bluuebunny/crossref_metadata_2025 huggingface dataset:
1216. An Outbreak Investigation of Pulmonary Infections Caused by Mycobacterium abscessus in a Cardiothoracic Transplant Population
Authors: Rathod Shardul N , Weber Rachel , Salim Asra , Tanna Sajal D , Stosor Valentina , Malczynski Michael , Chao Qi , Angarone Michael P , Ison Michael G , Williams Janna L , Zembower Teresa , Bolon Maureen K
Published: December 2022

Background

Nontuberculous mycobacteria (NTM) are environmental organisms that can form biofilms in municipal water systems and as such are difficult to eliminate. Mycobacterium abscessus is a rapid-growing NTM that can cause skin and soft tissue, disseminated, and pulmonary infections. M. abscessus is difficult to treat, often requiring prolonged therapy with several antibiotics due to its intrinsic drug resistance. In 2021, our institution identified a significant increase in pulmonary infections caused by M. abscessus in the cardiothoracic transplant population.

Methods

All M. abscessus cases among inpatients at our institution were extracted from the electronic medical record (EMR) between January 2019 and September 2021. Clinical characteristics were determined through EMR review and included demographics, transplant status, specimen type, COVID-19 history, and patient care practices involving water. A multidisciplinary team conducted an investigation to identify possible variations in practice related to the source of water used for clinical care activities in this identified population.

Results

Between January 2021 and September 2021, there were 12 cases of M. abscessus among inpatients at our institution compared to 6 cases in 2019 and 5 in 2020 (Figure 1).

Between 2019 and 2020, post-heart and pre-/post-lung transplant patients comprised 9% of cases, 55% of cases were pulmonary infections, and none had a history of COVID-19 infection. In 2021, post-heart and pre-/post-lung transplant patients comprised 58% of cases, 83% of cases were pulmonary infections, and 33% of cases had a history of COVID-19 infection.

There were varying sources of water utilized for the clinical care activities in this identified population (Table 1). Figure 1Mycobacterium abscessus epidemic curveTable 1Patient Care Practices Involving Water

Conclusion

To investigate the potential outbreak, we are actively collecting water samples and swabs from water fixtures in both patient and nourishment rooms for water culturing. To mitigate a potential water-borne source, we will use sterile water for all clinical care practices involving water and for all patient water drinking needs in the post-heart and pre-/post-lung transplant population impacted by the outbreak. The only use of tap water is hand hygiene and patient bathing.

Disclosures

Asra Salim, MPH, CPH, FAPIC, IRhythym Technologies Inc: Stocks/Bonds Valentina Stosor, MD, DiaSorin: Advisor/Consultant|Eli Lilly and Company: Grant/Research Support|Med Learning Group: Honoraria Michael P. Angarone, DO, Abbvie: Advisor/Consultant Michael G. Ison, MD MS, GlaxoSmithKlein: Grant/Research Support|Pulmocide: Grant/Research Support|Viracor Eurfins: Advisor/Consultant Janna L. Williams, MD, Abbvie: COVID19 Infection Prevention Consultant.
1217. An outbreak of carbapenem-resistant Acinetobacter baumannii in an isolation ward for COVID-19 and successful outbreak control with infection control measures
Authors: Lee Ki Hyun , Yeom Joon-sup , Ku Nam Su , Jeong Su Jin , Ahn Jin Young , Kim Jung Ho , Lee Hyuk M In , Kim Jinnam , Lee Se Ju , Lee Jung Ah , Hyup Kim Chang , Choi Jun Yong
Published: December 2022

Background

The superinfection of multidrug-resistant bacteria is an important complication in critically ill COVID-19 patients. An outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) occurred in an isolation ward for COVID-19. We performed an outbreak investigation, and successfully controlled the outbreak with the enhanced environmental cleaning and additional gowning and gloving.

Methods

This study analyzed all COVID-19 patients with CRAB in any specimen, who admitted to an isolation ward for COVID-19 of a tertiary hospital in South Korea from October to November 2021.

Results

During the outbreak period, a total of 23 patients with COVID-19 and CRAB were identified (Figure 1). Index case was 85-year old female patient who was referred from a long-term care facility. The mean age of cases was 72.9 and 14 (60.9%) patients were male. In most patients (91.3%), CRAB were identified in sputum culture, two were identified in blood culture at initial, and four patients were identified in sputum and blood culture at the same time. Most of the patients were applying high flow nasal cannula (26.1%) or mechanical ventilation (60.9%)(Table1). As shown in figure2, CRAB outbreak occurred mainly in the wards around the index case, and in particular, environmental culture was carried out in the area marked with a rectangle. CRAB was cultured on the floor, air inlet, air outlet, and window frame of the ward except for wards 3305 and 3319. Phenotypic antimicrobial resistance patterns of CRAB isolates from patients and environment were identical, and additional whole genome sequencing analyses are ongoing to find the clonality of isolates. We applied the infection control measures with the enhanced environmental cleaning using sodium hypochlorite(NaClO) 1000ppm and phenolic compounds more than twice a day, enhanced hand hygiene, and additional gowning and gloving over personal protective equipment (PPE) mandatory for COVID-19 on 29th October. No additional CRAB cases occurred since 2nd November 2021 for two weeks. Figure 1.Daily number of cases with carbapenem-resistant Acinetobacter baumannii during outbreak periodFigure 2.Floor plan of isolation ward with Acinetobacter baumannii outbreak

Conclusion

Even when PPEs and precautions for COVID-19 are applied to isolation wards for COVID-19, it is helpful for preventing transmission of multidrug-resistant bacteria to apply additional contact precautions and environmental cleaning.

