bluuebunny/crossref_metadata_2025 huggingface dataset:
1345. Patient Perspectives and Journey with Influenza and Seeking Care from US National Survey
Authors: Way Nate , Martin Ashley , Wallick Chris , Neuberger Edward , Corral Mitra
Published: December 2021

Background

In the 2017-2018 influenza season, 49 million people in the US presented with influenza symptoms, resulting in substantial morbidity, mortality, and a significant humanistic and economic burden. Although there are currently four FDA-approved antivirals for influenza, such treatments continue to be widely underutilized. The aim of this study was to better understand the patients’ perspective and experience with a flu episode and seeking care during the 2019-2020 influenza season.

Methods

Data were obtained from an online quantitative survey of influenza patients. Participants were recruited from two data sources: A pool of respondents who previously completed the National Health and Wellness Survey (NHWS) (N=74,977) or from Lightspeed M3 Global online “General Panel” (N=500,000+) in the US from January 2020 through May 2020. The sample included patients >18 years of age and having a self-reported diagnosis of influenza by a healthcare professional within the last 90 days. Outcomes related to patient demographics, health-related characteristics and perspectives on the influenza episode were collected.

Results

1,005 patients were included. Of those, 30.2% visited their primary health care professional (HCP) in person, 20.2% visited urgent care walk-in facility and 19.2% called their HCP. Important aspects of flu treatment included: feeling better quickly (69.5%), not transmitting to others (51.5%), and ease of administration (40.7%); 375 patients were treated with an antiviral. Of those, it took~4.6 days to feel generally better and ~8.8 days to feeling totally better. About 73% of patients took all of their antiviral medication, 9% took “some”. 43.9% of respondents considered themselves to be more likely to get serious flu-related complications, 52.5% reported that they were told by an HCP that they belong to a high-risk group that may be more likely to get flu-related complications. 41.3% reported they did not experience any high risk factors while experiencing influenza.

Conclusion

Influenza patients reported different attitudes and treatment approaches to handling their infection. It is critical to understand what matters most to patients regarding both influenza and treatment to optimally provide outreach and care.

Disclosures

Nate Way, PhD, Genentech, Inc. (Grant/Research Support)Kantar Health (Employee) Ashley Martin, PhD, Genentech, Inc. (Grant/Research Support)Kantar Health (Employee) Chris Wallick, PharmD, MS, Genentech, Inc. (Employee, Shareholder) Edward Neuberger, PharmD, MBA, MS, Genentech, Inc. (Employee, Shareholder) Mitra Corral, MS, MPH, Genentech, Inc. (Employee, Shareholder)
1346. The Risk of Readmission after RSV Hospitalization Among Children Younger than 5 Years
Authors: Choi Yoonyoung , Heller Evan G , Gesteland Per H , Amoafo Linda , Zhang Yue , Finelli Lyn , Ampofo Krow
Published: December 2021

Background

Respiratory Syncytial Virus (RSV) is one of the most common causes of childhood lower respiratory tract infection (LRTI) leading to hospitalization worldwide. Readmissions following viral LRTI hospitalization are common, however rates, timing and causes of readmission following RSV LRTI hospitalization are understudied. We evaluated readmissions occurring during 1-year post-discharge of RSV hospitalization.

Methods

We prospectively identified children < 5 years of age hospitalized with laboratory-confirmed RSV LRTI at Primary Children’s and Riverton hospitals in Salt Lake City, Utah during the 2019-2020 RSV season. An electronic alert system identified all-cause readmission between November 2019 and April 2021. Discharge diagnoses of readmissions were reviewed by two pediatricians. We calculated the incidence rate of all-cause and respiratory-related readmission.

Results

A total of 297 children had laboratory-confirmed RSV LRTI hospitalizations during the 2019-2020 RSV season, with 24% admitted to the intensive care unit (ICU) during index RSV hospitalization and 24% having a chronic medical condition. During the 1-year follow-up period, 59 readmissions occurred among 47 patients (Table 1). The incidence rate of all-cause and respiratory-related readmission was 19.9 (95%CI 15.5-24.9) and 13.1 (95%CI 9.5-17.5) per 100 patients, respectively. Median age of readmitted patients was 11 months (interquartile range 5.9-11 months). Median number of readmissions was 1 (range: 1-4), with initial readmissions occurring within 28 days (median) of index admission; most (74%) due to a respiratory-related illness. Second and 3rd admissions were less common and occurred at 67 (median) and 160 (median) days respectively. During all readmissions, 19% of children required ICU admission and 25% had chronic medical conditions.

Conclusion

All cause and respiratory readmission after Initial hospitalization with RSV LRTI commonly occurred among children < 5 years. These data support the need for RSV vaccines and immunoprophylaxis to prevent RSV hospitalization. A further study with a control group is needed to determine the role of RSV in readmission.

Disclosures

Yoonyoung Choi, PhD, MS, RPh, Merck (Employee) Lyn Finelli, DrPH, MS, Merck (Employee)
1351. Use of Mail-Out Sexually Transmitted Infection Test Kits in a Telehealth Pre-exposure Prophylaxis Clinic
Authors: Sikka Monica K , Do Long , Ha Hanifa , Smothers Dana , Evans Christopher , Pfeiffer Christopher D
Published: December 2021

Background

Standard of care for patients receiving pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) includes HIV screening and testing for sexually transmitted infections (STIs) at all sites of potential exposure every three months. We implemented a provider and pharmacist telehealth based PrEP program as part of the HIV, Hepatitis Specialty Telehealth Access Resource (H-START) Collaborative. Due to the COVID-19 pandemic and care via telehealth, we had limited ability to collect pharyngeal or rectal swabs in clinic. We created mail-out kits including swabs and instructions for self-collection to test for rectal and pharyngeal Neisseria gonorrhea and Chlamydia trachomatis.

