bluuebunny/crossref_metadata_2025 huggingface dataset:
1242. Hepatitis C Treatment as a Complement to Syringe Service Programs: Pilot Progress and Pathways Forward
Authors: Guzman Miriam , Smith Renata , Mayer Stockton , Messmer Sarah , Huyck Michael , Cotler Karen F , Chaisson Lelia H , Jimenez Antonio , Guerrero Stephanie , Fortson Neisha , Tai Rex
Published: December 2022

Background

Hepatitis C (HCV) poses a significant chronic infectious disease threat in the United States, and people who inject drugs (PWID) are at elevated HCV risk. We assessed implementation of a program that provided low-barrier services for high-risk PWID, coupling harm reduction with clinical care, including HCV treatment.

Methods

In 2018, the University of Illinois at Chicago established a program to deliver comprehensive care to PWID in an underserved Chicago neighborhood, including syringe services (SS) and HCV treatment. We performed chart reviews of SS clients who sought HCV care from 09/2018-01/2021. We assessed patient demographics; the proportions prescribed and initiated on HCV treatment; and the proportions with undetectable HCV RNA at treatment week 4, end of treatment, and 12-weeks post-treatment.

Results

Among 67 patients, 45 (67%) were male, median age was 45 years (IQR 35-57), 22 (33%) were Black, and 11 (16%) were Hispanic. 66 (99%) reported current or former drug use and 62 (93%) injection drug use, and 3 (4%) sex work. 36 (54%) were undomiciled or lived in unstable housing, 22 (33%) were unemployed, 19 (28%) had been incarcerated within the past year, and 30 (45%) had a history of psychiatric illness. Median pre-treatment HCV RNA was 701,626 IU/L (IQR 39,944-1,979,898). 40 (60%) were prescribed HCV treatment and 31 (46%) initiated treatment (Figure). Of these, 21/31 (68%) completed HCV RNA testing at treatment week 4, of whom 18/21 (86%) had an undetectable viral load; 16/31 (52%) completed end of treatment testing, of whom 16/16 (100%) had an undetectable viral load; and 15/31 (48%) completed 12-week post-treatment testing, of whom 13/15 (87%) had an undetectable viral load. Of the 2 patients who did not achieve sustained viral suppression following treatment, 1 missed four weeks of treatment due to incarceration and 1 reported full adherence to treatment.

Numbers and percentages of patients at each step in the treatment cascade

Conclusion

This comprehensive program offering SS and HCV care successfully reached PWID in an underserved area before and during the pandemic. Losses along the HCV treatment cascade were high: Only 60% were prescribed treatment and less than one-third of those prescribed treatment achieved sustained viral suppression. Among those who remained in care, over 80% achieved sustained viral suppression.

Disclosures

All Authors: No reported disclosures.
1246. Prevalence of Hepatitis C Antibodies (Ab) in people at risk for HIV infection in Kentucky
Authors: Soria Jaime , Collins Jana , Thacker James , Hoven Ardis , Thornton Alice C
Published: December 2022

Background

The Kentucky Income Reinvestment Program (KIRP) provides comprehensive early intervention services targeting those at the highest risk for HIV infection. The objective of this study was to evaluate the prevalence of Hepatitis C Antibodies (HCV Ab) in people at risk for HIV infections in Kentucky.

Methods

A cross-sectional study was conducted using the KIRP Outreach database, including data from people at risk for HIV infections from January 2021 to March 2022. A screening tool was used to identify the people at risk. A Point-of-Care rapid test was used for the detection of HCV Ab. We compared the frequency of HCV Ab in People who inject drugs (PWID) versus people who denied the use of injected drugs. Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Kentucky. Logistic Regression was performed, and the OR was reported. The statistical analyses were performed with Stata 17 (College Station, TX: Stata Corp LLC).

Results

The analysis included data of 8,225 people tested for Hepatitis C concomitant to screening for HIV; of them, 4,203 (51.1%) were female, and the median age was 41 years old (Range: 17 – 76). No previous test for HCV Ab detection was reported in 3,966 (48.2%).

A total of 1,180 (14.3%) tests were positive. HIV infection was detected in 14 (0.2%) people; of them 3 (21.5%) were in people with detectable HCV Ab. The prevalence of HCV Ab in PWID was 36.6%, and the prevalence in people who denied the use of injected drugs was 5.0% (p< 0.001). Most people with detectable HCV Ab (68.0%) were younger than 45. After being adjusted by age, HCV Ab was strongly associated with PWID (OR: 9.3; 95% CI 7.9 – 11.0; p< 0.001).

Conclusion

The prevalence of the Hepatitis C virus in Kentucky remains higher, mainly in PWID; it was not associated with age. HCV/HIV Coinfection was identified in more than 20% of the Clients. Efforts to continue screening both HIV and HCV infections in PWID are necessary.

Disclosures

All Authors: No reported disclosures.
1254. An Increase in Single-tablet Regimen (STR) Utilization for People Living with HIV (PLWH) Enrolled in Medicaid had Minimal Impact on Pharmacy Costs
Authors: Brogan Andrew P , Garris Cindy , Priest Julie , Divino Victoria , He Jing , Chen Justin , DeKoven Mitch
Published: December 2022

Background

The shift to antiretroviral single-tablet regimens (STR) from multiple-tablet regimens (MTR) has lagged for people living with HIV (PLWH) covered by Medicaid. This study examines STR and MTR utilization and pharmacy costs over a 5-year period for PLWH enrolled in Medicaid.

