bluuebunny/crossref_metadata_2025 huggingface dataset:
1850. Purpura Fulminans and Invasive Streptococcus pneumoniae in Immunocompetent individual
Authors: Perwez Talha , Zeineddine Nabil , Farooq Junaid , Duremala F N U , Khan Abrar
Published: December 2022

Background

Purpura Fulminans (PF) associated with invasive Streptococcus pneumoniae (ISP) is extremely rare. We present a case of PF associated with ISP in an immunocompetent person.

Methods

45-year-old male previously healthy, presented with fall, and dizziness for 1 day, preceded by bloody bowel movements and abdominal pain. On arrival to ED, he had shortness of breath, chest tightness and headache. He had a temperature of 101.7 F, HR 128 BPM, RR 37 BPM, and SpO2 94% RA. He had coarse breath sounds bilaterally, petechial and purpuric rash on chest, lips, bilateral upper and lower extremities. Laboratory findings were significant for WBC 39.3 10*3/uL, Hemoglobin 9.3 g/dL, platelets 33 10*3/uL, creatinine 2.8 mg/dl, AST 523, ALT 242, total bilirubin 3.2 with direct 1.5. INR was 2.86, PT 28.9, PTT 57.2, D dimer >20, and fibrinogen 175. CK was 16,295, ferritin 5294, and LDH 1749. Blood smear revealed schistocytes. Blood cultures grew Streptococcus pneumoniae. He was found to be in DIC, with multi organ failure. Over the course of stay he required O2 support with HFNC of 30 L/min. CT chest showed bilateral ground glass opacities. CT A/P was unremarkable. Autoimmune work up including ANA, ANCA, completement and immunoglobulin levels were unremarkable. HIV and hepatitis panel were negative. TTE negative for vegetations. LP could not be performed due to low platelets. He was started on ceftriaxone 2gm IV Q12. He was given 2 doses of IVIG and 3 days of methylprednisolone 1gm due to initial concerns IgA vasculitis.

Results

However, skin biopsy revealed small vessel neutrophilic vasculitis with thromboses consistent with purpura fulminan.

Conclusion

PF is an acute purpuric rash characterized by coagulation of the microvasculature, leading to purpuric lesions and skin necrosis. It is rapidly progressive and is often accompanied by disseminated intravascular coagulation and circulatory collapse. However, it is extremely rare in immunocompetent individuals. Upon our literature review there are only handful of case reports that has described the association of ISP with PF in immunocompetent individual. Our case highlights such rare association and stress on early recognition and treatment as it can cause significant morbidity and mortality.

Disclosures

All Authors: No reported disclosures.
1881. Detection of SARS-CoV-2 Transmission on a College Campus using a Combined Contact Tracing and Molecular Strategy
Authors: Brewer Jesse T , Wang Wei , Aranovich Irina , Notterman Daniel , Daskalaki Irini
Published: December 2022

Background

SARS-CoV-2 has caused unprecedented global disruption following its introduction into the human population. Beginning in August 2021, a residential college initiated an asymptomatic testing protocol using PCR-based detection of human saliva samples (Thermofisher, TaqPath SARS-CoV-2 Assay; QuantStudio v1.3). In January 2021 all students were invited to campus and were required to test once or twice weekly in an effort to isolate those positive (cases) as early as possible and minimize transmission.

Methods

Cases were contacted within 12 hours by trained clinical staff and interviewed with a standardized questionnaire to determine contacts and exposures. Positive samples were submitted for RNA-Seq analysis (ARTIC amplicon sequencing protocol, Illumina MiSeq) and analyzed using Nextclade and USHER (comparison data from GISAID). Using this sequence data, we monitored the evolution, transmission, and emergence of variants over time in the campus community.

Results

In March 2022 a one-week break and the activities preceding it were followed by an outbreak of COVID among campus members. All cases were attributed to the Omicron variant. Based on traditional contact tracing 10 presumed clusters of transmission were identified (34 students). Sequence data from these 34 samples were assembled to identify phylogenetic and molecular patterns of similarity. Several molecular signatures were identified. In a group of 5 cases, all were Omicron BA.2.9; these individuals comprised a clinical cluster of students who had travelled together. Other lineages were BA.2 (N=26), BA.1(N=2), BA.2.12. (N=3), BA.2.3 (N=1) and an Omicron Clade 21M variant that appeared to be a BA.1/BA.2 recombinant (N=2). The BA.2.12 samples were contributed over 2 days; they were found in two different clusters (a social club and an artistic group), demonstrating likely transmission between members. The BA.2 samples were distributed across a wide number of student groups, and while not identical with one another, did not fall into the clusters identified by contact tracing, suggesting endemic transmission across our campus.

Conclusion

This analysis demonstrates that molecular analysis of SARS-CoV-2 transmission can supplement and inform the data provided by clinical/epidemiological analysis of cases.

Disclosures

All Authors: No reported disclosures.
1891. Repeated Assessment of SARS-CoV-2 Seroprevalence among Health Care Workers Early in the Pandemic: Relationship to Workplace Exposures
Authors: Demian Sherry , Awuah Dominic O , Osterholzer Danielle , Altameemi Lina , Rios-Bedoya Carlos , Taftaf Ahmad , Nguyen Hoang C
Published: December 2022

Background

Early in the pandemic, heath care workers (HCWs) were deemed to be at high risk of acquiring SARS-CoV-2 from their patients and distanced themselves from their families. This study aimed to estimate the seropositivity of a cohort of healthcare over time while also looking for associations between seroconversion and hospital and community SARS CoV-2 exposures.

