bluuebunny/crossref_metadata_2025 huggingface dataset:
656. Cryptosporidiosis in Immunocompromised Patients with Cancer Receiving Chemotherapy, CAR-T Cell Therapy and Hematopoietic Stem Cell Transplantation: A Retrospective Analysis
Authors: Mann Inderjit , Okhuysen Pablo C
Published: November 2023

Background

Cryptosporidium is a parasitic protozoan that causes severe and potentially life-threatening diarrheal disease in immunocompromised patients. Infections can be asymptomatic, cause self-limited disease, or chronic diarrhea and in some cases result in biliary and pulmonary disease

Methods

We performed a detailed retrospective analysis of patients that presented with diarrheal illness, and Cryptosporidium infection diagnosed by GI multiplex (Biofire) at UT MD Anderson Cancer Center between January 2017 and March 2023.

Results

We identified 51 patients aged 24 to 89 years with cryptosporidiosis. Hematological malignancies (HM) were present in 44% of patients, while non-hematological malignancies (NHM) in 55%. Thirty-seven percent of patients had received hematopoietic stem cell transplantation (HSCT), 8% chimeric antigen receptor T-cell (CAR-T) therapy, 18% immunosuppressive therapy, and 65% received chemotherapy in the last 90 days. Two patients had human immunodeficiency virus (HIV). All patients presented with diarrhea, 39% with nausea, 43% with abdominal pain, and 51% had fever. The median duration of symptoms was 3 days. About 41% were severely neutropenic, and 61% had severe lymphopenia. Computed tomography (CT) abdomen was normal in 43% of patients, 16% had colitis, 12% had enteritis, and 4% had enterocolitis. All patients were treated with Nitazoxanide, with a median duration of therapy (DOT) of 14 days. The DOT was longer in HM than in NHM (14 ± 7.9 vs. 9.9 ± 5.6, p= 0.016) and in HSCT/CAR-T patients than without HSCT/CAR-T (13.8 ± 6.1 vs. 10.3 ± 7.3, p = 0.009). About 18% of patients had co-infections with other enteropathogens. Death from other causes occurred in 13 of 51 (23%) of patients. All cause mortality between HM and NHM (p=0.207), HSCT/CAR-T and non-HSCT/CAR-T (p=0.52), or chemotherapy vs. without chemotherapy (p=0.34) was similar. Most infections were encountered in the month of October.

Conclusion

We observed a limited response to nitazoxanide at our center, contributing factors and confounders included co-infections with other pathogens, active chemotherapy, or HSCT/CAR-T induced intestinal epithelium injury. Controlled, double blinded studies with new agents are needed to determine the optimal management of cryptosporidiosis in this population.

Disclosures

Pablo C. Okhuysen, M.D., FACP, FIDSA, Astra Zeneca: Stocks/Bonds|Beam Therapeutics: Stocks/Bonds|Biontech: Stocks/Bonds|Deinove Pharmaceutucals: Grant/Research Support|Ferring: Advisor/Consultant|GSK PLC: Stocks/Bonds|Haleon: Stocks/Bonds|Johnson and Johnson: Stocks/Bonds|Melinta Pharmaceuticals: Grant/Research Support|Merk Sharp and Dohme: Grant/Research Support|Moderna: Stocks/Bonds|Napo Pharmaceuticals: Advisor/Consultant|Napo Pharmaceuticals: Grant/Research Support|Novavax: Stocks/Bonds|Pfizer: Stocks/Bonds|SNIPR Biome: Advisor/Consultant|Summit Pharmaceuticals: Grant/Research Support
684. Characteristics of Patients with Initial Clostridioides difficile Infection (CDI) That Are Associated With Increased Risk of Multiple CDI Recurrences
Authors: Guh Alice , Li Rongxia , Korhonen Lauren C , Winston Lisa Gail , Parker Erin , Czaja Christopher A , Johnston Helen , Basiliere Elizabeth , Meek James , Olson Danyel M , Fridkin Scott , Wilson Lucy E , Perlmutter Rebecca , Holzbauer Stacy , D’Heilly Paige , Phipps Erin , Flores Kristina , Dumyati Ghinwa , Pierce Rebecca , Ocampo Valerie , Wilson Christopher , Watkins Jasmine , Gerding Dale , Clifford McDonald L
Published: November 2023

Background

Recent advancements in treating Clostridioides difficile infection (CDI) include therapeutics to prevent further recurrence in patients with recurrent CDI (rCDI). However, little is known about which patients are at increased risk for multiple recurrences (≥ 2 rCDI). We sought to identify predictors of multiple rCDI (mrCDI) in adults at the time of presentation with initial CDI (iCDI).

Methods

The Centers for Disease Control and Prevention’s Emerging Infections Program (EIP) conducts population-based CDI surveillance in 10 U.S. sites. We defined iCDI as a positive C. difficile test during January 2018–August 2019 in a person aged ≥ 18 years with no prior positive test reported to EIP. rCDI was defined as a positive test ≥ 14 days from the previous positive test within 180 days after iCDI. All patients with community-onset iCDI and a random sample of patients with healthcare-facility onset iCDI (i.e., hospital-onset, long-term care facility onset) had full chart reviews. Multiple imputation was performed on missing race/ethnicity. Candidate variables determined a priori to be potentially associated with mrCDI were entered into an initial multivariable logistic regression model. Patients without mrCDI who died within 180 days of their iCDI were excluded from the model. Candidate variables with a p-value < 0.1 in the initial model were included in the final model.