Disclosures

All Authors: No reported disclosures.
1221. Stenotrophomonas maltophilia Outbreak Associated with Sink Drains in an Intensive Care Unit
Authors: Matheu Michelle M , Rice Nicholas , Singson Karen , John Bonnie St , Lindsay Heather , Burnett Kayla , Coombs Jana , Fernley Tasha , Lopansri Bert K
Published: December 2022

Background

Stenotrophomonas maltophilia (SMA) is an opportunistic pathogen that causes significant morbidity and mortality and has been associated with outbreaks in various hospital environments. We describe an outbreak of SMA in our intensive care unit (ICU) and highlight the sink drain as the probable source of SMA.

Methods

Clinical surveillance for hospital-acquired infections due to SMA was instituted in December of 2017, when a cluster of cases was identified in our ICU. We first performed an environmental survey in random sites in our ICU rooms: high-touch surfaces, drains in handwashing sinks, clean water, enteral feeding, and ice machines. SMA was only found in the sink drain. We then performed an environmental survey focused on sink drains and the surrounding areas. We identified rooms where patients positive for SMA were previously hospitalized. Sampling sites were standardized for all rooms: bed rail, sink drain, splash zone, and air near sinks. Bed rails were swabbed with sponge-swabs and sink drains with flocked swabs with liquid Amies transport media. Swab samples were cultured in broth and solid media. Splash zone samples were collected using MacConkey agar plates left for four hours immediately adjacent and at one foot from the sink. Air samples were also collected for 10 minutes onto MacConkey agar plates using EMD Millipore MAS-100 NT impactor air sampler. All media was incubated aerobically at 35-37°C. Identification of all isolated gram-negative organisms was performed using MALDI-TOF MS.

Results

Five rooms were surveyed (Table 1). All rooms were found to have medical supplies within the splash zone. 100% (5/5) of sink drain samples had SMA recovered in culture, compared to 10% (1/10) of splash zone samples, 20% (1/5) of air samples, and 20% (1/5) of bed rails. In addition, we isolated other gram-negative organisms. We repeated the environmental survey after placing a sink drain cover in rooms found to have SMA in areas other than the drain. In the follow-up survey, we found no growth in cultures except for air samples (Table 2).

Conclusion

Sink drains pose a risk for SMA, possibly via contamination of medical supplies near sinks. Further investigation, including sequencing of environmental and clinical isolates, is needed to understand the mode of transmission.

Disclosures

All Authors: No reported disclosures.
1224. The incidence of severe C. striatum hospital-acquired pneumonia sharply increased and was associated with a high mortality rate
Authors: Lee Yun Woo , Huh Jin Won , Hong Sang-Bum , Jung Jiwon , Jae Kim Min , Pil Chong Yong , Kim Sung-Han , Sung Heungsup , Do Kyung-Hyun , Lee Sang-Oh , Lim Chae-Man , Soo Kim Yang , Koh Younsuck , Choi Sang-Ho
Published: December 2022

Background

The clinical information on patients with severe C. striatum pneumonia who require intensive care unit admission is currently limited.

Methods

We investigated the incidence and characteristics of severe Corynebacterium striatum pneumonia during a 6-year period at Asan Medical Center in comparison with severe pneumonia associated with MRSA.

Results

Between 2014 and 2019, there were 27 adult cases of severe C. striatum pneumonia. The majority of the cases (70.4%) were hospital-acquired pneumonia (HAP), and about half of the patients (51.9%) were immunocompromised. The incidence of C. striatum HAP significantly increased from 1.0% (2/200) in 2014-2015 to 5.4% (10/185) in 2018-2019 (P < 0.001), while the incidence of severe methicillin-resistant Staphylococcus aureus (MRSA) HAP significantly decreased from 12.0% to 2.7% during the same period. Of the 75 HAP cases whose bacterial pathogens were identified in 2018–2019, C. striatum was responsible for 13.3% of the cases. The 90-day mortality rates were similarly high in the C. striatum and MRSA groups (59.3% vs. 50.5%, P = 0.42).

Conclusion

In conclusion, C. striatum was a major pathogen of recent severe HAP and was associated with a substantially high mortality rate.

Disclosures

All Authors: No reported disclosures.
1226. Two consecutive outbreaks of carbapenemase-producing enterobacteriaceae (CPE) in a pediatric hospital
Authors: Mor Meirav , Rozenfeld Sigalit , Bitan Sarit , Zvi Haim Ben , Cohen Dalit , Levy Itzhak , Baruch Nurit , Bron-Harlev Efrat
Published: December 2022

Background

Carbapenemase-producing enterobacteriaceae (CPE) can cause hospital outbreaks with considerable health and economic implications. Intensive infection control measures are implemented to identify CPE carriers and contain outbreaks.

Methods

We describe a CPE-NDM (New Delhi Metallo-beta-lactamase) hospital wide outbreak, in a tertiary care pediatric hospital, which evolved into a CPE-KPC (Klebsiella pneumoniae carbapenemase) outbreak before subsiding.

Results

At 10/20/21 rectal screening for CPE was performed in patients in the NICU (neonatal intensive care unit) because of known CPE carriers hospitalized there. Multiple CPE carriers were discovered, and a hospital-wide outbreak of CPE-NDM was identified. All patients who were potential contacts of CPE carriers throughout the hospital were isolated and screened twice a week, as part of intensive infection control measures. Between 10/20/21 and 12/07/21 46 patients carrying CPE-NDM were discovered. Continued screening between 12/15/21 and 04/18/22 identified 81 additional patients carrying CPE, however the carbapenemases identified in 78 of them were KPC. No known CPE-KPC carrier was hospitalized at the beginning of the KPC outbreak. Surprisingly, in 6 of the patients carrying CPE-NDM, repeat screening done months later found the carriage shifted from CPE-NDM to CPE-KPC. The results were validated and analyzed at the National Infection Control Laboratory. No significant morbidity or mortality was observed due to CPE carriage.

