bluuebunny/crossref_metadata_2025 huggingface dataset:
2127. Is Routine TORCH Screening Necessary For Isolated Intrauterine Growth Restriction?
Authors: Wade Christine , Atkinson Naomi , Hui Lisa , Holmes Natasha
Published: December 2022

Background

Perinatal TORCH infections (Toxoplasma gondii, rubella, cytomegalovirus [CMV], herpes simplex virus [HSV]) cause significant fetal and neonatal morbidity and mortality. While perinatal infections are associated with a variety of clinical manifestations in the fetus, they rarely cause isolated intrauterine growth restriction (IUGR). TORCH screens are often ordered to investigate isolated IUGR, but there is limited evidence to support screening for these infections in the absence of other ultrasound abnormalities.

Methods

A retrospective review of antenatal TORCH testing between January 2014 and December 2018 was carried out at two hospitals in Melbourne, Australia. Records were reviewed to identify indications for testing, serology results, and subsequent antenatal investigations. Neonatal outcomes were also evaluated. Serology performed for stillbirth or pregnancy losses were excluded.

Results

Medical records of 718 pregnancies were reviewed, representing 760 fetuses. 82.5% of screens were ordered in the third trimester, with 43.5% ordered after 32 weeks gestation.

TORCH serology was performed for the following indications: isolated IUGR (71.2%), neurological abnormality (6.8%), echogenic bowel (3.4%), and maternal illness (1.7%). Screens ordered for isolated IUGR were positive in 7.4% (95% CI 5.5-10.0%).

TORCH screening identified 49 positive maternal IgM results (CMV = 34, toxoplasma = 15) Two acute maternal infections during pregnancy were diagnosed (CMV = 1, toxoplasma = 1). Both were identified due to symptomatic maternal illness. There was one confirmed neonatal CMV infection. Eight women did not have follow-up to determine the significance of a positive IgM result. No TORCH screen changed maternal management or neonatal outcomes.

Rubella IgM was ordered in 83.5% of women who had clearly documented evidence of prior rubella immunity. No acute HSV infections were identified.

Conclusion

Antenatal TORCH screening for IUGR is of minimal utility and is often performed as a reflex rather than in response to specific clinical syndromes. A more guided approach with selective testing is needed.

Disclosures

All Authors: No reported disclosures.
2128. Lack of Congenital Transmission in Infants Born of Female Patients with Chagas Disease who Became Pregnant During a Nifurtimox Study (CHICO and CHICO SECURE Study)
Authors: Jaime A L T C H E H , Ramirez Teresa , Sierra Victor , Moscatelli Guillermo , Dib Juan , Pinto Jimy , Ortiz Lourdes , Falaschi Andrea
Published: December 2022

Background

There is some concern about the safety of nifurtimox (NF) for the offspring of treated women. Potential genotoxicity of NF was reported in in vitro models. However, the evidence to support the risks in fetal development is lacking for humans. In addition, a preventative effect over transplacental transmission was reported in girls and women with T.cruzi infection treated before pregnancy (mainly with benznidazole).

Methods

A multicenter, randomized, double-blind phase 3 clinical trial (NCT02625974) was set up to evaluate safety and efficacy of NF. A total of 330 patients, younger 18 years old, were enrolled, 67 were females of child-bearing age.

The enrolled females of childbearing age agreed to use an effective method of contraception until 3 months after the last administration of NF. Pregnancy tests were performed at screening, during treatment and 30 days after end of treatment.

Results

No pregnancies were reported during treatment period. There were 5 pregnancies reported during the 1st year of post-treatment follow-up and another 21 pregnancies during the additional 3-year follow-up period. Two mothers did not consent to have their babies tested for T cruzi infection, and in one case an abortion was reported. Two women gave birth twice. There was information about transplacental transmission available in 18 babies. All mothers were T.cruzi RT-PCR negative at the end of the treatment period and remained negative during follow up.

All newborns were live, healthy full-term and of weight appropriate for their gestational age, and had no perinatal complications except one baby who was healthy but small for gestational age. T.cruzi infection was ruled out by a negative direct parasitological test during the first days of life in 12 infants , and /or by ELISA T.cruzi serology at 8 -12 months of age in 14 infants, which was negative in all cases.

Conclusion

Our results showed that treatment of females on childbearing age with nifurtimox may prevent transplacental transmission of CD as was reported previously for benznidazole.

Disclosures

Jaime ALTCHEH, Sr., MD,PhD, Bayer: Advisor/Consultant.
2129. Maternal Transmission of SARS-CoV-2-specific Antibodies, but not Cytokines/Chemokines to Neonates Following Infection and Vaccination During Pregnancy
Authors: Monroe Jonathon M , Punia Sohan , Quach Huy Quang , Enninga Elizabeth A , Fedyshyn Yaroslav , Fedyshyn Bohdana , Lemens Maureen , Littlefield Dawn , Sintim-Aboagye Elise , Mejia Plazas Maria C , Yamaoka Satoko , Ebihara Hideki , Pandey Akhilesh , Sun Jie , Johnson Erica L , Kennedy Richard B , Theiler Regan N , Chakraborty Rana
Published: December 2022

Background

Despite extensive studies of human immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) vaccination, research examining protective correlates of vertical transmission following maternal exposure in pregnancy remain limited. Here, we characterized antibody and cytokine responses in maternal and cord blood following infection or vaccination at various timepoints during gestation.

