bluuebunny/crossref_metadata_2025 huggingface dataset:
681. Antibiotic Treatment During Hospitalization Is a Major Risk Factor for The Occurrence Of Clostridium Difficile Infection Among Carriers
Authors: Gilboa Mayan , Cohen Ido , Peretz Yovel , Meltzer Eyal , Yahav Dafna , Regev-Yochay Gili
Published: November 2023

Background

Asymptomatic carriers of Clostridium difficile (CD) have a higher risk of developing CD infection (CDI). Previous studies have shown that reducing inappropriate antimicrobial use through antimicrobial stewardship programs can decrease rates of CDI. However, risk factors for the development of CDI among carriers, particularly the role of antibiotic treatment, have not been well-defined.

Risk factors for Clostridium Difficile Infection - multivariable logistic regression analysis

Methods

We conducted a prospective cohort study between January 2017 and March 2023, assessing 2524 asymptomatic CD carriers admitted to internal medicine and hematology wards. Patients were screened for CD carriage upon admission and followed untill discharge for occurence of symptomatic CDI. We performed multivariable logistic regression analyses adjusted for age, gender, immunosuppression status, Carbapenem-resistant Enterobacteriaceae (CRE) carriage, Previous intensive care unit admission in the past 30 days, Presence of a nasogastric tube (NG), chronic Protein Pump Inhibitor (PPI) usage, and debilitation and examined whether at least one antibiotic dose, either Intra venous or oral, during the hospitalization, was related to the occurrence of clinical CDI.

Results

Of the 2524 CD carriers, 225 (8.9%) developed clinical CDI during their hospitalization. In a multivariable logistic regression analysis, antibiotic treatment during hospitalization was the most significant risk factor for the occurrence of CDI among carriers (OR 2.15, 95% CI 1.43-3.22). Other risk factors included CRE carriage (OR 2.08, 95% CI 1.35-3.19) and the presence of an NG tube (OR 1.56, 95% CI 1.12-2.15).

Conclusion

In this large prospective cohort study, we found that antibiotic treatment during hospitalization was the most significant risk factor for the occurrence of CDI among carriers. These results emphasize the importance of antimicrobial stewardship programs and suggest that CD carriers represent a suitable target for focused stewardship efforts

Disclosures

All Authors: No reported disclosures
682. Novel rpoB mutations and trends in clinical Clostridioides difficile isolates with reduced fidaxomicin susceptibility
Authors: Gonzales-Luna Anne J , Le Thanh , Eubank Taryn A , Karim Md Ekramul , Jahangir Alam M , Begum Khurshida , Garey Kevin
Published: November 2023

Background

Fidaxomicin use is increasing to treat Clostridioides difficile infection (CDI) following clinical treatment guideline updates placing it as first-line therapy. This puts a selection pressure on the development of fidaxomicin resistance, which has been associated with in vitro fitness costs compared to wildtype isolates. Here we aimed to assess the epidemiology of reduced susceptibility (RS) to fidaxomicin and prevalence of rpoB mutations in a clinical cohort.

Methods

Stool samples from patients with CDI were collected from two different healthcare systems in Houston, TX between 2016-21. Fidaxomicin minimum inhibitory concentrations (MIC) were determined via agar dilution susceptibility testing following CLSI standards. RS was defined as MIC > 0.5 mg/L based on the EUCAST [T]ECOFF. A subgroup of 40 isolates with RS underwent Sanger sequencing to detect rpoB single nucleotide polymorphisms (SNPs).

Results

Of 535 patients included, 114 (21.3%) had infecting strains with fidaxomicin RS (MIC50 = 0.5 mg/L, MIC90 = 1.0 mg/L). Fidaxomicin RS was more common in RT 027 (49.4%, 41/83) compared to non-027 strains (16%, 68/425; P < 0.001). There were no differences in the proportions demonstrating RS across collection years (P=0.18) or based on location in or out of the Texas Medical Center (P=0.29). Mean MICs were similar between isolates collected before and after the IDSA/SHEA guideline update in 2018 (P =0.1). rpoB SNP mutations were detected in 12.5% (5/40) of isolates at 7 novel base positions; no SNPs were detected at previously reported position 3428.

Conclusion

RS to fidaxomicin occurred in one fifth of clinical isolates with no changes in incidence between 2016-21. Several new rpoB SNPs were observed in isolates with RS. Studies are needed to determine potential association(s) between fidaxomicin exposure and MIC changes.

Disclosures

Anne J. Gonzales-Luna, PharmD, BCIDP, Cidara Therapeutics: Grant/Research Support|Ferring Pharmaceuticals: Personal Fees|Paratek Pharmaceuticals: Grant/Research Support|Seres Therapeutics: Grant/Research Support Kevin Garey, PharmD, MS, BCIDP, Acurx Pharmaceuticals: Grant/Research Support|Cidara Therapeutics: Grant/Research Support|Ferring Pharmaceuticals: Advisor/Consultant|Paratek Pharmaceuticals: Grant/Research Support|Seres Therapeutics: Grant/Research Support|Vedanta Therapeutics: Grant/Research Support
709. Post-Clostridioides difficile Infection Neuroinflammatory Response in an Animal Model
Authors: Yang Suemin E , Costa Deiziane , Goldbeck Sophia M , Shin Jae Hyun , Warren Cirle A
Published: November 2023

Background

Clostridioides difficile infection (CDI) affects nearly half a million patients in the US annually. Previous studies have associated delirium and dementia with poor outcomes of CDI in older adults. We examined how CDI may affect the brain and induce neuroinflammation in the mouse model of CDI.