Methods

Kits were mailed out to patients between June 2020 and May 2021. Providers first confirmed patient comfort with self-swab collection during telehealth appointments. Kits included: an instruction sheet with visual diagrams for collection, swabs with appropriate labels; and a pre-paid envelope for patients to mail swabs back to our facility for laboratory testing. Prospective data collection included the date kits were mailed out to patients, the date of kit receipt at our facility and the test result. Charts were retrospectively reviewed to determine treatment completion.

Results

54 self-swab kits were mailed to patients. 53 of the patients were male and the average age was 41.3 years old. 38 (70.3%) swabs were returned. The median time for return of swabs was 21 days (Range 2-289). Of those returned, 5 (13.1%) were positive and all 5 patients were treated for their infection.

Conclusion

Mail-out STI testing was effective in identifying STIs for a telehealth PrEP program and for maintaining standard of care practice during the COVID-19 pandemic. This model may increase rates of testing compliance for care provided via telehealth and decrease rates of STI transmission and complications. Better communication around returning kits in a timely-manner and understanding reasons for non-return warrant further investigation.

Disclosures

Monica K. Sikka, MD, FG2 (Scientific Research Study Investigator) Christopher D. Pfeiffer, MD, MHS, C. difficile Vaccine Trial (Scientific Research Study Investigator)
1355. Cluster of Multi-drug Resistance Neisseria gonorrhoeae Isolates with Reduce Ceftriaxone Susceptibility, First Report in Thailand
Authors: Wannigama Dhammika Leshan , Kueakulpattana Naris , Luk-In Sirirat , Hongsing Parichart , Hurst Cameron , Badavath Vishnu Nayak , Jenjaroenpun Piroon , Wongsurawat Thidathip , Teeratakulpisan Nipat , Kerr Stephen J , Abe Shuichi , Pearson Lachlan , Saethang Thammakorn , Chantaravisoot Naphat , Higgins Paul G , Chatsuwan Tanittha
Published: December 2021

Background

Rapid emergence of global azithromycin resistance, with ceftriaxone reduce susceptibility/resistant strains, threatens the current recommends dual therapy with ceftriaxone and azithromycin for gonorrhea to ensure effective treatment. Thailand is a major risk area for gonorrhea because it as a key destination for sex tourism industry, where antibiotic resistance gonorrhea can spread easily and quickly across the region. Here, we identified a first cluster of Neisseria gonorrhoeae isolates with decreased ceftriaxone susceptibility in Thailand.

Methods

A 134 N. gonorrhoeae isolates collected from Thai Red Cross Anonymous Clinic, Bangkok, during 2016–2018 were studied. Broth micro-dilution and plate dilution methods to define resistance or decreased susceptibilityaccording to CLSI guidelines. Select isolates were subjected to whole genome sequencing with an Illumina MiSeq V2 instrument and analysis using CLCBio Genomics Workbench v6.5. Molecular docking studies were carried out to understand binding mode analysis and orientation of ceftriaxone in the active site of PBP2. Biofilm formation measured by confocal laser scanning microscopy.

Results

Among the N. gonorrhoeae clinical isolates, two isolates had significant reduced susceptibility to ceftriaxone (MICs of 0.125 mg/L), which were isolated from urethral swab in male heterosexual patients. Both were multidrug resistance and strong biofilm producers with ceftriaxone tolerance (MBEC > 128 mg/L). One isolate was resistant to azithromycin (MIC of 1 mg/L), and other one remained susceptible (MIC of 0.5 mg/L). Reduced susceptibility to ceftriaxone associated with alterations in PBP2, PBP1, PorB, MtrR, and mtrR promoter region with one belonged to ST7235 and second one had new allele number of tbpB with new sequence type (ST). Ceftriaxone weakly occupy the active site of mosaic XXXIV penicillin-binding protein 2 (PBP2) variant in both. Molecular epidemiology results reviled that both isolates display similarities with isolates from UK, USA, and Netherlands.

Conclusion

This first cluster of genetically related gonococcal isolates with decreased ceftriaxone susceptibility may bring threat of treatment failure in Thailand. Also highlighted the importance of maintaining surveillance for antimicrobial resistance.

Disclosures

All Authors: No reported disclosures
1356. Association Between Marital Status and Pre-pregnancy STI Counseling Among Women Who Have Recently Given Birth: RI PRAMS 2016-2018
Authors: Jang Eun Ji , Gjelsvik Annie , Amanullah Siraj
Published: December 2021

Background

As rates of sexually transmitted infections (STIs) continue to rise, all women of reproductive age can suffer from complications particularly during pregnancy which can lead to adverse neonatal outcomes. Currently, data on STI counseling among married women are limited. This study aims to assess differences in pre-pregnancy STI counseling based on marital status among women who have recently given birth.

Methods

We utilized the Rhode Island Pregnancy Risk Assessment Monitoring System (RI PRAMS) 2016-2018, a population-based survey of postpartum women. Mothers self-reported if they have received STI counseling for chlamydia, gonorrhea, and syphilis during any health care visit in the 12 months before becoming pregnant. Marital status was obtained from the birth certificate. Multivariable logistic regression analysis was performed adjusting for age, race, Hispanic ethnicity, education, insurance, income, and previous live birth. We accounted for weighting and complex survey design.