Methods

Spike S1 protein-specific binding antibodies and antibodies capable of blocking the interaction between the receptor binding domain (RBD) and the angiotensin converting enzyme 2 (ACE2) were measured in maternal and cord blood by ELISA. Serum concentrations of 74 cytokines/chemokines were measured by multiplex assay. Humoral responses and cytokine levels from matched maternal and fetal cord sera were compared and examined for potential correlations.

Results

We observed a highly significant correlation between Spike S1-specific antibody titer and RBD-ACE2 blocking antibody activity between maternal and fetal cord serum (p < 2.2e-16, R > 0.90). Blocking antibody activity was significantly higher for mothers infected during the 3rd trimester compared to earlier trimesters; however, vaccinated mothers developed and transferred higher antibody titers with greater RBD-ACE2 blocking antibody activity to their neonates than infected mothers. Furthermore, vaccine-induced Spike S1 IgG transfer ratios (fetal cord/maternal) were significantly higher than those induced by infection (p = 0.002). Multiplex assay showed significantly elevated levels of 33 cytokines/chemokines, mainly pro-inflammatory in infected maternal serum samples, while the paired fetal cord samples exhibited an anti-inflammatory cytokine predominance.

Conclusion

Our data support selective vertical transmission of potentially protective humoral responses against SARS-CoV-2, especially following vaccination in the 3rd trimester. The anti-inflammatory cytokine predominance in cord blood that persists despite maternal SARS-CoV-2 infection may offset the adverse outcomes of inflammation in pregnancy for the neonate.

Disclosures

All Authors: No reported disclosures.
2137. Effectiveness of Four Vaccines in Preventing SARS-CoV-2 Infection in Kazakhstan
Authors: Nabirova Dilyara , Horth Roberta , Nukenova Gaukhar , Smagul Manar , Yesmagambetova Aizhan , Singer Daniel , Henderson Alden , Tsoy Alexey
Published: December 2022

Background

In February 2021 Kazakhstan began offering COVID-19 vaccines to adults. Breakthrough SARS-CoV-2 infections raised concerns about real-world vaccine effectiveness. We aimed to evaluate effectiveness of four vaccines against SARS-CoV-2 infection.

Methods

We conducted a retrospective cohort analysis among adults in Almaty using aggregated vaccination data and individual-level breakthrough COVID-19 cases (≥14 days from 2nd dose) using national surveillance data. We ran time-adjusted Cox-proportional-hazards model with sensitivity analysis accounting for varying entry into vaccinated cohort to assess vaccine effectiveness for each vaccine (measured as 1-adjusted hazard ratios) using the unvaccinated population as reference (N=565,390). We separately calculated daily cumulative hazards for COVID-19 breakthrough among vaccinated persons by age and vaccine month.

Results

From February 22 to Sept 1, 2021 in Almaty, 747,558 (57%) adults were fully vaccinated (received 2 doses) and 108,324 COVID-19 cases (11,472 breakthrough) were registered. Vaccine effectiveness against infection was 78% (sensitivity estimates: 74–82%) for QazVac, 77% (72–81%) for Sputnik V, 71% (69–72%) for Hayat-Vax, and 69% (64–72%) for CoronaVac. Among vaccinated persons, the 90-day follow-up cumulative hazard for breakthrough infection was 2.2%. Cumulative hazard was 2.9% among people aged ≥60 years versus 1.9% among persons aged 18–39 years (p< 0.001), and 1.2% for people vaccinated in February–May versus 3.3% in June–August (p< 0.001).

Conclusion

Our analysis demonstrates high effectiveness of COVID-19 vaccines against infection in Almaty similar to other observational studies. Higher cumulative hazard of breakthrough among people >60 years of age and during variant surges warrants targeted booster vaccination campaigns.

Disclosures

All Authors: No reported disclosures.
2143. Contact Investigation after Exposure to Active Pulmonary Tuberculosis in the Pediatric Cancer Center
Authors: Yoon Yoonsun , Choi Joon-sik , Yoon Hanpum , Cho Sun Young , Kim Yae-Jean
Published: December 2022

Background

The prevalence of tuberculosis (TB) in Korean children has decreased due to universal BCG vaccination and the national TB elimination project. However, exposure to TB in children has been consistently reported. There have been few reports of TB exposure in the pediatric hematology-oncology ward.

Methods

A mother of a pediatric cancer patient was diagnosed with active TB with a cavity. Contact investigation was performed on patients, their parents, and healthcare workers who were exposed to the index case. The criteria for close contact were exposure in the same space with the index patient for more than 8 hours continuously or a total of 40 hours in case of multiple exposures. The initial assessment was performed as soon as the index case was identified. The second evaluation was conducted 8–10 weeks after the initial exposure. Both tuberculin skin test (TST), TB Specific Interferon-Gamma (T-SPOT) tests, and chest radiography were used in immunocompromised pediatric patients. For immunocompetent adults, the QuantiFERON-TB Gold (QFT-G) test and chest radiography were performed.

Results

Total 23 patients and 29 parents were exposed. The median exposure duration of patients was 3 days (1–8 days). The initial evaluation did not detect TB infection in pediatric patients. However, at the second evaluation, five patients (17.4%) were diagnosed with latent TB infection (LTBI, three with positive TST and two with positive T-SPOT), and two patients (8.7 %) were diagnosed with active TB infection (lymphadenitis and pulmonary TB). Among the 29 parents, 11 individuals (37.9%) were diagnosed with LTBI at the initial evaluation, which was considered as preexisting LTBI before this exposure. No additional case of TB infection was identified in the second evaluation. Among exposed 24 healthcare workers, two (9.1%) were eventually confirmed as newly diagnosed LTBI.