Methods

This is a prospective cohort study of HCWs from patient care (PC) and non-patient care (NPC) areas conducted from April 2020 through Dec 2020 at Hurley Medical Center in Flint, Michigan (MI). The first case of SARS-CoV-2 was diagnosed in MI on 3/10/2020. In early April 2020, HCWs underwent serum testing for total SARS-CoV-2 anti-spike protein antibody and completed a questionnaire to collect data on demographics, travel, job characteristics, in and out of hospital SARS-CoV-2 exposures, and use of personal protective equipment (PPE). The serum testing and survey were offered to the same HCWs in late May 2020 and again in December 2020. Statistical analysis such as Fisher's exact test and Student's t-test were used to determine if there was an association with SARS-CoV-2 antibody status for categorical and continuous variables, respectively.

Results

At baseline, 20/192 (10.4%) of HCWs were seropositive for SARS-CoV-2 total antibody with 9/20 (45%) providing PC. Job title was known for all participants however, initial survey completion was 79.6%. Eight weeks later, 13/131 (9.9%) were positive of which 5/13 (38.4%) were new seroconversions, 2/5 (40%) in PC. Eight months after the initial draw, 16/120 (13.3%) were positive with 13/16 (81.3%) new, 7/13 in PC (54%). The number of HCWs who tested positive at any time during the study was 38/192 (19.8%). No significant associations were found between seroconversion and taking care of COVID patients, any direct patient care duties, or other variables collected at the two-sided threshold of 0.05.

Conclusion

No association in this small study was found between PC and SARS-CoV-2 antibody seroconversion. HCWs in NPC areas were as likely to test positive as those in PC likely reflecting community prevalence. Universal masking at the medical center and use of full PPE to care for probable and confirmed COVID patients likely prevented higher rates of PC acquisition.

Disclosures

All Authors: No reported disclosures.
1901. Utilizing Antiviral Prescription Data as a Predictor of Increasing COVID-19 Incidence: A Retrospective Study of Citywide Data
Authors: Kaul Christina , Cohen Gabriel M , Silverstein Matthew , Wallach Andrew B , Diago-Navarro Elizabeth , Foote Mary K
Published: December 2022

Background

COVID-19 has caused over 6 million deaths worldwide. While testing was initially centered in healthcare facilities with automatic reporting to health departments, it is increasingly being performed in the home with rapid antigen testing. Many at-home tests are self-interpreted and not typically reported.

In December 2021, nirmatrelvir/ritonavir and molnupiravir were authorized for the treatment of COVID-19 in high-risk patients. In New York City (NYC), these antivirals are available for free via pickup or home delivery, allowing for early expanded access. We sought to identify if prescribing of antivirals might act as an early indicator of increasing COVID-19 incidence in the setting of decreased case reporting.

Methods

Confirmed and probable COVID-19 tests are reported to the NYC Health Department. All pharmacies participating in the federal COVID-19 therapeutics program are required to report daily utilization data, which are made available to jurisdictions through the Tiberius platform. From December 27, 2021 to April 18, 2022, we analyzed citywide weekly case counts, using patients 65 years and over as a proxy for high-risk eligible patients, and weekly oral therapeutic prescription fills. We calculated weekly case rates and prescribing rates per 100,000 residents. Weekly case rates and prescription fill rates were trended to assess for concordance over time.

Results

During this period, 17,522 prescriptions were filled. Prescription fills and case rates were concordant until the weeks of February 28 and March 7, when an increase in fill rate was noted from the week prior (1.76 to 2.34 to 4.10), while reported case incidence continued to decrease (6.16 to 5.08 to 4.61). This discordance coincided with the emergence of the BA.2 subvariant in NYC. After these weeks, an uptick in case incidence was noted for the remainder of the study period, in concordance with prescription data.

Conclusion

Increasing rates of oral therapeutic prescribing could be an early indicator of increasing COVID-19 transmission. Limitations include the unclear impact of public and prescriber education efforts on prescribing trends. Next steps include exploring the addition of prescription data into modeling to predict trends in transmission as reported cases becomes a less reliable indicator.

Disclosures

Gabriel M. Cohen, MD, Daybreak Health: Advisor/Consultant|Daybreak Health: Board Member|Daybreak Health: Ownership Interest Andrew B. Wallach, MD, Pfizer: Advisor/Consultant.
1917. Impact of the COVID-19 Pandemic on Antimicrobial Stewardship, Infection Prevention & Control, and Clinical Microbiology Practices in Argentina, Brazil, and Chile
Authors: Osuka Hanako , Patel Twisha S , McGovern Olivia L , Boszczowski Icaro , Munita Jose M , Garzon Maria I , Lipari Flavio , Salomao Matias , Marssola Giovanna , Travares Bruno , Peters Anne , Spencer Maria , Porte Lorena , Barbe Mario , Rojas Pamele , Stender Stacie C , Lessa Fernanda C
Published: December 2022

Background

During the coronavirus disease 2019 (COVID-19) pandemic, healthcare facilities (HCFs) were overwhelmed with increasing patient volumes and limited resources. Reports of disruptions in routine practices at HCFs have emerged. We evaluated changes in policies, practices, and programs for antimicrobial stewardship (AMS), infection prevention and control (IPC), and clinical microbiology across six HCF in South America following the onset of the COVID-19 pandemic.

Methods

We conducted a survey in 6 HCFs in Argentina, Brazil, and Chile; 2 HCFs in each country. Data on 5 components (facility characteristics, antibiotic procurement and distribution, AMS activities, IPC activities, and clinical microbiology) were collected from designated specialists within each HCF from March 2018 – February 2021. We compared observations within these 5 components pre-pandemic (March 2018 – February 2020) to during pandemic (March 2020 – February 2021.)

