bluuebunny/crossref_metadata_2025_split huggingface dataset:
1693. Risk Factors and Outcomes of Histologic Acute Graft Pyelonephritis following Kidney Transplantation
Authors: Powers Harry Ross , Hellinger Walter , Cortese Cherise , Elrefaei Mohamed , Khouzam Samir , Spiegel Matthew , Wadei Hani M 
Published: January 2021

Abstract

Background
Histologic acute graft pyelonephritis (HAGPN) is a complication of kidney transplantation (KT) diagnosed serendipitously by renal biopsy. A retrospective review of 1391 patients who underwent KT at our institution between 2008 and 2017 identified 46 cases (cumulative incidence 5%). Rejection was present in 50% of biopsies demonstrating HAGPN, complicating management. The aims of this study were to identify risk factors and outcomes of HAGPN.

Methods
Recipient, donor, operative and post-transplant characteristics of 46 cases of HAGPN and 138 controls randomly selected from the 1345 patients who underwent KT between 2008 and 2017 were assessed in univariable and multivariable Cox regression models. Associations of HAGPN with death or graft failure were assessed in univariable models.

Results
In univariable analysis, characteristics associated with increased risk of HAGPN in order of decreasing hazard ratio (HR) were rejection (HR 10.82, 5.66-20.72), urinary tract infections (UTI) or asymptomatic bacteriuria (ASB) (HR 6.28, 3.43-11.50), urologic malfunction (UM) within 30 days of KT, (HR 5.34, 2.85-10.02), less than 4 matches at HLA A/B/DR loci (HR 3.74, 1.19-11.76), delayed graft function (DGF) (HR 2.1, 1.47-3.00), basiliximab induction (HR 1.59, 1.05-2.42), diabetes mellitus (DM) at KT (HR 1.52, 1.07-2.16), operative time (HR 1.11, 1.03-1.19) and cold ischemic time (CIT) (HR 1.05, 1.02-1.06). UM, rejection and UTI or ASB were the most significant risk factors based on clinical and statistical importance, and after adjusting for them, DM, transplant type, CIT, ureteral stent placement and DGF remained significant risk factors. In univariable analysis, ureteral stent placement at transplant (HR 0.60, 0.43-0.88) and living-related donor (HR 0.18, 0.04-0.78) were each associated with reduced risk of HAGPN which persisted after multivariable analysis. In univariable analysis, HAGPN was associated with death (HR 17.04, 7.93-39.31) and graft failure (HR 3.77, 1.73, 8.20).

Conclusion
HAGPN is an infrequent, unanticipated, clinically significant complication of renal transplantation. Post-transplant dysfunction of the allograft collection system may be a modifiable risk factor.

Disclosures
All Authors: No reported disclosures
1696. The Black Box of Using Health Claims-Based Analyses to Estimate UTI Prevalence in Community-Dwelling Women
Authors: Stapleton Ann E , Wolfson Julian , Zhang Jianqiu , Smith Ariana , Newman Diane , Talley Kristine , Wyman Jean 
Published: January 2021

Abstract

Background
Urinary tract infections (UTIs) are common in women but most epidemiology studies occurred in specialized settings (university health clinics) or used outdated methods (random digit dialing). Currently, women receive UTI care in systems with electronic health records (EHR), thus documenting care of a wider female demographic in real-world settings. We estimated the prevalence of acute, uncomplicated UTIs in community-dwelling women in a health claims database using various operational definitions of UTI.

Methods
We conducted a retrospective analysis of claims data from the OptumLabs® Data Warehouse (OLDW), a de-identified claims and clinical information repository for privately insured and Medicare Advantage enrollees in a large, private US health plan. Non-pregnant female patients ≥ 15 years of age with two years of continuous enrollment between 2007-2015 and a visit encounter in an outpatient office, urgent care, or emergency department were included. Women with lower urinary tract disease/abnormalities, neurological disease, urological treatment, procedures or urinary catheter use, cancer or HIV treatment were excluded. Decision rules for identifying UTIs were derived using one or more combinations of: relevant ICD-9 codes, UTI symptom diagnosis codes, positive urine test results, and/or antibiotic prescription recorded in the EHR and claims. Prevalence rates were calculated for each decision rule.

Results
Of the 7,337,700 females in the claims database, 947,041 (12.97%) had an index UTI diagnosis or symptoms and met eligibility criteria. The table below illustrates prevalence rates according to each decision rule. As shown, applying decision rules based on common UTI definitions resulted in large differences in prevalence rates.
Table

Conclusion
Using common definitions for UTI to analyze claims data from an insurer of large proportions of the US, we obtained significantly different prevalence rates. This study highlights major limitations in using EHR and claims data for UTI quality initiatives such as tracking of practices associated with antimicrobial stewardship and lends credibility to proposals to track these infections as a reportable disease.

