensitive ones. Attributable mortality according to phenotypic resistance is described in table 1. Figure 2 is amplification plot of blaNDM by RT PCR of one of the isolates.

Conclusion

We found presence of blaNDM and blaIMP genes in our isolates of Pseudomonas aeruginosa as compared to global presence of blaKPC and blaVIM. High prevalence of carbapenemase genes even in pan-sensitive isolates can be attributed to excessive use of carbapenems and larger studies are required to find out its impact on clinical outcome.

Disclosures

All Authors: No reported disclosures
P-1356. Risk factors associated with community-onset infections due to clinically moderate to high-risk AmpC producing organisms
Authors: Baalbaki Nadeem , Mohsen Mahinaz , Al Hadidi Moayad , Boyle Leigh Ann , Sackey Joachim , Salim Tanzila
Published: January 2025

Background

The Enterobacterales order is among the most common group of bacteria relevant in clinical practice. Among them are inducible AmpC-producing Enterobacterales (AE). This unique group of bacteria may produce AmpC enzymes if induced in the setting of certain beta-lactam antibiotics, limiting the number of effective treatment options. Previous data have suggested that inappropriate antibiotics used empirically for AE increase the risk of treatment failure, but limited data are available to describe the risk factors associated with community-onset (CA) AE to help guide empiric therapy.

Methods

This was a retrospective case-control study of patients admitted to University Hospital from 2021 to 2023 with a CA Enterobacter cloacae, Klebsiella aerogenes, or Citrobacter freundii clinical isolate. The first clinical isolate was included for each patient. Patients were matched at a rate of 1:1 to a patient with a CA Enterobacterales organism without 3rd generation cephalosporin resistance. Patients were matched according to infection, age (+/- 5 years), and sex at birth. The primary outcome was to evaluate risk factors associated with CA AE infections.

Results

A total of 176 patients were included in this study, 88 in each group. In a univariate analysis, prior hospitalization (OR, 3.3 [95% CI, 1.72-6.4]), surgical intervention (OR, 5.8 [95% CI, 1.62-20.9]), exposure to any antibiotic (OR, 2.2 [95% CI, 1.15-4.14]), exposure to 1st generation cephalosporins (OR, 2.8 [95% CI, 1.09-7.07]), and exposure to cefepime (OR, 3.3 [95% CI, 1.03-10.72]) within 3 months were associated with an increased risk of a CA AE. Being Hispanic or Latino was associated with a decreased risk of having a CA AE in a univariate analysis and was the only variable statistically significant in a multivariable analysis (OR, 0.34 [95% CI, 0.15-0.74]).

Conclusion

Our findings suggest that patients with prior hospitalization, surgical intervention, exposure to any antibiotic, to 1st generation cephalosporins, and to cefepime within 3 months may be associated with an increased risk of a CA AE in a univariate analysis, although no association was seen in a multivariable analysis. In contrast, Hispanic or Latino patients may be at a decreased risk for CA AE. A larger sample size may be warranted to validate these findings.

Disclosures

All Authors: No reported disclosures
P-1359. Epidemiology of Carbapenem Resistant Enterobacterales in Monroe County, NY 2016-2023
Authors: Tsay Rebecca , Dietz Jenna , Felsen Christina B , Dumyati Ghinwa
Published: January 2025

Background

Carbapenem-resistant Enterobacterales (CRE) infections pose an urgent threat due to the limited treatment options and the potential for resistance spread among carbapenemase producing (CP) CRE strains.

Methods

We conducted active population-based surveillance for select Enterobacterales species resistant to ≥ 1 carbapenem from a normally sterile site or urine in Monroe County, NY as part of the CDC Emerging Infections Program. Epidemiologic data were collected through medical record abstraction. Cases were classified as hospital onset (HO) if they occurred 72 hours after hospital admission, healthcare-associated community-onset (HACO) cases if they had a prior healthcare risk factor, or community associated (CA). CRE isolates were tested at CDC or Northeast Antimicrobial Resistance Laboratory Network.