Conclusion

TB exposure in pediatric hematology-oncology ward and outpatient chemotherapy clinic caused active TB or LTBI cases with an attack rate of 26% in children. The high LTBI rate, up to 38% among parents even before this exposure, needs further intervention such as routine LTBI evaluation and treatment for families of pediatric cancer patients to prevent a similar event.

Disclosures

Joon-sik Choi, MD, MS, Ministry of Trade, industry and Energy, Republic of Korea: Grant/Research Support Yae-Jean Kim, MD, PhD, Janssen: Grant/Research Support|Korean Society of Pediatric Infectious Diseases: Grant/Research Support|Ministry of Trade, Industry and Energy: Grant/Research Support|MSD: Grant/Research Support.
2144. Duration of perioperative antibiotic prophylaxis in ventriculoperitoneal shunt surgery in children
Authors: Tada Ayumi , Ihara Satoshi , Suwa Junichi , Taniguchi Kimihiro , Shibata Meiwa , Funakoshi Hanako , Horikoshi Yuho
Published: December 2022

Background

Placement of ventriculoperitoneal (VP) shunt is an important treatment for pediatric hydrocephalus. Although prolonged perioperative antibiotic prophylaxis has theoretically no benefit in reducing device-associated infections, duration of antibiotic prophylaxis for VP shunt placement in pediatrics is not well established. As a part of antimicrobial stewardship program (ASP), our ASP team recommended to stop perioperative antibiotic prophylaxis for sterile medical placement within 48 hours following surgery in April 2017.

Our aim of this study was to evaluate rate of VP shunt-associated infections following shunt placement between children received < 48 hours and ≧ 48 hours of perioperative antibiotic prophylaxis.

Methods

Children aged 15 years old or younger who underwent VP shunt insertion between April 2014 and November 2021 were enrolled at Tokyo Metropolitan Children's Medical Center. Children with co-existing infection at time of surgery were excluded. Rates of VP shunt-associated infections following 1 month and 6 months of post-surgical periods were compared between children who received < 48 hours and ≧ 48 hours of perioperative antibiotic prophylaxis.

Results

A total of 110 children were identified. Among them, 11 cases with VP shunt-associated meningitis and 15 cases with other infections were excluded. Girl ratio was 44%. Median age was 4.5 months old (IQR 8-40). Numbers of children with cefazolin and vancomycin-contained regimen were 83 (98.8%) and 1 (1.2%), respectively. Numbers of children who received perioperative antibiotic prophylaxis for < 48 hours and ≧ 48 hours were 43 (51.2%) and 41 (48.8%), respectively. Incidence of VP shunt-associated infections for 1 month of post-surgical period in < 48 hours and ≧ 48 hours antibiotic prophylaxis groups were 4.65% (2/43) and 12.2% (5/41), respectively. (P=0.211)　Incidence of VP shunt-associated infections for 6 months of post-surgical period in < 48 hours and ≧ 48 hours antibiotic prophylaxis groups were 11.6% (5/43) and 12.2% (5/41), respectively. (P=0.936).

Conclusion

Shorter duration of < 48 hours of perioperative antibiotic prophylaxis did not increase rates of VP shunt-associated infections among children in short and long terms.

Disclosures

All Authors: No reported disclosures.
2146. Impact of MRSA colonization pressure on MRSA acquisition and MRSA infection in pediatric intensive care unit
Authors: Kim Gahee , Lee Sanghoon , Lee Jina
Published: December 2022

Background

Methicillin-resistant Staphylococcus aureus (MRSA) colonization pressure (CP) is a useful indicator for measuring the extent of MRSA reservoir in healthcare settings. The purpose of this study is to determine the MRSA colonization rate and invasive MRSA infection rate in severely ill pediatric patients requiring pediatric intensive care unit (PICU) stay, and to evaluate the association between MRSA CP and MRSA acquisition/invasive infection.

Methods

From January 2016 to December 2020, pediatric patients admitted to 2 PICUs with a total of 25 beds were retrospectively analyzed. Routine nasal and/or endotracheal cultures were performed on MRSA at the time of PCIU admission and thereafter, every week. MRSA CP was defined as the ratio of the monthly MRSA positive number of patients to 100 patient days. Among MRSA colonizers, MRSA obtained after 2 days of PICU admission was defined as an acquired colonizer, and imported colonizer was defined when it was confirmed as an MRSA colonizer at the time or within 2 days of entry. When MRSA was cultured in a normally sterile body fluids, it was defined as an invasive MRSA infection.

Results

Of the total 6,907 patients admitted to the PICUs during this study period, 8.4% (487/6,907) were MRSA colonizers; 30% (139/487) were acquired colonizers, and invasive MRSA infections occurred in 3.3% (16/487). During the stay in the PICUs, the MRSA acquisition rate was 4.1%. A total of 22 invasive MRSA infections occurred during this study period, with an incidence rate of 3.1/1,000 patient days, of which 72.7% (n=16) occurred to the patients with MRSA colonization. Invasive MRSA infection occurred in 2.4% (8/348) of imported colonizers, and 5.2% (8/139) of acquired colonizers (p=0.108). The median duration from the time of colonization to invasive infection was 24 days(IQR; 2.25-49.75). Although MRSA CP was not correlated with the incidence of invasive MRSA infection (p=0.101), MRSA CP itself affected MRSA acquisition in PICU (p< 0.001).

