bluuebunny/crossref_metadata_2025 huggingface dataset:
2609. Comprehensive cost assessment among families with children younger than 2 years-of-age hospitalized with RSV infection
Authors: Ampofo Krow , Heller Evan G , Adua Lazarus , Lovebridge Abbey , Miller Kaleb , Werdan Kathrine Lindsey , Gesteland Per H , Ruggieri Madelyn , Finelli Lyn , Choi Yoonyoung
Published: November 2023

Background

Respiratory Syncytial Virus (RSV) is a major cause of childhood lower respiratory tract infection (LRTI) in the U.S. While RSV hospital (direct) cost is well described, the impact on work productivity and additional RSV-related (indirect) costs are not known. We describe direct and indirect cost occurring to a family before, during, and after child’s RSV hospitalization.

Methods

We prospectively identified children < 2 years of age hospitalized with laboratory-confirmed RSV LRTI at Primary Children’s and Riverton Hospitals, Salt Lake City, UT, from 12/2019 to 5/2022. RSV hospitalization-related cost consisted of 1) Hospital cost, 2) indirect costs occurring between a week before admission and up to 2 weeks post discharge, and 3) productivity loss of caregivers during child’s admission. We abstracted hospital financial data and surveyed caregivers using a questionnaire developed for the study, along with the Work Productivity and Activity Impairment Questionnaire: Child’s Hospitalization for Respiratory Illness instrument.

Results

During the study period, 684 children < 2 years were hospitalized with RSV LRTI with a median length of stay 1.8 days (IQR 1-3.1 days) and mean hospital cost of 2023 USD $11703 (std: $25292). Of the 146 (21%) caregivers who participated in the survey, 140/146 (96%) reported at least one caregiver is currently employed and 123/146 (79%) were female. One week prior to admission, 109/146 (75%) visited a healthcare facility and spent a mean of $58 (std $129) out of pocket cost for the visits, medication, and additional childcare. Before RSV hospitalization, 81/140 (58%) employed caregivers lost work hours (hrs) (mean 15 hrs; std 15 hrs) and had an average productivity impairment score of 4.4 out of 10 (std 3.6) (10=worst impairment). After discharge, 68/146 (47%) children required a healthcare visit, 67/140 (48%) caregivers lost work hrs (mean 27 hrs; std 32 hrs) and spent a mean of $93 (std $206) out of pocket cost. (Table)

Conclusion

The hospitalization of children < 2 years with RSV LRTI is associated with significant costs during and after hospitalization. These costs include caregivers’ loss of work hours and additional out-of-pocket costs. Our data support the need for RSV vaccines and immunoprophylaxis to prevent RSV hospitalization.

Disclosures

Krow Ampofo, MBChB, Merck: Advisor/Consultant|Merck: Grant/Research Support Lyn Finelli, DrPH, MS, Merck&Co: Stocks/Bonds Yoonyoung Choi, PhD, MS, RPh, Merck: Employed|Merck: Stocks/Bonds
2623. Persistence of SARS-CoV-2 S IgG Antibodies in Children that suffered from COVID-19 and Association of Antibody Levels with Vaccination Status
Authors: Di Gregorio Federico , Tineo María S , Bonnin Florencia A , Torrado Lidia , Pavan María F , Ibañez Lorena I , Toledano Analía , Caratozzolo Ana , Acosta Patricio L , Contrini Maria M , Talarico Laura , López Eduardo L
Published: November 2023

Background

Serum levels of IgG antibodies against SARS-CoV-2 spike protein (S) in children who suffered COVID-19 have been found to last between 4 to 12 months. We aimed to characterize the antibody response against SARS-CoV-2 after 1 year of COVID-19 in unvaccinated and vaccinated children.

Methods

A cohort study included unvaccinated and vaccinated children (< 18 years) with a previous SARS-CoV-2 infection. Blood samples were collected during the acute phase, in convalescence and 1 year after suffering the disease. For comparative purposes, vaccinated adult relatives who suffered COVID-19 in the same period were included. SARS-CoV-2 S IgG serum levels were determined by immunoassay. Neutralizing activity was determined by the decrease of GFP expression in SARS-CoV-2 S-pseudotyped lentivirus infected HEK-293T cells.

Results

Eighty-four children were included, median age 8 years (IQR 2-12), 54% (n=45) were females; 38% (n=32) were vaccinated. Also, 50 adults were studied, median age 35 years (IQR 29-44), 76% (n=38) were females. SARS-CoV-2 S IgG levels 1 year after COVID-19 decreased 2.2- to 10.8- fold compared to convalescent levels in unvaccinated children. SARS-CoV-2 S IgG titers positively correlated with neutralizing antibody titers in convalescence and 1 year after COVID-19 (p< 0.05). SARS-CoV-2 S IgG levels were significantly higher in children with incomplete (p=0.0088) and complete/booster (p< 0.0001) vaccination as compared to unvaccinated children. Children that received mRNA vaccines showed higher SARS-CoV-2 IgG titers than children that received an inactivated vaccine (p< 0.0001). SARS-CoV-2 S IgG titers positively correlated with age in vaccinated children (rS=0.4303, p=0.014). SARS-CoV-2 IgG titers 1 year after COVID-19 did not associate with disease severity or the presence of comorbidities. No significant differences in SARS-CoV-2 S IgG levels were found between vaccinated children and adults, at the same vaccination level.

Conclusion

These findings highlight the importance of child vaccination to maintain a long-term humoral immune response against SARS-CoV-2 despite having been infected. Also, mRNA vaccines elicited a higher antibody response than inactivated vaccines against SARS-CoV-2 in children.