Methods

This retrospective study used IQVIA’s Prescription Claims (Rx) data to identify two mutually exclusive cohorts based on STR or MTR use within each of 5 calendar years (2016-2020). For the STR cohort, the date of the first STR claim in each calendar year was termed the index date. For the MTR cohort, the date of the first MTR drug in the first observed complete MTR regimen in each calendar year was termed the index date; a window of 5 days between prescription fills for the agents used in an MTR regimen was allowed. The regimen received on the index date was used to assign the study cohort for each year and study measures were reported for each of the 5 calendar years. Additional eligibility criteria are provided in Table 1.

Results

The final STR cohort was 47,140 (14.5% of the initial sample) in 2016 and 73,111 (13.5%) in 2020 (Table 1). The final MTR cohort was 36,007 (15.5%) in 2016 and 20,264 (13.5%) in 2020. The distribution of PLWH with Medicaid Fee-For-Service (FFS) or Medicaid managed care was generally similar by year for both STR and MTR cohorts from 2016 to 2019 (Figure 1); Medicaid managed care enrollment for both cohorts increased in 2020 (62.4-62.9%). Among PLWH, STR use increased annually from 56.7% in 2016 to 78.3% in 2020 (Figure 2). Conversely, MTR use decreased from 43.3% to 21.7% over the same time period. The increase in STR utilization over time was consistent for both plan types. Mean HIV-specific per member per month (PMPM) pharmacy costs were similar across years for both STR and MTR cohorts, ranging from $2,016-$2,342 for STR cohorts and $2,247-$2,380 for MTR cohorts (Figure 3).

Conclusion

Between 2019 and 2020, PLWH enrolled in Medicaid shifted from FFS towards managed care. STR use among PLWH enrolled in Medicaid increased from 2016 to 2020 with minimal differences in PMPM pharmacy costs compared with PLWH enrolled in Medicaid receiving MTR.

Disclosures

Andrew P. Brogan, PhD, ViiV Healthcare: Employee, Salary|ViiV Healthcare: Stocks/Bonds Cindy Garris, MS, ViiV Healthcare: Employee|ViiV Healthcare: Stocks/Bonds Julie Priest, MSPH, ViiV Healthcare: Employee, Salary|ViiV Healthcare: Stocks/Bonds Victoria Divino, BA, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Jing He, PhD, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Justin Chen, MHS, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Mitch DeKoven, MHSA, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support.
1262. Dolutegravir Plus 3TC In Antiretroviral Experienced Adults: Immunovirological Outcomes In a Multicenter Retrospective Cohort In Spain
Authors: Buzón-Martín Luis , Dueñas Gutierrez Carlos , Iribarren José Antonio , de los Santos Ignacio , Santiago Alberto Diaz-De , Morán-Rodríguez Miguel Ángel , Pousada Guillermo , Rico Claudia González , García Estela Moreno , Ferreira Eva , Gómez Alicia Iglesias , gómez Cristina Martín , Barquero Julia gómez , Egido Murciano Miguel V , Troya Jesús
Published: December 2022

Background

Dolutegravir-based dual therapies for treating people living with HIV (PLHIV) are strategies strongly recommended in several practice guidelines. The safety and efficacy combination of Dolutegravir (DTG) plus 3TC as a switching strategy in virologically suppressed patients was demonstrated in the TANGO study. Wide multicenter real life data supporting this treatment is needed. The aim of the current study was to describe the efficacy in terms of immunovirological outcomes in patients treated with this antiretroviral combination.

Methods

From November 1st 2020 to August 1st 2021, data from 1062 PLHIV collected from 13 Spanish institutions were recorded in a multicenter, retrospective study; After discarding cases in which relevant variables were missing, finally 694 cases underwent statistical analysis. Inclusion criteria were age >18 years, and to receive treatment with DTG/3TC as a switch strategy. Immunovirological impact of this strategy ( CD4+, CD8+ and CD4+/CD8+ cell count, as well as HIV plasma viral load through weeks 24, 48 and 96 of follow up) was evaluated using multivariable mixed models where the individual was considered as a random effect. Sex and age were added as demographic covariables.

Results

78% of patients were men, 16% had been previously diagnosed of AIDS. Mean age was 48 years old. Mean CD4 T cell count nadir was 300 cell/ml (160-480). We found a significant increase in CD4+ counts at 24, 48 and 96 weeks after switching drug strategy. We also detected a small increase in the CD4+/CD8+ count rate at 48 and 96 weeks. No significant change was found in CD8+ count. No differences were found on behalf of sex, between backbone drugs (73% switched from a TDF/FTC backbone and 26.9% from ABC/3TC) or amongst the different third agents used (62% switched from integrase inhibitors). We identified a strong and negative effect of having AIDS in the CD4+ count. However, this effect did not interact with the effect of switching drug strategies.

CD4, CD8 and CD4/CD8 after switch at 24, 48 and 96w

Log OR

Conclusion

PLHIV who, being virologically suppressed, switched to dual therapy based on DTG/3TC, experienced a statistically significant increase of CD4+ T cell count at weeks 24, 48 and 96, as well as an increase in CD4/CD8 T cell ratio, as well as high efficacy in terms of viral replication suppression, independently of the stage of HIV infection.