Disclosures
All Authors: No reported disclosures
1697. The Burden Of Multidrug-Resistant Urinary Tract Infections
Authors: Hammami Fatma , Koubaa Makram , Chakroun Amal , Rekik Khaoula , Smaoui Fatma , Elleuch Emna , Marrakchi Chakib , Jemaa Mounir Ben 
Published: January 2021

Abstract

Background
Urinary tract infections (UTIs) are the most common reason for consultation and for antibiotic use. Many factors interfere and increase the risk for antimicrobial resistance. We aimed to study the clinical, laboratory and evolutionary particularities associated with multidrug-resistant (MDR) UTIs.

Methods
We conducted a retrospective study including all patients hospitalized for UTIs in the infectious diseases department between 2011 and 2018.

Results
A total of 867 cases of UTIs were included in the study, among which 407 cases (46.9%) were MDR. There were 306 males (35.3%). The mean age was 53±21 years. Overall, MRD UTIs were significantly associated to male gender (39.1% vs 32%; p=0.02). Patients aged ≥65 years were significantly more affected with MRD UTIs (54.5% vs 36.5%; p&lt; 0.001). Previous medical history of diabetes (38.1% vs 24.6%; p&lt; 0.001), antibiotic consumption (30.7% vs 13%; p&lt; 0.001) and surgical intervention of the urinary tract (13% vs 5.4%; p&lt; 0.001) were significantly associated with MDR UTIs. The mean delay to hospitalization was significantly longer among MDR UTIs cases (5[3-10 days] vs 3[2-7 days]; p&lt; 0.001). In total, MDR UTIs were more frequently documented to Klebsiella pneumoniae (19.4% vs 12%; p=0.002). Comparison of the disease evolution showed that MRD UTIs were significantly associated with complications (9.1% vs 5.2%; p=0.02), recurrence (4.4% vs 1.5%; p=0.01) and death (2.2% vs 0.4%; p=0.02). As to laboratory investigations and antibiotic duration, no significant difference was noted.

Conclusion
Our study showed that MDR UTIs were associated with not only complications, but also with a poor prognosis. The continuous surveillance for antimicrobial resistance and the rational use of antibiotics are crucial in order to improve the prognosis.

Disclosures
All Authors: No reported disclosures
1703. Hematologic Toxicity of Valganciclovir Prophylaxis in Solid Organ Transplant Recipients as a Function of Weight-adjusted Ganciclovir Exposure
Authors: Campanella Toni A , Roy Amanda , Gintjee Thomas J , Donnelley Monica , MacDougall Conan , Gallagher Jason C 
Published: January 2021

Abstract

Background
Valganciclovir (VGC), an oral prodrug of ganciclovir (GCV), is 60% bioavailable. Manufacturer-recommended doses are adjusted for creatinine clearance (CrCl), but not weight (wt), while GCV doses are adjusted for CrCl and wt. Patients exposed to excess GCV by not wt-adjusting VGC doses may be at risk of hematologic toxicity. The purpose of this study was to investigate the impact of body weight on VGC toxicity in solid organ transplant (SOT) recipients.

Methods
This was a multicenter retrospective study at three academic medical centers of adult SOT recipients who received VGC for CMV prophylaxis between January 2016 and August 2019. The primary outcome was first occurrence of leukopenia within six months post-transplant. The primary predictor was the ratio between the patient’s estimated GCV exposure based on the initial VGC dose prescribed and the equivalent prophylactic GCV dose accounting for the patient’s CrCl and wt (rVGC:GCV).

Results
The study included 231 patients, mostly lung (59%) and kidney (KT, 28%) transplants (Table 1). The rVGCV:GCV was 4.4 (range, 0.6-25.1, SD 4.5), and was significantly higher in KT (7.7 vs 3.0, p &lt; 0.001). Leukopenia occurred in 133 patients (57.5%). After adjustment for type of transplant, rVGC:GCV ratio was not associated with increased odds (OR 0.97, 95% CI 0.91-1.04) or hazard of (HR 0.99, 95% CI 0.95-1.04) leukopenia. Exploratory analysis suggested threshold effects and interaction with transplant type: a rVGCV:VGC of &gt; 3 was associated with time to leukopenia (HR 2.02, 95% CI 1.09-3.74) among non-KT patients but not KT patients (HR 0.99, 95% CI 0.56-1.76) (Figure 1).
Table 1

Figure 1

Conclusion
Initial doses of VGC used for SOT CMV prophylaxis are estimated to result in significantly higher GCV exposures than IV GCV doses. A relationship with risk of leukopenia was only seen in non-KT patients, possibly because of rapid recovery of renal function and dose adjustment in KT patients.

