bluuebunny/crossref_metadata_2025_split huggingface dataset:
755. Posaconazole versus voriconazole as antifungal prophylaxis for invasive fungal diseases in patients with hematological malignancies
Authors: Almutairy Reem F , Khan Mansoor , Alshamrani Majed , Marhabi Hassan , Naeem Doaa 
Published: January 2021

Abstract

Background
The incidence of Invasive Fungal Diseases (IFDs) has dramatically increased in patients with hematologic malignancies due to prolonged neutropenia. IFDs are associated with significant morbidity and mortality. Due to these risks, international guidelines have recommended antifungal prophylaxis for Acute Myeloid Leukemia (AML) and Myelodysplastic syndromes (MDS) patients. Posaconazole has been recommended as the prophylactic agent of choice. Also, voriconazole has been recommended by guidelines with different levels of recommendations. Data on a direct comparison between Posaconazole delayed-release tablets (DR) and Voriconazole for IFD prophylaxis are lacking. Therefore, we aim to compare the efficacy and safety of the fungal prophylaxis; voriconazole versus posaconazole in AML/MDS patients at Princess Nourah Oncology Center, Jeddah

Methods
Retrospective chart review study for eligible patients from January 2017 to February 2019 to identify the breakthrough IFD rates and assess the frequency of adverse events within AML/MDS patients at PNOC, Saudi Arabia

Results
A total of 48 patients (130 chemo cycles) were included in the study: 50 using posaconazole (DR) and 80 using oral voriconazole as antifungal prophylaxis. The incidence rates of IFD in the posaconazole group was 8 % (4/50) of those 2 were probable, and 2 were possible infections while 6.26 % (5/80) of patients in the voriconazole group have developed IFD of them 4 had a possible infection, and one had a probable infection (p=0.7325). A higher percentage of patients in the voriconazole group discontinued prophylaxis due to adverse events (5 patients vs. 2 patients). Use of voriconazole as antifungal prophylaxis for 15 days in 130 cycles in 48 AML/MDS patients would cost 175,500 SR in comparison to the cost of the posaconazole for the same duration of 1,350,130 SR. So, use of voriconazole would save 1.13 million SR and is more cost effective when used as antifungal prophylaxis in AML/MDS patients in comparison to posaconazole although later is category 1 recommended antifungal prophylaxis in international guidelines

Conclusion
Our study has shown that both posaconazole and voriconazole have comparable efficacy and safety in the prevention of IFD in AML and MDS receiving chemotherapy but voriconazole is more cost effective

Disclosures
All Authors: No reported disclosures
756. Use Risk Factors to Early Screen Pneumocystis Pneumonia in Hospitalized Patients
Authors: Luo Ruihong 
Published: January 2021

Abstract

Background
The diagnosis of Pneumocystis pneumonia (PCP) may be delayed or missed if the underlying risk factors are not recognized, particularly in HIV-uninfected patients.

Methods
The adult hospitalized patients (≥18 years) with pneumonia were selected from the Nationwide Inpatient Sample database (2005-2014). The in-hospital outcomes of PCP patients including mortality, length of hospital stay (LOS) and charge were analyzed. The risk factors for PCP were evaluated by Logistic regression. A risk-adjusted model to screen PCP in HIV-uninfected patients was developed by discriminant analysis.

