bluuebunny/crossref_metadata_2025 huggingface dataset:
1334. Radiographic Features Associated with Increased Microbiology Culture Yields in Pediatric Orbital Cellulitis
Authors: Cirks Blake T , Claunch Kevin , Deperrior Sarah , Adams Dan
Published: December 2022

Background

Orbital cellulitis is an invasive infection defined by its location posterior to the orbital septum and can result in severe clinical manifestations. Computed tomography (CT) is the recommended imaging modality to assess for extent of disease and the Chandler classification system is used. It has 5 stages (CS): I is preseptal; II has inflammation beyond the orbital septum; III has subperiosteal abscess; IV has orbital abscess; and V has cavernous sinus thrombosis. There is limited data in its association with microbiology culture results. As part of a larger study to capture epidemiological and microbiological trends in pediatric orbital we hypothesize that culture yields and identification of a causative pathogen would increase as CS increases.

Methods

We performed a retrospective analysis using the US Military Health System database. ICD9/10 codes identified Individuals ≤ 21 years from June 2009 to September 2019 with orbital cellulitis. We excluded ophthalmia neonatorum and any cases without radiographic confirmation of orbital involvement. Demographic data, co-morbid diagnoses, imaging studies, microbiology results, and antibiotics prescribed were collected. CT reports were reviewed, and cases grouped by Chandler stage, (CS II-V). Descriptive statistics and χ 2 tests were used for categorical variables when appropriate.

Results

130 cases met the inclusion criteria. 66.9% were male, the median age was 9 years old (IQR 4-17), and 55.4% had a prior diagnosis of sinusitis. 50.7% of cases were classified as CS II, 35.3% as CS III, 13.1% as CS IV, and 0.01% as CS V. Microbiology cultures were positive in 33.8% of cases. There was a significant difference between CS and any culture positivity with p = 0.011 and there was a significant trend between increasing CS and culture positivity with p < 0.003. Staphylococcus aureus and Streptococcus intermedius were the two most commonly identified pathogens, with no significant difference or trend associated with CS.

Conclusion

Overall, our findings demonstrated microbiology yield being low but increases with radiographic characteristics and CS stage. Identification of causative pathogens could increase the likelihood for tailored definitive antimicrobial therapy in pediatric patients with orbital cellulitis.

Disclosures

All Authors: No reported disclosures.
1339. Utility of Next Generation Sequencing Cell Free DNA Testing in Pediatric Patients for Diagnosis and Excluding Infection
Authors: Downey Rachel , Karim Zuena , Russo Susan M , Fernandez Marisol , Murphey Donald , Hauger Sarmistha Bhaduri
Published: December 2022

Background

Next-generation sequencing of microbial cell-free DNA (NGS cfDNA) testing has the potential to quickly diagnose multiple pathogen types. Negative predictive value of NGS cfDNA is not well characterized, but this test has been described as helpful in excluding infection diagnosis.

Methods

This is a retrospective chart review study of 93 consecutive patients with first-time NGS cfDNA testing at a freestanding children’s hospital. Case results and exclusion are in figure 1. Each case was manually reviewed and then adjudicated as useful or not useful to the plan of care by two providers for agreement. Demographics, health history, diagnostics, and treatments were reviewed. Test results were considered useful if the NGS cfDNA test identified the causal pathogen and resulted before conventional testing, or if the test was actionable to help exclude infection. Figure 1.Case inclusion and overall categorization

Results

NGS cfDNA testing identified a pathogen responsible for illness exclusively, or before conventional testing in 15 cases (16%). In 67% (10) of these cases the patient had underlying oncology or congenital cardiac disease. In 11 cases, NGS cfDNA testing was used to change antibiotics (new antibiotic started in 7 cases; changed or deescalated in 2 cases; stopped in 2 cases). NGS cfDNA was used in 24 cases (26%) to help exclude infection as a diagnosis (5 positive for low level pathogens; 19 negative). In 5 cases, the NGS cfDNA test was negative, but conventional testing identified causative pathogens, which are detectable in this test. Of these, 3 were identified in cerebrospinal fluid and not in blood. Figures 2 and 3 describe NGS cfDNA findings. Figure 2:(2A) Demographics (2B) Underlying diagnosis and % positive and usefulFigure 3:Clinical utility of positive and negative tests.

Conclusion

NGS cfDNA testing identified pathogens quickly and correctly in 16% of cases. The test was more often diagnostic in cases with underlying cardiac or oncology diagnosis, rather than in previously healthy patients. It was considered useful for its negative predictive value. However, in 5% of cases, the diagnosis was missed by NGS cfDNA testing. NGS cfDNA testing can provide valuable information regarding diagnosis. We caution against using this test as a single evaluative measure to exclude infection, particularly in cases where disease is suspected outside the bloodstream.

Disclosures

All Authors: No reported disclosures.
1341. Risk Factors for Candidemia after Cardiac Surgery in Pediatric Patients with Congenital Heart Defects
Authors: Kahan Yaara , Tope Samantha G , Ovadia Adi , Shpring Adi , Shatzman-Steuerman Rachel , Sherman Gilad , Barkai Galia , Mandelberg Avigdor , Tasher Diana
Published: December 2022

Background

Candidemia is a serious complication in children with congenital heart defects (CHD) after cardiac surgery. Data on risk factors for postoperative candidemia in this high-risk population remains limited. This study aimed to identify the incidence, outcome, and risk factors for candidemia in this population.