Results

From 2016-2023, CRE incidence increased 135% from 8.8 to 20.7 per 100,000 population with 895 incident CRE cases identified in 745 unique patients. Patients were mostly non-Hispanic (89.2%), White (82.1%) and female (67.8%). Urine was the most common source (92.7%). 58.1% of cases were HACO, 28.6% CA and 13.2% HO. Urinary tract abnormalities (58%) and recurrent UTIs (32.6%) were prevalent. Prior healthcare exposures including hospitalization (57.2%), surgery (28.5%), and skilled nursing home stay (22.1%) were common in healthcare associated cases. Few (2%) had a history of international travel. Hospital onset cases were more likely to have CRE isolated from blood (21.2%), require ICU admission (33.1%), and die within 90 days of their infection (34.4%). 272 CRE isolates underwent carbapenemase testing, of those, 78 (28.7%) were CP-CRE: 71.1% blaKPC, 19.3% blaNDM, and 9.6% blaOXA48 with documented emergence of blaNDM CP in 2021. Only 6 (9.5%) of CA isolates were CP-CRE compared to 18 (40%) of HO, and 54 (33.1%) of HACO.

Conclusion

The incidence of CRE in Monroe County, NY has significantly increased since 2016 with documented emergence of blaNDM-producing strains. The high proportion of healthcare-associated CRE cases, particularly CP-CRE, underscores the need for enhanced infection control measures and ongoing surveillance. Further investigation is needed into the risk of CP-CRE in CA cases.

Disclosures

All Authors: No reported disclosures
P-1363. Cefiderocol Activity against Clinical Enterobacterales Isolates Carrying Metallo-β-lactamase Genes in United States and European Hospitals (2020–2023)
Authors: Mendes Rodrigo E , Kimbrough Hank , Beekman Danielle , Hubler Cory , Maher Joshua , Sader Helio S , Castanheira Mariana
Published: January 2025

Background

Cefiderocol (FDC) is a siderophore cephalosporin that uses the iron transport systems of Gram-negative bacteria to optimize cell entry. FDC is stable to hydrolysis by serine (e.g. ESBLs, KPC, and OXA-type carbapenemases) and metallo-β-lactamases (MBL). FDC and comparator activities were analyzed against Enterobacterales (ENT) carrying MBL genes, as part of the SENTRY Antimicrobial Surveillance Program.

Methods

32,052 ENT were collected from 35 sites in the US and 42 sites in the European (EU) regions during 2020–2023. Susceptibility (S) testing used broth microdilution with cation-adjusted Mueller-Hinton broth (CAMHB) for comparators and iron-depleted CAMHB for FDC. CLSI (same as the FDA) breakpoints were used for FDC; whereas CLSI were applied for comparators, except for colistin (EUCAST). ENT with MIC ≥2 mg/L (nonS based on CLSI criteria) for imipenem or meropenem were screened for β-lactamase genes.

Results

Carbapenem-nonS isolates comprised 2.9% (944/32,052) of the population, of which 1.4% (207/15,147) and 4.4% (737/16,905) originated from US and EU sites, respectively. FDC (94.6–96.6%S) had equivalent MIC90 of 4 mg/L against all carbapenem-nonS isolates, and the US and EU subsets, whereas other agents had S ≤86.5% (Table). FDC had MIC50/90 of 2/4 mg/L against isolates carrying MBL genes, including the blaNDM and blaVIM-1 subsets; in contrast, various other agents had off-scale MIC90 values (i.e. >8 mg/L). FDC MIC90 of 8 mg/L were obtained against isolates carrying blaNDM-5.

Conclusion

FDC showed potent activity against carbapenem-nonS ENT and those subsets of isolates carrying MBL genes. This potent FDC activity is presented against a particular subset of resistant ENT, for which antibiotic treatment options are limited. FDC should be considered as an important option for the treatment of infections caused by these resistant organisms.

Disclosures

Rodrigo E. Mendes, PhD, GSK: Grant/Research Support
P-1366. Outcome of 10 Patients with Colistin-Resistant Gram-negative isolates in a Tertiary Care Hospital in South India
Authors: Shibi S , Shobana S , Sanjai R
Published: January 2025

Background

The emergence of colistin-resistant gram-negative isolates poses a significant challenge in the management of infections, particularly in tertiary care settings. This study aims to investigate the clinical outcomes of 10 patients with colistin-resistant gram-negative isolates in a South Indian tertiary care hospital. Understanding the impact of these resistant strains on patient outcomes is crucial for guiding treatment strategies and improving patient care in the face of increasing antimicrobial resistance.

Methods

This study conducted between January 2023-April 2024 at a tertiary hospital in India. We reviewed patients’ clinical profile, outcome, and antibiotics that were used for treatment.

