bluuebunny/crossref_metadata_2025 huggingface dataset:
95. Prolonged respiratory viral infection associated with presence of coinfections in an urban birth cohort
Authors: Teoh Zheyi , Conrey Shannon C , Cline Allison R , Mattison Claire , Payne Daniel C , McNeal Monica , Burke Rachel M , McMorrow Meredith L , Morrow Ardythe L , Staat Mary A
Published: December 2022

Background

Prolonged infection by respiratory viruses has been reported, especially in hospitalized or immunocompromised children. However, little is known of factors contributing to prolonged respiratory viral infection, particularly in asymptomatic and less severe infections. We examined characteristics associated with prolonged viral infection in a community-based birth cohort.

Methods

The PREVAIL cohort is a CDC-sponsored two-year birth cohort in Cincinnati, Ohio conducted during 4/2017 to 8/2020. Mid-turbinate nasal swabs were collected weekly from children and tested using the Luminex Respiratory Pathogen Panel. The primary outcome was prolonged viral infection, which was defined as a viral nucleic acid detection lasting 4 or more weeks. Proportions of prolonged viral infections were compared using Fisher’s exact test with Holms corrections. Adjusted odds ratios (aOR) and 95% confidence intervals were calculated using a mixed effects logistic regression model while controlling for within-subject clustering, viral species, child age, child sex, symptom status, and coinfection. This analysis was limited to subjects who provided at least 70% of weekly samples.

Results

Among 101 children, providing 7871 child-weeks of follow-up, we identified 780 viral infections. The median duration of infection across all respiratory viruses was 1 week, except for bocavirus and coronavirus NL63, each with 2 weeks; 40% of bocavirus and >10% of adenovirus, coronavirus NL63, RSV A, human metapneumovirus, and parainfluenza 1 infections were associated with prolonged infection (>4 weeks). No prolonged infections were detected for influenza A or B, coronavirus 229E or HKU1, or parainfluenza 2 or 4 infections. Viral coinfection (aOR=3.1, 95% CI 1.9, 5.0) and female sex (aOR 1.8, 95%CI 1.1, 2.9) were significantly associated with prolonged infection, while symptom status and child age were not.

Conclusion

In the PREVAIL cohort, detection of respiratory viruses lasting 4 weeks or longer was common for certain respiratory pathogens and was especially prolonged for bocavirus. Biological factors such as the presence of additional viral infections or child sex may affect the likelihood of prolonged infection.

Disclosures

All Authors: No reported disclosures.
797. Investigation of HIV Clusters Among Hispanic/Latino Gay or Bisexual Men in Metro Atlanta, Georgia
Authors: Saldana Carlos S , Hershow Rebecca , Philpott David , Hassan Rashida , Curran Kathryn , Gettings Jenna , Garlow Eleanor , Mauck Daniel , Cantos Valeria D , Holland David P , Freeman Dorian , Johnson Erica , Reed Karrie , Adame Jose , Orozco Humberto , Wortley Pascale
Published: December 2022

Background

In Metro Atlanta, Georgia, annual HIV diagnoses among Hispanic/Latino (H/L) adolescents and adults have increased since 2014 (Figure 1), and four HIV molecular clusters, consisting primarily of Hispanic/Latino gay or bisexual men and other men who have sex with men (HLGBM), were identified in 2021. In March 2022, the Georgia Department of Public Health, the Centers for Disease Control and Prevention, and four health districts of Metro Atlanta (Fulton, Gwinnett, DeKalb, and Cobb) launched an investigation to characterize the clusters, assess barriers to accessing HIV care and prevention services, and inform improvements to service delivery.

Methods

We described the four clusters using HIV surveillance data. We conducted semi-structured qualitative interviews with 29 HLGBM and 28 providers through purposive sampling. Iterative analyses were conducted daily, comparing findings across interviews to identify commonly mentioned barriers to accessing HIV care and prevention services.

Results

The four clusters varied in size (5–42 members) and proportion of H/L members (41–100%); one cluster included members reporting injection drug use (14%) (Table 1). Viral suppression among cluster members was high across clusters (87–100%). Overarching reported barriers to accessing medical services included lack of culturally and linguistically concordant services, fear of deportation, transportation, and financial barriers (Table 2). LGBTQ and HIV stigma, low STD/HIV awareness, low access to primary care and HIV screening in primary and urgent care settings, and limited community outreach and marketing were common barriers to accessing HIV prevention services. For pre-exposure prophylaxis (PrEP) specifically, fear of being perceived as promiscuous, limited PrEP knowledge, and concerns with side effects were barriers. Navigating the healthcare system was noted as the primary challenge in HIV care.

Conclusion

The investigation of four clusters affecting HLGBM identified opportunities to improve access to HIV prevention and PrEP services for this population. State and local partners are planning cluster response activities, including ways to provide low-barrier culturally and linguistically concordant services (Table 3).

Disclosures

All Authors: No reported disclosures.
1535. Harm Reduction: A Missing Piece in Holistic ID Care for Patients Who Inject Drugs
Authors: Fracasso Francis Sarah M , Beekmann Susan E , Polgreen Phillip M , Marks Laura R , Liang Stephen Y , Durkin Michael J , Nolan Nathanial S
Published: December 2022

Background

The rise in injection drug use (IDU) has led to an increase in drug-related infections and hospitalizations. Harm reduction is an important strategy for preventing infections among people who inject drugs (PWID). We set out to evaluate how infectious disease physicians counsel PWID with serious injection-related infections on harm reduction practices.

Methods

An electronic survey was distributed to 1,510 physician members of the Emerging Infectious Network (EIN) to determine which harm reduction principles ID physicians recommend to PWID to reduce infection risks. EIN members who do not care for PWID were excluded. Two weekly reminders were sent to increase the response rate.