Results

Our analytic sample included 2,361 mothers. More than half of the women reported never having received pre-pregnancy STI counseling about the 3 most reported and curable STIs in the US. Among them, an estimated 78.9% (n=1,207) of married women did not receive pre-pregnancy STI counseling compared to 53.6% (n=429) of unmarried women (Table 1). Married women had 0.61 (95% CI: 0.46, 0.81) odds of receiving STI counseling before pregnancy compared to unmarried women (Figure 1). Other risk factors for not receiving STI counseling included having a college education or higher or having a previous live birth.

Table 1. Characteristics of Women who have Recently Given Birth by Marital Status, RI PRAMS 2016-2018 (n=2,361)

*Unknown/missing values for each category <10%.**Uninsured population <1%

Figure 1: Adjusted Odds of Having Received Pre-pregnancy STI Counseling among Recent Mothers, RI PRAMS 2016-2018 (n=2,361)

*P-value <0.05Reference Group; Marital Status: unmarried, Age: < 25 years old, Race: White, Hispanic: Non-Hispanic, Education: High school degree or less, Insurance: Public insurance, Income: < &24,000, Previous live birth: No previous live birth

Conclusion

Selective STI counseling creates gaps and missed opportunities to address STIs early before pregnancy. All women regardless of their perceived risk for STI or assumptions based on their marital status should receive proper STI counseling as all women are vulnerable and at higher risk of developing complications. Health care providers should increase efforts to address this gap and counsel all women about STIs during every visit irrespective of their marital status.

Disclosures

All Authors: No reported disclosures
1357. Patterns of Extragenital Gonorrhea and Chlamydia Testing at a Community-Based Academic Emergency Department in Columbus, Ohio
Authors: Magaña Francisco M , Sobhanie Mohammad Mahdee , Malvestutto Carlos , Bazan Jose A , Lipps Ashley
Published: December 2021

Background

Sexually transmitted infections (STI), including gonorrhea (GC) and chlamydia (CT), are on the rise in the U.S. and emergency department (ED) visits for STI-related complaints are common. The ED plays a key role in testing for GC/CT. In addition to testing genital sites for GC/CT, the Centers for Disease Control and Prevention (CDC) recommends extragenital testing (oral/rectal) based on sexual history and exposure. In this study, we reviewed the proportion of extragenital GC/CT tests performed at a community-based academic ED in Columbus, Ohio.

Methods

This study was a retrospective chart review of all GC/CT tests performed at the Ohio State University Hospitals East ED from November 1, 2018 to November 1, 2020. Clinical and demographic information was collected for all patients who received extragenital GC/CT testing, including symptoms, test results, and documentation of sexual practices. A random convenience sample of 100 patients who only had genital GC/CT testing performed was also reviewed.

Results

Of the 5644 GC/CT tests performed during the study period, only 364 (6.4%) were from extragenital sites, which included 311 (5.5%) from oral and 53 (< 1%) from rectal sites. Of the 100 patients reviewed who did not have extragenital GC/CT testing performed, only 5 (5%) had documentation of sexual practices, compared with 177/311 (56.9%) of those who had oral testing and 27/31 (50.94%) who had rectal testing performed. In the cohort of 100 patients who did not receive extra genital testing 28% were male and average age was 29. In the group who received extragenital testing 40% were male and average age was 30. The most common complaint across all groups was genital discharge

Conclusion

Despite the substantial number of CG/CT tests performed in the ED, only a very small proportion were from extragenital sites. Interventions are needed to identify and overcome barriers to extragenital GC/CT testing in the ED.

Disclosures

Mohammad Mahdee Sobhanie, M.D., Regeneron (Scientific Research Study Investigator)Regeneron (Scientific Research Study Investigator, Was a sub-investigator for Regeneron 2066 and 2069) Carlos Malvestutto, M.D., Lilly (Scientific Research Study Investigator)Regeneron Inc. (Scientific Research Study Investigator)ViiV Healthcare (Advisor or Review Panel member)
1359. Reported Neurologic, Ocular, and Otic Manifestations among Syphilis Cases — 16 States, 2019
Authors: Jackson David A , McDonald Robert , Weinstock Hillard , Torrone Elizabeth
Published: December 2021

Background

Syphilis can cause neurologic, ocular, or otic manifestations at any stage, possibly resulting in permanent disability or even death. In 2018, CDC began collecting clinical manifestation data for syphilis cases reported through the National Notifiable Diseases Surveillance System (NNDSS). We present the first estimates of the prevalence of neurologic, ocular, and otic manifestations among syphilis cases in the United States.

Methods

We reviewed NNDSS data to identify jurisdictions (states + DC) who reported ≥ 70% of their syphilis cases with clinical manifestation data (considered to have “complete reporting”) in 2019. Among these jurisdictions, we determined the prevalence of neurologic, ocular, and otic manifestations (combining verified, likely, and possible clinical manifestations together), stratified by HIV status and by syphilis stage (Unknown/late syphilis vs. Early syphilis [Primary, Secondary, and Early non primary non secondary syphilis]).

Results

In 2019, 16 states had complete reporting for neurologic, otic, and ocular manifestations. Of the 41,216 syphilis cases reported in these jurisdictions, clinical manifestations were infrequently reported: neurologic (n=445, 1.1%), ocular (n=461, 1.1%), and otic (n=166, 0.4%). Prevalence was higher among HIV-infected persons compared to HIV-negative persons for neurologic (1.4% vs. 0.9%) and ocular manifestations (1.3% vs 1.0%) but was similar for otic manifestations (0.4% vs 0.4%). Prevalence was higher among persons diagnosed with Unknown/late syphilis compared to Early syphilis for neurologic (1.6% vs 0.8%) and ocular manifestations (1.6% vs 0.9%) but similar for otic manifestations (0.5% vs 0.4%); however, 49.4% of cases reported with ≥ 1 of these clinical manifestations were diagnosed with Early syphilis.