Methods

6 and 18-month-old mice were infected with 105 CFU of C.difficile, monitored daily (body weight and diarrhea score), and euthanized on day 3, day 7, and day 10 post-infection (p.i.). Cecum and colon tissues were processed for histopathology. Hippocampus, prefrontal cortex, and cecum samples were analyzed for pro-inflammatory cytokine levels (S100B, IL-6, IL-1β, and MPO) by ELISA and for phosphorylated NFκB by western blot.

Results

Infected mice developed diarrhea and weight loss, resulting in maximum weight loss around day 3 p.i., which resolved around day 7 and day 10 p.i. for 6 and 18-month-old mice respectively. Inflammatory marker analysis showed elevated levels of IL-1β (p=0.04) and myeloperoxidase (MPO, p=0.004) levels in the cecum, as well as higher histopathology scores in the cecal (p=0.04) and colon (p=0.009) tissue on day 3 p.i. By day 7 and day 10 post p.i., the measures of intestinal inflammation were no longer elevated, including IL-1β and MPO levels. The inflammatory markers in the hippocampus were not significantly elevated on day 3 p.i., but on day 7 p.i., levels of hippocampal S100B (p=0.003) and IL-6 (p= 0.03) were elevated in the 6-month-old mice, indicating that CDI is associated with an inflammatory response in the brain after the initial intestinal inflammation. Moreover, hippocampal phosphorylated NFκB levels were detectable on day 7 p.i. 6-month-old infected mice by western blot, pointing to an NFκB pathway as a mechanism by which the neuroinflammation is activated post-CDI. In addition to the hippocampus, the prefrontal cortex also showed a trend towards elevation of MPO levels on day 7 and day 10 p.i.

Conclusion

Our findings demonstrate that CDI promotes neuroinflammation which occurs after the peak of intestinal inflammation. NFκB signaling may be involved in the upregulation of the pro-inflammatory cytokines contributing to this neuroinflammatory effect; however, further investigation is needed.

Disclosures

Cirle A. Warren, MD, Ser-109 Coactuate: Advisor/Consultant|Ser-109 Coactuate: Honoraria
745. Title: Epidemiology of Hospital-onset Bacteremia (HOB) caused by Methicillin-resistant Staphylococcus aureus (MRSA) in a Multi-hospital Health System
Authors: Singh Harjot K , Ross Barbara , Quinn Margaret , Calfee David P , Simon Matthew , Torres Heidi M , Acker Karen P , Horowitz Harold , Wang Tina Z , Gunawardhana Nuwan , Goldberg Robin H , Segal-Maurer Sorana , Prasad Nishant , Johnson Candace L , Kuang David , Gouveia Adam L , Yoko Furuya E , Westervelt Karen , Saiman Lisa
Published: November 2023

Background

Hospital-onset bacteremia (HOB) is a quality metric proposed by CDC. HOB caused by methicillin-resistant Staphylococcal aureus (MRSA) is reported to Centers for Medicare and Medicaid services through the National Healthcare Safety Network (NHSN), yet few studies have described HOB-MRSA epidemiology. Thus, we report HOB-MRSA epidemiology from 2020-2022 at our multi-hospital health system to inform quality improvement initiatives.

Methods

We used data submitted to the NHSN to prospectively identify HOB-MRSA LabID cases and collected demographic and clinical characteristics from patients’ electronic medical records. Hospital epidemiologists at each of the 9 hospitals adjudicated suspected sources of HOB-MRSA. Annual standardized infection ratios (SIRs) were calculated. Characteristics of HOB-MRSA episodes were analyzed by descriptive statistics. Relevant institutional review boards deemed this study exempt from Human Subjects Research.

Results

From 2020-2022, 174 (0.029%) HOB-MRSA episodes occurred among 573,433 hospitalizations. Table 1 provides the characteristics of patients with HOB-MRSA and Table 2 provides the SIRS and suspected sources of HOB-MRSA. Overall, 43% of patients were in an ICU, 44% had a central line (CL), and 30% were on a ventilator. The SIR was lowest in 2022. Respiratory sources (non-ventilator and ventilator-associated pneumonia (VAP)) were the most common and declined over time (p=0.002). Suspected sources of HOB-MRSA were unknown for 11% of episodes.

Conclusion

We found that episodes of HOB-MRSA were attributed to multiple primary sources of infection. Thus, bundle strategies for VAP and CL-associated bloodstream infections, while crucial, are insufficient to reduce all HOB-MRSA. In addition, prevention strategies for patients with skin and soft tissue infections are needed. Our findings highlight the importance of adherence to all device and procedure-related bundles, hand hygiene, cleaning/disinfection, and MRSA decolonization when appropriate. Elucidating the epidemiology of primary infection sources can further tailor prevention strategies for HOB.