Results

Three hundred ninety-nine (26%, still in progress) ID physicians responded to the survey. Practice settings included: university (37%), community (27%), non-university teaching (23%), or other (14%) hospital settings. Of those, 279 (70%) reported routinely caring for PWID. 274 (98%) performed screening for HIV and hepatitis, and 239 (86%) discussed the risk of these viral infections. 65% prescribed immunization against hepatitis and 44% discussed HIV PrEP. 57% (n=159) reported not counseling patients on safer injection strategies. Common reasons for not counseling included limited time and a desire to emphasize antibiotic therapy/medical issues (33%, n=91), lack of training (30%, n=85), and believing that it would be better addressed by other services (27%, n=75). Among physicians who reported counseling PWID, they recommended abstinence from IDU (38%, n=105), handwashing & skin cleansing prior to injection (33%, n=92), avoiding injecting areas of skin breakdown (27%, n=76), and cleaning needles between use (26%, n= 73). Finally, 17% (N=47) reported no access to any addiction services.

Conclusion

Almost all ID physicians screen PWID for HIV and viral hepatitis and discuss the risks of these infections. Despite frequently encountering PWID, less than half of ID physicians provide safer injection advice. Opportunities exist to standardize education of PWID on harm reduction, emphasizing safer injection practices in conjunction with other strategies (e.g. HIV PrEP, HAV/HBV vaccination) to prevent infections.

Disclosures

All Authors: No reported disclosures.
1174. Liposomal Co-Formulation of MPL and QS-21 Favors the Development of T-helper 1 Cells and Promotes the Induction of CD8+ T Cells Against SARS-CoV-2
Authors: van Haren Simon D , Thomas Sanya , Levy Ofer , Sanchez-Schmitz Guzman , Doss-Gollin Simon , Rodriguez Yamile Lugo
Published: December 2022

Background

Benefit of COVID-19 vaccines is limited by need for freezing, high cost, requirement for multiple boosters, and waning immunity. An unmet need for safe and effective vaccines that can be quickly deployed worldwide during a pandemic exists. A barrier to developing scalable low-cost vaccines is the restricted access to vaccine- or adjuvant-formulations due to protection by intellectual property rights. This limits research to understand their mechanism of action and potential applicability towards vulnerable populations or emerging pathogens.

Methods

We studied cellular and molecular mechanisms of action of adjuvant formulations developed for global open access in 4 distinct but complementary in vitro platforms that are human, age-specific, and enable the same individual to serve as control and test condition; generating data on adjuvant-induced responses in vitro that predict activity in vivo.

Results

Whole blood assay that models magnitude of innate immune activation and identifies cell types activated showed that liposomal co-formulation of MPL+QS-21 activated monocytes and natural killer cells and induced cytokine production; tissue construct assay that models monocyte extravasation and autonomous differentiation into dendritic cells (DC) showed that only MPL+QS-21 co-formulation promoted CD14+ cells towards DC phenotype; monocyte-derived DC (MoDC) assay that interrogates immune activation type showed that MPL+QS-21 co-formulation in lipid nanoparticles promoted MoDC maturation by increasing CD40, CD86, CCR7 and HLA-DR expression and Th1-polarizing cytokine secretion; and dendritic cell-T cell interface assay that assesses potential of formulations to re-activate SARS-CoV-2 Spike antigen-specific T cells showed that only MPL+QS-21 co-formulation enhanced activation of antigen-specific CD4+ and CD8+ T cells.

Conclusion

Thus, human in vitro modeling provides new insight into the mechanism of action and synergistic effects of MPL+QS-21, and positions us to study them in vulnerable populations to assess potential age-specific application on vaccine development. Precision vaccinology coupled with global access may enable marked public health progress by accelerating, de-risking, and advancing affordable adjuvanted vaccines to the most vulnerable.

Disclosures

All Authors: No reported disclosures.
1175. Low Treatment Rates and Associated Factors Among Pregnant Women with Syphilis in Zambia
Authors: Jones Anna V , Mubiana-Mbewe Mwangelwa , Xue Yumo , Kapesa Herbert , Mzumara Maureen , Manasyan Albert , Dionne Jodie
Published: December 2022

Background

Syphilis in pregnancy is common in Africa with prevalence as high as 10%. In high prevalence areas ( > 5%), WHO recommends universal syphilis screening and benzathine penicillin G treatment at the first antenatal clinic (ANC) visit. Implementation barriers include global stock outs and supply chain issues. Our goal was to document treatment rates and factors associated with lack of treatment among pregnant women with syphilis in Zambia.

Methods

The retrospective cohort study analyzed medical record data from pregnant women who sought care in 10 public ANC clinics in Lusaka, Zambia during 2018-2019 and tested positive for syphilis. Syphilis was diagnosed based on positive RPR testing and treatment was defined as documented penicillin therapy at the same facility. Patient characteristics were compared across treatment status using Wilcoxon Rank Sum Test for continuous variables, and Pearson Chi-Square Test for categorical variables. Simple logistic models with treatment status as the binary outcome were conducted to evaluate potential factors associated with lack of syphilis treatment in pregnancy. A multivariable logistic model was performed and a 2-sided P < 0.05 was accepted as statistically significant.

Results

Among 28,480 pregnant women screened for syphilis, 5.6% (n=1363) tested positive. Among those with syphilis, median age was 27 years, 21% of women were nulliparous and 43% were living with HIV. Most women (72%) had their initial ANC visit during the 2nd trimester and 96% were screened for syphilis at the first visit. The documented treatment rate was 42% and the only factor associated with lack of treatment was ANC entry in 2019 compared to 2018 (aOR 2.2; 95% CI 1.7-2.8; p < 0.001). (refer to Tables 1-2).

