bluuebunny/crossref_metadata_2025 huggingface dataset:
1234. Analysis of an Automated Letter HCV Screening Program within a Veterans Affairs Health System: Implications for Universal HCV Screening
Authors: Harjono Lucas , Motwani Yash , Mohtashemi Neaka , Chen Phillip , Tamkus Greta , Dong Tien , Benhammou Jihane , Goetz Matthew B , Kawamoto Jenna , Patel Arpan , Bhattacharya Debika
Published: December 2022

Background

Although universal Hepatitis C Virus (HCV) Screening in the US was recommended in 2020, the optimal implementation method is unknown. We characterized the efficacy of an automated letter HCV screening program at the Veteran’s Affairs (VA) Greater Los Angeles Healthcare System (VAGLAHS) and evaluated associations with linkage to care.

Methods

From January 2017 to May 2020, 14,804 Veterans born between 1945-1965 who did not have an HCV antibody (Ab) test result within the last 10 years and who were within the VAGLAHS catchment area were identified. Veterans were mailed a letter recommending HCV screening via a centralized process. Veterans then used the letter to present to a VA laboratory for HCV Ab testing, which included reflex HCV viral load. Those who were HCV viremic were referred to Hepatology/Infectious Diseases clinics for initiation of HCV treatment. Baseline characteristics of those with subsequent HCV viremia were collected. To determine associations with the first HCV visit (linkage to care), we performed independent chi-squared tests.

Flowchart of Automated Letter HCV Screening for Veterans

Results

A total of 12,875 Veterans were identified, 4,011 (31%) Veterans presented for HCV Ab testing, 167/4011 were HCV Ab + (4.2%), and 69/167 (41.3%) had HCV viremia. Of those viremic, 94 % were male, 26% were African-American, 62% had stable housing, 24% lived >90 miles from the nearest VA clinic, and 17% had cirrhosis. Fifty-five Veterans (80%) were evaluated in a viral hepatitis clinic and 84 % (46/55) initiated HCV treatment (Figure 1). Patients’ housing status (p = 0.02), cirrhosis (p< 0.0001), and distance to clinic (p=0.063) were associated with non-linkage to an initial HCV appointment.

Conclusion

One third of Veterans approached via mail participated in HCV Ab testing. Overall HCV Ab positivity rates were 4% and nearly half had HCV viremia. The majority of Veterans were linked to care but housing status, cirrhosis, and distance to clinic were associated with non-linkage to care. Automated letter screening is a promising approach to HCV screening, including universal screening. Future research should include investigations of telehealth and e-consults for linkage to care, especially for those who have marginalized housing status and live far from clinic.

Disclosures

Debika Bhattacharya, MD, MSc, Gilead: Grant/Research Support|Regeneron: Grant/Research Support.
1245. Outpatient Hepatitis C Management in Patients with Substance Use Disorder Following Hospital Admission for Severe Bacterial Infection
Authors: Conte Michael , Streifel Amber C , Sikka Monica K , Varley Cara D
Published: December 2022

Background

Patients with substance used disorder (SUD) are at high risk of hepatitis c virus (HCV) infection. During admission for acute illness, patients with SUD are often screened for or known to have untreated chronic HCV with outpatient follow-up recommended. However, many barriers to HCV treatment exists including lack of insurance, no primary care provider (PCP), drug cost, and transportation. Therefore, we aimed to investigate HCV follow-up and treatment in patients with SUD post-hospitalization.

Methods

We performed a retrospective review of patients with SUD admitted for a severe bacterial infection between July 2015 and March 2020. A descriptive analysis was performed to evaluate patients with positive HCV testing instructed to follow-up outpatient for HCV treatment per discharge summary. We collected key information via chart review including location and attendance of follow-up as well as HCV testing and treatment status within two years of discharge.

Results

We identified 108 patients during the study period with chronic HCV in which 48 were recommended follow-up for outpatient HCV treatment (Table 1). 38 (79.2%) were recommended to follow-up with PCP and 10 (20.8%) with hepatology. 15 patients (31.2%) made their follow-up appointment. 30 patients (62.5%) had documented repeat HCV testing within two years of discharge. Of these, one (3.3%) was HCV antibody (Ab) only, 10 (33.3%) were HCV Ab plus viral load (VL), and 19 (63.3%) were HCV VL alone. 41 patients (85.4%) had no evidence of HCV treatment and 7 (14.6%) had documented clearance (4 confirmed treatment, 2 presumed treatment, and one documented treatment without confirmed testing). Of the 7 treated, 4 (57.1%) had a PCP prior to admission, whereas in the 41 untreated, 5 (12.2%) had a PCP. Table 1:HCV Follow-Up Outcomes

Conclusion

A low proportion of patients were confirmed to initiate and complete outpatient HCV therapy following hospital discharge. Many patients were lost to follow-up and had no repeat testing available. One-third of patients with repeat testing had repeat HCV Ab screen indicating an area for diagnostic stewardship. More pro-active approaches coordinating HCV therapy in patients with SUD requiring hospitalization for other infections are warranted in order to prevent unnecessary sequelae including HCV cirrhosis and carcinoma.

Disclosures

Monica K. Sikka, MD, F2G: Site research investigator.
1247. Primary Care Teams in Veterans Health Administration Have High Knowledge of Universal HCV Screening But Favor System-Level Interventions to Close Care Gaps
Authors: Patel Arpan , Mohtashemi Neaka , Motwani Yash , Tseng Chi-hong , Kawamoto Jenna , Chen Phillip , Celedon Manuel A , Benhammou Jihane , Dong Tien , May Folasade , Goetz Matthew B , Bhattacharya Debika
Published: December 2022

Background

In 2020, the United States Preventive Services Taskforce recommended one-time Hepatitis C virus (HCV) screening for all adults aged 18-79. As the largest provider of HCV treatment in the US the Veterans Health Administration (VA) is committed to implementing these recommendations; thus, understanding perspectives of primary care teams towards this is critical.

