bluuebunny/crossref_metadata_2025_split huggingface dataset:
109. Preexisting Resistance and Week 48 Virologic Outcomes After Switching to B/F/TAF in African American Adults with HIV
Authors: Andreatta Kristen , D’Antoni Michelle L , Chang Silvia , Parvangada Aiyappa , Blair Christiana , Collins Sean E , White Kirsten L 
Published: January 2021

Abstract

Background
The BRAAVE 2020 study is evaluating the safety and efficacy of switching to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) among virologically suppressed Black adults with HIV. At Week (W) 24, 0.6% (2/328) on B/F/TAF vs 1.8% (3/165) who stayed on their baseline 3 drug regimen (SBR) had HIV-1 RNA ≥ 50 c/mL demonstrating noninferiority of B/F/TAF. Here, resistance analyses and virologic outcomes at W48 are described.

Methods
Enrollment criteria permitted prior treatment failure, except on an INSTI-containing regimen, and allowed documented resistance to NNRTIs, PIs and/or NRTIs, except for K65R/E/N, ≥ 3 thymidine analog mutations (TAMs), or T69-insertions; primary INSTI resistance (-R) was excluded. Preexisting drug resistance was assessed with historical genotypes and proviral DNA genotyping. B/F/TAF outcomes were determined by last on-treatment HIV-1 RNA through W48.

Results
Altogether, 495 participants enrolled (B/F/TAF n=330, SBR n=165). Preexisting primary NRTI-R, NNRTI-R, and PI-R substitutions were observed in 14% (70/495), 21% (102/495), and 13% (62/495), respectively. M184V/I and TAMs were detected in 10% (51/495) and 7% (34/495), respectively. Primary INSTI-R was detected post-randomization in 2% (11/495); all continued on study and were included in efficacy analyses. At W24, 163 in the SBR group switched to B/F/TAF (SBR to B/F/TAF). W48 outcomes were determined for 489 participants who had ≥ 1 post-switch HIV-1 RNA measurement: 99% (324/327) in the B/F/TAF and 100% (162/162) in the SBR to B/F/TAF groups had HIV-1 RNA &lt; 50 copies/mL at their last study visit, including 100% (68/68) with NRTI-R (50 of whom had archived M184V/I and post-switch data), and 100% (11/11) with INSTI-R (Table). No participant had treatment emergent resistance to study drugs.
Table. BRAAVE 2020 Preexisting Resistance and Virologic Suppression at Week 48 (Last On-treatment Observation Carried Forward Analysis)

Conclusion
Preexisting resistance was common among virologically suppressed Black adults in BRAAVE 2020, notably M184V/I, TAMs, and NNRTI-R. High rates of virologic suppression were maintained through 48 weeks of B/F/TAF treatment and there were no failures with de novo resistance, indicating that B/F/TAF is an effective treatment option for virologically suppressed people with HIV with or without preexisting resistance to NNRTIs, PIs, or non-tenofovir NRTIs.

Disclosures
Kristen Andreatta, MSc, Gilead Sciences (Employee, Shareholder) Michelle L. D’Antoni, PhD, Gilead Sciences (Employee, Shareholder) Silvia Chang, Masters, Gilead Sciences (Employee, Shareholder) Aiyappa Parvangada, MS Computational Biology, Gilead Sciences (Employee) Christiana Blair, MS, Gilead Sciences (Employee, Shareholder) Sean E. Collins, MD, MS, Gilead Sciences (Employee) Kirsten L. White, PhD, Gilead Sciences, Inc. (Employee, Shareholder)
115. Opioid Continuum of Care for Persons Living with HIV: The First 8 Months
Authors: Eaton Ellen , Hunt Paula , Turner Orlando , Raper James , Saag Michael 
Published: January 2021

Abstract

Background
Approximately 15% of persons with HIV (PWH) have opioid use disorder (OUD) over their lifetime. Due to substance use-related behaviors, untreated OUD is an obstacle to ending the HIV epidemic, especially in rural states with limited treatment options. In November, 2019, The UAB 1917 HIV Clinic opened an outpatient based opioid treatment (OBOT) clinic one half day a week. The objective of this study is to evaluate clinical outcomes and utilization over 8 months. We hypothesized that approximately 200 PWD would have OUD, many with comorbid stimulant use, and that new referrals would increase over time.