Disclosures

Luis Buzón-Martín, MD, ViiV, GILEAD, Jannsen, MSD: Lecture fees Carlos Dueñas Gutierrez, MD, ViIV, GILEAD, Jannsen, MSD: Lecture fees Jesús Troya, Staff, ViiV, GILEAD, Jannsen, MSD: Lecture fees.
1266. Effects of Rapid Initiation of Antiretroviral Therapy in an Urban Clinic Setting
Authors: Mesa Daniel , Kim Yae Ji
Published: December 2022

Background

Rapid initiation of antiretroviral therapy (ART), i.e. within 72 hours of diagnosis, in people living with HIV (PLWH) has shown improved viral suppression, medication adherence, and retention in care, compared to deferral until initial labs have resulted. More real-world experience with rapid ART programs is needed, however, particularly among clinics in resource-limited settings that serve a complex and largely uninsured or underinsured population, such as the HIV clinic at SUNY Downstate Medical Center. In 2017, the clinic implemented rapid ART in select PLWH.

Methods

This was a single-center retrospective chart review of patients seen at our HIV clinic between January 2015 and June 2021. Patients were included if they were ART-naïve or off ART for > 3 months. Exclusion criteria included baseline undetectable viral load (VL) and perinatal HIV infection. Patients were assigned to standard or rapid start groups based on time from intake to initiation of ART. The primary outcome was proportion of patients with VL < 50 copies/mL at week 52. Secondary outcomes were proportion of patients with VL < 200 copies/mL, retention in care, and mean weight change from baseline, all at week 52; time from intake to ART; and time to viral suppression.

Results

As shown in Table 1, of the 190 patients that were included, 133 were rapid start while 77 were standard start. 103 patients had baseline resistance data; only 1 had integrase stand inhibitor resistance. Median time to ART was 0 days and 2.5 weeks in the rapid and standard groups, respectively. The most common initial regimen was BIC/FTC/TAF in both groups (49.6%, 31.2%). As described in Tables 2 and 3, 62.1% and 73.7% of patients had VL < 50 and < 200 copies/mL at week 52, respectively. Nearly 73% of patients remained in care at week 52, with similar rates between groups. Time from ART to viral suppression was similar between groups.

Conclusion

Rapid ART was well-tolerated but resulted in similar viral suppression and retention in care at week 52 compared to standard ART. However, rapid ART resulted in quicker viral suppression, although further evaluation of the clinical impact of this finding is needed. This study highlights the need for a multifaceted approach to engaging patients with HIV throughout the care continuum to ensure retention in care.

Disclosures

All Authors: No reported disclosures.
1268. Efficacy, safety, and tolerability of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in adults with HIV-HBV infection - preliminary results
Authors: Kwakwa Helena , Bran Jacqueline , Ruff Julia , Choe Sunny , Chua Joel V
Published: December 2022

Background

Coinfection with HIV and hepatitis B (HBV) has been associated with higher risk of morbidity and mortality, especially acceleration of liver disease. HBV-active antiretroviral (ARV) regimens have significantly improved the outcome of people with HIV-HBV coinfection. B/F/TAF has been shown to be highly effective in the treatment of HIV infection based on treatment naïve and switch trials. Although it is an HBV-active regimen, there is scant data on the use of B/F/TAF for people with HIV-HBV coinfection. We hypothesize that B/F/TAF is both safe and efficacious in the treatment of coinfected adults.

Methods

This open label, single-arm, switch study enrolled HIV/HBV-coinfected adults from two clinical centers (Baltimore, MD and Philadelphia, PA). Patients were switched from their current ARV regimen (regardless of viral suppression) to fixed dose combination B/F/TAF taken once daily for 48 weeks. Primary efficacy endpoints were proportion of patients with HIV RNA < 50 copies/mL by FDA Snapshot Algorithm and HBV DNA < 29 IU/mL at Week 24 by missing = failure method.

Results

A total of 28 eligible participants were enrolled between May 2019 to December 2021. Median age was 51 years (range 34-71), majority were Black (89%), male gender (86%), and non-Hispanic (96%), 65% HIV and HBV virally suppressed. Two participants, one lost to follow-up and the other removed due to non-adherence prior to week 24, were excluded in the efficacy analysis. At baseline, 73% were HIV suppressed and 81% were HBV suppressed. Of the 21 patients with week 24 data, 20 (95%) had HIV RNA < 50 copies/mL and 19 (90%) had HBV DNA < 29 IU/mL. Eighteen (86%) were HIV and HBV suppressed, which was higher than prior to B/F/TAF use. There were ten treatment-related adverse events (AE), all of which were mild (grade 1) and transient. Most common treatment related AE was nausea (2 of 28). Four patients had elevated alanine aminotransferase at baseline, all of which normalized at week 24. There were no serious adverse events or hepatitis flare. No participants discontinued study treatment due to an AE.

Conclusion

B/F/TAF is efficacious and safe for patients coinfected with HIV and HBV after 6 months of treatment.

Disclosures

Helena Kwakwa, M.D., Viiv Healthcare: Grant/Research Support Sunny Choe, PhD, Gilead Sciences: Employee.
1273. Implementation of a Mobile Phone Intervention Method to Improve Clinical Outcomes in Patients with HIV
Authors: Cummings Bailee , Bordelon Stacie , Dare Ryan K , Crescencio Juan Carlos Rico
Published: December 2022

Background

Antiretroviral therapy (ART) adherence decreases morbidity and mortality; however, this is often complicated by various external factors. Strategies implementing cellular technology have demonstrated improved medication adherence. The objective of this pilot study was to assess the effectiveness of utilizing weekly mobile phone calls or text messages to improve clinical outcomes among patients with HIV.

Methods

This study was conducted at an infectious disease clinic at an academic medical center 2019-21. Twenty-two patients were selected based on a history of poor ART adherence. For a period of 6 months, patients were contacted weekly by text message or phone call to determine medication adherence and to encourage continued adherence. Outcomes during the 12-month intervention period (6m intervention and subsequent 6m) were compared to the 12-month pre-intervention period and included viral load, CD4 count, clinic visits, emergency department (ED) visits, hospitalizations, and new-onset opportunistic infections (OI). Wilcoxon signed rank test and McNemar’s test were performed, though study is not powered for true analysis.