CPE identification distribution by week and mechanism

Conclusion

We report an unusual sequence of two CPE outbreaks. We found no previous reports of consecutive outbreaks of CPE.

Disclosures

All Authors: No reported disclosures.
1233. System dynamics modelling for analysis of pre-surgical interventions to reduce surgical infections at a South Indian tertiary care centre
Authors: Edathadathil Fabia , Lebcir Reda , Singh Sanjeev
Published: December 2022

Background

Surgical site infections (SSIs) warrants exploring context-based interventions to minimise their occurrence especially in resource limited settings. Pre-operative interventions are highlighted as important in reducing infections along the surgical pathways. The aim of this study is to investigate whether these interventions can reduce SSIs to inform policy making.

Methods

A patient centred operational perspective of the entire surgical patients’ pathways including infection management was developed by employing the System Dynamics methodology using the STELLA software. The development process was based on the principles of Group Model building involving healthcare staff, and included: pre-surgery, surgery, post surgery, emergency, re-admission, clinical management, and infection management phases. The model represented (i) categories of patients entering the pathways, (ii) states of patients on the pathways and their evolution over their states, (iii) mix of resources involved in activities, (iv) rules and processes to manage patients, and (v) patients’ exit and discharge routes from the pathways. Literature and policy documents informed also the model building process and the model was validated with the participation of clinical staff involved in the pathways.

Results

The model was run over a period of 1 year and results regarding the total number of SSIs (TSSIs) and the total number of deaths (TND) following treatment from infections (includes deaths from both SSIs and non-surgical clinical management infections). Three World Health Organization recommended interventions scenarios namely (i) Decolonization of nasal and extranasal sites on hospital admission, (ii) administration of prophylaxis antibiotic 45 minutes before incision, and (iii) skin preparation using Chlorhexidine based alcohol were simulated. TSSIs are reduced from 48 to 33, 36, and 16 under scenarios 1, 2, and 3 respectively (Figure 1) whereas TND are reduced from 35 to 31, 32, and 31 under the same scenarios.

Conclusion

Pre-operative interventions can be effective in reducing SSIs. Some of these interventions can be successfully implemented in resources limited settings such as the hospital described in this study.

Disclosures

All Authors: No reported disclosures.
1241. Hepatitis C Cascade of Care in a Multidisciplinary Substance Use Bridge Clinic Model
Authors: Simonyan Ana , Chirunomula Samantha , Whelchel Kristen , Gispen Fiona , Marcovitz David , White Katie D , Chastain Cody A
Published: December 2022

Background

Hepatitis C virus (HCV) infection is common among persons who inject drugs. Treating HCV in patients who present for treatment of substance use disorder (SUD) is an opportunity to improve linkage to and retention in care. The Vanderbilt University Medical Center (VUMC) Bridge Clinic serves a unique patient population that includes individuals with opioid use disorder who recently presented to VUMC for complications related to substance use. These patients are treated by a multidisciplinary team for addiction with opioid agonist therapy as well as comorbid medical conditions. The aim of this study is to further characterize the HCV cascade of care (CoC) in a bridge clinic setting and identify barriers to HCV treatment.

Methods

We performed a single-center, ambispective cohort study of patients enrolled in the VUMC Bridge Clinic from 7/1/20 through 6/30/21. Data collection was continued through 12/31/21. All patients enrolled in the Bridge Clinic were reviewed, and patients with active HCV infection were monitored from initial evaluation through treatment and sustained virologic response (measured at least 12 weeks after completing therapy (SVR12). Descriptive statistics including demographics and progression through the CoC are presented.

Results

Characteristics of the 230 patients screened for HCV are reflected in Table 1. The CoC is reflected in Figure 1. Of these 230 patients, 96 (42%) had detectable virus as measured by blood HCV RNA. Of these 96 patients, 39 (40%) were approved for treatment, 33 (34%) initiated treatment, 25 (26%) completed treatment, and 13 (14%) achieved SVR12 with laboratory confirmation. The largest number of patients who did not progress through the CoC were those not approved for treatment; the most common reasons were loss to follow-up or incomplete workup. The majority of patients received opioid agonist therapy as part of their multidisciplinary treatment plan.

Conclusion

This study demonstrates opportunities and challenges for treating HCV in individuals with SUD in a bridge clinic model. Ongoing efforts should focus on linkage to care and strategies to keep individuals with SUD engaged throughout HCV treatment.

Disclosures

David Marcovitz, MD, Better Life Partners LLC: Stocks/Bonds|Silver Pines LLC: Stocks/Bonds.
1250. Screening for Hepatitis C as Part of an Opioid Stewardship Initiative: Identifying Infected Patients and Analyzing Linkage to Care
Authors: DeCamillis Becky , Hekman Aliza , Priest David H
Published: December 2022

Background

Hepatitis C (HCV) remains a major cause of liver-related morbidity and mortality even though direct-acting antiviral drugs (DAAs) are increasingly accessible and have cure rates approaching 100%. The demographics of HCV have shifted to younger patients, primarily due to the opioid epidemic and associated increased numbers of people who inject drugs (PWID). A robust screening program targeting patients with opioid use disorder (OUD) can identify patients with HCV and present opportunities for linkage to care, cure, and disease prevention by breaking the chain of transmission in high-risk groups.