Disclosures

All Authors: No reported disclosures
2667. Bridging the Gap: Sexually Transmitted Infections Testing, Treatment, and Prevention at a Miami Syringe Services Program for Women Who Inject Drugs
Authors: Herrera Tara E , Faraldo Monica , Forrest David , Hervera Belén , Ciraldo Katrina , Tookes Hansel , Chueng Teresa A
Published: November 2023

Background

Women who inject drugs (WWID) remain understudied despite their compounded vulnerability to HIV. WWID experience increased mortality and multilevel barriers to care, including violence, homelessness, stigma, and competing priorities of childcare. In 2016, Florida passed the Infectious Disease Elimination Act (IDEA), legalizing IDEA Syringe Services Program (SSP) as the first in the state. Located in one of the country’s highest-incidence areas of HIV, IDEA SSP in Miami offers harm reduction and health opportunities outside of the traditional health care system. Previous IDEA SSP data show that WWID, representing 27% of participants overall, are more likely to report opioid injection, syringe sharing, injecting more than 5 times a day, sexual activity in the past 30 days, and transactional sex compared to their male counterparts.

Methods

IDEA SSP offered sexually transmitted infection (STI) testing and treatment July 1, 2022 through March 31, 2023. This descriptive study included women of childbearing age (18-44 years old) who injected drugs and were SSP participants (N=47).

Results

Among chlamydial infections, 2.1% had oropharyngeal, 4.3% had urethral, and 6.4% had rectal involvement. Three women (6.4%) experienced both gonococcal pharyngitis and urethritis. Rectal gonorrhea was detected in four of the 47 women (8.5%), with half testing positive twice within a 3-month period. 14 women (29.8%) demonstrated reactive syphilis testing.

Of 37 women consenting to testing, three screened positive for pregnancy (8.1%). One had gonococcal pharyngitis, proctitis, and urethritis and two had other STI co-infections.

Within this cohort of 47 women, 31 of the 32 HIV-negative participants initiated pre-exposure prophylaxis (PrEP) of HIV at IDEA SSP. Of the 12 with HIV, 83% reported adherence to antiretroviral therapy (ART). Three women had unknown HIV status.

Conclusion

Despite high HIV/STI co-infection and stigma precluding care in traditional health settings, WWID accessing IDEA SSP engaged with PrEP/ART and STI screening, including 100% of women receiving treatment for gonorrhea, chlamydia, and syphilis. Tailoring STI services at an SSP where WWID access nonjudgmental care caters to a historically neglected but key cohort in Ending the HIV Epidemic.

Disclosures

Hansel Tookes, III, MD, MPH, Gilead sciences: Grant/Research Support|Viiv: Grant/Research Support
2673. Clinical and Demographic Characteristics of Suspected and Confirmed Monkeypox Patients: An Observational Cohort Study
Authors: Kundro Mariana A , Viloria Guillermo , Pastor Isabel , Serena Marina Alonso , Losso Marcelo H
Published: November 2023

Background

Monkeypox (mpox) infection is a re-emergent disease of public health concern worldwide.

Methods

All the patients with suspected mpox infection attending a large public sexual health clinic in Buenos Aires, were included in this single center, observational cohort study. Confirmed case of mpox was defined as a positive real time PCR of either skin lesions or anal/oropharynx swab samples. We aimed to describe clinical features and evolution of confirmed cases and to compare characteristics of confirmed and unconfirmed individuals during a mpox outbreak in Argentina.

Results

Of the 85 patients (96.47% male, 90.12 % MSM, mean age 34 years) with suspected mpox between July 2022 and March 2023, 60 (70.48%) had a confirmed diagnosis. All the patients presented skin and/or mucous rash with a median time from the onset of symptoms of 6.0 (IQR 4-7) days. Lesions were most commonly distributed on genital area (57% of confirmed cases), followed by perianal region in 37% of patients. Dysphagia was reported in 31.7% vs. 20% of confirmed and unconfirmed subjects respectively (p: 0.27) , whereas proctitis symptoms were more often in mpox cases (35.0 vs 12.0%; p: 0.01). Syphilis was diagnosed in 60% of the cohort. Compared to unconfirmed patients, mpox patients were more likely to be MSM (98.3% vs. 88%; p: 0.04) and PrEP users (50.0 vs. 18.7%; p:0.03) . We found no differences among groups regarding HIV status (30% vs. 36%; p: 0.58). Main alternative diagnoses in unconfirmed patients were syphilis in 44% and HIV infection in 8% of individuals.

Hospitalization rate was 4.25 % (5/85). Admissions in mpox group were due to: cellulitis (n:1), pain control (n:1), tonsillar abscess (n:1) and infectious mononucleosis/acute HIV coinfection (n:1). Other complications reported were penile edema (n:3) , skin sobreinfection (n:2), severe dysphagia (n:1) and conjunctivitis (n:1) One patient was admitted in the unconfirmed group due to severe sepsis. There were no fatal cases.

Conclusion

We found that almost a third of participants had no confirmed diagnosis of mpox infection despite high clinical suspicion in this cohort. MSM and PrEP users were more likely to be diagnosed with mpox. The elevated rate of concomitant syphilis reflects that patients should always be tested for other STIs.

Disclosures

All Authors: No reported disclosures
2679. Assessment of Sexually Transmitted Infection Incidence, Screening and HIV PrEP Uptake Among US Veterans with Opioid Use Disorder in Long Island, New York
Authors: Srivastava Pronoma , Modi Viraj , Lier Audun J
Published: November 2023

Background

Rates of sexually transmitted infections (STI) are on the rise in the US. Persons who inject drugs (PWID) and persons with opioid use disorder (OUD) are at an increased risk for acquisition of STI via high-risk sexual behavior concurrent with substance use. This study aims to compare rates of STI screening and diagnosis, hepatitis vaccination history, and receipt of HIV pre-exposure prophylaxis (PrEP) between PWID and non-PWID with OUD who presented to the Northport Veterans Affairs Medical Center (NVAMC).