Methods

This retrospective case-control study was carried out at two different pediatric intensive care units between 2004-2019. Candidemia cases were matched with control patients without candidemia. Univariate and multivariable logistic regression analyses were conducted to identify risk factors for postoperative candidemia.

Results

Overall, 105 patients were included. Thirty-five candidemia cases were matched to 70 control cases. The overall incidence of candidemia was 6.3/1000 admissions. The median age of candidemia cases was 4 months (range 16 days to 9.4 years). Crude 30-day mortality of candidemia cases was 43%. Risk factors independently associated with candidemia included cumulative antibiotic exposure for ≥4 days (OR 4.3, 95% CI 1.3-14.6; p =0.02), the need for total parenteral nutrition (TPN) or peritoneal dialysis (OR 6.1, 95% CI 2-18.8; p =0.001), male gender (OR 6.2, 95% CI 1.8-21.6, p=0.04) and delayed sternal closure ≥ 2 days (OR 3.2, 95% CI 1-11.2; p =0.05). The areas under the receiver operating characteristic curves for cumulative antibiotic exposure ≥ 4 days, the need for TPN or peritoneal dialysis, delayed sternal closure ≥ 2 days, male gender, and overall, were 0.74 (95% CI, 0.64-0.84), 0.75 (95% CI, 0.65-0.85), 0.65 (95% CI, 0.53-0.77), 0.65 (95% CI, 0.55-0.77) and 0.87 (95% CI, 0.81-0.94) respectively, which is for overall an excellent discrimination.

Receiver Operating characteristic (ROC) curves for cumulative antibiotic exposure ≥ 4 days, the need for TPN or peritoneal dialysis, delayed sternal closure ≥ 2 days, male gender and overall

Conclusion

We found that postoperative candidemia in patients with CHD is an uncommon complication, occurring mostly in young infants. In our population, cumulative antibiotic exposure ≥ 4 days and the need for TPN or peritoneal dialysis were the strongest independent discriminative risk factors. However, adding previously unreported risks such as gender and delayed sternal closure strengthen the discrimination. Our results may help to define which patients with CHD should be given prophylactic or presumptive antifungal therapy.

Disclosures

All Authors: No reported disclosures.
1344. Infectious Morbidity and Mortality of HIV-Exposed, Uninfected Infants Compared with HIV-Unexposed Uninfected Infants in Botswana
Authors: Dubois Melanie , Jao Jennifer , Sun Shan , Legbedze Justine , Jacobson Denise L , Schenkel Sara , Mmasa Nicholas , Kgole Samuel W , Masasa Gosego , Happel Anna-Ursula , Iwase Saori , Moyo Sikhulile , Jaspan Heather , Powis Kathleen
Published: December 2022

Background

Studies have shown increased risk for infection-related hospitalizations among infants HIV-exposed-uninfected (HEU) compared to infants HIV-unexposed-uninfected (HUU). However, limited data exist during an era of expanded antiretroviral therapy (ART) and improved healthcare access in pregnancy.

Methods

The Tshilo Dikotla study prospectively enrolled pregnant women ≥ 18 years old, both living with HIV (WLHIV) and HIV-seronegative, in Botswana, following mother-infant pairs through 3 years postpartum. Pregnant WLHIV received tenofovir/lamivudine or emtricitabine plus efavirenz or dolutegravir. For this analysis, the primary outcome, infectious morbidity, was hospitalization or death due to an infectious cause for infants in the first 12 months of life. Log-binomial models were fit to assess the association between in utero HIV exposure status and infectious morbidity. Subgroup analysis among infants HEU was performed to assess associations between timing of maternal ART initiation (pre-conception vs. during pregnancy) and infant infectious morbidity.

Results

Of 464 infants, 314 (67.7%) were HEU. Maternal age was higher among WLHIV (30.3 vs. 24.6 years; p < 0.01), as was gravidity (3.0 vs.1.0; p < 0.01). The proportion of WLHIV reporting senior secondary or tertiary education was lower (43.3% vs 72.0%; p< 0.01). A total of 35 (7.5%) infants were hospitalized/died due to infectious causes [26 (8.3%) HEU vs. 9 (6.0%) HUU (p=0.38)]. The most frequent infections were pneumonia and diarrhea/gastroenteritis. There was no significant difference in infectious morbidity by infant HIV exposure status [adjusted Odds Ratio (aOR), 1.17; 95% Confidence Interval (CI), 0.49, 2.81] after adjusting for maternal age, gravidity, income, and education. No association was found between timing of maternal ART initiation and infectious morbidity (aOR 0.60; 95% CI, 0.25, 1.40) among infants who were HEU, after additionally adjusting for maternal CD4 count and HIV viral load.

Characteristics of infants by in utero HIV exposure status

Conclusion

In this small sub-Saharan African cohort, no detectable associations were observed by infant HIV exposure status or timing of maternal ART initiation and infant infectious morbidity. Larger studies are needed to confirm these findings.

Disclosures

All Authors: No reported disclosures.
1346. Viral Suppression Rates Among Children and Adolescents Living with HIV in Baringo County, Kenya
Authors: Rono Robert
Published: December 2022

Background

Annually, 220,000 infants are infected with HIV globally. Kenya has 139,000 children living with HIV and among this, 78.9% know their HIV status, 93.2% are on ART and 67.1% are virally-suppressed. Achieving viral suppression is challenging in children and adolescents residing in resource limited settings. Contributing factors include variability in weight and anti-retroviral pharmacokinetics, pre-treatment drug resistance and poor palatability of drugs. Adolescents’ developmental stage does affect their psychosocial and emotional functions which can have an adverse effect on their health seeking behavior and adherence to ART care and treatment. The study objective was to determine the viral suppression rates among children and adolescents in Baringo county Kenya for the period 2016-2020.

