bluuebunny/crossref_metadata_2025 huggingface dataset:
1375. Validation of a Syndromic Surveillance Query for Lyme Carditis – New York, 2017-2021
Authors: Beeson Amy , White Jennifer , McCormick David , Gates Abigail , Hinckley Alison F , Marx Grace E
Published: December 2022

Background

Lyme carditis is a rare and potentially fatal manifestation of Lyme disease. Although Lyme disease is nationally notifiable, data on specific clinical manifestations are not collected systematically. We sought to use a novel syndromic surveillance query to identify patients with Lyme carditis in New York State (excluding New York City) during 2017-2021.

Methods

Using the National Syndromic Surveillance Program’s BioSense Platform, we developed a query using a combination of diagnosis codes and chief complaint terms to identify emergency department visits related to Lyme carditis. We systematically reviewed and abstracted key information in each identified individual medical record through New York’s regional health information exchange system, requesting supplemental records when needed. Two physicians independently assigned a clinical case status (confirmed; probable; not a case) to each abstracted record; when adjudications differed, an infectious disease physician provided a final adjudication. Positive predictive value for the query was calculated and characteristics of cases and non-cases were described.

Results

The query identified 175 individuals. Records were available for review for 139 individuals. Among these, 37% (n = 52) were classified as confirmed, 17% (n = 24) as probable, and 45% (n = 63) as not a case. In total, we identified 76 cases of confirmed or probable Lyme carditis for which records were available; the positive predictive value of the query was 45%. Cases occurred in 28 of New York’s 57 counties (excluding New York City); most (64%) occurred during May–September. Median age was 60 years for cases (IQR 33 – 73) and 67 years for non-cases (IQR 42 – 78) (p = 0.13); 29% of cases and 38% of non-cases were female (p = 0.23). Among cases, 76% had positive IgG or IgM immunoblots and 37% had second- or third-degree atrioventricular block.

Conclusion

Using a syndromic surveillance query, we detected 76 cases of Lyme carditis, a rare disease of public health importance. Syndromic surveillance using this query may provide a useful marker for Lyme-endemic states to use to detect changing disease patterns, including temporal or spatial clusters of severe Lyme disease manifestations.

Disclosures

All Authors: No reported disclosures.
1377. Bloodstream and Skin Infection MRSA Isolates, 2019-2021: Strain Differences and Phylogenetic Clustering in a Single Health System
Authors: Hofstetter Katrina , Jacko Natasia F , Gunoskey Jessica J , Talbot Brooke M , Read Timothy D , David Michael Z
Published: December 2022

Background

Methicillin-resistant S. aureus (MRSA) is a common antibiotic-resistant human pathogen that spreads from person to person. Asymptomatic host colonization precedes both skin and soft tissue infections (SSTI) and bloodstream infections (BSI), but it is not known how closely related MRSA strains are that cause infections at different body sites.

Methods

Using Illumina whole genome sequencing, we compared the strain types and genomes of MRSA isolates from 132 SSTIs and 145 sequential BSIs at 3 Philadelphia hospitals in 7/2018-1/2021. We investigated the epidemiological links and genomic clusters among isolates causing BSI and SSTIs.

Results

Abscesses were the most common type of SSTIs (65/132, 49%). Clonal complex (CC) 8 was the most identified CC among both SSTI strains (102/132, 77%) and BSI strains (73/145, 50%). While CC5 was more commonly found among BSIs than SSTIs (50/145, 34% vs. 19/132, 13%). Outbreak clusters with 15 or fewer SNPs were identified. Three clusters that contained only strains from SSTIs were all CC8, and the five clusters that only contained strains from BSIs had three CC5 clusters and two CC8 clusters. Among eight clusters that included at least one SSTI and one BSI strain, only one was composed of CC5 and the others were all CC8 strains. Within these eight clusters the SSTIs were from cellulitis infections (4/8), an abscess (3/8), or an infected ulcer (1/8).

Conclusion

We found that CC8 strains were the most common among both SSTIs and BSIs. CC5 strains, however, were more commonly found in BSIs than SSTIs, and among outbreak clusters in the BSI strains. Eight outbreak clusters were identified that linked strains causing SSTIs or BSIs, seven of the clusters contained only CC8 strains. While abscesses were the most common infection type to cause an SSTI, within the outbreak clusters containing strains from both SSTIs and BSIs, both cellulitis and abscess were equally identified.

Disclosures

Michael Z. David, MD PhD, Contrafect: Grant/Research Support|GSK: Advisor/Consultant|Johnson and Johnson: Advisor/Consultant.
1655. Factors Associated with Acceptance of Telehealth-based Antimicrobial Stewardship Program Recommendations in a Community Hospital Health System
Authors: Shively Nathan R , Jacobs Max W , Moffa Matthew A , Schorr Rebecca E , Walsh Thomas L
Published: December 2022

Background

Telehealth-based antimicrobial stewardship programs (TeleASPs) have led to reduced broad-spectrum antimicrobial utilization. Data on factors associated with acceptance of stewardship recommendations are limited.

Methods

A TeleASP, facilitated by remote infectious disease physicians and local pharmacists, was implemented in 2 community hospitals from February 2018 through July 2020. Variables potentially affecting acceptance of TeleASP recommendations were tracked. Odds ratios of acceptance were determined utilizing multiple logistic regression.