Conclusion

Syphilis prevalence among pregnant women tested in ANC clinic in Zambia during 2018-2019 was 5.6%. Recommended penicillin treatment was only documented in 42% of cases. No maternal or clinic characteristic was associated with lack of therapy. Calendar year may have been associated with treatment for unclear reasons. Novel approaches to ensure access to universal diagnosis and early treatment of syphilis among pregnant women in Zambia are needed to improve maternal and neonatal outcomes.

Disclosures

All Authors: No reported disclosures.
1573. Impact of the COVID-19 Pandemic on Antibiotic Use among Hospitalized Adults in Argentina, Brazil, and Chile
Authors: Patel Twisha S , McGovern Olivia L , Mahon Garrett W , Boszczowski Icaro , Munita Jose M , Garzon Maria I , Lipari Flavio , Salomao Matias , Marssola Giovanna , Tavares Bruno , Francisco Debora , Gurgel Alessandra P A , Arantes Tiago , Bori Andrea , Nogueira Cassimiro , Peters Anne , Spencer Maria , Orellana Cristian , Barbe Mario , Roldán Analía , Lopez Constanza , Bortoletto Josefina , Stender Stacie C , Lessa Fernanda C
Published: December 2022

Background

Reports showing high rates of antibiotic use (AU) in patients with coronavirus disease 2019 (COVID-19) despite low rates of secondary bacterial infection have emerged from various countries across the globe. We evaluated the impact of the COVID-19 pandemic on AU in healthcare facilities (HCFs) in Argentina, Brazil, and Chile.

Methods

We conducted an ecologic evaluation of AU in inpatient adult acute care wards (excluding maternity wards) in 6 HCFs in Argentina, Brazil, and Chile; 2 HCFs per country. AU data for intravenously administered antibiotics commonly used to treat respiratory infections were collected from pharmacy dispensing records and aggregated to monthly defined daily dose (DDD)/1000 patient days. Graphs were created to depict AU and COVID-19 discharges over time throughout the 36-month study period (03/2018–02/2021). Relative changes in AU for all antibiotics combined and specific classes were calculated by comparing median AU for the 24-month pre-pandemic period (3/2018–2/2020) with the 12-month pandemic period (3/2020–2/2021). Only statistically significant differences (P< 0.05) determined by the Wilcoxon signed-rank test are reported.

Results

Compared to the pre-pandemic period, the use of all included antibiotics combined increased in 4/6 HCFs (6.7–35.1%). In the 4 HCFs that experienced increases in AU, Figure 1 shows that use was high during months when COVID-19 patient surges occurred. In 3/4 of these HCFs, AU remained high despite significant decreases in COVID-19 discharges. Ceftriaxone use increased in 2/6 HCFs (27.1–51.6%). Use of β-lactam antibiotics with activity against Pseudomonas aeruginosa increased in 3/6 HCFs (31.3–82.5%) and decreased in 1/6 HCFs (-18.9%). Vancomycin and linezolid use increased in 3/6 HCFs (36.9–77.1%).

Conclusion

Increases in AU among hospitalized adults were observed in 4 of 6 South American HCFs included in this study. The high rates of broad-spectrum antibiotic use in the HCFs may impact further emergence of antibiotic resistance. Understanding how this increase in antibiotic use compares to rates of bacterial infections during this time period is critical.

Disclosures

Jose M. Munita, MD, BioMerieux: Grant/Research Support|MSD: Grant/Research Support|Pfizer: Grant/Research Support Matias Salomao, MD, Cepheid: Lecture.
1231. Microbial Profile of Biliary Stent, Bile and Surgical Site Cultures in Pancreaticoduodenectomy Patients – Implications for Surgical Prophylaxis
Authors: Hung Kai Chee , Lee Winnie , Kwa Andrea Layhoon , Koh Ye Xin , Goh Brian Kim Poh , Chung Jasmine
Published: December 2022

Background

Surgical site infection (SSI) rates post pancreaticoduodenectomy (PD) range from 20 to 40%. Biliary obstruction (± stent in situ) leads to colonization of the biliary tract with gut flora, and bile contamination during surgery increases SSI risk. Current guidelines recommend surgical prophylaxis (ppx) with 1st or 2nd generation cephalosporins. However, emerging data favor targeted ppx based on biliary cultures to reduce SSI. We reviewed the microbial profile of pathogens isolated from perioperative biliary stent and bile cultures, and evaluated the impact of ppx on culture positive SSIs within 30 days of PD.

Methods

This was a retrospective study conducted in Singapore General Hospital. Patients who had PD from 1/1/2013 to 31/12/2019 were included. The first positive cultures from perioperative biliary stent, bile, and SSI cultures obtained within 30 days of surgery were reviewed. Antibiotic use 30 days prior and during surgery was collected.

Results

A total of 341 patients with a mean age of 63.9 ± 11.3 years were included; 202 (59.2%) were male and 137 (40.2%) received antibiotics in the past 30 days. For surgical ppx, patients received either cephalosporins ± metronidazole (216 [63.3%] ceftriaxone, 25 [7.3%] cefazolin), piperacillin-tazobactam (TZP) (35 [10.3%)], ciprofloxacin ± metronidazole (16 [4.7%)] or other antibiotics (14 [4.1%]), while 35 had missing data. Of the positive cultures from 84 biliary stent, 86 bile and 79 SSI, the most common organisms isolated were Enteroccocus spp., E. coli, Klebsiella spp., Enterobacter spp. and Candida spp. Ceftriaxone susceptibility rates in E. coli were 50.0%, 54.8% and 22.2% in biliary stent, bile and SSI cultures respectively; similarly low rates were also seen in Klebsiella spp. (Tables 1-3). Antibiotic use 30-days prior was associated with higher ceftriaxone resistance rates in E. coli and Klebsiella spp. from bile cultures (70.8% vs 36.4%, p=0.019). In patients with biliary stents cultured, use of TZP ppx showed a trend towards lower rates of culture positive SSIs compared to non-TZP ppx (9.1% vs 29.4%, p=0.054).