Conclusion

The prevalence of neurologic, ocular, and otic manifestations was low among syphilis cases, but case data likely underestimate the true burden given potential underreporting. The frequency of clinical manifestations, including among HIV-negative persons and persons diagnosed with Early syphilis, emphasizes the importance of evaluating all syphilis cases for clinical signs or symptoms regardless of stage or HIV status.

Disclosures

All Authors: No reported disclosures
1360. Prevalence of Bacteremia in Hospitalized Patients with Skin and Soft Tissue Infections (SSTI)
Authors: Suarez Maria J , Lin Yu Shia
Published: December 2021

Background

Skin and soft tissue infections (SSTI) are common in outpatient and inpatient settings. The prevalence of positive blood cultures (BC) ranges from 2% to 52%. Because of the variations in published data, the exact prevalence of bacteremia in hospitalized patients with SSTI is unknown. Our objective is to determine the prevalence of bacteremia in hospitalized patients with SSTI.

Methods

Retrospective chart review from January 2017 to December 2018. Patients older than 18 years admitted with SSTI who required BC on admission were included. Patients who met the criteria for systemic inflammatory response syndrome (SIRS)/sepsis or severe SSTI, or had an underlying immunodeficiency underwent BC collection. Patients with diabetic foot ulcer, device related SSTI, necrotizing fasciitis, and osteomyelitis were excluded. Patients were divided into 3 groups: true positive (TP) defined as a true pathogen, false positive (FP) defined as a contaminant, and true negative (TN) defined as no growth in BC. Physician assessment, microorganisms isolated, number of positive bottles/culture sets, and timing of growth were reviewed. Patients’ comorbidities, presence of SIRS, laboratory data, duration of antibiotic use, and length of stay (LOS) were compared.

Results

We screened 583 patients and included 541 patients. The mean age was 62 ± 18.4 years, and 60% were male. 47/ 541 (8.6%) had skin abscesses. 57 patients (11%) had positive BC, of whom 32 were TP (6%), and 25 were FP (5%). 89% of patients (484) had TN BC. The organisms isolated are described in Figures 1 and 2. Patients in the FP and TN groups had prior antibiotic use, compared to TP (P< 0.05). The FP group had a longer LOS and duration of antibiotic use compared to the TN group (p< 0.05). 76% of FP had repeated BC. Beta-lactam antibiotics were mostly used, followed by anti-MRSA antibiotics (40%). We did not find risk factors to predict the likelihood of bacteremia. The outcome was not different among the 3 groups.

Figure 1. Microorganisms isolated from blood cultures of patients with SSTI – True pathogens

Figure 2. Microorganisms isolated from blood cultures of patients with SSTI – Isolated contaminants

Conclusion

There was a low incidence of true bacteremia (6%) in hospitalized patients with SSTI. More than 90% of TP were predictable causal microorganisms, which are covered by empiric antibiotics. BC may not affect the initial treatment of SSTI. FP BC were associated with an increased LOS, longer antibiotic use, and increased healthcare cost.

Disclosures

All Authors: No reported disclosures
1362. Adding Insult to Injury: Association of Stigmatizing Language and Suboptimal Outcomes in People Who Inject Drugs
Authors: Carpenter Joseph , Catalanotti Jillian S , Notis Melissa , Brokus Christopher J , Moran Timothy P , Kuo Irene , Akselrod Hana , McGonigle Keanan , Mai William , Eaton Ellen , Eaton Ellen , Burgan Kaylee W , Burkholder Greer A , Steck Alaina , Kattakuzhy Sarah , Rosenthal Elana S
Published: December 2021

Background

The National Academy of Medicine has identified stigma surrounding substance use disorders (SUDs) and infectious diseases (ID) as a key barrier to integration of opioid use disorder (OUD) and ID services. Prior literature on stigmatizing language in OUD clinical care focuses on surveys and theoretical scenarios rather than real-world data. As part of a larger study of patients admitted for infectious complications of injection drug use (CHOICE), we sought to determine how inpatient physicians describe persons with OUD, as well as associations of this language with outcomes along the OUD continuum of care.

Methods

CHOICE is a retrospective review of adults hospitalized with an infectious complication of OUD and IDU at four academic medical centers. Included patients were hospitalized between 1/1/2018-12/31/2018, had ICD9/10 diagnosis codes consistent with OUD and acute bacterial/fungal infection, and chart review verification of active infection associated with OUD. Data was abstracted regarding demographics, inpatient interventions, transitions of care, and outcomes 1 year after admission. Potentially stigmatizing language was identified based on the discharge summary. “Abuse” and “misuse” were considered potentially stigmatizing; “use disorder” was considered best practice. Associations of language and outcomes were analyzed via logistic generalized estimating equations.

Results

A total of 287 subjects met inclusion criteria; 119 (42%) were female and the median age was 40 years (IQR: 32 – 52). The most common terms used to describe OUD were “abuse” (190, 66%) and “IVDU” (119, 42%). “Use disorder” was noted in only 72 (25%) charts. In a regression analysis, any mention of “use disorder” was associated with not leaving against medical advice (OR 2.48, 95% CI 1.24 – 4.95), a plan for ongoing OUD treatment (OR 5.17, 95% CI 2.05-13.0), and addiction-specific follow up (OR 2.94, 95% CI 2.34-3.68).

Conclusion

In this multicenter retrospective study, inpatient physicians commonly referred to patients with OUD using stigmatizing language. When NIH-preferred language was used this was associated with improved outcomes along the OUD continuum of care, possibly reflecting increased awareness of best practices for treating patients with OUD.

