bluuebunny/crossref_metadata_2025_split huggingface dataset:
1062. HCV GET-UP: A Group Evaluation and Treatment Uptake Intervention Improves HCV Linkage to Care for PWID
Authors: Norton Brianna L , Norton Brianna L , Gutierrez Nataly Rios , Cunningham Chinazo O , Litwin Alain H 
Published: January 2021

Abstract

Background
Though PWID represent the overwhelming majority of those living with HCV in the United States, most have not been treated. PWID often have reduced access to specialty care, as well as limited HCV knowledge, low perceived vulnerability to poor HCV-related health outcomes, poor self-efficacy, high levels of perceived stigma, and mistrust of healthcare providers. We therefore evaluated an primary care based HCV Group Evaluation and Treatment UPtake (HCV GET-UP) intervention to improve HCV medical evaluation and treatment uptake for HCV+ PWIDs.
Figure 1

Methods
We enrolled 84 HCV+ PWID and randomize them 1:1 to a 4-week group evaluation intervention followed by individual treatment (intervention) versus onsite treatment alone (control). The group consisted of 4 weekly 1-hour sessions focused on HCV education, peer motivation, and health behavior change skills, along with an HCV medical evaluation. Both arms received HCV treatment according to national guidelines. Baseline questionnaires were performed via Audio Computer-Assisted Self-Interview (ACASI) technology. Clinical Data was extracted from the medical chart. Our primary outcomes were HCV linkage to care (HCV evaluation) and treatment uptake. Bivariate analyses were performed to evaluate HCV treatment outcomes between arms using chi square tests.

Results
Of the 76 participants that have currently completed the study (84 enrolled) 35% identified their race as black, 61% identified their ethnicity as Hispanic, 79% were male, and 25% of the participants were homeless. 87% had genotype 1, 28% were HIV+, and 20% had cirrhosis. Baseline urine tocixicologies were positive for cocaine in 38% of participants and 40% for heroin. Of those randomized to the group treatment arm vs individual arm 87% vs 62% were linked to care (p=0.012), 51% vs. 41% initiated treatment (p=.35), 41% vs. 35% completed treatment (p=0.6), and 33% vs. 27% (p=0.6)

Conclusion
HCV GET-UP, a primary-care based group evaluation and treatment uptake intervention significantly improved linkage to care for HCV+ PWID. Though this is encouraging, we must integrate other interventions to aid PWID as they move through the more proximal steps of the HCV cascade, for HCV cure still remains elusive for the majority of PWID enrolled.

Disclosures
Chinazo O. Cunningham, MD, MPH, General Electric Health (Other Financial or Material Support, My husband is currently employed by General Electric Health and receives stock and stock options.)Quest Diagnostics (Other Financial or Material Support, My husband was previously employed by Quest Diagnostics and received stocks and stock options.) Alain H. Litwin, MD, MPH, MS, Gilead (Advisor or Review Panel member)Merck (Advisor or Review Panel member)
1068. Large-Scale Migration and the Changing Viral Hepatitis Prevalences in North America: A modeling approach
Authors: Valles Kenneth A , Roberts Lewis R 
Published: January 2021

Abstract

Background
Infection by hepatitis B and C viruses causes inflammation of the liver and can lead to cirrhosis, liver failure, and hepatocellular carcinoma. The WHO’s ambition to eliminate viral hepatitis by 2030 requires strategies specific to the dynamic disease profiles each nation faces. Large-scale human movement from high-prevalence nations to the United States and Canada have altered the disease landscape, likely warranting adjustments to present elimination approaches. However, the nature and magnitude of the new disease burden remains unknown. This study aims to generate a modeled estimate of recent HBV and HCV prevalence changes to the United States and Canada due to migration.

Methods
Total migrant populations from 2010-2019 were obtained from United Nations Migrant Stock database. Country-of-origin HBV and HCV prevalences were obtained for the select 40 country-of-origin nations from the Polaris Observatory and systematic reviews. A standard pivot table was used to evaluate the disease contribution from and to each nation. Disease progression estimates were generated using the American Association for the Study of the Liver guidelines and outcome data.

Results
Between 2010 and 2019, 7,676,937 documented migrants arrived in US and Canada from the selected high-volume nations. Primary migrant source regions were East Asia and Latin America. Combined, an estimated 878,995 migrants were HBV positive, and 226,428 HCV positive. The majority of both migrants (6,477,506) and new viral hepatitis cases (HBV=840,315 and HCV=215,359) were found in the United States. The largest source of HBV cases stemmed from the Philippines, and HCV cases from El Salvador.