Methods

Data was collected from a retrospective chart review of US Veterans (USV) aged >18 years who presented to the NVAMC between 2010-2020 and carried an ICD9 or ICD10 diagnosis of OUD. Rates of STI screening and diagnosis, hepatitis A (HAV) and B (HBV) vaccination status, and receipt of PrEP were compared between PWID and non-PWID using either a two-sample T-test or Chi-square analysis.

Results

We identified 502 USV with a diagnosis of OUD. Mean age was 52.6 years, 469 (92.4%) were male, 396 (78.9%) were white, 172 (34.8%) were employed and 216 (43%) had health insurance. A total of 337 (67.1%) USV had a history of cocaine use and 216 (43%) had a history of injection drug use. An STI was diagnosed in 51 (10%) USV, most frequently herpes simplex virus 1 or 2 (n=19, 3.8%), followed by syphilis (n=9, 1.8%). There was no difference in rates of STI between PWID and non-PWID USV. Eleven (2.2%) USV had HIV and 144 (28.7%) had HCV. A total of 411 (81.9%) USV received screening for HIV, 438 (87.3%) for HCV, 371 (74%) for syphilis, 160 (31.9%) for gonorrhea, and 169 (33.7%) for chlamydia. PWID were more likely to be screened for HIV (93.5% PWID vs. 73.1% non-PWID, p< 0.001), HCV (95.8% PWID vs. 80.8% non-PWID, p< 0.001) and syphilis (80.0% PWID vs. 69.2% non-PWID, p = 0.006) and to be vaccinated against HAV (73.6% PWID vs. 44.1% non-PWID, p< 0.001) and HBV (77.7% PWID vs. 54.3% non-PWID, p< 0.001). PrEP was prescribed in 4 (0.8%) USV.Table 2.STI screening rates and diagnoses among US Veterans with OUD, stratified by injection substance use. PWID, persons who inject drugs. STI, sexually transmitted infection. HAV, hepatitis A virus. HCV, hepatitis C virus. HSV, herpes simplex virus. PrEP, pre-exposure prophylaxis.Figure 1.Rates of STI Screening among PWID and non PWID with OUD who presented to Northport VAMC. STI, sexually transmitted infection. PWID, persons who inject drugs. OUD, opioid use disorder.

Conclusion

Among USV with OUD screening rates for gonorrhea and chlamydia occurred less frequently than for syphilis, HCV and HIV. PWID were more likely to be screened for HIV, HCV, and syphilis than non-PWID. There were low rates of PrEP uptake. USV with OUD may benefit from increased STI screening as well as linkage to PrEP evaluation and treatment.

Disclosures

All Authors: No reported disclosures
2686. High HIV and STI Rates in Patients with MPOX Identified in a Large National Database
Authors: Alfego David , Dale Suzanne , Curanovic Dusica , Boles Deborah , Williams Jonathan , Harris Ayla , Urban Thomas J , Walworth Charles M
Published: November 2023

Background

In mid-2022, mpox virus infection emerged outside of African countries to which it is endemic. Infections increased worldwide and were identified in 16 countries by late June 2022, with the US documenting the highest number of cases. Here we report patient characteristics and assess coinfection rates between those who tested positive for mpox and those who tested negative.

Methods

On July 6, 2022, an FDA-approved PCR-based test for mpox (Orthopoxvirus) was launched with high-throughput modifications. The test is a qualitative assay that uses DNA extracted from swabs of the viral rash. Clinicians were instructed to swab or brush the base of the lesion for sample submission. Test volumes were evaluated, and mpox positivity rates were assessed by sex, age, and geography. Coinfection with HIV, HBV, HCV, and STIs was also assessed. Differences in coinfection rates were assessed for significance using chi square testing with Bonferroni correction for multiple comparisons.

Results

Between July 6 and November 30, 2022, 48,818 samples were tested for 38,388 unique patients; 12,045 (24.7%) samples and 8,247 (16.9%) unique patients were positive for mpox. The median age of patients who tested positive was 35 years and 96.5% were male. Patients who were positive for mpox compared to those who were negative had significantly higher rates of coinfection with HIV (22.9% vs 6.0%, p< .0001), HBV (2.3% vs 1.6%, p< .005), chlamydia (10.4% vs 7.5%, p< .0001), gonorrhea (13.4% vs 7.3%, p< .0001), or syphilis exposure (11.0% vs 2.9%, p< .0001). In contrast, patients who tested negative for mpox compared to those with mpox had significantly higher rates of coinfection with HSV-1 (15.7% vs 1.7%, p< .0001), HSV-2 (10.5% vs 3.2%, p< .0001), VZV (14.1% vs 0.3%, p< .0001) and exposure to HCV (5.0% vs 4.7%, p< .0001). Testing rose rapidly, peaked by the end of July, and steadily declined by the end of November. Highest mpox positivity rates were seen in FL and GA, followed by NY, TX and CA.

Conclusion

The rates of HIV, HBV, and most STIs were significantly higher among those positive for mpox; the rates of HSV-1, HSV-2, VZV, and HCV were significantly lower. These data also highlight the need for a comprehensive evaluation of all vesicular lesions for non-mpox etiology.