Disclosures

Sorana Segal-Maurer, MD, Gilead Sciences, Inc: Advisor/Consultant|Gilead Sciences, Inc: Honoraria|Janssen: Advisor/Consultant|Janssen: Honoraria|Theratechnologies: Advisor/Consultant|Theratechnologies: Honoraria|Viiv: Advisor/Consultant|Viiv: Honoraria Nishant Prasad, MD, Gilead Sciences, Inc.: Grant/Research Support Lisa Saiman, MD MPH, Merck & Co., Inc,: Grant/Research Support|Merck & Co., Inc,: Member, DSMB|Pfizer, Inc: Member, DSMB
746. A Bacteriophage-Based Validation of a Personal Protective Equipment Doffing Procedure to be Used with High Consequence Pathogens
Authors: Burke Kylie , Berryhill Brandon A , Kraft Colleen S , Smith Andrew , Morgan Jill , Tarabay Jessica , Mamora Josia , Varkey Jay , Mumma Joel , Grant Darryl , Busch Lindsay M , Carag Jessica
Published: November 2023

Background

Personal protective equipment (PPE) is the cornerstone of healthcare worker (HCW) safety and prevention of the spread of pathogens. To limit the potential risk to HCWs, healthcare institutions have employed infection control policies and procedures. When treating patients with high consequence infectious diseases, such as Ebola virus disease, HCWs wear complex personal protective equipment (PPE) ensembles that cover their entire body with multiple layers. These layers build redundancy to ensure protection of the HCWs' skin and clothing. Manufacturers typically provide recommendations for donning and doffing individual PPE pieces, but protocols differ between healthcare institutions for PPE ensembles. These PPE ensembles and their associated doffing protocols are rarely tested empirically.

Methods

We reviewed footage of the doffing protocol currently employed at a Regional Emerging Special Pathogen Treatment Center. From this analysis we identified potential contamination pathways which we verified by using a fluorescent pathogen proxy. To account for viable pathogen susceptibility to alcohol-based disinfectant, HCWs donned the PPE ensemble and were then contaminated with three genetically marked bacteriophages (phage). After completing the doffing protocol, the HCW’s skin and PPE were swabbed to test for the transfer of viable phage to the HCW.

Results

All four of the HCWs that completed the initial doffing protocol had a high recovery of phage from at least one sampling location. Subsequently, we implemented interventions to both the equipment and the doffing procedure. In nine trials with this modified protocol, no viable phage was recovered from any of the HCWs.

Recovery of Bacteriophage Transferred to HCW during Doffing Before and After Protocol Interventions. N=4 subjects for original protocol, N=9 subjects for revised protocol. Percentage of HCW for whom bacteriophage PCR was positive, average density of recovered phage when available--% (avg density). X- PCR positive, phage inactivated

Conclusion

Our experiments revealed potential contamination pathways that allowed for high densities of viable phage to move from areas of the outermost layers of PPE to the skin and clothing of HCWs. While the individual PPE functioned correctly, the original ensemble and doffing procedure were not effective. Our updated protocol eliminated phage contamination. This study highlights the need for infection prevention protocols to be evaluated in an empirical manner in a framework such as this.

Disclosures

All Authors: No reported disclosures
755. Infectious Diseases Journal Watch: a Pilot Study
Authors: Chen Benjamin , Wooten Darcy
Published: November 2023

Background

Staying apprised of the scientific literature can be a challenge for health science researchers and clinical practitioners alike [1, 2]. Journal surveillance is a popular modality for disseminating curated topic-specific health science research in a scheduled newsletter. The New England Journal of Medicine (NEJM) Journal Watch is a prominent example of this format [3], but despite its wide adoption, little research has examined the effectiveness of this model as an educational tool.

Methods

We conducted a pilot study examining the impact of journal surveillance as an educational tool within the University of California San Diego’s (UCSD) Division of Infectious Diseases. Modeled after the NEJM Journal Watch, we created an internal monthly newsletter summarizing the latest research in the field of infectious diseases (ID). We then surveyed readers to evaluate the content covered in article summaries, the barriers and facilitators to learning from the newsletter, and the impact on self-reported clinical knowledge and practice.

Results

Across 10 monthly editions we summarized 45 articles covering a diverse array of content topics published in high impact journals (Figure 1). Thirty-two (71.1%) summaries included an infographic or visual abstract. Eighteen ID division members completed the survey evaluation of the monthly newsletter; most were fellow physicians or early career faculty (Figure 2). Thirteen respondents (71.1%) had read 4 or more editions. Most (94.4%) viewed ID Journal Watch favorably, citing the ability to remain up to date with literature and to improve clinical care after reading the newsletter (Figure 3). Eleven (61.1%) reported that their main barrier to engaging with the newsletter was a lack of time. Infographics were viewed favorably by a majority (66.7%) as a learning tool, supporting previous findings that visual media can decrease cognitive load when interpreting new information [4].

Figure 1

Article topics and journals surveyed from 45 article summaries

Figure 2

Demographics of survey respondents, n = 18 (%)

Figure 3

Self-reported benefits of engaging with ID Journal Watch, n = 18

Conclusion

Journal surveillance is a valuable learning tool particularly for trainees and early career faculty. The format allows for rapid acquisition of knowledge that is relevant to clinical care. Visual media should remain a key component of journal surveillance due to its ability to facilitate comprehension.

Disclosures

All Authors: No reported disclosures
756. Factors that Increase Engagement on Social Media for an Infectious Diseases Fellowship Program
Authors: Cherian John , Herc Erica , Yared Nicholas F , Brar Indira , Gudipati Smitha , Shallal Anita
Published: November 2023

Background

Social media is increasingly being used among Infectious Disease (ID) programs. It can be a valuable recruitment tool in addition to providing education, self-promotion, and increasing collaborations across the ID community. We sought to analyze factors associated with increased engagement for our ID fellowship program’s Twitter account.