Disclosures

Ellen Eaton, MD , Gilead (Grant/Research Support) Ellen Eaton, MD , Gilead (Individual(s) Involved: Self): Research Grant or Support Greer A. Burkholder, MD, MSPH, Eli Lilly (Grant/Research Support) Sarah Kattakuzhy, MD, Gilead Sciences (Scientific Research Study Investigator, Research Grant or Support) Elana S. Rosenthal, MD, Gilead Sciences (Research Grant or Support)Merck (Research Grant or Support)
1363. Most Psoas Abscesses are Pyogenic; not Tuberculous: Experience from South India
Authors: Muhammed Niyas Vettakkara Kandy , Ananthanarayanan Rajalakshmi , Jomes Jeffery , Devi Arun Aravindakshan Sasikala , Sasidharan Aswathy
Published: December 2021

Background

It is a common belief that psoas abscess in patients from developing countries like India are mostly tubercular in origin. However, most of the diagnosis of a tubercular psoas abscess are based on radiological features and are not confirmed microbiologically. It is possible that many cases of pyogenic psoas abscesses are misdiagnosed as tubercular due to lack of good quality microbiology lab facilities in developing nations. We studied the microbiology of psoas abscess in patients admitted to KIMSHealth, a tertiary care hospital in Kerala, South India.

Methods

Clinical details of patients with a diagnosis of psoas abscess over a 6-year period (2015 – 2020) were retrieved from electronic medical records. Microbiological investigations done included bacterial culture of the pus, fungal culture, mycobacterial culture, cartridge based nucleic acid amplification test for Mycobacterium tuberculosis and blood cultures.

Results

21 patients who had complete clinical details were included. 15 of them were males and the median age was 58 years. Diabetes mellitus was the most common comorbidity (52%). Fever (61.9%) and back pain (52.4%) were the most common symptoms. The abscess was left sided in 11 patients, right sided in 7 and bilateral in 3. Vertebral involvement was present in 9 patients while hip joint was involved in 3 patients. A microbiological diagnosis was made in 14 patients (66%). Most commonly isolated organism was Staphylococcus aureus (8 patients,MSSA:6, MRSA:2) followed by E.coli (3)and Klebsiella pneumoniae (2). Blood cultures were positive in 5 patients. Anti-tuberculous therapy was started in only one patient, which was based on characteristic histopathology and negative bacterial cultures. Rest of the culture negative cases were also treated as pyogenic abscesses with antibiotics. Surgical drainage was done for 7 patients and pig tail drainage for 3 patients, while percutaneous aspiration was done for 9 patients. All 19 patients who followed up had clinical resolution, while two were lost to follow-up.

Conclusion

Contrary to what is believed, we observed that most psoas abscesses are pyogenic in origin. Our observations reiterates diligent microbiological investigations in all cases of psoas abscess to avoid empiric anti-tuberculous therapy.

Disclosures

All Authors: No reported disclosures
1366. Deep Neck Infections: Bacteriology and Antimicrobial Susceptibilities, Akron Children’s Experience
Authors: Upadhyayula Shankar , habeck Caleb
Published: December 2021

Background

Deep neck infections (DNI’s) are uncommon (~45,000 US cases annually) but, potentially serious. Published data regarding bacteriology and antibiotic usage for DNI’s in children is limited. In addition, geographic variation in the incidence of pathogens and their antimicrobial susceptibility limits generalization of treatment guidance. Reviewing our practice at Akron childrens we noted considerable variation in the choice of empiric antibiotics (ampicillin-sulbactam vs piperacillin-tazobactam vs Ceftriaxone and Clindamycin/vancomycin/linezolid). Admission unit (floors vs intensive care) and service (hospitalist vs infectious diseases) were some important determinants that influenced choice of empiric antibiotics. This retrospective study aimed to review local data and come up with standard guidance for empiric therapy.

Summary of the predominant bacterial isolates.

Methods

We reviewed records of 125 patients who underwent surgical drainage of DNI’s from 1/2015 – 12/2019. In addition to demographic data we gathered information on bacterial isolates and their susceptibilities. Chart review was performed for patients with staphylococcus aureus, to look for any unique presenting features.

Results

Up on reviewing the data- peritonsillar abscesses were common in older children (Median age 11 years). As expected, retropharyngeal and parapharyngeal infections were common in younger ones (< 5 years). Group A streptococcus remained the most common aerobic isolate followed by Hemophilus influenzae/parainfluenzae. MRSA was detected in ~7 % of all cultures (see enclosed table). Notably, none of the MRSA isolates were clindamycin resistant. However, MSSA resistance to clindamycin was about 20%. No clinical characters predicted isolation of S. aureus. Anaerobic infections (polymicrobial) were overwhelmingly common across all abscess types.

Conclusion

Based on our review, Ampicillin-Sulbactam is a good empiric choice antibiotic for deep neck infections in our institution. Ceftriaxone with clindamycin is another option. Clindamycin monotherapy seems to be inadequate. Staph aureus and especially MRSA, were only isolated in a small percentage of cases. Unless a patient is ill appearing, vancomycin use seems unnecessary. Clinical presentation was not helpful to suspect infection with Staph aureus.