Disclosures

Dusica Curanovic, PhD, Labcorp: employed by labcorp during study|Labcorp: Stocks/Bonds Deborah Boles, PhD, Laboratory Corporation of America: Stocks/Bonds
2692. Epidemiology and Risk Factors for Clostridioides difficile Infection after Pancreas Transplantation
Authors: Akhtar Haris , Yetmar Zachary A , Seville Maria T , Bosch Wendelyn , Beam Elena
Published: November 2023

Background

Clostridioides difficile infection (CDI) is a common and potentially life-threatening infection. Transplant recipients are vulnerable to CDI due to immune suppression and frequent antibiotic exposure. CDI can lead to serious complications in these patients, including allograft failure. In a population of pancreas transplant recipients, we aimed to identify epidemiologic characteristics and risk factors associated with CDI within 90 days of transplant.

Methods

We performed a retrospective cohort study of adults who underwent pancreas transplantation between January 1, 2010, and December 31, 2020, at three centers in Arizona, Florida, and Minnesota. Patients were excluded if they developed pancreas allograft failure within 48 hours of transplantation. The primary outcome was diagnosis of CDI within 90 days of transplantation and the secondary outcome was pancreas allograft failure. The main analyses were performed by Cox regression.

Results

A total of 482 patients were included, of which 35 (7.3%) developed CDI within 90 days (Table 1). Within the subset of 35 CDI patients, the median time to CDI was 17.0 (IQR 13.0–28.5) days (Figure 1) with most (83%) diagnosed with non-severe CDI. Most patients with CDI were on current systemic antibiotics (94%), primarily for prophylaxis (73%). CDI treatment was vancomycin for the majority of patients (71%) and metronidazole for the rest (29%). One patient had a fecal transplant for recurrence, and none required surgery. In multivariable cox regression of associations with 90-day CDI, significant associations were anastomotic leak (HR 3.04, 95% CI 1.2-7.4; p=0.015) and simultaneous pancreas-kidney transplantation (HR 8.70, 95% CI 1.15-66.7; p=0.036); age (HR 0.97, 95% CI 0.94-1.01; p=0.110) was not significant. In a secondary analysis, CDI was not associated with pancreas allograft failure (p=0.719).Table 1.Characteristics of 482 patients who underwent pancreas transplantation.

Conclusion

This study identified preceding anastomotic leak as a risk factor for 90-day CDI after pancreas transplantation, likely due to subsequent intra-abdominal infection and antibiotic use. simultaneous pancreas-kidney transplantation is another risk factor due to additional comorbidity. Transplant providers should be cognizant of the risks of CDI and mitigate these risks as possible.

Disclosures

All Authors: No reported disclosures
2697. Fungal Infection Patterns in Hematopoietic Stem Cell Transplant Patients of a Tertiary Care Indian Cancer Hospital
Authors: Chatterji Soumyadip , Nag Arijit , Kumar Jeevan , Chattopadhyay Debranjani , Podder Dibakar , Nair Reena , Das Parijat , Bhattacharya Sanjay , Goel Gaurav , Chandy Mammen
Published: November 2023

Background

Fungal infections are a common and serious complication in patients undergoing Hematopoietic Stem Cell Transplantation (HSCT). Despite the use of prophylactic antifungal therapy, breakthrough infections can still occur and lead to significant morbidity and mortality. The emergence of antifungal resistance has further complicated the management of these infections. Therefore, there is a pressing need to understand breakthrough fungal infection patterns in HSCT patients.

Methods

In this record-based observational descriptive study, we attempted to understand the fungal infection patterns in HSCT patients in our hospital. Cases were analysed from 2012 to 2021. Diagnosis of invasive fungal infection (IFI) was done as per EORTC MSG criteria. For the patients who were on prophylactic antifungal agents, date of sample collection was tallied with the period of medication to determine eligibility for breakthrough invasive fungal infection (BIFI).

Results

Out of 563 recruited cases, 16 fungal infections were confirmed. Responsible pathogens were identified as Aspergillus sp. (11 by Galactomannan antigen test, 1 by DNA PCR from blood), Candida sp. (1 by PCR, 1 by blood culture, 1 by mannan antigen) and Fusarium sp. (1 by blood culture), see Fig.1.

Number of patients receiving (treatment/prophylaxis) each type of antifungal agent is shown in Fig. 2. Antifungal prophylaxis was administered in 544 patients (Fluconazole n=219, 40.3%; Voriconazole n=2, 0.4%; Posaconazole n=310, 57%; Amphotericin B n=13, 2.4%; see Fig. 3). Further analysis yielded 14 cases of BIFI (10 on Posaconazole and 4 on Fluconazole prophylaxis).

Number of patients receiving each type of antifungal

Percentage of patients on prophylactic antifungal drug

Conclusion

These results thoroughly describe the pattern of fungal infection in HSCT patients of the hospital for the first time.

Disclosures

All Authors: No reported disclosures
2703. Descriptive Epidemiology of Respiratory Syncytial Virus (RSV) Infection – a 10-year Review at the National Institutes of Health (NIH) Clinical Center
Authors: Forrester LaToya A , Odom Robin T , Henderson David K , Sinaii Ninet
Published: November 2023

Background

RSV can lead to severe infection in immunocompromised individuals. We performed a 10-year retrospective review of RSV infections to assess the pre-COVID-19 pandemic versus current RSV epidemiology. Asymptomatic patients were tested for RSV to clear isolation precautions and inadvertently, when testing for SARS-CoV-2 prior to aerosol–generating procedures or hospital admission.

Methods

Nasopharyngeal swabs and washes, bronchoalveolar lavages, and bronchial washes collected 1/2012-12/2022 were tested by multiplex PCR. Chart reviews were completed for RSV-positive patients to detect respiratory symptoms on admission through day 8 to delineate community- vs. healthcare-acquired cases, determine comorbidities, identify co-infection with other respiratory viruses, and stem-cell transplant recipients within the prior year. Data were analyzed using longitudinal models.