Methods

We disseminated a 24-item online survey to PCPs at the VA Greater Los Angeles Healthcare System (VAGLAHCS), serving 1.5 million Veterans within an area that spans five counties. Our sample included physicians, pharmacists, nurse practitioners, and physician assistants on primary care teams. Our survey contained questions on demographics, provider knowledge of HCV testing, practice patterns and beliefs, and preferences for new screening tools. Descriptive statistics were completed and we compared item responses across demographics. Hypothesis testing was performed using Wilcoxon rank sum test for continuous variables and Fisher’s exact or Chi-square tests for categorical variables.

Results

In total, 107 PCPs responded to the survey (107/385=28% response rate), with 100 complete responses. Most respondents were women (63%) with median age of 42 years, physicians (53%), Internal Medicine-trained (47%), and of Asian descent (45%). A majority (59%) were aware of new screening recommendations. Most PCPs reported confidence (71%), intent (77%), and commitment towards (82%) HCV screening. Only 38% reported remembering to screen Veterans regularly. Physicians were most aware of new recommendations (73%), compared to pharmacists (55%) and nurse practitioners (42%). The most strongly preferred strategies to enhance screening included automatic test orders during physician visits (71%), automatic electronic-consults (68%), clinician reminders for HCV screening (57%), and opt-out phlebotomy (48%).

Conclusion

In a sample of providers within a large and diverse VA, 3 in 5 PCPs were aware of new universal HCV screening recommendations. There is high motivation among PCPs to perform screening, but forgetting to screen is still common. Several strategies to augment universal HCV screening were acceptable towards PCPs.

Disclosures

Debika Bhattacharya, MD, MSc, Gilead: Grant/Research Support|Regeneron: Grant/Research Support.
1249. Rise in ALT after Hepatitis C Treatment is a Highly Sensitive Marker of Treatment Failure
Authors: Flower Barnaby F , Fellow Clinical Research , Day Jeremy , Cooke Graham
Published: December 2022

Background

Hepatitis C nucleic acid testing to confirm sustained virological response (SVR) after antiviral treatment is technical and expensive, hampering scale-up and decentralisation of care in resource-poor settings. Serial liver function testing may offer a cheaper means of screening for treatment failure.

Methods

In an HCV treatment shortening study in Vietnam (n=51), we analysed whether a change in ALT or AST from EOT to EOT+ 12 weeks (ΔALT; ΔAST) was a sensitive surrogate for HCV RNA in detecting treatment failure. We compared ΔALT and ΔAST between cures (38) and failures (13), and assessed sensitivity, specificity and area under receiver-operator curves (AUROC) vs gold standard HCV RNA. We validated our findings in a second, larger study population from a UK treatment shortening study (n=202). Both study populations had mild liver disease, and all participants were treated with 4-8 weeks direct acting antiviral therapy.

Results

In Vietnam, among 46 HCV genotype 1 or 6-infected individuals who supressed ALT on therapy, 11 failed to achieve SVR. Median ΔALT was -1 IU/L in cures vs +24 IU/L in treatment failures (p< 0.001). Increase in ALT (ΔALT > 0) after end-of-treatment was 100% (95% C.I. [66.4 – 100]) sensitive and 48% [26.8 – 69.4] specific vs HCV RNA in identifying failures (AUROC = 0.99). These results were validated among 193 genotype 1 or 4-infected individuals who supressed ALT on treatment in a UK study (in which 60 failed to achieve SVR). Median ΔALT was +1 IU/L in cures vs +45 IU/L in treatment failures (p< 0.001). ΔALT > 0 was 100% sensitive (95% C.I. [94.6 – 100]) and 47% [38.3-56.3] specific (AUC = 0.98). ΔAST performed similarly. Figure 1Change in ALT from EOT to EOT+12 in cures and from EOT to start of retreatment (EOT+6 to 24) in treatment failures in a) Vietnam study b) UK study

Conclusion

ΔALT from EOT to EOT+12 is a highly sensitive screen for identifying DAA treatment failures. Using this strategy, only around half of treated individuals require HCV RNA testing 12 weeks after end of treatment, offering substantial benefits in terms of cost reductions and decentralisation of care.

Disclosures

All Authors: No reported disclosures.
1257. Antiretroviral treatment failure in a prospective cohort of Persons Living with HIV in the Philippines
Authors: Dungca Nina Theresa , Schwem Brian , Arevalo Geraldine , Li Kingbherly L , Salvana Edsel Maurice
Published: December 2022

Background

Widespread access to antiretrovirals has resulted in improved survival among PLHIV in resource-limited settings. In a previous study, ART failure in the Philippines after one year was found to be 10.3%. However, this was done as a cross-sectional study and did not capture dropouts or pre-existing drug resistance (PDR). Treatment failure, taking into account PDR, dropouts, and long-term viral suppression has not been studied. As part of a transmitted drug resistance (TDR) study, we prospectively followed patients and documented long-term viral suppression.

Methods

We enrolled 227 treatment-naïve PLHIV without TDR on Sanger-based sequencing and measured viral load (VL) every 6 months. VL “>”1000 copies/mL after initiation of treatment was considered treatment failure. An intention to treat analysis counting loss to follow-up as treatment failure was performed along with secondary analysis by subtype.