Methods

This was a cross sectional study where retrospective data was analyzed. The study sites were Baringo County hospital (BCRH) and Marigat sub-county hospital comprehensive care clinics (CCC). Electronic medical records of children and adolescents currently enrolled in care were retrieved from the Kenya EMR system. Data collected included demographics, clinical and laboratory data. Descriptive analysis was carried out.

Results

A total of 54 cases were retrieved. Mean age was 8.5 years (SD=5.4), males being 15/29 (52%). Majority, 51/54(94%) had WHO Stage 1 classification, while 4/54 (7.4%) had TB co-infection. The most widely-used treatment regimen was ABC/3TC/LPV/r 19/54 (35%). Regarding viral suppression status, 31/54(57%) were suppressed 10/54; (18.5%) had virologic failure and 13/45 (24%) had missing viral load tests. Majority, 45/53(85%) were retained in care; 4/53(7.5%) lost to follow up and 1/53 (2%) having died.

Conclusion

Viral-suppression was low with significant TB-HIV co-infection while retention to care was good. We recommend intensification of TB screening and improved viral load monitoring rates in this age-cohort. Treatment plans need to be designed to meet the clients’ specific needs. Community ART groups should be optimized and treatment peer champions engaged to support drug distribution and psychosocial support. Learning institutions should be involved in addressing barriers in accessing treatment by school-going children.

Disclosures

All Authors: No reported disclosures.
1348. I can see myself there: Messages of inclusion on ID fellowship program websites
Authors: Tischendorf Jessica S , Filipiak Rachel
Published: December 2022

Background

Fellowship program websites are a key means of recruitment, particularly during all-virtual interview seasons. Perceptions of the value placed on diversity, equity and inclusion (DEI) influence applicant interest in training programs. To attract candidates from diverse backgrounds, infectious disease (ID) fellowship program websites should reflect the importance of diversity to patient care and program culture. Here we describe the current landscape of DEI elements within ID fellowship program websites.

Methods

Data for all ID fellowship programs that participated in the 2022 match were gathered from the NRMP, FREIDA and program websites, including: location, population, census region, university or community affiliation, visas accepted, and number of positions offered. ID fellowship program websites were reviewed for elements that reflect values of DEI, including: 1) presence of a program mission statement and whether it included inclusive language, 2) presence of inclusive language elsewhere, 3) separate DEI webpage, 4) fellow and faculty photographs and biographies on fellowship or division website, 5) statement of nondiscrimination in hiring, and 6) formal programming or support for underrepresented in medicine (URM), women, LGBTQ or disabled trainees.

Results

153 programs participated in the 2022 ID fellowship match; 149 have dedicated websites. Fifty-three programs had fellowship-specific mission statements, of which 14 had language oriented toward DEI. Forty-two (28%) had inclusive language reflected anywhere on their website; 14 (9%) maintained a separate section for DEI. Disclosure of non-discrimination was identified on 74 (50%) of websites. Fellow photos and biographies were available on approximately 60% of division or fellowship websites and faculty photos and biographies on approximately 90% of fellowship or division websites. Mention of formal programming or support for URM (6), women (4), LGBTQ (2) and disabled trainees (2) was uncommon.

Conclusion

Most ID fellowship program websites lack elements that reflect DEI as a priority. Program websites should incorporate inclusive language to attract and support URM, women, LGBTQ and disabled trainees.

Disclosures

Jessica S. Tischendorf, MD, MS, Merck: Grant/Research Support.
1363. Moving from Public Health Outbreak Response to Mitigation for a Regional Outbreak of Highly-Resistant New Delhi Metallo-β-Lactamase-Producing Acinetobacter baumannii in California, May 2020 – April 2022
Authors: Holden Diana , Mitsunaga Tisha , Ahanya Shantala , Trausch Kristy , Haridass Vikram , Levit Rachel , Velasquez Kiara , Garcia Erin , Sardana Neha , Cabral Ashya , Garcia Elias Geraldo , Schneider Emily C , Epson Erin
Published: December 2022

Background

Since May 2020, the California Department of Public Health and 12 local health jurisdictions (LHJ) have responded to a regional outbreak of highly-resistant New Delhi metallo-β-lactamase-producing Acinetobacter baumannii (NDM AB). Starting in October 2021, public health shifted from outbreak response to resource-conscious long-term mitigation in affected healthcare facilities, and prevention of spread to interconnected facilities.

Methods

We defined a case as a patient identified with an NDM AB clinical isolate, or NDM positive colonization screening and epidemiologic linkage. In October 2021, we lengthened the screening interval and changed the screening population in outbreak skilled nursing facilities (SNF) and long-term acute care hospitals to only include high-risk patients (total dependence for activities of daily living, having wounds or indwelling devices, or ventilated); we continued to screen ventilator units in ventilator-equipped SNF, and epidemiologically-linked unit(s) in acute care hospitals. Concurrently, public health initiated a prevention collaborative focused on improving environmental services (EVS) practices in the most affected LHJ, including 3 outbreak and 4 non-outbreak SNF to promote sustainable EVS practice improvement and peer-to-peer learning.