Results

During the 30 month period, 4863 (91.2%) of the total 5333 recommendations were accepted. Hospitalist and Critical Care Medicine services had significantly higher odds of acceptance in univariable analysis, while General Surgery, Private Practice Primary Care Physician, Pulmonology, and Urology had lower odds of acceptance. Only Critical Care Medicine remained significant on multivariable analysis (OR 3.23, 95%CI 1.4–7.5). Other factors associated with a higher odds of acceptance in multivariable analysis were recommendations for antimicrobial dose/frequency adjustment (OR 2.63, 95%CI 1.6–4.3) and order for labs/tests (OR 3.30, 95%CI 2.1–5.2), while recommendations for antimicrobial de-escalation (OR 0.75, 95%CI 0.60–0.95) and antimicrobial discontinuation (OR 0.57, 95%CI 0.42–0.76) were associated with lower odds of acceptance. Female physicians were more likely to accept recommendations compared to males (93.1% vs 90.3% acceptance, OR 1.65; 95%CI 1.3–2.2). Compared to physicians with less than 3 years of experience, who had the highest acceptance rate (96.3%), physicians with 21 or more years of experience had the lowest (87.1%, OR 0.26; 95%CI 0.15–0.45).

Conclusion

TeleASP recommendations were accepted at a high rate. Acceptance rates were higher among female physicians, and recommendations to stop or de-escalate antimicrobials led to lower acceptance. Recommendations made to the most experienced physicians were the least accepted, which may be an important factor for stewardship programs to consider in education and intervention efforts.

Disclosures

Thomas L. Walsh, MD, Accelerate Diagnostics: Honoraria.
1386. Prescribing Patterns of Skin and Soft Tissue Infections in Patients Discharged from the Emergency Department
Authors: Feist Jacqueline , Panecaldo Nicholas , Kale-Pradhan Pramodini , Delgado George , Giuliano Christopher , Johnson Leonard B
Published: December 2022

Background

Treatment of skin and soft tissue infections (SSTIs) are a growing reason for Emergency Department (ED) visits. Inadequate treatment of SSTIs has been reported in up to 25% of patients treated in ED. The purpose of this project was to describe prescribing patterns for SSTIs from the ED.

Methods

Single center retrospective cohort study of SSTI patients discharged from ED between July 1- December 31, 2020. The primary outcome was to describe the proportion of patients receiving guideline directed therapy (GDT) for SSTIs. Secondary outcomes include describing the proportion of patients readmitted within 30 days, the reason for readmission, and to compare 30-day readmission rates in patients who received GDT versus non-GDT.

Results

Of 876 patients screened, 576 were excluded primarily for being admitted to the hospital. Of the 300 included patients, 117 (39%) received GDT and 183 (61%) received non-GDT. Fifty-six of 300 patients were readmitted within 30 days, of which 21 (17.9%) had received GDT and 35(19.1%) had received non-GDT (p=0.8). Readmissions related to persistence or progression of SSTI were not significantly different between GDT and non-GDT, 9 patients and 11 patients respectively (p=0.57). The remaining 36 patients (64.3%) were readmitted for reasons unrelated to SSTI.

Conclusion

The majority of prescribed antibiotic therapy for SSTI did not conform to GDT. However, 30-day readmission rates were not significantly different between the groups. Further research on GDT and ED treated SSTI is needed.

Disclosures

All Authors: No reported disclosures.
1656. Impact of Pharmacist Intervention on Antibiotic Prescribing at Hospital Discharge for Community-Acquired Pneumonia, Urinary Tract Infection, and Skin and Soft Tissue Infections
Authors: Liu Elaine , Linder Kristin E , Dempsey Casey J , Kuti Joseph L , Nicolau David P , Bilinskaya Anastasia , O'Sullivan David M , Colmerauer Jessica L
Published: December 2022

Background

The high incidence of suboptimal antibiotic use at transitions of care represents a novel area for antimicrobial stewardship for community-acquired pneumonia (CAP), urinary tract infection (UTI), and skin and soft tissue infections (SSTIs). The objective of this study was to investigate the role of a pharmacist intervention at discharge to improve antibiotic use.

Methods

This was a single-center, retrospective, crossover analysis of patients admitted to general medicine units from 11/1/21 to 3/31/22 with a diagnosis of CAP, UTI, or SSTI. The study was divided into two phases separated by a one-month washout. Each two-month phase included two pre-specified units, an intervention and control. During phase 2, the intervention and control units were switched. Patients on antibiotics identified for discharge were reviewed and interventions were communicated by the pharmacist to the provider. Interventions were made based on predefined guidance for oral step-down therapy and total duration. The primary outcome, discharge antibiotic days of therapy (DOT), was compared between the intervention and control cohorts. Secondary outcomes included total DOT, hospital length of stay (LOS), 30-day readmission, and appropriateness of drug selection, dose, and duration.

Results

Records of 161 patients were included in this study, 85 in the intervention cohort (47 in phase 1, 38 in phase 2) and 76 in the control (41 in phase 1, 35 in phase 2). Overall discharge DOT was 3 (IQR 0–4.5) in the intervention cohort and 3 (IQR 0-5) in the control cohort (P = 0.8), and overall total DOT was 7 (IQR 5-9) and 7 (IQR 5-10) respectively (P = 0.27). Patients in the intervention group were more likely to have appropriate total duration (61.2% vs 44.7%, P = 0.001) and discharge duration of antibiotics (67.1% vs 53.9%, P = 0.013) for all three indications based on predefined guidance. Hospital LOS was 4 (IQR 3-5) vs 5 days (IQR 3-6.3) in the intervention and control cohorts (P = 0.001) respectively, and a lower 30-day readmission (14.1% vs. 23.7%, resp.).

