bluuebunny/crossref_metadata_2025_split huggingface dataset:
916. National Estimates of the Proportion of Bacterial Pathogens Expressing Resistant Phenotypes in US Hospitals, 2012-2017
Authors: Baggs James , Hatfield Kelly M , Wolford Hannah , Olubajo Babatunde , Reddy Sujan , McCarthy Natalie , Paul Prabasaj , McDonald Clifford , Kallen Alexander , Fiore Anthony , Jernigan John A 
Published: January 2021

Abstract

Background
In 2019, CDC updated national estimates of antibiotic resistance. In this abstract we provide national estimates of and trends in proportion of bacterial pathogens expressing resistant phenotypes (%R), specifically: MRSA, VRE, CRE, ESBL, CRAsp, and MDR Pseudomonas, see Figure.

Methods
We measured incidence of clinical cultures yielding the bacterial species of interest among hospitalized adults in hospitals submitting data to the Premier Healthcare Database, Cerner Health Facts and BD Insights Research Database from 2012- 2017. Community-onset (CO) cultures were obtained ≤ day 3 of hospitalization; hospital-onset (HO) were obtained ≥ day 4. We determined hospital-specific %R for each species. We generated national estimates using a raking procedure to generate weighted adjustments to match the distribution for all U.S. acute care hospitals based on U.S. census division, bed size, teaching status, and urban/rural designation. We applied a weighted means survey procedure to calculate national estimates for each year. We used weighted multivariable logistic regression adjusting for hospital characteristics to examine trends.

Results
From 2012-2017, the overall number of hospitals contributing data was 890 (over 20% of U.S. hospital hospitalizations annually). National estimates and trends of %R are shown in the Figure. Between 2012-2017, significant annual decreases in %R were observed for MRSA, VRE, CRAsp, and MDR Pseudomonas. CRE %R did not change. Overall ESBL %R increased by 44% (CO=49% increase, HO=27% increase).

Conclusion
Reductions in %R were observed among MRSA, VRE, CRAsp, and MDR Pseudomonas, suggesting that prevention efforts focused in health care settings are having a disproportionate effect on resistant strains. However, %R remains unacceptably high for all pathogens we studied, and %R among ESBL-producing Enterobacteriaceae has increased, most prominently among CO infections. Continued focus on currently recommended intervention strategies as well as new ones for community onset infections is needed.

Disclosures
All Authors: No reported disclosures
917. Persistence of Multidrug-Resistant Organisms during Occupancy Changes in the Nursing Home Setting, and Impact of Patient Hand Hygiene Assistance
Authors: Cassone Marco , Lansing Bonnie , Mantey Julia , Gibson Kristen , Gontjes Kyle , Mody Lona 
Published: January 2021

Abstract

Background
We investigated the effect of changes in room occupancy, and patient hand hygiene, on the burden of multidrug-resistant organisms (MDRO) in nursing homes. We assessed: 1/ persistence of MDRO after patients are discharged; and 2/ impact of hand hygiene assistance on colonization and room contamination.

Methods
Prospective cohort study of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and ceftazidime, ciprofloxacin or meropenem-resistant gram-negative bacilli (rGNB) in 9 single rooms screened three times a week for 34 weeks (five environmental surfaces, plus nares, groin, and hands of enrolled patients). Relative risk (RR) for patient colonization and room contamination were calculated in patient visits based on: 1/ performance of hand hygiene, and 2/ receiving assistance to perform it.

Results
We collected 4670 swabs over a total of 723 visits. Of 143 patient discharges, 31 times the room was swabbed before another patient was admitted (41 total visits), 48 times the next admitted patient was enrolled and available to be swabbed (295 visits), and 64 times the patient was not enrolled but the environment was sampled (387 total visits) (Figure).
Twenty-four (50%) patients were colonized at least once with an MDRO. Rooms were contaminated at least once with MDRO in 72 cases (64%). MDRO persistence during occupancy changes involving at least one screened patient was observed in 21 of 73 cases (29%). In addition, we detected 2 cases of contamination of unoccupied, terminally cleaned rooms with MDRO recovered also in the previous (MRSA) or the following occupancy (VRE).
In 40 occasions, patients performed hand hygiene with assistance from healthcare personnel, while in 169 occasions they performed hand hygiene by themselves. Requiring assistance was a risk factor for patient colonization (27.5% vs. 12.4% not requiring assistance (RR 2.20, 95% CI 1.16-4.18), and for room contamination (37.5% vs. 18.9%, RR 1.97, 95% CI 1.18-3.27) (Table).
Figure. Example of successive changes in room occupancy.