Results

Of 18,829 patients with iCDI, 882 (4.7%) had mrCDI, ranging from 2 to 5 rCDI per patient in the 180 days following iCDI. Median time between each rCDI was 43 days (interquartile range: 27–65 days). Full charts were reviewed for 435 iCDI patients with mrCDI and 7474 iCDI patients without mrCDI. Characteristics of patients with and without mrCDI are shown in Table 1. In multivariable analysis, age ≥ 65 years, recent hospitalization, chronic hemodialysis, and recent nitrofurantoin use were significantly associated with mrCDI (Table 2).

Conclusion

Patients with iCDI who are older, on hemodialysis, or had recent hospitalization or nitrofurantoin use may be at increased risk of mrCDI and may benefit from early use of adjunctive therapy to prevent mrCDI. If confirmed, these findings would aid in clinical decision making.

Disclosures

Ghinwa Dumyati, MD, Pfizer: Grant/Research Support
687. Zinplava Expert Retrospective Observations (ZERO) Study Findings on Clostridioides difficile Recurrence
Authors: Jacobs Micah , Morris Sharon
Published: November 2023

Background

Describe real world experience in the use of bezlotoxumab (BZT) for the prevention of recurrent Clostridioides difficile(CDI) infection with a 1 year follow up following administration. The original BZT studies showed approximately 16% rate of recurrence at 12 weeks with other baseline and outcome data as noted in Figure 1.

Methods

Retrospective study of patients administered BZT in a community based private practice infusion suite from May 2017 to October 2020. A total of 50 consecutive patients were included with background demographics, relevant medical history and CDI history obtained through chart review. In addition to the chart review, patients were contacted at least 1 year after BZT administration to see if there were any recurrences and if other treatments were required. Primary objective was to show the rate of CDI recurrence in the 1 year after BZT administration. All BZT was administered in an outpatient setting in patients who were responding to initial Standard of care (SOC) therapy.

Results

50 patients were included with infusion dates from May 2017 to October 2020. Baseline patient characteristics (Figure 2) include median Age of 69 and 74% female. CDI history (Figure 3) includes an average of 2.06 episodes including the current episode at time of time treatment and median of 19.5 days to BZT administration from last positive episode (positive test or starting a new treatment course for presumed positive). SOC treatments over the course of patient’s episodes are listed in Figure 3, most patients received more than agent.

In the 1 year following BZT only 4 patients had recurrence (Figure 4) with 2 going on fecal microbiota transplant. There were 3 deaths reported, all at least 3 months after BZT and none had CDI recurrence.

Conclusion

In our real-world use, BZT administered in an outpatient setting to patients who responded to SOC treatment resulted in only 8% recurrence after 1 year compared to 16% after 12 weeks in the trial. This supports the existing guidelines on the use of BZT in patients over 65 and with recurrent CDI to prevent further recurrence. Our data also supports administration later in the course of therapy when patients have achieved initial response.

Disclosures

MICAH JACOBS, Micah Jacobs, MD, FIDSA, FACP, Abbvie: Honoraria|Cumberland Pharmaceuticals: Honoraria|Merck: Grant/Research Support|Spero Pharmaceuticals: Advisor/Consultant
691. Association between Clostridioides difficile Colonization, Rectal Swab NAAT Positivity, and Environmental Contamination
Authors: Lee Mary Morgan , Hink Tiffany , Newcomer Erin , Fishbein Skye , Reske Kimberly , Struttmann Emily , Iqbal Zainab , Cass Candice , Kwon Jennie H , Olsen Margaret A , Burnham Carey-Ann , Dantas Gautam , Dubberke Erik R
Published: November 2023

Background

Clostridioides difficile (CD) colonization is common among hospitalized patients. Screening for toxigenic CD (TCD) colonization with rectal swab nucleic acid amplification tests (NAAT) may identify people at risk for CDI and help prevent onward TCD transmission, especially in immunocompromised patients with long hospitalizations. The study objective was to test whether rectal swab NAAT could detect TCD colonized patients and whether NAAT results identify patients that contribute to environmental contamination.

Methods

This was a prospective cohort study on two BMT/Leukemia units. Stool specimens, rectal swabs, and environmental swabs (bedrail, room sink, keyboard) were collected from patients at admission and weekly and cultured semi-quantitatively for TCD. NAAT (Cepheid) was performed on rectal swabs (eSwabs; Copan Diagnostics). The relationship between stool TCD concentration, NAAT Ct, and a positive environmental culture was evaluated using univariate logistic regression. Bleach was used for daily and terminal discharge cleaning of all rooms. Toxigenicity was determined by detection of tcdA or tcdB by whole genome sequencing (WGS).

Results

From January 2019 - July 2019, 659 stool specimens and 495 rectal swabs were collected from 384 patients. Specimens from 554 patient-days were cultured and 126 (23%) were positive. Of those, 88 (70%) were TCD. 21 of 987 (2%) environmental swabs were TCD positive; 18 (86%) were from bedrails. Among 61 unique patient calendar days with paired rectal swab NAAT and stool culture results (paired samples), overall sensitivity of rectal swab NAAT to detect toxigenic CD colonization compared to culture was 44%, with 4/16 (25%) of people colonized with > 0 - < 10,000 CFU/g of TCD and 7/9 (78%) with ≥ 10,000 CFU/g TCD (Figure 1). There was no relationship between stool culture or rectal swab NAAT result and risk of a positive environmental swab (Figure 2).

