bluuebunny/crossref_metadata_2025_split huggingface dataset:
1539. Pilot Study of Sexual Networks and Sexually Transmitted Infection Risk in a Military Population
Authors: Rahman Nazia , Robles Roberta Lugo , Magno Nicholas , Hsieh Hsing-Chuan , Waggoner Sandra , Kao Tzu-cheg , Smith Realisha , Lalani Tahaniyat , Garges Eric 
Published: January 2021

Abstract

Background
In the U.S., military members experience a higher incidence of sexually transmitted infections (STIs) than the age and gender-adjusted general population, placing a costly and preventable burden on the military health system (MHS). These increased rates are likely due to differences in both individual and network level risk factors. To assess the feasibility of a survey examining the impact of sexual network risk factors on risk, a survey assessing STI individual and network level risk factors to include a 90-day sexual partnership inventory was piloted at a single military medical center.

Methods
A sample of 50 military beneficiaries completed a computer-assisted self-interview (CASI) cross-sectional egocentric survey administered on a tablet. Demographical and clinical data were captured from the electronic medical record. Non-parametric statistics were used to analyze the data.

Results
45 of 50 subjects (90%) completed the survey. 40 (88%) subjects completed at least one partnership survey and reported 1 to 20 partners per subject. Respondents were mostly active duty (91.8%) and had been active duty for less than five years (68.2%). Common risk behaviors were explored and included meeting partners online (68.75%) and having partners who use drugs (48.94%) or are heavy drinkers (44.68%). Partnership inventories suggest sexual concurrency and disassortative mixing on age, racial and ethnic groups, and military service.

Conclusion
While previous studies demonstrate that service members will complete sexual risk behavior surveys, this pilot egocentric partnership study demonstrates their willingness to provide detailed information on risk behaviors as well as detailed information on sexual partnerships. While we report on statistically significant associations, these may be subject to bias due to the underlying characteristics of the source population. As a result, these data will not likely be reflected in the full study population. 80% of pilot subjects completed the questionnaire and submitted at least one partnership survey, indicating the possibility of gathering more diverse individual sexual risk questionnaires from active duty service members. Based on these data, a multisite study of sexual networks was implemented in the MHS and is currently under analysis.

Disclosures
All Authors: No reported disclosures
1542. Provider Uptake of Extragenital Screening for Gonorrhea and Chlamydia in Active Duty Air Force Members with Incident HIV Diagnosis
Authors: Lamb Christian C , Yabes Joseph , Hakre Shilpa , Okulicz Jason 
Published: January 2021

Abstract

Background
The prevalence of Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) is much higher at extragenital anatomic sites among men who have sex with men (MSM) with HIV infection. National guidelines recommend that all MSM with HIV infection undergo screening for extragenital sexually transmitted infections (EG-STIs), however uptake is low in many primary care settings. We evaluated EG-STI screening by primary care providers (PCPs) for US Air Force (USAF) members with incident HIV infection.

Methods
All USAF members newly diagnosed with HIV infection who received initial HIV specialty care with Infectious Disease (ID) providers at Brooke Army Medical Center from 2016-2018 (n=98) were included. A retrospective chart review was conducted to evaluate STI screening performed by PCPs within 1 week of HIV diagnosis compared to screening at entry into ID care. Demographic, clinical, laboratory and behavioral risk data were collected. STI screening included GC/CT EG-STIs, urethral GC/CT, syphilis, and hepatitis B and C.

Results
Patients were predominantly male (97.9%) with a median age of 26 (IQR 23, 32) years at HIV diagnosis (Table 1). A previous history of STIs was reported in 53 (54.1%) patients and the majority of males self-identified as MSM (66.3%) or bisexual (22.5%). The median time from HIV diagnosis to ID evaluation was 26 days (IQR 9, 33). PCPs performed any STI screening in 61 (62.2%) patients (Table 2). EG-STI screening was conducted in 3 (3.1%) patients overall and in (3.4%) MSM/bisexuals. A total of 31 (31.6%) patients had missed STIs; the majority due to EG-STIs of the rectum (71%) and pharynx (21.9%). All EG-STIs would have been missed by urethral GC/CT screening alone.
Table 1

Table 2

Conclusion
EG-STI screening uptake was low among PCPs evaluating USAF members with incident HIV infection. Underutilization of EG-STI screening can result in missed infections and forward transmission of GC/CT. Barriers to low uptake need to be explored. Continued education and training of PCPs may be necessary to improve uptake of EG-STI screening.

