bluuebunny/crossref_metadata_2025 huggingface dataset:
2199. Herpesviridae lung reactivation and infection in patients with severe Covid-19 or influenza virus pneumonia: a comparative study
Authors: Luyt Charles-Edouard , Burrel Sonia , Guiraud Vincent , Combes Alain , Boutolleau David
Published: December 2022

Background

Lung reactivations of Herpesviridae, herpes simplex virus (HSV) and cytomegalovirus (CMV) have been reported in Covid-19 patients. Whether or not those viral reactivations are more frequent than in other patients is not known.

Methods

Retrospective monocentric cohort study of 145 patients with severe Covid-19 pneumonia requiring invasive mechanical ventilation and who were tested for HSV and CMV in bronchoalveolar lavage performed during fiberoptic bronchoscopy for ventilator-associated pneumonia suspicion. Rates of HSV and CMV lung reactivations, and HSV bronchopneumonitis were assessed and compared with an historical cohort of 89 patients with severe influenza pneumonia requiring invasive mechanical ventilation.

Results

Among the 145 Covid-19 patients included, 50% and 42 % had HSV and CMV lung reactivations, respectively; whereas among the 89 influenza patients, 63% and 28% had CMV lung reactivations, respectively. Cumulative incidence of HSV lung reactivation (taking into account extubation and death as competing events) was higher in influenza than in Covid-19 patients (p = 0.03, see figure 1), whereas the rate of HSV bronchopneumonitis was similar in both groups (31% and 25%, respectively). Cumulative incidence of CMV lung reactivation (taking into account extubation and death as competing events) was similar in Covid-19 and influenza patients (p=0.07). Outcomes of patients with HSV or CMV lung reactivations were similar to that of patients without, whatever the underlying conditions, i.e., in Covid-19 patients, in influenza patients, or when all patients were grouped.

Estimated cumulative incidence of herpes simplex virus (HSV) lung reactivation, extubation or death in Covid-19 and influenza patients, taking into account only the first event that occurred.

p values for differences between Covid-19 and influenza patients were 0.03 for HSV reactivation, 0.53 for death and 0.87 for extubation.

Conclusion

HSV and CMV lung reactivations are frequent in Covid-19 patients, but not more frequent than in patients with influenza-associated severe pneumonia, despite a higher severity of illness at intensive care unit (ICU) admission of the latter and a longer duration of mechanical ventilation of the former. Although no impact on outcome of HSV and CMV lung reactivations was detected, the effect of antiviral treatment against these Herpesviridae remains to be determined in these patients.

Disclosures

CHARLES-EDOUARD LUYT, MD PhD, AdvanzPharma: Honoraria|Aerogen: Honoraria|Merck: Honoraria.
2200. Impact of COVID-19 Pandemic on Influenza-like Illness (ILI) Experience among Healthcare Workers in Military Treatment Facilities
Authors: Liberg Ryan , Schofield Christina , Richard Stephanie A , Collins Limone , Spooner Christina , Seshadri Srihari , Ganesan Anuradha , Campbell Wesley R , Hrncir David , Lalani Tahaniyat , Warkentien Tyler , Mende Katrin , Markelz Ana E , Berjohn Catherine M , McClenathan Bruce , Modi Jitendrakumar , Williams Alan , Burgess Timothy , Colombo Rhonda E
Published: December 2022

Background

Healthcare workers (HCWs) are at heightened risk of exposure to respiratory pathogens, and occupy an important epidemiologic position in the COVID-19 pandemic. PAIVED, a multicenter, multiservice study assessing influenza vaccine effectiveness in the Department of Defense over four consecutive influenza seasons (2018-22), provides an opportunity to describe influenza like illness (ILI) experience and assess the impact of SARS-CoV-2 in HCWs compared to non-HCWs.

Methods

PAIVED participants were randomized to receive either egg-based, cell-based, or recombinant-derived influenza vaccine and then surveyed weekly for ILI. At enrollment, participants provided key demographic data including whether they were HCWs with direct patient contact. ILI was defined a priori as 1) having cough or sore throat plus 2) feeling feverish/having chills or having body aches/fatigue. Participants with ILI completed a symptom diary for seven days and submitted a nasal swab for pathogen detection. Study recruitment was conducted from September-January over four consecutive years.

Results

Of 13188 eligible participants enrolled, 4819 (36%) were HCWs. Overall, HCWs were more likely to be female (43% vs 31%), active duty military (86% vs 69%), and to identify as white (61% vs 56%). HCWs more commonly reported ILI than non-HCWs (25% vs 21%, p< 0.01). Of those experiencing ILI, SARS-CoV-2 was identified in a higher proportion of HCWs than non-HCWs (17% vs 12%, p< 0.01). Influenza was isolated in similar proportion of HCWs and non-HCWs (5% vs 4%). Each group reported similar ILI duration and severity (p< 0.01).

Conclusion

In a prior analysis of the 2019-20 PAIVED season, HCWs were more likely than non-HCWs to report ILI, have shorter illness duration, and isolate influenza A (H1N1). The propensity for HCWs to report ILI persisted over the four years. While SARS-CoV-2 emerged as a major pathogen in both groups, HCWs were more likely to have it identified as a cause of ILI, suggesting increased risk of symptomatic SARS-CoV-2 in our HCW population. Influenza incidence was lower than that of SARS-COV-2, and did not differ between HCWs and non-HCWs. Mean duration of illness did not differ between groups over four years; this equalization may relate to the higher incidence of SARS-CoV-2 in HCWs.