Conclusion

Despite similar antibiotic DOTs, pharmacist intervention at discharge appeared to improve overall antibiotic total duration and discharge duration for CAP, UTI, and SSTI. Opportunities to improve discharge stewardship processes should be further explored.

Disclosures

Joseph L. Kuti, PharmD, Abbvie: Honoraria|bioMeriuex: Advisor/Consultant|bioMeriuex: Grant/Research Support|Contrafect: Grant/Research Support|Entasis: Grant/Research Support|Merck and Co: Grant/Research Support|Roche Diagnostics: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Shionogi: Honoraria|Summit: Grant/Research Support David P. Nicolau, PharmD, Shionogi: Grant/Research Support.
1414. Substance Use Treatment Utilization Among Women with and at Risk for HIV
Authors: Fujita Ayako W , Ramakrishnan Aditi , Mehta Cyra Christina , Yusuf Oyindamola , Wilson Tracey , Shoptaw Steven , Carrico Adam , Adimora Adaora A , Eaton Ellen , Cohen Mardge , Cohen Jennifer , Adedimeji Adebola , Plankey Michael , Jones Deborah L , Chandran Aruna , Sheth Anandi N
Published: December 2022

Background

Substance use (SU) contributes to poor health outcomes , yet limited data exist to inform strategies to optimize SU treatment among people with HIV (PWH). We describe SU and SU treatment utilization among women with and at risk for HIV in the Women’s Interagency HIV Study (WIHS).

Methods

We included data from participants enrolled in 10 WIHS sites from 2013-2020. Current SU was defined as self-reported, non-medical use of drugs in the past year, excluding use of only marijuana. SU treatment utilization was determined by self-reported use of a drug treatment program in the past year. Multivariable regression models were used to determine associations between participant characteristics and SU treatment.

Results

Among 2559 women (1802 HIV+, 757 HIV-), 66% (n= 1690) reported lifetime SU (65% HIV+, 69% HIV-), and 14% (n=367) reported current SU (13% HIV+, 18% HIV-). Among women with current SU, 71% reported crack/cocaine, 40% opioids, 12% any intravenous drug, 6.5% tranquilizers, and 6.5% methamphetamines. Of these women, 77% reported smoking cigarettes, 52% marijuana use, and 27% using >7 drinks/week. Among women with current SU, 42% (n=155) reported any treatment in the past year (40% HIV+, 45% HIV-); the most common treatments were methadone (64%), narcotics anonymous (29%), inpatient (28%), and outpatient programs (16%). Among women with opioid use (n= 147), 67% reported methadone use in the past year compared to only 5% using buprenorphine/naloxone. In multivariable analysis, HIV seropositivity and concurrent alcohol or marijuana use were associated with lower odds of SU treatment, and visit with a psychiatrist/counselor with higher odds of treatment (Table). In a separate model including only women with HIV, SU treatment was not associated with having an HIV care visit or viral suppression. Table- part 1Table - part 2

Conclusion

In the WIHS cohort, SU treatment utilization was higher than expected, especially for methadone use, reflecting the resilience of a population which is known to face stigma and barriers to treatment. Still, our analysis highlights opportunities for accessing SU treatment in the context of HIV care for women with HIV, such as the need to prioritize providing buprenorphine/naloxone in HIV care settings.

Disclosures

Steven Shoptaw, PhD, Alkermes Inc: Grant/Research Support|Gilead Sciences, Inc: Grant/Research Support Adaora A. Adimora, MD, MPH, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support Ellen Eaton, MD, MPH, Gilead HIV Research Scholar: Grant/Research Support|Gilead HIV research scholar: Grant/Research Support.
1421. A 5-year Review of Mycobacterium abscessus Susceptibility in a Tertiary Hospital in Thailand
Authors: Phuensan Pawat , Petsong Suthidee , Suwanpimolkul Gompol
Published: December 2022

Background

Mycobacterium abscessus is a common rapid growing mycobacteria (RGM). It causes chronic nodular or cavitary lung disease in adults with bronchiectasis or cystic fibrosis, skin and soft tissue infection following penetrating injury or an unsterile skin procedure. It was also a pathogen of disseminated infection in patients with anti-interferon-gamma autoantibodies. The 2018 clinical and laboratory standards institute (CLSI) guideline suggested that amikacin, cefoxitin, ciprofloxacin, clarithromycin, doxycycline, imipenem, linezolid, meropenem, moxifloxacin, trimethoprim-sulfamethoxazole, tigecycline and tobramycin should be tested against RGM. We aimed to review the antimicrobial susceptibility of this organism in our hospital.

Methods

We performed a retrospective descriptive review of the minimal inhibitory concentration (MIC) of clinical isolates of M. abscessus from 2013 to 2018.

Results

We found 267 isolates of M. abscessus. Eighty-four isolates were tested for MICs. Of these, 4 isolates were excluded due to duplication. The remaining 80 isolates were included for analysis. The susceptibility results were as follows.

Conclusion

To our knowledge, this is the largest report of susceptibility pattern of M. abscessus in Thailand. MICs of cefoxitin and imipenem, which are the recommended intravenous antimicrobials, were high. Most isolates also demonstrated high MICs of doxycycline, linezolid, trimethoprim-sulfamethoxazole, tobramycin, ciprofloxacin and moxifloxacin. In contrast, most of MICs of amikacin and clarithromycin were in susceptible range. These findings may be used to guide the treatment regimen although clinical outcomes of each drug are still to be investigated.