Methods
This is a retrospective study PWH at the 1917 clinic from OBOT start until June 2020. Opioid misuse was identified by patient reported illicit use using validated tools and/or ICD9 code in the last 12 months. We stratified PWH to determine the OUD continuum of care for all versus those with comorbid stimulant disorder: OBOT referral, attendance, buprenorphine initiation, and HIV suppression (viral load &lt; 20). We explored changes in clinic utilization following COVID19.

Results
A total of 3,580 patients receive care in the UAB 1917 HIV clinic of whom 40 were identified as having opioid misuse (Fig 1, blue). Overall, 30 patients were referred to OBOT, 25 attended any OBOT visit, 19 were initiated on buprenorphine and 14 (74%) had a VL &lt; 20 in the last 3 months. Over half of patients had comorbid stimulant use disorder (orange). Patients received an average of 3.7 visits (range 1–10) over the study period. Although the number of new referrals did not increase (average 3.8 per month), the overall number of OBOT appointments increased from an average of 12 per month before COVID to 26 per month after March 1.
Figure 1. The Opioid Continuum of Care for PWH at the UAB Outpatient Opioid Treatment Clinic (blue) including those with comorbid Stimulant Use Disorder (orange)

Conclusion
A surprisingly low percentage of patients report opioid misuse, which likely underestimates the true OUD burden in the Deep South. Stimulant Use Disorder affects over half: an added barrier to HIV suppression. In this small and early assessment, there are multiple missed opportunities for progress along the OUD continuum starting with diagnosis and referral. Yet, even this small clinic has rapidly reached clinical capacity (1/2 day weekly) accelerated by psychosocial needs in the context of COVID19.

Disclosures
All Authors: No reported disclosures
120. Impact of a Molecular Point-of-care ‘test and Treat’ Strategy for Influenza in Hospitalised adults: A Multi-centre, Randomised Controlled Trial (FluPOC)
Authors: Clark Tristan William , Beard Kate , Brendish Nathan J , Malachira Ahalya , Mills Samuel , Chan Cathleen , Poole Stephen , Ewings Sean , Cortes Nick , Nyimbili Esther , Presland Laura 
Published: January 2021

Abstract

Background
The diagnosis of Influenza in hospitalised patients is delayed due to long turnaround times of laboratory testing, leading to inappropriate and late antiviral and isolation facility use. Molecular point-of-care test (mPOCT) are highly accurate, easy to use and generate results in under 1 hour but high quality evidence for their clinical impact is lacking.

Methods
In this multicentre, randomised controlled trial we enrolled adults hospitalised with acute respiratory illness during influenza seasons. Patients were randomised (1:1) to receive mPOCT for influenza or routine clinical care. The primary outcome was the proportion of influenza-infected patients who received antivirals. Secondary outcomes included time to antivirals, isolation facility use, and clinical outcome. This study is registered with ISRCTN, number:17197293, and has completed.

Results
Between December 2017 and May 2019, 613 patients were enrolled (307 assigned to mPOCT and 306 to routine care) and all were analysed. 100 (33%) of 307 patients in the mPOCT group and 102 (33%) of 306 in the control group had influenza. 100 (100%) of 100 influenza-infected patients were diagnosed in the mPOCT group and 60 (59%) of 102 were diagnosed though routine clinical care (relative risk 1·7, 95%CI 1·7 to 1·7;p&lt; 0·0001). 99 (99%) of 100 influenza-infected patients received antivirals in the mPOCT group versus 63 (62%) 102 in the control group (relative risk 1·6, 95%CI 1·4 to 1·9;p&lt; 0·0001). Median time to antivirals was 1·0 hour in the mPOCT group versus 6·0 hours in the control group (difference of 5·0 hours, 95%CI 0 to 6·0;p=0·004). 70 (70%) of 100 influenza-infected patients in the mPOCT group were nursed in single room accommodation versus 39 (38%) of 102 in the control group (relative risk 1·8, 95%CI 1·4 to 2·4;p&lt; 0·0001). Median hospital recovery scale score (an ordinal 6 point scale used to assess patient outcome) at 7 days was lower in the mPOCT group verses the control group (p=0·045).
Figure 1a: Time-to-event curve showing antiviral use over time in influenza-infected patients.

Figure 1b: Time-to-event curve showing isolation facility use over time in influenza-infected patients.

Conclusion
Routine mPOCT for influenza was associated with enhanced influenza detection, improvements in appropriate and timely antiviral and isolation facility use, and more rapid clinical recovery.