Results

Treatment failure at different time points are shown in Table 1. Of the 227 patients, 177 were subtype CRF01_AE, 30 were B, 14 were CRF01_AE/B recombinants, 2 were subtype CRF02_AG, 2 were CRF01_AE/B/F recombinants and one was an A1/D recombinant. Median VL was 295,000 copies/mL at baseline (range: 40 - 658,000 copies/mL). Seventeen PLHIV developed treatment failure over an observation time of up to 60 months, while 74 were lost to follow-up. Comparison between B and non-B subtypes showed a higher rate of failure among non-B subtypes (OR 2.868 95% CI 1.018 to 10.016 p=0.0380) at one year, but this was no longer significant at 24 months (p=0.1534) and 48 months (p=0.0716).

Conclusion

HIV viral suppression at one year of treatment is 65.6% in an intention to treat analysis. It is 63.4% at 24 months and 60.8% at 48 months. Excluding dropouts, viral suppression is 95.5%, 92.3%, and 89.0% at 12, 24, and 48 months, respectively. Non-B subtypes are more likely to fail than those with B subtypes in the first year of treatment. Loss to follow-up is a significant problem in the Philippines and needs to be addressed proactively in order to improve local efforts to reach the 90-90-90 thresholds of UNAIDS for control of HIV in the country.

Disclosures

Edsel Maurice Salvana, MD, MSD: Advisor/Consultant|MSD: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria.
1272. Impact of Rapid Initiation of Antiretroviral Therapy on Retention in Care in the Southern United States
Authors: Benidir Bailey , Ali T’shura , Sanchez Lucia Puga , Salunkhe Vidyulata , Gootee Steven , Arnold Forest W
Published: December 2022

Background

Rapid initiation of antiretroviral therapy (ART) is now a well-established approach for reducing time to viral suppression in persons newly-diagnosed with HIV. However, there is limited data examining the effect of rapid initiation of ART on retention in care—which is also crucial to reducing transmission—especially in the disparate populations of the southern United States. The goal of this study is to determine if rapid start ART increases retention in HIV care in this region.

Methods

This was a prospective population-based cohort study of newly-diagnosed HIV patients who established care at the 550 Clinic from July 2021 to April 2022. The intervention was utilizing a team to facilitate warm hand-offs of newly diagnosed patients to clinic, in contrast with standard of care, a faxed referral. All patients were enrolled in one of two arms: rapid prospective (ART initiated within 7 days of diagnosis) or non-rapid prospective (ART started > 7 days of diagnosis). Data was also matched to a retrospective arm from historical data. Patients were followed at a visit 4-8 weeks from initiation then again in 8-12 weeks. Descriptive statistics were done to compare demographics, clinical characteristics and time to follow-up visit by study arm.

Results

Of the 105 patients enrolled, 41 were in the rapid prospective arm, 35 in the non-rapid prospective arm, and 29 in the retrospective arm. The median age was 31 years, 83% were male, 35% African American, and 12% Hispanic. In the rapid arm, time from initiation to first kept follow-up was significantly less compared to the non-rapid arm (44 days vs 70 days, p < 0.001). From baseline to third visit, there was a 93% increase in the CD4 count among the rapid arm vs a 58% increase among the non-rapid arm. Additionally, 80% of rapid participants had an undetectable viral load by visit 3 vs 66.7% of non-rapid participants.

Conclusion

Results showed that addition of a warm hand-off and rapid initiation of ART improves linkage to care and increases adherence to follow-ups, as well as rates of viral suppression. This intervention was effective in improving outcomes, even among the medically vulnerable populations seen in the southern US. This data can therefore contribute to closing gaps in data on regional HIV care where ethnic minorities experience healthcare disparities.

Disclosures

Bailey Benidir, PharmD, AAHIVP, Gilead Sciences, Inc.: Grant/Research Support Forest W. Arnold, DO, MSc, Gilead Sciences, Inc.: Grant/Research Support.
1275. Leveraging Big Data to Understand and Improve Continuity of Care Among HIV-Positive Individuals with Criminal Charges in North Carolina
Authors: Arant Elizabeth C , Rosen David L , Kavee Andrew L
Published: December 2022

Background

Little is known about the impact of having criminal charges on HIV outcomes. We sought to understand the relationship between having criminal charges and viral suppression among people living with HIV (PLWH) in North Carolina (NC).

Methods

We linked statewide NC criminal court records to the state’s confidential HIV records (both databases: 2017-2020) to assess HIV viral suppression (viral load [VL] < 200 copies/ml) in the 12 months before receiving and after resolution of criminal charges using the viral load most closely preceding and proceeding the charges. For each period, PLWH without a VL were coded as unsuppressed. We used generalized estimating equations to examine changes in viral suppression pre-post criminal charges, adjusting for other demographic and legal system factors.

Results

During the study period, 9,586 PLWH experienced criminal charges. Compared to others with charges, PLWH were more likely to be male (78% v 69%, p < 0.001) report Black race (77% vs 37%, p < 0.001) and be older (median age: 41 vs 36 years, p < 0.001). The median duration of unresolved charges was longer for PLWH compared to others (68 vs. 37 days, p < 0.001). The proportion with suppressed viral load pre- and post-charges was respectively 71% and 73%, p = 0.01. When adjusting for demographic and legal factors, the period following resolution of criminal charges was associated with an increased odds of viral suppression (adjusted odds ratio [aOR] 1.11; 95% Confidence Interval [CI] 1.03-1.19) compared to the period prior to charges. Factors negatively associated with viral suppression included Black race (aOR 0.60; 0.51-0.70), HIV acquisition via self-reported heterosexual contact (aOR 0.75; 0.62-0.91) or intravenous drug use (IDU) (aOR 0.51; 0.41-0.63) compared to men who report sex with men (MSM). Compared to those aged 18-29 years, those aged 60-69 were more likely to be suppressed (aOR 2.41; 1.78-3.25).