Disclosures

All Authors: No reported disclosures.
1422. A Multi-Center Evaluation of Omadacycline for Multi-Drug Resistant Infections
Authors: Ghali Amer El , Ghali Amer El , Allosaimy Sara , Morrisette Taylor , Molina Kyle C , Frens Jeremy J , Stevens Ryan W , Bouchard Jeannette , Brandon Bookstaver P , Veve Michael P , Vemula Raaga , Philley Julie , Rebold Nicholas S , Holger Dana , Kunz Coyne Ashlan J , Lagnf Abdalhamid M , Lucas Kristen , Witucki Paige , Rybak Michael J
Published: December 2022

Background

Multi-drug resistant (MDR) pathogens are a continuously evolving threat for which there are limited effective treatment modalities. Omadacycline (OMC) is a novel oral and intravenously administered aminomethylcycline with potent in-vitro activity against MDR gram-negative and gram-positive pathogens. Post-marketing data investigating its potential place in the antibiotic armamentarium is limited. This study aimed at describing the clinical success and tolerability of patients receiving OMC for various infections.

Methods

This was a multicenter, retrospective, observational study conducted from January 2020 to March 30, 2022. We included all patients ≥ 18 years of age that received OMC for any infection not related to Mycobacterium spp. for ≥72 hours. The primary outcome was clinical success at 30 days, defined as survival, the absence of persistence or re-emergence of infection during or after therapy, and the absence of escalation or alteration of OMC. Incidence of adverse effects while on OMC and reasons for OMC utilization were also analyzed.

Results

This analysis included 19 patients from 10 distinct academic centers. The median age was 50 years (IQR, 37-63), 58% were male, 63% were Caucasian, and the median APACHE II, Charlson and SOFA scores were 10 (IQR 5-12.5), 4 (IQR 2-6.3), and 1 (IQR 0 – 2.25), respectively. Most patients had a bone and joint (8/19, 42.1%) or intra-abdominal infections (4/19, 21.1%), all with positive cultures. Eight patients (44.1%) had a polymicrobial infection and 4 (22.2%) had bacteremia. The most common pathogens encountered were Carbapenem-resistant A. baumannii (5/19, 27.8%), E. coli (5/19, 27.8%), Vancomycin-resistant Enterococcus spp. (4/19, 22.2%), and K. pneumoniae (3/19, 16.7%). Clinical success was observed in 14 patients (74%) and 7 (36.8%) received combination therapy. Adverse drug reactions were reported in 3 patients (15.8%) and of those patients, none discontinued therapy. Reasons for prescribing OMC were mostly attributed to oral availability (12/14, 85.7%) and resistance to other agents (7/14, 50%).

Conclusion

OMC demonstrated clinical effectiveness and safety against a large number of MDR pathogens. More robust, prospective, comparative studies are needed to confirm our preliminary findings.

Disclosures

P. Brandon Bookstaver, PharmD, Spero Therapeutics: Advisor/Consultant.
1425. Changes in Clinical Presentation of TB due to the COVID-19 pandemic
Authors: Khan Nazia , Sirichand Surksha , Xie Xianhong , Achkar Jacqueline M
Published: December 2022

Background

In 2020/21, deaths due to active tuberculosis (TB) increased globally for the first time in decades with concomitant global decline in TB detection rates, suggesting that delay in TB diagnosis during the COVID-19 pandemic is associated with increased mortality. In the US and New York City, 20% decline in TB cases was reported in 2020/21. We aimed to compare symptom duration, sputum microscopy and radiographic findings in patients with newly diagnosed TB at Montefiore Medical Center (MMC) in the Bronx, New York, before and during the COVID-19 pandemic. We hypothesized that patients during the COVID-19 pandemic present with signs of more advanced TB than before.

Methods

Using a cross-sectional study design, we retrospectively reviewed medical records of TB patients identified through microbiology lab records from 11/1/2018 to 3/11/2022 and stratified by admission before (11/1/2018–2/29/2020) and during (3/1/2020–3/11/2022) the COVID-19 pandemic. Inclusion criteria were age ≥18 years, admission to an MMC hospital, and new diagnosis of culture-confirmed TB.

Results

We identified 24 TB patients who presented before and 24 during the pandemic. About 1.7 new TB cases were diagnosed monthly before vs 1.0 during the pandemic, an >40% decline. Patients had both pulmonary and/or extrapulmonary manifestations without differences between groups. There were no significant differences in demographics and comorbidities between the two groups aside from diabetes, which was higher in the pre-COVID group (p = 0.03). Two TB patients had a prior history of COVID and one developed nosocomial COVID during the admission. There was no difference in mortality between groups. Patients with pulmonary manifestations had higher sputum AFB smear positivity (p=0.14) and significantly higher occurrence of multilobar or miliary infiltrates on chest X-ray during compared to before COVID (p = 0.01; Table 1). Table 1.Symptoms and diagnostics on initial presentation of patients with pulmonary TB before and during the COVID-19 pandemic

Depending on distribution, t-tests or Mann Whitney U tests were used for continuous and Chi-square tests or Fisher’s exact tests for categorical variables. Sputum AFB smears results are reported for the initial 3 smears.

Conclusion

Our findings show >40% decline in patients presenting with TB in the Bronx during vs before the COVID-19 pandemic and suggests patients presented with more advanced disease than before the pandemic. Whether COVID-19 could have contributed to this remains to be investigated. Our results have implications for public health and emphasizes the need for earlier identification of TB.