Figure 1. Toxigenic C. difficile semi-quantitative culture and rectal swab NAAT on paired patient-day of specimen collection (N=61 patient-days) Figure 2. Toxigenic C. difficile semi-quantitative stool and rectal swab NAAT results and environmental contamination by paired patient-day of specimen collection

Conclusion

Rectal swab NAAT may not be sufficiently sensitive to screen for TCD colonization that contributes to environmental contamination.

Disclosures

Erik R. Dubberke, MD, MSPH, Abbott: Advisor/Consultant|AstraZeneca: Advisor/Consultant|Ferring Pharmaceuticals: Advisor/Consultant|Ferring Pharmaceuticals: Grant/Research Support|Merck and Co.: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Seres Therapeutics: Advisor/Consultant|Summit: Advisor/Consultant|Theriva Biologics: Grant/Research Support
704. Antibiotic Use Audit in Hospital-onset Clostridioides difficile (HO-CDI) Cases in a Tertiary Medical Center in New York City
Authors: Swaminathan Neeraja , Yune Philip , Cowman Kelsie , Weston Gregory D , Nori Priya , Bartash Rachel , McSweeney Terrence D , Guo Yi
Published: November 2023

Background

Hospital-onset Clostridioides difficile infection (HO-CDI) is a nosocomial infection that adversely impacts length of stay, morbidity, and mortality, and contributes to 6 billion dollars in U.S. healthcare expenditures. Our aim was to identify and categorize antibiotic prescribing patterns amongst patients with HO-CDI at our institution and design targeted interventions based on these findings.

Methods

A physician-assigned review of electronic medical records for all laboratory-confirmed cases of HO-CDI was conducted at Montefiore Medical Center Moses Campus (Bronx, NY) from July 2022 to March 2023. HO-CDI was defined using the CDC’s NHSN definition as a positive stool test for Clostridium difficile occurring after 3 days of hospital admission. Our hospital follows a 2-step testing algorithm: a positive test occurs when both glutamate dehydrogenase (GDH) and C. difficile toxin are detected. If there is discordance at this stage, a confirmatory polymerase chain reaction (PCR) test is performed. Formed stool specimens are rejected and Montefiore has institutional guidance for appropriate C. difficile testing. Antimicrobial choice, indication, and duration were reviewed. We characterized the inappropriateness of antibiotic use into 3 non-mutually exclusive categories (inappropriate indication, spectrum of activity, or duration).

Results

77 HO-CDI cases were identified from 15 inpatient services encompassing medical, surgical, and intensive care services. Exposure to one or more antibiotics within 30 days prior to CDI diagnosis was seen in 88% of cases (n=68). Of these, 16 (23.5%) had inappropriate antibiotic use (Table 1). Antibiotics were used for longer than clinically indicated in 11 (69%) cases. Inappropriately broad-spectrum antibiotics were used in 9 (56%) cases. Antibiotic use was deemed unnecessary in 4 (25%) cases (Figure 1). The most frequently used antibiotics were piperacillin/tazobactam in 8 (50%) cases, followed by ceftriaxone in 5 (31%) cases, and meropenem in 2 (12.5%) cases (Figure 2).

Conclusion

Targeting inappropriate antibiotics is an important strategy to reduce HO-CDI. We intend to follow-up with directed provider feedback and education and heightened antibiotic stewardship efforts.

Disclosures

All Authors: No reported disclosures
728. Potential Reservoirs for Additional Carbapenemase Gene Spread: Detection of Carbapenemase Genes in non-Pseudomonas aeruginosa and non-Acinetobacter baumannii isolates
Authors: Sabour Sarah , Kent Alyssa , Brown Allison C
Published: November 2023

Background

Public Health Laboratories (PHL) across 50 U.S. states, several cities and Puerto Rico participate in CDC’s Antimicrobial Resistance Laboratory Network (AR Lab Network), to test clinical isolates of carbapenem-resistant Pseudomonas aeruginosa (CRPA) and Acinetobacter baumannii (CRAB) for the presence of targeted carbapenemase (CP) genes. PHLs have submitted reports of these targeted genes in CR non-aeruginosa Pseudomonas (CR-NAP) and non-baumannii Acinetobacter (CR-NBA) isolates. Here we describe the ad-hoc detection of targeted CP genes in CR-NAP and CR-NBA species tested by the Network.

Methods

Clinical laboratories submitted CR isolates to PHLs for organism identification. Isolates were deemed suspected CR-NAP and CR-NAB when a PHL ruled out aeruginosa or baumannii, respectively, but their MALDI ToF MS database prevented further speciation. PHLs used real-time polymerase chain reaction or whole genome sequencing to detect the presence of targeted CP genes: blaKPC,blaNDM,blaOXA-48-like,blaIMP, and blaVIM in Pseudomonas and Acinetobacter, and blaOXA-23-like,blaOXA-24/40-like, and blaOXA-58-like in Acinetobacter.

Results

During 2017–2021, the AR Lab Network tested 56,092 CR-Pseudomonas isolates, 71 of which were CR-NAP; P. putida (n=15; 21%), P. fluorescens (12; 17%) P. otitidis (5; 7%), P. monteilii (3; 4%), 1 (1%) each of P. koreensis and P. mosselii, and 34 (48%) other suspected CR-NAP. Three (4%) of the 71 CR-NAP isolates tested carried a targeted CP gene: 1 P. fluorescens with blaIMP, 1 P. putida with blaVIM, and 1 P. Japonica with blaKPC.