Disclosures
All Authors: No reported disclosures
1545. Three Site Testing for Sexually Transmitted Infections for People Living with HIV in One Southeastern Ryan White HIV/AIDS Program Clinic: First Year of Experience
Authors: Geba Maria , Powers Samuel , Williams Brooke , Dort Kathryn R , McQuade Elizabeth T Rogawski , McManus Kathleen A 
Published: January 2021

Abstract

Background
For comprehensive care, it is recommended that people living with HIV who are sexually active have annual multisite testing for gonorrhea and chlamydia. Appropriate testing is defined by testing at all sites of sexual exposure (urogenital, pharyngeal, rectal). In the first year of 3 site testing at our HIV clinic, we aimed to describe (1) the rate of appropriate sexually transmitted infection (STI) testing, (2) the factors associated with STI diagnosis, and (3) the percentage of extragenital STIs that would have been missed with only urogenital testing.

Methods
Participants were &gt; 14 years old with &gt; 1 in-person medical visit at the Ryan White HIV/AIDS Program clinic in 2019. We collected demographics, reported sexual activity, and STI test dates and results. Controlling for number of sites tested, a log-binomial model was used to estimate the association of different characteristics with an STI diagnosis.

Results
For this cohort (n=857; Table 1), 44% reported sexual activity, 34% reported no sexual activity and 22% had no sexual activity information recorded. Of 1185 STI tests performed for 491 participants, 51 STIs were diagnosed in 33 participants. One STI was diagnosed for a female (0.7%). Overall, 68% (253/375) received appropriate urogenital testing, 63% (85/134) received appropriate pharyngeal testing and 69% (72/105) received appropriate rectal testing. For male participants with &gt; 1 STI test (n=347), Hispanic ethnicity was associated with an STI diagnosis (Table 2). Of those with concurrent extragenital and urogenital tests, 96% of people with an STI (n=26) were positive at only an extragenital site.
Table 1: Study Participants’ Characteristics

Table 2: Factors Associated with Being Diagnosed With a Sexually Transmitted Infection for Men Living With HIV: Frequencies and Results of Univariable and Multivariable Log-binomial Model

Conclusion
Nearly a quarter of participants had no sexual activity information recorded in the year, which is an area for improvement. Despite newly adopting 3 site testing, appropriate extragenital and urogenital testing rates were similar and were high compared with national averages. There was no obvious clinician/patient bias against extragenital testing. Hispanic male participants’ higher STI diagnosis rate may point to more condomless sex in this population. Based on the identification of many infections exclusively at extragenital sites, we likely missed STIs previously. This highlights the importance of 3 site testing availability and testing at all appropriate sites.

Disclosures
Kathleen A. McManus, MD, MSCR, Gilead Sciences, Inc (Research Grant or Support, Shareholder)
1548. Association of bacterial colonization in ulcerative lesions of the diabetic foot together with the cicatrization process
Authors: Loveras Alexander A Ozoria , Espinal Jacques Paré , de luna David , Acevedo Noemi 
Published: January 2021

Abstract

Background
In 2018, a review of the scientific literature identifed biofilm studies in the past 3 years. Wherein, the role of the biofilm in the progression of the diabetic foot ulcer with the presence of biofilm is reviewed. As a result, tissue sampling is more effective than transcure, Levin, and aspiration.
A study in Cuba evaluate the effectiveness of a new proposal for antimicrobial treatment in patients with diabetic foot infection in 2017. The method used was a experimental type of two groups. The control group, was treated with the treatment scheme proposed in the Comprehensive Care Program for the patient with diabetic foot ulcer (PAIPUPD). Instead, the other experimental group was treated according to the scheme based on the local microbial map. They used a random distribution. Using the Wagner classification, there were patients classificate with a grade of W2 (13% of patients), W3 (66%) and W4 (12%). The most frequent germs found were Staphylococcus aureus, Escherichia coli and Enterobacter sp. The experimental group required less days with hospitalization.

Methods
This is an observational study of primary source with a non-probability sample with 58 patients. Adult patients diagnosed with type 2 diabetes mellitus, with diabetic foot, Wagner classification 1, 2 and 3, who attended the healing area of the Institute of Diabetes of Santiago were included. After identifying the colonized pathogen, its cicatrization process was evaluate for four weeks.

Results
Of the total sample, 12.07% belonged to Wagner 1, 43.1% to Wagner 2 and 44.83% to the Wagner 3 classification. In the case of the Wagner 3 group, S. aureus and Pseudomona aeruginosa were present in 6 cases. Despite the infectious processes detected by the culture, the patients showed a successful cicatrization process after four weeks of evaluation.
Graph 1: Isolated Microorganism Vs Wagner’s Degree (n=60)

Graph 2: Gram positive microorganism vs. healing process per week in patients with diabetic foot (n=22)

Graph 3: Gram-negative microorganism vs. healing process (n=33)

Conclusion
During the four weeks of clinical evaluation, more than 88% of patients progressed positively to clinical recovery, regardless of the type of bacteria colonized and/or their resistance to antibiotics.