Methods

We analyzed various metrics from consecutive Twitter posts and utilized the Twitter Analytics Dashboard to extract data from time of account inception. Impressions were defined as the number of times a tweet was seen by users, and engagements as a composite of interactions with a tweet. Tweet content was organized into educational, social, promotional, and other categories. Educational content was subcategorized into tweetorial, microbiology, question & answer (Q&A), and journal articles. A subset of tweets were analyzed for engagement from April 2022 to March 2023 for trends according to content and date the tweet was posted. Standard univariate descriptive statistical analyses, moods median test, and one-way analysis of variance was performed. Data analysis was performed using R version 3.4.0.

Results

460 tweets were posted from October 2020 to March 2023 (Figure 1). Educational subcategories showed a large amount of engagement related to microbiology, with specifically more retweets, likes, and profile clicks (Table 1). There was no difference in engagement based on time of day of tweet (Table 2), although profile clicks were significantly more likely if tweets occurred on a weekend (p=0.04). A subset of 284 tweets from April 2022 to March 2023 revealed that months where multiple content categories were tweeted resulted in the most engagement (Figure 2). Generally, more twitter posts correlated with more engagement with a Pearson correlation coefficient of 0.7.Figure 1.Tweet content by (a) overall categories and (b) educational categories.

Conclusion

To increase engagement with social media, there should be frequent tweets with varied content categories. Subcategories of content such as microbiology tweets draw further interest and showcase a program's educational and clinical innovation.Figure 2.Composite categorical engagement from April 2022 – March 2023.

Disclosures

Indira Brar, MD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Janssen: Grant/Research Support|Janssen: Honoraria|ViiV: Advisor/Consultant|ViiV: Grant/Research Support|ViiV: Honoraria
766. "Assessing the impact of advanced vaccine education on pharmacy students’ knowledge, confidence, and preparedness in becoming future immunization providers: A National Study"
Authors: Johal Ajit
Published: November 2023

Background

With community pharmacists emerging as prominent immunization providers, there is an increased need for additional training in this area. The primary objective of this pre-post questionnaire study was to evaluate the impact of a comprehensive webinar on advanced vaccine education on the knowledge, confidence, and preparedness of undergraduate PharmD students across Canada.

Methods

A 25-question, web-based survey was administered to PharmD students at seven Canadian pharmacy schools prior to and immediately after attending a comprehensive educational webinar from March 13th to April 7th, 2023. The pre- and post- survey data were analyzed using SPSS 26. A Friedman rank test was performed on questions which answers consisted of ordinal data.

Results

In a group of 355 pharmacy students across Canada who attended our live educational webinars, 279 completed the pre-survey questionnaire, and 132 students completed the post-survey questionnaire. Pre-survey questionnaire results showed knowledge and confidence gaps in the areas of addressing vaccine hesitancy, immunization assessment, and recommended vaccinations. After the educational webinar event, students showed higher knowledge and confidence across all domains, and statistically significant improvements in critical areas pertaining to community vaccination practice. This highlights pedagogical changes which can be made to pharmacy school curriculums to better prepare students for future immunization practice.

Conclusion

Considerable knowledge gaps exist for graduating community pharmacists in vaccine education. Pharmacy students will benefit from integrated education focusing on addressing vaccine hesitancy, immunization status assessment, and jurisdictional routine immunization programs. Communities may also benefit from frontline healthcare providers who are highly trained and empowered with an expanded scope of practice to address their lifespan vaccination needs.

Disclosures

Ajit Johal, BSP BCPP RPh, CSL Seqirus: Advisor/Consultant|GSK: Honoraria|Merck: Honoraria|Pfizer: Honoraria
768. Digital Patient Education: A Tool to Improve Awareness of CMV
Authors: Larkin Amy , Nair Arun S
Published: November 2023

Background

More than half of US adults over the age of 40 have already been infected by CMV. Despite high prevalence, patient awareness and understanding of CMV is low. This study assessed the impact of online patient education on knowledge, confidence and intent to act regarding CMV.

Methods

The educational intervention consisted of 4 activities hosted on a dedicated learning center on WebMD Education from February-June, 2022. The activities were comprised of text, integrated visuals, and either a patient or healthcare professional (HCP) video commentary. Demographic questions were asked prior to each activity. Knowledge questions were asked both before and after to assess learning gains. Intent to change and confidence questions were asked at the end of each activity. Absolute improvements were calculated for pre/post questions.

Results

Activity 1: What is Cytomegalovirus (CMV)?

63,476 learners; 9,239 completers of all questions

72% female; 57% white, non-Hispanic; 18% 35-44 years of age

24% improvement in knowledge regarding complications of CMV infection; 50% intend to talk to HCP about CMV; 52% confident in talking to HCP about what CMV means for family

Activity 2: CMV: What You Can Do to Help Stop the Spread

61,818 learners; 3,583 completers of all questions

56% female; 40% black/African American; 22% 25-34 years of age

18% improvement in knowledge regarding the spread of CMV; 75% intend to talk to HCP about CMV; 90% confident in preventing spread of CMV

Activity 3: Pregnant, Thinking About Pregnancy, or Have a New Baby? What to Know About CMV

66,918 learners; 4,504 completers of all questions

91% female; 21% black/African American; 44% 25-34 years of age

38% improvement in knowledge regarding CMV in pregnancy and babies; 69% intend to talk to HCP about CMV; 76% confident in understanding how CMV effects pregnancy and babies

Activity 4: Are You at Risk for CMV?

2,802 learners; 368 completers of all questions

62% female; 51% white, non-Hispanic; 25% 35-44 years of age

17% improvement in knowledge regarding who is at risk for CMV infection; 61% intend to talk to HCP about CMV; 75% confident in understanding CMV

Conclusion

The outcomes gathered in this assessment are a strong indicator that online patient activities on WebMD Education improved knowledge and confidence and prompted intent to act related to CMV.