Table. Breakdown of colonization and contamination at each visit according to hand hygiene performance and need for assistance.

Conclusion
MDRO can persist during changes in patient occupancy. Patients requiring assistance with hand hygiene experienced a higher MDRO burden. These observations call for further investigation of improved cleaning practices and patient assistance.

Disclosures
All Authors: No reported disclosures
918. Pilot Surveillance for Carbapenemase Gene-positive Organisms Among Hospitalized Solid Organ Transplant Recipients
Authors: Chan June L , Nazarian Elizabeth , Musser Kimberlee A , Fung Monica , Doernberg Sarah B , Pouch Stephanie M , Pouch Stephanie M , Leekha Surbhi , Anesi Judith A , Kodiyanplakkal Rosy Priya , Turbett Sarah , Walters Maroya Spalding , Epstein Lauren , Epstein Lauren 
Published: January 2021

Abstract

Background
Carbapenemase gene-positive organisms (CPOs) are associated with infections with high mortality rates and have the potential to facilitate epidemic spread of carbapenem resistance. Passive reporting to CDC identified CPOs among organ transplant recipients, potentially representing an emerging reservoir for spread. We aimed to determine the prevalence of CPOs in hospital units where solid organ transplant (SOT) recipients receive care in order to inform public health action to prevent transmission.

Methods
All healthcare facilities identified one medical unit where SOT recipients received inpatient care and conducted point prevalence surveys (PPS) of all consenting patients on 1-2 designated calendar days. We used the Cepheid Xpert® Carba-R assay to identify carbapenemase genes (blaKPC, blaNDM, blaVIM, blaIMP, blaOXA-48) from rectal swabs; carbapenemase-positive swabs were cultured for organisms. All laboratory testing was conducted at the Wadsworth Center, part of CDC’s Antibiotic Resistance Laboratory Network.

Results
Five participating hospitals performed nine PPS from September 2019 through June 2020. In total, 154 patients were screened and 92 (60%) were SOT recipients (Table). The most common transplanted organs were kidney (44, 48%) and liver (39, 42%). Carbapenemase genes were detected among 5 (5%) SOT recipients, all from a single healthcare facility; 4 (80%) were blaKPC and 1 (20%) was blaNDM. Of the positive specimens cultured, blaKPC was carried by Enterobacter cloacae complex (ECC), Klebsiella pneumoniae, and Klebsiella oxytoca and blaNDM was carried by K. oxytoca; blaKPC was carried by both ECC and K. pneumoniae in a single individual. For SOT patients with CPOs, the median interval from transplantation to swab collection was 108 days (range: 12 to 323). CPOs were only detected in 1 (2%) of 62 non-transplant patients.
TABLE Characteristics of Carbapenemase Gene-positive Organism (CPO) Pilot Surveillance Participants

Conclusion
Among participating facilities, most did not identify CPOs among patients admitted to transplant units. These findings represent a small number of patients and facilities; additional PPS in areas with varied CPO epidemiology are needed to understand whether SOT recipients should be routinely screened for CPOs.

Disclosures
All Authors: No reported disclosures
927. Antiretroviral Laboratory Monitoring and Implications for HIV Clinical Care in the Era of COVID-19 and Beyond
Authors: Fantry Lori E , York lawrence , fisher Julia , august jessica , marquez jose , Ellis Kristen , Malladi Lakshmi , Kaveti Ashwini , Khachatryan Marine , paz Marissa , Adams Matthew , Bedrick edward 
Published: January 2021

Abstract

Background
In the era of COVID-19, providers are delaying laboratory testing in people with HIV (PWH) to avoid unnecessary exposures despite antiretroviral guidelines recommending periodic testing. The purpose of this study was to examine the clinical significance of periodic renal, liver, and lipid testing.

Methods
We reviewed the charts of 265 people with HIV (PWH) who initiated outpatient care at HIV clinic between 1/1/16 and 12/21/18 and had at least two clinic visits. Analysis included frequency distributions, descriptive statistics, one-sided binomial exact tests, and Poisson models with 95% confidence intervals (CI).