Conclusion

In the context of other risk factors for sub-optimal HIV suppression, the resolution of criminal charges was modestly associated with improvement in viral suppression. To further understand the mechanism underlying this association, future analyses will incorporate the role of additional factors such as charge type, incarceration, and state region.

Disclosures

All Authors: No reported disclosures.
1296. Customized Learning About Bettering Sterile Insertion (CLABSI): A Look at Reducing Hospital Acquired Line Infections
Authors: Abusalem Lana , Smith Jake , Fugere Tyler , Tilley Zachary , Savenka Tatsiana , Wright Caitlyn L , Liverett Hazel K
Published: December 2022

Background

Central line associated bloodstream infections (CLABSIs) are associated with significant clinical and economic impacts. A large portion of central venous lines (CVLs) placed at the University of Arkansas for Medical Sciences are done so by resident physicians. A formal education session focusing specifically on aseptic technique for residents has not been utilized so far.

Methods

Literature review and expert opinion was used to guide development of a multi-modal resident education session. The session consisted of a PowerPoint presentation, a video tutorial, and a CVL insertion checklist. More than 50% of the time was allotted to a hands-on session led by residents demonstrating how to aseptically place a CVL under the supervision of an Infection Preventionist. A Likert scale was utilized to assess the level of confidence residents had regarding eight CLABSI prevention metrics both before and after attending the session. Additionally, residents were polled to assess their preferred teaching modality. 66 internal medicine residents and 18 internal medicine-pediatrics residents participated in the study over a five-week period. The results were assessed for statistical significance with a two-tailed Mann-Whitney U-test.

Results

Responses were received from 54 residents prior to the simulation lab session, and from 56 residents after the simulation lab session. The total resident response rate was 66.67%. A statistically significant improvement in resident confidence was found in all eight surveyed CLABSI prevention metrics. The majority of responding residents found workshop style sessions, peer-to-peer teaching and educational videos to be the most useful modalities to deliver information.

Bar Graph Demonstrating a Side by Side Comparison of Resident Reponses Pre- and Post-Intervention

Bar Graph Demonstrating a Side by Side Comparison of Resident Reponses Pre- and Post-Intervention

Resident Responses to Preferred Methods of Learning about CLABSI's Pre- and Post-Intervention

Conclusion

Attendance of a two-hour multimodal resident-driven educational session improved the confidence of residents in their knowledge and implementation of CLABSI prevention metrics. Participants preferred learning via workshop style sessions and educational videos. We recommend a multi-modal approach to resident education, and the consistent involvement of an Infection Preventionist. We hope to expand our curriculum to involve residents in other departments and explore the variation in preferred learning modalities and its overall impact on hospital CLABSI rates

Disclosures

Hazel K. Liverett, MD, Merck: Stocks/Bonds.
1301. ID Fellows Cup: Developing Confidence Through Content Creation
Authors: Kahn Mauricio J , Walker Jeremey , Yagnik Kruti J , Chiosi John , Herrera Lauren Nicholas N , Chavez Miguel A , Dong Sara W , Willig James , Nolan Nathanial S
Published: December 2022

Background

The ID Fellows Cup (IDFC) is a multiple-choice question set delivered via the Kaizen Education software, which uses gamification to enhance engagement. Questions are directed to ID fellows worldwide, but all learners can participate. In the inaugural year, 541 individuals (344 fellows) played in ≥1 of 3 rounds. Content creation by learners is known to enhance knowledge and confidence with material. We hypothesized that inviting trainees to author questions would enhance their perceived ID knowledge and confidence in creating Free Open Access Medical Education (FOAMed) content.

Methods

We invited trainees to write questions for the 10/2021 and upcoming 5/2022 games (105 questions) through an online volunteer call. They received a brief lecture and outline on question development. Mentors (early faculty or other fellows) reviewed their content and gave constructive feedback. We developed a 22-item survey targeted to writers and mentors using input from the literature and involved educators. Items included demographics, prior experience, perceptions of benefit, and areas to improve. We distributed it by email after question submission.

Results

Thirty-eight of 54 (70%) writers and mentors completed the survey. 1 asked to remove their responses from research. 35 (94.6%) participants answered all survey questions. Table 1 shows their demographics. Before the IDFC, 18 (48.6%) respondents had never written a board-style ID question; 21 (56.8%) had never created FOAMed content, and 23 (63.9%) had low confidence in creating it. 35 (97.2%) found that writing a question was an effective use of their time, and 36 (100%) felt it increased knowledge of the assigned topic. 33 (91.7%) found it increased their confidence as near-peer educators, and 31 (86.1%) that it increased confidence in creating future FOAMed content (Table 2).

Conclusion

Crowdsourcing questions through a mentored process allows for an enhanced educational experience for trainees and early faculty. Authoring board-style questions was felt to increase ID knowledge and was rated as effective use of time. Many authors had limited experience in FOAMed content creation but gained skills and confidence from the process. Similar initiatives may support and empower early educators to step into the global digital education platform.