Methods

As part of an organizational opioid stewardship long-term goal (2018-2020), Novant Health screened patients with OUD for HCV. A best practice alert (BPA) in the electronic health record (EHR) prompted providers to order HCV antibody. Management of positive tests was left to the discretion of the ordering provider. The disposition of patients with a positive HCV antibody was evaluated by retrospective chart review with patients categorized as: (a) known spontaneous virus clearance (b) linked to care with HCV specialist (c) previous treatment (d) not appropriately linked to care (e) not linked to care due to patient-directed discharge or nonadherence.

Results

Of 5560 patients encountered (average age 40.9, 49% female, 73.7% White, 21.8% AA/Black), 4405 patients were tested. Of those screened, 33.9% were positive. Among those with a positive HCV antibody, 24% had known spontaneous viral clearance and 73.9% needed linkage to care or follow up bloodwork, with 301 linked to care and 804 not successfully linked. Of eligible patients, 27.2% were linked to care.

Conclusion

There is a need for ongoing screening efforts in patients with OUD. Despite a BPA intervention, a large percentage of positive patients were not appropriately linked to care. Barriers to linkage include lack of provider education on HCV referral and treatment concurrent to the BPA rollout, as well as psychiatric comorbidities and social vulnerabilities more prevalent in patients with OUD.

Disclosures

All Authors: No reported disclosures.
1265. Effectiveness and Durability of Dolutegravir (DTG)-Based Regimens in Older People Living with HIV (PLWH) from the Veterans Aging Cohort Study (VACS)
Authors: Yan Lei , Henegar Cassidy , Gordon Kirsha , Hicks Charles , Vannappagari Vani , Justice Amy C , Aslan Mihaela
Published: December 2022

Background

HIV management among older people living with HIV (PLWH) may be complicated by the presence of multiple comorbidities and polypharmacy. This study evaluated effectiveness and durability of modern 3-drug antiretroviral regimens among older PLWH.

Methods

Using data from the Veterans Aging Cohort Study (VACS), PLWH ≥50 years old initiating a dolutegravir (DTG), bictegravir (BIC), elvitegravir (EVG), raltegravir (RAL), or darunavir (DRV)-based 3-drug regimen for the first time between January 1, 2014, and March 31, 2020 were followed from regimen initiation (baseline) until regimen discontinuation (d/c), death, loss to follow-up, or end of study (September 30, 2020). Suppression [viral load (VL)< 50 copies/mL], change in CD4 cell count, and regimen d/c were compared between regimens 6- and 12-months post-baseline using multivariable logistic or linear regression. Virologic failure (VF; 2 consecutive VLs ≥ 200 copies/ml, or 1VL ≥ 200 copies/ml followed by regimen d/c) was evaluated over 12 months. For all outcomes, DTG-based regimens were compared to each other regimen. Outcomes were stratified by treatment experience (ART-naïve and ART-experienced).

Results

2,489 ART-naive (DTG: 912, BIC: 432, EVG: 751, RAL: 159, DRV: 235) and 13,810 ART-experienced (DTG: 5097, BIC: 1765, EVG: 3582, RAL: 1486, DRV: 1880) individuals were included. Included PLWH were 97% male and 30% were ≥65 years old (Table 1). For both naive and experienced PLWH, those on DTG were more likely suppressed and had greater increases in CD4 counts at 6 and 12 months compared to those on DRV or RAL (Table 2). Odds of VF did not differ by regimen for ART-naive. For ART-experienced, DTG showed reduced likelihood of VF compared to DRV and RAL. Discontinuations within the first year were higher for RAL and DRV compared to DTG. For ART-experienced PLWH, 6-month d/c was greater for DTG vs. EVG. Regardless of treatment status, no other statistical differences in outcomes were observed between DTG-, BIC-, and EVG-based regimens.

Conclusion

For both ART-naïve and ART-experienced PLWH >50 years old, treatment responses during the first 12 months of follow-up were similar for those taking DTG-, BIC-, and EVG-based regimens. DTG-based regimens demonstrated greater effectiveness and durability compared to DRV- or RAL-based regimens.

Disclosures

Cassidy Henegar, PhD, MSPH, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: full-time employee Charles Hicks, MD, MD, ViiV Healthcare: I am a full time employee of ViiV Healthcare. Vani Vannappagari, MBBS, MPH, PhD, ViiV Healthcare: I am full time employee of ViiV Healthcare and receive GlaxoSmithKline stock as part of my compensation package|ViiV Healthcare: Stocks/Bonds.
1269. End HIV with DOT: Maybe?
Authors: Garcia Bismarck Bisono , Bengualid Victoria , Dahdouh Michelle , Marinello Carla , Salazar Hernando , Berger Judy
Published: December 2022

Background

Directly observed Therapy (DOT) has proven to be a valuable asset used in ascertaining adherence to tuberculosis (TB) medications, methadone, psychiatric medications and HIV medications. Both HIV and TB share the need of adherence to treatment to avoid resistance. However, unlike TB, HIV treatment must be taken for life.

Argus Community (Argus DOT) provides Directly Observed Therapy to assist with medication adherence to HIV positive patients with medication adherence barriers who are not virally suppressed as long as the patient is from an affiliated medical provider network which includes St. Barnabas Designated AIDS Center (SBH DAC).

Methods

SBH DAC started referring patients who have not been virally suppressed to Argus DOT March 2021 to help reach our goal of 90% virally suppressed rate (viral load < 200 copies/ml) by the end of 2021. Those who agreed to DOT were referred, accepted and enrolled in Argus. Argus DOT calls patients daily Monday to Friday to remind them to take their medications.