Disclosures

All Authors: No reported disclosures.
1427. Correlation of Dermoscopic and Histopathologic Patterns in Leprosy-a Pilot Study
Authors: Mitra Debdeep , Chopra Ajay
Published: December 2022

Background

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. It is diagnosed based on clinical features and confirmed on the histological findings and peripheral slit skin smear staining. Dermoscopy is a handy easily accessible tool to diagnose this granulomatous disease and classify patients based on the immunological and clinical response.

Methods

A total of 50 patients in different poles of leprosy were evaluated as a single spot observational analysis. The clinical and histological findings were correlated with the characteristic dermoscopy findings.

A Lepromatous leprosy showing xerosis and scaling along leg as part of glove and stocking distribution of lesions

Dermoscopic pattern in lepromatous leprosy showing partial loss of hair follicles, dry xerotic skin, and white characteristic scaling (Heine Delta® 20 T dermatoscope; 16×; polarizing)

Results

The dermoscopy findings correlated with the clinical and histological findings. Tuberculoid poles of leprosy classically showed loss of hair and skin pigment along with absence of white dots as sweat glands in dermoscopy. Lack of blood vessel changes ruled out any lepra reaction. Lepromatous pole of leprosy on the other hand showed characteristic xerosis and white scaling on dermoscopy in the background of hypotrichosis and hypopigmentation. leprosy reactions were characterized by blood vessel changes and arborizing blood vessels were characteristic in erythema nodosum leprosum and a diffuse erythema was a clue towards diagnosing type I lepra reaction. Interestingly clofazimine induced pigmentation was picked up characteristically on dermoscopy as a ‘honey comb pattern’.

Borderline tuberculoid leprosy with a hypoaesthetic patch on the left side of face with a thickened greater auricular nerve

Dermoscopic pattern in borderline tuberculoid leprosy showing white areas with loss of hair follicles. In between yellow globules can be seen which was the hallmark apart from white areas demonstrating hypopigmentation. Absence of blood vessels rules out lepra reaction (Heine Delta® 20 T dermatoscope; 16×; polarizing)

Conclusion

Dermoscopy is certainly a handy tool in aiding the diagnosis of leprosy, lepra reactions and course of therapy. Characteristic patterns during the course of leprosy would certainly facilitate a quick and definitive diagnosis of patients suffering from leprosy. Also patient drug compliance particularly to Clofazimine can also be picked up objectively on Clofazimine.

Multiple erythematous plaques on the back depicting type 1 lepra reaction

Dermoscopic features of type I lepra reaction showing characteristic diffuse erythematous background and branching telangiectatic vessels along with sparse hair follicles and scaling (Heine Delta®20 T dermatoscope; 16×; polarizing)

Disclosures

All Authors: No reported disclosures.
1428. Clinical Characteristics and Management of Nontuberculous Mycobacterial Infections in the Finger Lakes Region of New York
Authors: Croix Michael , Dumyati Ghinwa , Adams Alexandra , Hardy Dwight , Levy Paul , Lesho Emil , Munsiff Sonal
Published: December 2022

Background

Nontuberculous Mycobacteria (NTM) are ubiquitous in the environment and associated with pulmonary and extra-pulmonary infections. Evaluation and treatment of these infections is complex and prolonged, involving oral, intravenous and inhaled therapies, although not all patients with NTM need treatment. We reviewed the clinical characteristics and referral patterns of NTM patients in our institutions to evaluate resource needs.

Methods

We retrospectively identified all patients who had NTM isolated from 2 referral labs servicing the Finger Lakes Region of NYS, from April 1, 2018 thru March 31, 2020. Demographic, comorbidities, culture, and treatment data were collected from medical records. We compared comorbidities, clinical symptoms, and species among patients with pulmonary and extra-pulmonary NTM. Pearson’s chi-squared and student t-test were performed where appropriate for statistical analysis.

Results

155 NTMs were isolated from 149 patients, 128 from pulmonary and 27 from extra-pulmonary sites. Patients with pulmonary NTM were more likely to be older, female, and have underlying lung disease (Table 1). Patients with extra-pulmonary NTM were more likely to have immunodeficiency. Mycobacterium avium complex (MAC) was isolated more frequently in pulmonary samples and rapidly growing mycobacteria more frequently from extra-pulmonary samples (Table 2). Disease site specific symptoms were more common than constitutional symptoms in both groups. 36% of patients with pulmonary NTM were treated compared with 70% of patients with extra-pulmonary NTM (Table 3). 69% were referred to Pulmonologists, and 43% to infectious diseases for evaluation and management. Table 1Demographics

Demographic data for patients with pulmonary and extrapulmonary NTM Table 2Mycobacterium species

Mycobacterium species isolated from patients with pulmonary and extrapulmonary NTM Table 3Clinical characteristics

Clinical characteristics of patients with pulmonary and extrapulmonary NTM including symptoms, referral to specialists, whether patients were diagnosed with disease by a clinician, and how many were treated.

Conclusion

Though not all patients with NTM isolated from culture require treatment, most of the patients in our cohort had extensive evaluation, those on treatment required multidisciplinary care, and many not on treatment require ongoing monitoring. Knowing the volume and clinical characteristics of NTM patients in our region has helped to identify the needed resources for developing a comprehensive regional NTM center of Excellence. Other institutions can similarly assess their volume to plan for the increasing incidence of these infections.

Disclosures

Ghinwa Dumyati, MD, Pfizer: Grant/Research Support.
1434. Incidence of Tuberculosis after Transplantation: A Nationwide Cohort Study in South Korea, 2008-2020
Authors: Hyun JongHoon , Jeong Su Jin , Kang Ji-Man
Published: December 2022

Background

Tuberculosis (TB) is one of the leading causes of morbidity and mortality among transplant recipient. The purpose of this study is to evaluate the standard incidence ratios (SIRs) of TB in all transplant recipient and to compare which is more risk by transplant type.