Disclosures

All Authors: No reported disclosures.
1313. Clinical significance of Rickettsia rickettsii antibody testing among children in Eastern Long Island, New York
Authors: Wang Joye , Handel Andrew S
Published: December 2022

Background

Rocky Mountain spotted fever (RMSF) is a tickborne illness caused by Rickettsia rickettsii (Rr). Diagnosis is challenging due to non-specific symptoms and reliance on convalescent antibodies (Ab) for definitive diagnosis. Early doxycycline administration reduces poor outcomes but is sometimes prescribed without clear exposure or suggestive symptoms. Confusion also arises from positive Ab testing in patients lacking RMSF symptoms. Our study aims to describe Rr Ab results and clinical impact in a low incidence region. Specific objectives were to describe signs and symptoms of children tested for RMSF, false-positive Ab rates, and unnecessary antibiotic administration.

Methods

Retrospective chart review of patients ≤ 21 years old tested for Rr Ab within the Stony Brook Medicine system from 2010-2020. Patients were identified by ICD-9/-10 RMSF diagnosis code and/or Ab test results. Charts without clinical notes were excluded. Data collected included demographics, symptoms, laboratory results, treatments, and outcomes. Patients were classified as RMSF confirmed, probable, suspected, unlikely, or negative based on symptoms and Ab results, per CDC definitions (Table). Results recorded in Qualtrics. Descriptive statistics were calculated. ‘Unlikely RMSF’ cases were considered false positive Ab and ‘proven’ or ‘probable’ cases were considered true positive Ab.

Case definitions based on CDC Rocky Mountain spotted fever (RMSF) case surveillance definition

Abbreviation: Rr - Rickettsia rickettsii

Results

172 charts were included. Average age was 14 years. 56% were male. Of RMSF classic triad symptoms, 52% had fever, 41% rash, and 44% headache. Of RMSF case categories, 2 (1.2%) were confirmed, 3 (1.7%) probable, 10 (5.8%) suspected, 14 (8.1%) unlikely, and 143 (83%) negative. Both confirmed cases had fever, rash and headache. False positive and true positive Rr Ab rates were 8.9% (n=5) and 2.9% (n=5), respectively. 5 patients with false positive Ab received doxycycline within 14 days of Ab collection date.

Conclusion

Among children in a low-incidence region, Rr Ab were frequently obtained without signs of infection, including half without fever. The cause of false positive Rr Ab in patients lacking RMSF symptoms is unknown, but may be due to non-severe infection or cross-reactivity with other Rickettsia. Focused testing on those with suggestive symptoms may avoid unnecessary treatment and anxiety.

Disclosures

All Authors: No reported disclosures.
1315. Dental Discoloration and Enamel dysplasia after Tetracyclines Exposure in Children: A Nationwide Population-Based Study in Korea
Authors: Lee Ji Young , Kim Eun Hwa , Lee Myeongjee , Shin Je Hee , Lim Sung Min , Jung In Kyung , Ahn Jong Gyun , Kang Chung-Min , Kang Ji-Man
Published: December 2022

Background

Tetracycline (TC) is not recommended for pediatric use due to the risk of permanent teeth discoloration and enamel dysplasia. We aimed to assess the incidence of dental abnormality in Korean children and investigate whether the risk was greater in tetracycline-exposed children compared to the general population.

Methods

This nationwide, population-based study using Health Insurance Review and Assessment service database included children (aged 0-12 years) who were prescribed tetracycline for at least a day between January 2008 and December 2020. We evaluated the incidence rate of children who were inserted diagnosis codes for dental discoloration and enamel dysplasia after at least 6 months after prescription as the primary outcome. Standardized incidence ratio was analyzed to determine whether the risk of dental abnormalities was greater in the exposed group compared to the general population in Korea.

Results

A total of 56,990 patients with TCs exposure were included, 3% were under the age of 8 (n=1,735) while the majority of 97% were between ages of 8 and 12 (n=55,255). The incidence rate in 0-7 year old age group was 734 cases per 100,000 person-years, which was about five times higher than the 143 cases per 100,000 person-years of the 8-12 year old group with statistical significance (P< 0.001). The 5-year cumulative incidence rate in the 0-7 years old age group was 4.1 % (95% CI, 3.0-5.7%) and 5.7% (95% CI, 4.1–7.8%) in 10-year period. In the 8-12 year old age group, 5-year cumulative incidence was 0.8% (95% CI, 0.7-0.9%) and 1.3% (95% CI, 1.1-1.4%). The risk of dental abnormalities was not significantly increased in the TC-exposed group of 0-7 year old age group compared to the general population (SIR = 1.08; 95% CI, 0.69-1.60).

Conclusion

The incidence of tooth discoloration and enamel dysplasia was lower than previously suggested, particularly between the ages of 8 and 12 and as low as one-fifth of those under the age of 8, suggesting a reconsideration of limiting use of TCs in children if clinically indicated.

Disclosures

All Authors: No reported disclosures.
1318. Etiology of Infectious Conjunctivitis in Children: A Multi-Center Case-Controlled Study
Authors: Frost Holly M , Sebastian Thresia , Jenkins Timothy C , Keith Amy , Kurtz Melanie , Meece Jennifer K , Dominguez Samuel R , Savor-Price Connie
Published: December 2022

Background

Acute infectious conjunctivitis (AIC) is a common pediatric infection affecting one in eight children annually. The etiology of AIC is poorly understood but important to inform treatment and return to school recommendations. Additionally, the association of bacteria isolated from the conjunctiva with the development of clinical AIC is not well defined. We aimed to determine the bacterial and viral causes of AIC in children.