Conclusion

Our local gram-negative bacteria susceptibility rates to ceftriaxone are low in biliary stent, bile fluid cultures, and even lower for SSI post PD. Antibiotic ppx for PD in high-risk patients may need to be broadened.

Disclosures

All Authors: No reported disclosures.
1235. Anti-HCV Prevalence and Associated Risk Factors in Patients of Psychiatry Hospitals in Latvia
Authors: Tolmane Ieva , Upmace Inga , Azina Inga , Rozentale Baiba
Published: December 2022

Background

According to previous epidemiological studies there is 2.4% prevalence of anti-HCV in Latvian population. Hepatitis C can lead to liver cirrhosis and HCC. There is available an effective HCV treatment with 100% reimbursement. WHO has settled a goal – to eliminate HCV as a public health threat by 2030. The biggest obstacle to achieve this goal is to find an infected persons.

The aim of this study was to screen and analyze the data of patients from Psychiatry hospitals (PH) in Latvia. Patients were screened for hepatitis C infection (anti-HCV) and analyze the possible risk factors.

Methods

795 patients of all PH in Latvia were tested, including 57.1% males and 42.9% females. The mean age was 49 years (range 18 - 93). Data were obtained by performing survey and rapid blood antibody tests. The questionnaire included demographic information and 10 questions on infection risk factors. Study was done from May till October 2021 by HIV Prevention Point workers in PHs of 7 PH in Latvia – Riga, Daugavpils, Liepaja, Strenci, Gintermuiza, Akniste and Vecpiebalga. Data were analyzed using MS Excel and IBM SPSS.

Results

24.8% of patients noted they have been sexually active in the last year, but only 9.9% admitted usage of condoms. 3.8% noted they are or have been used IV drugs. 11.2% of patients have a history of incarceration.

In total 6.8% of performed tests were positive for anti-HCV. Incarcerated persons were positive in 16% of cases, non-incarcerated – in 6%. IV drug users (IVDU) were positive in 49%, non-users – in 4.9%, all differences are statistically significant.

Conclusion

Patients in PH are at higher risk of HCV infection in comparison to population in Latvia. Besides already well known risk groups – IVDU and incarcerated people, we found 2.8 times higher anti-HCV prevalence in psychiatric hospital’s patients, with markedly higher prevalence in those previously incarcerated or IVDU. This study provides valuable data to better identify groups of individuals with higher risk of HCV infection. Latvia. PNC patients should further be tested, especially individuals who have been incarcerated, use or have used IV drugs.

Disclosures

All Authors: No reported disclosures.
1244. Inpatient vs. outpatient initiation of Hepatitis C treatment among hospitalized patients who inject drugs: Lessons from a quality improvement project
Authors: Madeline McCrary L , Roberts Katelyn , Jordan Robyn , Bowman Mary Catherine , Schranz Asher J
Published: December 2022

Background

Hepatitis C (HCV) diagnoses are rising, driven by infections in people who inject drugs (PWID). PWID are identified as a target population for treatment, but access to care is a barrier. At our institution, Addiction Medicine (AM) and Infectious Diseases (ID) routinely screen hospitalized PWID for HCV. Our novel quality improvement project assessed feasibility of starting HCV care processes for PWID inpatient. This included: (1) inpatient e-consults, (2) inpatient treatment initiation with direct acting antivirals (DAAs) when possible, and (3) post-discharge telehealth care.

Methods

The project was implemented at an academic hospital in the Southeast in August 2021, with results observed through April 2022. Patients seen by AM consultants with detectable HCV RNA and interest in treatment were eligible. AM recommended ID e-consults focused on HCV care, which began care coordination, including inpatient treatment initiation in select cases (based primarily on length of stay) (Fig 1). The primary outcome was “likely cure,” defined as treatment completion or SVR-4 (chosen due to concerns for loss to follow up). Cascades of care were constructed including: (1) completed HCV e-consult; (2) linkage to care (defined as telehealth visit for those not initiating inpatient); (3) treatment initiation; and (4) likely cure. Figure 1:Workflow

Results

Twenty patients had detectable HCV RNA and all were interested in treatment. Enrolled patients had a mean age of 33 years; 9/20 (45%) were female; and 17/20 (85%) were White. Of 20 patients (Fig 2), 16 (80%) were linked to care with 13 (81%, 65% overall) started on HCV treatment, of which 9 were started inpatient. Likely cure was achieved for 7, and 6 were still on treatment at the time of this report (Fig 2). Likely cure has so far been achieved in 66% of inpatient initiators (6 of 9), compared with 18% of others (2 of 11) (Figs 3 and 4). 6 patients were lost to follow-up. None of those initiating DAAs inpatient were lost.

Conclusion

Inpatient initiation of HCV treatment for PWID was feasible for patients with prolonged hospitalizations and may be effective at facilitating HCV treatment and cure among a vulnerable population with substantial barriers to care. Future steps should address inpatient barriers to DAAs, and examine models of HCV telehealth.