Results

Twenty-two patients were selected for inclusion and 13 (55%) maintained persistent communication throughout the intervention. For all 22 enrolled participants, this intervention resulted in increased mean yearly clinic visits (2.6 vs 3.8), decreased median viral load (32,979 vs 852 copies/mL, p=0.017), and increased median CD4 (142.5 vs 249 cells/uL). This also led to a decrease in patients with > 1 ED visit (54.6% vs 36.4%), > 1 inpatient hospitalization (36.4% vs 13.6%), and diagnosis of an OI (18.2% vs 13.6%). These outcomes were most remarkable in the 13 patients who maintained scheduled communication [mean yearly clinic visits (2.9 vs 5.2), median viral load (27,633 vs 118 copies/mL, p=0.0248), median CD4 cells/uL (76 vs 253), > 1 ED visit (61.5% vs 30.8%), > 1 inpatient hospitalization (38.5% vs 23.1%), and new OI (23.1% vs 7.7%)].

Impact of Intensifying Outpatient HIV Management

Clinical outcomes for the pre-intervention year (routine communication) and the intervention year (enhanced communication) for all 22 patients initially selected for the study are compared to outcomes for the 13 patients who maintained persistent communication throughout the intervention period.

Conclusion

Enhanced communication through weekly mobile phone reminders may serve as a useful tool in the outpatient setting to improve ART adherence and reduce morbidity among adults with HIV. The findings of this small pilot study provide support for the need of a larger study to prove the benefit of this care model.

Disclosures

All Authors: No reported disclosures.
1289. A Practical Approach to Antimicrobial Stewardship Education: Engaging Infectious Diseases Trainees in Targeted Outpatient Provider Feedback Program
Authors: Khan Parisa , Xu Teena , Xu Teena , Rodriguez-Barradas Maria C
Published: December 2022

Background

A 2016 needs assessment survey of infectious diseases (ID) training program directors revealed gaps in ID fellows’ education including the application of antimicrobial stewardship into clinical practice. Direct involvement of ID trainees in inpatient antimicrobial stewardship (AS) activities has previously been described with favorable outcomes and achievement of program goals. Engagement of ID fellows in outpatient (OP) AS activities including targeted provider feedback has not been well described and may provide opportunity for more hands-on OP AS experience for trainees.

Methods

Our OP AS program developed a 4-week virtual rotation experience for ID fellows to meet organizational needs for AS education during the COVID-19 pandemic. Acute respiratory tract infection (ARI) was chosen as a disease state priority. The expected progression of the ID fellow was as follows: Week 1: Review Core Elements of outpatient AS, regulatory requirements, and disease state priorities; review available stewardship tracking data sources; Week 2: Review facility-level antibiotic use data for a single outpatient clinic, and identify top 3 antibiotic prescribers in the clinic; Week 3: Deliver a virtual outpatient AS presentation to all providers at a single clinic, and create antibiotic report cards (See Figure 1) for top antibiotic prescribers; Week 4: Conduct 15-min targeted provider feedback sessions using antibiotic report cards for top 3 providers.

Example Antibiotic Report Card

Results

Between September 2021-April 2022, three ID fellows completed the OP AS rotation experience. All fellows completed each week of the rotation successfully. Solicitation of feedback from providers receiving targeted feedback sessions (See Figure 2) is ongoing, and a standardized feedback form will be sent to all ID fellows completing the rotation at the end of the academic year to evaluate the program’s success in meeting pre-specified learning objectives. The rate of antibiotic prescribing for uncomplicated acute respiratory tract infection will be re-evaluated post-intervention for providers receiving targeted education.

Targeted Provider Feedback Survey

Conclusion

Direct involvement of ID fellows in OP AS activities may be mutually beneficial for trainees and OP AS programs. A virtual format for AS education and intervention was practical and feasible.

Disclosures

All Authors: No reported disclosures.
1298. Donor Call Simulation: A Novel Medical Education Tool to Evaluate Trainees’ Clinical Decision-Making in Transplant Infectious Disease
Authors: Sigler Rachel , Wooten Darcy , Kumar Rebecca , Hand Jonathan , Marschalk Nicholas , Go Roderick , Prakash Katya , Stohs Erica J , Law Nancy
Published: December 2022

Background

Simulation is a useful education tool for high-stakes clinical skills and decision-making. Recommending whether to accept or reject an organ for transplantation based on infection risk is a critical core competency in Transplant Infectious Disease (ID), however there are no published data that learners have opportunities to practice this during training. We created a novel simulation to expose learners to this real-life clinical scenario and evaluated their clinical decision-making in these situations.

Methods

We created 6 simulations with common ID consult questions about whether to accept or reject an organ for transplant based on infection risk (Table 1). During learners’ Transplant ID rotations, faculty periodically texted or paged them with the simulation cases as though they were the transplant coordinator. Learners had 15 minutes to ask follow up questions before deciding to accept or reject the organ and explain their decision-making process in a survey. Learners completed a survey 1 month after the simulation experience to evaluate its effectiveness.