Disclosures
Tristan William. Clark, BM MRCP DTM&H MD, BioFire Diagnostics (Other Financial or Material Support, Equiptment and consumables for the purposes of research)BioMerieux (Other Financial or Material Support, Equipment and consumables for the purposes of research)Qiagen (Other Financial or Material Support, Discounted Equipment and consumables for the purposes of research)
131. The Protective Role of Mucosal Interferons in Infants with Respiratory Syncytial Virus (RSV) Infection
Authors: Taveras Jeanette , Garcia-Maurino Cristina , Moore-Clingenpeel Melissa , Mertz Sara , Peeples Mark E , Ramilo Octavio , Mejias Asuncion 
Published: January 2021

Abstract

Background
Despite the high burden associated with RSV infection in young children the factors that determine disease severity are not well understood. The objective of this study was to assess the association of mucosal cytokine profiles, RSV loads (VL) and RSV disease severity.

Methods
Single-center, prospective study in previously healthy infants with mild (outpatients; OP), moderate (inpatient-IP; ward) or severe (IP-PICU) RSV infection. Mid-turbinate swabs were obtained to measure VL by PCR, and cytokine concentrations (conc.) using a 13-plex panel that included type I (IFN-α2), II (IFN-γ), and III (IFN-λ2/λ3) interferons (IFN), and inflammatory cytokines. Multivariable analyses were performed to identify factors predictive of disease severity.

Results
From 2014 to 2019 we enrolled 219 infants: 78 with mild RSV infection (OP; median [IQR] age, 6 [3.4–10.5] mo.), 101 with moderate disease (3.5 [1.3–8.3] mo.), and 40 with severe disease (2.3 [1.5–5.7] mo.). Duration of symptoms at enrollment was 4 (3–5) days and comparable between OP and IP, yet RSV VL in OP were significantly higher than in IP (8.1 [7.4–8.6] vs 7.4 [6.4–8.1] log10 copies/mL; p&lt; 0.01) with no differences between ward and PICU infants. Median conc. of IFN-α2, IFN-γ, and IFN-λ2/λ3 were significantly higher in OP vs IP irrespective of hospitalization unit (Table 1). IP-10 conc. were also higher in OP and in ward patients vs PICU patients (p&lt; 0.0001) and were independently associated with lower odds of supplemental O2 needs (OR, 95% CI: 0.4 [0.22–0.69]; p&lt; 0.01) and PICU admission (0.4 [0.23–0.67]; p=0.001). In addition, higher IFN-λ2/λ3 conc. were nearly associated with lower odds of prolonged O2 use (OR: 0.35 [0.11–1.07]; p=0.07), and prolonged hospitalization (OR: 0.42 [0.16–1.03]; p=0.06).

Conclusion
Infants with mild RSV infection had higher RSV VL and higher conc. of IP-10 and type-I, III IFN than those hospitalized with severe disease. These findings suggest that IP-10 and mucosal IFNs are associated with protection against severe RSV disease and could be used as biomarkers for patient stratification in the clinical setting.

Disclosures
Octavio Ramilo, MD, Bill & Melinda Gates Foundation (Grant/Research Support)Janssen (Grant/Research Support, Advisor or Review Panel member)Medimmune (Grant/Research Support)Merck (Advisor or Review Panel member)NIH/NIAID (Grant/Research Support)Pfizer (Consultant, Advisor or Review Panel member)Sanofi/Medimmune (Consultant, Advisor or Review Panel member) Asuncion Mejias, MD, PhD, MsCS, Janssen (Grant/Research Support, Advisor or Review Panel member)Merck (Advisor or Review Panel member)Roche (Advisor or Review Panel member)
135. Impact of #idjclub, a Synchronous Twitter Journal Club, as a Novel Infectious Disease Education Platform
Authors: Schwartz Ilan S , Woc-Colburn Laila , McCarty Todd P , Cutrell James B , Cortes-Penfield Nicolas W 
Published: January 2021

Abstract

Background
Journal clubs have been a mainstay of medical education since the days of Osler. Social media platforms allow virtual journal clubs to connect global participants. We describe the creation and impact of #IDJClub, an Infectious Diseases (ID) Twitter journal club.

Methods
We launched #IDJClub in October 2019. The format presents a recent ID publication for a 1-hour synchronous Twitter chat led by an ID physician from @IDJClub. Sessions started monthly, but increased in frequency due to interest during the COVID-19 pandemic. Pre-scripted tweets guide participants through the article description and analysis. We used Symplur’s Healthcare Hashtag project to track the number of impressions, tweets, participants, and the engagement rate (average tweets/participant) of #IDJClub per 60 minute discussion plus the following 30 minutes to capture ongoing conversations. We also conducted an online anonymous survey using Likert scales and open-ended questions to assess educational impact.