Disclosures

Jitendrakumar Modi, MD, GlaxoSmithKline: I am a paid speaker for GSK. I do not speak for their flu brand. Timothy Burgess, MD, MPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.
104. Evaluation of Vaccination Rates and Factors associated with Vaccine Uptake among People Living with HIV in Detroit, MI
Authors: Birk Navina K , Brar Indira , Monday Lea M , Singh Tarandeep , Cherabuddi Medha R , Hojeij Marwa , Ho Brandon , Chen Anne , Alangaden George J
Published: December 2022

Background

Determination of vaccination rates for people living with HIV (PLWH) and factors that affect adherence to vaccination is important to ensure these vulnerable patients are optimally protected against vaccine-preventable diseases. We analyzed the rates of vaccination and associated factors in PLWH receiving care in the Henry Ford Health Infectious Diseases (HFH ID) Clinic in Detroit, MI.

Methods

We implemented a retrospective, observational study. Inclusion criteria were all PLWH who had at minimum two clinic visits at HFH ID clinic within 12 months from 2015-2021.

Charts were reviewed for demographic data. We analyzed the rates of all eligible vaccines including the hepatitis A and B, HPV, influenza, pneumococcal, tetanus, zoster, and COVID-19 vaccines.

Results

A total of 661 met the inclusion criteria. Average age of the patients was 50 years. 78.6% were male, 74.3% black, and 57.6% patients were from Detroit. On average, patients had 1 clinic visit in the past year at HFH ID Clinic.

Rates of influenza, pneumococcal, and tetanus vaccinations were above 90%. Rates of hepatitis A and B vaccinations were above 80%. Rates of zoster and HPV vaccinations were above 50%. COVID-19 vaccination had the lowest rate at 42.1%. Patients who had received all recommended vaccines were more likely to be male, have a HFH PCP, men who have sex with men (MSM), younger, more HFH ID clinic visits, and have a higher CD4 count on entry into care. Factors associated with increased vaccine uptake include having a HFH primary care physician (PCP), more HFH ID clinic visits, and a CD4 count above 200 on entry. Having 2 clinic visits in the previous year was associated with a higher likelihood of vaccine adherence [OR 5.85 (95% CI 0.360 – 0.723)].

Conclusion

Our study shows that even in this highly vulnerable, vaccine-hesitant population, programs that integrate vaccines and promote adherence to clinic care into the routine care of PLWH results in high rates of vaccine uptake.

Disclosures

Indira Brar, MD, Gilead: Grant/Research Support|Gilead: speakers bureau|Janssen: Grant/Research Support|Janssen: speakers bureau.
2201. Impact of Educational Sessions on Knowledge and Attitudes About RSV Infection and Prevention Among Residents of Long-Term Care Facilities
Authors: Gravenstein Stefan , Feramisco Jamison , Carter Jeffrey D , Simone Laura , Nelson Marykate
Published: December 2022

Background

Older adults are at risk for severe disease following respiratory syncytial virus (RSV) infection. We assessed knowledge and attitudes regarding RSV infection and prevention among residents of long-term care facilities (LTCFs).

Methods

Between October and December of 2021, surveys were administered to residents of LTCFs before and after 1.25-hour educational sessions led by health care professionals (HCPs) at 5 centers.

Results

Surveys were completed by 167 residents (76% female, average age 67 years). Residents reported low levels of knowledge of RSV-related topics, which increased significantly after the sessions (Figure 1). Before the sessions, 43% used family/friends and social media to obtain information about RSV and other infectious diseases, while only one-fourth consulted an HCP to learn about these topics. After the sessions, residents were more likely to confer with their HCP (P < .001) and less likely to utilize unreliable sources.

Although most residents indicated that they would get tested as soon as possible if they came down with symptoms suggestive of RSV or other infections, only 64% reported high confidence in preventing spread. Although most residents believed that it was important to get vaccinated against respiratory viruses and that FDA-approved vaccines are safe, only 48% would be very willing to get an RSV vaccine if available. This proportion increased to 74% after the educational sessions (Figure 2). Less than one-half were very comfortable sharing questions and concerns about vaccines with HCPs, which increased to 62% after the sessions (P = .016). After attending the sessions, more than 80% reported that they plan to get an RSV vaccine when one is available and be more diligent in taking actions to prevent the spread of infectious diseases.

Conclusion

While residents of LTCFs recognize the importance of RSV testing and prevention, they exhibit low levels of knowledge about RSV-related topics, lack of confidence in reducing the spread of disease, discomfort in raising issues regarding vaccination with their HCP, and unwillingness to get the RSV vaccine once available. Educational sessions can help to narrow knowledge gaps, increasing the potential for changes in behavior related to RSV prevention.

Disclosures

Stefan Gravenstein, MD, MPH, Genentech: Advisor/Consultant|Genentech: Grant/Research Support|Janssen: Advisor/Consultant|Janssen: Honoraria|Longeveron: Honoraria|Merck: Honoraria|Moderna: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi: Grant/Research Support|Sanofi: Honoraria|Seqirus: Grant/Research Support|Seqirus: Honoraria.
2205. Potential Causative Association between Respiratory Viruses and Pneumococcus-Associated Disease in Young Children in Israel: Lessons from the COVID-19 Pandemic
Authors: Dagan Ron , van der Beek Bert Adriaan , Greenberg David , Avni Yonat Shemer , Ben-Shimol Shalom , Weinberger Daniel M
Published: December 2022

Background

During the early Covid-19 pandemic, we observed a close-to-full disappearance of the activity of 4 respiratory viruses (RSV, hMPV, influenza, and parainfluenza), followed by an off-season sequential re-emergence in 2021. Surprisingly, a striking similarity between the dynamics of pneumococcus-associated disease (PAD; namely community-acquired alveolar pneumonia [CAAP; often considered pneumococcal] and bacteremic-pneumococcal pneumonia [IPD-Pneumonia]), was also observed. In contrast, adenovirus and rhinovirus activities did not change during COVID-19. We examined the association between PAD and RSV, hMPV, influenza, and parainfluenza (PAD-viruses).