Results

Between October 2021 and April 2022, 16 learners from 7 medical centers participated in the simulation (Table 2) and 94% (15/16) completed the follow up survey. Eighty-seven percent (13/15) of ID learners reported that the simulation was effective in teaching them when to accept or reject organs and 80% (12/15) felt more prepared to make these decisions in practice. Most learners correctly identified acceptable organs for transplant during the simulations (Figure 1). Of the 100 clinical reasoning decisions made during the activity, 19% were discordant, where the learner correctly decided to accept or decline the organ but with incorrect or incomplete reasoning for this decision (Figure 2).

Conclusion

ID learners perceived our transplant ID simulation as an effective educational tool to learn when to accept or reject an organ for transplant. By evaluating the clinical reasoning behind these decisions our simulation provides ID educators with nuanced insight into their learners' thought process and allows for targeted coaching to correct deficits in reasoning.

Disclosures

Rebecca Kumar, MD, Gilead: Grant/Research Support|Regeneron: Grant/Research Support Jonathan Hand, MD, GlaxoSmithKline: Grant/Research Support|Janssen: Grant/Research Support|Pfizer: Grant/Research Support Roderick Go, DO, Aptose Biosciences: Stocks/Bonds|Bristol Meyers Squibb: Stocks/Bonds|Cytodyn Inc.: Stocks/Bonds|Scynexis: Grant/Research Support Erica J. Stohs, MD, MPH, bioMerieux: Grant/Research Support.
1300. Feedback on Abstracts Benefits Both Authors and Reviewers: Results of a Pilot Study at IDWeek 2021
Authors: Melia Michael T , Tackett Sean , Armstrong Wendy S , Blyth Dana M , Bonura Erin , Cutrell James B , Escota Gerome V , Luther Vera , Nematollahi Saman , Person Anna K , Schwartz Brian S
Published: December 2022

Background

Many abstracts are submitted to scientific meetings each year. Scholarly work benefits from peer review, yet specific feedback from abstract reviewers is rarely given to authors. Here reviewers provided feedback to all authors who submitted Medical Education abstracts to IDWeek 2021.

Methods

All IDWeek 2021 abstract reviewers for the Medical Education category were invited to an abstract review instructional webinar and were asked to provide feedback on each assigned abstract in a free text box on the review website. Each submitting author was sent this feedback when informed of their abstract disposition. In October 2021, these authors were sent an email containing a link to a survey soliciting their perspectives on the feedback; the survey included demographic questions and Likert scale questions. Descriptive data analysis was performed. All 10 reviewers participated in one of two virtual, semi-structured focus groups about their experience. Two authors conducted thematic analysis on transcripts.

Results

Among abstract authors, 18/26 (69%) responded to the survey. All respondents found the feedback helpful. Twelve (67%) incorporated the feedback into their IDWeek presentations. All 14 submitters who plan to write a manuscript intend to incorporate the feedback into that work. Most (94%) would want to receive feedback on future abstract submissions (Figure); all wish other scientific meetings would provide feedback on abstracts. Among reviewers, common themes included that they (1) provided more attentive reviews due to a sense of responsibility to provide thoughtful feedback, (2) found the work rewarding, (3) improved their abstract-reviewing skills, (4) planned to use this experience to help trainees write better abstracts, and (5) felt this activity built community within IDSA. While providing feedback required more time than past reviews, all would volunteer to provide feedback in the future.

Conclusion

Authors who submitted Medical Education abstracts to IDWeek valued abstract feedback and used it to strengthen their presentations; reviewers found it to be a positive experience and would do it again. IDSA and other societies should consider providing feedback for all abstract categories.

Disclosures

All Authors: No reported disclosures.
1304. Mission-based Academic Tweeting: Analysis of Content Engagement over One Year
Authors: Xu Teena , Guajardo Emmanuel
Published: December 2022

Background

The Baylor College of Medicine Infectious Diseases Fellowship program (BCM ID) launched a new academic Twitter account during the COVID-19 pandemic with the mission to promote the achievements of fellows and faculty (promotion-based tweets, or PBT) and disseminate original educational material (education-based tweets, or EBT) during a fellowship recruitment season that became virtual due to the pandemic. Account content was developed by both ID fellows and faculty, with the goal of increasing social media engagement with the fellowship program. Currently, the average Twitter engagement rate per tweet is 0.037% across all industries and 0.7% for higher education accounts. We looked at the engagement rate of mission-based tweets during the inaugural year of the BCM ID Fellowship twitter account.

Methods

We conducted a retrospective review of tweets published on the BCM ID Fellowship account during the first year of operations (8/1/20-7/31/21). We reviewed 64 mission-based tweets for impressions (number of times a tweet is shown to users), engagement (number of times users interacted with a tweet), and reach (number of followers). We calculated engagement rate (engagement-to-impression ratio, or E:I) for each tweet and compared the engagement rates between EBT and PBT. We also examined the trend of followers over time. Data were collected in October 2021.

Results

EBT comprised 41% of total tweets, and PBT comprised the remaining 59%. EBT averaged 3,662 impressions and 458 engagements, for an E:I of 9.6%. PBT averaged 2,449 impressions and 130 engagements, for an E:I of 5.3% (p = 0.007). Despite a decrease in total posts per month over this time period, follower count continued to increase, and monthly engagement rate per tweet remained above 1%.

Conclusion

Our experience suggests that user engagement is higher for EBT. Programs planning to launch a new academic Twitter account should consider focusing initial content on education to maximize overall engagement and reach. One limitation of this study is that frequency of tweets also impacts engagement, which may confound data from later in the inaugural year, when tweeting from the account became less frequent.