Results

Ten colistin-resistant isolates were reported over 16 months. Respiratory was the most common source of the isolate, followed by blood and urine samples. Klebsiella pneumoniae constituted 50%, Acinetobacter baumannii 30%, Pseudomonas aeruginosa 20% of all isolates. Susceptibility of these isolates to other drugs were Amikacin 70%, tigecycline 58%, and chloramphenicol 25%. Antibiotics that were used for treatment combinations among the following antimicrobials as shown in Table 1.Table 1:Patient profile, antibiotic combination used, and outcomeS.NOSAMPLEANTIBIOTICS USED FOR TREATMENTOUTCOME1RespiratoryColistin +Tigecycline + ChloramphenicolDeath2RespiratoryMeropenem + ColistinDeath3RespiratoryCo-trimoxazole + TigecyclineDischarge4BloodTigecycline + ChloramphenicolDeath5PusAmikacin + ColistinDischarge6UrineChloramphenicol + ImipenemDischarge7RespiratoryColistin + TigecyclineDeath8RespiratoryAmikacin + ColistinDischarge9Wound SwabFosfomycin + ColistinDeath10RespiratoryMeropenem + ColistinDeath

Conclusion

Colistin resistance is becoming more common in Gram-negative bacteria, particularly K. pneumoniae, in Indian hospitals. Among patients infected with colistin-resistant gram-negative isolates, the mortality rate is 60%, while 40% are discharged. Amikacin, tigecycline, and chloramphenicol could be considered for combination therapy.

Disclosures

All Authors: No reported disclosures
P-1367. Changing Epidemiology of Carbapenemase-producing Carbapenem-resistant Enterobacterales (CRE) in Taiwan
Authors: Lee Susan Shin-Jung , Hsia Hui-Ling , Lee Yi-Ting , Chen Chii-Shiang , Huang Tsi-Shu , Sy Cheng Len , Lin Hsi-Hsun
Published: January 2025

Background

Rapid spread of carbapenemases (CP) among Enterobacterales require prompt identification to enable timely and appropriate treatment. This study aimed to determine the accuracy of NG-Test CARBA 5 for rapid detection of CP and to describe the epidemiology of carbapenem-resistant Enterobacterales (CRE) in Taiwan.Fig 1.Increasing Prevalence of Carbapenemase-producing Carbapenem-resistant Enterobacterales (CRE) in Taiwan (2018-2023)

Methods

316 isolates of CRE were collected from a medical center, Kaohsiung Veterans General Hospital in Taiwan during 2018 to 2023, of which 30.4% were CP producers. The NG-Test CARBA5, PCR for blaKPC, blaVIM-2, blaIMP, blaNDM, and blaOXA-48-like genes were performed on 101 strains. Sequencing and phylogenetic analysis for blaKPC and blaNDM was done.Table 1.Performance of Rapid NG-Test Carba 5 compared to PCR for detecting carbapenemase genes in clinical isolates of carbapenem-resistant Enterobacterales (CRE) in Taiwan (N=101)

Results

A significant increase in the prevalence of CP-producing CRE was observed during this period from 9.9% before 2020 to 29.0% in 2020-2021 and 48.6% in 2022-2023 (OR for trend: 2.46, 95% CI: 1.78-3.38, p< 0.001). CP genes was detected by PCR in 100%, however, the NG-Test CARBA 5 failed in 9 strains, with a detection rate of 91.1%. The agreement between the 2 methods were high (94.4 % for CR-Escherichia coli, 90.6 % for CR-Klebsiella pneumoniae, 87.5 % for CR-Citrobacter freundii and 81.8 % for CR-Enterobacter spp). The major CP genes in CRE was blaKPC 38.6%, blaNDM 34.7%, blaIMP7.6% and blaOXA-48-like 6%. Metallo-β-lactamase (MBL) genes became prevalent over time and accounted for 54.5% of CP genes, which was mainly found in CR-E.coli. Highest expression of CP genes blaKPC and blaOXA-48 was in CR-K.pneumoniae (52.9% and 27.5%, blaNDM was in CR-E.coli (55.6%), and blaIMP in CR-Enterobacter spp. (68.2%). The most common genotype of blaNDM was blaNDM-1 (24/35, 68.6%), following by blaNDM-5 (9/35, 25.7%) and blaNDM-4 (2/35, 5.7%). All 33 blaKPC strains were KPC-2 type.Fig 2.Distribution of Carbapenemase (CP) genes in clinical isolates of CP-producing CRE in Taiwan (N=101)

Conclusion

Our study demonstrated that the NG-Test CARBA 5 was useful for rapid detection of CP genes, and the rising prevalence of MBL genes in Taiwan is a cause of concern due to limited treatment options.