Methods

Surveillance of CAAP and IPD-Pneumonia incidences and viral activity in children < 5 years was described in detail previously [Danino D. et al. Clin Infect Dis. 2022, https://doi.org/10.1093/cid/ciab1014]. We extended the observations until December 2021, to capture the sequential re-emergence of the 4 PAD-viruses. A hierarchical linear regression model was used to quantify the association between PAD-viruses (each virus individually and combined), adenovirus and PAD. After fitting the models, the contribution of each virus was estimated.

Results

The Figure shows striking similarities in the dynamics of CAAP, IPD-Pneumonia, and PAD-viruses both before and during the COVID-19 pandemic. During the expected peak season (Oct 2020 – Apr 2021) PAD episodes were extremely low. However, off-season peaks were seen during May – Dec 2021. Overall, 78% and 25% of all CAAP and IPD-Pneumonia episodes, respectively, were attributable to these viruses in children < 5 (Table). In CAAP, cases were attributable to each of the 4 PAD-viruses individually throughout the first 5 years of life: RSV and hMPV combined contributed 80%, 63%, and 42% of all CAAP episodes in children aged < 1, 1, and 2-4 years, respectively. The respective figures for influenza and parainfluenza combined were 13%, 21%, and 22%. Only RSV significantly contributed to IPD-Pneumonia (19%). Adenovirus did not contribute to PAD episodes.

Conclusion

Our model suggests an important causative association between RSV, hMPV, influenza, and parainfluenza viruses and CAAP, and between RSV and IPD-Pneumonia.

Disclosures

All Authors: No reported disclosures.
2210. Follow-up of Military Blood Donors Who Screen Positive for Syphilis
Authors: Hojnoski Cara E , Kieffer John , Casey Theresa , Osuna Angela , Casleton Brian , Okulicz Jason , Marcus Joseph E
Published: December 2022

Background

Most data on the transmission and outcomes of syphilis occur in community sexually transmitted infection (STI) clinics and have shown increased risk for other STIs in patients who test positive. There is limited data on outcomes in other lower risk populations that undergo universal syphilis screening, such as blood donors. This study describes the initial evaluation, follow-up, and STI risk of Air Force military basic trainees who screen-positive for syphilis at blood donation.

Methods

Blood donor data was gathered from the Armed Services Blood Bank Center-San Antonio for Air Force basic trainees who were screen-positive for syphilis between January 2014- September 2021. For each screen-positive case, six screen-negative controls were analyzed. Prospective donors were unable to donate if they reported male-to-male sexual encounters, HIV positive partners, or a bacterial STI in the prior year. Electronic medical records of cases and controls were examined for demographic information, STI history, and additional STI positivity within three years.

Results

A total of 63,375 basic military trainees donated blood at the Armed Services Blood Bank Center-San Antonio during the study period, of which 23 (0.36 per 1,000 donors) screened positive for syphilis (Table 1). At time of screening, 3 (13%) trainees who screened positive for syphilis also tested positive for an additional STI. After initial treatment and screening, donors who screened positive for syphilis had a RR: 3.8 (95% CI 1.3-10.5, p=0.01) of developing an additional STI in the three years after blood donation compared to controls. Cases of N. gonorrhoeae (Table 2) in the 3-year period following blood donation were significantly higher in those who were syphilis screen-positive compared to those who were negative.

Conclusion

There is limited data on follow-up of blood donors who screened positive for syphilis. This study found that in a low-risk population of military donors, those who screened positive for syphilis were at increased risk of future STIs compared to donors who were screen-negative. Syphilis screen-positive donors may be a potential target for future interventions to decrease the STIs burden in this population.

Disclosures

All Authors: No reported disclosures.
105. Expanding and Sustaining Influenza Vaccination Acceptance amongst Adults with HIV in Delaware during the COVID-19 Pandemic
Authors: Kahal Deborah A , James Christopher , Wharton Brian
Published: December 2022

Background

Influenza vaccination remains vital for people with HIV (PWH) who experience more severe disease and poorer outcomes than people without HIV. During the ongoing COVID-19 pandemic, influenza vaccination indirectly eases strain on healthcare systems. Historical annual adult influenza vaccination rates were 65% with 85.5% coverage achieved during a 2020-21 pilot site (N=750) quality improvement (QI) project.

Methods

An expanded QI initiative sought to again achieve ≥80% influenza vaccination coverage for the 2021-22 season in PWH ≥18 years old attending program sites throughout Delaware (N=1853) (Fig. 1). A voluntary multidisciplinary team continued the initiative with a fishbone diagram detailing previously successful, rapidly implementable, and reproducible levers for change (Fig. 2). Space changes included: diverse, prominent visual displays, phone messaging, and virtual platform use. The team provided consistent, multi-modality staff education. Vaccinations were confirmed by statewide electronic health records or tangible proof-of-vaccination receipt and cross-referenced with Ryan White CareWare data. Overall and county-specific vaccination rates were monitored and displayed weekly to patients and staff.

Results

84.9% vaccination coverage was achieved program-wide with county level rates ranging from 79.1 to 89.7% (Table 1).