Methods

Patients age 6 months-18 years with AIC at Denver Health (Denver, CO) and Marshfield Clinic (Marshfield, WI) from 2019-2021 were included. Age-matched healthy and upper respiratory infection (URI) controls without conjunctivitis were enrolled within 30 days of each case. Patients had a conjunctival flocked swab (Eswab®, Copan Diagnostics) obtained. Nucleic acids were extracted using the NucliSENS® easyMAG® system (Quidel, San Diego, CA) per manufacturer’s instructions. Multiplex RT-PCR for S.pneumoniae, H.influenzae, M.catarrhalis, S.aureus , and 11 respiratory viruses were completed using Lyra® (Quidel, San Diego, CA) and AnDiaTec® assay kits (Quidel Germany GmbH, Kornwestheim, Germany, Table). Nucleic acid amplification and detection was completed on the Applied Biosystems® (ABI) 7500 Fast Dx Real-Time PCR Instrument. Odds ratios were computed for each organism.

Results

A total of 78 cases and 71 controls (33 healthy, 38 URI) were included (Table). Bacteria were detected in 59 (75.6%) cases and 36 (50.7%) of controls (OR 14.3; 4.7,33.7). Respiratory viruses were infrequently detected (cases 2, 2.6%; controls 6, 8.5%), including in the pre-pandemic period. Of bacteria detected in cases, H.influenzae was the most common (56.4%) and had the highest association with conjunctivitis (OR 11.8; 4.8, 29.1) followed by M.catarrhalis (35.9% cases, OR 2.5; 1.2, 5.3). S.pneumoniae was detected more often in controls than cases (33.8% v 26.9%).

Conclusion

H.influenzae is likely the most important pathogen associated with AIC in children. Though data have suggested marginal benefit of antibiotic treat for conjunctivitis overall, studies specifically looking at benefit by organism would advance the field. A rapid diagnostic test for H.influenzae and possibly M.catarrhalis could help direct antibiotic treatment to children most likely to benefit.

Disclosures

Samuel R. Dominguez, MD PhD, Biofire DIagnostics: Advisor/Consultant|Biofire DIagnostics: Grant/Research Support|DiaSorin Molecular: Advisor/Consultant|Karius: Advisor/Consultant|Pfizer: Grant/Research Support.
1326. Mupirocin Resistance in Staphylococcus aureus in Pediatric Patients for Ten Years
Authors: Park Hwanhee , Kim Doo Ri , Kim Kyung-Ran , Kim Jong Min , Huh Hee Jae , Lee Nam Yong , Kim Yae-Jean
Published: December 2022

Background

Mupirocin has been recommended for decolonization in methicillin-resistant Staphylococcus aureus (MRSA) carriers for recurrent skin and soft tissue infections and treatment for impetigo. However, the indiscriminate use of mupirocin causes mupirocin resistance, associated with decolonization failure. The aim of the study was to investigate the epidemiology of mupirocin resistance and to identify clinical characteristics among children in a single center.

Methods

From January 2011 to October 2020, we retrospectively analyzed the epidemiology of antibiotic resistance and clinical characteristics of pediatric patients under 19 years old in whom S. aureus was firstly isolated at any body site.

Results

Of the 3,414 S. aureus isolates, 46% (1569/3414) were methicillin-resistant, and 20.3% (692/3414) were mupirocin resistant. Among MRSA, Mupirocin-resistant (MupR) was 22.6% (354/1569), and among methicillin-sensitive S. aureus (MSSA), MupR was 18.3% (338/1845) (P< 0.001). The median age of MupR MRSA patients was 0.14 years (interquartile range 0.04-0.79), and the median age of MupR MSSA patients was 5.0 years (interquartile range 2.0-8.1) (P=0.000). Of 692 MupR S. aureus, 94.2% (652/692) were mainly detected in the skin. MupR MRSA was most frequently isolated in the neonatal intensive care unit (40.1%, 142/354), but MupR MSSA was most frequently isolated in the outpatient setting (81.4%, 275/338) (P< 0.001). Of these, 43% (119/275) patients were diagnosed with atopic dermatitis. By age, mupR MRSA was the more commonly isolated in infants younger than one year (77.4%, 274/354), and MupR MSSA was more commonly isolated in children older than three years old (65.4%, 221/338) (P< 0.001). The frequency of MupR MRSA and MSSA showed an increase in trend over time (P< 0.001). Among other topical agents, 6.5% (102/1569) of MRSA was resistant to fusidic acid.

Conclusion

As mupirocin resistance gradually increases, a test for mupirocin susceptibility should be performed before applying the skin lesions or decolonization for MRSA. In addition, clinicians should carefully prescribe mupirocin to prevent the development of MupR S. aureus.

Disclosures

Yae-Jean Kim, MD, PhD, Janssen: Grant/Research Support|Korean Society of Pediatric Infectious Diseases: Grant/Research Support|Ministry of Trade, Industry and Energy: Grant/Research Support|MSD: Grant/Research Support.
1335. Retrospective evaluation of doxycycline for the treatment of Lyme disease among young children
Authors: Brown Katie , Handel Andrew S
Published: December 2022

Background

Lyme disease is the most common pediatric tickborne infection. Due to largely disproven concerns of doxycycline-related dental staining among patients < 8 years old, no prospective data exist on efficacy and adverse effects in young children with Lyme disease. Based on emerging data, our institution has used doxycycline during the past decade when alternatives cannot be given. Our study aims to describe short-term adverse effects and treatment failures among young children receiving oral doxycycline for Lyme disease.