Disclosures
All Authors: No reported disclosures
1549. Association of Skin Infections with Sharing of Injection Drug Preparation Equipment among People who Inject Drugs
Authors: Jawa Raagini , Stein Michael , Anderson Bradley , Liebschutz Jane M , Stewart Catherine , Keosaian Julia , Barocas Joshua A 
Published: January 2021

Abstract

Background
Sharing needles and injection drug preparation equipment (IDPE) among people who inject drugs (PWID) are well-established risk factors for viral transmission. Shared needles and IDPE may be a reservoir for bacteria and serve as a nidus for skin and soft tissue infections (SSTI). Given the rising rates of SSTIs in PWID, we investigated the association of needle and IDPE sharing on history and incidence of SSTI in a cohort of PWID.

Methods
Active inpatient PWID were recruited to a randomized control trial of a risk reduction intervention aimed at reducing bacterial and viral infections. A subset of participants (N=252) who injected drugs were included in the analysis. The primary dependent variable in this cross-sectional cohort study was self-reported incidence of SSTI one year post-hospitalization. We assessed three self-reported independent variables from baseline enrollment: 1) sharing needles, 2) sharing IDPE, and 3) sharing needles or IDPE and compared these groups separately to persons who reported not sharing via univariate and multi-level Poisson regression model estimating the adjusted effect of baseline sharing on incidence of SSTI during follow up.

Results
Participant characteristics: 37.9 years [mean]; 58% male; 90% primarily inject opioids, 43% inject with others, 13% shared IDPE only, 50% shared needles or IDPE. In general, persons who shared IDPE only compared to those who did not share were younger, more likely female, more likely Caucasian, were less likely to primarily inject opioids, and had a higher mean on the knowledge scale. We found no significant differences of prior self-reported SSTI. Adjusted for those randomized in the behavioral intervention arm for skin cleaning, persons who shared needles only and needles or IDPE had a higher incidence of SSTI compared with persons who did not share (IRR 1.90, 95% CI1.03-3.51, p=0.04; IRR 2.14, 95% CI 1.23-3.72 p=0.007). Persons who shared IDPE only did not have a statistically significant higher incidence of SSTI compared with persons who did not share (IRR 1.3, 95%CI 0.89-1.95 p=0.157).

Conclusion
In this cohort of hospitalized active PWID, we found a significant association between baseline sharing of needles or IDPE but not IDPE only with incidence of self-reported SSTI.

Disclosures
All Authors: No reported disclosures
1551. Cat Scratch Disease as a Mimicker of Malignancy: Rare and Elusive
Authors: Dhal Udit , Tarrand Jeffery , Kontoyiannis Dimitrios P 
Published: January 2021

Abstract

Background
Cat scratch disease (CSD) mimicking malignancy has been the subject of scattered case reports. To that end, we reviewed patients (pts) with CSD at MD Anderson Cancer Center (MDACC), focusing on the clinical overlap of CSD presentation with that of malignancy.

Methods
We retrospectively reviewed all pts diagnosed with CSD at MDACC (11/2015-1/2020). CSD was diagnosed based on Bartonella henselae serology, animal exposure and biopsy findings consistent with the diagnosis. We collected data on CSD epidemiology, signs, symptoms, laboratory findings, histopathology, radiological studies, treatment used, outcome and the malignancy mimicked. We also reviewed the published cases of CSD mimicking malignancy (1952-2020).

Results
We identified 11 such pts; 1 (9%) was male and 5(45%) were ≤ 18 years old. No pt had a prior history of malignancy. All but 1 pt reported an exposure to cats. Only 2/11 (18%) had fever, and none of the pts had skin lesions or hepatosplenomegaly. All pts had lymphadenopathy; 2/11 (18%) had only inguinal lymphadenopathy. PET scan was performed for 3 pts and revealed only enlarged lymph nodes. Several malignancies were considered as initial diagnostic impressions, including sarcoma (n=3), lymphoma (n=2), breast cancer (n=2). Serum Bartonella IgG titer was ≥ 1:512 in 9/11(82%) pts with 3 pts (28%) positive for IgM. 8 pts had a biopsy and non-necrotizing granuloma was the most common finding, present in 4. Azithromycin was used in all 8 pts that were treated. Nearly all pts improved or had resolution of symptoms with one pt having persistent fever and lymphadenopathy. Literature search identified 33 cases of CSD that mimicked malignancy (10 for breast cancer, 10 for lymphoma, 6 for sarcoma with 1 each for lung, pancreatic, parotid and 4 others).