Conclusion

Our statewide initiative to sustain and expand high influenza vaccination rates again exceeded 80% in adult PWH attending an array of HIV clinics during the COVID-19 pandemic. Components vital to success include harnessing a motivated multidisciplinary team, focusing on feasible, wide-reaching change levers to promote desirability and accessibility of vaccination to patients, and real-time sharing of progress to patients and staff. The bundled approach challenges efforts to understand individual change effects on outcomes. Opportunities to improve site-specific outcomes remain. Translation of this work has contributed to >85% of PWH receiving ≥1 COVID-19 vaccination, with a goal of further program-wide expansion targeting all administered vaccinations.

Disclosures

All Authors: No reported disclosures.
2214. National Testing Assessment of Select Bacterial STIs During the COVID-19 Pandemic
Authors: Fonseca Giuiseppe A , Maier Marissa , Keddem Shimrit , Borgerding Joleen , Lowy Elliott , McFarland Lorenzo , Comstock Emily , Van Epps Puja , Ohl Michael , Hauser Ronald , Ross David , Beste Lauren
Published: December 2022

Background

Chlamydia, gonorrhea, and syphilis infections rose in the US for 6 consecutive years before the COVID-19 pandemic. Patterns of sexually transmitted infection (STI) testing during the COVID-19 pandemic have yet to be fully assessed.

Methods

We performed a retrospective study of STI testing in the Veteran’s Health Administration (VHA) healthcare system during each calendar year 2019-2021 using electronic health record data. We determined the number of chlamydia (CT) and gonorrhea (GC), and syphilis tests performed overall and in demographic groups defined by age, birth sex, self-reported race, region, and HIV status.

Results

VHA performed 202,503 CT tests, 201,314 GC tests and 250,790 syphilis tests in 2019, followed by a 23% and 25% decrease in 2020 for CT/GC and syphilis testing, respectively. We observed decreases among all subgroups defined by age, sex, race, and geography. Race groups with the biggest decreases in 2020 include Asian Americans (-28%) and Hawaiian and Pacific Islanders (-27%). By 2021, overall testing rates demonstrated a partial recovery to 89.8% of their 2019 levels. Testing rates in 2021 in rural/ highly rural residents remained 17% below baseline, compared with 10% for urban dwellers. Veterans living in the Northeast, South, or Midwest had the least recovery among geographic regions (16%, 11% and 11% below baseline, respectively). People with HIV experienced a decline in CT/GC testing of 15% but by the end of 2021 this had recovered to 1.9% below baseline. Women experienced both a steeper drop and a smaller recovery in CT and GC testing relative to men (Figure 1), except for women under age 25 (Figure 2). Figure 1STI testing rates by CY and sexFigure 2Percent change in STI testing rates versus 2019

Conclusion

After dramatic reductions in STI testing during the COVID-19 pandemic, rates returned to near-baseline levels nationally by 2021. Testing rates have lagged in some patient groups, most notably rural and highly rural populations, women, and Black and Asian American Veterans, placing them at risk for disparities in STI diagnosis, and therefore treatment. Testing rates in Veterans under age 25 years have reached or exceeded pre-pandemic levels.

Disclosures

All Authors: No reported disclosures.
2224. Aminopenicillins versus Non-aminopenicillins for Treatment of Enterococcal Cystitis
Authors: de Oca Jamison Montes , Veve Michael , Kenney Rachel M
Published: December 2022

Background

Aminopenicillins achieve urinary concentrations that overcome aminopenicillin resistance in Enterococcus spp. lower urinary tract infections (UTI). With this rationale, our clinical microbiology laboratory discontinued routine identification on Enterococcus urine isolates in 2012 and report “aminopenicillins are predictably reliable for uncomplicated enterococcal UTI”. The study objective was to compare outcomes of patients treated with aminopenicillins (AP) versus non-aminopenicillins (NAP) for enterococcal cystitis.

Methods

IRB approved, retrospective cohort of adults hospitalized with symptomatic enterococcal cystitis from 2013-2021. Exclusion: definitive E. faecalis, enterococcal UTI in past year, review of systems unavailable/altered mental status, urinary instrumentation except for stent/catheter, systemic infection, fever, genitourinary trauma, renal transplant. Primary endpoint: clinical and microbiologic success at 14 days, defined as resolution of symptoms without new symptoms and no repeat culture growth of index organism. Logistic regression evaluated characteristics associated with 14-day failure. Sample size of 178 calculated for non-inferiority using α=0.025, β=0.8, 15% non-inferiority margin.

Results

178 subjects included, 89 AP, 89 NAP . VRE identified: 73 (82%) AP and 76 (85%) NAP (P=0.50). Amoxicillin (36/89, 40%) and ampicillin (36/89, 40%) used most in AP. Linezolid (41, 46%) and fosfomycin (30, 34%) most common agents in NAP. 14-day clinical composite endpoint was no different between AP and NAP groups, respectively (74 [83%] vs. 73 [82%], P=0.84). No variables independently predicted failure (Table 1). Non-inferiority analysis for AP vs. NAP for 14-day composite: mean difference 1.1% (-0.14 to 0.127, 97.5% CI; P=0.42). Definite E. faecium subgroup: 14-day clinical composite success for was no different between AP and NAP groups, respectively (27/34 [79%] vs. 53/66 [80%], P=0.916).

Conclusion

AP were non-inferior to NAP, supporting their use as first-line therapy for cystitis due to enterococci, including E. faecium. This stewardship strategy has implications to preserve VRE active therapies (e.g. linezolid) for serious infections.

Disclosures

All Authors: No reported disclosures.
2228. Antibiotic Appropriateness for UTI Treatment on Monday vs Friday in a NYC Hospital ED
Authors: LeBron Kira , Bielawski Adrienne , Popiel Patrick , Shams Setareh , Grimes Cara
Published: December 2022

Background

Urinary tract infections (UTI) are common and often lead to an antibiotic prescription. Prior studies have shown that antibiotic prescriptions can vary between weekdays and weekends.