Results
Eighty-five percent (221) of PWH had no laboratory abnormalities while on antiretroviral therapy (ART). The most common abnormality was a glomerular filtration rate (GFR) &lt; 60 ml/min found in 10% of PWH. Multivariate analysis revealed that diabetes mellitus (DM) was associated with an increased risk of GFR &lt; 60 ml/min (estimated rate ratio 2.68, 95% CI 1.35-5.33) and age &lt; 60 years (estimated rate ratio .122, 95% CI .05-.32) was associated with a decreased risk (estimated rate ratio .24, CI .14 –.43). When a GFR was &lt; 60 ml/min or an AST or ALT was &gt;2X upper limit of normal (ULN), no action was taken in 52% of the cases. When an action was taken, the most
common action was to repeat testing (18%). After a lipid panel result, the most common actions were to calculate a 10-year cardiovascular risk score (32%) and add a statin (18%). Taking action after lipid panel results was strongly associated with age ≥ 40 (estimated rate ratio 9.1, 95% CI 3.3-25). ART was changed in seven PWH based on GFR, AST/ALT, or lipid panel results. There were four individuals with poor outcomes including cerebrovascular accident, acute renal failure, end stage renal disease, congestive heart failure, myocardial infarction, and death. Contributing factors were hypertension, DM, and hypercholesterolemia.

Conclusion
Individuals &lt; 40 years without ithout comorbidities had a low risk of having clinically significant renal and liver function abnormalities and rarely had actions taken after renal, liver, or lipid results. In the era of COVID-19 and beyond, it may be prudent for in certain groups to delay or eliminate liver, renal, and lipid testing to eliminate exposure, reduce cost, and avoid patient anxiety.

Disclosures
All Authors: No reported disclosures
931. Congestive Heart Failure in Persons Living with HIV: Are we providing standard of care?
Authors: Chowdhury Salil K , Seo Jung M , Keller Steven , Solanki Pallavi , Finkel Diana 
Published: January 2021

Abstract

Background
With antiretroviral therapy, Human Immunodeficiency Virus (HIV) infection has become a life-long chronic condition. Persons Living with HIV (PLWH) have increased risk of cardiovascular diseases including congestive heart failure (CHF) and increased morbidity and mortality from these diseases due to factors such as HIV-induced chronic inflammation. This study will assess if providers at University Hospital in Newark, NJ are providing standard of care for CHF in PLWH.

Methods
This study was approved by Rutgers IRB (Pro2020000391). A database of 154 charts including all patients with diagnoses of both HIV and CHF was generated using ICD-10 codes for HIV and CHF. After screening, 79 patient charts were eligible. Patients were excluded if their CHF was managed elsewhere, if they were misdiagnosed or deceased. Nine were diagnosed with heart failure with preserved ejection fraction (HFpEF) defined as an ejection fraction above 50%. Seventy were diagnosed with heart failure with reduced ejection fraction (HFrEF) defined as an ejection fraction below 40%. Treatment was assessed using the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines.
Recommendations for treatment of HFrEF

Recommendations for treatment of HFpEF

Results
For patients with HFrEF, 10% of eligible patients were not prescribed aldosterone antagonists due to an incorrect contraindication. Thirty eight percent of patients requiring consideration for device therapy were not considered. Fourteen percent of patients did not have NYHA/ACC/AHA class documented. Three additional charts were found to not follow class-based management. Thirty five percent of patients with hypertension did not have guideline-based titrated therapy. In terms of HFpEF, 43% of patients did not have proper hypertension treatment.
Heart Failure with Reduced Ejection Fraction

Heart Failure with Preserved Ejection Fraction

Conclusion
Adherence to evidence-based guidelines for CHF in PLWH is important due to their increased risk of mortality and morbidity. Improvements such as documentation of heart failure class, contraindications to medications, and consideration for devices may improve outcomes going forward.

Disclosures
All Authors: No reported disclosures
934. Diagnostic Utility of Blood (1- &gt;3)-β-D-Glucan Testing in Patients with HIV in Arkansas
Authors: Krishnan Gayathri , Hasan Lana , Saccente Michael 
Published: January 2021

Abstract

Background
Blood (1- &gt; 3)-β-D-Glucan (BDG) is a sensitive marker for Pneumocystis jirovecii pneumonia (PJP) in patients with AIDS (PWA). However, other fungal infections, including progressive disseminated histoplasmosis (PDH), cause high levels of BDG. At our hospital, PDH is a common diagnosis in PWA with fever and respiratory complaints, making it difficult to differentiate PJP from PDH based on clinical features alone. The objective of this study was to assess BDG as a diagnostic test for PJP in Arkansas where histoplasmosis is endemic.

Methods
We performed a retrospective review of patients with confirmed PJP and confirmed PDH who had BDG testing between 2014-2020. Positive cytological or histological evidence of P. jirovecii in bronchoalveolar lavage (BAL) or lung biopsy, or positive PCR on sputum or BAL confirmed PJP. Identification of Histoplasma capsulatum in culture of blood or other normally sterile site, histology showing typical yeast forms, or a positive urine H. capsulatum antigen assay (MiraVista Diagnostics) confirmed PDH. The Fungitell Assay determined BDG levels as follows: negative, &lt; 60 pg/mL; indeterminate, 60-79 pg/mL, and positive &gt; 80 pg/mL. Values below 31 pg/mL and those above 500 pg/mL were censored at 30 and 500, respectively. Respiratory symptoms were defined as the presence of cough, shortness of breath, or dyspnea on exertion.