Conclusion

MRSA CP influenced the new acquisition of MRSA during PICU stay, and newly acquired colonizers are more likely to experience invasive MRSA infection. Continuous multi-faceted efforts to minimize MRSA CP can provide opportunities for reducing MRSA colonization and infections rates in PICU settings.

Disclosures

All Authors: No reported disclosures.
2150. Surgical Prophylaxis in Pediatric Liver Transplant Recipients: Variations in Protocol and Impact on 30-Day Surgical Site Infections
Authors: Marshall Nicholas P , Foster Charles B , Arakoni Venkatraman , Hashimoto Koji , Radhakrishnan Kadakkal , Gonzalez Blanca E
Published: December 2022

Background

Children undergoing liver transplantation are at risk for surgical site infections (SSI). IDSA/ASHP/SIS/SHEA guidelines recommend surgical prophylaxis with a third-generation cephalosporin plus ampicillin or piperacillin-tazobactam alone. The study objectives were to describe the surgical prophylaxis used at our institution, obtain data on whether prophylactic antimicrobials are adjusted for multidrug resistant organisms and to determine whether adjustments correlate with SSI.

Methods

Pediatric liver transplant procedures, with associated peri-operative and intra-operative antimicrobials, were extracted from our institutions’ Anesthesia Record Keeping System (ARKS) between 2005-2022. Medical records were reviewed for demographics, microbiological data (e.g., colonization), protocol deviations and 30-day CDC/NHSN SSIs.

Results

Seventy-one procedures were performed in 69 patients, median age 3 years (range, 5 months- 17 years), where 89% had a pre-transplant infectious disease consultation. Variations from protocol occurred in 39% (n=28), of which 3 were consult-directed. Sixteen were colonized with an organism prior to transplant (3 MDRO and 1 Candida spp.), of which 10 had a protocol adjustment (p< 0.001). The most common additional antimicrobials were vancomycin (n=17) and fluconazole (n=8). Reasons for fluconazole were fulminant liver failure (n=2), surgeon concern (n=3), colonization or prolonged antimicrobials prior to transplant (n=2) and continuation of prophylaxis (n=1). Ten procedures were complicated by an SSI (14%). SSI rates did not differ in those with and without protocol adjustments (p=0.50).

Conclusion

Adjustments to guideline concordant surgical prophylaxis recommendations occurred in 39% of pediatric liver transplant procedures, with the most common being addition of vancomycin or fluconazole. Adjustments were based on a pre-transplant infectious disease consult recommendations in 11% of cases. Protocol adjustment correlated with any pretransplant microbiology culture result, but not with either MDRO colonization or subsequent SSI. Antimicrobial stewardship efforts may be indicated to address variations in antimicrobial prophylaxis in pediatric liver transplant patients.

Disclosures

All Authors: No reported disclosures.
2151. Time to Positivity in Blood Cultures at a Free-Standing Level IV NICU
Authors: Nishihara Yo , MacBrayne Christine , Prinzi Andrea , Zenge Jeanne , Grover Theresa , Parker Sarah K
Published: December 2022

Background

In the Neonatal Intensive Care setting, subtle clinical deterioration of the infant combined with the lack of specificity in clinical signs to identify true infection often triggers an evaluation for sepsis. Blood cultures are obtained, and empiric antibiotics are initiated. Limiting the duration of antibiotic exposure has potential benefits in curtailing antimicrobial resistance and reducing unwanted adverse effects. We aimed to determine the time to positivity (TTP) of blood cultures in a level IV NICU over a 6-year period, with the goal to reassess our antimicrobial practice.

Methods

Data were extracted from the Children’s Hospital Colorado data warehouse for all neonates admitted to the NICU with a positive blood culture between Jan 2013 to Dec 2018. These patient’s charts were reviewed for both microbiologic and clinical data. TTP was calculated based on date and time culture was collected, compared to the date and time growth was first reported. Micro-organisms were categorized into absolute pathogens, potential pathogens, common contaminants, yeast and other less frequently identified organisms.

Results

A total of 309 positive blood cultures were identified from 268 neonates. The mean gestational age was 34.7 weeks with an average birthweight of 2353g. Overall TTP median and interquartile range (IQR) was 21.1 (14.4 ,25.4) hours. The median (IQR) TTP for gram-positive absolute pathogens and gram-negative absolute pathogens were 16.3 (13.0, 22.4) and 12.6 (11.3, 14.4) hours, respectively. Of the 309 positive culture results, 295 (95%) had been initiated with antibiotics; 110 (37%) were later deemed as contaminant, and treatment discontinued. Central line associated bacterial infection was documented in 35 cases (11%). Death within 4 weeks of culture positivity was recorded in 25 (9.5%) cases.

Conclusion

The majority of gram-positive and gram-negative pathogens were identified within 24h of blood culture collection. A substantial number of cases were later categorized as contaminants, highlighting the importance of correct sterile technique when obtaining cultures. These findings highlight opportunities for antimicrobial stewardship to limit antibiotic exposure in the NICU. The high mortality within 4 weeks of blood culture positivity warrants further study.

Disclosures

All Authors: No reported disclosures.
2155. Evaluation of the Effect of Omicron Variant on Case Numbers in Children
Authors: Arslan Aslı , Yıldırım Arslan Sema , Avcu Gülhadiye , Durusoy Raika , Çiçek Candan , Şahbudak Bal Zümrüt , Özkınay Ferda , Kurugöl Nuri Zafer
Published: December 2022

Background

SARS-CoV-2 Omicron variant has become dominant in many countries, and a significant increase in the number of cases has been noted due to this highly contagious variant. This study aimed to determine the changes in case numbers, age distribution and hospitalized patients’ characteristics in children with COVID-19 by comparing the Omicron variant that was dominant before.