Methods

This is a retrospective case series of female patients ≥18 years with simple cystitis presenting to the ED between 2019 to 2021 in a NYC community hospital. Our primary objective was to determine how often the appropriate antibiotic was prescribed and compare this between Monday and Friday. Antibiotic appropriateness was defined using the 2011 Infectious Disease Society of America clinical practice guidelines for acute uncomplicated cystitis. Criteria included antibiotic selection, dose, frequency, and duration. Per the NYC outpatient UTI antibiogram, Amoxicillin, Ampicillin, Ciprofloxacin, and TMP/SMX were not appropriate empiric therapies. Categorical data is reported as counts (%) and compared with Chi-square; age (nonparametric) is reported as median (range) and compared with Mann-Whitney. Sample size calculation estimated that 71 subjects were needed on each day to detect an effect size of 20% difference in our primary outcome (90% antibiotic appropriateness on Monday and 70% on Friday) with 80% power and an alpha error of 0.05.

Results

160 subjects were included, 80 seen on Mondays and 80 seen on Fridays. Demographics were similar between groups, except for antibiotic allergies (Table 1). There was no difference between appropriate antibiotics prescribed on Mondays compared to Fridays, 54/80 (67.5%) vs 60/80 (75%) (p-value = 0.29). Failure to meet criteria for appropriateness was due to inappropriate prescription duration (44/160) or selection (14/160). All prescriptions met criteria for dose and frequency. There was no difference in antibiotic selection, dose, frequency, or duration of prescription on Monday vs Friday (Table 2). More urine cultures were collected on Mondays (62/80) vs Fridays (49/80) (p =.03).

Conclusion

1 in 3 patients were prescribed inappropriate antibiotics for simple cystitis, though there was no difference between Mondays and Fridays. Inappropriate antibiotic duration and differences in urine culture collection indicate an inconsistent approach to treatment and missed opportunity to course correct in cases of pathogen resistance.

Disclosures

Cara Grimes, MD, MAS, Johnson and Johnson: Expert Testimony|Provepharm, Inc: Advisor/Consultant.
2234. Clinical Significance of Staphylococcus aureus Bacteriuria without Bacteremia
Authors: Ochoa Brennan , Jones Makoto M , Pupaibool Jakrapun
Published: December 2022

Background

Staphylococcus aureus urinary tract infection (UTI) is uncommon. Staphylococcus aureus bacteriuria (SABU) can occur in patients with urinary tract instrumentation, urinary calculi, or S. aureus bacteremia (SAB) and is associated with development of invasive diseases and death. Thus, SABU is often treated with a prolonged course of antimicrobial therapy similar to SAB. However, little is known about the significance of SABU in patients without SAB and recent urinary tract instrumentation.

Methods

We conducted a retrospective study of patients with SABU in the Veterans Affairs (VA) system nation-wide from 2017 to 2019. Patients with concomitant SAB, recent history of urinary tract instrumentation, or overt urologic abnormalities were excluded. The primary outcome was development of invasive S. aureus infections or death within 12 months. The secondary outcome was recurrent SABU within 12 months.

Results

133 patients met the inclusion criteria. 102 patients (76%) received antimicrobial treatment for SABU. The duration of treatment ranged from 3-30 (mean = 8.5) days. Compared with the non-treated group, patients treated with antimicrobials had significantly more urinary tract symptoms (p = 0.0001), microscopic pyuria (p = 0.002), and hematuria (p = 0.035). Of those treated, 11 (7.3%) died within 12 months of SABU compared to 4 patients (13%) who did not receive treatment (p = 0.749). Three percent of patients from both groups (n = 3 vs 1) developed invasive S. aureus infections within 12 months (p = 1.00). 16% of patients in the treatment group (n = 17) and non-treatment group (n = 5) were found to have recurrent SABU within 12 months (p = 1.00).

Conclusion

Patients without recent urinary tract instrumentation, overt urologic abnormalities, and SAB who were treated for SABU did not have significant differences in death, invasive diseases, or recurrent SABU at 12 months compared to those who did not receive treatment. Untreated patients did not appear to have frequent complications; however, our numbers were small and our analysis did not take confounding into account. Further analysis into SABU treatment may be warranted.

Disclosures

All Authors: No reported disclosures.
2239. Evaluating the Use of Cefuroxime for the Treatment of Outpatient Pyelonephritis at an Indian Health Service Hospital
Authors: Gopalakrishnan Vaishnavi
Published: December 2022

Background

In 2015, a rural Indian Health Service Hospital found itself unable to use SMX/TMP due to high E. coli resistance rates. The stewardship team decided to include cefuroxime as a first line agent for outpatient pyelonephritis to have a fluoroquinolone sparing agent. Oral B-lactams are not typically recommended over SMX/TMP or fluoroquinolones for pyelonephritis, however there is sparse literature on the use of cefuroxime. This retrospective review aims to evaluate the efficacy of cefuroxime therapy for acute uncomplicated pyelonephritis over a five-year period.

Methods

528 patients with a diagnosis of pyelonephritis from January 1st, 2015 to December 31st, 2019 were screened. Data collection included 30-day reinfection rates, emergence of ESBL isolates, duration of therapy, one time IV antibiotic administration, urine culture and susceptibility, increased risk (genitourinary abnormalities and diabetes), white blood cell count, and symptoms. Pediatric patients and patients requiring hospital admission were excluded.