Results

Overall 17,023 respiratory tests were sent during the 10-year period, with 537 RSV-positives from 286 patients, a 3.15% positivity. A decrease in RSV detection was observed between the pre-pandemic and pandemic time periods for all patients (p=0.007) and for adults (p=0.011). Cases were community-acquired (85% in pediatrics and 95% in adults). The rationale for testing was symptom-based for 82% of pediatrics and 91% of adults. Positive tests were observed in pediatrics with congenital immune deficiency diseases (53%) and in adults with hematologic malignancy (44%). 35% of pediatrics and 42% of adults had a stem-cell transplant within the prior year. 21% of pediatrics and 20% of adults were co-infected with atleast one other respiratory virus. Incidental screening of asymptomatic patients identified RSV in 24 patients. Cyclical changes in RSV occurred during the pre-pandemic years, and a substantial decrease and irregularity (p=0.007) were noted in the monthly frequency of RSV beginning in 2020.

Conclusion

RSV remains a common pathogen in immunocompromised patients. Persistent RSV positivity was identified in the absence of symptoms and after treatment for RSV infection. We observed a sharp decrease in RSV activity in 2020; the subsequent gradual increase has not reached pre-pandemic levels.

Disclosures

All Authors: No reported disclosures
159. Diagnostic Utility of Nasal Methicillin-resistant Staphylococcus aureus Polymerase Chain Reaction Testing in Head and Neck Infection
Authors: Smith Jake , Cummings Bailee , Dare Ryan K
Published: November 2023

Background

Methicillin-resistant Staphylococcus aureus (MRSA) is a clinically important pathogen that is responsible for significant morbidity and mortality worldwide. MRSA is a colonizer of human nasal passages. Prior studies have shown that lack of detection of MRSA via polymerase chain reaction (PCR) of nasal swab specimens can accurately predict absence of MRSA in certain infections. Currently, guidelines posed by the Infectious Disease Society of America make no mention of the utility of MRSA PCR swabs for empiric antibiotic choice in facial abscess. This study investigated the diagnostic performance characteristics of MRSA nasal PCR in patients undergoing various ear, nose, and throat surgeries.

Methods

A retrospective analysis was performed at UAMS looking at adult patients with; (1) Ear nose and throat (ENT) surgeries, (2) collection of nasal MRSA PCR, (3) operating room (OR) culture data from the surgery; all within the same admission. OR culture data was used as the reference standard for presence of MRSA in surgical isolates. MRSA PCR was the index test of interest. The primary outcome was the diagnostic performance characteristics of the assay. Secondary outcomes included diagnostic performance characteristics of PCR for methicillin-sensitive staphylococcus aureus (MSSA).Table 1:Baseline demographics and clinical characteristics of study cohort

1: Includes necrotizing fasciitis, neck mass, tracheo-esophageal fistula repair, and tracheal stenosis repair. Abbreviations: T2DM - Type 2 diabetes mellitus, COPD - chronic obstructive pulmonary disease, CAD - coronary artery disease, SSI - surgical site infection

Results

In 45 patients meeting inclusion criteria, MRSA was isolated in 4.4% of OR cultures. When compared to OR cultures, MRSA nasal PCR demonstrated 100% sensitivity and 93% specificity with a positive predictive value of 40% and a negative predictive value (NPV) of 100%. MSSA PCR testing showed a lower negative predictive value of 97.1% for presence of MRSA or MSSA.Table 2:Diagnostic characteristics of MRSA nasal PCR assayTable 3:Diagnostic characteristics of MSSA nasal PCR assay

Conclusion

In patients undergoing ENT surgeries, MRSA nares PCR assay has a high NPV for presence of MRSA and can be used to help guide vancomycin de-escalation.

Disclosures

All Authors: No reported disclosures
2724. Community-acquired Pneumonia in Immunocompromised Patients: Predictors and Outcomes Associated with Empiric Broad-spectrum Antibiotic Treatment
Authors: Saravolatz Louis , Gandhi Tejal N , Vaughn Valerie , Ratz David , Horowitz Jennifer K , Gupta Ashwin , McLaughlin Elizabeth , Weinmann Allison J , Paje David , Malani Anurag , Dumkow Lisa E , Flanders Scott A , Petty Lindsay A
Published: November 2023

Background

Immunocompromised patients (ICP) are at higher risk of infection, but are often excluded from trials for community-acquired pneumonia (CAP). Due to limited data on CAP treatment in ICP, the IDSA/ATS CAP guideline omits recommendations for ICP. We aimed to assess predictors and outcomes associated with empiric broad-spectrum antibiotic (BSA) use versus standard CAP treatment in ICP hospitalized with CAP without IDSA risk factors for drug-resistant organisms (DRO).

Methods

We collected data from non-ICU adult ICP hospitalized with CAP [Table 1] between 1/2017 to 12/2022 at 69 Michigan hospitals who received either BSA on hospital day 1 or 2 or a standard CAP regimen. BSA included anti-MRSA and anti-Pseudomonal antibiotics. We excluded patients with moderate/severe COPD, structural lung disease, pulmonary complications, and IDSA risk factors for DRO. Collected data included patient characteristics, laboratory results, antibiotic data, and 30-day outcomes via phone follow up. Logistic regression was used to assess predictors of empiric BSA accounting for hospital-level clustering. We assessed the association of empiric BSA vs. empiric standard CAP treatment with 30-day outcomes using regression models adjusted for variables associated with probability of treatment and known predictors of each outcome.