Methods

5647 pediatric patients with SARS-CoV-2 PCR positive between 11 March 2020 and 28 February 2021 at Ege University Hospital were included in the study. Two time periods of 2.5 months were determined: Omicron predominant period (16 December 2021 and 28 February 2022) and the pre-Omicron period (1 October and 15 December 2021). The information was obtained from the files of patients retrospectively.

Results

The Omicron variant caused a significant increase in pediatric patients after December 15, 2021 (Graphic 1). There were 2893 pediatric patients since the beginning of the pandemic, while 2754 pediatric patients after the Omicron variant only the 2.5 months. While the test positivity rate was 10.4% on average before the Omicron, it increased to 30.37% on average after Omicron (Graphic 2). The comparison of the epidemiological characteristics of the Omicron and the pre-Omicron period is given in Table 1. In the Omicron period, 17.1% of the cases were 0-4 years old, and 0-6 months was 3.9%. While the disease was more common in children over 5 years old in the pre-Omicron period, a 4.6-fold increase was observed in 0-4 years after Omicron. Children under the age of 5 constitute 51.9% of the hospitalized children; a 4.5-fold increase occurred in the Omicron period. While hospitalization rates increased after the Omicron, no significant difference was found in intensive care unit admission. There was a significant decrease in the number of patients receiving oxygen and the need for mechanical ventilation.

Number of SARS-CoV-2 PCR positive children by months in Ege University Hospital

Test positivity rate in children by month at Ege University Hospital

Comparaiton of pre-Omicron and Omicron period

Conclusion

The number of cases in children increased with the effect of the Omicron variant, especially the increase was more pronounced between 0-4 years of age. Despite this increase in the cases, no serious increase was observed in the severity of the disease, but a decrease in pneumonia, oxygen demand, and mechanical ventilator requirement was observed. While the number of tests decreased, test positivity rates increased.

Disclosures

All Authors: No reported disclosures.
2159. Monoclonal Antibody Treatment for COVID-19 in Children: Experience of a Pediatric Tertiary Care Center
Authors: Ibrahim Osama , Ferlisi Kristen , McCormick Winston , Alcorta Cristina E , Koster Michael
Published: December 2022

Background

Pediatric patients are more likely than adult patients to experience mild COVID-19 infection but may still suffer severe infection with lasting sequalae or death. One treatment modality is monoclonal antibodies (MABs), which prevent viral replication by binding the epithelial surface receptor for the SARS-CoV-2 spike protein. The Food and Drug Administration (FDA) issued emergency use approval (EUA) for multiple MAB regimens. Clinical trials have shown decreasing viral loads and reductions in hospitalization and death in high-risk adult COVID-19 patients after MAB administration, yet casirivimab/imdevimab (C/I) and bamlanivimab/etesevimab (B/E) have decreased efficacy against Omicron compared to other variants. There is insufficient literature studying MABs in clinical practice among the pediatric population.

Methods

This study seeks to fill this knowledge gap by reporting the experiences and outcomes with MAB administration of a single pediatric tertiary care center in Rhode Island.Our retrospective case-series documents all mild-to-moderate COVID-19-infected patients who received MABs at Hasbro Childrens Hospital in Providence, RI from January 2021 to March 2022. Included patients had at least one risk factor for severe COVID-19 infection as indicated by the FDA EUA.

Results

Overall, 108 patients received MABs. Out of the 108 patients, 97 had COVID-19, 11 received post-exposure prophylaxis, 62 patients received B/E, 36 received C/I, 9 received B, and 1 patient received Sotrovimab. Regarding comorbid conditions, 65 had 1 condition and 43 had 2+ conditions. The most common comorbidities were obesity (48), chronic lung disease (37), and immunocompromised state (33). There were 7 cases of infusion-related reaction that resolved during observation in the infusion site. In all, 101 patients completed their recovery at home without events, 1 patient was admitted to the ICU for worsening respiratory status, 3 patients presented to the ED for worsening symptoms and were discharged home, and 3 patients presented for unrelated symptoms within 28 days.

Conclusion

This study suggests MABs are well-tolerated and effective for preventing severe COVID-19 infection or death among high-risk pediatric patients and for decreasing the health burden of COVID-19 during surges.

Disclosures

All Authors: No reported disclosures.
2165. Surveillance of Severe Viral Respiratory Infections among Children Presenting to Hôpital Saint Damien in Haiti
Authors: Turner Jasmine C M , Gassant Pascale , Gautier Jacqueline , Joseph Marie Betanie , Gustinvil Robens , Deroncelay Alexandra , Dor Vanessa , Lee Natalie , Homsi Maysam R , Webby Richard , Caniza Miguela A
Published: December 2022

Background

Learning the burden and seasonality of respiratory viral infections in children in resource-limited settings is critical for hospital infection care and prevention and national public health programs. We built a prospective surveillance program of severe acute respiratory illness (SARI) in hospitalized children at Hôpital Saint Damien - Nos Petits Frères et Soeurs to gather local evidence and support informed clinical and policy decision-making. The COVID-19 pandemic erupted as we were launching our project, requiring the use of available point-of-care diagnostics.