Methods

We conducted a nationwide population-based retrospective study using data retrieved from the Health Insurance Review and Assessment Service. Active TB case were studied, and SIRs was calculated based on the most recent year, 2019. SIRs were computed as the ratio of observed to expected numbers of TB, based on national age and sex. All analyses were conducted by transplant type and age group.

Results

From 2008 to 2020, a total of 57,103 patients who underwent transplantation were included. 830 cases were confirmed with TB (1.45%) and median time to develop TB was 1.74 year following transplantation. When analyzing the cumulative incidence by transplant group, it was in the order of allogenic hematopoietic stem cell transplantation (HSCT), solid organ transplantation (SOT), and autologous HSCT (P< 0.001). In SOT, liver transplantation had the highest incidence of TB, followed by lung, heart, and kidney (P< 0.001). The cumulative incidence for the age group increased with age (P< 0.001). Incidence of TB was markedly increased among transplant recipients compared with general population (SIR: 3.53, Confidence interval (CI): 3.38-3.67). SIR varied according to age group: age under 20 years (SIR: 4.98 CI: 3.16-7.47), age between 20 and 40 years (SIR: 5.83 CI: 5.22-6.49), age between 40 and 60 years (SIR: 4.66 CI: 4.42-4.92), age over 60 years (SIR: 2.05 CI: 1.89-2.21). Based on a multivariate analysis, male sex (hazard ratio (HR) = 1.398; P < 0.001), previous TB history (HR = 1.515; P=0.014) were the common independent risk factors for TB after transplantation.

Baseline characteristics of study population

Cumulative incidence of TB following transplant

Risk factor of tuberculosis after transplanatation

Conclusion

The incidence of TB in transplant recipient is at least three times higher than the general population in South Korea. Regardless of the type of transplant, TB should be considered as a complication within 1 years of transplantation and special attention should be paid to patients with a history of previous TB history.

Disclosures

All Authors: No reported disclosures.
1435. Incidence of Tuberculosis Infection Among New Prisoners in Southern Thailand
Authors: Ruangchan Sujinda , Kiamkan Nongnuch , Kabinlapat Sumonta , Jeduman Nichareekorn , Kasa Aunjai , Silpapojakul Khachornsakdi
Published: December 2022

Background

Tuberculosis in prisons was reported to be 100 times higher than the normal population. Late diagnosis, overcrowding, and poor ventilation encourage the transmission of tuberculosis. Five percent of new tuberculosis infections turn into active disease within two years. This study was conducted to determine the incidence of tuberculosis infection among new prisoners in southern Thailand.

Methods

A prospective cohort study was planned for January 2020‒December 2021 at Songkhla Provincial Prison. However, due to the emerging COVID-19 pandemic, the study was terminated early in February 2021. All new prisoners aged ≥15 years were included. Subjects were excluded if they had any history of a previous diagnosis of tuberculosis, household contact with a tuberculosis patient, or a history of repeated imprisonment. Chest radiography together with a 2-step tuberculin skin test (TST) was done within 2 weeks after imprisonment and at 6 months using the one-step TST. A positive TST was defined by a skin reaction ≥1.5 cm. Prisoners with negative TST had a repeat TST at 6 months. New tuberculosis infection was defined by conversion of TST to positive after 6 months of imprisonment without evidence of active tuberculosis from chest radiography.

Results

The number of new prisoners during the study period was 602. All prisoners were men with an average age of 31.11 (range 18‒75) years Fifty-one prisoners were excluded. Three hundred and eighty-five prisoners completed the 2-step TST. A total of 11.07% (61/551) of subjects had initially tested positive. Three hundred and seventy prisoners were followed. The COVID-19 pandemic caused a total shutdown of the study because access to the prison was blocked. Therefore, only 53 (9.6%) prisoners completed the study protocol at 6 months. Five prisoners (9.4%) were tuberculin converters with no evidence of active tuberculosis from chest radiography

Conclusion

The incidence of tuberculosis infection in new prisoners was 9.4%. This study has limitations. Due to the emerging COVID-19 pandemic, 90.4% of subjects were lost to follow-up and some prisoners were released before 6 months, which caused low power of the study. Further studies are needed to identify the incidence of new tuberculosis infection in new prisoners.

Disclosures

All Authors: No reported disclosures.
1440. Local Antibiogram for Mycobacterium abscessus Shows Variability from Previously Published Susceptibility Data
Authors: McElroy Timothy , Starlin Richard , Van Schooneveld Trevor C
Published: December 2022

Background

Mycobacterium abscessus complex (MabsC) causes a wide variety of human disease and is frequently resistant to multiple agents. Empiric therapy is typically based on previously published susceptibility data which suggests amikacin (AMK), cefoxitin (FOX), clarithromycin (CLR), and imipenem (IPM) should be utilized. However, there is considerable variability in susceptibility patterns according to locale. We generated an antibiogram based on local MabsC isolates and compared it to previously reported susceptibility data to determine if local variation exists and assist in empiric therapy choice.

Methods

Non-duplicate local isolates of MabsC from 2011-2021 with in-vitro susceptibility data (via broth microdilution per CLSI guidance) available were included in the generation of a local antibiogram. This included standard 14 day incubation for inducible macrolide resistance. A review of the literature via PubMed search was undertaken to generate comparator susceptibility patterns with a focus on published reports with greater than 20 isolates.