Results

Of 40,882 patients with CAP, 2719 were ICP. Of 2719 ICP with CAP, 41% (N=1115) received standard empiric CAP coverage. Compared to ICP who received standard empiric CAP coverage, those who received empiric BSA had a higher incidence of severe sepsis, higher Pneumonia Severity Index, and hospitalization or IV antibiotics in prior 90 days [Table 2]. The most common CAP pathogen identified was Pseudomonas (2.0% (22/1115) standard CAP vs 2.5% (40/1604) BSA) [Table 3]. Of ICP started on BSA, median duration of BSA was 4.4 days [SD 3.4]. After adjustments, receipt of empiric BSA was associated with increased readmission, transfer to ICU and longer hospitalization compared to standard empiric CAP coverage [Table 4].

Conclusion

ICP hospitalized with CAP often received empiric BSA but few had identified DRO. Empiric BSA use for CAP in ICP without IDSA risk factors for DRO was associated with worse patient outcomes compared to standard empiric CAP coverage.

Disclosures

Elizabeth McLaughlin, MS, RN, Blue Cross Blue Shield of Michigan: Support provided through the Value Partnership Program
2737. Real World Evaluation of Antifungal Prophylaxis in Allogeneic Hematopoietic Stem Cell Transplant (aHSCT) Patients, Is Routine Antifungal Prophylaxis Needed?
Authors: Perreault Sarah , Schiffer Molly , Roeder Heidi , McManus Dayna , Topal Jeffrey E
Published: November 2023

Background

Invasive fungal infections (IFI) are a known complication in aHSCT patients. Risk factors for IFI post aHSCT include history of IFI, high intensity conditioning regimens, prolonged neutropenia, and degree of donor matching. Guidelines recommend anti-Candida prophylaxis in low risk patients and anti-mold prophylaxis in high risk patients through day 75. Yale New Haven Health’s practice is to use fluconazole in all patients unless they have a history of a mold infection. For patients receiving tacrolimus/sirolimus, antifungal prophylaxis is not recommended due to significant azole drug interactions. The goal of this study is to compare outcomes in patients who receive fluconazole prophylaxis versus those who did not receive antifungal prophylaxis.

Methods

This is a retrospective review of aHSCT patients from January 1, 2015 to July 1, 2022. Exclusion criteria were prior history of IFI requiring anti-mold treatment, concurrent prolonged neutropenia, death prior to day 75 from non-fungal etiologies or < 18 years old. Infections were diagnosed based on EORTC criteria. A subgroup analysis was performed in patients who did not receive any steroids prior to day 75. These patients were then stratified by conditioning regimen and IFI risk factors. The primary endpoint is overall breakthrough IFI rate to day 75. Secondary endpoint is the rate of IFI stratified by IFI risk group.

Results

439 patients underwent aHSCT and 94 patients were excluded. Of the 345 patients included, 7 (2%) had breakthrough IFIs prior to day 75. All 7 IFIs occurred in patients who were not receiving high dose steroids. See table 1 for IFIs stratified by conditioning regimen and risk status for IFI. P values were not statistically significant. The details of the individual IFIs are further described in Table 2.

Patient Analysis

Breakthrough Fungal Infections

Conclusion

This study revealed a low incidence of IFIs (2%) which did not correlate with the number of risk factors. Of the breakthrough IFIs, only 1 IFI could have been potentially prevented by fluconazole prophylaxis. Overall mortality was low with one patient death due to C. albicans who received fluconazole prophylaxis and one due to Rhizopus spp. Due to the low incidence of IFIs in the absence of corticosteroid use, the use of antifungal prophylaxis in aHSCT patients up to day 75 should be re-evaluated in future studies.

Disclosures

All Authors: No reported disclosures
2738. Two-step sulfonamide antibiotic challenges in patients who require treatment with trimethoprim-sulfamethoxazole at an academic medical center: Outcomes in a largely immunocompromised population
Authors: Samhan Aya , Joshi Shyam , Ham YoungYoon
Published: November 2023

Background

Sulfonamide antibiotic allergy is the second most reported medication allergy. The allergy label limits the use of trimethoprim-sulfamethoxazole (TMP-SMX), the antibiotic of choice for pneumocystis jirovecii pneumonia (PJP), Toxoplasma, and many types of urinary tract infections. Immunocompromised patients, including solid organ transplant recipients, are considered to be at a higher risk for developing an infection. While penicillin allergies are commonly tested and patients delabeled, sulfonamide challenges are not as prevalent. Patients who are tested following a transplant may be on medications that lower the negative predictive value of the challenge, raising questions about whether they truly passed the challenge or whether mild reactions were masked.

Methods: Thirty-seven patients labeled with a sulfonamide allergy who were evaluated and challenged with two doses of TMP-SMX were included. Adults (≥18 years) with a sulfonamide antibiotic allergy were evaluated and challenged between June 2020 and May 2023. Data collection included the number of patients challenged and delabeled, number of patients who had reactions and what type of reaction, and proportion of patients who completed the treatment or prophylaxis course for which TMP-SMX was the first-line antibiotic.

Results

Thirty-seven patients were challenged, of which twenty-seven patients were immunocompromised (73%). Thirty-four (92%) passed the sulfonamide challenge and were delabeled, and thirty-two (86%) completed the full course of TMP-SMX prophylaxis or treatment. Nineteen patients (51%) were tested following immunosuppression or antihistamine treatment due to a new transplant. Five patients were not able to be delabeled due to mild or delayed reactions to the challenge or treatment, including two patients that passed the sulfonamide challenge and were delabeled but had a mild reaction during SMX-TMP therapy and were relabeled.

Conclusion

The benefits of sulfonamide antibiotic allergy testing can have great effects in immunocompromised patients in preventing the use of second-line antibiotics. Sulfonamide challenges were shown to be safe and effective in immunocompromised patients in delabeling the sulfonamide antibiotic allergy and leading to the completion of treatment with TMP-SMX.