Results

Whereas we identified 170 cases during the outbreak response period May 2020 – September 2021, since October 2021 we identified only 43 cases. Screening test percent positivity decreased from 3.0% (105/3542) through September 2021 to 1.4% (21/1505) since October 2021. During the outbreak response period, we completed 42 infection prevention and control (IPC) onsite assessments that identified poor adherence to core EVS practices; since October 2021, we completed 29 assessments, including 14 for the EVS prevention collaborative.

Conclusion

Long-term mitigation of regional, multifacility novel multidrug-resistant organism outbreaks is possible by implementing a coordinated package of interventions including proactive targeted IPC assessment and support at interconnected facilities, and continued routine public health follow-up at outbreak facilities.

Disclosures

All Authors: No reported disclosures.
1369. Ten Year Trends of Typhus Fever in North Texas: Epidemiologic Characteristics and Clinical Manifestations
Authors: Hopkins Brian J , Hanna John J , Lehmann Christoph U , King Helen L , Medford Richard J
Published: December 2022

Background

Murine Typhus remains endemic in southern California and in southern Texas where it is transmitted by fleas, with opossums serving as the amplifying host. In Texas, the disease is increasingly recognized in municipalities outside its historic rural range and is spreading in a northward distribution. Since its expansion, we have observed increased cases in the Dallas-Fort Worth (DFW) area and aim to describe murine typhus in North Texas from 2011-2021.

Methods

Leveraging the electronic health record, we retrospectively identified 482 individuals tested for murine typhus by Rickettsia typhi (R. typhi) serology in 2 Dallas hospitals. We subsequently collected epidemiologic characteristics, clinical features, and outcomes of 58 patients with positive R. typhi serologies ( >1:64).

Results

Of the 58 patients with positive R. typhi serology, 39 (67%) were male, 45 (78%) were White, and 23 (40%) were Hispanic. Seventy-nine percent had symptom onset between May and November, and 36/58 (62%) were diagnosed in 2020 and 2021. Twenty-six (45%) had exposure to dogs, 18 (31%) to cats, and 13 (22%) to opossums. Twelve (21%) patients were immunocompromised. Fifty-two (90%) had fever, 35 (60%) headache, 26 (45%) nausea and vomiting, 26 (45%) rash, 25 (43%) myalgia, 20 (34%) cough, and 17 (29%) abdominal pain. In 2020 and 2021, 35/36 (97%) patients were additionally tested for COVID-19, and 29/35 (83%) patients had more than one negative SARS-CoV-2 test prior to R. typhi serologies being sent. Twenty-one out of fifty (42%) had an abnormal chest x-ray (CXR) and 28/30 (93%) had an abnormal chest computed tomography (CT). Nine (16%) had hypoxia, 9 (16%) required an intensive care unit, and 3 (5%) required mechanical ventilation. No patients died within 30 days of diagnosis.

Conclusion

Our study highlights the expansion of murine typhus in North Texas (Figure 1) and demonstrates the heightened need for clinicians to be aware of this disease in the appropriate epidemiologic and clinical settings. We also describe increasing rates of respiratory findings, demonstrated through over half of patients having at least one respiratory symptom, and 93% having an abnormal chest CT (findings traditionally associated with severe disease). Figure 1:Heatmap Distribution of Murine Typhus Cases in the Dallas-Fort Worth Metroplex (2011-2021)

Disclosures

Christoph U. Lehmann, MD, FAAP, FACMI, FIAHSI, Celanese: Stocks/Bonds|Markel: Stocks/Bonds|Springer: Honoraria Helen L. King, MD, Gilead Sciences: Grant/Research Support.
1370. The Impact of Increased Recombinant Zoster Vaccine Use on the Burden of Herpes Zoster Among Adults Aged 50 to 59 Years
Authors: Singer David , Salem Ahmed , Stempniewicz Nikita , Ma Siyu , Poston Sara , Curran Desmond
Published: December 2022

Background

Recombinant zoster vaccine (RZV) was approved by the Food and Drug Administration for prevention of herpes zoster (HZ) in adults aged ≥50 years in 2017 and recommended for this population by the Advisory Committee on Immunization Practices (ACIP) in 2018. Since the ACIP recommendation, vaccination rates have been increasing but are suboptimal for adults aged 50-59 years compared to adults aged ≥50 years overall. The objective of this study was to model the change in outcomes associated with improved vaccination rates in this population.

Methods

A multicohort Markov model was used to compare a scenario using the real-world vaccination rate for adults in the US aged 50-59 years in 2020 to a scenario assuming a higher vaccination rate based on that of adults aged 60-64 years in 2020. Outcomes, based on a lifetime horizon, included HZ cases and complications averted, quality-adjusted life-years (QALY), and costs. Model inputs, including age-specific HZ epidemiology, RZV efficacy, real-world RZV series completion, utilities, and costs (direct and indirect), were based on published literature and US sources. The size of the population aged 50-59 years was based on 2020 US census estimates.

Schematic overview of Markov model structure

HZ: herpes zoster; PHN: postherpetic neuralgia

Results

For the 43 million adults aged 50-59 years, increasing the percentage who received at least one dose of RZV from the current estimate of 7.3% in 2020 to 14.6%, assuming 80% series completion, could avoid an additional 504,468 HZ cases. An estimated additional 42,077 post-herpetic neuralgia cases and an additional 56,247 other complication cases of HZ could be avoided. Based on the estimated cases and complications avoided, an additional 5,230 discounted QALYs would be gained. Direct costs could be reduced by an additional $638 million (M) and indirect costs by $493M. With incremental vaccination costs of approximately $1,032M, from a societal perspective, cost savings of $99M would be realized.