Disclosures

Asher J. Schranz, MD, MPH, UnitedHealthCare: Honoraria.
1322. Infectious Complications Following Pediatric Lawn Mower Injury: A Case Series
Authors: Weslander Erin , Doyle Joshua D , Nowalk Andrew , Bykowski Michael
Published: December 2022

Background

According to the National Electronic Injury Surveillance System, there are an estimated 9,400 riding lawn mower injuries in the United States in pediatric patients per year. Previous case series report a 7-12.5% infection rate after injury. We report our experience of lawn mower injury-related infections over a 4-year period.

Methods

Cases of lawn mower injury at our center were identified by the ICD-10 code W28.XXXA for contact with a powered lawn mower between 2017-2020. Patient demographics, injury background, microbial results, and antimicrobial use were collected via manual chart review.

Results

During the 4-year period, 25 patients presented to UPMC Children’s Hospital of Pittsburgh who had a diagnosis of lawn mower injury. The median age of the patients was 6.5 years old. Most cases sustained foot injury (68%, 17/25), followed by leg (24%, 6/25), and hand or arm (24%, 6/25). Perioperative antibiotics depended on the extent of the damage, intent to amputate or salvage a limb, and extent of obvious contamination. These included 24-48 hours of piperacillin-tazobactam for 44% (11/25) of patients, ampicillin/sulbactam for 32% (8/25) of patients, and cefazolin for 24% (6/25) patients. Four of the 25 patients (16%) had infection after the initial injury as defined as growth of organisms from a wound culture collected more than 48 hours after the initial injury and debridement. Antimicrobials for the treatment of infection were further tailored to the culture results. From the four patients with infection after initial debridement or amputation, pathogens included: Serratia marcescens, Staphylococcus aureus, Myroides odartus, Stenotrophomonas, Prevotella, Aeromonas, Coagulase negative Staphylococcus, Enterobacter cloacae, Sphingomonas, Bacillus species, Pseudomonas aeruginosa, Candida albicans, Rhizopus, and Trichosporon.

Conclusion

Infections after lawn mower injures are infrequent with early, aggressive surgical debridement. However, infections following lawn mower injuries are frequently polymicrobial and involve a wide variety of pathogens. Obtaining repeat cultures during subsequent surgical debridements can be useful to track persistent growth and identify new and uncommon pathogens.

Disclosures

All Authors: No reported disclosures.
1342. Serial Microbial Cell-Free DNA Next Generation Sequencing (NGS) As A Means of Diagnosis and Monitoring of Clinical Response To Treatment Of Invasive Fungal Infections (IFI) In Immunocompromised Pediatric Patients
Authors: Ashouri Negar , Nieves Delma , Nieves Delma , Singh Jasjit , Arrieta Antonio
Published: December 2022

Background

IFIs are a leading cause of morbidity and mortality in immunocompromised pediatric patients. Early diagnosis and initiation of therapy is critical for treatment success but is often hindered by difficulty obtaining tissue samples, lack of growth on culture and time required for culture positivity. Non-culture methods such as aspergillus galactomannan and 1-3 B-D glucan lack sensitivity and specificity.

NGS has shown promise in identifying a wide array of pathogens. The Karius test is a NGS which can identify viral, bacterial, and fungal infections by detecting cell free pathogen DNA in peripheral blood with a rapid turnaround time. Over the past few years we have used the Karius test as an adjunct to our standard of care in the workup and treatment of IFI in our oncology population

Methods

We report our experience in using serial NGS testing for diagnosis of IFI as well as a means for monitoring clinical response to treatment in our pediatric hematological malignancy population.

Results

Between 12/1/20-12/31/21, 5 patients had serial NGS for IFI. Most common indication for testing was prolonged fever and neutropenia with abnormal imaging. Initial diagnosis was made by NGS in all 5 patients. All had tissue biopsies with fungal elements seen on path in 4 of 5 patients. Culture was positive in 3 of 5 patients (2 days, 10 days and 12 days post NGS testing result). One patient with persistent positive NGS testing was found to have resistance to treatment drug on susceptibility testing and subsequently had negative NGS testing once appropriate antifungals were started. A second patient had sterilization of cultures with concomitant negative NGS results but developed increasing fungal copies on NGS testing followed by positive culture when chemotherapy was resumed and subsequently died due to his infection. 4 of 5 patients had serial negative follow up NGS and continue to do well.

Summary of Diagnostic Work-Up

Conclusion

In our small series of patients, NGS testing allowed for rapid diagnosis of IFIs and corresponded to clinical response to treatment. Future prospective studies will be needed to further evaluate the use of NGS in this patient population.

Disclosures

All Authors: No reported disclosures.
1366. Re-examining the Origins of Ebola virus Emergence
Authors: Judson Seth D
Published: December 2022

Background

Ebola virus (EBOV) is one of four ebolaviruses known to cause Ebola virus disease (EVD). It is widely thought that EVD outbreaks originate from spillover of ebolaviruses from wildlife into humans. However, phylogenetic analysis of EBOV sequences from recent EVD cases reveal genetic similarity to EBOV from prior outbreaks. Therefore, it is likely that these recent EVD outbreaks originated through human-to-human transmission instead of wildlife spillover. The aim of this study is to re-examine the origins and contexts of EVD outbreaks given this new knowledge.

Methods

All known EVD outbreaks and EBOV emergence events from 1976-2021 were analyzed via literature review. The primary and index cases for each outbreak were compared based on demographics and suspected sources of transmission. The diagnostic testing and treatment locations for each EVD index case were also investigated. Phylogenetic and epidemiologic relationships were examined to characterize whether outbreaks likely originated from separate spillover events or human-to-human transmission.

Results

Overall, 22 outbreaks caused by EBOV were identified from 1976-2021 (Table). 5/22 (22.7%) of outbreaks were possibly linked to previous EVD outbreaks, including the four most recent outbreaks. Possible sources for these outbreaks included relapse and delayed sexual transmission from survivors. 12/22 (54.5%) of outbreaks were linked to suspected spillover sources, which included contact with duikers, chimpanzees, gorillas, monkeys, and bats. The locations of these Ebola virus emergence events are shown in the Figure.