Disclosures
Jason C. Gallagher, PharmD, FIDP, FCCP, FIDSA, BCPS, Allergan (Consultant)Astellas (Consultant)Merck (Consultant, Grant/Research Support)Nabriva (Consultant)Qpex (Consultant)scPharmaceuticals (Consultant)Shionogi (Consultant)Spero (Consultant)Tetraphase (Consultant)
1707. Clinical Profile of Human T-Lymphotropic Virus Type I Infection in Pediatric Population in a Referral Hospital in Colombia
Authors: Mejia- Mertel Juliana , Rojas -Hernandez Juan P 
Published: January 2021

Abstract

Background
The Human T-lymphotropic virus type 1 (HTLV-1), affects around ten to twenty million people worldwide, predominantly in intertropical regions (Africa, Japan, Melanesia, Australia, and South America Pacific Coast). The most common disorders associated are T-cell leukemia/lymphoma (ALT) and HTLV-1-associated myelopathy (HAM). Studies have reported other clinical manifestations in HTLV-1, still studies are needed in pediatric population to improve diagnosis and treatment of infected patients.

Methods
Descriptive, retrospective cohort study, conducted in our referral pediatric hospital in Cali, Colombia. Included pediatric patients (1 to 18 years of age) diagnosed with HTLV-1 infection, between January 2017 to March 2020.

Results
Twelve patients were included, seven males and five females. Eleven patients were from and resided in the Colombian Pacific coast. Ten patients showed nutritional deficiencies.
None showed clinical or laboratory signs of ALT, neither neurological symptoms or physical exam suggesting HAM. In terms of associated diseases and opportunistic infections, none had a positive HIV ELISA test, and stool tests were all negative for Strongiloydes. Four presented infective dermatitis, and two showed lesions suggesting scabies.
Eight patients presented respiratory symptoms with chest CT scans showing signs of chronic inflammation, bronchiectasis, and subpleural bullae as the major findings. Additional tests were carried out in bronchoalveolar fluid, four had positive galactomannan test,suggesting pulmonary aspergillosis, two exhibited positive gene PCR testing for Mycobacterium tuberculosis.
Regarding inflammatory diseases, one patient presented with symptoms of Inflammatory Bowl Disease, with biopsy confirming Crohn’s disease. Another patient presente abrupt vision loss, diagnosed with Vogt Koyanagi Hadara Syndrome after ophthalmological evaluation.
Summary features HTLV-1 patients

Ground-glass opacity diffusely distributed in both lungs with multiple bronchiectasis involving predominantly lung bases. Cystic images diffusely distributed in both lungs, some subpleural and other centrilobular.

Conclusion
It is important to consider alternative manifestations of HTLV-1 infection in the pediatric population, including pulmonary disease, opportunistic co-infections, and inflammatory disorders. It is crucial to diagnose this disease in childhood to reach a better control of this neglected infection that affects predominantly vulnerable population in low-income countries.

Disclosures
All Authors: No reported disclosures
1708. Impacts of age and season on rates of hospitalization for respiratory syncytial virus (RSV) in infants in the United States and their use of mechanical ventilation and charges
Authors: Shepard Donald S 
Published: January 2021

Abstract

Background
Respiratory Syncytial Virus (RSV) infection is the leading cause of hospitalization in infants below age 12 months and highest below age 6 months. Despite considerable evidence on the clinical predictors of RSV hospitalizations, little is known about their cost, its drivers and their relation to age and season.

Methods
We used the National Inpatient Sample to examine RSV inpatient admissions and their average charge from 2009 to 2011. This 3-year data set includes a large, nationally representative all-payer sample of 37,376 RSV admissions of infants in the US under age 12 months recorded by month. We calculated the rate per 1000 infants of RSV hospitalizations, the share receiving mechanical ventilation (MV), and the mean charge per admission (separated by use of MV) with 95% confidence intervals by age and season, excluding incomplete data. We adjusted charges to Jan 2020 based on the medical care Consumer Price Index.