Disclosures

All Authors: No reported disclosures
831. Majocchi’s Granuloma – A Single Institution Retrospective Review
Authors: Montagnon Carmen M , Khodadadi Ryan B , Yetmar Zachary A , Johnson Emma F , Abu Saleh Omar M
Published: November 2023

Background

Majocchi’s granuloma (MG) is an uncommon deep fungal folliculitis predominantly caused by dermatophytes. Available data regarding predisposing comorbidities/risk factors, clinical characteristics, offending microbiologic pathogens, diagnostics, pathologic findings, and treatment approaches has been inferred from historical cases. Given these limitations in the existing literature of MG, we sought to conduct a detailed review of our institutional experience with biopsy-confirmed cases of MG.

Methods

Following IRB approval, we retrospectively identified and analyzed a multicenter cohort of adult patients diagnosed with MG between September 1992 and September 2022 at Mayo Clinic campuses (Figure 1). Data extracted included demographics, comorbid conditions, presenting clinical characteristics, diagnostic, microbiologic, and biopsy characteristics, treatment details, and outcomes.

Figure 1

Flow Diagram show exclusion of patients from the final cohort.

Results

A total of 147 patients with MG with the accompanying baseline characteristics met study criteria (Table 1). One-hundred and five patients were male with a median age of 55.6 years. Immunosuppressant and topical corticosteroid use were common prior to development of MG (Table 1). Dermatologic lesions and their sites of involvement did not differ based on the immune status of patients (Table 2). Trichophyton rubrum was the most common causative pathogen of MG, in addition to other dermatophytes and fungal organisms (Table 3a). Treatment duration for all prescribed agents was median 31.5 days. Oral terbinafine was the most frequently utilized agent and clinical resolution was achieved in 96.6% of cases (Table 3b).

Baseline Characteristics of 147 Patients with Majocchi’s Granuloma

Diagnostic, Microbiologic, and Biopsy Characteristics, Treatment Characteristics and Outcomes

Conclusion

While rare and clinically variable in presentation, the diagnosis of MG requires careful clinical examination and history-taking, histopathologic confirmation, and frequently fungal culture. Most cases of MG in our study responded well to a course of oral terbinafine at a median of 31.5 days of treatment.

Disclosures

All Authors: No reported disclosures
847. Cryptococcal disease in HIV and non-HIV-infected patients: clinical features and outcome
Authors: Roman-Montes Carla M , Velez-Pintado Mariana , Seoane-Hernandez Lisset , Rangel-Cordero Andrea , Martínez-Gamboa Rosa Areli , Crabtree-Ramírez Brenda , Ruiz-Herrera Vida V , Sifuentes-Osornio Jose , Ponce-de-Leon Alfredo , González-Lara Fernanda
Published: November 2023

Background

Cryptococcosis is an emerging fungal infection, particularly in patients without HIV. Yet, late diagnoses and worse prognoses are seen. We aimed to compare clinical characteristics and outcomes in patients with cryptococcosis.

Methods

We conducted a retrospective cohort (2001-2021) of patients with cryptococcosis, comparing HIV+ and non-HIV groups in a tertiary center in Mexico. The primary outcome was 20-week mortality. We used descriptive statistics and logistic regression for mortality.

Results

We found 107 patients, 51.5% (55) in HIV+ and 48.5% (52) non-HIV. HIV+'s median CD4+ count was 25 (IQR 12-47). In the non-HIV group, patients were older (median 53.5 vs. 40 years, p=< 0.02), less frequently male (40% vs. 89% p=0.01), and more with autoimmune diseases (41% vs. 0%, p= < 0.01) were found; only 6% were immunocompetent.

The most frequent presentation was disseminated (51% vs. 35%, p=0.08), followed by meningeal (38% vs. 33%, p=0.5). The pulmonary disease was frequent in non-HIV group (27% vs. 4% p=0.001). The most frequent isolated species was Cryptococcus neoformans (89% HIV+ vs. 98% non-HIV group, p=0.06), followed by C. neoformans var grubii (9% HIV+ vs. 2% non-HIV p=0.10) and C. gattii (2% HIV+ p=0.32) and was most frequently isolated from cerebrospinal fluid (CSF) in the HIV+ (64% vs. 38% p=0.009). Serum cryptococcal antigen was less frequently positive in the non-HIV group (44% vs. 88% HIV, p=0.007). The median days from symptom onset to diagnosis were longer in HIV+ (25 vs. 7, p< 0.01).

Both groups received similar antifungal treatment (87% vs. 94% HIV, p=0.16). No difference in mortality in both groups (31% vs. 31% p=0.9). In multivariate analysis, diabetes mellitus (DM) was associated with increased mortality (OR 6.9 (95%CI 2.1-22.7), while antifungal treatment was associated with reduced mortality (OR 0.11 95%CI 0.02-0.59).Table 1.General characteristics in Cryptococcal disease in HIV and non-HIV infected patients. Abbreviations. CSF: cerebrospinal fluid, ICU: intensive care unit, IQR: interquartile range.

Conclusion

In this retrospective cohort, non-HIV with Cryptococcosis were mostly females with autoimmune diseases and pulmonary involvement, compared with younger males with cryptococcal meningitis among HIV+ patients. A late presentation was frequent in HIV+. We found no difference in mortality at 20 weeks between both groups. DM was associated with increased mortality, and the proportion of patients with DM and a worse outcome is a relevant finding.