Conclusion
Massive human movement has significantly changed HBV and HCV disease burdens in both the US and Canada over the past decade and the long-term outcomes of cirrhosis and HCC are also expected to increase. These increases are likely to disproportionally impact individuals of the migrant and refugee communities and screening and treatment programs must be strategically adjusted in order to reduce morbidity, mortality, and healthcare expenses.

Disclosures
All Authors: No reported disclosures
1072. The Impact of Hepatitis C-Related Knowledge on Perceptions of Stigma Among Infected Individuals
Authors: Saine M Elle , Szymczak Julia E , Forde Kimberly A , Moore Tyler M , Bamford Laura P , Barg Frances K , Schnittker Jason , Holmes John H , Mitra Nandita , Re Vincent Lo 
Published: January 2021

Abstract

Background
Stigma is an important and understudied barrier to hepatitis C virus (HCV) infection treatment and elimination. Education to dispel disease-based myths and misinformation has been identified as a key intervention point to reduce disease-related stigma; however, the association between knowledge about HCV infection and perceptions of stigma among HCV-infected patients remains unknown.

Methods
To address this gap and evaluate the association between patient-level HCV knowledge and HCV-related stigma, we conducted a cross-sectional study among 270 HCV-infected patients (147 [56%] HIV-coinfected) from 5 clinics across Philadelphia. HCV-related stigma was measured using the validated 33-item HCV Stigma Scale (range, 33-132). HCV-related knowledge was measured via the National Health and Nutrition Examination Survey (NHANES) Hepatitis C Follow-up Survey (2003-2008), an eleven item True/False survey (range, 0 to 11) comprising statements about HCV-related health effects and transmission. The association between HCV knowledge and HCV-related stigma was evaluated via linear regression by HIV status. Self-reported demographic, behavioral, and clinical covariates were evaluated in adjusted analyses.

Results
The median overall HCV knowledge score was high at 9 out of 11 points (IQR, 9-10). Median knowledge scores did not significantly differ between HIV/HCV-coinfected and HCV-monoinfected participants (10 versus 9; p=0.29). However, higher HCV knowledge scores were associated with higher HCV-related stigma score among HCV-monoinfected participants (p=0.03) but not among HCV/HIV-coinfected participants (p=0.12). Differences by HIV status were also observed when adjusting for demographic, behavioral, and clinical covariates.

Conclusion
Regardless of HIV status, the majority of both HIV/HCV-coinfected and HCV-monoinfected participants in this study answered questions about HCV knowledge correctly. Surprisingly, greater HCV knowledge was associated with increased HCV-related stigma among HCV-monoinfected participants, but this association was not observed among coinfected participants. Additional studies are needed to understand why this association was observed only among monoinfected persons.

Disclosures
M. Elle Saine, PhD, MA, Leonard Davis Institute of Health Economics Research (Grant/Research Support)
81. Physicians’ Knowledge, Attitude, and Practice regarding Prolonged Antimicrobial Use
Authors: Kim Da Young , kim Dahye , Heo Eunjeong , kim Hyung-sook , Park Ji Young , lee Hyunju , Seo Jun-won , Jung Jongtak , Moon Song Mi , Song Kyoung-Ho , Kim Eu Suk , Kim Hong Bin 
Published: January 2021

Abstract

Background
To reduce unnecessary long-term antibiotic therapies, pharmacist-led intervention followed by the involvement of infectious diseases (ID) specialist was implemented. In addition, a survey for the prescribers was conducted to find the gaps for improvement.

Methods
The “less is better” intervention was implemented between August 1, 2018 and February 28, 2019, which was focused on those to whom antibiotics had been administered for over 15 days. However, the following patients were excluded: patients having hematologic diseases, patients in the neonatal intensive care units, and patients who were recommended to maintain antibiotics by ID specialist. Treatment duration according to the indications was compared between pre-intervention period (Aug to Sep 2017) and post-intervention period. A questionnaire based on clinical vignettes was distributed among 140 prescribers.

Results
Among 500 prescriptions assessed as a prolonged treatment, 475 (95%) were stopped after intervention. Over the pre- and post-intervention period, pneumonia was the most common indication of prolonged antibiotic use (43.8 versus 43.0%). The treatment durations decreased from 21.0 (interquartile range [IQR], 27.3-18.0) days pre-intervention to 16.0 (IQR, 20.0-15.0) days post-intervention (p=0.000).
The survey response rate was 76.4% (107/140). Regarding community-acquired pneumonia, there was a significant difference between knowledge and practice, showing that 53% were aware of the standard duration, but 72% actually prescribed for a longer duration. There was a similar trend for the treatment of urinary tract infection (30% versus 83%, p=0.024). The reasons why the physicians prescribed antibiotics of a prolonged duration in spite of adequate knowledge were not only the lack of symptom alleviation in patients but also organizational factors.