Methods

Retrospective chart review of patients < 8 years old within the Stony Brook Medicine system from 2010-2020. Patients were identified by ICD-9/-10 codes for Lyme disease prescribed doxycycline at the same visit. We excluded those lacking an objective finding of Lyme disease, including single or multiple erythema migrans (EM), facial nerve palsy, carditis, meningitis (headache with pleocytosis >5 WBC/μL), and/or arthritis, those with an alternative diagnosis, and those receiving post-tick exposure prophylactic doxycycline. Data collected included demographics, symptoms, laboratory results, treatments, and outcomes. Descriptive statistics were calculated.

Results

32 charts were included. Average age was 5.1 years. 66% were male. The majority of the patients presented with a single EM (Table for presenting symptoms). Initial antibiotics were doxycycline (63%) or a beta-lactam (37%). Rationale for doxycycline included beta-lactam allergy or intolerance (47%), required for treatment of clinical syndrome (such as CNS disease) (28%), concern for alternative tickborne infection (3%), and no reason given (22%). There were no severe adverse reaction to doxycycline; 2 patients stopped due to nausea/vomiting and 1 due to refusal of oral medications. Among the 29 patients who completed doxycycline, there were no known Lyme disease treatment failures.

Presenting symptoms of children <8 years old treated with doxycycline for Lyme disease

Total percent exceeds 100% due to patients presenting with multiple symptoms. Percent calculation based on all included patients (n = 32).

Conclusion

In this small cohort of young children with Lyme disease, doxycycline was generally well-tolerated, without severe short-term adverse effects, and resulted in no treatment failures. As there is no prospective data evaluating doxycycline in this population and future randomized trials are unlikely, the data presented provides reassurance that doxycycline is effective and safe for this indication.

Disclosures

All Authors: No reported disclosures.
1356. Case Series of Children with Hepatitis and Adenovirus Infection, Alabama, October 2021—February 2022
Authors: Buchfellner Markus A , Amanda Ingram L , Shiau Henry , Sanchez Luz Helena Gutierrez , Saaybi Stephanie , Britt William , Sanchez Veronica , Potter Jennifer L , Kelly David , Lu Xiaoyan , Ayers-Millsap Stephanie , Willeford Wesley G , Rassaei Negar , Bullock Hannah , Reagen-Steiner Sarah , Martin Ali , Lamson Daryl M , Parashar Umesh D , Hall Aron J , MacNeil Adam , Tate Jacqueline E , Kirking Hannah L
Published: December 2022

Background

Human adenoviruses (HAdV) are a common cause of respiratory and gastrointestinal infections but rarely cause end-organ disease in children. From October 2021 to February 2022, several previously healthy children admitted to a single center for significant hepatitis also tested positive for HAdV. The aim of this investigation is to describe characteristics of these children.

Methods

Children admitted to Children’s of Alabama (COA) from October 2021 to February 2022 with hepatitis who tested positive for HAdV by whole blood RT-PCR were included. Demographic, clinical, laboratory and treatment data were collected from medical records. Residual blood specimens were sent for adenovirus typing.

Results

Nine pediatric patients with hepatitis and HAdV infection were identified (78% female; median age 3.0 years; IQR 1.7-3.0). Before admission, six reported diarrhea and three had respiratory symptoms. At presentation, eight had scleral icterus, six had jaundice, seven had hepatomegaly, and one was encephalopathic. All patients had elevated transaminases (AST range: 447-4000 U/L, ALT range: 784-4695 U/L); initial total bilirubin varied [range 0.23-13.5 mg/dL]). All had confirmed HAdV by RT-PCR on whole blood (initial qPCR range: 991-70,680 copies/mL). Notably, two children who transferred to another facility were negative for HAdV by RT-PCR when plasma was tested (instead of whole blood). Six children underwent liver biopsy showing varying degrees of hepatitis with no adenovirus detected on immunohistochemistry stains. Five children had HAdV type 41 confirmed. Three children presented or progressed to acute liver failure, two children were treated with cidofovir, and two underwent successful liver transplantation. No known epidemiologic links between patients were identified and all were from geographically distinct parts of Alabama.

Conclusion

HAdV is a potentially underrecognized cause of hepatitis. Whole blood specimens may be preferred over plasma for HAdV RT-PCR testing. HAdV type 41 was identified in all patients with typing results available. Improved type-based surveillance may help determine HAdV patterns of circulation and inform future diagnostic testing.

Disclosures

William Britt, MD, First Energy Corporation: Stocks/Bonds|Hookipa Pharma: Advisor/Consultant|Kroger Care: Stocks/Bonds|MDU Resources Group: Stocks/Bonds|PG&E Corporation: Stocks/Bonds.
1357. Collateral consequence of COVID pandemic: Increased incidence of cat scratch disease.
Authors: Praino Maria L , Infectologist Peditric , Julia Grigioni , Infectologist Peditric , Tineo Soledad , Infectologist Peditric , Martinez Mayra , Caratozzolo Ana , Toledano Analía , Cazes Claudia , Infectologist Peditric , Contrini María M , López Eduardo L
Published: December 2022

Background

Cat scratch disease (CSD) is a zoonosis caused primarily by Bartonella henselae.

The aim of our study was to determine the incidence CSD before the preventive and obligatory social isolation/distancing that was indicated in Argentina as a consequence of the SARS-CoV-2 pandemic on March 19, 2020 ("first period") and to compare it with the incidence since then to present ("second period").