Methods

Children < 18 years of age with cough, history of fever ≥ 38 C°, of < 10 days evolution, and requiring hospitalization were included in the study. We obtained a nasopharyngeal swab and collected demographic and clinical data for eligible patients. Samples were tested using antigen test on-site for influenza A (Flu A) and B (Flu B), respiratory syncytial virus (RSV), and SARS-CoV-2. Afterwards, all specimens (both negative and positive) were stored and shipped for molecular studies.

Results

We obtained and tested 167 samples from patients since April 30, 2021, through January 31, 2022. Single isolates were detected in 88 samples (53%), multiple isolates in 20 samples (12%), and no isolates in 59 samples (35%). Positive cases for RSV, Flu A, and Flu B peaked between November and January. Rhinovirus 1A (RhV) was detected throughout the study period, with peaks around August-September and was the most often detected viral isolate (49, 38%), followed by RSV (37, 29%). Co-infections were seen with RSV, Flu A, RhV, and SARS-CoV-2. Molecular studies detected 7 isolates of Flu A not detected by rapid test, 1 isolate of Flu B, and 1 isolate of SARS-CoV-2. However, it failed to detect 2 isolates of Flu A detected by rapid test, 1 isolate of Flu B, and 1 isolate of SARS-CoV-2.

Conclusion

Our study captured circulating respiratory viruses in children with SARI in Haiti during the COVID-19 pandemic. Preliminary data suggest an increase in respiratory viruses between August and January. Improving point-of-care diagnostics can better inform providers of the local epidemiology of respiratory viruses and support clinical decision-making, such as good use of antibiotics. However, we confirmed the sensitivity of molecular testing.

Disclosures

All Authors: No reported disclosures.
2174. Development and Validation of a Clinical Prediction Model for Community-Onset Pneumonia caused by Extended-Spectrum Beta-lactamase-Producing Enterobacteriaceae
Authors: Enriquez Jhon Ryan G
Published: December 2022

Background

The study aims to identify specific risk factors associated with developing pneumonia cause by ESBL producing organisms and develop a Clinical scoring model base on the risk factors identified to be able to provide guidance on appropriate empiric antibiotic therapy

Methods

We conducted a single-center retrospective cohort study in a tertiary hospital on Pasig City, Philippines including 150 patients admitted with Community onset Pneumonia from 2018 to 2019

Baseline Characteristics

Independent variables included in the study

Results

Among 150 patients admitted with Community onset Pneumonia, 70.2% their respiratory isolates were K. Pneumoniae followed be E. coli at 14.57%. The Total ESBL rate among all the respiratory isolate was 45.3%. Univariate analysis of all the risk factors showed significant statistical difference in female Sex (OR 0.49; 5% CI: 0.26-0.96), Charlson Score (OR 26.00; 95% CI: 10.66-63.39), Recent Hospitalization (OR: 29.35; 95% CI: 11.53-74.46), Recent Antibiotic Use (OR 84.49; 95% CI: 28.66 – 251.87), Prior History of ESBL (OR: 57.14; 95% CI: 12.96 – 525.01), and Frequent ED visits (OR:45.88; 95% CI; 15.92 – 132.23). Multivariate analysis was done to generate the final model. The results shows that Charlson Score (OR 11.86, 95%CI: 2.55 – 55.18, p value 0.002), Recent Antibiotic Use (OR: 31.09, 95%CI: 5.36-180.44, p value < 0.001). and Frequent ED visits (OR 6.52; 95% CI 1.04-41.07) were found to be significant predictor of ESBL. The final model of the three risk factors has a performance AU ROC Curve of 0.9780 at distinguishing between the positive and negative samples.

Sensitivity, Specificity, PPV, NPV and ROC area of each of the variables included in the final model

Conclusion

The results of this study suggest a simple and easy-to-use prediction model to predict Community-onset pneumonia caused by ESBL-producing Enterobacteriaceae.

Disclosures

All Authors: No reported disclosures.
2175. Diagnostic Utility of Pneumococcal Urinary Antigen Assay in Clinical Practice: a Retrospective Study in a Community Hospital in Evanston, Illinois
Authors: Egoryan Goar , Nava Guillermo Rodriguez , Nava Guillermo Rodriguez , Kishmiryan Armen
Published: December 2022

Background

While the pneumococcal urine antigen test (PUAT) is a validated tool for diagnosing pneumonia, recent evidence suggested lower sensitivity than expected (approximately 60-65%) and limited impact on clinical outcomes. A lack of clinical indicators for a positive test result and the absence of clear recommendations based on high-quality evidence create grounds for potential test misuse in real practice.

Methods

We performed a Workbench report to retrieve individual orders of Streptococcus pneumoniae urine antigen test (BinaxNOWTM) from our community hospital in Evanston, Illinois, between January 1, 2011, and December 31, 2021. We then identified patients with or without clinical pneumonia based on McGeer criteria: new infiltrates on chest x-ray plus cough, shortness of breath, oxygen saturation < 94%, or respiratory rate ≥ 25 plus fever, leukocytosis, or altered mental status.

Results

Among 8,110 individuals tested for PUAT, only 273 positive results were identified (3.36%); of those, 83 (30.4%) did not meet criteria for clinical pneumonia (Figure 1). The median age of patients in a group with clinical pneumonia and without was 67 and 69 years, respectively. The prevalence of diabetes mellitus, COPD/asthma, and immunosuppression was not statistically significant between groups (Table 1). The signs and symptoms are presented in Table 2.S. pneumoniae was cultured in only 13.9% of cases in patients with clinical pneumonia, which correlates with the known sensitivities of this test (Table 3). More ICU admissions and NIPPV use were noted in patients with clinical pneumonia (p = 0.04 each). However, there was no difference in the use of antibacterial therapy among the two groups (p = 0.83), mechanical ventilation rates (p = 0.2), and length of hospital stay (p = 0.2) (Table 4). The positive predictive value of PUAT was 69% in our study (Table 5).