Disclosures

All Authors: No reported disclosures
P-1371. Identifying Occurrences of Plasmid-Borne Antimicrobial Resistance Gene Transfer between Diverse Bacterial Species within Environmental Biofilms Using Proximity-Ligation Sequencing
Authors: Tanner Windy , Tajammul Ayesha , Benson Scott , Ahmed Jamil , VanDerslice James , Brazelton William
Published: January 2025

Background

Antimicrobial resistance is a critical global concern. Pathogens may become resistant through acquisition of mobile genetic elements harboring antimicrobial resistance genes (ARGs). Environmental biofilms provide an excellent venue for ARG transfer via mobile elements. Mobile ARG dissemination pathways in the environment require a better understanding. Here we use proximity-ligation (Hi-C) and metagenomic sequencing to pair plasmids and ARGs to their bacterial hosts and present evidence of plasmid sharing between bacterial species.

Methods

Eight environmental biofilm swabs collected from water sources in Sindh Province, Pakistan were equally aliquoted for preparation by 1) DNA cross-linking for proximity ligation and Hi-C metagenomic sequencing, and 2) traditional shotgun metagenomic sequencing. Metagenomic Hi-C was used to analyze the proximity-ligation and shotgun sequencing data to construct metagenomic-assembled genomes, determine if ARGs were chromosomally- or plasmid-located, and associate mobile genetic elements and ARGs with their host cells.

Results

Actinomycetia, Gammaproteobacteria, and Alphaproteobacteria were the most frequently detected taxa in most samples, with Bacteroidia also being at higher numbers than other taxa in most samples. Multiple classes of ARGs in the sample were identified as being located on plasmids, including aminoglycoside ARGs (e.g. aph(3'), aph(6)), beta-lactam RGs (blaCTX-M-15, blaEC, blaTEM-1, blaOKP-A), macrolide RGs (ere(A), erm(X), mph(A), mef(C), mph(G)), quinolone RG qnrS1, sulfonamide RG sul1, and several tetracycline and metal ARGs. TetC, blaA2, and aac(3)I, were only found on bacterial chromosomes. Analysis of unique assembled ARG-bearing plasmids and taxonomic clusters revealed plasmid sharing between bacterial species, some of which were not closely related taxa.

Conclusion

Mobile ARGs are common in environmental biofilms. These ARGs have the potential to spread within biofilms between species, as evidenced by shared plasmid between different bacterial species. The environment should be considered an important source for mobile ARG dissemination between bacterial species.

Disclosures

All Authors: No reported disclosures
P-1376. Impact of COVID-19 and Mpox on Inpatient Screening of STIs
Authors: Levine Samara , Carpenter Brian , Streifel Amber C , Shonk Alexandria , Varley Cara D
Published: January 2025

Background

Sexually transmitted infections (STIs) continue to pose a considerable public health challenge, with a notable uptick in STI rates over the last few years. Access to care, both inpatient and outpatient, was disrupted during COVID-19 with a subsequent increase in STIs reported in many areas, followed by additional strain on services with the emergence of Mpox in Oregon.

Abbreviations: sexually transmitted infection (STI)

STIs include chlamydia, gonorrhea, syphilis, human immunodeficiency virus (HIV), and hepatitis C

Methods

We conducted a retrospective cohort of hospitalized patients at the Oregon Health & Science University (OHSU) Internal Medicine and Family Medicine services to evaluate STI screening and diagnoses (including chlamydia, gonorrhea, HIV, HCV and syphilis) across distinct periods: pre-COVID-19 pandemic (1/1/2018-2/29/2020), during the COVID-19 pandemic (3/1/2020-7/31/2022), and amidst the Mpox surge (8/1/2022-3/1/2023). We calculated the proportion screened, percent positivity by time and compared proportions between our pre-designated periods using the two-sample test of equal proportions.

Results

During the study period, 5802 patients were admitted to OHSU. Most were White (4705, 81.1%), non-Hispanic (5308, 91.5%) and Female sex (3600, 62.1%). In total, 2151 (37%) were screened for one or more STIs. HIV and syphilis were the most frequently screened STIs at 15.0% and 33.1%. The highest proportion of STI screenings were among those 25-44 years at 40.9% with the highest percent positivity in those 55-64 years at 34.0%. There was a statistically significant increase in proportion screened for all STIs (see Table 2), along with percent positivity for syphilis (P<0.01) between pre-COVID-19 and COVID-19 period, however this trend did not consistently continue after emergence of Mpox.