Methods

Retrospective analysis of patients with CSD admitted to the Infectious Diseases outpatient office at Ricardo Gutiérrez Children’s Hospital (a tertiary care center) from March 2012 to March 2022. Charts were reviewed for demographic and epidemiological data, duration of symptoms, clinical manifestations and systemic compromise.

Results

Two hundred twenty-nine patients were observed during the study period. The median delay between symptoms onset and medical consultation was 15 days (IQR 9-30d), without statistically significant differences between periods The median age at presentation was 101.67 months (range 11.3 to 211.87 months) Age and gender were similar between periods.

The average number of cases per month was 1.63 (158 in 97 months) versus 3.23 (71 cases in 22 months) in the first and second periods, respectively, with an increasing incidence of 98%. The frequency of systemic compromise was higher in the second period: 47.89% versus 32.28% (p= 0.01).

The months with the highest incidence were February to July.

Conclusion

A significant increase of CSD were observed during the COVID pandemic probably related to a closer children´s contact with pets due to the strict quarantine that health authorities implemented. Moreover, an unexpected finding was a higher proportion of patients with systemic CSD during the pandemic period.

Disclosures

All Authors: No reported disclosures.
1371. Tularemia During Pregnancy: A Systematic Review of Treatment and Outcomes
Authors: Cooley Katharine M , Scheets Camryn , Meaney-Delman Dana , Nelson Christina , Fleck-Derderian Shannon
Published: December 2022

Background

Francisella tularensis, the gram-negative bacterium that causes tularemia, is endemic throughout the Northern Hemisphere and is a Tier 1 bioterrorism agent. Signs and symptoms can include fever, lymphadenopathy, pharyngitis, or pneumonia. Aminoglycosides, fluoroquinolones, and tetracyclines are effective for treatment; however, data on their use for tularemia in pregnancy is lacking. We performed a systematic review of tularemia during pregnancy to describe antimicrobial treatment and examine maternal, fetal, and neonatal outcomes.

Methods

We searched nine literature databases using terms related to tularemia and pregnancy and included articles describing cases of tularemia with at least one maternal or fetal outcome. Information abstracted included clinical features of tularemia; antimicrobial treatment during pregnancy; and maternal, pregnancy, and neonatal outcomes.

Results

Of 4,181 articles identified, 25 articles describing 47 cases of tularemia in pregnant patients were eligible for inclusion. Cases were reported between 1930 and 2021 from eight countries. Among cases with clinical form described, oropharyngeal tularemia was the most common (n=13/22, 59%), followed by ulceroglandular (n=5/22, 23%), glandular (2/22, 9%), and oculoglandular (n=2/22, 9%) forms. Patients were initially infected during the 1st trimester (26%), 2nd trimester (47%), 3rd trimester (18%), and before pregnancy (9%). Nineteen (40%) mothers were treated with at least one antimicrobial effective against F. tularensis: gentamicin (n=13), ciprofloxacin (n=6), doxycycline (n=1), and streptomycin (n=1). Four intrauterine fetal deaths (IUFD) occurred, all among pregnancies in which the mother received no effective antimicrobials. No pregnancy losses were reported among treated mothers. Among 34 live births, two were preterm and one case of hydranencephaly was identified, all among untreated mothers. No maternal deaths were reported.

Conclusion

Pregnancy loss and preterm birth have been documented in pregnant patients with tularemia who did not receive effective antimicrobial treatment. Prompt recognition and treatment of tularemia during pregnancy is important and could minimize risk for adverse outcomes.

Disclosures

All Authors: No reported disclosures.
1378. Fungal infections in burn patients during Northern California wildfires
Authors: Hauser Naomi , Branch Barbara , Palmieri Tina
Published: December 2022

Background

Wildfires are an increasing human health concern. In 2020 there were nearly 10,000 fires in California including 5 of the 6 largest wildfires recorded in the state, burning 4.1million acres. In addition to the known risks of direct burn and inhalation injury, extreme heat exposure, and psychological stress, there are unrecognized infection risks associated with smoke exposure. Fungal elements travel great distances in the air, and smoke significantly alters the number and diversity of fungal particles in affected geographical regions. Aims: To analyze the incidence and contributing factors for mould infections in hospitalized burn patients in the fall of 2020, during the peak of wildfire season.

Methods

We reviewed the electronic medical records for all patients admitted with burns in the fall of 2020 and recorded demographics, treatment, and outcomes. Data was stored in a secure electronic database.

Results

Of the 10 patients admitted with wildfire related burns, 4 developed mould infections. Two additional cases were diagnosed in patients burned in a plane crash and one in a house fire. Five of the 7 patients (71%) were men; patients had a mean age of 37.7 years (range 24-56 years); mechanism in 4 of the 7 was direct wildfire exposure (57.1%); mean total body surface area (TBSA) burned was 69% (range 44-90%). Mould infection was identified on or after hospital day 14 in all patients. A total of 5 mould genera were isolated, with Aspergillus mould genus isolated from 6 patients (85.7%). All 7 patients (100%) were treated with at least 2 days of antibacterials before identification of mould infection; 4 (57.1%) of the patients died before leaving the hospital. Following this period, mould cases decreased to baseline low levels of < 10% for all burn sizes.

Conclusion

Wildfires in the western United States have had a devastating effect on the ecosystem and human health. We suspect that wildfires may increase the risk of invasive mold infections in burn patients with ambient wildfire smoke exposure. We observed a disproportionate number of invasive mould infections in hospitalized burn patients during large wildfires, which may have a significant impact on the seasonal treatment of burn patients. The relationship between wildfires and fungal infection warrants future investigation.

Disclosures

All Authors: No reported disclosures.