Disclosures

All Authors: No reported disclosures
868. Early Organism Identification by Matrix Assisted Laser Desorption Ionization Time Of Flight Mass Spectrometry (MALDI TOF MS) Decreases the Time to Optimal Antibiotic Therapy for Common Bacterial Infections
Authors: Keri Vishakh C , Gupta Ankesh , Kumar Das Bimal , Mohapatra Sarita , Soneja Manish , Kapil Arti , Xess Immaculata , Wig Naveet
Published: November 2023

Background

MALDI-TOF helps in precise identification of microorganisms from positive cultures. It is based on the principle of proteomics and obviates the need for the use of biochemicals. It reduces the turnaround time for reporting microbiologic cultures. Early identification and reporting of the organism, before the availability of antimicrobial susceptibilities, may reduce the time to first antibiotic modification and impact the clinical outcomes of patients.

Methods

This is a prospective observational two-arm comparative study conducted at a tertiary care centre in North India, with a sample size of 50 patients in the conventional arm and 100 patients in the interventional arm. The workflow of both arms are depicted in figure 1&2. The study population included patients in the medical ward and intensive care units (ICU) with positive cultures. The primary objective of this study was to compare the average time to first antibiotic modification post-culture positivity in the conventional and interventional arms and to compare clinical outcomes of patients in both arms. Escalation, de-escalation and any modification in antibiotics were also recorded.

Results

The median time to first antibiotic modification was significantly shorter in the intervention arm compared to the conventional arm (2010 mins vs 2905 mins, p=0.002). Overall 44/100 antibiotic modifications were made in the interventional arm out of which 43.2% (19/44) were made based on the MALDI report alone without awaiting susceptibilities. The major type of modification was the de-escalation of antibiotics (47.4%). Mortality rates were 32% in the conventional arm and 27% in the intervention arm, but the difference was not statistically significant (p=0.52) (table 1).

Conclusion

MALDI-TOF helps in the early modification of antibiotics. The major utility is in the de-escalation of unnecessary antibiotics. Coupled with a robust antimicrobial stewardship programme, this modality can help in reducing antibiotic use.

Disclosures

All Authors: No reported disclosures
876. Real-world impact of a novel host response test for distinguishing between bacterial and viral infections in pediatric patients at ten Urgent Care Centers
Authors: David Shirley Shapiro Ben , Rahamim-Cohen Daniella , kalmovich Boaz
Published: November 2023

Background

Antibiotic misuse is a major driver of antimicrobial resistance and is prevalent in the urgent care setting. A leading cause of misuse is uncertainty regarding infection etiology. MeMed BV® (MMBV) is an FDA-cleared test designed to aid physicians in differentiating between bacterial and viral infections based on computational integration of the blood levels of three host proteins into a score. Here we examined the real-world impact of integrating MMBV in the urgent care workflow on clinical decision-making.

Methods

A retrospective cohort study. MMBV test was ordered as part of the routine care for clinically appropriate pediatric patients at ten Maccabi Healthcare Services outpatient urgent care centers in Israel. MMBV results were interpreted based on manufacturer’s instructions as viral or bacterial infection or equivocal.

As part of MMBV evaluation, physicians who ordered the test were immediately and automatically asked to complete a short questionnaire reporting their initial etiological diagnosis and likelihood to prescribe antibiotics. Upon discharge, physicians completed a second questionnaire to report if MMBV impacted their decision-making process.

The physician’s intent, MMBV results and final antibiotic prescription practice were compared to evaluate the impact of MMBV on antibiotic misuse.

Results

Between 04-12/2022, 2,265 patients were enrolled and 1,759 had fully filled out questionnaires (Figure 1, Table 1). In 1,566 cases, a bacterial or viral MMBV result was received.

Among the 449 cases for whom physicians initially intended to prescribe antibiotics, 320 (71.7%) had viral MMBV results and in 198 cases (61.9%) the physician did not prescribe antibiotics. Conversely, among the 805 cases for whom physicians did not initially intend to prescribe antibiotics, 153 (19%) had bacterial MMBV results and the physician prescribed antibiotics in 93 (60.8%) cases.

Physicians reported uncertainty with regard to antibiotic prescription in 312 (19.9%) cases and acted in accordance with MMBV results in 236 (75.6%). Overall, physicians reported that MMBV aided in their patient management for 82.4% of cases.

Conclusion

Physicians incorporate MMBV into their real-world decision-making in the urgent care center setting and report that it aids in patient management.

Disclosures

All Authors: No reported disclosures
886. Impact of Race on the Early Diagnosis and Treatment of Lyme Disease
Authors: Starke Samuel J , Rebman Alison , Miller John , Aucott John
Published: November 2023

Background

Previous studies using single-state and Medicare surveillance data found that Black patients with Lyme Disease (LD) are more likely to present outside of the typical summer months and have higher rates of disseminated disease at diagnosis. We further explored differences in clinical presentation and early treatment of Lyme Disease by self-reported race among a large cohort of patients at an academic research clinic.

Methods

We abstracted data from all patients with untreated or post-treatment LD seen at the Johns Hopkins Lyme Disease Research Center (LDRC)—either for clinical care or research participation. Patients self-reported their demographics, and clinical information regarding their initial Lyme presentation was either recorded at the time of diagnosis or was abstracted from prior, external medical records. We examined the distribution of race across initial LD clinical presentations—categorized as 1) erythema migrans (EM) rash only, 2) disseminated disease, or 3) non-specific symptoms only—using chi-squared or Fisher’s exact test and fit logistic regression models. We compared racial differences in time to appropriate treatment using a one-sided Mann-Whitney test.