Results
These data confirm that rates of hospitalization by age were highest for infants 1 month of chronological age (2.42 times the annualized average) and declined steadily thereafter. The percentage of hospitalizations with MV declined from months &lt; 1 to 4, with subsequent fluctuations (Fig 1). Charges exceeded the annual average only for infants aged &lt; 1 and 1 month (Fig 2). In 2020 prices, hospitalization charges per episode averaged $175,211 with MV vs. $17,313 without MV, totaling $1.51 billion annually for the birth cohort of 4.04 million infants ($374 per infant). As only 4.5% of hospitalizations had MV, those without MV comprised 67.5% of aggregate yearly charges. Admissions were highly seasonal, with the rate in the highest month (Feb) 341 times that in the lowest month (July). However, utilization of MV (Fig 3) tended to be lower in the RSV season but depended mostly on age. While average charges were higher outside the RSV season, their seasonal pattern was similar for admissions with and without MV.
Fig. 1. Share of hospitalizations with RV (bars) vs. rate of RSV hospitalizations (line) by age

Fig. 2. Charges (bars) vs. rate of RSV hospitalizations (line) by age

Fig. 3. Utilization of MV (bars) vs RSV hospitalization rate (line) by season

Conclusion
RSV in infants under one year generate substantial hospital charges. While each of the small share of infants receiving MV is expensive, infants with MV are not the main driver of costs (Fig 4). Rather, the large number and share (94.5%) of hospitalizations without MV is the major determinant of aggregate charges (Fig 5).

Fig. 4. Relation between use of mechanical ventilation (MV) [bars] and RSV hospitalization rate [lines] by season and age (in months)

Fig. 5. Hospitalization charges (bars) vs RSV hospitalization rate (line) by season

Disclosures
Donald S. Shepard, PhD, Sanofi Pasteur (Grant/Research Support)
1715. Influenza-like Illness (ILI) Experience Among Healthcare Workers in Military Treatment Facilities: An Offshoot of the Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) Study
Authors: Colombo Rhonda , Richard Stephanie , Schofield Christina , Collins Limone , Ganesan Anuradha , Geaney Casey , Hrncir David , Lalani Tahaniyat , Markelz Ana E , Maves Ryan C , McClenathan Bruce , Mende Katrin , Modi Jitendrakumar , Montgomery Jay R , Seshadri Srihari , Skerrett Catherine , Spooner Christina , Utz Gregory , Warkentien Tyler , Burgess Timothy , Burgess Timothy , Coles Christian L 
Published: January 2021

Abstract

Background
Healthcare workers (HCWs) are at heightened risk of exposure to respiratory pathogens. There are limited published data on influenza-like illness (ILI) experience among HCWs, and the few available studies were hampered by incomplete vaccination histories. PAIVED, a multicenter, multiservice study assessing influenza vaccine effectiveness in the Department of Defense, provides a unique opportunity to describe ILI experience among vaccinated HCWs compared to vaccinated non-HCWs.

Methods
PAIVED participants were randomized to receive either egg-based, cell-based, or recombinant-derived influenza vaccine then surveyed weekly for ILI. At enrollment, participants provided key demographic data including whether they were HCWs with direct patient contact. ILI was defined a priori as 1) having cough or sore throat plus 2) feeling feverish/having chills or having body aches/fatigue. Participants with ILI completed a daily symptom diary for seven days and submitted a nasal swab for pathogen detection.

Results
Of 4433 eligible participants enrolled during the 2019-20 influenza season, 1551 (35%) were HCWs. A higher percentage of HCWs experienced an ILI than non-HCWs (34% vs 26%, p&lt; 0.001). Overall, HCWs were more likely to be female (42% vs 32%), age 25-34 years (39% vs 28%), active-duty military (81% vs 62%), non-smokers (88% vs 75%), and physically active (92% vs 85%). Self-reported race differed between HCWs and non-HCWs; a higher proportion of HCWs identified as White (63% vs 56%) or Asian (8% vs 5%). Similar demographic differences existed among HCWs and non-HCWs with ILI. HCWs were more likely to respond to at least 50% of weekly surveillance messages, irrespective of ILI status. HCWs with ILI had less severe lower respiratory symptoms (p&lt; 0.001) and a shorter duration of illness (12.4±8.1 days vs 13.7±9.0, p=0.005) than non-HCWs. Pathogen data is pending.

Conclusion
HCWs in PAIVED were more likely to report ILI than their non-HCW counterparts yet tended to have lower illness severity, possibly reflecting a higher level of baseline health or enhanced awareness of early ILI symptoms. The important epidemiologic position HCWs occupy for ILI has been apparent in the COVID-19 pandemic. Exploring ways to mitigate ILI risk in HCWs beyond influenza vaccination is warranted.
Disclaimer

Disclosures
All Authors: No reported disclosures
1718. Respiratory Syncytial Virus (RSV) Surveillance in the Department of Veterans Affairs (VA), 2010-2018
Authors: Lucero-Obusan Cynthia , Schirmer Patricia , Oda Gina , Holodniy Mark 
Published: January 2021

Abstract

Background
Respiratory Syncytial Virus (RSV) is an increasingly recognized cause of acute respiratory illness in older adults, leading to an estimated 177,000 hospitalizations and 14,000 deaths each year in the US. In adult populations, diagnostic testing for RSV has historically been underutilized. Herein, we examine national trends in RSV testing and infection across the Veterans Affairs (VA) healthcare system.