Conclusion
The duration of long-term antibiotic treatment was shortened by active participation of pharmacist as well as ID specialists. However, gaps between the knowledge and practice on the duration of antibiotic treatment were also found. Therefore, it is necessary to implement appropriate feedback and education based on clinical scenario in order to improve the physicians’ antibiotic prescription.

Disclosures
All Authors: No reported disclosures
1082. Characterization of Ceftriaxone-Resistant Viridans Streptococci Bacteremia Among Patients at a Comprehensive Cancer Center
Authors: Marsland Paula , Jain Rupali , Tverdek Frank , Hendrie Paul , Liu Catherine , Pergam Steven A , Bourassa Lori 
Published: January 2021

Abstract

Background
Viridans streptococci (VS) are opportunistic oral commensals and a common cause of bacteremia, particularly in neutropenic patients. We sought to investigate the prevalence of ceftriaxone (CTX) resistance in VS blood isolates at our medical center among patients with cancer or treated with hematopoietic cell transplant (HCT), and to describe treatment and clinical course.

Methods
In this retrospective single center cohort study, we identified CTX-resistant (CTX-R) VS isolates among patients between January 2005 – June 2020. VS in blood cultures were identified using a combination of biochemicals and mass spectrometry. Susceptibility testing was performed by Kirby Bauer and E-Test. Demographic data, clinical outcomes, and antimicrobial use, including prophylactic, empiric treatment and definitive therapy choices were assessed through electronic medical record review.

Results
Of unique VS with sensitivities (n=693), 27 (3.9%) patients had confirmed CTX-R VS bacteremia over the 15-year period; the majority were S. mitis (23/27 [85%]). 17 (63%) were cancer center patients, of whom 15/17 (88%) had a known hematologic malignancy, 11 (65%) had undergone HCT, and 15 (88%) were neutropenic (absolute neutrophil count ≤500 cells/microliter). Of CTX-R strains, 15/17 (88%) had concomitant resistance to penicillin, erythromycin (12 [71%]), and levofloxacin (12 [71%]); all were sensitive to vancomycin. Most were on levofloxacin prophylaxis (11/17 [65%]) at the time of diagnosis. Initial empiric antibiotic choices primarily included cefepime, ceftazidime, or meropenem, with 16/17 (94%) receiving concomitant empiric vancomycin; 14/17 (82%) were de-escalated to vancomycin once sensitivities were obtained. 2/17 (12%) patients died within 30 days of CTX-R VS bacteremia. Despite increasing susceptibility testing among VS isolates, there did not appear to be an increase in the percentage of CTX-R over time.

Conclusion
VS is a common pathogen in neutropenic cancer patients treated with chemo and/or BMT, and multi-drug resistant CTX-R strains are of concern. In the modern era of ambulatory cancer care, prescribers must be cautious using ceftriaxone monotherapy in the absence of susceptibility information, particularly among patients with hematologic malignancies.

Disclosures
Steven A. Pergam, MD, MPH, Chimerix, Inc (Scientific Research Study Investigator)Global Life Technologies, Inc. (Research Grant or Support)Merck & Co. (Scientific Research Study Investigator)Sanofi-Aventis (Other Financial or Material Support, Participate in clinical trial sponsored by NIAID (U01-AI132004); vaccines for this trial are provided by Sanofi-Aventis)
1084. Epidemiology and Long-term Outcomes of Cytomegalovirus (CMV) in Pediatric Liver Transplant Recipients (PLTR) at Texas Children’s Hospital (TCH)
Authors: Deray Kristen Valencia , Hosek Kathleen , Munoz Flor M , Moulton Elizabeth A , Demmler-Harrison Gail J , Leung Daniel H , Bocchini Claire 
Published: January 2021

Abstract

Background
Despite widespread use of prevention strategies, CMV DNAemia remains common in PLTR. Contemporary data, however, is limited. We sought to determine the frequency of, risk factors for, and long term outcomes of CMV DNAemia in a large, single center cohort of PLTR.

Methods
A retrospective cohort study of PLTR &lt; 22 yrs of age transplanted from 2011-2018 was completed. Per protocol, CMV prophylaxis with ganciclovir/valganciclovir was universally implemented; high risk (HR)(D+/R-) and intermediate risk (IR)(R+) patients received 6 months while low risk (LR)(D-/R-) patients received 3 months. Primary outcomes included any CMV DNAemia, CMV DNAemia &gt;1000 IU/mL and long term outcomes including rejection, graft failure, hepatic steatosis (HS), and de novo autoimmune hepatitis (AIH). Associations with CMV DNAemia were measured using Fisher exact and multivariate regression. Survival analysis, time to CMV infection, and time to PLTR long term outcomes were assessed using Kaplan-Meier plots.