Conclusion
Although there was a probable referral bias in the CSD pts at MDACC, CSD should be included in the differential diagnosis of malignancy. Although publication biases are probable, literature review also supports the notion that atypical CSD rarely can simulate a variety of malignancies.

Disclosures
Dimitrios P. Kontoyiannis, MD, Amplyx Pharmaceuticals (Consultant)Astellas Pharma (Consultant)Ciadara Therapeutics (Consultant)Gilead Sciences (Other Financial or Material Support, Honoraria)Mayne Pharma (Consultant)Merck & Co (Consultant, Honoraria)Pharma (Consultant)United Medical (Other Financial or Material Support, Honoraria)
1552. Clinical Outcomes and Healthcare Costs of Inpatients with Tetanus in Korea in 2011–2019
Authors: Bae Sohyun , Chang Hyun-Ha , Jung Sook In , kim Shin-Woo , Kim Yoonjung 
Published: January 2021

Abstract

Background
We aimed to investigate the recent trend of clinical outcomes and medical costs of inpatients with tetanus, which is a rare, vaccine-preventable but extremely grave disease, in Korea, in 2011–2019 for the first time.

Methods
From January 2011 to October 2019, this study examined 49 patients with tetanus admitted in 2 national university hospitals in Gwangju and Daegu of South Korea. Patients’ medical records were retrospectively reviewed to determine the clinical factors and medical cost for tetanus management.

Results
The mean age was 65.3 ± 16.1 years and 32 (65.3%) of them were female. All patients (100.0%) had generalized tetanus, and 5 (10.2%) died during admission. The median duration from symptom onset to hospital visit was 4 days. Trismus (85.7%) was the most common symptom, and wound of the lower extremities (24.5%) was the most frequent presumed entry site of toxin. Only 6 (15.0%) patients were operated for wound management. The median hospital stay was 39 (9; 49) days. Furthermore, 32 (65.3%) needed mechanical ventilation, and 20 (40.8%) patients developed aspiration pneumonia. The median total healthcare cost was 21,072 KRW(Korean Republic Won) (17,560 USD(United States Dollar); 1 USD = 1200 KRW) per person. After discharge, 35 (79.5%) patients fully recovered without any disability.

Conclusion
Tetanus remains a grave disease that requires long duration of admission and huge medical cost in Korea. The completion rate of 3-time tetanus toxoid (Td) or tetanus toxoid, acellular pertussis and diphtheria vaccine (Tdap) vaccination was low; thus, the medical staff needs to establish more medical advice or policies to the general population of Korea

Disclosures
All Authors: No reported disclosures
1567. In Vitro Activity of Aztreonam-Avibactam and Comparator Agents Against Multidrug-Resistant Enterobacterales Collected Globally as Part of the ATLAS Surveillance Program, 2016-2018
Authors: Kazmierczak Krystyna , Arhin Francis , Stone Greg , Sahm Daniel F 
Published: January 2021

Abstract

Background
Avibactam (AVI) is a serine-β-lactamase inhibitor in development with aztreonam (ATM) for treatment of infections caused by drug-resistant Enterobacterales (Ent), especially carbapenem-resistant isolates co-producing serine- and metallo-β-lactamases (MBL), which are often resistant to agents from multiple drug classes. This study evaluated the in vitro activity of ATM-AVI and comparators against Ent collected globally as part of the Antimicrobial Testing Leadership and Surveillance (ATLAS) program.

Methods
44,671 non-duplicate clinical isolates were collected in 2016-2018 in 52 countries in Europe, Asia/Pacific (excluding China and India), Middle East/Africa, and Latin America. Susceptibility testing was performed by CLSI broth microdilution and interpreted using CLSI 2020 and FDA (tigecycline) breakpoints. ATM-AVI was tested at a fixed concentration of 4 µg/mL AVI. Drug-resistant phenotypes were defined as: multidrug resistant (MDR), resistant (R) to ≥3 of 7 sentinel agents (amikacin [AMK], ATM, cefepime [FEP], colistin [CST], levofloxacin [LVX], meropenem [MEM], piperacillin-tazobactam [TZP]); extensively drug resistant (XDR), susceptible to ≤2 sentinel agents; and pandrug resistant (PDR), non-susceptible to all sentinel agents. Isolates with MEM MIC &gt;1 µg/mL were screened for β-lactamase genes by PCR and sequencing.