Conclusion

Increasing RZV vaccination among adults aged 50-59 years could reduce the burden associated with HZ cases, complications, and result in fewer QALY losses. From a societal perspective, cost savings could be achieved in this population in addition to improved clinical outcomes. These findings demonstrate the potential value of increasing RZV vaccination for adults in the US aged 50-59 years.

Disclosures

David Singer, PharmD, MS, The GSK group of companies: Employed|The GSK group of companies: Stocks/Bonds Ahmed Salem, MSc, The GSK group of companies: Employed Nikita Stempniewicz, MSc, The GSK group of companies: Employed Siyu Ma, PhD, MBBS, The GSK group of companies: Grant/Research Support Sara Poston, PharmD, The GSK group of companies: Employed|The GSK group of companies: Stocks/Bonds Desmond Curran, PhD, The GSK group of companies: Employed|The GSK group of companies: Stocks/Bonds.
1379. Idiopathic Granulomatous Mastitis: Experience at a Cancer Referral Center
Authors: Gutiérrez Cyntia Ibanes , Guerrero-del-Cueto Fuensanta , Román-López Cristina , Nuñez-Luna Luis , Cornejo-Juárez Patricia , Vilar-Compte Diana
Published: December 2022

Background

Idiopathic granulomatous mastitis (IGM) is challenging as it is a rare disease with unknown etiology, risk factors difficult to establish, and controversies regarding its treatment. Here we describe demographic and clinical characteristics of patients with IGM diagnosed at a cancer referral center, as well as the microbial isolates and treatment.

Methods

We reviewed the clinical charts of patients with IGM, diagnosed from 2004 to 2019. Males were excluded. Demographic data, past medical history, signs and symptoms, clinical examination findings, radiological and microbiological results, and treatments were retrieved. Frequencies were calculated for qualitative variables and measures of central tendency and dispersion for quantitative variables. Association between categorical variables was explored with a logistic regression to identify risk factors associated with treatment response.

Results

Two hundred cases of IGM, with a median age of 38 years, were reviewed. Concerning past medical history data, 66 patients (33.8%) were obese; 45 (30.4%) had used hormonal therapy; 6 (3.4%) had an autoimmune disease; 158 (89.8%) had been pregnant and 100 (77.5%) had breastfed. The most common signs were skin induration (65%), a delimited mass (64.5%), and suppuration (52%). On imaging findings, 53.8% was suspicious for malignancy. Culture was performed on 88 patients (44%), 32 had a microorganism isolated, most commonly Staphylococcus spp. (n=16; 51.6%) and Corynebacterium spp. (n=7; 22.6%). The most common treatment was an antibiotic regimen (n=84, 42%). Improvement was noted with the first-line therapy in 92 patients (46%). Fourteen patients (7%) had persistent symptoms and 46 (23%), relapsed. The presence of fever (OR 11.94; CI95% 1.33-106.80; p=0.027) or induration (OR 2.78; CI95% 1.25-6.19; p=0.012) were associated with a poor response.

Conclusion

We describe one of the largest IGM series in Latin America, on a population similar to those from other resource-limited countries. Fever and induration were associated to a greater risk of failure to initial treatment. The isolation of Corynebacterium spp. has also been described in other series. The variation of initial therapeutic strategies is an opportunity to standardize treatment by the means of prospective studies.

Disclosures

All Authors: No reported disclosures.
1395. COVID 19 Incidence rates were not different among high risk health-care workers and non-health workers after SARS-CoV-2 vaccination: a prospective study in Cali-Colombia.
Authors: Rosso Fernando , Torres-Canchala Laura A , Zapata-Vasquez Isabel L , Llanos-Torres Julio , Tafur Eric , Muñoz-Lombo Jenny P , Albornoz Ludwig , Prada-rios Sergio I
Published: December 2022

Background

The seroprevalence of COVID-19 among health-care workers (HCWs) is still not well characterized in Latin America and the Caribbean. The objective of this study was to compare incidence rates (IR) during the COVID-19 pandemic among HCWs vs. non-HCWs in a university hospital in Cali, Colombia. Figure 1Figure 2

Methods

A prospective study was performed. The study included two groups: HCWs with high-risk contact of SARS-CoV-2 infections vs. administrative hospital workers (non-HCW). Seroprevalence of SARS-CoV-2 antibodies between both groups was compared according to vaccination history and confirmed SARS-CoV-2 infection during follow-up (March 6th, 2020, to February 28th, 2022). The study was developed in three phases according to the infection waves in Colombia, measuring antibodies anti-nucleocapsid and anti-spike serum concentration in each one. A descriptive analysis was done to compare both groups and IR per month (Figure 1).