Conclusion

Our study demonstrated a low positivity rate of PUAT despite a large sample size and a significant proportion of positive test results in patients without clinical pneumonia. The widespread use of PUAT should be carefully reconsidered and applied only to a selected category of patients. Such a strategy will reduce the discrepancy between current guidelines and real-world care patterns and provide an additional benefit of cost-effectiveness.

Disclosures

All Authors: No reported disclosures.
2179. Multiple cytokine analysisbased on QuantiFERON-TB Gold Plus in different tuberculosis infection status:anexploratory study
Authors: Yang Zhengrong , Zhang Lifan , Ge Qiping , Zhang Yueqiu , Wu Fengying , Gao Mengqiu , Liu Xiaoqing
Published: December 2022

Background

To explore the differences of multiple cytokines secretion based on QuantiFERON-TB Gold Plus(QFT-Plus)antigens stimulation, and to screen cytokines with potential to differentiate tuberculosis infection status.

Methods

Twenty patients diagnosed microbiologically with active tuberculosis(ATB)in Peking Union Medical College Hospitaland Beijing Chest Hospital from February to April 2022 were enrolled.Fifteen healthcare workers(HCWs) with latent TB infection(LTBI),10 HCWs with previous TB and 10 HCWs as healthy control(HC) were recruited during the same period. After stimulated by QFT-Plus antigens,the secretion of interferon gamma(IFN-γ),tumor necrosisfactor-α(TNF-α), interleukin(IL)-2(IL-2), IL-6, IL-5, IL-10, interferon-inducible protein-10(IP-10), IL-1 receptor antagonist(IL-1Ra),chemokine(C-X-C)Ligand-1(CXCL-1)and macrophage chemoattractant protein 1(MCP-1)) in Plasma were measured by Luminex Assays.

Results

1.After stimulation with QFT-Plus TB1 orTB2 antigens, the level of IFN-γin ATB and LTBI groups was significantly higher than that in HC group(p<0.05),while there was no significant difference between ATB and LTBI groups(p >0.05).Cytokines including IL-2,IL-1Ra, CXCL-1have the similar secretion patterns to IFN-γ. 2.After stimulation with TB1 antigen, the level of IP-10 in ATB group was significantly higher thanthat inLTBI,previous TBand HC groups(p<0.05).After stimulation with TB2 antigen, the level of IL-6in ATB group was significantly higher thanthat in LTBI and HC groups(p<0.05). 3.There was no significant difference incytokines secretion levels in QFT-Plus specific CD8 response(TB2-TB1) in most groups.

Conclusion

In addition to IFN-γ, thedetection of IL-2, IL-1Ra, CXCL-1by QFT-Plusmay havethe potential to detect tuberculosis infection.Combined detection of IP-10 and IL-6 levels may have the potential to differentiate ATB from LTBI

Disclosures

All Authors: No reported disclosures.
2182. Pneumonia in Patients who Inhale drugs, experience in a tertiary care hospital
Authors: Suryadevara Madhu , Bishburg Eliahu , Nagarakanti Sandhya , Amin Krushna , Ejayeriese Eguono
Published: December 2022

Background

Drug use (DU) is associated with various infectious diseases complications including pneumonia. Inhalational drug use (IHDU) associated pneumonia have not been well described. We sought to describe our experience with pneumonia associated with IHDU.

Methods

A retrospective chart review from 2015-2021 in a tertiary care teaching hospital. Patients (pts) diagnosed with pneumonia who reported IHDU were included. Data was collected for age, type and route of DU, comorbidities, etiological diagnosis, radiological results and outcome.

Results

A total of 237 pts were identified. Median age 53 years (range of 22-75), females 128 (54%). Smoking drugs in 158 (66.6%), 115 (48%) used drugs by sniffing/snorting, 19(8%) reported also active intravenous drug use (IVDU) and 16(6.7%) had a past history of IVDU. Overall 120 (50.6%) used cocaine, heroin in 78 (33.3%), while 156 (66%) used both heroin and cocaine. HIV infection in 57 (23.7%). Blood cultures were positive in 18/153: 4 Staphylococcus aureus, 2 Streptococcus pneumonia, 1 Serratia spc., 1 Pseudomonas aeruginosa. Sputum cultures were (+) in 20/69 and bronchoalveolar lavage (BAL) was (+) in 8/10, of them 7 Staphylococcus aureus, 2 Streptococcus pneumonia, 2 Klebsiella pneumonia, 2 Haemophilus influenza and 1 Pneumocystic carnii. Pneumococcal urine Ag in 3. Chest imaging was done in 228 (96%). Imaging was (+) in 192 (84.2%), infiltrates in 83 (43%), opacities in 30 (17%), consolidation in 21 (11%), 1 lung cavity and 44 (23%) had mixed findings. Negative imaging in 36 (15.8%) and no imaging in 9 (4%). In 6(2.5%) there was no imaging or cultures to diagnose pneumonia. The average length of stay was 5.8 days. Rehospitalization in 107/237 (45.1%) within 6 months of initial admission of these 43/107 (40.2%) were diagnosed with pneumonia, 74 (69%) were diagnosed with another pulmonary diagnosis. Five (2.1%) patients expired; of them 3 Had HIV and 3 were active IVDU.