Conclusion

The proportion of inpatient STI screening is low for patients admitted to internal medicine and family medicine services with percent positivity by age ranging from 5.9-34.0%. We observed an overall increase in proportion screened during the COVID-19 period.

Disclosures

All Authors: No reported disclosures
P-1378. Linezolid For Early Syphilis Treatment: Pilot study
Authors: Stafylis Chrysovalantis , Nguyen Ryan M , Konda Kelika , Reyes-Diaz Michael , Keith Kori , Warren Ebony , Johnson Byron , Creticos Catherine , Stokes Keith , Klausner Jeffrey
Published: January 2025

Background

Syphilis rates have been increasing. At the same time, important shortages of benzathine penicillin G have been reported. Existing alternatives, doxycycline, tetracycline, and azithromycin are inadequate to treat syphilis in all patients due to the absence of safety data in pregnancy and children, or antibiotic resistance, respectively. Linezolid is an FDA-approved, safe, low-cost, oral antibiotic that crosses the blood-brain barrier. It has shown efficacy against Treponema pallidum in vitro and in animal studies. Although a recent clinical study evaluating of 600mg Linezolid once daily for 5 days showed limited success, pharmacological simulations show that a longer regimen may be efficacious. We aimed to assess the efficacy of linezolid 600mg, twice a day for 10 days for the treatment of early syphilis.

Methods

We are conducting a randomized, non-comparative, pilot study enrolling 24 adult patients (18 linezolid, 6 penicillin) with primary, secondary, or early latent syphilis in Chicago, Illinois, and Jackson, Mississippi. The experimental arm receives oral linezolid 600mg twice daily for ten days, while the control arm receives benzathine penicillin G 2.4 million units intramuscularly once. The main outcome is a ≥4-fold RPR titer decline by 6 months after treatment. Linezolid participants are monitored for adherence and adverse events during treatment. Clinical and serological response is evaluated at 1-, 3-, and 6-month follow-up visits.

Results

Currently, six out of 24 participants are enrolled in the study; four in the linezolid arm, and two in the penicillin arm. All participants had early latent syphilis. All participants receiving linezolid adhered 100%. One penicillin participant (enrollment RPR 1:16, 3-month RPR 1:2) and one linezolid participant (enrollment RPR 1:64, 3-month RPR 1:16) have completed their 3-month follow-up. No serious adverse reactions have been reported.

Conclusion

Studies of new treatment options for syphilis are underway

Disclosures

Jeffrey Klausner, MD MPH, Direct Diagnostics: Advisor/Consultant
P-1379. Congenital Syphilis in Southeast Michigan: A Retrospective Case Series
Authors: Cardenas-Maldonado Diana D D , Gudipati Smitha , Santana-Garcés Maria , Maki Gina , Brar Indira
Published: January 2025

Background

Cases of congenital syphilis (CS) have been increasing substantially, but CS is preventable through timely testing and adequate treatment of syphilis during pregnancy. From 2012 to 2021, cases of CS in the United States increased by 755%. Our study aims to describe the demographics of pregnant persons infected with syphilis and outcomes in their infants to identify potential predictors of adverse events.

* Received adequate treatment: Complete Penicillin treatment in pregnant patients, thirty days before delivery

IQR: Interquartile range; HIV: human immunodeficiency virus;

Methods

This is a retrospective case series of pregnant persons diagnosed with syphilis who delivered their babies at Henry Ford Health from January 2020 to January 2024. Charts were reviewed for demographic data, syphilis serology, treatment in mothers and infants, and infant outcomes. Descriptive statistics were used to report the study population’s demographic and clinical characteristics. Chi-squared tests were used to determine the association between receipt of penicillin, prenatal care, prior sexually transmitted infection (STI), and CS diagnosis in neonates. Our chosen significance level was 0.05.

RPR: rapid plasma reagin; CSF: Cerebrospinal fluid; VDRL: Venereal disease research laboratory test.