Disclosures

All Authors: No reported disclosures
156. Correlation Between WHO (World Health Organization) Case Definition of Severe Pneumonia and Lung POCUS (Point of Care Ultrasound) vs Chest X-ray (CXR) Findings to Diagnose Pediatric Community-Acquired Pneumonia (CAP) in Limited Resource Settings
Authors: Camelo Ingrid Y , Pieciak Rachel , castro-aragon Ilse , Setty Bindu , Etter Lauren , Gill Christopher
Published: December 2021

Background

Childhood pneumonia is one of the leading causes of death in low-income countries. The diagnosis of pediatric pneumonia is a critical epidemiological duty for treatment effectiveness and vaccine surveillance. Previous studies have demonstrated an important lack in correlation between CXR findings and the clinical WHO case definition of severe pneumonia. Lung Point of Care Ultrasound (POCUS) has demonstrated in multiple studies to be more sensitive and specific for diagnosing pneumonia in the pediatric population. With no exposure to radiation, extensive availability in limited-resource settings, and easy interpretation, this modality can be a breakpoint in making a more accurate correlation between pneumonia clinical findings and diagnostic imaging.

Methods

50 children from 1-59 months meeting the WHO case definition of severe pneumonia were enrolled at the Emergency Department at University Teaching Hospital (UTH) in Lusaka, Zambia. Children underwent lung POCUS and CXR. Correlation between symptoms and all abnormalities (consolidation, effusion, and interstitial patterns) seen in both imaging modalities were analyzed by calculating the proportion of children with abnormalities on CXR and ultrasound. Each participant was assigned a score based on findings. 0 = normal, 1 = consolidation only, 2 = Consolidation and non-consolidation (interstitial and/or effusion) and 3 = non-consolidation (interstitial and/or effusion) only.

Results

44 (90%) of children had abnormalities on CXR and 46 (94%) on POCUS. Five children (10%) had normal findings on CXR vs 3 (6%) on Lung POCUS. 4 (8%) had consolidation only on CXR vs 0 (0%) on POCUS. 19 (39%) had consolidation and non-consolidation (interstitial and/or effusion) on CXR vs. 20 (41%) on POCUS. 21 (43%) had non-consolidation (interstitial and/or effusion) only on CXR vs. 26 (53%) on POCUS.

Figure 1. Scores Asigned Based on Imaging Findings for CXR and Lung POCUS

Figure 2. Chest X Ray Anterior Posterior (AP) view showing Bilareral Interstitial Pattern

Figure 3. Lung POCUS (Point of Care Ultrasound) findings of bilateral Consolidation and non-consolidation pattern and bilateral interstitial pattern (only finding on CXR)

Conclusion

More children with clinical pneumonia had normal findings on CXR than on POCUS. POCUS was a better imaging technique to show consolidation and non-consolidation patterns than CXR. The higher proportion of children diagnosed with consolidation and non-consolidation patterns on POCUS suggest that CXR might not be the ideal gold standard to diagnose pneumonia in children.

Disclosures

All Authors: No reported disclosures
1368. Species Diversity and Co-Occurrence Patterning in Bone and Soft Tissue Infections
Authors: Mindru Cezarina , Rodriguez-Barradas Maria , Bidare Deeksha , Dudenhoeffer Jan-Hendrik , Crawford Kerri , Barshes Neal R
Published: December 2021

Background

Polymicrobial results from conventional cultures in bone and soft tissue infections have generally been reported as independent co-occurrences (i.e. assuming no relationship or interaction between species). The objective of this study was to identify non-random (dependent) co-occurrence in bone and soft tissue infections.

Methods

We used single center Theradoc (Premiere Inc., Charlotte, NC) data on microbiology specimens collected over a decade (4/2010 to 4/2020). We included only tissue, fluid and swab specimens identified as being obtained from bone, skin, soft tissue or a wound during a patient’s first episode of infection. Blood and liver biopsy specimens were excluded. Patterning involving >2 organisms was examined with factor analysis. Analyses were done with R version 3.6.1. Threshold p-values were adjusted for multiple comparisons, often to p< 0.001.

Results

Polymicrobial culture results were seen much more frequently in the foot (76%) and sacrum (78%) than specimens from other locations (43%). The highest Shannon diversity index was seen in sacral specimens, followed by foot and leg specimens. Pseudomonas aeruginosa and E. coli was found more frequently in sacral bone and soft tissue specimens, while S. aureus was found most often in the spine bone and foot bone and soft tissue. Corynebacterium was found more frequently in foot bone (23%) and foot soft tissue (18%) than in non-foot soft tissue specimens (11%). Analysis of pairwise species co-occurrences in foot specimens (n=765) demonstrated that S. aureus made significantly less frequent the presence of Bacteroides, Enterobacter, and other staphylococcal species (Table 1). Analysis of non-foot soft tissue specimens (n=2,647) confirmed this pairwise associations and suggested three patterns (Table 2): A, polymicrobial without S. aureus; B, Enterococcus + gram negatives; and C, streptococcal.

Table 1. Pairwise co-occurrences between species in bone and soft tissue specimens from foot infections (n=765).

Factor analysis results demonstrating species associated with three polymicrobial patterns in soft tissue infection specimens. Blue denotes positive association (more often occurring as part of the pattern), red or grey denotes negative associations (less often occurring as part of the pattern). Numbers denote factor weights, a measure of the strength of the association.

Conclusion

Species incidence and diversity vary by location and tissue type. The many non-random occurrences found suggest complex interrelationships between microbes in soft tissue and bone infections, including organisms often classified as non-pathogens. Further study may further characterize these relationships and aid in antibiotic selection.