We performed a retrospective chart review of SBH DAC/Argus DOT patients to see if this intervention improved our suppression rate from March 2021 to December 2021 and if there were any barriers for our patients in regards to receiving these benefits.

Results

18 patients were approached by the DAC team to enroll in Argus DOT; of those 15 originally agreed to the program. 3 patients declined the enrollment.

Of the 15 patients who agreed to the program, 6 patients discontinued the program and none of these 6 patients achieved viral load suppression. Results of 9 patients who stayed with Argus DOT: 8 out of 9 patients achieved a viral load < 200 copies/ml and one achieved 230 copies/ml from 2200 copies/ml. 2 patients achieve a viral load < 20 copies/ml (undetectable).

Conclusion

This small study shows Argus DOT as valuable asset in achieving decrease HIV viral load in patients with medication adherence barriers. 50% accepting and staying with the program achieved 89% viral suppression; close to the 90% needed to End the Epidemic. 9 out of 18 who did not agree or discontinued Argus DOT due to uncontrolled psychiatric, substance use, nonworking phones and distrust did not achieve viral suppression. Co-located psychiatric, substance use as well as in-house SBH DOT personnel is needed to achieve viral load suppression.

Disclosures

All Authors: No reported disclosures.
1270. HIV Drug Resistance and Viral Outcomes after 2nd-line Antiretroviral Failure in Kenya
Authors: Ali Shamim M , Humphrey John , Novitsky Vladimir , Sang Edwin , DeLong Allison , Jawed Bilal , Kemboi Emmanuel , Goodrich Suzanne , Gardner Adrian , Hogan Joseph W , Kantor Rami
Published: December 2022

Background

Program data on HIV drug resistance and clinical outcomes after 2nd-line antiretroviral therapy (ART) failure in resource-limited settings are limited, yet can inform care, particularly with better ART access and options.

Methods

We examined resistance upon 2nd-line failure and subsequent viral outcomes at the Academic Model Providing Access to Healthcare (AMPATH) in Kenya. Charts of people with genotypes upon 2nd-line failure up to 6/2021 were reviewed; and associations with viral suppression (< 1000 copies/mL) closest to 12 months post-genotyping were determined using bi- and multivariate analyses, adjusting for age, sex, time on ART, switch to 3rd-line (darunavir-, dolutegravir-, and/or raltegravir-based ART), and any resistance to regimens upon viral load (VL) testing.

Results

Of 194 participants (53% female; median age 41 years; median 3.3 and 4.1 years on 1st- and 2nd-line), 60% were on lopinavir/ritonavir and 40% on atazanavir/ritonavir-based regimens. Overall, 178 (92%) had any resistance: 19% mono-, 40% dual-, 41% triple-class; 79% to NRTIs; 81% NNRTIs; and 43% PIs - 33% of those on lopinavir/ritonavir; 58% on atazanavir/ritonavir (p< 0.001); 24% with intermediate-high predicted resistance to darunavir/ritonavir (12 upon LPV/ritonavir, and 8 upon atazanavir/ritonavir failure; p=0.98). Of 140/194 people with post-genotype VLs, 55% stayed on 2nd-line, and 45% switched to 3rd-line. Of those 140, 72% virally suppressed (89% who switched to 3rd-line; 58% who didn't), and 75% had any resistance to their regimen at post-genotype VL (90% who switched to 3rd-line; 62% who didn't). In bivariate analysis, suppression was associated with switching to 3rd-line, and with resistance upon VL testing (Table). In multivariate analysis, suppression remained more likely among those who switched to 3rd-line, and association with resistance was less pronounced.

Conclusion

In a large Kenyan HIV program, high resistance upon 2nd-line failure, high failure rates, and suppression association with 3rd-line switch suggest the need for dedicated management of this vulnerable population. Potential association between resistance and better viral outcomes, similar to reports upon 1st-line failure, needs further data and suggests significance of inadequate adherence.

Disclosures

All Authors: No reported disclosures.
1281. Rifampicin and Tenofovir Alafenamide Containing Regimen Drug Interaction in People Living with HIV: Case Series Report
Authors: Mohzari Yahya , Musawa Mohammed A L , Alrashed Ahmad , Alamer Ahmad , Almulhim Abdulaziz S
Published: December 2022

Background

Owing to the excellent safety and efficacy profile of the tenofovir alafenamide (TAF) over tenofovir disoproxil fumarate (TDF), it is the preferred prodrug of tenofovir (TFV) implicated in the management of people living with HIV (PLWH). PLWH are more susceptible to having tuberculosis (TB) and therefore, rifampicin (RIF) use as a key component of antituberculosis therapy is frequently indicated. However, since TAF is a substrate for drug transporters such as P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) and RIF being an inducer for these transporters, the concomitant use of RIF and TAF is not recommended. The magnitude of this drug-drug interaction in PLWH is not known. Hence, the objective of this study was to

Methods

We retrospectively reviewed the charts of PLWH (≥ 18 years old) seen in our center and who received the TAF-containing regimens and RIF together for ≥ 4 weeks. Demographic data were described using descriptive statistics. We defined the clinical impact as the following: 1- maintaining viral suppression (< 20 copies/mL) for those with suppressed viral load at baseline, 2- the attainment of the viral load suppression (< 20 copies/mL) for those with unsuppressed viral load at baseline. The clinical impact was assessed from the RIF initiation to the end of the therapy.