Conclusion

Recent EVD outbreaks have changed our understanding of the emergence of EBOV in humans. Most recent outbreaks have originated from human-to-human transmission rather than spillover from wildlife. Multiple large EVD outbreaks have created the potential for future resurgence among humans. Therefore, increased surveillance among humans as well as awareness among healthcare workers and traditional healers, who are often the first to encounter index cases, will be critical to preventing the next epidemic. Clinicians and researchers will need to carefully evaluate the origins of EVD outbreaks through epidemiological and phylogenetic analyses while also preventing stigma among survivors.

Disclosures

All Authors: No reported disclosures.
1372. Unprecedented West Nile Virus Outbreak — Maricopa County, Arizona, 2021
Authors: Kretschmer Melissa , Dale Ariella P , Ruberto Irene , Zabel Karen , Maldonado Keila , Townsend John , Will James , Busser Nicole , Damian Dan , Venkat Heather , Sunenshine Rebecca
Published: December 2022

Background

West Nile virus (WNV) causes a mosquito-borne disease that can lead to permanent paralysis or death. WNV became endemic in Maricopa County in 2003. The Maricopa County Department of Public Health (MCDPH) and Environmental Services Department Vector Control (MCESD VC) and Arizona Department of Health Services (ADHS) collaborated to monitor and respond to mosquito surveillance and human WNV cases. We describe an unprecedented WNV outbreak in 2021.

Methods

MCESD VC monitored vector complaints, mosquito vector positive traps, and vector index (VI) data. Reported human cases (using the CSTE/CDC case definition) were interviewed by MCDPH. MCDPH and ADHS sent surveillance alerts to healthcare providers regarding WNV symptomology and clinical testing guidance. MCDPH consulted with providers and/or Infection Preventionists during case investigations.

Results

The first WNV-positive mosquito trap occurred the week of May 1 (VI=0.235); VI peaked the week of September 11 at 53.608; the last positive trap was the week of November 20. MCESD VC fogged >400,000 acres (∼2x the 10-year average) with adulticide, applied larvicide to ∼25,000 sites, and received ∼9,500 mosquito complaints (40% more than prior season). During the 2021 WNV season, 1,487 cases were reported, of which 960 (64.6%) had neuroinvasive illnesses (WNND) and 101 (6.8%) died (all were WNND cases). Median case age was 66 (IQR=53–75) years; for deaths, it was 79 (IQR=71-83) years. In total, 1,017 (68.4%) cases were hospitalized with a median length of stay (LOS) of 7 (IQR=4–10) days. WNND cases accounted for 91.2% of hospitalizations. Median LOS for hospitalized WNND cases was 7 (IQR=4-11) days, compared to 4 (IQR=2-6) days for non-neuroinvasive cases. Despite 3 surveillance alerts sent to providers and media coverage, providers were not consistently aware of the WNV outbreak or that serum can be tested for WNV.

Conclusion

This was the largest WNV outbreak in Maricopa County. It taxed an already stressed healthcare system during the COVID-19 pandemic with over 1,000 hospitalized cases, including nearly 100 in people without WNND. During WNV season, clinicians should consider WNV testing of both serum and CSF in severely ill patients with and without evidence of neuroinvasive disease.

Disclosures

Ariella P. Dale, PhD, MPH, Infectious Disease Society of America - Arizona Chapter: Honoraria Karen Zabel, MSN RN, Express Scripts: Immediate family member employment.
1380. Impact of Doxycycline Prophylaxis on Skin and Soft Tissue Infections in Naval Special Warfare Trainees
Authors: Spiro Jeffrey , Wisniewski Piotr , Schwartz Julia , Smith Alfred G , Burger Sara , Tilley Drake , Maves Ryan C
Published: December 2022

Background

Several severe cases of SSTIs caused by salt-water associated Gram-negative pathogens (mainly Shewanella algae) among U.S. Naval Special Warfare (NSW) trainees prompted introduction of doxycycline prophylaxis during the highest risk portion of training, “Hell Week”. We present analysis of this intervention’s impact on disease incidence and hospital admission for serious SSTI.

Necrotizing fasciitis caused by Vibrio harveyi in an NSW trainee during “Hell Week” prior to introduction of doxycycline prophylaxis.

Methods

We performed a retrospective cohort study examining data from hospital admissions for SSTI in trainees between 2013-2020. We assessed hospital admission rates for SSTIs, hospitalization rates per SSTI diagnosed at the clinic level, overall rates of SSTI, length of hospital stays and blood and wound culture data. We then compared data from pre- and post-intervention cohorts.

Results

3371 NSW trainees participated in “Hell Week” training during the study period with 284 SSTIs diagnosed overall, 29 of which led to hospital admission. After introduction of doxycycline prophylaxis, admission rates for SSTI decreased from 1.37 to 0.64 admissions per 100 trainees (p=0.036). Overall SSTI rates diagnosed at the clinic level remained stable from 7.42 to 8.86 SSTI per 100 trainees (p=0.185). Hospitalization rates per diagnosed SSTI decreased from 18.4% to 7.2% (p=0.009). Average length of hospitalization decreased from 9.01 days to 4.33 days (p=0.034). Blood and wound culture data showed a notable decrease in SSTI from salt-water associated Gram-negative rods (Shewanella algae and Vibrio spp.).

Total number of SSTI diagnosed at Naval Special Warfare Center (NSWCEN) medical clinic each “Hell Week” training period with corresponding percentage of NSW trainees diagnosed with SSTI in each class. Date of doxycycline prophylaxis initiation labeled for reference.