Disclosures

All Authors: No reported disclosures.
1309. Adherence to Short-Term Antibiotic Therapy in Children – a Blinded, Prospective, Electronically-Monitored Study
Authors: Youngster Ilan , Klainer Hodaya , Gelernter Renana , Kozer Eran , Goldman Michael
Published: December 2022

Background

Non-adherence to short-term antibiotic treatment in children can lead to treatment failure and development of drug resistance. To develop effective interventional programs reliable adherence data is needed, but previous studies are scarce and have mostly used parental self-reports. We aimed to determine true adherence rates of pediatric patients treated for acute infections with antibiotic suspensions. Secondary goals were to evaluate patient and treatment characteristics influencing adherence rates and whether the prescriber can predict adherence rates of patients.

Methods

A prospective, blinded, electronically monitored, observational study. Patients aged 2 months to 5 years diagnosed with an acute bacterial infection requiring short (5-10 days) oral antibiotic monotherapy were enrolled. Parents were told they received a new "childproof" cap for evaluation, but unknowingly were provided with an electronically monitored medication bottle recording every manipulation of the cap. At the end of treatment study purpose was disclosed and, if approved, cap data and patient and treatment information collected.

Results

100 infants (49 boys, mean [range] age 1.87 years [0.2-5.1]) were included in the final analysis. Only 11 participants received all the recommended doses. Overall adherence (defined as administration of >75% of prescribed doses) was 62%, while timing adherence (administration of >75% of doses within ±20% of the prescribed interval) was only 21%. After applying a logistic regression model, the only factor significantly associated with non-adherence was being a single parent [OR=5.7 95%CI (1.07-30.3)]. Prescribers overestimated adherence, defining 49/62 (77.7%) participants as likely adherent. Patient/parent pairs that were predicted to be adherent were not more likely to be overall or timing adherent than those predicted to be non-adherent (31/47 vs. 6/16, p=0.77).

Conclusion

Adherence of children to short-term antimicrobial treatment for an acute infection is suboptimal, with only 62% showing good adherence and 21% with good adherence at proper timing intervals. Providers were unable to predict patient adherence. This data is important when considering recommended treatment durations and developing interventional programs to increase adherence.

Disclosures

All Authors: No reported disclosures.
1320. Incidence and Outcome of Gram Negative Blood Stream Infections in Pediatric Intensive Care Unit: a Real Life Experience in a Pediatric Hospital in Italy
Authors: Labate Laura , Valentino Maria Sole , Bigatti Carolina , Medici Chiara , Palmero Candida , Losurdo Giuseppe , Cristina Emilio , Mariani Marcello , Ugolotti Elisabetta , Franceschi Alessia , Russo Chiara , Tavella Elisa , Bondi Elisabetta , Montalto Shana , Ricci Erica , Moscatelli Andrea , Castagnola Elio , Mesini Alessio
Published: December 2022

Background

Antimicrobial resistance (AMR) among Gram Negative (GN) bacteria is a medical and economic concern. In the pediatric setting there is a paucity AMR data due to a lower surveillance in this population.

Aim of this study is to describe incidence and outcomes of GN bloodstream infections (GN-BSI), especially caused by MDR among children admitted to intensive care unit of Istituto Giannina Gaslini Pediatric Hospital in Genoa from January 2017 to December 2021.

Methods

In this retrospective observational single-center study all pediatric patients admitted to ICU with GN-BSI were enrolled.

We collected demographical and clinical data (such as underlying disease, empiric and targeted therapy, presence of devices, prior colonization due to MDR GN, prior treatments and surgery), and outcome and mortality at 7 and 30 days.

Results

Overall, 97 GN-BSI among 85 children admitted to PICU were included during the study period.

Among all patients 40% (34/85) were male, with median age of 3 months (IQR: 1; 11; range: 0-292) and 75% (64/85) were aged < 1 years). Rates of GN BSI according to 1000 admission are showed in figure 1.

The major causative agent was Klebsiella pneumoniae (28/97, 29%), followed by Escherichia coli (18/97, 18%), while 10 episodes (10%) were due to Pseudomonas aeruginosa (figure 2).

A mechanism of resistance was found in 22/97 (23%), with a prevalence of ESBL producers (13/22, 59%), followed by AmpC (4/22, 18%) and KPC (2/22, 1%). 14/97 patients (14%) had a surveillance swab positive by the same bacteria causing BSI. The susceptibility to the 4 more used drugs for 4 more frequent pathogens are showed in figure 3.

In 40% of GN-BSI the empiric therapy was piperacillin/tazobactam, followed by carbapenem in 28/98, 28% of episodes.

Overall, 18 (21%) patients died, half of whom within 7 days of the BSI, including 3/6 of the onco/hematological patients. Figure 1Rates of GN BSI in PICU according to 1000 admissionFigure 2Species distributionFigure 3Susceptibility to the more used drugs for the more frequent pathogens.

Conclusion

This study confirmed the increasing role of GN in BSI and high mortality among children admitted to PICU, especially the youngest, with an increased rate in our Center. Carbapenem resistance isn’t common, but the empirical treatment with piperacillin/tazobactam often it might be useless.

Disclosures

All Authors: No reported disclosures.
1330. Pediatric infective endocarditis at a referral children’s hospital during 19-year period: Trends and Outcomes
Authors: Shawaqfeh Ahmad , Gupta Shipra , Asmar Basim , Abdel-Haq Nahed M
Published: December 2022

Background

We noted an increase in infective endocarditis (IE) cases in recent years. The purpose of the study was to examine the changes in incidence, risk factors, microbiology, complications and outcome of IE in our patient population.

Methods

Records of children < 18 yrs with discharge diagnosis of IE during 2002-2020 at Children’s Hospital of Michigan, Detroit were reviewed. Modified Duke criteria were used to determine “definite” and “possible” IE cases.