Results

A total of 6 PLWH were identified, 5 (83.3%) of them were males. The median (IQR) age was 41.5 years old (49.25 to 36). All patients received dolutegravir 50 mg twice daily (DTG) plus the combination of TAF 25 mg and emtricitabine 200 mg (FTC) once daily as their antiretroviral regimen. Pulmonary tuberculosis was the indication for RIF in all the cases. The RIF dose of 600 mg was the most frequently prescribed (83.3%). The mean (±SD) duration of RIF-TAF co-administration was 30 weeks (2.8). Four patients had suppressed viral load levels at baseline, which was maintained throughout the course of TB treatment. Two patients had unsuppressed viral load levels at baseline and attained viral load suppression throughout the treatment course.

Conclusion

This case series study demonstrated the possibility of RIF-TAF co-administration, without attenuation the efficacy of TAF, however further work on a large sample is needed to confirm our findings.

Disclosures

All Authors: No reported disclosures.
1292. Accessible Antibiotic Stewardship: Development of an Open-Source, Interactive Online Curriculum
Authors: Rendell Sara , Goren Eric , Degnan Kathleen , Hamilton Keith W
Published: December 2022

Background

Significant gaps exist at all levels of medical training with regards to knowledge and confidence in antimicrobial prescribing and stewardship. Studies of antimicrobial prescribing perceptions have also noted that trainees and physicians desire further education on antibiotics and antimicrobial stewardship. Although courses in antimicrobial stewardship exist, these have generally been limited in scope and accessibility.

Methods

We first performed a needs assessment by reviewing all existing online antibiotic curricula. We then developed an open-source, comprehensive online antibiotic curriculum comprising educational modules for adult clinical learners to build expertise at their own pace, without financial burden. We based the curriculum on a previously validated framework for learning principles of antibiotics and drew on cognitive-load theory. Our intended learners were medical students, medical and surgical residents, and advanced practice provider trainees.

Results

There are 24 currently accessible online antibiotic learning materials, 4% of which are comprehensive, 25% of which include interactive content, and >40% of which include inaccuracies. We designed a curriculum to address these gaps. Our curriculum consists of 22 modules including videos lasting 8 minutes or less and accompanied by activities to apply and reinforce content. We partnered with a student in graphic design to create visually appealing and memorable animated videos. The modules reinforce the “3Ps and 3Ds”: 1) from what place is the infection coming, 2) what pathogens tend to live in the place of the infection and should be empirically covered with antibiotics, 3) are there patient-specific factors that affect antibiotic choice, and ) what are the drug, dose, and duration of antibiotic therapy.

Conclusion

To our knowledge, this would be the first open-source, comprehensive online curriculum targeting appropriate antibiotic selection using a novel framework for choosing antimicrobials: the “3Ps and 3Ds”. Our antibiotic curriculum is also novel in that we have built short, interactive learner-friendly modules that incorporate microbiology concepts as well as fundamentals of antimicrobial stewardship to facilitate antibiotic learning.

Disclosures

Kathleen Degnan, MD, Gilead: Grant/Research Support.
1299. Effectiveness of Educational Interventions to Reduce Incidence of Occupational Exposure to Blood and Body Fluid in First-clinical-year Medical Students of A Thai University-based Medical School
Authors: Khawcharoenporn Thana , Boonruang Krittapol
Published: December 2022

Background

Occupational exposures to patients’ blood and body fluid are not uncommon and increase risk of blood-borne infections among medical students during their clinical clerkship. However, existing data on interventions to prevent such exposures are limited in Thailand. We conducted this study to evaluate effectiveness of the study interventions in decreasing incidences of the occupational exposures among first-clinical-year medical students (4th-year students) in a Thai university-based medical school.

Methods

A quasi-experimental study was conducted to compare the incidence of the occupational exposures between the pre-intervention period (2019 academic year) and the intervention period (2020 academic year). The interventions included an orientation session about occupation exposure prevention and procedure review for the medical students on the first day of each major department rotation and the use of LINE application to send video clips and articles for procedure review, weekly remind the students how to prevent themselves from common occupational exposures via short messages and provide Q&A sessions between the researchers and medical students regarding procedures and occupational exposure prevention.

Results

A total of 63 medical students, men (57%) and women (43%), and 66 medical students, men (47%) and women (53%) participated in the study during the pre-intervention and intervention periods, respectively. The incidence of occupational exposure among the students was significantly lower in the intervention period compared to the pre-intervention period (7.9 vs. 35.86 per 100 person-years; P< 0.001). The most common exposures were mucosal exposure (44%), needle stick injury (25%), and sharp object injuries (25%). After the exposures, there was no acquisition of syphilis and infections due to human immunodeficiency virus, hepatitis B virus and hepatitis C virus among the students in both periods.

Conclusion

The study interventions that included focused orientation and the use of LINE application to communicate with the students regarding procedure review and occupational exposure prevention were associated with significant decrease in the incidence of occupational exposure during their clinical clerkship.

Disclosures

All Authors: No reported disclosures.
1303. Making Infectious Disease Fellowship More Rashional: A Needs Assessment of Program Directors
Authors: Rockney Danica , Tackett Sean , Melia Michael T
Published: December 2022

Background

Many infectious diseases present with rashes. Despite this, limited data have been published regarding dermatology training in infectious disease (ID) fellowships. We aimed to understand the perceived importance, current effectiveness, and existence of dermatology curricula for ID fellows in the United States (US).

Methods

Over four weeks in March-April 2022, we emailed US ID fellowship program directors (PDs) individualized links to a Qualtrics survey. Up to two reminder emails were sent. Using NRMP Match Results and Data, we identified 151 PDs. Email addresses were found for 147 PDs. Descriptive data analysis was performed. This study was IRB exempt.