Conclusion

In our hospital pts with IHNU diagnosed with pneumonia had an increased risk of rehospitalization within 6 months of admission. There were no predominant radiological findings or microorganism isolated. Etiological diagnosis was found in a small number of patients. Mortality rate was relatively low.

Disclosures

All Authors: No reported disclosures.
2192. Clinical and Molecular Characteristics of Severe Respiratory Syncytial Virus Pneumonia in Critically Ill Adults
Authors: Kim Taeeun , Hong Sang-Bum , Huh Jin Won , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Kim Sung-Han , Sung Heungsup , Lee Sang-Oh , Kim Yang Soo , Choi Sang-Ho
Published: December 2022

Background

Respiratory syncytial virus (RSV) has been increasingly recognized as a frustrating cause of morbidity and mortality in adults. However, the clinical impact and molecular characteristics of severe RSV-associated pneumonia in critically ill adult patients have rarely been addressed.

Methods

This study, nested in a prospective cohort of severe pneumonia, was conducted at a 2,700-bed tertiary care hospital and comprised two parts. In part 1, the clinical characteristics of severe RSV-associated pneumonia were compared with severe influenza virus (IFV)-associated pneumonia between 2010 and 2019. In part 2, we performed phylogenetic and amino acid analyses of the G protein of RSV strains from three groups of different infection severity between 2015 and 2019 (Figure 1). Figure 1.Clinical samples for whole-genome sequencing in part 2.

Results

In part 1, 92 RSV- and 163 IFV-positive patients were identified. Structural lung diseases, diabetes mellitus, and malignancy were common underlying diseases in both groups. Immunocompromise (57.6% vs. 34.4%, p < 0.001) and hospital acquisition (47.8% vs. 23.9%, p < 0.001) were significantly more common in the RSV group. Clinical manifestations at diagnosis between the groups were generally similar. The mortalities of patients in both groups were similarly high (Table 1). In part 2, 26 RSV strains from three groups (group 1: 11 strains, group 2: 8 strains, and group 3: 7 strains) were analyzed. All isolated RSV-A and -B strains belonged to the ON1 and the BA9 genotypes, respectively. The phylogenetic analysis revealed that the adult severe pneumonia strains clustered by contemporary strains rather than other severe pneumonia strains. There were no significantly different genetic variations among the three groups, including the subtype clades, amino acid sequence substitutions, and changes in potential glycosylation sites. Table 1.Characteristic and outcomes of 255 patients with virus-associated severe pneumonia

Conclusion

Severe RSV pneumonia was more commonly associated with hospital acquisition and immunocompromised status. Overall clinical features and mortalities of the RSV group were comparable to the IFV group. The molecular characteristics of RSV strains from the adults with severe pneumonia were not distinct from strains from non-pneumonic adults or children, underscoring that the severity of RSV respiratory tract infection is mainly determined by host factors, not by viral factors.

Disclosures

All Authors: No reported disclosures.
2195. Etiologies of medically attended acute respiratory infections among young Ecuadorian children prior to the start of the 2020 SARS-CoV-2 pandemic
Authors: Suryadevara Manika , Pizarro Fajardo Freddy A , Aponte Cinthya Cueva , Aponte Jorge Carrillo , Bonville Cynthia , Torres Irene , Domachowske Joseph B
Published: December 2022

Background

Data regarding respiratory pathogen epidemiology in the tropical country of Ecuador are limited. Here, we describe the temporal patterns and etiologies of medically attended acute respiratory infections among Ecuadorean children during the 20-month period preceding the onset of the 2020 SARS-CoV-2 pandemic.

Methods

Children < 5 years old presenting to a designated outpatient clinic with at least 2 new symptoms consistent with an acute respiratory infection are eligible for enrollment. Informed consent is obtained. Demographic and clinical details are collected. A nasopharyngeal sample is collected for diagnostic testing of 22 target pathogen groups using Biofire’s Respiratory Panel v1.7 multiplex polymerase chain reaction assay.

Results

Of the 820 subjects enrolled between July 15, 2018 and March 15, 2020, 655 (80%) tested positive for at least one pathogen. The detection of pathogens was more likely from samples collected from children enrolled in Quito (85%) compared to Machala (76%) (p < 0.05). The most frequently detected pathogen groups were rhinovirus/enterovirus (46%), parainfluenza virus (14%), respiratory syncytial virus (RSV) (12%), and influenza virus (10%). Two or more pathogen groups were co-detected in 174 (27%) of the respiratory samples. Pathogen specific seasonal patterns were not observed for rhinovirus/enterovirus, adenovirus, or atypical bacteria at either site. Samples collected in Quito were positive for the detection of RSV spanning a 32-week period between November and June. In contrast, detection of RSV from samples collected in Machala spanned only a 17- week period between February and May. In Quito, influenza viruses were detected between August and February, with influenza A activity preceding that of influenza B. In Machala, the detection of influenza B virus coincided with the dry season, while detection of influenza A virus was clustered in the rainy period between January and March.

Conclusion

The specific etiologies and seasonality of acute respiratory tract infections among Ecuadorean children < 5 years of age differ by site of enrollment. Such differences in regional data can be used to optimize regional implementation of existing and soon-to-be available public health prevention measures.

Disclosures

Manika Suryadevara, MD, Janssen: Grant/Research Support|Merck: Grant/Research Support|Roche: Grant/Research Support.