Results

101 patients with IE were identified, representing annual incidence of 4.9/10,000 admissions. During 2002-2011 (early period), the incidence was 2.8/10,000 (33 cases). However, during 2012-2020 (late period), the incidence was 7.0/10,000 (68 cases): a 2.5-fold increase. Males were 53.4%. The age range was 1 mo – 17 yrs (median 6 yrs). Of 101 patients, 37 (36.6%) met criteria for definitive and 64 (63.4%) for possible IE. The most common predisposing conditions included congenital heart disease (CHD) (50.5%), central venous catheter (CVC) (25.7%), and immunosuppression (13.9%). CHD was more frequent in the late period (41/68, 60.3%) compared to early period (10/33, 30.3%) (p = 0.0059). Cardiac surgery had been performed in 28/51 (55%) prior to IE diagnosis. CVC related infections were more frequent in the early period (16/33, 48.5%) than the late period (10/68, 14.7%), (p = 0.0005). Overall, 16 (15.8) cases were culture negative. In culture-positive IE, S. aureus was most common (33/101, 32.7%) followed by streptococci (17), S. epidermidis (10), Gram negative bacilli (8), Enterococci (7), fungi (5) and HACEK group (4). Causative organisms were similar in both periods except for fungal organisms (5) and B. henselae (1) in the late period only. Valve replacement or valvuloplasty were performed in 19 (18.8%) patients. Complications included acute kidney injury (9) and emboli to brain (10) and to lungs (7). Mortality occurred in 15 (14.8%): 8 had CHD, 5 had CVC and 1 had fulminant MRSA infection.

Conclusion

Most of our IE patients had underlying medical conditions. The higher incidence of IE during the late period is likely due to an increase in the number of patients with complex cardiac conditions who underwent surgery at our institution. S. aureus was the predominant pathogen followed by streptococci. Mortality rate in our patients was 14.8%.

Disclosures

All Authors: No reported disclosures.
1337. Stewardship Opportunities for Cervical Lymphadenitis and Deep Neck Space Infections
Authors: Shaw Aaron , Lee Brian R , Kazmaier Lauren , Arnold Sandra , Myers Angela
Published: December 2022

Background

Cervical lymphadenitis (LAD) and deep neck space abscesses (DNSA) are common pediatric infections caused by similar bacteria. We sought to determine differences in presentation, diagnosis, and treatment between LAD and DNSA to identify antimicrobial and diagnostic stewardship opportunities.

Methods

Charts were obtained using ICD9/10 codes for retropharyngeal and parapharyngeal abscessed (DNSA), and LAD between 1/1/10-12/31/20 from two pediatric centers. 1981 charts were identified. Charts were excluded if the diagnosis was not a bacterial infection (e.g. Kawasaki disease), if the LAD was not in the neck, or if caused by less common bacteria (e.g. tuberculosis). Data on presenting signs, symptoms, imaging, microbiology results, antibiotics, and surgical interventions were collected. Statistical analyses between LAD and DNSA groups were performed with Fisher’s exact and Wilcoxon rank-sum tests.

Results

1432 patients met inclusion criteria; 767 patients with LAD, 665 with DNSA. Median age and gender differed between LAD and DNSA, but no difference was seen in race between groups (Table). Presenting symptoms were different between groups (p < 0.0001) (Figure). Almost all patients in the DNSA group received a CT scan, compared to 69% in the LAD group. Only 8% in the DNSA group had an ultrasound, in contrast to 50% in the LAD group. Most patients in both groups had a blood culture obtained; these were negative in ≥ 95% of all cases. Abscess cultures in the LAD group more commonly grew S. aureus, while S. pyogenes was more common in the DNSA group. Clindamycin was the most common antibiotic utilized; 91% of LAD, 87% of DNSA. Most patients received ≥ 2 antibiotics; 81% of DNSA and 63% of LAD (Table).

Conclusion

These data may be used to help target diagnostic and treatment stewardship interventions for DNSA and LAD. Ultrasound alone may be sufficient for some cases of LAD, and CT reserved for DNSA when suspected based on presenting signs and symptoms. Routine blood cultures appear to be unnecessary for these patients. Multiple antibiotics are used to treat LAD when a single antibiotic may be more appropriate, given the prevalence of Gram positive organisms that would likely respond to clindamycin.

Disclosures

Brian R. Lee, PhD, MPH, CDC: Grant/Research Support|Merck: Grant/Research Support.
1349. Lesson Learned from Investigators of Clinical Trials to Identify Therapeutics for COVID-19: Qualitative Study
Authors: Jindai Kazuaki , Saito Hiroki , Horii Satoko , Kamata Kazuhiro
Published: December 2022

Background

Implementation of high-quality clinical trials especially early in the pandemic caused burden on clinical investigators given lack infrastructure, networks and systematic supports. To prepare for future pandemic, we investigated facilitator and obstacles that enable investigators to operate clinical trials for COIVD-19 in Japan.

Methods

We conducted individual semistructured qualitative interviews to assess the process of how clinical trials for COVID-19 were planned and implemented at the early stage of pandemic. Clinical investigators were primarily selected through purposive sampling to ensure that participants involved in the clinical trials were well covered. Additional participants were identified using snowball sampling. Interviews were analyzed using qualitative descriptive method.