Results

480 participants were included, 291 (60.6%) were HCWs, and 189 (39.4%) were non-HCWs. After the second wave and before vaccination, the accumulative seroprevalence was 40.6%: 49.1% of HCWs vs. 27.5% of non-HCWs (p< 0.001). 9.2% of HCWs and 7.9% of non-HCWs seropositive individuals had an asymptomatic infection (p=0.447). Of the 51.9% of susceptible HCWs and 72.5% of susceptible non-HCWs before the third wave, the risk of developing SARS-CoV-2 infection was 9.2% and 12.8%, respectively. After 24 months, the infection rate was higher in HCWs and non-HCWs (55.6% vs. 41.9%, p< 0.001) (Figure 2). The total IR was 31.4/1,000 person-month, with an IR difference of 21/1,000 person-month being higher in HCWs comparing non-HCWs (40.7 vs. 19.8, p< 0.001), but after vaccination (April 2021), the IR difference was not significative (IR difference 5%, p=0.1605). The asymptomatic disease was 9.8% of HCWs vs. 10.2% of non-HCWs. Since vaccination, 93.6% of workers had positive anti-S antibodies after 2 doses; and 100% had them after 3rd dose. SARS-CoV-2 Omicron variant increased cases during the fourth wave, more in non-HCWs.

Conclusion

Before vaccination, HCWs had higher infection rates, mainly after the second wave. However, after the immunization, the IR in both groups significantly decreased and equalized in both groups.

Disclosures

All Authors: No reported disclosures.
1397. COVID-19 Hospitalizations in North Texas: Impact of Insurance Status
Authors: Jain Mamta K , Zhang Yi , Thamer Mae , Harms Michael , Smartt Jillian , Baierlipp Stefanie , Bhavan Kavita
Published: December 2022

Background

Texas has one of the highest rates of uninsured populations in the US (Fig1). We hypothesized that those without insurance were more likely to be hospitalized for COVID-19 but were at higher risk for severe disease and mortality due to uncontrolled medical illness prior to hospitalization.

Methods

We conducted a retrospective analysis of patients hospitalized in 81 hospitals in Dallas- Ft. Worth (DFW) area. All inpatients and outpatients with COVID-19 from 3/1/2020 to 4/1/2021 were included to examine risk for hospitalization. Subset analysis included those hospitalized with COVID-19. Data presented is comparison between Medicaid and uninsured population as they were similar in age distribution (Fig 2).

Results

198, 174 COVID-19 unique individuals were identified; 7.5% had Medicaid and 25.1% were uninsured. Among Medicaid, 29.6% were hospitalized vs. 25.8% of Medicaid vs. uninsured (adjusted odds ratio (aOR) 1.26 (1.20, 1.33). Among the 71,778 (∼36%) hospitalized for COVID-19, comparing Medicaid vs. uninsured: 44.9 vs. 56.3% had ICU care; 51.4% vs. 80.2% had pneumonia, 41.1% vs. 67.5% had respiratory failure with higher odds of developing these outcomes in uninsured (see Table 1). Median duration of hospital stay was longer in uninsured than Medicaid ( see Table 2a) and mortality in the hospital was 7.4% vs. 7.9% among Medicaid vs. uninsured (p< 0.0001). Thirty-day readmission rates were lower for Medicaid vs. uninsured (Table 3). In the year prior to the COVID-19 hospitalizations, use of health care among the uninsured was lower compared to Medicaid patients for outpatient, inpatient, and ER visits (p< 0.0001 for all comparisons; see Table 2b).

Conclusion

Uninsured in North Texas had lower odds of hospitalization vs. Medicaid patients, likely due to younger age, but once hospitalized had higher risk for COVID pneumonia, ICU care, and respiratory failure. Median number of days was higher among uninsured but in-hospital mortality was higher among Medicaid population. Prior contact with healthcare system was lower among uninsured and 30-day readmissions were also lower, suggesting barriers accessing health care. Poorer outcomes among uninsured once hospitalized may be due to untreated co-morbidities (Fig 3). Expansion of Medicaid has the potential of ameliorating these disparities. Figure 3Conclusion graphic

Disclosures

Mamta K. Jain, MD, MPH, Gilead Sciences: Grant/Research Support|GSK/ViiV: Grant/Research Support|Janssen: Grant/Research Support|Merck: Grant/Research Support|Regeneron: Grant/Research Support Mae Thamer, PhD, Gilead: Grant/Research Support Kavita Bhavan, MD, MPH, Gilead: Grant/Research Support.
1398. Disparities in HIV continuum of care in the pediatric population: a real-life study in Brazil
Authors: Ferreira Alexandre A C M , Pinho Rosana Gonçalves Gonçalves , De Aquino Lais M , Perini Filipe B , Fonseca Fernanda F , Tressi Alexsana S , Pereira Gerson F M , Avelino-Silva Vivian I , Pascom Ana Roberta
Published: December 2022

Background

The pediatric HIV follow-up is challenging, and treatment indicators are markedly distant from UNAIDS goals. In this study, we describe the 2019 Brazilian HIV cascade according to age categories and sociodemographic variables and address temporal trends between 2009-2019.

Methods

We obtained data from the Brazilian Ministry of Health monitoring database. Cascade outcomes included retention in care, antiretroviral use, and viral suppression. The effect of age on timely initiation of antiretroviral treatment (ART, initiation with CD4+ T cell count ≥350 cells/mm3 or a first ART dispensation ≤30 days after the first CD4+ T cell measurement) and detectable HIV viral load (>50 copies/mL) was assessed in univariable and multivariable analysis adjusted for gender, race, and Social Vulnerability Index (SVI). Temporal trends in timely ART initiation and viral suppression were evaluated graphically.