Results
Among 270 PLTR, 81 (30%) had quantifiable CMV DNAemia; 36 (13%) had CMV DNAemia &gt;1000 IU/mL. Fifty (19%) developed CMV DNAemia while on prophylaxis. Median time (range) to CMV DNAemia was 162 days (5-2213). HR (OR 4.18; 95% CI 1.84-9.49, p&lt; 0.01) status was associated with CMV DNAemia and time to CMV DNAemia. CMV DNAemia was not associated with age at transplantation or cold ischemic time.
Eight PLTR (3%) developed CMV syndrome (4 HR, 3 IR, 1 LR), the median peak (range) DNAemia was 2133 IU/mL (202-58000) for these patients. No PLTR developed CMV tissue invasive disease.
CMV DNAemia was not associated with rejection (15% vs. 33%, p=0.62), graft failure (7% vs. 13%, p=0.17), HS (8% vs. 12%, p=0.32), or AIH (10% vs. 8%, p= 0.68). CMV DNAemia was associated with a longer time to rejection (p=0.02). Time to development of graft failure, HS, and AIH were not associated with CMV DNAemia (Figure 1). Finally, there was no difference in survival during the study follow-up period (1 – 9 yrs) for PLTR with vs. without CMV DNAemia (p=0.58).
Figure 1

Conclusion
This large cohort of PLTR demonstrates high rates of CMV DNAemia but low rates of CMV disease. HR status remains associated with CMV DNAemia. CMV DNAemia did not increase the risk of long term adverse outcomes such as rejection, graft failure, HS, and AIH.

Disclosures
All Authors: No reported disclosures
1085. Epidemiology and Outcomes of Histoplasmosis in Transplant Recipients
Authors: Rutjanawech Sasinuch , Larson Lindsey , Franklin Alexander , Hendrix Michael Joshua , Powderly William , Spec Andrej 
Published: January 2021

Abstract

Background
Histoplasmosis in transplant recipients is understudied. We reviewed a large cohort of histoplasmosis in patients with solid organ and stem cell transplants in an endemic area to describe the epidemiology, clinical findings and outcomes.

Methods
We performed a single-center retrospective cohort study of patients diagnosed with histoplasmosis between 2002 and 2017. Demographic data, clinical findings, diagnostic methods, treatment, and mortality were collected. We compared the characteristics of patients with history of transplant to non-transplant (NT) patients.

Results
We identified 261 patients with histoplasmosis. Of those, 28(11%) were transplant recipients; 8(29%) liver, 8(29%) lung, 6(21%) kidney, 3(11%) heart, and 3(11%) stem cell.
Median time from symptom onset to diagnosis was 6 vs 34 days in transplant vs NT groups (p=0.001). Lung was the most common organ involvement (89% in transplants vs 78% in NT, p=0.168). Spleen involvement was more commonly found in transplant patients (29 vs 14%, p=0.039). In patients with disseminated disease, urine antigen was 100% sensitive in transplant patients compared to 78% in the NT group (p=0.038). Duration of treatment was 13 vs 6 months in transplant vs NT patients (p= 0.003). Mortality was comparable between groups (14 vs 15% in transplant vs NT, p=0.918).
Median time from transplant to diagnosis was 4.21 years. However, five patients (18%) developed histoplasmosis within 6 months. For these early diagnosed patients, ICU admission rate was 80 vs 30% (p=0.04) and rate of mechanical ventilator use was 80 vs 22% (p=0.011) compared to patients diagnosed later.
Table 1: Patient characteristics

Table 2: Organ involvement

Table 3: Diagnostic test positivity

Conclusion
Transplant recipients with histoplasmosis are likely to be diagnosed early and be treated longer. Urine antigen is highly sensitive for diagnosis of disseminated disease. Histoplasmosis that occurs within the first 6 months after transplantation tends to be more severe.

Disclosures
Andrej Spec, MD, MSCI, Astellas (Grant/Research Support)Mayne (Consultant)Scynexis (Consultant)
1093. Infectious Complications after Pancreatic Islet Transplantation
Authors: Raval Milan , Lam Anna , Cervera Carols , Senior Peter , Shapiro James , Kabbani Dima 
Published: January 2021

Abstract

Background
Despite the significant advancement in islet transplantation over the past three decades, our understanding of infectious complications post islet transplant remains limited.