Results

During the pandemic, the number of ICU beds increased across all the 6 HCFs by 57-633%, and the number of ventilators increased by 15-317% in 5 out of the 6 HCFs. Healthcare personnel shortages were observed in all 6 HCFs, notably common for nurses and laboratory personnel (Table 1). Extended use of N95 respirators was reported across all 6 HCFs with 2 doing extended use of gowns and medical masks. The only PPE reused was N95 respirators in 2 HCFs. Difficulties in cohorting patients with multi-drug resistance organism (MDRO) was reported by one of the HCFs. Three HCFs reported shortages in drugs with coverage for MRSA, gram-negative bacteria, and fungal pathogens despite no reports of interruption in AMS activities in these HCFs. Two hospitals reported delays on microbiology results.

Facility characteristics and reported changes during COVID-19 pandemic (March 2020-February 2021)

Conclusion

The COVID-19 pandemic led to substantial increases in ICU beds, number of ventilators, and extended use of PPE suggesting increases in admission of severe patients and suboptimal IPC practices in HCFs in South America. It is unclear if shortages in agents commonly used to treat MDRO was related to overuse or access difficulties. Additional evaluation is needed to determine the impact of these findings on antimicrobial resistance and antimicrobial use.

Disclosures

Matias Salomao, MD, Cepheid: Lecture.
1937. COVID-19 Vaccine Distribution in Massachusetts Jails
Authors: Cassarino Nicole , Smyth Emma , Gail Wurcel Alysse
Published: December 2022

Background

Vaccination is one of the main mitigation strategies to protect people from COVID19 mortality. People incarcerated in jails experienced disparate rates of COVID19 infection compared to people in the community, thus operationalization of COVID19 vaccine delivery in jails was prioritized in several states, including Massachusetts (MA). The goal of this project was to track COVID19 vaccine ordering in MA jails and compare numbers and types of COVID19 vaccines ordered by MA jails to those in the MA community, with specific attention to the Centers for Disease Control and Prevention’s (CDC) guidelines for COVID19 vaccines.

Methods

MA jails received COVID19 vaccines free of charge through the MA Department of Public Health. We requested de-identified, facility-level data from the MA DPH including: number of vaccines ordered by each jail, type of vaccine, and date of the vaccine order from December 2020 - January 2022. We obtained COVID19 vaccines distribution data for the MA general population from the CDC.

Results

Vaccine orders were available for 13/14 MA jails. A total of 23,060 vaccines were ordered from the MA DPH between December 2020 - January 2022. January 2021 marked the highest number of vaccine orders by the jails, and all other months were orders < 33% of the January 2021 order. Moderna COVID vaccines were most frequently ordered by the MA jails (88%), followed by Janssen (11%) then Pfizer (1%). In the general population, Pfizer was the most frequently distributed vaccine type (59%), followed by Moderna (37%), then Janssen (4%).

Conclusion

Prioritization of jails in MA led to a strong initial push for vaccine distribution which then waned. Potential reasons for the drop in orders include: the initial vaccine orders in January 2021 may have lasted several months, people entering jail after spring 2021 may have received vaccines in the community, and clinical and administrative fatigue may have limited continued robust vaccine protocols. Tracking COVID-19 vaccine orders by jails is a way to assess equitable vaccine operationalization. As recommendations for vaccination evolve, public health and carceral leaders should collaborate to ensure consistent low-barrier COVID19 vaccine access in jails

Disclosures

All Authors: No reported disclosures.
1957. Increased short-term vaccine effectiveness of BNT162b2 with same-arm vs. cross-arm administration of sequential doses
Authors: Grupel Daniel , Pasternak Yehonatan , Schonmann Yochai
Published: December 2022

Background

It is unknown whether administering the second BNT162B2 vaccine dose on the cross-arm or the same arm as the first dose creates a more robust local and systemic immune response leading to favorable clinical results. We used data from Israel’s largest healthcare provider (Clalit health services [CHS]) to assess the impact on vaccine effectiveness of contralateral vs. ipsilateral administration of BNT162b2.

Methods

A retrospective cohort study, conducted on all CHS members who received the BNT162b2 vaccine between December 2020 and December 2021.

The primary endpoint was a positive RT-PCR test for SARS-CoV-2 between 10 days and 38 days after the administration of the second dose of bnt162b2.

A logistic regression model was used to compare the likelihood of COVID-19 infection at different time intervals following vaccination.

Results

During the study, 2,678,226 CHS members received both doses of BNT162b and were eligible for analysis. Of these, 2,367,694 (88.41%) received the first two doses of the vaccine on the same arm (ipsilateral). The primary endpoint was observed in 2061 (0.077%) participants. The primary endpoint was observed more frequently in the contralateral vs. the ipsilateral group. The adjusted odds ratio for occurrence of the primary endpoint in the ipsilateral vs. the contralateral group was 0.83 (95% CI 0.73-0.94 P=0.004).

Statistically significant reduction in OR was also observed in two of our secondary outcomes – hospitalization due to COVID-19 and all-cause mortality.

Conclusion

Our study suggests that administration of the first and second BNT162b doses in the same arm, might increase vaccine effectiveness in the short term, possibly due to more robust local lymph node activation. This intervention could have a dramatic effect on public health. Further studies are needed to assess the long-term effectiveness of our findings.