Disclosures

Shyam Joshi, MD, Cogent: Honoraria|Leo Pharma: Honoraria|Nectar Allergy: Advisor/Consultant|Nectar Allergy: Stocks/Bonds|Sanofi/Regeneron: Advisor/Consultant|Sanofi/Regeneron: Honoraria|Takeda: Honoraria
2771. Antibiotic Prescription Practices and Perceptions Among Physicians in Bangladesh
Authors: Harun Md Golam Dostogir , Sumon Shariful Amin , Islam Md Saiful
Published: November 2023

Background

Antimicrobial resistance (AMR) is a global public health threat, especially in low-resource settings. Irrational and inappropriate use of antibiotics in healthcare settings has led to widespread drug resistance. Antibiotics are widely and inappropriately used without adherence to international guidelines in Bangladesh, which may contribute significantly to the development of antimicrobial resistance (AMR). With the rapid raising of AMR, it is important to assess antibiotic prescribing perceptions and practices among physicians in Bangladesh.

Methods

From September to December 2020, a hospital-based cross-sectional survey was conducted among 517 physicians in 11 tertiary care hospitals across Bangladesh. Face-to-face interviews were done to collect information. Descriptive statistics were performed to analyze the data and for interpretation

Results

Nearly two-thirds (66 %) of the physicians considered AMR a significant concern. Over three-fourths (77%) opined that easy access to antibiotics without a prescription was the most important contributor to AMR, followed by overuse/inappropriate use (68%); whereas 42% of physicians reported inadequate diagnostic tests and one-fifth blamed poor infection control measures as the cause of rising AMR. The majority (77 %) of the participants reported following senior physicians’ guidance to prescribe antibiotics while 41.6% prescribe considering the affordability of patients and antibiotic cost. All (100%) physicians stated that updated antibiotic use guidelines are necessary for the appropriate and rational use of antibiotics

Conclusion

The assessment's findings can aid policymakers in the development and implementation of a national guideline for ensuring the rational use of antibiotics and enforcement of drug regulations at all stages, including the dispense of antibiotics in Bangladesh.

Disclosures

All Authors: No reported disclosures
2772. Isolation and Characterization of Lytic Bacteriophages Targeting Clinical Isolates of genus Enterobacter
Authors: He Yanling , Zong Zhiyong
Published: November 2023

Background

Enterobacter strains are part of the human intestinal commensal microflora and important pathogens of hospital-acquired infections,such as bacteremia, lower respiratory tract infections, and urinary tract infections.

In an era of increasing antibiotic resistance, bacteriophage therapy is one way to combat bacterial pathogens considering its unique merits,such as self-replicating, self-limiting, safe, and highly specific.

Methods

Bacteriophages were isolated from water samples collected from Jinjiang River in Chengdu, PR China and sewage water from a hospital of the same city.Twenty carbapenem-resistant clinical isolates represent common species of Enterobacter were used to screen phages. Biological characteristics of all isolated phages were analyzed including host range determination with a panel of 50 Enterobacter strains and planktonic bacterial lysis assay of the host cells.All phages were subjected to genome sequencing.

Results

Twenty-three lytic bacteriophages were isolated and most of which belong to three families,Straboviridae(n=17). Two phages are respectively members of Autographiviridae(n=1) and Casjensviridae(n=1) as novel genera.Four phages could not be matched into any known classification.Most phages could lyse multiple isolates of genus Enterobacter as well as one isolate of genus Huaxiibacter.

The determination of lytic activity in vitro revealed that most phages are able to Inhibit bacterial growth for 4-24 hours.

taxonomic information of bacteriophages against Enterobacter

Partial lytic profiles of bacteriophages against Enterobacter

Planktonic cell lysis curve

Conclusion

Enterobacter-targeting phages has a wide lysis spectrum and some phages were significantly inhibited for an extended period of more than 24 hours.These results indicate the potential value of bacteriophages against Enterobacter infection in clinical treatment.

Disclosures

All Authors: No reported disclosures
2797. Antimicrobial Photodynamic Therapy (aPDT) Is Highly Effective Against Multidrug-Resistant HA- and CA- S. aureus Strains
Authors: Romo_Bernal Cristina P , Chavez Micah , Levengood Sheeny , Sabino Caetano , Loebel Nicolas G
Published: November 2023

Background

Methicillin-resistant Staphylococcus aureus (MRSA) is often associated with multidrug-resistant (MDR) infections found in healthcare settings, resulting in 48,000 deaths in the US and 1.27 million deaths worldwide each year. S. aureus strains are a common component of nasal microbiota and can be disseminated by both patients and healthcare workers, posing a substantial hospital-acquired infection risk. Antimicrobial photodynamic therapy (aPDT) combines the use of a photosensitizer (PS) with a specific wavelength of light to induce photochemical reactions lethal to a broad spectrum of microbes, without resistance induction. The objective of this study was to demonstrate the efficacy of aPDT against clinically-relevant multidrug-resistant S. aureus strains using a commercially-available photosensitizer formulation (SteriwaveTM, Ondine Biomedical Inc., Vancouver, BC).

Resistance profile of MRSA strains

Methods

The MRSA strains used in this study included confirmed resistance to: cefoxitin, clindamycin, erythromycin, levofloxacin, mupirocin, oxacillin, penicillin, rifampicin, novobiocin, tetracyclines, trimethoprim/sulfamethoxazole, gentamicin, chloramphenicol, ciprofloxacin, moxifloxacin, linezolid, tedizolid quinupristin/dalfopristin and mupirocin. aPDT was carried out by exposing planktonic suspensions of each strain to photosensitizer formulations containing either 0.01% MB or SteriwaveTM (0.01% MB and 0.25% chlorhexidine gluconate in an aqueous excipient base). Illumination was performed at 670 nm, 150 mW/cm2 for 60 s (9 J/cm2). Samples were serially diluted and plated on TSA for CFU counting

Results

Relative to untreated controls, aPDT resulted in a minimum reduction of 3log10 (99.9%) against all MRSA strains tested, with the commercial SteriwaveTM formulation producing an average of 10X greater kills than aqueous methylene blue under the same illumination parameters.