Results

Forty-three patients were included; 19 (44%) were black; median age 27 years (IQR 24-32.5); 28 (66%) were from Detroit; 18 (53%) reported a history of STI. Eight (18%) did not receive prenatal care. Syphilis was primarily diagnosed during second trimester (34%), and late latent syphilis was reported in 80%. Syphilis treatment was completed 30 days before delivery in 67%. There were 17 early-term deliveries, 1 stillbirth, and 1 elective abortion. Ninety percent of neonates had a normal physical exam. Fifteen lumbar punctures were performed, one positive Venereal Disease Research Laboratory test. Of the 8 placenta studies, 2 had positive immunoperoxidase treponemal stain. Seventeen neonates were treated with 10 days of aqueous Penicillin, 6 neonates had definite/highly probable CS. Using Chi-square analysis, receipt of penicillin treatment by the mother less than 30 days before delivery was significantly associated with CS in the neonate (p < 0.001)

Conclusion

In our analysis, we identified a significant association between CS and appropriate timing of treatment of syphilis in the mother. Further studies are needed with a larger cohort to determine if social determinants of health affect appropriate prenatal care in pregnant persons.

Disclosures

Indira Brar, MD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Merck: Grant/Research Support|ViiV Healthcare: Grant/Research Support|ViiV Healthcare: Honoraria
P-1387. Barriers to PrEP Implementation in Publicly Funded Family Planning Clinics in Atlanta, Georgia
Authors: Bonadonna Lily , Anderson Katherine M , Er Deja , Sales Jessica , Sheth Anandi N
Published: January 2025

Background

Although Georgia has the highest HIV incidence in the US, uptake of pre-exposure prophylaxis (PrEP) for HIV is inadequate, especially among cisgender (cis) women. The Title X Family Planning Program (FP) provides federal funding for sexual health services to low income or uninsured individuals. We sought to understand clinic interest in and capacity for women-centered PrEP care implementation in Title X FP clinics in metro Atlanta.

Methods

From Jan 2022-Nov 2023, we held focus groups with 47 participants representing 22 FP clinics across four metro Atlanta Ending the HIV Epidemic priority counties (71% of all Title X FP clinics in the area). We used a structured interview guide to assess PrEP implementation strategies across each step of PrEP care; participants included advanced practice providers, medical assistants, nurses, and FP program leaders. Following standard rapid qualitative analytic methods, two trained researchers created a matrix of responses by question, assessed salience of responses by deductive themes, and used memos to summarize themes for narrative description.

Results

Clinics had few-to-no cis women on PrEP. Conversations regarding PrEP eligibility were often patient-initiated, rather than provider-initiated. Many providers expressed unfamiliarity with sexual history taking and assessing HIV risk, especially with cis women. Providers also cited patient barriers to PrEP uptake and persistence, including insurance navigation and follow-up visit costs. All providers expressed a need for time-efficient screening and counseling procedures and trainings covering sexual history taking, destigmatizing PrEP, and medication access. Population-tailored information, such as non-English, youth-focused, and low literacy responsive materials were highly desired (Table 1).

Conclusion

Family planning clinics in Atlanta require comprehensive training across the steps of PrEP care, given limited provider initiation of and comfort with risk assessment and counseling, and perceived barriers to uptake and retention. Multi-pronged implementation strategies are necessary to prevent new HIV infections, particularly among cis women, and to progress toward ending the HIV epidemic.

Disclosures

All Authors: No reported disclosures
P-1390. Anorectal Human Papillomavirus (HPV) Infection in HIV-Positive Men who have Sex with Men (MSM) in Nicaragua
Authors: Meléndez-Avendaño Miguel A , Marenco-Avilés Sunaya , Gavarrete-Rivas Kevin , Porras-Cortés Guillermo D
Published: January 2025

Background

HIV-positive men who have sex with men (MSM) are at increased risk for sexually transmitted infections, including anorectal HPV, with the consequent likelihood of neoplasia at that level. There is a complete lack of information on this situation in Nicaragua. This study explores and establishes for the first time the prevalence of anorectal HPV infection in HIV-positive MSM and its correlation with cytological abnormalities, and some associated behavioral, virological, and immunological factors in Nicaragua.Figure 1.Prevalence of HPV Anorectal Infection in MSM HIV Positive Diagnosed by RT-PCR Xpert HPV.