Disclosures

All Authors: No reported disclosures
1370. Role of Clindamycin Versus Linezolid for Serious Group A Streptococcal Infections
Authors: Heil Emily , Heil Emily , Basappa Sapna
Published: December 2021

Background

Streptococcus pyogenes can cause severe illnesses such as toxic-shock syndrome and necrotizing fasciitis due to pyrogenic exotoxins. Clindamycin is added to penicillin for treatment of severe S. pyogenes infections as it is a bacterial protein synthesis inhibitor which reduces toxin production. However, clindamycin is associated with several adverse effects including C. difficile infection. Linezolid is a bacterial protein synthesis inhibitor that has been shown to provide excellent coverage of S. pyogenes including toxin inhibition in vitro, but clinical evidence is lacking. We compared outcomes of patients treated with linezolid versus clindamycin for serious S. pyogenes infections.

Methods

This was a retrospective study of patients with necrotizing fasciitis or toxic shock syndrome caused by S. pyogenes admitted to the Shock Trauma Center at University of Maryland Medical Center treated with at least 48 hours of either clindamycin or linezolid. Data collected included Sequential Organ Failure Assessment (SOFA) and Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) severity scores, time to resolution of infection, number of surgeries, C. difficile infection, other antibiotic associated adverse effects, and mortality. Associations between patient characteristics, antibiotic groups, and outcomes were analyzed using the chi-square test, Fisher’s exact test and t-test or Wilcoxon rank-sum test as appropriate (SAS v 9.4).

Results

52 patients were included, 26 treated with clindamycin and 26 with linezolid. Most patients (85% clindamycin and 96.2% linezolid) were treated for necrotizing fasciitis. Baseline characteristics, including SOFA and LRINEC scores, were similar between the groups. There was no difference in mortality between patients treated with clindamycin versus linezolid (11.5% vs. 7.7%, p = 0.22), and resolution of infection was similar between the groups (92.3% vs. 88.5%, p = 1.0). There was no difference in adverse effects between the clindamycin and linezolid groups, including C. difficile infection (3.9% vs. 0% p = 1.0) and thrombocytopenia (30.8% vs. 42.3%, p = 0.4).

Conclusion

Linezolid could be an alternate to clindamycin for the treatment of serious toxin producing S. pyogenes infections. Further prospective studies are needed.

Disclosures

Emily Heil, PharmD, MS, BCIDP, Nothing to disclose
1371. Identification of Risk Factors to Predict Gram negative bacteria in Patients with Upper Extremity Infections
Authors: Zhitomirsky Sophia , Sy Hendrik , Yassin Arsheena , Stavropoulos Christine , Farkas Andras
Published: December 2021

Background

Gram negative bacteria (GNB) have been identified as a cause of upper extremity infections and empiric treatment directed to both gram positive and negative organisms is often recommended. Risk-based approaches to establish need for gram-negative coverage may help to minimize unnecessary drug exposure, but further information on such methods are currently lacking. The aim of this study was to identify risk factors associated with the isolation of GNB in patients with upper extremity infections.

Methods

We reviewed records of patients with upper extremity infections treated in two urban hospitals between March 2018 and July 2020. Prosthetic joint infections were excluded. Baseline demographic, clinical, surgical and microbiology data was collected. Multivariable logistic regression models were screened using Akaike Information Criterion to establish the best model and risk factors associated with isolation of a GNB.

Results

We identified 111 patients, the majority of whom were male with frequent history of IV drug use. Deep wound cultures in 30 (33.3%) individuals yielded a GNB, and 80% of these cases were polymicrobial. Among the GNB, most prevalent were Enterobacterales (10.4%), HACEK group (6.39%), and Pseudomonas spp. (4.5%) (Tables 1. and 2.). Infections were mostly limited to the soft tissue structures of the hand and the forearm, with involvements of the joint and bone being second and third most common. The final model identified the use of IV medications (OR 4.14, 95% CI 1.3 - 14.46) together with prior surgery at the site of infection within the last year (OR 5.56, 95% CI 1.06 - 30.98), and having an open wound on presentation (OR 3.03, 95% CI 1.04 - 9.47) as factors independently associated with isolation of a GNB (Table 3). AUROC of 0.702 indicates acceptable model discrimination.

Table 1: Baseline characteristics

Table 2: Bacterial isolates

Table 3: Final model

Conclusion

Our logistic regression model identified significant predictors for isolation of GNB in upper extremity infections within this population. Results of this study will assist clinicians in making a better informed decision for the need of empiric gram negative coverage aimed to support the reduction of patient exposure to unnecessary antimicrobial coverage. External validation of the model is warranted prior to application to clinical care.

Figure 1: AUROC

Disclosures

All Authors: No reported disclosures
1375. Professional Status of Infectious Disease Specialists in Korea: A Nationwide Cross-sectional Study
Authors: Kim Bongyoung , Eun Byung Wook , Lee Eunjung , Kim Tae Hyong , Park Suyeon , Park Se Yoon
Published: December 2021

Background

Emergence of more antimicrobial-resistant pathogens and repeated occurrence of infectious disease (ID) outbreaks highlight the importance of ID specialists. This study aimed to assess the working status of ID specialists and identify problems faced by ID professionals in Korea.

Methods

An online-based survey was conducted over 11 days (from December 17–27, 2020), targeting all active adult (n=281) and pediatric (n=71) ID specialists in Korea (total=352). An online-based survey link was forwarded to them via text messages and e-mails by the office of the Korean Society of Infectious Diseases and the Korean Society of Pediatric Infectious Diseases. Questions regarding the practice areas of the specialists were divided into five categories: (1) clinical practices of outpatient care, inpatient care, and consultations; (2) infection control; (3) antibiotic stewardship; (4) research; and (5) education and training. We investigated the weekly time-use patterns for these areas of practice.