Disclosures

All Authors: No reported disclosures.
1965. Promoting COVID-19 Health Equity through Partnership with Community-Based Organizations and Home Vaccination Services
Authors: Daniels Justin , Holland David P , Forbes Tanner , Scott Jane Y
Published: December 2022

Background

The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups. The Fulton County Board of Health (FCBOH) sought to promote COVID-19 health equity by partnering with Community Organized Relief Effort (CORE) and Community-Based Organizations (CBOs) to address access barriers and increase vaccine acceptance in Black and Latinx residents. These priority populations were identified using data from the Social Vulnerability Index, the COVID-19 Community Vulnerability Index, and local data regarding COVID-19 positivity and death rates.

Methods

With support from the Centers for Disease Control, FCBOH partnered with CORE to deploy mobile units that provided free at-home vaccination services to Fulton County residents. CORE promoted their services in zip codes identified as having higher proportions of Black and Latinx residents. Additionally, CORE partnered with three CBOs that represented and had pre-existing relationships with our target populations. These CBOs promoted CORE’s at-home services to their constituents. CORE also provided vaccination and health education services at community outreach events hosted by the CBOs as well as at clinics operated by the CBOs.

Results

Between the months of September 2021 and March 2022, our programs were able to provide a total of 897 vaccinations - 510 (57%) at community events, 330 (37%) through at-home services, and 54 (6%) in community-based clinics. Among the 714 vaccinations for which race and ethnicity information were available, 348 (49%) were delivered to Black individuals and 326 (46%) vaccines were administered to Latinx individuals. Uptake of vaccines for Black and Latinx individuals was highest at community events (54% and 88%, respectively), followed by at-home services (35% and 12%, respectively).

Conclusion

At-home vaccination services and partnerships with local CBOs can support a higher proportion of COVID-19 vaccinations administered to populations most at-risk. Notably, community events were the most effective settings for administering vaccines to these populations. Utilizing these methods can help overcome barriers to accessing healthcare and ultimately reduce COVID-19 health disparities in underserved minority communities.

Disclosures

All Authors: No reported disclosures.
1976. Using a Patient Portal as a Recruitment Tool to Diversify the Pool of Participants in COVID-19 Vaccine Clinical Trials
Authors: Yuh Tiffany , Srivastava Tuhina , Fiore Danielle , Schmidt Harald , Frank Ian , Metzger David , Momplaisir Florence
Published: December 2022

Background

Because the COVID-19 pandemic disproportionately affected racial/ethnic minorities in the US, there was a push to ensure diversity in COVID-19 vaccine clinical trials. Historically, minority groups have been underrepresented in research. We assessed the feasibility of recruiting racial/ethnic minorities through an electronic health record (EHR) patient portal.

Methods

The UPenn Health System EHR was used to identify individuals ages 40 and older, living in zip codes with high rates of SARS-CoV-2 test positivity, with a risk factor associated with severe COVID-19 disease. Eligible individuals with an activated patient portal account were sent a message inviting them to participate in the COVID-19 vaccine clinical trial. A follow-up phone call was made to those who did not respond or declined, and reasons for or against participation were coded to extract themes.

Results

In August 2020, a total of 13,779 patients fit the inclusion criteria, of which 5,614 (40.7%) had an activated patient portal account and were invited to participate. The majority, 5,426 (96.7%), identified as black, and 73 (1.3%) identified as Hispanic/Latinx. Only 301 (5.4%) of messaged individuals responded. Among respondents, 55 of 206 (26.7%) blacks, 5 of 7 (71.4%) Hispanic/Latinx, and 50 of 76 (65.8%) whites expressed interest. Among the 115 respondents who expressed interest, 24 agreed to a screening visit, and 9 were ultimately enrolled in the trial, which consisted of 6 black, 3 white, and 1 Hispanic/Latinx individual. During phone outreach to those who did not respond and those who declined, common reasons for declining included underlying health conditions, fears of an unproven vaccine, not wanting to be experimented upon, the rapid speed of vaccine development, and the lack of time to participate in a trial.

Patient portal response rates by race/ethnicity

Conclusion

Because of low rates of patient portal account activation and use, compounded with vaccine hesitancy, recruitment of racial/ethnic minorities into COVID-19 vaccine clinical trials through patient portal messaging yielded a small number of participants. Strategies to increase use of the patient portal combined with approaches to address concerns of trial participation should be considered to increase enrollment of racially/ethnically diverse groups into vaccine clinical trials.

Disclosures

All Authors: No reported disclosures.
1977. Vaccine confidence among the adult population of Bishkek and Naryn, Kyrgyz Republic, 2021
Authors: Malysheva Marina , Horth Roberta , Nabirova Dilyara , Zikriyarova Sanam
Published: December 2022

Background

Vaccines against COVID-19 are critical to controlling COVID-19. A successful vaccination campaign requires high vaccine uptake. Knowledge of people’s perceptions towards vaccines and their readiness to be vaccinated helps inform messaging around vaccine confidence. Our study aimed to assess the level of vaccine confidence and identify associated factors in two cities in Kyrgyz Republic.

Methods

In August 2021, we conducted a convenient sample study of adults (≥18 years old) at public service centers and malls in Bishkek and Naryn. A participant had high vaccine confidence if they (1) believed that the COVID-19 vaccine is important to protect oneself or to protect others in their community, and (2) had been vaccinated or planned to get vaccinated. We used logistic regression to assess associations with high vaccine confidence.