Methods
Electronic RSV laboratory testing results, ICD-coded hospitalizations and outpatient encounters were obtained from VA’s Praedico Surveillance System (1/1/2010-12/31/2018). Patients were reviewed for positive results, repeat testing, and demographics. Antibody tests were excluded.

Results
A total of 102,251 RSV results were included. Overall, 4,372 (4.3%) specimens from 4,263 unique individuals were positive with a median age of 67 years (range 0-101) and 90% were male. 1,511 individuals (35.4%) also had an RSV-coded hospitalization. RSV type was specified for only 7.8% of positives (Table). During 2010-2018 there were 2,522 RSV-coded hospitalizations (median length of stay = 4 days) among 2,444 unique individuals, which included 413 ICU stays (16.4%) and 98 deaths (3.9%) during the RSV-coded hospitalization. Approximately 78% of RSV-coded hospitalizations within VA (excluding all non-VA hospitalizations) had a documented positive test result. A greater than 15-fold increase in RSV tests performed, hospitalizations and outpatient encounters was observed from 2010-2018, although the percent testing positive remained relatively stable (Figure, Table).
Figure. Testing for Respiratory Syncytial Virus (RSV), Department of Veterans Affairs, 2010-2018.

Table. Select RSV Surveillance Metrics, Department of Veterans Affairs, 2010-2018

Conclusion
RSV testing and identification of patients with RSV infection increased dramatically during the time period analyzed, likely due to increased availability of PCR-based multi-pathogen panels and duplex assays. While the percentage of tests positive for RSV remained relatively stable, the rise in coded hospitalizations may be due to increased testing for RSV among hospitalized Veterans with severe respiratory infections. These surveillance data may allow for further characterization of RSV disease burden estimates which can help inform clinical management and development of interventions for adults, such as vaccines and antiviral therapies.

Disclosures
All Authors: No reported disclosures
1719. Respiratory Syncytial Virus-Associated Hospitalization Rates among US Infants: A Systematic Review and Meta-Analysis
Authors: McLaughlin John M , Khan Farid L , Schmitt Heinz-Josef , Agosti Yasmeen , Jodar Luis , Simões Eric , Swerdlow David L 
Published: January 2021

Abstract

Background
Understanding the true magnitude of infant respiratory syncytial virus (RSV) burden is critical for determining the potential public-health benefit of RSV prevention strategies. Although global reviews of infant RSV burden exist, none have summarized data from the United States or evaluated how RSV burden estimates are influenced by variations in study design.

Methods
We performed a systematic literature review and meta-analysis of studies describing RSV-associated hospitalization rates among US infants. We also examined the impact of key study characteristics on these estimates.

Results
After review of 3058 articles through January 2020, we identified 25 studies with 31 unique estimates of RSV-associated hospitalization rates. Among US infants &lt; 1 year of age, annual rates ranged from 8.4 to 40.8 per 1000 with a pooled rate= 19.4 (95%CI= 17.9–20.9). Study type was associated with RSV hospitalization rates (P =.003), with active surveillance studies having pooled rates per 1000 (11.1; 95%CI: 9.8–12.3) that were half that of studies based on administrative claims (21.4; 95%CI: 19.5–23.3) or modeling approaches (23.2; 95%CI: 20.2–26.2).

Conclusion
Applying the pooled rates identified in our review to the 2020 US birth cohort suggests that 73,680 to 86,020 RSV-associated infant hospitalizations occur each year. To date, public-health officials have used conservative estimates from active surveillance as the basis for defining US infant RSV burden. The full range of RSV-associated hospitalization rates identified in our review better characterizes the true RSV burden in infants and can better inform future evaluations of RSV prevention strategies.

Disclosures
John M. McLaughlin, PhD, Pfizer (Employee, Shareholder) Farid L. Khan, MPH, Pfizer (Employee, Shareholder) Heinz-Josef Schmitt, MD, Pfizer (Employee, Shareholder) Yasmeen Agosti, MD, Pfizer (Employee, Shareholder) Luis Jodar, PhD, Pfizer (Employee, Shareholder) Eric Simões, MD, Pfizer (Consultant, Research Grant or Support) David L. Swerdlow, MD, Pfizer (Employee, Shareholder)