Methods

A prospective, multicenter cohort study was conducted between January 2023 at December 2023, at Dr. Fernando Vélez Paiz Hospital, Antonio Lenin Fonseca Hospital, and Manolo Morales Hospital in the city of Managua, Nicaragua. HIV-positive MSM patients were enrolled to the study with prior consent. Anorectal swab samples were processed by molecular method for HPV detection (GeneXpert HPV®) of different genotypes individually or grouped into genetic patterns (16, 18/45, P3: 31/32/35/52, P4: 51/59, and P5: 39/56/66/68). In addition, anorectal Pap smears were performed for cytopathology study. All samples were processed in the microbiology and pathology laboratories of the Dr. Fernando Vélez Paiz Hospital, the main center of the research.Figure 2.Different Genotypes Detected by Xpert HPV Anorectal Infection in MSM HIV Positive.

Results

A total of 44 patients were enrolled in the study. A significant proportion of patients declined to participate in the study. The mean age was 35.2 ± 12.4 years. Most of the patients reported having a passive or versatile sexual role. 22.7% were naïve to antiretroviral therapy (ART). The prevalence of anorectal HPV infection was 86.3% (Figure 1). The most frequent genotype was HPV 16 (21.7%) (Figure 2). In the combined genotype patterns, P3 (31/32/35/52) was observed in 40.5% of patients. All patients were infected with more than one genotype. 31.5% of those infected had cytological abnormalities, the most frequent being low-grade squamous intraepithelial lesion (Table 1). HPV-positive patients were younger, had a higher viral load, and a lower CD4+ lymphocyte count (Table 2).Table 1.Abnormalities in Anal Papanicolau in MSM HIV-positive con HPV Infection Diagnosed by Xpert HPV.

Conclusion

The prevalence of anorectal HPV infection in this study is high, with serotype 16 being the most frequent. Almost a third of them have altered cytology, with low-grade squamous intraepithelial lesion being the most frequent finding.Table 2.Differences in Age, HIV Viral Load and Count of Lymphocyte CD4+ in MSM HIV-Positive with and wihtout HPV Infection

Disclosures

All Authors: No reported disclosures
P-1391. Epidemiological Characteristics and Clinical Manifestations of Mpox among People with and without Vaccination: An Institutional Experience
Authors: Kim Minji , Wu En-Ling , Wang Yingbao , Aaby David , Cheung Ying , Krueger Karen M , Bolon Maureen K , Galvin Shannon
Published: January 2025

Background

Since May 2022, there have been over 90,000 cases of mpox, with over 32,000 cases in the US. The smallpox and mpox vaccine modified vaccinia Ankara-Bavarian Nordic (MVA-BN; JYNNEOS), which was approved by the FDA in 2019, is currently the predominant vaccine used to prevent mpox infections. Data on vaccine efficacy varies, ranging from 66% to 86-88% with complete vaccination. This study aims to delineate the epidemiological characteristics, as well as the clinical features and outcomes in those who were unvaccinated and vaccinated in one institution.

Methods

This is a retrospective analysis of data obtained via EHR chart review and managed Research Electronic Data Capture tools with approval by the Northwestern University Institutional Review Board. Key descriptive characteristics included baseline demographics, clinical manifestations, concomitantly diagnosed sexually transmitted infections, and clinical outcomes (including markers of disease severity such as the mpox severity score system, Mpox-SSS). Vaccinated, partially vaccinated, and unvaccinated groups were compared using Fisher’s exact tests (categorical characteristics) and one-way ANOVA (continuous characteristics).

Results

There were 108 individuals with PCR-confirmed mpox at our institution between July 20, 2022 and October 16, 2023. Of these 108 individuals, 14 were fully vaccinated, 24 were partially vaccinated, and 70 were unvaccinated. Baseline demographics are reported in Table 1. Unvaccinated persons differed from vaccinated and partially vaccinated persons in HIV status and with respect to PrEP usage. Clinical outcomes are reported in Table 2. Notably, median Mpox-SSS scores were as follows: 5 in the fully vaccinated group, 5 in the partially vaccinated group, and 7 in the unvaccinated group (p=0.03). There were no hospitalizations, ICU stays, and deaths in the fully vaccinated group but 11 hospitalizations (p=0.27) and 1 death in the unvaccinated group.

Conclusion

Epidemiologically, both the vaccinated and unvaccinated population consisted predominantly of cisgender men who have sex with men (MSM). There were differences in HIV status and PrEP usage. Overall, compared to the unvaccinated group, the vaccinated group appears to have clinical features and outcomes that were less severe.