Results
53 episodes of PDH occurred in 46 patients. 42 were accompanied by a BDG result. Of these, 38 (90%) were positive; 3 (7%) were negative; and 1 (2%) was indeterminate. 44 (83%) of the PDH episodes were associated with respiratory symptoms. 36 of these had a BDG result. 34 (94%) were positive; 1 (3%) was negative; and 1 (3%) was indeterminate. 44 episodes of PJP occurred in 40 patients. All had a BDG result. 43 (98%) were positive.10 (23%) episodes of PJP were accompanied by a concomitant infection.
The mean BDG level was significantly higher in the PJP group compared to those with PDH and respiratory symptoms (P=.002). However, values overlapped substantially, and BDG positivity was not significantly more frequent in the PJP group (P=.586).

Box-and-Whisker Display of (1-&gt;3)-β-D-Glucan Results

Conclusion
In Arkansas, BDG positivity is not a reliable marker of PJP because it cannot distinguish between PJP and PDH. Attributing an elevated BDG to PJP without additional evaluation risks misdiagnosis.

Disclosures
All Authors: No reported disclosures
937. Factors Associated with Metabolic Syndrome in People with HIV under 40 Years in Guatemala
Authors: Marroquín Hugo E , Ortiz Dean , Larson Lindsey , Franco Katherine , Spec Andrej , Melendez Johanna , Pinzon Rodolfo , Mejia-Chew Carlos , Samayoa Johanna , O’Halloran Jane A 
Published: January 2021

Abstract

Background
HIV infection and antiretroviral therapy (ART) can lead to metabolic abnormalities associated with increased cardiovascular disease risk, some of these abnormalities (central obesity, elevated fasting glucose, triglycerides, and blood pressure and low HDL cholesterol) are in metabolic syndrome (MetS). The prevalence of MetS increases with age. Currently, the status of MetS in people with HIV (PWH) Guatemala is unknown. We assessed the prevalence of MetS and potential predictors in PWH participating in prospective cohort study at Hospital Roosevelt in Guatemala City.

Methods
We performed a cross-sectional analysis of PWH under 40 years old receiving ART for at least 6 months from July 2019 to March 2020. The harmonized criteria for MetS and the cut-off for waist circumference recommended by the Latin American Diabetes Association were used. Association between MetS and gender, place of residency, ethnicity, educational level, baseline and current CD4 count, smoking, alcohol consumption, physical activity, viral load, body mass index (BMI) and ART exposure was assessed in bivariate analysis. Potential predictors (p-value &lt; 0.1) were included in a multivariate binary logistic regression model.

Results
Of total cohort of 757 participants enrolled390 (51.5%) were younger than 40 years. Of those under &lt; 40 years, 150 (38.5%) were women, 59 (15.1%) Mayan, median age was 32 years (IQR 27, 37). 93 (23.8%) had MetS. Between group differences in Table 1. Of those with Met, 51 (54.8%) had elevated waist circumference, 87 (93.5%) elevated triglycerides, 83 (89.2%) low HDL-c, 56 (60.2%) elevated blood pressure and 35 (37.6%) elevated fasting glucose. Body mass index (BMI) ≥ 25 kg/m2 or higher and 2 years or more of cumulative non-nucleoside reverse transcription inhibitors (NNRTI) where more common in those &lt; 40 years with MetS compared to those without MetS. On multivariable regression, MetS was associated with current CD4 count &lt; 200 (OR 3.1; IC 1.51, 6.34; p-value &lt; 0.01) and BMI ≥ 25 kg/m2 (OR; 6.53; IC 3.64, 11.73; p-value &lt; 0.01).
Table1. Between group differences (No MetS vs MetS)

Conclusion
Nearly one in every four PWH under 40 years old in our cohort was affected by MetS. Dyslipidemia (elevated triglycerides and low HDL-c) was the main driver of MetS. Lower CD4 count and overweight were predictors for MetS in PWH under 40.