Results

Sixty one unique local isolates of MabsC were identified, 44 of which were from lung, eight skin/soft tissue, five bone/joint, two blood, one urine, and one ascitic fluid. Susceptibilities are shown in Table 1. Twenty one manuscripts described susceptibility patterns with a range of isolates from 20 to 404 with a median of 70. These revealed susceptibility ranges for AMK range from 45-100%, FOX 0-72%, CLR 19-96%, and IPM 0%-71% as seen in Table 2.

Susceptibilities of Mycobacterium abscessus isolates

Results of antimicrobial susceptibility testing for 61 isolates of MabsC with percent resistant, intermediate, and susceptible shown, along with break points used per CLSI

Comparison of Drug Susceptibility Rates from Previous Studies

Conclusion

We found high local resistance rates to cefoxitin and imipenem in contrast to empiric therapy recommendations and greatest susceptibility to amikacin. Published data shows a wide variation of susceptibility patterns to the recommended therapies based on location. It would be clinically advantageous for institutions to generate an antibiogram based on their local resistance data to assist empiric therapy choices in MabsC infections. Our data suggests that such local antibiograms could lead to substantial changes from the recommended empiric therapy at the institutional level for these infections which are historically challenging to treat.

Disclosures

Trevor C. Van Schooneveld, MD, bioMerieux: Advisor/Consultant|bioMerieux: Grant/Research Support|Insmed: Grant/Research Support|Merck: Grant/Research Support|Thermo-Fischer: Advisor/Consultant.
1441. LTBI screening cascade for non-US-born persons in a large health system assessed using EMR data
Authors: Shapiro Adrienne E , Gupta Ayushi , Lan Kristine F , Nina Kim H
Published: December 2022

Background

The majority of tuberculosis (TB) diagnosed in the US is reactivation TB in non-US-born (nUSb) persons. Guidelines recommend screening persons born in high TB burden countries for latent TB infection (LTBI) and treating if positive. We evaluated the LTBI cascade in primary care among nUSb persons in a large academic medical system in Washington State.

Methods

We used electronic medical record (EMR) data to evaluate the LTBI screening cascade. nUSb individuals were identified using the primary language recorded in the EMR. Place of birth is not routinely collected in the EMR. All persons with a non-English primary language who entered care and attended one or more primary care visits in UW clinics between April 2016- April2021 were identified and considered eligible for LTBI screening. Persons with a documented IGRA or tuberculin skin test were considered screened for LTBI. Prescription records were reviewed to determine LTBI treatment.

Results

5148 persons with non-English primary language attended primary care visits 2016-2021 and considered eligible for LTBI screening. Eligible persons were 58.5% female, median age 41 (IQR 30-58). Primary WHO regions of origin were Asia (37%), the Americas (36%), and Africa (19%), with a minority from North Africa, Middle East, and Europe. 1012 (20%) had a documented history of LTBI testing (Quantiferon-GOLD (N=949) or tuberculin skin testing (N=63)). Among 296 (29%) persons with a positive test for LTBI, 140 (47%) were treated for LTBI. The highest proportion of persons tested for LTBI were patients attending the HIV clinic (120, 66%) and the International/Refugee clinic (227, 81%). The majority of eligible patients were seen outside these clinics (N=4687) in whom the percent of persons tested ranged from 3-18% (14% overall).

LTBI cascade among non-US-born primary care patients

IGRA: interferon-gamma release assay; TST: tuberculin skin test.

Conclusion

Although this subset underestimates the number of non-US-born individuals (since many non-US-born individuals use English as their primary language) eligible for screening, it nonetheless highlights the significant gap between actual and guideline-recommended screening in primary care, as well as further drop-off on the cascade from positive LTBI test to LTBI treatment. EMR platforms could be leveraged to prompt LTBI screening and treatment initiations in primary care to help achieve TB elimination goals in the US.

Disclosures

Adrienne E. Shapiro, MD, PhD, Vir Biotechnology: Support as a trial site paid to my institution and non-financial support for medical writing GlaxoSmithKline third party funding to Vir support H. Nina Kim, MD, MSc, Gilead Sciences: Grant/Research Support.
1444. Pediatric Tuberculosis in Mexican Children: A Retrospective Analysis of 100 Patients
Authors: Villarreal Enrique G , Estrada-Mendizábal Ricardo J , Ramos-Barrera Emilia , Treviño-Valdez Pablo D , Tamez-Rivera Oscar
Published: December 2022

Background

Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis complex, mainly by M. tuberculosis. Annually, 1 million children develop TB disease and many more present a latent form of infection. The objective of this study is to define the epidemiological trends of the different clinical presentations of TB in pediatric population.

Methods

A retrospective, cross-sectional study, carried out at a pediatric referral hospital in Mexico between 2012-2021. Pediatric patients diagnosed with TB were included. Descriptive statistics were performed in order to summarize the demographic, clinical and paraclinical characteristics of pediatric patients with TB. A Chi-squared univariate analysis was performed evaluate the association between several variables of interest with mortality.