Of 13,624 CR-Acinetobacter isolates tested, 25 (< 1%) were CR-NBA; A. pitti (10; 40%), A. radioresistens (6; 24%), A. variabilis (2; 8%), 1 (4%) each of A. berezinaiae, A. lwoffii, and A. ursingii, and 4 (16%) other suspected CR-NBA. The A. variabilis isolates each harbored both blaNDM and blaOXA-58-like genes.

Conclusion

Although CR-NAP and CR-NBA isolates are not solicited by the Network, some of these species are submitted for characterization. Our findings suggest these other species do harbor some targeted CP genes and may represent unmonitored reservoirs for CP gene spread in the U.S. An expansion of testing to include these species in the AR Lab Network may improve our ability to slow the spread of antimicrobial resistance.

Disclosures

All Authors: No reported disclosures
739. Impact of Alcohol-based Nasal Decolonization’s Method of Documentation in Reducing Methicillin-resistant Staphylococcus aureus Hospital-associated Infections
Authors: Alderman Shawn , Heishman Crystal , Skiff Richard
Published: November 2023

Background

Infections related to multi-drug resistant organisms (MDRO) are increasingly difficult to treat and contribute to elevated mortality, prolonged length of stay and financial burden. At a 382-bed academic medical center, universal decolonization using an alcohol-based nasal decolonizing agent is performed twice daily on all inpatients, as well as chlorhexidine gluconate (CHG) bathing on select populations. Numerous studies cite decolonization as an effective reduction method for MDRO such as methicillin-resistant Staphylococcus aureus (MRSA). Unfortunately, documentation method is a seldomly considered variable.

The purpose of this review was to evaluate the impact of documentation method for an alcohol-based nasal decolonization agent in reducing MRSA hospital-associated infections.

Methods

The study included all National Healthcare Safety Network (NHSN) defined hospital associated laboratory identified (Lab ID) MRSA blood infections from July 2019 through March 2023. Data was divided into descriptive categories with number of infections noted. The baseline period included population specific decolonization (n=35), followed by universal decolonization documentation via nursing task list (n=13), and concluded with electronic medication administration record (EMAR) implementation (n=7). The Kruskal Wallace Test was utilized for evaluation due to non-normative distribution.

Results

A Kruskal Wallace H Test indicated a statistical significance in medians between the task list and EMAR H(1) =5.10, p=0.024. There was no significance noted between the baseline and task list H(1 =0.04), p=0.841. Medians between baseline and EMAR approached significance but did not meet for this study H(1) =3.24, p=0.072.

Clinically, there was a reduction in MRSA Lab ID of 48% between baseline and task list, followed by a 46% reduction between task list and EMAR. Overall reduction from baseline to EMAR was 80%.

Conclusion

Reduction of infection is crucial for patient safety and quality outcomes. Documentation is not typically highlighted as a risk reduction method. This study noted a significant decrease in hospital-associated MRSA Lab ID events after transition of documentation from the nursing task list to the EMAR.

Disclosures

All Authors: No reported disclosures
741. Assessing the Concordance of MRSA Carriage Screening with MRSA Infections
Authors: Mannheim Jonathan , Kumar Madan , Bhagat Palak , Nelson Allison
Published: November 2023

Background

There is a lack of research on MRSA surveillance in children. This study focused on children with confirmed MRSA infections to determine the utility of MRSA screens in guiding empiric anti-MRSA treatment for children without history of MRSA infection. We examined the concordance of screens to assess for differences by infection type, and used statistical analysis to determine significant contributors to concordance.

Methods

Pediatric hospital patients admitted from 2002-2022 were included. Subjects had MRSA infections subsequent to a MRSA surveillance screen performed in the preceding year. Statistical analysis, namely multivariable and binomial regression, identified associations between MRSA screens and infections. Number needed to treat analysis calculated the utility of re-screening.

Results

Among 246 subjects, 39.0% had concordant screens. 151 (61.4%) screens were obtained in the two weeks preceding infection. Sensitivity for bacteremia was 50.0% (n=42), for ET/respiratory 44.4% (n=81), for SSTI 29.4% (n=102). For children under 6 months of age, sensitivity was 35.9% (n=78). Multivariable analysis significantly associated days since MRSA screening and decreasing likelihood of concordance. Binomial regression modeled the probability of concordance to drop below 50.0% for all infections after four days, after six days for bacteremia specifically, and twelve days for ET/respiratory infections.

Probability of Concordance Over Time

The probability of MRSA screening concordance over time based upon binomial prediction modeling. Each line represents the probability of concordance on a given day subsequent to MRSA screening.

Number Needed to Treat (test) Analysis

A theoretical control arm of patients receiving no re-screening is compared to a theoretical treatment arm receiving re-screening. Each column represents the number needed to re-screen (for a given number of days) to predict one MRSA infection. Absolute risk reduction is overlaid.

Conclusion

The concordance of screens was far lower than NPV found in past studies. Bacteremia concorded at 50.0%, ET/respiratory infections 44.4%, SSTI 29.4%. The number of days elapsed since MRSA screening proved the only significant covariate. When that covariate modeled the probability of screening concordance with infection, 7 days represented when the probability of concordance fell to or dropped below 50.0% for infection types. Only patients with a known MRSA infection were included in our study, and concordance of screens was far lower than NPV found in past studies; previous results may have been impacted by low prevalence to inform high NPV. We suggest that negative MRSA screens should not invalidate reasonable suspicion for MRSA infection in patients with high pre-test probabilities for infection. Re-screening patients may optimize concordance.