Results
As of June 11 2020, @IDJClub garnered 5,338 followers from around the world (Figure 1). In its first 9 months, 12 virtual journal clubs were conducted with a mean of 791,624 impressions, 328 tweets, and 48 participants per session, which steadily increased over time (Figure 2). A total of 134 participants completed the survey, of whom 40% were ID physicians, 19% pharmacists, 13% ID fellows, and 10% medical residents. Most respondents followed 1–2 (38%) or 3–4 (38%) of the discussions, with variable levels of active participation. Majorities agreed that #IDJClub provided clinically useful knowledge, increased personal confidence in review of literature, and compared favorably with in-person journal clubs (Figure 3). The format addressed several barriers such as lack of access to in-person journal clubs or subject experts at one’s own institution and lack of time to read new research or attend traditional journal clubs (Figure 4).

Conclusion
#IDJClub is an effective platform for virtual journal club, providing an engaging, open-access tool for critical appraisal of ID literature. This innovation in medical education overcomes several barriers to traditional journal clubs while fostering professional relationships within the global ID community.

Disclosures
Todd P. McCarty, MD, Amplyx (Scientific Research Study Investigator)Cidara (Scientific Research Study Investigator)
142. Frequency of Short-course Empiric Antibiotic Use as an Antimicrobial Stewardship Metric
Authors: McGregor Jessina C , McCracken Caitlin M , Hohmann Samuel F , Pakyz Amy L 
Published: January 2021

Abstract

Background
Antimicrobial stewardship metrics that provide actionable guidance are needed to support efforts to improve hospital use of antibiotics. Antibiotics such as vancomycin and piperacillin/tazobactam are common empiric agents used frequently when the infectious process remains unknown. Thus short, incomplete courses of therapy are used more frequently for such agents. We aimed to evaluate the variability in short courses of vancomycin and piperacillin/tazobactam use across U.S. hospitals.

Methods
We performed a cross-sectional study among U.S. hospitals that contributed inpatient pharmacy data to the Vizient clinical database in 2016. We identified vancomycin and piperacillin-tazobactam courses initiated within the 48 hours of admission, measured as days of therapy received. We calculated the percent of patients that received 1, 2, 3, 4 or &gt;4 days of therapy at each facility to describe short course empiric therapy use. To describe the variability across facilities, we then assessed the median, interquartile range (IQR), and total range of that percentage.

Results
We identified 145 hospitals representing approximately 3.7 million patient encounters for inclusion in this study. Within 48 hours of admission, 13.9% of encounters received vancomycin, 7.7% piperacillin/tazobactam, and 4.6% received both. The figure demonstrates the variability in the frequency of short course antibiotic use across hospitals; boxes indicate the IQR with the transecting line representing the median and whiskers representing the full range. The proportion of patients that received one day of therapy varied most across hospitals, with vancomycin ranging from 0–100%. In contrast, the frequency of patients that received greater than four days of therapy varied considerably less across hospitals; 0–33% for vancomycin.

Conclusion
The variability in use of short course empiric therapies suggests that use for non-infectious processes or infections not appropriately treated by these agents varies greatly across facilities. Measuring short course use for common empiric agents may serve as an important antimicrobial stewardship metric. Such a metric could inform antimicrobial stewardship efforts to reduce unnecessary initiation of empiric antimicrobial therapy.

Disclosures
All Authors: No reported disclosures
151. The Use of Dried Blood Spot Cards to Assess Serologic Responses of Individuals Vaccinated Against Measles, Hepatitis A, Tetanus, Influenza and Varicella Zoster
Authors: Danko Janine R , Taylor Robert , Reinhardt Brian , Watson Nora L , Banks Taylor 
Published: January 2021

Abstract

Background
Traditional blood sampling by venipuncture is cumbersome and expensive. Dried Blood Spot (DBS) sampling is desirable because of its ease of sample collection, transportation and storage. It has been used in clinical diagnosis but not been thoroughly studied for the potential use to assess the immune status of individuals following natural infection or preventive vaccination. The goal of this study is to compare DBS to traditional blood samplings in detection of antibodies in individuals vaccinated against measles, hepatitis A, tetanus, influenza and varicella zoster.