Wound and blood culture (Cx) data from the pre-intervention and post-intervention cohorts

Conclusion

Doxycycline prophylaxis during “Hell Week” training for NSW trainees was associated with decreased frequency and severity of hospitalization for SSTI, as well as near elimination of infection with invasive salt-water associated pathogens.

Disclosures

All Authors: No reported disclosures.
1393. Body Mass Index Change In People Living With HIV During The COVID-19 Pandemic In New York
Authors: Chang Kai-Ming , Ramirez Guillermo , Vikraman Praveen , Nadi Lemar , Sison Cristina , Oey Michael
Published: December 2022

Background

People living with HIV (PLHIV) suffer from adverse outcomes of metabolic syndrome. We hypothesized the COVID-19 pandemic, particularly with the stay-at-home status in 2020, resulted in physical inactivity and dietary changes leading to increases in weight and body mass index (BMI).

Methods

This retrospective observational chart review evaluated PLHIV at an infectious diseases clinic with a documented BMI from 2017 to 2020. Data on patients’ demographics, comorbidities, and antiretroviral therapy (ART) as of 2020 and the yearly values of BMI, A1c, and LDL from 2017 to 2020 were collected.

Results

Among 256 HIV-infected persons, mean age±SD was 48.5±13.1 (median=51; Q1-Q3: 39.5-57.5; range: 20-78) and 95 (37%) were female. Mean BMI were 28.19±6.32, 28.44±5.95, 28.57±5.91, and 29.00±6.09 for 2017, 2018, 2019, and 2020 respectively. Unadjusted and adjusted analysis showed a significant difference in BMI across time, where the mean BMI in 2020 was significantly higher than in 2017 (p< 0.0001), 2018 (p< 0.0001), and 2019 (p< 0.0001). Furthermore, for each consecutive year prior to 2019, there was no significant difference in mean BMI (2017 vs. 2018, p< 0.3464; 2018 vs. 2019, p< 0.4671; 2017 vs. 2019, p< 0.0861). There was a significant difference in A1c when adjusting for age, sex, race, and ART (Geometric Mean: 5.64, 5.68, 5.68, 5.78 for 2017 through 2020), with the visit year 2020 being significantly higher than 2017 (p< 0.003) and 2019 (p< 0.023) but not 2018 (p< 0.092). There were no significant differences in annual LDL using the same variables for adjustment.

Body mass index (BMI) increased over time from 2017 to 2020

Mean BMI were 28.2±6.3, 28.4±5.9, 28.6±5.9, and 29.0±6.1 for 2017, 2018, 2019, and 2020 respectively.

Pairwise comparison of BMI from 2017 to 2020

Unadjusted and adjusted analysis showed a significant difference in BMI across time, where the mean BMI in 2020 was significantly higher than in 2017 (p<0.0001), 2018 (p<0.0001), and 2019 (p<0.0001). Furthermore, for each consecutive year prior to 2019, there was no significant difference in mean BMI (2017 vs. 2018, p<0.3464; 2018 vs. 2019, p<0.4671; 2017 vs. 2019, p<0.0861).

Conclusion

Among PLHIV at our clinic, there was a substantial BMI increase in 2020, possibly due to the stay-at-home status in early 2020. A previous study utilized questionnaires to estimate the weight change in this patient population but this is the first report of documented BMI in the clinic setting. It is important to note that the magnitude of these differences was small and should be interpreted with caution. On the other hand, depending on a person’s initial height and weight, a one-unit change in BMI may translate to a substantial weight gain, which can be meaningful.

Disclosures

All Authors: No reported disclosures.
1412. Racial Differences in Candidemic Patients at a Southern California Teaching Hospital
Authors: Grant Victoria C , Zhou Anna Y , Abdul-Mutakabbir Jacinda C , Tan Karen K
Published: December 2022

Background

Racial disparities in diagnosis and management of infectious diseases in the US healthcare system have been reported. Candidemia is a leading healthcare associated bloodstream infection and is associated with significant mortality. Further, global rates of azole-resistant C. parapsilosis have dramatically increased. Nonetheless, literature describing racial and ethnic differences among candidemic patients is limited. The objective of this study was to describe infection characteristics and outcomes among non-Hispanic White (n-REM) and racially and ethnically minoritized (REM) patients with candidemia.

Methods

Adult patients hospitalized with ≥ 1 positive blood culture growing Candida between 1/2020 and 12/2021 were included. Based on documented race and ethnicity, patients were dichotomized into the n-REM or REM group. Pertinent data was collected and then compared between groups using univariate analysis. Significance was defined as P ≤0.05.

Results

86 unique episodes of candidemia were included. REM patients were significantly younger (mean age 54 vs 62 years; P = 0.017) and had more risk factors for candidemia (median 4 vs 3). REM patients were also more likely to present with sepsis/septic shock (87% vs 81%) and require an ICU stay (57% vs 53%). Time to detection of candidemia was shorter in the REM group (median 38.5 vs 43 hours); however, time to initiation of active antifungal therapy was longer (median 48 vs 44 hours). Additionally, hospital LOS was longer in the REM group (median 25.5 vs 19.5 days). Central line infection was the most common source of candidemia. Despite similar documented sources of infection, microbiological differences were noted. Candida glabrata was more often isolated in n-REM patients (50% vs 27%; P = 0.04), whereas C. parapsilosis was more often isolated in REM patients (17% vs 3%; P = 0.048).

Conclusion

Despite being younger, REM patients were at an increased risk for candidemia. Furthermore, C. parapsilosis, a globally growing species of concern due to azole resistance, was more frequently isolated among REM patients. Rapid detection and speciation of candidemia may be particularly important among REM patients to ensure early initiation of optimal therapy. Further research exploring racial differences among candidemic patients is needed.