Results

Response rate was 91/147 (62%). Most PDs (79/91, 87%) felt like it was very-to-extremely important for ID fellows to know basic dermatologic manifestations of infections (Image 1), though 91% (82/90) felt that they were only slightly-to-moderately effective at preparing fellows for this (Image 2). Most (55/90; 61%) programs do not have a formal dermatology curriculum for their fellows. Lack of faculty capacity, lack of reliable resources, and other topics taking priority were most commonly selected as significant barriers to implementing a dermatology curriculum (Image 3). Of the programs that do not have a dermatology curriculum, 76% (41/54) of PDs were interested in incorporating an externally produced dermatology curriculum with synchronous lectures (81%), asynchronous content (78%), and flipped classroom guides (72%) being the most favored educational strategies. For programs that currently have a dermatology curriculum (35/90, 39%), 67% (22/33) of PDs felt their fellows found their current dermatology curriculum very-to-extremely valuable.

Conclusion

These data indicate that current ID training often does not include formal dermatology-ID training. This data, along with a planned focus group of fellows, will help inform the development of a dermatology-ID curriculum to help address this content gap and improve ID fellowship education.

Disclosures

All Authors: No reported disclosures.
1307. The Success of ID Carnival in Achieving Doctor of Pharmacy Educational Outcomes
Authors: Lee Yuman , Bradley Nicole
Published: December 2022

Background

ID Carnival was established as a term project in the infectious disease (ID) elective for pharmacy students in their third professional year. In small groups and with frequent faculty feedback, students designed, developed, and created games based on an ID topic. At the end of the semester, students presented their development process and played each other’s games during ID Carnival. The goal of ID carnival was to engage and motivate students to reinforce the foundational knowledge taught in the course and challenge students to develop personally and professionally. The purpose of this study was to assess the impact of ID Carnival on achieving the Center for the Advancement of Pharmacy Education (CAPE) 2013 Educational Outcomes and evaluate students’ perception of ID Carnival.

Methods

From 2019 to 2022, student feedback was anonymously collected via an electronic survey. Students evaluated the impact of ID Carnival based on the 4 domains of the CAPE 2013 Educational Outcomes (Foundational Knowledge, Essentials for Practice and Care, Approach to Practice and Care, and Personal and Professional Development) on a Likert scale from strongly disagree (1) to strongly agree (5).

Results

125 students responded. Majority strongly agreed or agreed that ID Carnival allowed them to build foundational knowledge (122/125, 98%), apply drug information skills (120/125, 96%), develop problem solving skills (121/125, 97%), improve effective communication skills (124/125, 99%), become self-aware in their ability to enhance personal and professional growth (120/125, 96%), hone their leadership skills (123/125, 98%), and creatively think of ways to accomplish professional goals (125/125, 100%). Additionally, students expressed that ID Carnival enhanced their desire to learn ID, provided a fun, engaging, and rewarding environment to learn, and felt motivated to participate in ID Carnival.

Conclusion

ID Carnival was positively received and provided an opportunity for students to expand beyond foundational knowledge and skills, and develop on the affective domain, including self-awareness, innovation, leadership, and professionalism. Opportunities like ID Carnival are important in the education of pharmacy students to prepare them to practice at the highest level of the profession.

Disclosures

All Authors: No reported disclosures.
1312. Clinical and Economic Burden of Otitis Media in Children under 5 in the United States
Authors: Debba Lilia Ben , Derreumaux Dominique , Pickett Jessica , Taddei Laura , Beck Ekkehard , Scherbakov Michael
Published: December 2022

Background

Otitis media (OM) is one of the most common childhood illnesses and frequent cause of antibiotic use among patients under 5 years old.

Pneumococcal conjugate vaccines (PCVs) led to a reduction in the burden of OM caused by Streptococcus pneumoniae (Spn) strains in the United State (US).

Overall, OM incidence was reduced after introduction of PCV7 and plateaued in the late PCV13 era, though there was an increase in OM episodes caused by non-typeable Haemophilus influenzae and non-vaccine-type Spn.

The objectives of this study were to assess the incidence and treatment costs of OM episodes and their complications in the US.

Methods

This retrospective observational study used data from IBM MarketScan to study pediatric OM incidence and complications (tympanostomy tube placement [TTP], hearing loss [HL] and hospitalizations) by age groups and their associated costs. OM episodes occurring between January 1, 2016, and December 31, 2017, were considered in this analysis. Results of the total cost are weighted by the proportion of children covered under commercial insurance and Medicaid, respectively.

Results

The incidence of OM among children < 5 increased gradually with age, reaching a peak of incidence between 1 and 2 years (figure 1) and more precisely between 6 and 15 months. Overall, most OM episodes were without HL and treated in an outpatient setting without TTP (∼ 94% of cases); OM episodes without HL requiring TTP represented only 4% and the vast majority were performed in an outpatient setting ( > 99%). OM without HL leading to hospitalization was very rare (< 0.025%) for both plans. OM leading to HL corresponds to 2% of all OM episodes.

The incidence rate and the mean cost per episode were used to extrapolate an overall economic burden of ∼5 billion USD in 2020, driven by outpatient episodes (50%) followed by OM episodes plus TTP (37%), and OM episodes plus HL (13%). Figure 1:Incidence rates by age groups for (A) Commercial/Medicare; (B) Medicaid

Conclusion

The burden associated with OM in children < 5 reflects a significant and ongoing unmet need. Thus, prevention of OM not currently covered by existing vaccines is warranted to address the significant burden including the potential emergence of antimicrobial resistance.