Disclosures

All Authors: No reported disclosures
P-1403. Measuring Impact of COVID-19 Pandemic using Novel EPII Survey on PLWH in New Orleans
Authors: McGaugh Angela , Meyers Erik , Srinivasan Shruti , Francis Mariza , Zheng Crystal , Grasso Damion , Adams Leah , Adams Suzanne
Published: January 2025

Background

Research has shown that the impacts of the COVID-19 pandemic stretch beyond solely physical health. This study uses the newly developed Epidemic-Pandemic Impacts Inventory (EPII), a 92-item tool designed to quantify the impact of COVID-19 pandemic across several personal and social domains. People living with HIV (PLWH) have an increased morbidity and mortality associated with COVID-19 infection and are overall more vulnerable to social change. The current study uses the EPII to compare pandemic-related experiences of PLWH to those without HIV in New Orleans.

Methods

The Tulane University COVID-19 Antibody and Immunity Network (TUCAIN) maintains a longitudinal cohort of PLWH who provide clinical data and biological specimens for studies on the immune response to COVID-19 infection and vaccination. For the current study, participants were asked to complete the EPII assessing their perception of the pandemic. Participants were invited to complete the survey in person or via phone with a study coordinator. Responses from participants ≥18 years old who completed the survey were reviewed. Survey responses were analyzed using SPSS software.

Results

Both the PLWH (N=54) and control group (N=220) were similar in age; however, the PLWH subset was predominantly male and more racially diverse. PLWH reported more severe impacts of pandemic such as food insecurity (χ2=15.9; df=1; p< 0.01) and loss of employment (χ2=26.9; df=1; p< 0.01) and housing (χ2=6.6; df=1; p=0.01). PLWH reported more interruptions in medical care (χ2=12.6; df=1; p< 0.01) and more health problems unrelated to COVID-19 (χ2=7.2; df=1; p< 0.01). The PLWH subset was also less likely overall to report positive impacts of the pandemic (i.e. increased quality time with loved ones) compared to control group.

Conclusion

Results indicate that the HIV cohort reported greater rates of financial and health ramifications of the pandemic relative to control population. This study further reinforces the notion that this population was more susceptible to the socioeconomic turmoil of the COVID-19 pandemic. The results from this study will help to refine EPII as a survey tool for use in future pandemics and more precisely identify domains of social impact that affect the PLWH population the most.

Disclosures

All Authors: No reported disclosures
P-1412. HIV Retention in Care and Viral Suppression among Transgender Women in a Large Ryan White Clinic
Authors: Gilbert Danielle L , Moise Hope Oddo , Richey Lauren
Published: January 2025

Background

Transgender women (TW) are disproportionately affected by HIV with 1 in 5 TW in the United States living with HIV. TW with HIV (TWH) have lower rates of retention and viral suppression than cisgender women and cisgender men, resulting in worse health outcomes and increased HIV transmission. The aim of this quality improvement initiative was to identify TWH at a large urban Ryan White clinic in New Orleans to guide future quality improvement efforts to improve retention and viral suppression of TWH.Table 1.Characteristics of Transgender Clinic Patients Reviewed

Methods

A list of established clinic patients with a gender identity of transgender was generated to create a database with basic demographic information, viral suppression, retention in care, and potential barriers to viral suppression or retention from April 1, 2023-March 31, 2024. Insurance status, mental health or substance use disorder, and prescription of gender affirming hormone therapy (GAHT) were documented for each patient. Patients were further subdivided into three categories “In Care and Virally Suppressed,” “Out of Care,” and “Not Virally Suppressed” for further analysis.

Results

Out of 1393 established clinic patients, 28 patients were identified as transgender (2%). 27/28 of these patients are black/African American, 1 is Hispanic/Latino. 64% were retained in care, compared to 81% of all clinic patients. 75% were virally suppressed, compared to 84% of all clinic patients. Detailed characteristics are displayed in Table 1. Patients who were out of care or not virally suppressed were younger and had higher rates of mental health diagnoses. 70% of patients who were out of care carried a mental health diagnosis. There was no correlation between GAHT, substance use, or insurance status and retention in care or viral suppression.

Conclusion

As suggested by previous studies, a significantly lower percentage of TWH were retained in care and virally suppressed when compared to the total clinic population, thus highlighting the need to focus on this disproportionately affected group. This TWH database will be used to track retention in care and viral suppression, and data regarding potential barriers will be used to guide quality improvement efforts among TWH, with a plan to focus on mental health services.

Disclosures

All Authors: No reported disclosures