Results

Among 771,774 people living with HIV (PLHIV), those from youngest age categories had poorer indicators in the care cascade (Figure 1). PLHIV in younger age groups, those with higher SVI, and those declaring black and native Brazilian race/ethnicity, had higher odds of having detectable viral load and delayed ART initiation (Table 1).Social aspects are also associated with worse outcomes. Although children living with HIV tend to start ART with higher CD4+T cell counts, time-series analysis suggest that improvements observed in the adult population do not extend to the pediatric population (Figure 2)

Continuum of care in Brazil, 2019

Retention in care, antiretroviral use and viral load suppression in people living with HIV under care in the Brazilian Unified Health System in 2019, overall and by age category (N=771,774).

Temporal trends, Brazil (2009-2019)

Temporal trends of timely initiation of ART based on a CD4+ T cell count ≥500m/mm3 (panel A), timely initiation of ART based on a first ART dispensation ≤30 days after the first CD4+ T cell count measurement (panel B) and viral load suppression (panel C) overall and according to age categories between 2009 and 2019 in Brazil. Table 1Associations between demographic variables and timely initiation of ART (based on a CD4+ T cell count ≥350m/mm3 or ≤30 days after the first CD4+ T cell count measurement) and detectable viral load using univariable and multivariable logistic regression models in the 2019 dataset.

Conclusion

Our results highlight the challenge faced by children and adolescents living with HIV to achieve UNAIDS goals. Lower access to ART among children is a central barrier to improve pediatric care.

Disclosures

All Authors: No reported disclosures.
1403. Facilitators and barriers to latent tuberculosis infection diagnosis and care in Massachusetts: a convergent mixed methods study of clinicians
Authors: Campbell Jeffrey , Adusumelli Yamini , Tabatneck Mary , Sherman Susan N , Lamb Gabriella S , Sabharwal Vishakha , Goldmann Don , Epee-Bounya Alexandra , Haberer Jessica , Sandora Thomas J
Published: December 2022

Background

Understanding barriers and facilitators to latent tuberculosis infection (LTBI) diagnosis and care is needed to successfully treat children/adolescents with LTBI in the US. We explored physicians’ perspectives on pediatric LTBI diagnosis and care, and strategies to improve care.

Methods

We conducted a convergent mixed methods study with physicians in Massachusetts. Participants were purposefully sampled from primary care clinics (n=10), clinics seeing immunocompromised patients (n=2), and TB clinics (n=2). Physicians participated in individual qualitative semi-structured interviews exploring experience and comfort with LTBI care, and perceived barriers and facilitators to care. We used applied thematic analysis to analyze transcripts. Participants completed surveys to assess comfort with LTBI care and volume of LTBI patients in their care.

Results

Of the 25 physicians invited, 14 participated. Most participants reported “medium” or “high” comfort with current LTBI guidelines; volume of LTBI care varied by physician type (Table 1). Analysis revealed perceived barriers (Figure 1) at four steps of care: 1) identification of risk and testing for LTBI (e.g., family/patient risk perception, physician knowledge gaps), 2) completion of referral after a positive test (e.g., communication barriers), 3) treatment acceptance and initiation (e.g., lack of social support), and 4) treatment adherence and completion (e.g., adolescents’ emerging autonomy). Facilitators such as protocolized screening, counseling strategies, free medication, and telehealth (Figure 2) overcame some barriers. Important emergent themes included: 1) COVID-19 has induced rapid positive and negative changes in LTBI care in primary care clinics; 2) immigrant adolescents are uniquely at risk for disengagement due to lack of social support; and 3) physicians and clinics are ill-equipped to provide TB care for patients’ close contacts, despite knowledge of need for care. Table 1.Volume of patients by clinician type (N=13 respondents)Figure 1.Barriers to LTBI diagnosis and care.Figure 2.Facilitators of LTBI care.

Conclusion

Lack of perceived risk, family and clinic resource constraints, and accessibility challenges hindered LTBI care; protocolized screening, telehealth, and free medications were among the facilitators that overcame some but not all barriers. These results will inform improvement of LTBI care within and between clinics.

Disclosures

Jessica Haberer, MD, MS, Merck: Advisor/Consultant|Natera: Stocks/Bonds.
1406. IMPACT (Infection Management Plus Addiction Care Together): A Combined Contingency Management Pilot for Substance Use Disorders & Antibiotic Adherence in the Acute Care Setting
Authors: Appa Ayesha Ashley , Stein Brianna , Baral Stefan , Knight Kelly , Gandhi Monica , Coffin Phillip , Martin Marlene
Published: December 2022

Background

Amidst interrelated problems of increasing infections related to drug use and overdose deaths, contingency management (CM) is an underutilized substance use disorder treatment that leverages incentives for objective behavior change. CM implementation outside of drug treatment settings is limited, despite its regard as gold-standard treatment for stimulant use disorder and potential use to support infection treatment completion.

Objective: to describe feasibility and preliminary effectiveness of a novel CM program incentivizing reduced drug use and antibiotic adherence in the acute care setting.

Methods

We conducted a pilot of twice weekly CM in an urban public hospital and its attached skilled nursing facility with escalating opportunities to earn incentives from a fishbowl based on 1) antibiotic adherence and/or 2) absence of stimulants or opioids on urine drug testing. Eligible participants were people with stimulant and/or opioid use disorders hospitalized for at least 2 weeks of infection treatment. We measured feasibility via visits attempted/completed and cost of gift cards dispensed. We evaluated effectiveness via antibiotic completion, discharge type, and participant perception of intervention effectiveness collected via structured survey.