Funding

GlaxoSmithKline Biologicals SA (GSK study identifier: VEO-000264])

Disclosures

Lilia Ben Debba, PharmaD, GlaxoSmithKline SA: Advisor/Consultant Dominique Derreumaux, M.Sc, GlaxoSmithKline SA: is employed by the GSK group of companies Jessica Pickett, PhD, GlaxoSmithKline SA: is employed by and hold shares in the GSK group of companies Laura Taddei, M.Sc, GlaxoSmithKline SA: is employed by and hold shares in the GSK group of companies Ekkehard Beck, PhD, GlaxoSmithKline SA: is employed by and hold shares in the GSK group of companies Michael Scherbakov, PhD, GlaxoSmithKline SA: is employed by and hold shares in the GSK group of companies.
1321. Increased Prevalence of Group A Streptococcus (GAS) High Level Macrolide Resistance During the COVID-19 Pandemic
Authors: Patel Ami B , Guzman-Cottrill Judith A , Fleming-Dutra Katherine E , Chochua Sopio , Beall Bernard , Jaggi Preeti , Rippe Jason , Inguglia Christine L , Katsogridakis Yiannis L , Ozer Egon A , Shulman Stanford , Tanz Robert R
Published: December 2022

Background

COVID-19 affected the epidemiology of many respiratory pathogens including GAS. Assessing genetic heterogeneity (emm type, antimicrobial resistance, virulence factors) can inform treatment recommendations and targets for potential GAS vaccines. We assessed GAS clinical antibiotic susceptibility and performed whole genome sequencing (WGS) among pediatric pharyngeal isolates from 2020–2022.

Methods

From 1/2020–3/2022 we collected throat swabs in pediatric clinics and EDs from children aged 3-18 years in Chicago, IL; Atlanta, GA; Portland, OR; and Phoenix, AZ: 1) with acute GAS pharyngitis and 2) among a convenience sample of asymptomatic children to assess for GAS colonization. Swabs were plated on blood agar. E-tests were used to assess clinical susceptibility to erythromycin (ERY) and ciprofloxacin (CIP). emm type and antimicrobial resistance genes (ERY, Clindamycin (CLI), and fluoroquinolones) were assessed by WGS.

Results

1144 pharyngeal swabs were collected: 359/684 (52%) from children with GAS pharyngitis by rapid test and 20/460 (4.3%) from asymptomatic children yielded GAS on culture. Phenotypic resistance: 55/364 (15%) tested isolates were ERY resistant and 5/364 (1.4%) CIP resistant. The proportion of isolates with ERY resistance increased significantly from 2020 (6%) to 2021–2022 (25%) (χ2 = 23.70, p< .00001) (Figure 1). MICs were high among ERY resistant GAS (Table 1). Genotypic resistance: Of 304 sequenced GAS isolates 40/304 (13%) were ERY resistant, 35/304 (11.5%) were both ERY resistant and CLI (inducible or constitutive) resistant, and 4/304 (1.3%) fluoroquinolone resistant. ermB (62%) was the most common gene for ERY resistance and constitutive CLI resistance, followed by ermTR (23%) and ermT (11%) both conferring inducible CLI resistance. Among the 20 isolates from asymptomatic children no ERY, CLI, or CIP resistance occurred, and no resistance genes were identified. emm types 11, 9, 77, 58 and 94 were associated with ERY and CLI resistance.

Conclusion

ERY resistance increased from 2020–2022. The high rate of CLI resistance among ERY resistant GAS was associated with erm genes. These results are important to inform treatment recommendations for GAS pharyngitis and targets for vaccine development that can reduce antimicrobial-resistant GAS disease.

Disclosures

All Authors: No reported disclosures.
1329. Pediatric Group A Streptococcus (GAS) Pharyngitis Incidence has Decreased During the COVID-19 Pandemic
Authors: Patel Ami B , McHugh Matthew , Shulman Stanford , Tanz Robert R
Published: December 2022

Background

The COVID-19 pandemic has affected respiratory disease epidemiology. Measures to reduce transmission of SARS-CoV-2 (e.g., masking, social distancing, school closures) have reduced the incidence of common infectious diseases. At least one early report described changes in rates of pediatric GAS pharyngitis. We sought to determine the difference in GAS pharyngitis rates before and after the onset of the pandemic at our children’s hospital.

Methods

Clinical pharyngeal specimens tested for GAS by rapid antigen tests (RADTs) or LAMP methodology (loop-mediated isothermal amplification of GAS DNA) from January 2019 to March 2022 at our children’s hospital were analyzed. Clinician’s evaluating patients for GAS pharyngitis perform a RADT, when positive the patient is treated for GAS pharyngitis. When the RADT is negative, a LAMP test is performed. Patients were considered test-positive if either test was positive regardless of clinical symptoms. Annual positivity rates were compared using statistical process control (SPC) charts with both 2019 and 2020 as baseline years (i.e., 2019 vs 2020-3/2022; 2020 vs 2021-3/2022). The change in GAS incidence rate (positive patients/1000 tested) between years was assessed by chi-square tests.

Results

9,896 patients had throat swabs tested for GAS from January 2019 through March 2022. Using SPC with 2019 as a baseline, there was a 15.1% decrease in mean GAS positivity through 3/2022. With 2020 as baseline, there was a 13.0% decrease in mean GAS positivity through 3/2022. The incidence of positive GAS tests decreased significantly: 2019 vs. 2020-3/2022 (x2 = 84.97, p ≤0.00001) and 2020 vs. 2021-3/2022 (x2 = 154.01, p ≤0.00001). Figure 1.

Conclusion

Using throat swab results, the incidence of pediatric GAS pharyngitis at our hospital has decreased significantly during the COVID-19 pandemic. Implications: Pandemic-related risk mitigation measures, such as masking, social distancing, and school closures, were associated with significantly decreased incidence of GAS pharyngitis. It is likely that GAS colonization and invasive infections were also affected.

Disclosures

All Authors: No reported disclosures.