Results

Of 1363 individuals seen at the LDRC, 93% were white, 3% were Black, 2% were Asian, and 3% self-identified as either ‘other’ or more than one race. Compared to white patients, Black patients were less likely to present with erythema migrans (EM) rash (p < 0.0001) and more likely to present with disseminated disease or non-specific symptoms (p=0.009, p=0.019, respectively). Black patients were more likely to have received a course of inappropriate antibiotic therapy ( 16.7% vs 8.0 %, p= 0.058). Also, Black patients with EM rash experienced longer time to appropriate treatment (16.3 days vs 4.0, p=0.062).

Number of asterisks indicates degree of statistical significance. N/S means "non-significant"

Conclusion

We identified several racial disparities in the early detection and treatment of Lyme Disease, highlighting the need for increased awareness of Lyme and its early manifestations among patients of color and the front-line clinicians who care for them. Because darker skin tones are generally under-represented in medical textbooks and patient education materials, we include several examples of EM rashes from Black patients seen at the LDRC (Figure 2).

Disclosures

John Aucott, MD, Pfizer, Inc.: Advisor/Consultant
900. The Epidemiology of Viral Coinfections within Households with Children
Authors: Ibiebele Jessica C , Martin Emily T , Monto Arnold , Callear Amy
Published: November 2023

Background

Improvements in virus detection using molecular assays, such as multiplex polymerase chain reaction, has led to more common identification of viral coinfections. The incidence of viral coinfections may depend on population factors, such as age structure, distribution of chronic respiratory conditions, geographic location, and setting of the study population (e.g., community, in-patient admission), which has new relevance given observations of coinfections involving SARS-CoV-2. Household-level data on mild to moderate illnesses offer an important complement to other coinfection data that are largely measured in clinical settings.

Methods

The Household Influenza Vaccine Evaluation (HIVE) study is an ongoing prospective cohort study of households with children in Southeast Michigan that began in 2010. Active acute respiratory illness (ARI) surveillance is conducted, and participants with eligible ARI’s are tested for a range of respiratory pathogens. Descriptive statistics were used to characterize viral coinfections within this cohort for a period prior to the COVID-19 pandemic (2010-2020) and will be performed for a period during the pandemic (2020-2022). The consequences of these coinfections in terms of symptoms and household transmission are under evaluation.

Results

There were 6,245 virus-positive ARI’s in the cohort from 2010-2020, with multiple viruses detected in 896 (14.3%) ARI’s. Of the coinfections, rhinovirus/enterovirus most frequently appeared (58.15%), followed by common CoV (38.84%), and AdV (24%) (See Figure 1). The most common virus combination was a coronavirus (229E, OC43, NL63, or HKU1) along with rhinovirus/enterovirus, making up 12.05% (n=108) of coinfections. Eight infections were made up of four or more viruses. Similar analyses will be conducted for pandemic-period data.

Conclusion

While awareness of viral coinfections has grown since the start of the COVID-19 pandemic, coinfections within the HIVE cohort were not uncommon prior to the pandemic. Coronaviruses were the second leading viruses identified in coinfections, which aligns with observations noted during the pandemic. These results contribute important information about coinfections and expand the understanding of respiratory virus dynamics within households.

Disclosures

Emily T. Martin, PhD, MPH, Merck: Grant/Research Support Arnold Monto, MD, Roche: Advisor/Consultant|Roche: Honoraria
902. Incidence of Influenza-Related Medical Encounters Among Adults in The United States During the 2015-2020 Influenza Seasons
Authors: McGovern Ian , Cappell Katherine , Bogdanov Alina , Haag Mendel
Published: November 2023

Background

Research on the burden of influenza often focuses on the most impacted groups; children and older adults (65 years of age and older). This study aimed to evaluate how age impacted incidence of influenza-related outpatient visits, emergency room (ER) visits, and hospital admissions by broader adult age groups (18-49, 50-64, and 65 years and older) as well as within more granular 5-year age increments.

Methods

Patients 18 years of age or older in the United States were evaluated retrospectively in five seasonal cohorts (2015-2016 through 2019-2020 seasons). Patient-level electronic medical records linked to pharmacy and medical claims were used to ascertain outcomes. Influenza-related medical encounters were identified based on influenza-related diagnostic codes (ICD-10 codes J09*–J11*). Incidence was evaluated among the overall population as well as among people with no (low-risk) and 1 or more (high-risk) risk-factors for severe outcomes following influenza infection.

Results

Between 887,260 and 3,628,168 patients were included per season. When evaluated in 5-year increments, influenza-related outpatient visit incidence was highest among people 18-35 years old, and then declined with increasing age (figure 1). For ER visits, incidence tended to be elevated for patients 18-34 and then stayed somewhat flat from 35 (or 40) through 60 years of age and increased quickly after 60. Hospital admission incidence stayed somewhat flat until around 50 years of age and then increased with age. The prevalence of risk factors increased with age, with the number of patients with 1+ risk factors increasing from 38% for 18-49, 62% for 50-64, and 80% for 50-64. Across outcomes, high-risk patients consistently had higher incidence than low-risk patients, but differences were smaller than the differences in incidence between age groups. Although similar trends were observed in the broader age groups (figure 2), the 5-year age increments provided more granular insights into the effects of age on incidence of influenza.

Conclusion

This analysis demonstrates that changes in influenza incidence often occur gradually as patients age increases. For the most severe outcomes (hospitalizations), the incidence begins to increase around 50 years of age rather than the more common cutoff of 65 years of age.