Results

Of 1595 respondents, 29% had high COVID-19 vaccine confidence, 37% believed getting a vaccine was important to protect oneself, and 39% believed it was important to protect others in their community. Moreover, 63% of respondents were not vaccinated and did not plan on getting vaccinated,61% reported concerns about safety and side effects, and 44% believed (incorrectly) that vaccines would not effectively prevent COVID-19. Vaccine confidence increased with age (42% aged ≥50 years vs 21% aged 18-29 years) and education level (38% among those with higher education vs 22% lower education). Higher age (adjusted odds ratio [AOR]: 1.8, 95% confidence interval [CI] 1.4-2.3), higher education (AOR 1.5, CI 1.2-1.8), high COVID-19 knowledge (AOR 2.5, CI 1.6-4.1), prior COVID-19 testing (AOR 1.5, CI 1.3-1.8), and reporting healthcare workers as a primary source of COVID-19 information (AOR 1.3, CI 1.1-1.6) were associated with high vaccine confidence.

Conclusion

Results demonstrate that building vaccine confidence is likely needed, especially among younger people and people with lower education. Healthcare providers can work with populations to address safety concerns and promote vaccine effectiveness.

Disclosures

All Authors: No reported disclosures.
1979. Waning of humoral immunity depending on the types of COVID-19 vaccine
Authors: Lim So Yun , Kim Ji Yeon , Jung Jiwon , Yun Sung-Cheol , Kim Sung-Han
Published: December 2022

Background

There are limited data on the rates of the waning of antibody levels after two-dose and booster vaccination according to the different platforms of COVID-19 vaccines.

Methods

We enrolled healthcare workers (HCWs) in a tertiary care hospital who received homologous two-dose vaccination, followed by a homologous or heterologous booster mRNA vaccine. SARS-CoV-2 S1-specific IgG was measured using ELISA. A linear mixed regression model was used to compare the slope from the peak antibody titer to the lowest antibody titers 3 months after vaccination.

Results

A total of 113 HCWs (BNT162b2 (n=48 [42%]), ChAdOx1 nCoV-19 (n=52 [46%]) or mRNA-1273 (n=13 [12%])) were enrolled in this prospective cohort study. More gradual antibody waning was observed over 3 months with the two-dose ChAdOx1 nCoV-19 (ChAdOx1) than with the two-dose BNT162b2 or mRNA-1273 (p< 0.001 and p=0.001, respectively). In addition, homologous mRNA-1273 booster induced a more durable antibody response than homologous BNT162b2 booster (p< 0.001) or heterologous ChAdOx1-BNT162b2 booster (p< 0.001).

Conclusion

2-dose homologous ChAdOx1 vaccination or homologous mRNA-1273 booster appears to induce more-durable antibody responses than 2-dose homologous mRNA vaccination, homologous BNT162b2 booster, or 2-dose ChAdOx1 followed by BNT162b2 booster.

Disclosures

All Authors: No reported disclosures.
1983. Impact of postoperative antibiotics duration on prognosis in patients with infective endocarditis
Authors: Kim Jinnam , Kim Jung Ho , Lee Hi Jae , Lee Se Ju , Lee Ki Hyun , Kim Chang Hyup , Lee Jung Ah , Ahn Jin Young , Jin Jeong Su , Ku Nam Su , Lee Seung Hyun , Yong Choi Jun , Yeom Joon-sup
Published: December 2022

Background

Infective endocarditis (IE) remains a major medical problem with high morbidity and mortality. Appropriate antibiotic treatment in patients with IE lowers the risk of embolism, recurrence, and long-term mortality. However, there are concerns about renal toxicity and an increase in the incidence of resistant strains due to long-term use of antibiotics. In this study, we compare the difference in overall mortality according to the duration of postoperative antibiotics therapy in patients with IE for each group.

Methods

From 2005 to 2017, we retrospectively reviewed 416 patients with IE at a 2400-bed tertiary hospital in South Korea. A total of 239 IE patients who underwent valve surgery and appropriate antibiotics duration were enrolled. The primary endpoint was long-term overall mortality. The secondary endpoints were reoperation rate, recurrence rate, and postoperative complications, such as new-onset heart failure, paravalvular and embolic complications.

Results

The median follow-up duration was 71 (interquartile range, 46–109) months. The duration of postoperative antibiotic therapy was less than 2 weeks in 67 patients (28.0%) and more than 2 weeks in 127 patients (72.0%). The median age was 53 years. The overall mortality was 13.0% (31/239). There were no statistical differences in overall mortality (13.4% vs. 12.8%, p=0.894), reoperation (6.0% vs. 4.1%, p=0.507), and recurrence (7.5% vs. 2.9%, p=0.148) between patients with postoperative antibiotic therapy for ≥2 weeks and less than 2 weeks. The duration of postoperative antibiotic therapy based on 2 weeks in the Kaplan-Meier curve was not associated with overall mortality (log-rank test, p=0.971).

Conclusion

In conclusion, there was no statistically significant difference in the overall mortality, recurrence, and reoperation rate according to the duration of postoperative antibiotic therapy. When surgery and recommended total antibiotics duration are properly performed according to guidelines, the effect of duration of postoperative antibiotic therapy on overall mortality, recurrence rate, and reoperation rate is reduced to a statistically insignificant extent.

Disclosures

All Authors: No reported disclosures.
2022. Evaluation of Antimicrobial Prophylaxis and Infectious Outcomes in Penile Prosthetic Implants at VA Long Beach Healthcare System
Authors: To Anna , Tran Thuong , Tan Susanna , Chun Patricia
Published: December 2022

Background

Penile prosthetic implants (PPI) offer an effective treatment for erectile dysfunction. The risk of postoperative infection in primary PPI is estimated at 0.33-11.4% and up to 18% in revision surgery. The most common causative organisms include Escherichia coli and coagulase negative Staphylococcus. The AUA guidelines recommend perioperative antibiotics for no more than 24 hours. However, a survey of urologists revealed that the majority used oral antibiotics for 5-14 days after surgery. There have been increasing reports of anaerobic and fungal infections, but the AUA guidelines do not recommend antimicrobial prophylaxis against these organisms.