Disclosures

All Authors: No reported disclosures
750. Launching the South Carolina Regional Infection Prevention Training (SCRIPT) Center: A Pilot in Interprofessional Education
Authors: Bailey Pamela , Dash Sangita , Williams Shanetta , Custer Sabra , Derrick Caroline , Green Katherine , Al-Hasan Majdi N , Justo Julie Ann
Published: November 2023

Background

Structured education of healthcare professionals around infection prevention practices and protocols is currently lacking. We launched a pilot program of an infection prevention interprofessional education (IPE) elective for students in their clinical years of medical, pharmacy, nursing, and physician assistant school.

Methods

Both quantitative and qualitative assessments prior to initiation and at completion of the 2-week multidisciplinary interactive and practical IPE elective were performed. We assessed students’ confidence with specific infection prevention skills knowledge, and attitudes towards IPE, and obtained qualitative feedback. Wilcoxon signed rank test was used to compare assessment results before and after IPE elective.

Results

Twelve students completed the IPE elective. There was a significant increase in Lickert scale rankings of students’ comfort level with various infection prevention concepts and skills after IPE (p< 0.001). Similarly, a significant improvement in students’ assessment of their IPE attitudes was noted after completion of the IPE elective (p=0.001).

Feedback comments included: “I really enjoyed learning the ‘why’ behind everything [because] it's made me comfortable passing the information to others and speaking up if needed--even still as a student”; “learned information I will use every day”; “people from different backgrounds”; “knowledgeable facilitators, excited to teach & facilitate learning.”

Conclusion

Infection prevention education was impactful via the incorporation of an IPE elective into clinical rotations, and use of knowledgeable and adept teachers from multiple disciplines. Leaders emphasized the “why” behind protocols, and allowed students to practice the hands-on skills of infection prevention.

Disclosures

Julie Ann Justo, PharmD, MS, FIDSA, BCPS, Gilead Sciences: Advisor/Consultant|Shionogi: Advisor/Consultant|Vaxart: Stocks/Bonds
785. British Transplant ID, Mycology, and Infection in the Immune Compromised Network (BRITMIC) -Addressing the unmet need of Transplant ID in the United Kingdom
Authors: Stone Neil R H , Murthy Saraswathi , Wey Emmanuel , Lambourne Jonathan
Published: November 2023

Background

There is currently no formal sub-specialty training program in transplant ID or mycology in the UK. Practice is diverse and is provided by either ID physicians or clinical microbiologists with a self declared interest in these aspects of infection medicine. To address this, we established a new network is designed to promote this ever expanding niche within the wider specialty of infectious diseases and microbiology

Methods

British Transplant ID, Mycology, and Infection in the Immune Compromised Network (BRITMIC) was established in 2021 as a UK-wide network for infection specialists with an interest in clinical mycology, infections in solid and stem cell transplants and infections in the immunocompromised host. Our aim is to share interest and experience in invasive fungal infections and transplant infectious diseases, and provide a platform for communication, education and research, as well as real-time clinical case discussions.

Results

Since establishment we have 117 registered members and have run quarterly meetings (currently virtual), with our inaugural meeting having been held in July 2021. We have held 10 meetings to date had outstanding international guest speakers, complex case discussions, as well as hosting a highly successful session on Transplant ID at the Federation of Infection Societies (FIS) Conference in November 2021. We are now affiliated to the larger British Infection Association (BIA) and have an established governance framework and terms of reference.

Achievements to date include developing a UK working group on treatments for COVID-19 in the immune suppressed and establishing a national case conference for complex mycology or transplant related infections.

Conclusion

The BRITMIC Network has established a new resource for mycology and transplant ID in the UK, and is an important stepping stone to establish these as recognised sub specialties within the field of ID in our setting. This can act as a model for others in settings with limited existing networking and education infrastructure in this branch of ID

Disclosures

Neil RH Stone, MD PhD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Pfizer: Honoraria|Shionogi: Honoraria Emmanuel Wey, MBBS, Clover Biosoft: Advisor/Consultant Jonathan Lambourne, MB BS, BA, MSc, DTM&H FRCP, FRCPath, PhD, Mundipharma: Advisor/Consultant|Mundipharma: Advisor/Consultant
807. Trimethoprim/Sulfamethoxazole for Pneumocystis jirovecii pneumonia prophylaxis in B-cell lymphoma: A multicenter randomized double-blinded placebo-controlled trial
Authors: Angsutararux Taksaon , Wongwatcharanon Kiattikon , Dhitinanmuang Wutthiseth , Chintabanyat Anothai , Jit-Ueakul Dusit , Owattanapanich Weerapat , Karoopongse Ekapun , Jangkananun Piyanut , Piyabun-yanon Chavada , Munsakul Warangkana , Chayakulkeeree Methee
Published: November 2023

Background

The studies to compare the efficacy and safety of trimethoprim/sulfamethoxazole (TMP/SMX) for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in lymphoma patients are scared.

Methods

A multicenter randomized double-blinded placebo-controlled trial was conducted in adult B-cell lymphoma patients receiving R-CHOP. Participants were randomly assigned to received either TMP/SMX (160/800 mg) or placebo trice weekly until 1 month after the last chemotherapy cycle. The primary outcome was PJP at 30 days after cessation of chemotherapy. The secondary outcomes were bacterial infection, survival at day 90 and adverse drug reactions. The modified-intention-to-treat analysis included participants who received at least one dose of the study drugs. Per-protocol analysis included participants who received a complete course of the study drugs or met the study endpoints.