Disclosures
Andrej Spec, MD, MSCI, Astellas (Grant/Research Support)Mayne (Consultant)Scynexis (Consultant)
938. Identifying Gaps in the Treatment of Hepatitis C in Patients Co-Infected with HIV in Edmonton, Alberta
Authors: Savaryn Bohdan , Round Jessica , Plitt Sabrina , Shafran Stephen , Charlton Carmen 
Published: January 2021

Abstract

Background
The Northern Alberta HIV Program (NAHP) provides care and support for about 2500 HIV positive individuals. Part of the program includes screening and therapy for co-morbidities such as hepatitis C virus (HCV) infection. This study aims to assess the occurrence of HCV co-infection among these patients, determine whether they had received treatment for HCV, and identify patients who are currently viremic so they can be linked to care.

Methods
NAHP patients from 2010 to 2019 were linked to their HCV antibody, RNA, and genotyping laboratory testing data from January 1, 2000 to December 31, 2019 as well as HCV medication dispensation data. Each patient’s current and previous state of HCV infection and treatment status was assessed. Chart reviews were conducted for patients presently HCV viremic to assess their HIV care and social determinants.

Results
Of the 2417 NAHP patients, 392 (16.2%) were identified as having been co-infected with HCV at some point between January 1, 2000 to December 31, 2019 and meeting the inclusion criteria. Overall, 198 (50.5%) of the HIV-HCV co-infected patients had received HCV treatment and 232 (59.2%) were no longer viremic at their most recent HCV RNA test. 99 (69.2%) of the 143 HCV viremic patients had a suppressed HIV infection suggesting they are active in their HIV care and good candidates for HCV treatment.
Figure 1. 2417 patients in the Northern Alberta HIV Program were evaluated for the presence of an HIV- HCV co-infection. 404 patients were identified as having been HIV-HCV co-infected at some point between January 1, 2000 and December 31, 2019.

Figure 2. 404 HIV-HCV co-infected patients from the Northern Alberta HIV Program were assessed for the occurrence of treatment as well as the current status of their HCV infection. 143 patients were found to currently have an active HIV-HCV co-infection.

Table 2. Characteristics of HIV-HCV co-infected patients from the NAHP with an active HCV infection (n=143)

Conclusion
The NAHP has been successful in identifying and treating many of their HIV HCV co-infected patients, however, there remain patients with viremic HCV. Despite the availability of direct-acting antivirals (DAAs) in Alberta and many of these patients being successfully treated for HIV, a significant proportion of co-infected patients have not initiated HCV treatment The HIV treating physicians of these individuals will be notified and encouraged to assist in getting them linked to HCV care and treatment.

Disclosures
All Authors: No reported disclosures
940. Impact of Using Arts Programming to Support Treatment in Adolescents Living with HIV in Eswatini
Authors: Agrawal Vedika , Ness Tara , Small Amanda , Simelane Tandzile T , Lukhele Bhekemusa , Dlamini Sandile , Petrus Jamie 
Published: January 2021

Abstract

Background
Adolescents and young adults with HIV are a unique population given the distinct psychosocial challenges of their age-group coupled with having a stigmatizing disease. In 2018, approximately 1.6 million adolescents were living with HIV worldwide, with the highest HIV prevalence found in Eswatini. As this group struggles more than any other age-group with medication adherence, novel interventions that are peer-inclusive and empowering should be explored to support their treatment.

Methods
We piloted a theater camp to determine the impact of fostering creative expression amongst adolescents and young adults enrolled at our HIV clinic in Mbabane, Eswatini. A two-week camp was conducted in collaboration with a non-profit organization of professional teachers, actors, and musicians. We emphasized enrollment of patients struggling with medication adherence, teen mothers, and those on second-line antiretroviral treatment. Twenty individuals (ages 12-23) participated in self-expression activities, story development, and a final play performed for the community. To assess impact, we compared viral loads pre- and post- camp as well as surveyed participants on effect of participation on areas such as personal stigma, sense of community, and confidence.

Results
Of those who participated, 25% showed a substantial decrease and 10% a substantial increase in viral load after the camp (&gt;0.1 log10 change). Those who completed the survey (n=18) felt the camp helped them with confidence (13/18), teamwork (13/18), and friendships (11/18). Quotes from participants reinforced this growing sense of community, confidence, and decreased personal stigma. One wrote “theater camp helped me know that I can do a lot of things in life to achieve my future goals although I am HIV positive” and another stated “it made me not feel sorry for being an HIV positive person.”

Conclusion
Our pilot program demonstrates creative arts programming has beneficial psychosocial effects, aids in community building, and potentially enhances the effectiveness of medical treatment. Further programs and studies should continue to investigate creative arts as an avenue for treatment support, self-expression, and community building among vulnerable populations such as adolescents and young adults with HIV.

Disclosures
All Authors: No reported disclosures