Diagnostic criteria for TB in children according to the Mexican Clinical Practice Guidelines

Results

A total of 100 patients were included in the study. Pulmonary TB was the most common presentation (51%), followed by ganglionic (21%), meningeal (14%), and milliary (7%). A male predominance was observed (54%). Mean age of presentation was 7.8 years ± 1.5, most lived in urban areas (79%) and had a positive COMBE (57%). Half of the patients had BCG vaccination. Fifty-two patients were successfully cured, 36 patients were receiving antituberculous treatment and fatality rate was 12%. Meningeal TB was the most fatal clinical presentation. Fever was the most common sign (65%), followed by cough (56%) and weight loss (37%). The most common sign of meningeal TB were generalized seizures (10/14), fever (10/14), and vomiting (7/14). Brain imaging was performed in all patients with meningeal TB: hydrocephalus (71.4%) and basal arachnoiditis (64.3%) were present. Cerebrospinal fluid analysis was also performed: 11 patients had pleocytosis, 10 had hyperproteinorrhachia, and 10 had hypoglycorrhachia. Clinical TB presentation (p=0.009) and immunodeficiency (p= 0.015) were significantly associated with mortality.

Epidemiological Characteristics According to TB Clinical Presentation.

Signs and symptoms in children according to their clinical presentation of TB.

Clinical, radiological and cerebrospinal fluid characteristics in meningeal TB.

Conclusion

Pediatric TB cases in this referral hospital indicated an equivalent proportion of pulmonary and extrapulmonary TB. Most of the patients with milliary and meningeal TB were not vaccinated; however, BCG vaccination was not significantly associated with mortality. Patients with extrapulmonary forms of the disease and with immunodeficiency were associated with mortality.

Clinical outcomes of children with TB according to their epidemiological characteristics

Disclosures

All Authors: No reported disclosures.
1662. Impact of a Documented Penicillin Allergy on Antibiotic Selection in Patients with Osteomyelitis
Authors: Li Caitlin Naureckas , Herman Katherine , Yim Ramy , Nakamura Mari M , Chu Esther , Wilder Jayme , Alfieri Maria , Ethier Benjamin , Esty Brittany
Published: December 2022

Background

Penicillin allergy is the most commonly reported drug allergy, affecting approximately 10% of patients. Although historically there has been concern about administering cephalosporins to patients allergic to penicillin, the rates of cross-reactivity are only approximately 2%. As cephalosporins are the first-line and safest treatment for many infections, unnecessary avoidance of cephalosporins places patients at risk of poor disease outcomes and antibiotic-associated harms. We assessed the relationship between penicillin allergy label and antibiotic selection in pediatric patients with acute osteomyelitis.

Methods

We performed a retrospective review of inpatients at our quaternary children’s hospital diagnosed with osteomyelitis between 2011 and 2021. During this period, the institutional osteomyelitis clinical pathway recommended clindamycin for patients with cephalosporin but not penicillin allergy. We compared rates of antibiotics used as definitive therapy between patients with and without documented penicillin allergy.

Results

Of 365 patients hospitalized with a diagnosis of osteomyelitis, 41 (11.2%) had a documented penicillin allergy. First-generation cephalosporins were administered less frequently to penicillin-allergic patients compared with those without documented penicillin allergy (37% vs. 58%, p=.009), while clindamycin was administered more frequently (22% vs. 10%, p=.02). There was no significant difference in vancomycin use (2% vs. 9%, p=.17).

Conclusion

Patients with osteomyelitis and a penicillin allergy label were significantly less likely to receive a first-generation cephalosporin and significantly more likely to receive clindamycin. Given higher regional resistance rates and more frequent adverse effects, including Clostridioides difficile infection, of clindamycin relative to first-generation cephalosporins, these data support the need for quality improvement work to increase cephalosporin use in patients with penicillin allergy labels.

Disclosures

Mari M. Nakamura, MD, MPH, Gilead: Grant/Research Support.
1461. The Impact of Universal Varicella Vaccination on Herpes Zoster Incidence in the United States
Authors: Leung Jessica W , Dooling Kathleen L , Marin Mona , Anderson Tara C , Harpaz Rafael
Published: December 2022

Background

The varicella vaccination program was implemented in the United States in 1995 and has resulted in large reductions in varicella disease burden. At the start of the varicella vaccination program, impacts on herpes zoster (HZ) epidemiology were unknown. We used a large claims database to examine national HZ incidence during 1998–2019 in cohorts of persons born before and after varicella vaccine introduction.

Methods

Medical claims data were obtained from 1998–2019 IBM® MarketScan® Research Databases. We identified HZ based on first outpatient service with an HZ ICD-9/10 code (053.xx/B02.xx) and calculated age-specific incidence for persons aged ≥30 years (all born pre-vaccine) and persons aged 1–29 years (includes persons born post-vaccine).

Results

Among persons aged ≥30 years, HZ incidence increased with age and calendar time (Fig. 1); incidence in the two oldest age groups (60–69 and ≥70 years) started to decelerate in 2007. Among persons aged 1–29 years, HZ incidence increased early in the study period for the oldest age groups (born pre-vaccine, i.e., born after 1990), but later declined once each age group was comprised of persons born in the post-vaccine period (children and adolescents) (Fig 2); the peak incidence occurred in progressively-earlier calendar years among progressively younger age groups.

Conclusion

HZ incidence in persons aged ≥30 years increased early in the study period for all age groups followed by declines starting with the oldest cohorts. The U.S. data do not support previous modelled predictions that reduced VZV exposure would result in increased HZ incidence among adults. The patterns of decline in HZ incidence in persons aged 1–29 years can likely be explained by the success of the U.S. varicella vaccination program and increasingly uncommon latent infection with wild type varicella-zoster virus. These data suggest that continued declines in age-specific HZ incidence are likely as varicella vaccinated cohorts age. The reduction of HZ resulting from the varicella vaccination program, should ultimately extend to the entire U.S. population over time.

Disclosures

All Authors: No reported disclosures.