Results

A total of 110 patients were enrolled to the study. Five patients were self-withdrawn after randomization and did not receive any of the study drugs given. Thirteen patients were lost to follow up during the study and 4 patients were prematurely terminated. Therefore, 105 patients were included in the modified intention-to-treat analysis, 55 in TMP/SMX and 50 in placebo group. Eighty-eight patients were included in the per-protocol analysis, 48 in TMP/SMX group and 40 in placebo group. For modified intention-to-treat analysis, 1 patient in the TMP/SMX group developed PJP (1.8%), compared to 0% in the placebo group (p-value 1.0). There was indifference of bacterial infection rate between the TMP/SMX and placebo groups (16.3% and 14%, respectively; p-value 0.7). The survival rate without PJP events within 90 days was comparable between TMP/SMX and placebo group, 96.4% and 96%, respectively (p-value 1.0). Adverse events were significantly higher in the TMP/SMX group compared with the placebo group (18.2% vs. 2%; p-value 0.007). Per-protocol analysis also showed no statistically significance in PJP, bacterial infection and 90-day survival between two groups.

Conclusion

TMP/SMX cannot be recommended for primary prophylaxis in lymphoma patients receiving R-CHOP at this time, as it showed higher adverse effects with no benefit on prevention of PJP and bacterial infection as well as survival.

Disclosures

All Authors: No reported disclosures
840. Risk-Based Screening on Admission Cultures (SOAC) vs. Unit-Wide Reactionary Surveillance Cultures (UWRC) for Candida auris: A Pilot QI Study in a Tertiary Care Center ICU
Authors: Strong Nora , Patel Bela , Daniels LaRhonda , Ausborn Valerie , Mitchell Elizabeth , Denman Chris , Von Wenckstern Toni , Ellsworth Misti G , Ostrosky-Zeichner Luis , Wanger Audrey
Published: November 2023

Background

Candida auris (C. auris) is a highly pathogenic, often multidrug resistant organism, that spreads in healthcare facilities. CDC recommends UWRC when a case is found in a unit. Currently, no recommendation exists for C. auris SOAC. We investigated if UWRC can be avoided, and clinical cases be prevented by SOAC in high-risk patients being admitted to an ICU.

Methods

We conducted a pilot QI study in which high-risk patients for C. auris colonization (defined as those admitted from long term care facilities, a history of echinocandin use in the last 3 months, or a history of C. auris infection or colonization) were screened for skin colonization with fungal axillary and groin swab cultures. These patients were placed on contact precautions pending test results. If C. auris was recovered, the patient would be upgraded to “Contact plus” precautions. If cultures were negative, precautions were downgraded to standard. No UWRC would be required if patients were identified and isolated upfront. We tracked the number of SOAC and clinical cases and compared them to the number of UWRC and clinical cases in the pre-study period.

Results

Between January 2023 and March 2023, an average of 273 C. auris UWRCs were performed per month in reaction to 18 clinical cases, with 8 positive surveillance cultures over those 3 months (0.98% positive rate). In April 2023, our pilot study month, a total of 13 admission screening cultures were collected, of which none were positive. No UWRC were performed, and no clinical cases were detected.

Conclusion

Although limited by the pre- and post-nature, the abbreviated time, and the sample size of this pilot QI study, we found that risk based SOAC is a strategy that warrants further study as an alternative to UWRC, which are costly and labor intensive.

Disclosures

Luis Ostrosky-Zeichner, MD, FACP, FIDSA, FSHEA, FECMM, CMQ, Astellas: Grant/Research Support|Cidara: Advisor/Consultant|Cidara: Advisor/Consultant|F2G: Advisor/Consultant|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|NIH: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Pulmocide: Grant/Research Support|Scynexis: Grant/Research Support|T2 Biosystems: Grant/Research Support|Viracor: Advisor/Consultant
852. Epidemiology, clinical characteristics and outcomes of invasive pulmonary aspergillosis among critically ill patients in medical intensive care unit: A retrospective study from the tertiary care hospital in Thailand
Authors: Yutthana Noppharut , Jutivorakool Kamonwan , Vanichanan Jakapat
Published: November 2023

Background

Invasive pulmonary aspergillosis (IPA) is a serious infection which leads to poor outcomes particularly in immunocompromised patients. Recently, IPA in critically ill patients in intensive care unit (ICU) has been increasingly recognized owing to its substantial morbidity and mortality. However, clinical data of IPA in ICU is scarce especially in Thailand.

Methods

A single-center, retrospective, observational study was conducted in King Chulalongkorn Memorial Hospital. We collected data on demographic, clinical characteristics, and outcomes of the patients who developed IPA during admission in the medical intensive care unit (MICU) between Jan 2016 to Dec 2021. IPA was identified by using ICD-10 and medication code for voriconazole, amphotericin B or liposomal amphotericin B. Patients met proven, probable IPA according to EORTC/MSG definition or putative IPA were included. The primary outcome was the incidence of IA in the MICU. Clinical characteristics, 12-week all-cause mortality and associated risk factor were the secondary outcomes.