Conclusion

aPDT is highly effective against a variety of clinically-relevant multidrug-resistant S. aureus strains in 60 s of treatment. The technique represents a promising alternative to antibiotics in healthcare systems where antimicrobial resistance strategies are important

Disclosures

Nicolas G. Loebel, PhD, ONDINE Biomedical Inc.: Board Member|ONDINE Biomedical Inc.: Employee|ONDINE Biomedical Inc.: Stocks/Bonds
2800. Carbapenem Resistant Enterobacteriaceae bloodstream infections in children from Latin America & Caribbean region: systematic review and meta-analysis
Authors: Ruvinsky Silvina , Jimena Carla , Roel Macarena , Brizuela Martin , Portillo Victoria Maria , Naranjo-Zuniga Gabriela , Ulloa-Gutierrez Rolando , Ciapponi Agustin , Comande Daniel , Bardach Ariel
Published: November 2023

Background

Systematic reviews about the burden and use of resource related to Carbapenem Resistant Enterobacteriaceae bloodstream infections (CRE-BI) in children from Latin America and Caribbean (LAC ) is scarce.

Methods

Objectives

To analyze demographic, epidemiological, clinical, use of resource and microbiological data from CRE-BI in LAC

Methods

A systematic review following Cochrane methods, PRISMA/MOOSE statements was performed (PROSPERO 2022 CRD42022352504). We searched all databases (MEDLINE, Embase, LILACS, SciELO, CENTRAL, CINAHL, Cochrane Library, WHO Database and relevant websites) from 1/1/2012 to 9/30/2022. Independent selection, data extraction, and risk of bias assessment (RoB) were performed with COVIDENCE. Types of study included; observational/surveillance/experimental/quasi-experimental. Population: Inpatients < 19 years old, with CRE-BI. Outcomes: age, underlying conditions, previous (invasive procedures, colonization, antibiotic treatment, PICU). treatment and use of resources. Statistical analysis: proportion meta-analyses applying an arc-sine transformation and RoBTo, We conducted proportion meta-analyses and applied arc-sine. R studio was used

Results

25/858 screened studies included for full text assessment with 243 patients were included. The most represented countries were Brazil (30%), Colombia (26%) and Argentina (22%). Median age was 34.5 months (IRQ 14-85). Predominant resistance mechanisms: KPC (96%), NDM (58%), OXA (27%). Pool proportion were: Male 55%. Underlying conditions 100% (immunocompromised host 84%), Previous Colonization with CRE was 42% (CI95% 13-78) and broad spectrum antibiotic used was 88% (CI95% 46-98%), most commonly carbapenems 84% (CI95% 72-91%) Bacteremia secondary to intra-abdominal infection was 80%. Combination antimicrobial treatment was 96% (CI95% 22-100%). Median length of stay 22.5 (IQR 22-30 days). Overall case fatality ratio was 48% (IC95% 27-69%).

Conclusion

CRE-BI cause morbidity and mortality mainly in pediatric population with underlying disease in LAC region. Considering its high impact in public health, it's mandatory to establish adequate policies and programs to improve antimicrobial stewardship.

Disclosures

All Authors: No reported disclosures
2804. Azole versus echinocandin combination therapy for the treatment of invasive mucormycosis: A case series
Authors: Shah Meera , Gibbons Emily A , Gutierrez G Christina , Reveles Kelly
Published: November 2023

Background

Mucormycosis is a rare and aggressive mold infection with an all-cause mortality of 54%. Treatment for mucormycosis has historically consisted of high dose liposomal amphotericin B (LAmB) as monotherapy. Recent data has emerged studying combination therapies; however, this data is conflicting, and the benefit of combination therapy remains unclear. This case series aims to explore different combination therapies utilized for the treatment of mucormycosis and their effect on mortality.

Methods

We report 17 cases of proven or probable mucormycosis managed with combination therapy for at least 48 hours at University Hospital between March 2020 and November 2022.

Results

The median age of patients was 60 years old (range 21-74), and 11 patients were male (64.7%), with a median BMI of 27.8 kg/m2. Of the 17 patients, all patients (100%) were Hispanic, nine patients (53%) had diabetes and two patients (12%) were lung transplant recipients. The most common infection site was rhino-orbital (6/17; 35%) and surgery was performed on 11 patients (64.7%) after a median of two days after hospital admission. All 17 patients received LAmB with an average initial dose of 5.13 mg/kg/day (range 2.9-6.4 mg/kg/day). All patients received combination therapy with either posaconazole (6/17; 35.2%), micafungin (4/17; 23.5%), or triple therapy (7/17; 41.2%). Duration of combination therapy was a median six days (range 2-21 days). Five of the 17 patients (29%) died of mucormycosis-related complications. Mortality observed in patients receiving combination therapy is as follows: micafungin combination (4/4; 100%), posaconazole combination (5/6; 83%), and triple therapy (0/7; 0%).

Conclusion

Mucormycosis is an aggressive fungal infection with high morbidity and mortality that requires immediate recognition, urgent intervention, and appropriate antifungal dosing. Combination therapy with micafungin maybe associated with higher mortality compared to posaconazole or triple therapy. In this cohort, combination may be associated with lower mortality that previously documented but further investigation is required to determine optimal combination treatment for invasive mucormycosis.

Disclosures

Kelly Reveles, PharmD, PhD, Ferring Pharmaceuticals: Advisor/Consultant|Ferring Pharmaceuticals: Honoraria