Results
14.9%, 4.3%, 3.7%, 1.3%, and 0.3% of Ent collected globally were MDR, XDR, MEM-R, MBL-positive, and PDR, respectively. ATM-AVI tested with MIC90 values of 0.12 µg/mL against all Ent and 0.5 µg/mL against subsets of resistant isolates (Table). On the regional level, similar values were observed against all (MIC90, 0.12 µg/mL) and resistant isolates (MIC90, 0.25-1 µg/mL) (not shown). The tested comparators, excluding TGC, showed percentages of susceptibility &lt; 90% against regional and global subsets of resistant isolates. 99.97% (44658 of 44671) Ent, including all MBL-positive and PDR isolates, were inhibited by ≤8 µg/mL of ATM-AVI.
Table

Conclusion
Based on MIC90 values, ATM-AVI demonstrated potent in vitro activity against resistant and MBL-positive subsets of Ent collected globally. ATM-AVI could be an effective therapy for difficult-to-treat infections caused by drug-resistant Ent.

Disclosures
Krystyna Kazmierczak, PhD, IHMA (Employee)Pfizer, Inc. (Consultant) Francis Arhin, PhD, Pfizer, Inc. (Employee) Greg Stone, PhD, AztraZeneca (Shareholder, Former Employee)Pfizer, Inc. (Employee) Daniel F. Sahm, PhD, IHMA (Employee)Pfizer, Inc. (Consultant)Shionogi & Co., Ltd. (Independent Contractor)
1568. In Vitro Activity of Ceftazidime-Avibactam and Comparator Agents Against Enterobacterales and Pseudomonas aeruginosa Collected &lt; 48 Hours and ≥48 Hours Post-Admission from Pediatric Patients, ATLAS Surveillance Program 2015-2018
Authors: Kazmierczak Krystyna , Stone Greg , Sahm Daniel F 
Published: January 2021

Abstract

Background
Ceftazidime-avibactam (CAZ-AVI) is a β-lactam/non-β-lactam β-lactamase inhibitor combination with in vitro activity against Enterobacterales (Ent) and Pseudomonas aeruginosa (Psa) carrying Class A, C and some Class D β-lactamases. We examined the in vitro activity of CAZ-AVI and comparators against presumed community-acquired (CA; cultured &lt; 48 h after hospital admission) and hospital-acquired (HA; cultured ≥48 h post-admission) isolates collected from pediatric patients as part of the ATLAS surveillance program.

Methods
6023 non-duplicate isolates were collected in 50 countries in Europe (n=3122), Latin America (n=1220), Middle East/Africa (n=1007), and Asia/Pacific (excluding China; n=674) from patients (newborn to 17 y) with lower respiratory tract (LRTI; n=1641), urinary tract (UTI; n=1595), skin and soft tissue (SSTI; n=1027), intra-abdominal (IAI; n=949), and bloodstream (BSI; n=811) infections. Susceptibility testing was performed by CLSI broth microdilution and values were interpreted using CLSI 2020 breakpoints. CAZ-AVI was tested at a fixed concentration of 4 µg/mL AVI. Isolates with CAZ or aztreonam MICs ≥2 µg/mL (Escherichia coli, Klebsiella spp., Proteus mirabilis) or meropenem MICs ≥2 µg/mL (all Ent species) or ≥4 µg/mL (Psa) were screened for β-lactamase genes.

Results
The in vitro activity of CAZ-AVI exceeded that of meropenem and other tested β-lactams against Ent (98.5% susceptible (S)) and Psa (93.1% S) collected globally from pediatric patients (Table). Percentages of susceptibility to CAZ-AVI ranged from 96.8-99.3% among CA Ent from different infection types and were reduced 0.4-1.0% among HA isolates from SSTI, IAI and BSI. Susceptibility to CAZ-AVI was also similar (92.7-95.4% S) among CA Psa from different infection types and was reduced 0.1-4.4% among HA isolates. For both Ent and Psa, the lowest percentages of susceptibility to the tested β-lactams were observed among isolates from BSI, which included a higher proportion of isolates carrying extended-spectrum β-lactamases and/or carbapenemases than isolates from other infection types.
Table

Conclusion
CAZ-AVI could provide a valuable therapeutic option for treatment of CA and HA infections caused by Ent and Psa in pediatric patients.

Disclosures
Krystyna Kazmierczak, PhD, IHMA (Employee)Pfizer, Inc. (Consultant) Greg Stone, PhD, AztraZeneca (Shareholder, Former Employee)Pfizer, Inc. (Employee) Daniel F. Sahm, PhD, IHMA (Employee)Pfizer, Inc. (Consultant)Shionogi & Co., Ltd. (Independent Contractor)