Methods

This is a retrospective, chart review, quality-improvement study. Veterans who had a PPI procedure between May 1999 to July 2021 were included. Patients with only removal of the prosthesis were excluded. For patients who had multiple procedures, only the most recent procedure was considered. Data collection included demographics, pertinent medical history (history of polysubstance abuse, homelessness, smoking, chronic immunosuppression, anticoagulation, diabetes, HIV, spinal cord injury, Peyronie’s disease or priapism), prior PPI, relevant labs (BMP, A1C), microbiologic results, and medications prescribed.

Results

176 patients underwent a PPI-related procedure between May 1999 and July 2021. 137 patients were included in this study. 14 patients (10.2%) experienced a PPI infection. For all patients, the average total duration of antimicrobial prophylaxis was 11.8 days. Mean duration of antimicrobial therapy after procedure was 12.4 days and 10.5 days for the infection and no infection group, respectively (p-value 0.118). The most common antibiotic combination was vancomycin and gentamicin. There were no statistically significant difference in patient risk factors between infection and no infection groups, but the most common risk factors were smoking and prior implant. Gram positive organisms were most commonly isolated. There were no incidences of fungal infections. 2.2% incidence of AKI and 1.5% incidence of antimicrobial resistance were observed.

Conclusion

Further evaluation of the necessity of prolonged duration of antimicrobial prophylaxis and antifungal prophylaxis should be evaluated.

Disclosures

All Authors: No reported disclosures.
2035. Detecting Vancomycin-resistant Enterococci infection in an immunosuppressed population after screening
Authors: Hamad Yasir , Hashem Nehal G , Henderson David K , Decker Brooke K , Odom Robin T
Published: December 2022

Background

Vancomycin-Resistant Enterococci (VRE) are major pathogens for severely immunosuppressed patients. Because VRE are common pathogens in our institution, such patients are often empirically treated to cover VRE, exposing them to broad-spectrum antimicrobials. Analogous to nasal screening for Methicillin-resistant Staphylococcus aureus carriage, targeted VRE surveillance is performed to identify and isolate colonized patients to reduce transmission. To assess risks and benefits of empiric therapy, we evaluated this surveillance procedure.

Methods

All patients admitted to two inpatient hospital units from 01/01/2019 to 12/31/2021 had routine perirectal VRE surveillance ordered and results retrospectively reviewed. One swab from each Culturette set was tested by vanA PCR, and the other was inoculated on CHROMEID® VRE (Biomerieux) if the PCR was positive. Subsequent clinical cultures of any site within 14 days of surveillance screening were reviewed for VRE.

Results

1133 patients were screened; 46 (4.1%) patients had VRE colonization. Within 2 weeks following VRE screening 20 patients had clinical samples that were positive for an Enterococcus species (14 in the first 7 days and 6 in days 8-14). The most common sites of clinical cultures were urine, 8 (40%), wound, 4 (20%), intra-abdominal, 4 (20%), and blood, 2 (10%). No clinical culture sample contained VRE.

Conclusion

The rate of VRE carriage was low in this population, raising the question of the value of broad-spectrum empiric therapy coverage for VRE. No VRE infections were subsequently detected in any patients irrespective of surveillance. The negative predictive value for clinical VRE infection was 100% with negative surveillance screening in this population.

Disclosures

All Authors: No reported disclosures.
2038. Epidemiology of Carbapenem-Resistant Organisms in Alameda County, California (July 2019 - June 2021)
Authors: Marusinec Rachel , Shemsu Munira , Lloyd Tyler , Kober Brendan M , Herrera Jade A , Gregory Misha , Heaton Dustin T , Varghese Vici , Trivedi Kavita K
Published: December 2022

Background

Carbapenem-resistant Enterobacterales (CREs) and some Carbapenem-resistant organisms (CROs) are considered urgent threats by the CDC. Since 2017, the Alameda County Public Health Department has mandated the reporting of CRE and encouraged voluntary reporting of non-CRE CROs. Surveillance data from these cases were analyzed to describe the epidemiology of infections and to target local public health interventions.

Methods

Healthcare facilities in Alameda County reported cases of CROs to the public health department directly to staff or through Electronic Laboratory Reporting and submitted isolates to the public health laboratory for ascertainment of carbapenemase genes by whole genome sequencing on the Illumina MiSeq platform; deaths were recorded via the California Electronic Death Registration System. Surveillance data were analyzed for cases July 2019 – June 2021 identified by the clinical laboratory as resistant to one or more carbapenems.

Results

From July 2019 – June 2021, 444 cases of CROs were reported to Alameda County from 409 patients. The county case rate for CROs over the two-year period was 29 cases per 100,000 population. Of the reported cases, 218 (49%) were CRE species: Escherichia coli, Klebsiella spp., and Enterobacter spp. Of the remaining cases, 157 (35%) were carbapenem-resistant Pseudomonas aeruginosa, 46 (10%) were carbapenem-resistant Acinetobacter baumannii (CRAB), and 23 (5%) were other carbapenem-resistant species. Cases by carbapenemase status are described in Table 1. Of the cases, 192 (43%) were among residents of long-term care facilities or long-term acute care hospitals; 340 (77%) cases were identified in patients over >50 years, and 168 (38%) cases have a death on record through January 2022. Among isolates with a carbapenemase gene (n = 129), KPC (32%) was the most commonly identified (Table 2).