Methods
This is a single center retrospective review of Islet transplant recipients at the University of Alberta between February 2006 and December 2015. All infectious episodes events occurring after transplant were categorized as opportunistic and non-opportunistic.

Results
We analyzed 142 patients receiving a median of 2 islet transplants per patient, with 18 patients receiving 1 transplant (13%), 77 (54%) 2, 33 (23%) 3, 13 (9%) 4 and 1(1%) 5 transplants. Median age at first transplant was 50 years and 85 (47%) were male. Lymphocyte depleting agent with thymoglobulin or alemtuzumab was used for induction in 94% in first and 53% in second transplant. CMV serostatus was CMV D+/R- 61 (43%), CMVD+/R+ 52 (37%), CMVD-/R+ 16 (11%) and CMVD-/R- 13 (9%). CMV infection occurred in 21 patients (15%) [CMVD+/R- 6 (9.8%) and CMVR+ 15 (22.1%), p=0.06]. Other opportunistic infections included VZV 7 (4.9%), Nocardia 3(2.1%), and Pneumocystis jirovecii pneumonia 1. Non-opportunistic infections included skin and soft tissue infection 14 (9.9%), urinary tract infection 11 (7.7%), pneumonia 7 (4.9%) clostridium difficile infection (CDI) 4 (2.8%), and non-CDI gastroenteritis 5 (3.5%) (Table 1).
Table 1: Infectious Complication post islet transplant

Conclusion
Although the rate of infections after islet cell transplant is less frequent than other types of transplants, opportunistic infections, especially CMV, are not uncommon and should be considered in this setting.

Disclosures
Carols Cervera, MD, PHD, Merk (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Other Financial or Material Support, Lecture fees) James Shapiro, MD, PHD FRCS(Eng) FRCSC MSM FRSC, ViaCyte (Consultant) Dima Kabbani, MD, Merck (Research Grant or Support)
1097. Microbial Cell Free DNA Sequencing for Prediction of Culture-Negative Infection Events in Children with Cancer
Authors: Goggin Kathryn , griffen Amanda , Kohler Christina , Allison Kim J , Inaba Yuki , Ahmed Asim A , Hollemon Desiree D , Brenner Abigail , Maron Gabriela , Maron Gabriela , Sun Yilun , Tang Li , Margolis Ellie , Gawad Charles , Wolf Joshua 
Published: January 2021

Abstract

Background
Culture-independent diagnostics may help diagnose or predict infection; microbial cell free DNA sequencing (mcfDNA-seq), can detect a wide range of pathogens directly from plasma. Immunocompromised children who develop febrile neutropenia (FN) without documented bloodstream infection (BSI) may have undiagnosed bacterial infection, but identification of this is difficult, and the proportion of such episodes is unknown, as is the relative contribution of non-bacterial etiologies. We analyzed mcfDNA-seq results in a convenience sample of FN cases without known etiology.

Methods
Participants were &lt; 25 years of age and undergoing treatment for cancer. Remnant plasma was prospectively obtained and stored. Samples from Days 0 and -1 underwent mcfDNA-seq by Karius Inc., reported in molecules per microliter (MPM) of plasma. Samples from participants without impending or recent fever or infection were also tested.

Results
There were 8 episodes in 7 patients; 4 (50%) had a common bacterial pathogen identified by mcfDNA-seq on Day 0 (Table 1). In 2 (50%) of these cases, the same organism was also identified on Day -1, at a lower concentration. One fungal pathogen was identified prior to and at onset of FN. A common bacterial pathogen was identified in 3/64 (5%) control samples from the population.
Culture-negative sepsis was the final diagnosis in one episode; Streptococcus mitis, an important cause of neutropenic sepsis, was found in Day 0 and Day -1 samples. In an episode where E. coli was identified by mcfDNA-seq, FN recurred after antibiotic discontinuation.
Table 1. Quantitative mcfDNA-seq Results for Prediction & Diagnosis of Febrile Neutropenia Episodes

Conclusion
In this sample of culture-negative FN episodes in pediatric patients leukemia, mcfDNA-seq identified a bacterial pathogen in 50% of cases. The same organism was identifiable on the day prior to FN in 50% of cases, suggesting that predictive testing might be feasible.

Disclosures
Asim A. Ahmed, MD, Karius (Employee) Desiree D. Hollemon, MSN, MPH, Karius inc (Employee) Charles Gawad, MD PhD, Karius inc (Grant/Research Support) Joshua Wolf, MBBS, PhD, FRACP, Karius inc (Grant/Research Support)