Results

During the study period, a total of 5,019 patients were admitted in MICU. Fifty-seven met definitions of IPA which represented incidence of 1.14%. Seven patients (12.3%) had proven IPA, while 37 (61.4%) and 13 (22.8%) patients had probable and putative IPA, respectively. Cardiovascular disease (33.3%), chronic liver disease (26.7%), and diabetes (20.0%) were common comorbidities in patients with putative IPA. Diagnosis was made at median of 5 (3-10) days after ICU admission. Organisms were identified in 36 patients (63%) which Aspergillus fumigatus was the most common species (36.8%). All-cause mortality at week 12 was 89.5%. SOFA score (OR 1.494, 95%CI 1.058-2.110) and vasopressor used on admission (OR 16.00, 95%CI 2.209-115.92) had trend toward increase mortality. Median survival in putative and probable IPA group were 4 and 8 days after diagnosis (p= 0.023). Patients who received treatment with voriconazole had median survival 13 days compared to 5 days in other antifungal agents (p= 0.006).

Conclusion

IPA carried a high mortality among critically ill patients in MICU. High SOFA score and vasopressors used at the MICU admission were associated with mortality. Voriconazole therapy appeared to correlate with longer survival time.

Disclosures

All Authors: No reported disclosures
853. Rapid, non-invasive detection of Borrelia miyamotoi infection using a plasma-based microbial cell-free DNA sequencing test
Authors: Ahmad Sharjeel , Kasper Douglas , Rubio Luis , Marinez Javier E
Published: November 2023

Background

Borrelia miyamotoi is a zoonotic infection transmitted by the same genus of ticks that transmits Borreliella burgdorferi which causes Lyme disease. It can cause an acute non-specific febrile illness ("hard tick-borne relapsing fever") with chills, sweats, headache, neck stiffness, fatigue, myalgias, and arthralgias. Serious manifestations such as meningitis or meningoencephalitis or uveitis can occur in immunocompromised hosts. Many features of this infection are indistinguishable from other tick-borne illnesses. Rapid, non-invasive diagnosis of B. miyamotoi by microbial cell-free DNA (mcfDNA) sequencing of plasma offers a means to overcome these limitations.

Methods

The Karius TestTM (KT) detects and quantifies mcfDNA in molecules/µL (MPM) from > 1000 organisms in plasma (performed at the CLIA certified/CAP accredited Karius laboratory). KT detections of B. miyamotoi were compiled from three medical centers in different regions of United States. Clinical review was performed by the health care providers.

Results

KT detected B. miyamotoi in three patients. All were adult males in whom the diagnosis was unexpected. None of the patients recalled tick bites. (See Table 1 for patient characteristics). Two patients were on immunomodulator therapy while the third one had hepatitis C (treated) – mediated cirrhosis. A broad infectious disease work-up was performed and broad-spectrum empiric antibiotic was initiated in one case. KT was the first test to identify B. miyamotoi as the microbiological diagnosis in all cases and was the only test to establish the diagnosis in two cases, with the third having subsequent positive Borrelia PCR testing. All responded well to treatment with doxycycline with resolution of symptoms and lab abnormalities.

Conclusion

KT enabled rapid, non-invasive, plasma-based diagnosis of "hard tick-borne relapsing fever" caused by B.miyamotoi. Given an unclear etiology and a potentially diverse differential diagnosis, especially in immunocompromised patients, an unbiased diagnostic test such as the KT can prove a useful complement to conventional diagnostic work-up to provide real-time results. Additionally, mcfDNA sequencing can prove useful in detecting emerging, diagnostically challenging microbes.

Disclosures

All Authors: No reported disclosures
869. Evaluation of the Impact of Polymicrobial Bloodstream Infections (BSIs) on the Performance of BioFire Blood Culture Identification 2 (BCID2) Multiplex Polymerase Chain Reaction (PCR) Panel
Authors: Lapin Jonathan S , Gogineni Aishwarya , Singh Karan , Gao Nina , Johnson J Kristie , Claeys Kimberly C
Published: November 2023

Background

Rapid diagnostic tests (RDTs) have led to a paradigm shift in the management of BSIs, allowing for earlier species identification and decreased time to appropriate antimicrobials. The University of Maryland Medical Center recently switched from Verigene, a nucleic acid microarray panel, to BioFire BCID2, a multiplex PCR panel. Whereas Verigene is known to perform poorly in polymicrobial BSIs, it is unknown how BioFire BCID2 performs and how this impacts downstream antimicrobial therapy decisions.

Methods

We performed a retrospective cohort study of adult patients with polymicrobial blood cultures tested with BioFire BCID2 between 01/01/2022 and 05/31/2022. Family, genus, species, and resistance identification from BioFire BCID2 were compared to conventional microbiological methods and phenotypic antimicrobial susceptibility testing (AST) to assess the on-panel accuracy of BCID2 in polymicrobial BSI. Antimicrobial prescribing based on BioFire BCID2 results was collected to determine how the BCID2 impacts decision making in polymicrobial BSIs.

Results

Among 504 patients with positive blood cultures, 52 (10.3%) were polymicrobial BSIs. Among these 52 BSIs, 91 distinct organisms were identified using BCID2, and 19 Enterobacterales, 33 Staphylococcus spp., and 14 Streptococcus spp. identified at the family or genus level. Additionally, 105 organisms and 19 Coagulase-negative Staphylococci were recovered with conventional methods. BCID2 correctly identified 89.4% (101/113) of on-panel organisms at the species level. There was 88.5% concordance between BCID2 resistance identification and phenotypic AST. 36 (69.2%) and 20 (38.5%) patients had antimicrobial regimen changes within 24 hours of BCID2 results and AST, respectively – most were de-escalations (66.7% and 85%, respectively). 12 of these patients had further changes in antimicrobials; 2 of which were escalations due to discrepant BCID2 and AST results.