Results

264 patients were included and 188 patients received cefuroxime therapy. Baseline characteristics included 94.5% female patients, median age of 44 years, and average duration of therapy of 11.6 days. 95% of the isolates were E. coli. 31 patients had treatment failure defined as a return to the ED with 30 days for UTI. 25 of those patients received cefuroxime and of those, 20 had a one-time IV antibiotic dose. 10 patients with treatment failure had a history of ESBL after the encounter and of those 3 patients had cefuroxime therapy. 5 patients who had treatment failure with cefuroxime had diabetes and genitourinary abnormality.

Conclusion

This review suggests a lower rate of bacteriological cure of acute uncomplicated pyelonephritis with cefuroxime therapy with or without a one-time IV antibiotic dose with a cephalosporin or aminoglycoside.

Disclosures

All Authors: No reported disclosures.
14. Monkeypox viral detection from different body sites. Northern California, June–July 2022
Authors: Srinivasan Krithika , Yuk-Wai Ho Dora Y , Contag Caitlin A , Grant Philip , Karan Abraar , Kappagoda Shanthi , Dieringer Thomas , Styczynski Ashley , Pinsky Benjamin A , Salinas Jorge
Published: December 2022

Background

Unlike prior outbreaks of monkeypox, the 2022 outbreak is unique because lesions have been predominantly noted in the anogenital area, especially among persons identifying as gay, bisexual, or other men who have sex with men. The role of various body sites in monkeypox transmission is currently unclear. We assessed monkeypox PCR positivity from various body sites.

Methods

We collected demographic, clinical, and laboratory data from patients with confirmed monkeypox at Stanford during June–July 2022. We obtained samples from skin lesions, oropharynx, saliva, conjunctiva, urine, semen, and rectum. Monkeypox DNA analysis was performed on site using a quantitative PCR modified from published CDC assays.

Results

During June–July 2022, 10 patients were confirmed to have monkeypox. All were men; median age was 40 (range 24–46). Four patients identified as Hispanic, three as Caucasian, two as African American, and one as Asian. Additionally, three had HIV infection and the remaining seven were on HIV pre-exposure prophylaxis. At the time of diagnosis, eight patients (80%) described a prodrome of fever and malaise. Seven (70%) had genital lesions; the remaining three (30%) presented with only extra-genital lesions. Complications included two patients with proctitis (20%), one with phimosis (10%) and one with tonsillar involvement and impending airway compromise (10%). A total of seven (70%) received tecovirimat, and one was hospitalized. Median time from symptom onset to sample collection was seven days (range 3–14). All patients had at least one skin lesion sample positive for monkeypox virus DNA (Table 1). Six rectal samples (100%), Eight oropharyngeal samples (89%) and two (66%) urine samples were also positive.

Conclusion

We found monkeypox PCR positivity from different body sites. Public health messaging should consider targeting behaviors that involve body sites beyond skin, with particular consideration to mucosal surfaces.

Disclosures

All Authors: No reported disclosures.
LB1531. Administration of Abatacept or Infliximab Reduces Mortality in Hospitalized Patients with COVID-19 Pneumonia: Results from the ACTIV-1 IM Master Protocol
Authors: Ko Emily R
Published: December 2022

Background

Severe COVID-19 infection is characterized by a dysregulated hyperinflammatory state that contributes to morbidity and mortality. Immunomodulatory therapy has been shown to improve outcomes. We investigated if abatacept, CTLA-4-Ig, a selective costimulation modulator, provides additional benefit when added to standard of care.

Methods

We conducted a double-blind, randomized, placebo-controlled trial evaluating abatacept (given as a single infusion of 10mg/kg, to a maximum of 1000 mg) compared to standard of care (including remdesivir and dexamethasone) in patients hospitalized with COVID-19 pneumonia. The primary outcome was median time to recovery by day 29. Key secondary endpoints included 28-day mortality.

Results

A total of 1019 patients received an infusion (509 assigned to abatacept and 510 to placebo), constituting the analyzed modified intention-to-treat cohort. The mean age 54.9 years (SD 14.65), 60.5% were male, 44.2% Hispanic or Latino and 13.7% black. Patients were evenly matched in terms of severity of illness, and comorbidities. Participants randomized to abatacept did not show a statistically significant difference in the primary endpoint with a recovery rate ratio of 1.135 (95% CI 0.996-1.294, p=0.057) compared to placebo. The median (IQR) time to recovery was 9 days (8, 10) for both groups. The 28-day mortality in the abatacept arm was 11.0% and in control arm 15.0% (OR 0.62 (95% CI 0.41, 0.94)), with a 37.8% lower odds of dying in patients receiving abatacept. The improvement in mortality was demonstrated for patients requiring low or high flow O2 at baseline but was not seen in patients who required mechanical ventilation or ECMO at time of randomization. Subgroup analysis identified the strongest effect in those with baseline CRP >75mg/L, age >65 and diabetics. Safety data demonstrated slightly lower risk of adverse events. Rates of secondary infections were similar (abatacept 16.1% and placebo 14.3%).

Conclusion

Although single-dose IV abatacept did not demonstrate statistically significant improvement in time to recovery, it did show a substantial reduction in 28-day mortality compared to standard of care.

Disclosures

All Authors: No reported disclosures.
LB1532. The Impact of COVID-19 on nursing home residents’ clinical, functional, and psychosocial outcomes
Authors: Popejoy Lori , Vogelsmeier Amy , Petroski Gregory , Mehr Daivd , Rantz Marilyn , Miller Steven , Ilboudo Christelle , Johnson Justina Yevu , Dardis Michelle
Published: December 2022

Background

Data on COVID-19 related nursing home infections and mortality accumulated at a rapid pace; yet little is known about the impact of nursing homes’ response to COVID-19 on resident clinical, functional, and psychosocial outcomes.