Conclusion

The high burden of CROs in Alameda County highlights the need for continued partnership on reporting, testing and infection prevention measures to limit the spread of resistant organisms. A large proportion of cases were identified in vulnerable long-term care residents and 104 (24%) cases were identified as carbapenemase-producing, with a higher percentage among CRAB isolates, informing future targeted public health interventions.

Disclosures

All Authors: No reported disclosures.
2039. Evaluation Of Diagnostic Considerations In The Evaluation Of Hospital Acquired Pneumonia
Authors: Mendoza Maria A , Bhatia Monisha C , Lazo-Vasquez Alex F , Abbo Lilian M , Shukla Bhavarth S
Published: December 2022

Background

Hospital-Acquired Pneumonia (HAP), defined as pneumonia that occurs 48 hours or more after hospital admission, is considered a part of the health care-associated infections (HAIs). HAIs are one of the top ten causes of death in the United States. Correct diagnosis of HAIs is key to reducing its impact, however, the diagnosis of HAP is challenging because clinical findings are nonspecific and there is no combination of signs, symptoms, and laboratory or imaging results that can predict this diagnosis with a good sensitivity or specificity. This study aims to clarify the prioritization of clinical elements considered in the diagnosis of HAP by physicians at our center.

Methods

This is a cross-sectional study at a large, tertiary care academic center in Miami, Florida. The target population included hospitalists, internal medicine residents, critical care and infectious disease fellows. REDCap was used to administer the survey and collect data. A rank individual analysis was conducted to assess for the most significant diagnostic criteria overall. Kruskal-Wallis analysis was conducted to assess for significance of the individual diagnostic criteria.

Results

At the end of the survey period, 130 people responded (45.8% of sent surveys). Overall Kruskal-Wallis rank sum test of the systemic factors showed significant differences between the diagnostic criteria chosen. The presence of a new or worsening infiltrate on imaging was selected as most important. After that, fever, a positive respiratory culture, worsening hypoxia and new cough and shortness of breath were in the second tier of important criteria (Figure 1). The median number of factors needed to have HAP in the differential diagnosis and start empiric treatment was 3, while the needed number to secure the diagnosis of HAP was 4. In an immunocompromised patient, the median number of factors needed was 2 (Figure 2). Color red, represents selection 1 - meaning, the larger the tab, it means that specific factor was highly considered as the first factor in the diagnosis of HAP.

Color green represents second most selected factor

Color blue represents third most selected factor

Upper box: median number of factors needed to secure the diagnosis of HAP

Mid box: median number of factors needed to include HAP as the differential diagnosis in an immunocompromised patient

Lower box: media number of factors needed to have HAP in the differential and start empirical treatment

Conclusion

In this study, we observed that the most highly considered criteria for the diagnosis of HAP are new or worsening infiltrate on imaging, new or worsening hypoxia, and respiratory cultures with growth of a classical respiratory pathogen. Most of these criteria are part of the IDSA guidelines on the evaluation and treatment of HAP. Future directions include developing a decision support tool for diagnosing HAP.

Disclosures

All Authors: No reported disclosures.
2043. In Vitro Activity of Manogepix Against 2,810 Fungal Isolates from the SENTRY Surveillance Program (2020-2021) Stratified by Infection Type
Authors: Huband Michael D , Pfaller Michael , Carvalhaes Cecilia G , Bien Paul , Castanheira Mariana
Published: December 2022

Background

Manogepix is a new antifungal with a novel mechanism of action and potent in vitro activity against Candida (except C. krusei), Aspergillus, and rare mold isolates. The manogepix prodrug fosmanogepix is in Phase 2 development for the treatment of invasive mold infections caused by Aspergillus and rare molds (NCT04240886) and has completed Phase 2 studies for candidemia (NCT03604705) and C. auris (NCT04148287) infections. We evaluated the in vitro activity of manogepix and comparators against 2,810 geographically diverse fungal isolates collected in the SENTRY Surveillance Program during 2020-2021 and stratified them by infection type.

Methods

Antifungal susceptibility testing of manogepix and comparator agents was conducted according to CLSI M27 (2017) and M38 (2017) guidelines. Fungal surveillance isolates were collected from medical centers located in North America (30 sites; 37.9%), Europe (30 sites; 38.4%), Asia-Pacific (11 sites; 14.7%), and Latin America (6 sites; 9.0%). Infection sites included bloodstream infections (BSI; 48.3%), pneumonia in hospitalized patients (PIHP; 19.9%), skin and skin structure infections (SSSI; 7.8%), urinary tract infections (UTI; 3.1%), intra-abdominal infections (IAI; 1.6%), and other infection types (19.3%).

Results

Manogepix demonstrated potent in vitro activity against Candida spp. isolates (MIC50/90, 0.004-0.03/0.008-0.06 mg/L) regardless of infection type (Table). Similarly, manogepix was highly active against 534 Aspergillus spp. isolates (MEC50/90, 0.015/0.03 mg/L). Manogepix was active against 53 Cryptococcus neoformans var. grubii (MIC50/90, 0.25/1 mg/L), 19 Fusarium spp. (MEC50/90, 0.015/0.06 mg/L), 12 Lomentospora prolificans (MEC50/90, 0.03/0.06 mg/L), and 17 Scedosporium spp. isolates (MEC50/90, 0.06/0.12 mg/L).