Disclosures

Ian McGovern, MPH, CSL Seqirus: Employment|CSL Seqirus: Stocks/Bonds Katherine Cappell, PhD, CSL Seqirus: Advisor/Consultant Alina Bogdanov, MA, Moderna, Inc.: Advisor/Consultant|Veradigm: Salary Mendel Haag, PhD, PharmD, CSL Seqirus: Stocks/Bonds
915. Prevalence and Treatment of Genital Herpes in a United States Administrative Claims Database
Authors: Viscidi Emma , Jain Purva , Embry Alan , Arakaki Brent , Estevez Irisdaly , Marcum Zachary
Published: November 2023

Background

Herpes simplex virus type-2 (HSV-2) is the most frequent cause of genital herpes (GH) in the United States (US). There is no cure for HSV-2, but antiviral drugs can reduce outbreaks. Limited epidemiologic data exist on the contemporary burden of GH and treatment. The objective of this study was to estimate the annual GH prevalence and antiviral treatment rates.

Methods

This observational study utilized cohorts to calculate annual period prevalence rates of GH and included US administrative claims data from HealthVerity medical and pharmacy claims of continuously enrolled insured individuals. The crude and age-sex standardized prevalence rates of GH and recurrent GH were calculated from 01/01/2019 to 12/31/2021, by calendar year. GH was defined as >1 ICD-10 diagnosis code. Recurrent GH was defined as >2 GH diagnosis codes, at least 28 days apart, or >1 GH diagnosis code followed by at least 2 non-overlapping antiviral drug claims. Among those with GH, the proportion of patients untreated or on episodic or suppressive antiviral treatment was estimated. Episodic treatment was defined as <6 months of antiviral treatment, and suppressive treatment was defined >6 months of antiviral treatment, within each calendar year. Analyses were stratified by age, sex, and immunocompromised status.

Results

From 2019 to 2021, the age-sex standardized prevalence rates of GH ranged from 236 to 280 per 100,000 person-years (py) and from 81 to 98 per 100,000 py for recurrent GH. The prevalence rates of GH and recurrent GH were highest among females, those 25-29 years of age, and in immunocompromised individuals. Approximately one-third of patients with GH were untreated (32%-35%) in a given year. Among those treated for GH, the majority received episodic antiviral treatment (80%) rather than suppressive treatment (20%).

Conclusion

GH prevalence rates were 236 to 280 per 100,000 py and recurrent GH was one-third of this. GH and recurrent GH were more common in females, young adults, and immunocompromised individuals. Approximately two-thirds of GH patients were treated with antivirals, and the majority of these received episodic treatment.

Disclosures

Emma Viscidi, PhD, MHS, Moderna: Employee|Moderna: Stocks/Bonds Alan Embry, PhD, Moderna Therapeutics: Stocks/Bonds Brent Arakaki, BS, Aetion, Inc.: Employee
1145. Meningococcal B Immunization for Adolescents in the Presence of Added Gonorrhea Protection: A Public Health Impact Modelling Study in the United States
Authors: Kocaata Zeki , Bhor Menaka , Sohn Woo-Yun , Meszaros Kinga
Published: November 2023

Background

Several observational studies showed the added gonorrhea protection of outer membrane vesicle (OMV)-containing meningococcal B (MenB) vaccines, raising hopes for achieving WHO gonorrhea control targets. With evolving meningococcal vaccine recommendations in the United States (US), a key policy consideration can be the optimal age for adolescent MenB immunization considering added gonorrhea protection. This study assessed the additional gonorrhea public health impact that could be achieved in the two major existing meningococcal vaccination platforms at 11 and 16-18 years of age in the US.

Methods

A single cohort Markov model was built to simulate primary and recurrent gonorrhea infections (Figure 1). Vaccine effectiveness was assumed to follow recent observational evidence in the US (40% [95% Confidence Interval: 23%, 53%]) post two-doses. Based on clinical evidence on the OMV antigen decay of the 4CMenB vaccine, protection was assumed to wane exponentially over 72 months. The impact was assessed based on (i) uptake rates for completed immunization series (20% to 90%) and (ii) two age groups to mimic the existing MenACWY and MenB vaccination recommendation features for adolescents: 11 vs 17-year-old as a proxy for 16-18-year vaccine recommendation.

Results

Substantial reductions in gonorrhea prevalence were observed for the cohort following vaccination at age 17 years, ranging from 3.0% [Credibility Interval (CrI): 1.7%, 4.0%] to 13.5% [CrI: 7.8%, 18.0%] for low (20%) to high (90%) uptake scenarios. The reductions in prevalence were substantially lower for vaccination at 11 years of age, ranging from 0.6% [CrI: 0.3%, 0.8%] to 2.7% [CrI: 1.5%, 3.5%] for the same uptake scenarios (Figure 2). Scenario analyses on shorter durations of protection confirmed the directionality of the results (Table 1).

Conclusion

Even with low coverage and without considering disease transmission, an OMV-containing MenB vaccine recommendation for older adolescents could result in significantly higher gonorrhea public health impact compared to younger adolescents. Dual effects for MenB and gonorrhea could be considered when recommending vaccines based on age of vaccination.

Disclosures

Zeki Kocaata, PhD, GSK: Stocks/Bonds Menaka Bhor, PhD, GSK: Stocks/Bonds Woo-Yun Sohn, MD, GSK: Stocks/Bonds Kinga Meszaros, MBA, GSK: Employee|GSK: Stocks/Bonds