Methods

We examined aggregated Minimum Data Set (MDS) assessments to describe resident outcomes using an interrupted times series methodology for three timeframes: pre-COVID (1/2019 to 2/2020), pandemic (3/2020–12/2021), and vaccination (1/2021-6/2021). Data included 307,558 federally mandated resident MDS assessments from 60,846 resident in 489 nursing homes in a Mid-Western state. We calculated MDS based quality measures (QM) using definitions available from Centers for Medicare and Medicaid Services. Each QM-based outcome was fit to a logistic regression model using the method of generalized estimating equations.

Results

None of the QMs displayed a statistically significant trend pre-COVID. The prevalence of excessive weight loss and ADL decline increased sharply during the pandemic and reversed that trend with vaccination. Pressure ulcers among high-risk residents followed a similar trend, although pandemic and vaccination-related regression parameters for that QM were only marginally significant (p = .08). Pain worsened during the pandemic and vaccination period approaching significance (p=.07). Antipsychotic medication use worsened in the pandemic (p< .001) and did not improve in the vaccination period. Other QMs including any fall, fall with major injury, and incontinence did not exhibit statistically significant change in trend.

Prevalence Profiles

Circles: Observed proportions, Dashed Line: Model expected value, Solid Lines: 95% confidence limits for expected values

Conclusion

We noted significant changes in QMs for antipsychotic use, ADL loss, and weight loss, with the latter two improving in the vaccination period. Isolation, disease outbreaks, and staffing issues in facilities could have affected these QMs. Data variability may have limited our ability to detect other changes. Antipsychotics may have increased with the need to reduce wandering and other behaviors common in the nursing home population; behaviors high risk for spreading COVID-19. Why antipsychotic use did not improve during the vaccination period is less clear. Data beyond June of 2021 may help clarify the pattern of antipsychotic use.

Disclosures

Lori Popejoy, PhD, RN, FAAN, New Path: Board Member|New Path: Ownership Interest Amy Vogelsmeier, PhD, RN, FAAN, New Path: Board Member|New Path: Ownership Interest Marilyn Rantz, PhD, RN, FAAN, New Path: Board Member|New Path: Ownership Interest.
LB1531B. Administration of the TNF-alpha inhibitor, infliximab, reduces mortality in hospitalized patients with COVID pneumonia. Results of a randomized controlled trial
Authors: O'Halloran Jane A , Anstrom Kevin J , Kedar Eyal , McCarthy Matthew W , Ko Emily R , Melsheimer Richard , Boucher Cynthia , Chang Soju , Bozzette Samuel , Powderly William G
Published: December 2022

Background

Severe COVID-19 infection is characterized by a dysregulated hyperinflammatory state that contributes to morbidity and mortality. Immunomodulatory therapy has been shown to improve outcomes. We investigated if the TNF-alpha inhibitor, infliximab (IFX), provides additional benefit over standard of care.

Methods

We conducted a double-blind, randomized, placebo-controlled trial of IFX (single infusion of 5 mg/kg) compared to standard of care (including remdesivir and dexamethasone) in patients hospitalized with COVID-19 pneumonia. The primary outcome was time to recovery by day 29. Key secondary endpoints included 14-day clinical status and 28-day mortality.

Results

A total of 1033 patients received study agent (517 assigned to IFX, 516 to common placebo), constituting the analyzed modified intention-to-treat cohort. Mean age 54.8 years, 60.3% were male, 48.6% Hispanic/Latino and 14% Black. Randomization was balanced for severity of illness and comorbidities. Participants randomized to IFX did not show a statistically significant difference in the primary endpoint with a recovery rate ratio of 1.13 (95% CI 0.99-1.27, p=0.0631) compared to placebo. The median (IQR) time to recovery was 8 days (7, 9) for IFX and 9 days (8, 10) for placebo. Patients assigned to IFX were more likely to have an improved clinical status at day 14 (OR 1.32; 95% CI 1.05, 1.66). The 28-day mortality was 10.1% in the IFX arm and 14.5% in the placebo (OR 0.59 (95% CI 0.39, 0.90)), with a 40.7% lower odds of dying in patients receiving IFX. The improvement in mortality was demonstrated in patients requiring low- or high-flow O2 at baseline but not in those requiring mechanical ventilation or ECMO. Subgroup analysis identified the strongest effect in those with baseline CRP >75mg/ml. There was no imbalances in serious adverse events. Secondary infections were similar between groups (IFX 18.0%, placebo 16.5%).

Conclusion

Although single-dose IV IFX did not demonstrate statistically significant improvement in time to recovery, it was associated with improvement in clinical status at day 14 and showed a substantial reduction in 28 day mortality compared to standard of care.

Disclosures

Jane A. O'Halloran, MD PhD, Janssen Scientific Affairs, LLC: Grant/Research Support Richard Melsheimer, n/a, Janssen Pharmaceuticals, a Johnson & Johnson Company: Employee of Janssen/J&J|Janssen Pharmaceuticals, a Johnson & Johnson Company: Stocks/Bonds William G. Powderly, MD, Merck: Advisor/Consultant.
LB2303. Single High-dose of Liposomal Amphotericin B in HIV/AIDS-related Disseminated Histoplasmosis: a Randomized Trial
Authors: Pasqualotto Alessandro C , Godoy Cassia M , Lana Daiane Dalla , Leitao Terezinha S , Bay Monica B , Damasceno Lisandra S , Soares Renata B , Falci Diego R , Kist Roger , Silva Larissa R , Melo Marineide , Guimaraes Taiguara F , Guimaraes Marilia R , Vechi Hareton T , Mesquita Jaco , Macedo Erianna Y , Adenis Antoine A , Bahr Nathan C , Spec Andrej , Boulware David R , Israelski Dennis , Chiller Tom M
Published: December 2022

Background

Histoplasmosis is a major AIDS-defining infection in Latin America. Liposomal amphotericin B (L-AmB) is the drug of choice for treatment, but access is limited.