Results

A total of 144/281 (51.2%) adult ID specialists and 51/71 (71.8%) pediatric ID specialists participated in the survey. Among them, 144 (73.8%) respondents were involved in all practice categories investigated. The most common practice area was outpatient service (93.8%), followed by consultation (91.3%) and inpatient service (87.7%)(Table 1). Specialists worked a median of 57 (interquartile range: 50–65) hours weekly: patient care, 29 (14–37) hours; research 11 (5–19) hours; infection control 4 (2–10) hours; antibiotic stewardship, 3 (1–5) hours; and education/training, 2 (2–6) hours (Table 2).

Conclusion

We identified areas of practice and patterns of time use among adult and pediatric ID specialists in Korea. Most experts were in charge of all necessary areas (including treatment, education, research, infection control, and antibiotic stewardship) in medical institutions with limited resources. It is expected that these problems can be solved by appropriately compensating individuals and medical institutions for their invisible activities (including infection control and antibiotic stewardship) and by securing additional human resources.

Disclosures

All Authors: No reported disclosures
1376. Cryptococcal Infection Presenting Solely as a Pleural Effusion
Authors: Alpizar-Rivas Rodolfo M , Chuang Sally , Gupta Purba
Published: December 2021

Background

Cryptococcal infections are frequently seen in immunosuppressed hosts. To date, few cases of cryptococcal infections presenting solely as pleural effusion have been described in liver transplant recipients. To our knowledge, this is the first case of cryptococcal pleuritis presenting with acute respiratory failure early post liver transplant.

Methods

51- year old male with non- alcoholic cirrhosis complicated by chronic right hydrothorax underwent deceased donor liver transplantation with methylprednisolone induction. A week later, he developed acute respiratory failure requiring intubation. Pleural fluid was exudative with lymphocyte predominance; aerobic culture grew C. neoformans. Serum cryptococcal antigen was initially negative (prozone phenomenon was excluded) and subsequently turned positive titer 1:16. He was started on liposomal amphotericin and flucytosine, but developed acute kidney injury; induction therapy was changed to fluconazole with flucytosine for 2 weeks followed by fluconazole consolidation for 8 weeks. He remains on maintenance therapy. Donor serum cryptococcal antigen was negative, and recipients of other organs from the donor were clinically well.

Results

Pleural effusions are common in cirrhotic patients with ascites from hepatic hydrothorax. Although rare, Cryptococcal infection can manifest as isolated pleural effusion. Our patient was diagnosed with Cryptococcal empyema early post-transplant, though likely had subclinical or latent infection pre-transplant; evaluation for donor-derived infection was negative. Diagnosis of isolated pleural disease may be missed if only serum Cryptococcal antigen is tested, as antigen may not be detectable. Diagnosis is mainly established by pleural fluid culture and may be delayed, as pleural fluid is not routinely cultured when effusions are attributed to hepatic hydrothorax. Cryptococcal antigen in the pleural fluid may have a better diagnostic yield.

Conclusion

Cryptococcal infection should be considered in patients with cirrhosis and liver transplant recipients presenting with pleural effusion without any other abnormalities on chest imaging. Diagnosis may be missed if only serum cryptococcal antigen is used.

Disclosures

All Authors: No reported disclosures
1377. Impact of Pre-Transplant Infectious Diseases Wellness Visit on Vaccine Uptake in Solid Organ Transplant Candidates
Authors: Parraga Tommy J , McCorquodale Jennifer , Greenlee Sage , Osborn Zachary , Hanna Zachary W , Williams Jonathan D , Lanfranco Odaliz Abreu , Mayur Ramesh , Alangaden George J
Published: December 2021

Background

Despite published guidelines, vaccine uptake in solid organ transplant candidates (SOTc) remains suboptimal. We established an Infectious Disease pre-transplant clinic (IDPT) to perform a wellness visit for all SOTc. The visit was conducted by a nurse practitioner (NP) primarily and included pre-transplant assessment and optimization of vaccinations. We report the preliminary results of this pilot project on vaccine uptake in SOTc.

Methods

Retrospective review was done on all SOTc referred to the IDPT from January 2020 to February 2021 at Henry Ford Transplant Institute in Detroit, MI. SOTc were patients listed for different types of transplants. Sociodemographic data, comorbidities, vaccination status for influenza, pneumococcus, hepatitis B, Tdap, Td, and varicella zoster were assessed from electronic medical records and the Michigan Care Improvement Registry that includes vaccination records. Follow up was at least 3 months after IDPT visit. Binomial analysis was performed comparing vaccine uptake in a previous institutional cohort of 530 SOTc from January 2015 to December 2016 in which there was no IDPT visit. Data was analyzed using EpiInfo ver. 7.2.4.0.

Results

A total of 183 SOTc were evaluated in IDPT. Baseline characteristics are shown in Table 1. Median age was 57 years, mean Charlson Comorbidity Index was 4.1. Majority of IDPT visits were done by the NP and most were video visits given the COVID-19 pandemic. Vaccine uptake improved post IDPT for all vaccines and most notably for hepatitis B, varicella zoster and pneumococcal 13V vaccines (Table 2). Of the SOTc, 38 (20.8%) received their vaccines during the IDPT visit or shortly after. Compared to the prior cohort, all vaccines rates improved with the post IDPT visit (p< 0.001) (Table 3).

IDPT and vaccines - ID week 2021 - Table 1

IDPT and vaccines - ID week 2021 - Table 2

IDPT and vaccines - ID week 2021 - Table 3

Conclusion

IDPT clinic visits significantly improved vaccine uptake in SOTc at our institution. Approximately one in five SOTc had vaccines administered at the time of IDPT visit or shortly after. Implementation of an Infectious Diseases wellness visit as a requirement for all SOTc can provide opportunities to greatly optimize vaccine completion before transplantation.

Disclosures

All Authors: No reported disclosures