Conclusion

On-panel agreement between BioFire BCID2 and conventional methods was high in polymicrobial BSI, although less than reported in studies assessing only monomicrobial BSI. In patients with polymicrobial BSIs, the implementation of BCID2 allowed for early changes to antimicrobial therapy.

Disclosures

Kimberly C. Claeys, PharmD, Abbvie: Advisor/Consultant|bioMérieux Inc.: Advisor/Consultant|bioMérieux Inc.: Speaker|La Jolla Pharmaceuticals: Advisor/Consultant|Melinta Therapeutics: Advisor/Consultant
887. Associated factors with Monkeypox in patients with suspected infection in a university hospital in Colombia.
Authors: Arboleda Santiago , Mantilla Fabian , Reyes Elizabeth , Valderrama Sandra , Alvarez Carlos
Published: November 2023

Background

Monkeypox was an infection limited to the African continent, the study of which regains relevance after the breaking of its geographical barrier in May 2022. In Colombia, in agreement to the Colombian National Institute of Health 4090 cases have been confirmed and 97% have occurred in men. We evaluate epidemiological and clinical characteristics of people suspected of being diagnosed with monkeypox and we compare the differences between patients who underwent positive RT-PCR tests with those who had negative results in order to determine clinical variables that increase the possibility of having a positive result.

Methods

This is a cross-sectional case-control study between August and December 2022 in adult patients who consulted due to suspected Monkeypox infection in a university hospital in Bogota-Colombia. We characterized the different epidemiological and clinical characteristics of the disease. We performed an exploratory analysis of the variables related to a positive RT-PCR for Monkeypox. The cases were patients with positive RT-PCR and the controls were patients with a negative result. A multivariate analysis was carried out by unconditional logistic regression and the variables with a p< 0.2 and that did not present collinearity were included in the model. All analyses were conducted in R software version 4.1

Results

A total of 162 medical records of patients with suspected diagnosis of smallpox were analyzed. 102 samples were RT-PCR positive for monkeypox and 60 were negative. Table 1 describes the bivariate analysis. All patients who had positive RT-PCR were MSM. In the multivariate model the associated factors with having a positive RT-PCR test for Monkeypox were: age (OR:0.01, CI95%:0.01-0.17), contact with a suspected or confirmed case (OR:6.08, CI95%:1.96-21.65), fatigue (OR:3.91, CI95%:1.47-11.43), arthralgia (OR:7.45, CI95%:1.48-58.41), lymphadenopathy (OR:10.46, CI95%:3.50-36.44) and perianal lesions (OR:18.64, CI95%:4.64-104.53).

Part1

Part 2

Conclusion

This study reaffirms the increased frequency of monkeypox infection in MSM and HIV-positive patients. In patients who consult for suspected monkeypox, there is an increased odds of infection in patients with contact with Monkeypox, fatigue, arthralgia, lymphadenopathy or perianal lesions.

Disclosures

All Authors: No reported disclosures
898. Influenza Surveillance in the US Veterans Health Administration (VHA): 2022-2023 Season
Authors: Lucero-Obusan Cynthia A , Schirmer Patricia , Edson Connor W , Oda Gina , Holodniy Mark
Published: November 2023

Background

Influenza causes seasonal epidemics with substantial morbidity and mortality. Veterans Health Administration’s (VHA) large elderly population is at higher risk for influenza complications, including hospitalization, and death. Herein we summarize VHA’s national annual surveillance data for influenza activity and vaccinations.

Methods

Influenza-like-illness (ILI) as well as influenza-coded outpatient visits and hospitalizations, laboratory testing, and antivirals were obtained from VHA data sources (10/2/2022-4/22/23) and compared to prior years and CDC data. Vaccinations were captured starting 8/1/2022, with rates calculated based on VHA users in each fiscal year. Influenza RT-PCR positive respiratory samples underwent whole genome sequencing (WGS) to analyze clade and antiviral resistance.

Results

Surveillance metrics are presented (Table). Vaccinations were decreased compared to 2021-22, but the used of adjuvanted vaccine was increased. Weekly ILI ranged from 0.4%-1.4% in primary/urgent care settings. Activity was highest for 2022 Week 48, matching national influenza trends (Fig.1). Testing found 23,297 influenza positives of 457,020 tests performed (5.1%). Median length of stay (3 days) for hospitalized patients and deaths (127, 3%) were stable. Among 115 deaths where influenza type was available, 110 had Influenza A and 5 Influenza B. Following two low activity seasons, total influenza positives, outpatient visits, and hospitalizations during 2022-23 tracked closer to seasons prior to the COVID-19 pandemic (Table, Fig.2). 411 samples (in 16 states) were sequenced (410 Flu A: 136 H1, 274 H3; 1 B/Victoria), representing 12 subclades, which aligned with CDC reporting. No drug resistance mutations were found (Fig.3).

Conclusion

For 2022-23, influenza vaccinations in VHA dropped but percent vaccinated was stable. For the first time, over half of VHA-administered vaccines were adjuvanted formulation. The influenza season was notable for an earlier than usual peak (late Nov/early Dec), with overall increased activity compared to the prior two seasons. Testing for influenza during 2022-23 season was decreased but remained higher than pre-COVID-19 pandemic testing levels. VHA influenza activity and WGS analysis tracks closely with national CDC reporting.

Disclosures

All Authors: No reported disclosures