Results

Through interviews, we identify factors that can impact on conduct clinical trials in infectious diseases field during health emergency in Japan (Figure). First, there are obstacles in rolling out clinical trials and this theme was further divided into two subthemes: obstacles in system(such as lack of regulatory frameworks to support trials, lack of clinical trial networks/platform, and understanding and attitude of the public to clinical trial); and obstacles in clinical level (such as limited resource for non-academic hospitals to implement clinical trials, and lack of trained experienced researchers and coordinators with regards to clinical trials). Secondary, a few factors that facilitate clinical trials exist. Not only governmental and organizational commitment but also presence of physicians and other healthcare professional interested in conducting trials are the key for facilitate clinical trials.

Facilitators and obstacles to implement clinical trials for COVID-19 therapeutics

Conclusion

In this qualitative study, clinical investigators in Japan who conducted clinical trials recognized both obstacles and facilitators. System level obstacles likely led to the obstacles in clinical level. Our finding emphasizes importance for health care policies to respond to such insight from front line clinical investigators to encourage systemwide efforts to facilitate and develop transparent clinical trials during future pandemic.

Disclosures

All Authors: No reported disclosures.
1653. Transcriptional Variation of Adhesion and Biofilm Genes in CTX-M-15-Expressing Klebsiella pneumoniae
Authors: Maclean Alyssa K W , Hanson Nancy D
Published: December 2022

Background

Klebsiella pneumoniae can produce a number of β-lactamases, including the cefotaximase, CTX-M-15. While classically associated with ST131 Escherichia coli, CTX-M-15 is associated with increased virulence in K. pneumoniae. Clinical isolates of K. pneumoniae have been shown to produce high levels of CTX-M-15 RNA. But, the overall transcriptomic changes due to CTX-M-15 expression are unknown. The purpose of this study was to determine if acquisition of CTX-M-15 altered the global transcriptome of K. pneumoniae in addition to decreasing β-lactam susceptibility.

Methods

The structural gene and native promoter of CTX-M-15 were cloned into a low copy number vector and transformed into Kp 23, a clinical isolate from the 1970s with no known acquired β-lactam resistance genes. CTX-M-15 production was confirmed by qRT PCR and western blot. MICs to cefotaxime, ceftazidime, cefepime, ceftolozane/tazobactam, ceftazidime/avibactam, meropenem, meropenem-vaborbactam, and imipenem-relebactam were determined by E-test according to CLSI guidelines. RNA-Seq analysis and bioinformatics were performed by MiGS.

Results

CTX-M-15 carriage led to non-susceptible MICs to cefotaxime, ceftazidime, and cefepime. CTX-M-15 production was associated with statistically significant upregulation of 204 genes and downregulation of 231 genes. Among these, the biofilm genes mrkA and two copies of mrkB were downregulated by 7.5, 4 and 3.5-fold, respectively. Additionally, ecpA, ecpB, ecpC, and ecpR – components of the E. coli Common Pilus (ECP) – were upregulated by 3, 2, 2, and 3-fold, respectively.

Conclusion

High-level expression of CTX-15 β-lactamase has a significant impact on the transcriptome of K. pneumoniae. These changes include a down regulation of genes associated with biofilm formation with a concomitant increase in the expression of genes associated with adherence. These data indicate that overexpression of CTX-M-15 and perhaps other β-lactamases may help promote the pathogenicity of K. pneumoniae or influence its ability to colonize the tissue it infects. This may be important during urinary tract infections when an increase in adhesion by CTX-M-15 producing isolates may be required over biofilm formation to establish an active infection.

Disclosures

Nancy D. Hanson, PhD, Merck: Grant/Research Support.
1362. Lyme Disease and Neurologic Manifestations in a District Hospital in Portugal
Authors: Batista Clara , Moura Luís , Duarte Frederico , de Abreu Ricardo Correia , Neves Isabel
Published: December 2022

Background

Lyme disease (LD), caused by Borrelia burgdorferi sensu lato’s species, has a wide presentation and severity and is often a neglected diagnosis. Neuroborreliosis (NB) occurs in 10-15% of patients (pts).

This study evaluate NB (clinical manifestations, treatment and evolution) in a district acute hospital in Portugal.

Methods

Pts with Borrelia burgdorferi antibodies detected by ELISA, confirmed by Immunoblot and with neurological manifestations, between January 2015 - April 2022, in Pedro Hispano Hospital, Matosinhos, Portugal.

Results

Twenty-one pts: encephalitis (n=5), optic neuropathy (n=5), peripheral neuropathy (n=5), VII cranial nerve palsy (n=4), meningitis (n=3), myelitis (n=2), III cranial nerve palsy (n=1), meningoradiculitis (n=1), radiculitis (n=1) and stroke (n=1); majority female (71.4%) with mean age 50.8 years old. No cases of erythema migrans or arthralgias were observed. ECG performed in 13 pts and only one intraventricular conduction block detected. Lumbar puncture performed in 15 pts, only two presented inflammatory cerebrospinal fluid. Therapeutic strategies: 28 (n=4), 21 (n=5), 14 (n=3) and 10 (n=1) days of ceftriaxone and 28 (n=4), 21 (n=2) and 14 (n=2) days of doxycycline were applied. Complete clinical resolution observed in 6 pts (28.6%) and clinical improvement in 10 (47.6%). One (4.8%) developed post-treatment Lyme disease syndrome and one death occurred, not related with LD. Three pts had no clinical improvement but there was not disease progression, two treated with doxycycline (28 days) and the other one with ceftriaxone (21 days).

Conclusion

These data show the non-negligible prevalence of NB and the variability of clinical presentations that requires a high suspicion in the differential diagnosis. The heterogeneity of therapeutic regimens reflects the absence of a well-defined treatment and opens this discussion.

Disclosures

All Authors: No reported disclosures.