Methods
Blood from 220 vaccinated individuals were collected by venipuncture into serum separation tubes and by fingerstick onto Whatman 903® protein saver cards. ELISA was used to test DBS eluates and serum samples for antibodies against measles, varicella, tetanus and hepatitis A. Sensitivities, specificities, and correlation coefficients were evaluated to compare optical density (OD) values of paired serum and DBS samples. Hemagglutinin inhibition (HAI) and microneutralization assay (MNA) were used to determine anti-influenza antibody in serum and DBS samples. The long term stability of DBS samples at different temperatures was assessed using simulated immune measles blood.

Results
DBS OD was highly correlated with serum OD for antibodies to measles (r = 0.93), varicella (r = 0.82), and tetanus (r = 0.91) (Fig.1). Sensitivities of DBS OD ranged from 86–99% and specificities ranged from 96–100% using cut-offs established by each assay. By contrast, the hepatitis A data showed a low sensitivity (31%) and a weak correlation (r = 0.14) between DBS and serum samples. HAI and MNA assays showed a broad range of anti-influenza A (H1N1 and H3N1) antibody titers in serum samples but failed to detect the antibodies in DBS eluates. The stability data indicated that DBS samples were stable for 4 weeks when stored at room temperature and for 6 months at 4°C (Fig. 2).
Figure 1. Correlation of antibody levels detected by DBS sampling to the antibody levels detected by serum sampling for measles, hepatitis A, tetanus and varicella zoster.

Figure 2. Stability of the blood samples on DBS cards stored under various temperatures for 25 weeks as measured by the titers of anti-measles antibody (IgG) at various time points.

Conclusion
DBS sampling was sensitive, specific, and highly correlated with traditional venipuncture sampling in detection of antibodies against measles, tetanus and varicella zoster, but not hepatitis A and influenza. Thus, the success of using DBS sampling to assess the antibody levels in immunized individuals may be dependent on the pathogens and the type of assay used.

Disclosures
All Authors: No reported disclosures
157. patient to Environment Transmission of Multidrug-resistant Bacteria Within Intensive Care Units
Authors: Ziegler Matthew J , Kelly Brendan , David Michael Z , Dutcher Lauren , Tolomeo Pam C , Bekele Selamawit , Loughrey Sean , Reesey Emily , Glaser Laurel , Lautenbach Ebbing 
Published: January 2021

Abstract

Background
Identifying risk factors for environmental contamination with multidrug-resistant organisms (MDROs) is essential to prioritize methods for prevention of hospital transmission.

Methods
Patients admitted to an ICU with an MDRO detected on clinical culture in the prior 30 days were enrolled. Patients (4 body sites) and high-touch objects (HTO) (3 composite sites) in ICU rooms were sampled. Environmental transmission was defined by shared MDRO species cultured on patient and HTO cultures obtained on multiple time points during the patient’s stay. Risk factors for environmental transmission were identified with logistic regression.

Results
Forty-five patients were included (median 2 days of longitudinal sampling [IQR 1–4 days]). Enrollment anatomic cultures included extended-spectrum beta-lactamase-producing Enterobacterales (ESBLE) (n=12, 27%), carbapenem-resistant organisms (CRO) (n=4, 9%), methicillin-resistant S.aureus (MRSA) (n=11, 24%), vancomycin-resistant Enterococci (VRE) (n=4, 9%), and C.difficile (CDIFF) (n=14, 31%). Patient colonization during serial sampling was common with CRO (n=21, 47%), ESBLE (n=16, 36%), and VRE (n=16, 36%) and less so with MRSA (n=7, 16%) and CDIFF (n=5, 11%). Detection of MDROs on environmental surfaces was also common with identification of CRO in 47% of patient rooms (n=21) and ESBLE in 29% (n=13); MRSA (n=2, 4%), VRE (n=9, 20%), and CDIFF (n=3, 7%) were rarer. Patient to environment transmission was observed in 40% of rooms (n=18). Thirteen (29%) rooms had foreign MDRO contamination (i.e., one not detected on a body culture), most (n=10) with CRO. Environmental MDROs were most common in bathroom/sinks (n=22), followed by surfaces near the patient (n=10), and least common surfaces often touched by staff within the room (n=6).
On multivariable logistic regression, naïve to clustering by patient, recent receipt of a proton pump inhibitor (OR 2.35, 95% CI 1.00 – 5.52, P=0.049) and presence of one or more wounds (OR 2.56, 95% CI 1.05 – 6.26, P=0.038) were significantly associated with environmental transmission (OR 1.56, 95% CI 1.01 – 2.43, P=0.046) (Table 1).

Conclusion
MDRO contamination of patient rooms is common with detection of organisms attributed to, and foreign to, the occupant.

Disclosures
Michael Z. David, MD PhD, GSK (Consultant)