Conclusion

Manogepix showed potent in vitro activity against Candida spp., Aspergillus spp., C. neoformans var. grubii, and rare molds, including Fusarium spp., L. prolificans, and Scedosporium spp. isolates. Notable activity was also demonstrated by manogepix against C. auris isolates. Further clinical development of fosmanogepix in difficult-to-treat, resistant fungal infections is warranted.

Disclosures

Michael D. Huband, BS, AbbVie: Grant/Research Support|Melinta: Grant/Research Support Cecilia G. Carvalhaes, MD, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support Mariana Castanheira, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support.
2051. Relebactam enhances Imipenem activity across the Imipenem susceptibility spectrum among Pseudomonas aeruginosa isolates collected in the United States--SMART 2018-2020
Authors: Hilbert David W , DeRyke Charles A , Motyl Mary , Young Katherine
Published: December 2022

Background

The Beta-Lactamase Inhibitors (BLIs) Relebactam (REL) and Avibactam (AVI) both inhibit class A and C beta-lactamases and are approved in combination with the beta-lactam antibiotics imipenem (IMI/REL) and ceftazidime (CAZ/AVI), respectively. Our goal was to evaluate the effect of these BLIs on susceptibility of Pseudomonas aeruginosa isolates that are either nonsusceptible (NS), Intermediate (I) or Susceptible (S) to the partner beta-lactam antibiotic.

Methods

In 2018-2020, ∼20 unique participating sites in the United States each collected up to 250 consecutive aerobic gram-negative isolates per year (50 each from urine, intraabdominal and blood; 100 from lower respiratory tract). Susceptibility to Imipenem (IMI) and Ceftazidime (CAZ) were determined alone as well as in combination with their cognate BLIs. MICs were determined using broth microdilution and evaluated by CLSI interpretive criteria.

Results

A total of 2,537 P. aeruginosa isolates were evaluated. Among IMI-NS isolates (MIC >2 μg/mL) REL restored IMI susceptibility to 75% and among CAZ-NS isolates (MIC >8 μg/mL) AVI restored CAZ susceptibility to 73%. For IMI-I isolates (MIC of 4 μg/mL), the presence of REL restored susceptibility to 98%, and 95% had MICs at least one dilution less than the susceptible breakpoint. For CAZ-I isolates (MIC of 16 μg/mL), AVI restored susceptibility to 84% of isolates, and 62% had MICs at least one dilution below the susceptible breakpoint. The addition of REL shifted the mode IMI MIC of IMI-S (MIC ≤ 2 μg/mL) isolates 4-fold, from 2 to 0.5 μg/mL, whereas there was no change in the mode CAZ MIC of CAZ-S (MIC ≤ 8 μg/mL) isolates in the presence of AVI.

Conclusion

Both REL and AVI restore susceptibility to P. aeruginosa isolates nonsusceptble to their cognate beta-lactam antibiotics (IMI and CAZ, respectively). However, REL had greater enhancement of IMI towards IMI-I isolates when compared to the effect of AVI on CAZ towards CAZ-I isolates. REL substantially enhances IMI activity towards IMI-S isolates whereas no such enhancement was observed for AVI upon CAZ activity towards CAZ-S isolates. REL is differentiated by its ability to enhance the activity of the cognate beta-lactam (IMI) across the susceptibility spectrum.

Disclosures

Charles A. DeRyke, PharmD, Merck & Co., Inc. Merck Research Laboratories: Stocks/Bonds Katherine Young, M.S., Merck & Co., Inc.: Stocks/Bonds.
2053. The Need to Expand the Infection Prevention Workforce in Home Infusion Therapy
Authors: Oladapo-Shittu Opeyemi , Hannum Susan M , Salinas Alejandra B , Weems Kimberly O , Marsteller Jill A , Gurses Ayse P , Cosgrove Sara E , Keller Sara C
Published: December 2022

Background

Infection preventionists who perform surveillance for central line-associated bloodstream infections (CLABSIs) in hospitals receive training in application of rigorous surveillance definitions. However, in the home infusion setting where CLABSIs also occur, the approach for training and methods to perform surveillance has not been well defined.

Objective

In this qualitative study, we sought to characterize how home infusion surveillance staff are trained in CLABSI surveillance and to identify barriers to CLABSI surveillance in the home infusion setting.

Methods

We interviewed 21 surveillance staff members of five non-profit home infusion agencies covering portions of thirteen states and Washington, DC across the Mid-Atlantic, Northeast, and Midwest. Interview questions were developed using the Systems Engineering in Patient Safety (SEIPS) 2.0 framework. Data were analyzed both inductively and deductively by two team members. These interviews are part of a larger study, some of whose findings have been previously discussed in prior publications. Data specific to training home infusion surveillance staff in CLABSI surveillance are presented (Table 1).

Results

Many of the CLABSI surveillance staff had received no formal training in CLABSI surveillance. Instead, many either learned on the job (often from predecessors who also had not been formally trained), drew from previous clinical experience, perused online resources, or attended conferences. A lack of (1) resources for learning, (2) formal training offered by their agencies, and (3) awareness of professional development resources were identified as barriers to CLABSI surveillance training in the home infusion setting.

Conclusion

Our findings indicate a current lack of formal training in CLABSI surveillance for staff performing CLABSI surveillance in home infusion therapy. The home infusion surveillance workforce can be strengthened by providing home infusion-specific standardized training, perhaps through adaptations of resources used for training surveillance staff in other settings.

Disclosures

Sara E. Cosgrove, MD, Basilea: Member of Infection Adjudication Committee.