Methods

Prospective randomized open-label trial of induction therapy with L-AmB for disseminated histoplasmosis in AIDS, followed by oral itraconazole therapy (started on the day after L-AmB was finished). We conducted this trial at 6 centers in Brazil (2019-2022). We randomized subjects to 3 arms of: Single dose 10 mg/kg of L-AmB;10 mg/kg of L-AmB on D1, and 5 mg/kg of L-AmB on D3;3 mg/kg of L-AmB for 2 weeks (control).

As a non-inferiority trial, 80% power could detect > 20% non-inferiority margin for a one-sided alpha=0.05 with a sample size of 29 subjects per arm. Clinical response at day 14 was the primary outcome.

Results

Of 512 screened patients, 118 subjects were randomized (Arm 1, n=40; Arm 2, n=39; Arm 3, n=39). Median CD4 was 25 cells/µL. Subjects presented with weight loss (70%), pulmonary complaints (67%), fever (66%), abdominal findings (59%), skin lesions (38%), lymphadenopathy (38%), and oral lesions (36%). Clinical and lab findings did not differ among arms. Histoplasmosis diagnosis was predominantly via urine antigen (97%).

Infusion-related toxicity on D1 was similar in each arm (p=0.56). Kidney toxicity was similar on D3 (p=0.83), D7 (p=0.10), and D14 (p=0.17) as was frequency of anemia, hypokalemia, hypomagnesemia, and liver toxicity (all p >0.05). No subject withdrew due to drug toxicities.

D14 clinical response was 82% for Arm 1, 68% Arm 2, and 72% Arm 3 (p=0.69). Absolute risk difference for Arm 1 was 10.3% (95%CI, -8.3% to 28.8%) vs. Arm 3 controls; Arm 2 was -4.2% (95%CI, -24.9% to 16.4%) to controls. Overall survival on D14 was 89.5% (34/38) for Arm 1, 78.4% (29/37) for Arm 2, and 92.1% (35/38) for Arm 3 (p=0.82); 2 subjects were excluded from efficacy analysis due to meningitis and tuberculosis, and 3 were lost to follow up.

Conclusion

Induction therapy with 10 mg/kg of L-AmB in AIDS-related histoplasmosis was safe. Although efficacy is likely to be non-inferior to standard L-AmB therapy, a confirmatory phase III trial is needed. Such a strategy would markedly reduce drug-acquisition costs (> 4-fold), therefore improving access to L-AmB across the globe.

Disclosures

Alessandro C. Pasqualotto, FECMM, Gilead: Grant/Research Support|United Medical: Advisor/Consultant|United Medical: Honoraria Diego R. Falci, MD, United Medical: Advisor/Consultant|United Medical: Honoraria Andrej Spec, MD, MSCI, Astellas: Grant/Research Support Dennis Israelski, MD, Gilead Sciences: Empoyee.
118. Rapid Uptake of 2014 ACIP Pneumococcal Vaccination Recommendations among Adults Aged 65 or Higher at the Veterans Health Administration
Authors: Kakiuchi Satoshi , Hasegawa Shinya , Suzuki Hiroyuki , Goto Michihiko
Published: December 2022

Background

Vaccination of the 13-valent pneumococcal conjugate vaccine (PCV13) for adults 65 years and older was recommended by the Advisory Committee on Immunization Practices (ACIP) in 2014 until it was withdrawn in 2019. While estimated overall vaccination coverage rates with both vaccines at ∼30% were previously reported using data from surveys or Medicare claims, it is unclear how rapidly the uptake of this ACIP recommendation occurred. We aimed to describe the uptake of the ACIP among the Veterans Health Administration (VHA) population.

Methods

We conducted a retrospective cohort study of patients who were at 65 years or older in October 2014 who were registered in primary care of VHA. The study period was from October 2014 to November 2019. We obtained data on the first PCV13 and 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccination and dropout from primary care follow-up due to death and termination of primary care relationship from the VHA Corporate Data Warehouse. We calculated the monthly proportion of PCV13 and PPSV23 vaccination among primary care follow-up patients in VHA.

Results

We enrolled 2,166,173 patients at the beginning of the study period (median age: 73 (interquartile range: 68–81)), and at the end of the study period, 30% (645,975) were dropout due to death. The numbers of patients who had at least one PCV13 and PPSV23 vaccination at the beginning of the study period were 17,718 (0.8%) and 934,836 (43.2%), respectively. Of the PCV13 used during the study period, 78.4% were administered in the first two years (Figure 1). At the end of the study period, 50.3% of the follow-up patients had been vaccinated with PCV13 and 53.3% with PPSV23 (Figure 2). 55.3% of patients received at least one dose of any vaccine, and 48.2% received both. Figure 1.Administered dose of first PCV13 and PPSV23 among the study populationFigure 2.The proportion of vaccination coverage among the study population

Conclusion

At the VHA, there was a very rapid uptake of 2014 ACIP pneumococcal vaccination recommendations in the first two years, followed by a steady increase. At the end of the study period, the VHA achieved comparable or higher vaccination coverage in this population with both PCV13 and PPSV23 than the previously reported Medicare population. Further studies are needed to elucidate factors contributing to this rapid uptake and improve the implementation of future vaccine recommendations.

Disclosures

Michihiko Goto, MD MSCI, Merck & Co.: Grant/Research Support.