Disclosures

All Authors: No reported disclosures.
1418. The Relationship Between Modifiable Health Behaviors and Health Literacy in People with HIV is Complicated by Multiple Factors
Authors: Richey Lauren , Schroeder Jonathan , Apolzan John , Mistretta Kyle , Holloway Kaila , Lin Hui-Yi , Arnold Connie , Welsh David
Published: December 2022

Background

People with HIV (PWH) who achieve viral suppression have a normal lifespan, however, they now contend with more cardio-metabolic disease and exaggerated rates of malignancies. The etiology of these disparate rates of comorbidities are multifactorial but likely include modifiable behaviors such as smoking, poor diet, and substance use. We created a multidisciplinary team to study health behaviors in PWH. The team included researchers and HIV clinics in three Louisiana cities; New Orleans, Baton Rouge, and Shreveport, forming the Louisiana Translational Collaborative on Health Behaviors [LATCH] network. We hypothesized that patients with low health literacy would have higher BMIs and higher usage of tobacco and illicit drugs.

Methods

PWH aged ≥ 18 were recruited from three HIV clinics during regular appointments. Participants completed surveys using standardized tools that assessed diet, physical activity, health literacy, tobacco and substance use. Weight and height were also recorded.

Results

100 PWH were enrolled. Most were African American (80%), men (57%), and the mean age was 50.72 (range 21-70). Mean BMI was 30.2 (range 18-51). Limited health literacy was found in 50% (REALM-SF < 7). Past month drug use was reported in 24%. Lifetime tobacco use was reported in 59%, with 31% reporting current use. For BMI, the average BMI for those with low health literacy (REALM-SF < 7) was 29.26 compared to 30.62 for those with adequate health literacy (REALM-SF 7) (p< .001). Among patients with limited literacy (REALM-SF < 7) 27.1% reported current tobacco use, compared with 36.7% of those with adequate literacy (REALM-SF 7) (p=0.68). Among patients with limited literacy (REALM-SF < 7) 25% reported past month drug use, compared with 24.5% of those with adequate literacy (REALM-SF 7) (p=0.59).

Conclusion

We hypothesized that PWH with lower health literacy would have higher BMIs, which was the opposite of what we found. We also found higher rates of smoking among those with higher health literacy although it was not significant. No differences were seen in past month drug use. Health literacy and education to improve health literacy may not directly impact modifiable health behaviors which are likely influenced by many different factors.

Disclosures

All Authors: No reported disclosures.
1690. Assessing the safety of TP-102 bacteriophage treatment in the management of diabetic foot infections
Authors: Nir-Paz Ran , Onallah Hadil , Gellman Yechiel N , Haze Amir , Braunstein Ron , Hazan Ronen , Leandro Clara , Barbosa Raquel , Dordio Helena , Wagner Alexandra , Corte Real Sofia V , Garcia Miguel
Published: December 2022

Background

Diabetic Foot Ulcers (DFU) are a major complication in patients with diabetes and affect globally 170 million patients. Approximately 28% of patients with infected DFU require amputation. Diabetic foot infections (DFI) caused by persistent or multidrug resistant organisms are a threat to the outcome of therapy. Infections are mostly polymicrobial, and major pathogens include Staphylococcus aureus and Pseudomonas aeruginosa. A promising new approach using phages may potentially be a novel modality to increase treatment success. TP-102 is an innovative bacteriophage cocktail for treatment of DFI, a diabetes related unmet need.

Methods

TP-102 comprised of 5 different phages, targeting S. aureus, P. aeruginosa and Acinetobacter baumannii. This study is a Phase I/II clinical trial performed in Israel looking at safety and tolerability. TP-102 bacteriophage cocktail was applied topically at a titer of 109 PFU/mL/cm3 of target ulcer. Two cohorts receive multiple doses of TP-102. In non-infected DFU (cohort 1) for 1 week and for 28 days in DFU with infection grade 2 or 3 (PEDIS classification, cohort 2). Treatment groups were TP-102 with standard of care versus placebo and standard of care. Outcomes include microbiologic data on the 3 target bacteria, ulcer healing characteristics, incidence and severity of TP-102-emergent solicited local and systemic adverse events, and their relationship to the treatment, from the first application of TP-102 until the end of study.

Results

For the evaluation of safety in patients with non-infected ulcers, eight patients were enrolled to the first cohort. Six were treated with TP-102 and 2 with placebo. TP-102-treated patients had no severe adverse events associated with the treatment. In the second cohort a total of 18 patients are currently being treated with TP-102 or placebo for 28 days, three times a week. Recruitment is ongoing and results of the trial will be presented.

Conclusion

TP-102 appeared to be safe when applied to patients with uninfected diabetic foot ulcers. The treatment is a potential new non-traditional antimicrobial for topical application. The efficacy of TP-102 in the treatment of infected diabetic ulcers is being assessed in an ongoing randomized clinical trial.

Disclosures

Ran Nir-Paz, MD, BiomX: Advisor/Consultant|Technophage: Advisor/Consultant Clara Leandro, PhD, Technophage: Employee Raquel Barbosa, PhD, Technophage: Employee Helena Dordio, PhD, Technophage S.A.: Employee Miguel Garcia, n/a, IBV Innovation Bioventures Lda: Board Member|IBV Innovation Bioventures Lda: Ownership Interest|LX Bio Pharmaceuticals SA: Board Member|LX Bio Pharmaceuticals SA: Ownership Interest|TechnoPhage, SA: Board Member|TechnoPhage, SA: Author of several patent applications|TechnoPhage, SA: Ownership Interest.