Results

Between March-April 2022, n=9 participants were referred to IMPACT, and n=7 were enrolled. Most participants (5/7) required antibiotics for osteomyelitis, and most had stimulant use disorder (methamphetamine, 5/7) and opioid use disorder (fentanyl, 5/7). In 4 of 7 instances, multiple visits were necessary to complete a CM visit, and participants earned between $10-$350 during intervention. Only 1 participant self-directed discharge without antibiotic completion. Most participants reported CM “extremely effective” in supporting antibiotic completion, though were more likely to describe CM as moderately effective (range 5-8/10) in addressing drug use reduction.

Conclusion

CM for patients with stimulant and/or opioid use disorders needing prolonged antibiotics in acute care settings may be effective in supporting antibiotic completion, and additional exploration is needed to understand both program feasibility and its role in supporting reduced drug use for participants after discharge.

Disclosures

All Authors: No reported disclosures.
1413. Regional variation in substance use associated infectious endocarditis in New York State: 2000-2014.
Authors: Carey Edward T , Hrycko Alexander , Kapadia Shashi , Eckhardt Benjamin
Published: December 2022

Background

Injection drug use is a significant and growing public health concern in New York State (NYS). Infectious endocarditis (IE) is a serious complication of injection drug use, and is associated with significant morbidity and mortality, prolonged hospitalizations, and high healthcare costs.

Methods

Data was extracted from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP)’s New York State Inpatient Database (SID) to determine incidence of IE in New York between 2000-2014. The HCUP-SID database includes inpatient discharge records from hospitals across the state regardless of payer and contains information on inpatient healthcare utilization. Regional incidence was then calculated using population values from the 2010 regional census. Cost of hospitalization was derived from the HCUP using the cost to charge ratio (CCR) file to estimate the cost of inpatient hospital stays.

Results

During the study interval the number of statewide substance use-associated IE cases fluctuated between a low of 262 cases in 2000, and a high of 362 cases in 2007. Approximately 70-80% of the patients with substance use-associated IE in NYS in this study were insured through public programs (Medicare or Medicaid). In-hospital mortality from substance use-associated IE appears to be decreasing slightly, however, there is an accompanying increase in hospital costs, in part due to long average length of hospital stays between 13 and 18 days. The mean cost of hospitalization rose notably from $51,934 to $134,325 over the course of our study. Over 10% of hospitalizations culminated in patient directed discharges. Over the study period New York City’s incidence rates appeared to decrease while other region’s incidence rates appeared to increase, specifically in the Capital District, Central New York, and Southern Tier regions.

Trends in substance use associated infectious endocarditis in NYS

This figure shows trends in endocarditis in the study period. It shows a rise in cases in substance use associated endocarditis in NYS in less urban areas.

Conclusion

Between 2000 and 2014 the rates of substance use-associated infective endocarditis in NYS fluctuated but remained fairly constant. Despite the relatively constant statewide rates, there was important regional variation, including decreasing incidence rates of SUIE in New York City and rising incidence rates in non-New York City counties.

Disclosures

Shashi Kapadia, MD, GIlead: Grant/Research Support.
1659. Association of Rurality and Identifying as Black with Receipt of Specialty Care among Patients Hospitalized with Diabetic Foot Ulcers: a Medicare cohort study
Authors: Taylor Lindsay , Gangnon Ronald , Powell Ryan , Kramer Joseph , Kind Amy J , Bartels Christine , Brennan Meghan B
Published: December 2022

Background

Among those with diabetic foot ulcers, rural patients identifying as Black face at least 10% greater risk of major amputation or death compared to the US as a whole. As specialty care is associated with lower risk of major amputation, this difference could be driven by specialty care access. We hypothesize that rural patients and, particularly, rural patients identifying as Black, receive less inpatient specialty care compared to the overall cohort.

Methods

We built a cohort of all Medicare patients hospitalized with diabetic foot ulcers (2013–2014). Rurality was measured using Rural Urban Commuting Area codes. Race was categorized using the Research Triangle Institute algorithm. Specialty care was defined as receiving inpatient care from at least 1 of 6 relevant specialties to address diabetes, infection, biomechanics or vascular disease, per National Provider Taxonomy codes: endocrinology, infectious disease, orthopedic surgery, plastic surgery, podiatry, and vascular surgery. We reported observed differences in specialty care, overall and stratified by rurality, identifying as Black, and ulcer severity. Pearson X2 tests were performed on observed frequencies.

Results

Overall, 32.2% of the cohort received inpatient specialty care. This proportion decreased to 29.6% for rural patients (X2 = 36.2, p ≤ 0.001) and 26.2% for rural patients identifying as Black (X2 = 19.5, p ≤ 0.001). Among those with osteomyelitis, 54.3% of the cohort received specialty care, while only 49.5% of rural patients, 50.8% of patients identifying as Black, and 37.6% of rural patients identifying as Black received specialty care; the disparity for rural patients identifying as Black was greater than the sum of rural and racial disparities (4.8% for rural + 3.5% for Blacks = 8.3% versus a 16.7% observed difference for rural Blacks; Figure 1). Notably, only 2.7% of patients presenting with osteomyelitis were seen by an infectious disease specialist. This proportion decreased to 2.5% for rural patients.

Observed Proportions of Patients Receiving Specialty Care Stratified by Rurality, Identifying as Black, and Ulcer Severity

Conclusion

A smaller proportion of rural patients received specialty care, and rural patients identifying as Black were half as likely to receive specialty care than the overall cohort. Improving specialty access for these high-risk patients may reduce disparities in major amputations.

Disclosures

All Authors: No reported disclosures.