Results
24,025,696 hospitalized patients with pneumonia were identified, including 135,749 PCP patients. The incidences of PCP in pneumonia patients were 0.12% in HIV-uninfected group and 30.5% in HIV-infected group respectively. Comparing with other pneumonia patients, those with PCP had higher mortality (11.8% vs. 8.2%), longer LOS (median 8 vs. 5 days) and increased hospital charges (median $40,082 vs. $26,980). HIV infection was the major risk factor for PCP (OR=270.2, 95% CI 264.5-276) in all patients with pneumonia. In HIV-uninfected patients, the comorbidities including lymphoma (OR=10.7, 95% CI 10.2-11.2), CMV infection (OR=8.1, 95% CI 7.6-8.7), leukemia (OR=6.8, 95% CI 6.4-7.1), metastatic cancer (OR=5.3, 95% CI 4.6-6.0), immune thrombocytopenic purpura (OR=5.0, 95% CI 4.5-5.5), chronic steroid use (OR=4.1, 95% CI 3.9-4.3), solid organ transplant (OR=3.5, 95% CI 3.3-3.8), inflammatory bowel disease (OR=2.6, 95% CI 2.4-2.8), connective tissue disease (OR=2.4, 95% CI 2.3-2.6) and non-metastatic solid tumor (OR=2.3, 95% CI 2.1-2.4) were associated with increased risk for PCP. A risk-adjusted model composed of risk factors above could help to screen PCP with the sensitivity 42.9%, specificity 94.4% and accurate rate 94.3% (Table 1).
Table 1

Conclusion
PCP should be considered as one of the differential diagnoses in patients with pneumonia if they have underlying risk factors other than HIV infection. The risk-adjusted model can help to early screen PCP for HIV-uninfected patients before the pathogen test.

Disclosures
All Authors: No reported disclosures
757. Association between cumulative febrile, respiratory and diarrheal illness in the first year of life and neurodevelopmental and growth outcomes among a cohort of children in rural Guatemala
Authors: Olson Daniel , Lamb Molly , Connery Amy , Bauer Desiree , Paniagua-Avila Alejandra , Colborn Kathryn L , Natrajan Muktha , Waggoner Jesse , Anderson Evan J , Calvimontes Mirella , Bolanos Guillermo Antonio , Holliday Andrea , El Sahly Hana , Munoz Flor M , Asturias Edwin 
Published: January 2021

Abstract

Background
Recurrent infections are associated with neurodevelopmental (ND) delay in infants, but the primary drivers are poorly understood. Leveraging an infant cohort from rural Guatemala designed to evaluate the effects of post-natal Zika virus on ND (DMID 16-0057), we evaluated the association between cumulative illness and ND delay and stunting.

Methods
Infants enrolled at 0-3 months of age underwent weekly at-home surveillance for caregiver-reported syndromic illness, including cough, fever and vomiting/diarrhea for a 12-month period. Anthropometric assessments and ND testing by Guatemalan psychologists using the Mullen Scales of Early Learning (MSEL) were perforrmed at 12-15 months of age. Multivariable generalized linear regression models were used to test associations between syndromic illness in infancy, 12-15-month MSEL Early Learning Composite (ELC) Score, and stunting (height-for-age &lt; -2 SD) at 12-15 months.

Results
The cohort (n=425) had a mean enrollment age of 1.3 months; 202 (48%) were female, 387 (91%) self-reported a literate mother, and 301 (71%) were breastfeeding at study completion. Infants had reported illness for a median of 16 weeks during the surveillance period; cough was reported most frequently (median=11 weeks, range=0-37 weeks). Lower maternal education (p=0.007) and literacy (p=0.002) as well as infant age (p=0.007) and male gender (p=0.004) were associated with MSEL ELC Score &lt;85 (-1 SD). After adjusting for gender, breastfeeding, age, and maternal literacy, the cumulative number of weeks with reported cough (p=0.0009), fever (p=0.0001), or any syndromic illness (p=0.0007) were associated with decreased 12-month MSEL ECL Score; there was no association with diarrhea/vomiting (p=0.36). There was no association between caregiver-reported syndromic illnesses (any type) and stunting at final study visit.

Conclusion
In a cohort of Guatemalan infants, cumulative fever and cough episodes were significantly associated with lower MSEL ELC Score, whereas there was no association with diarrhea/vomiting. In this low-resource community, these findings highlight the potential negative ND consequences of febrile illness and persistent cough in the first year of life. NIAID Contract HHSN272201300015I Task Order HHSN27200013 (Co-PIs: FMM and EJA).

Disclosures
Molly Lamb, PhD, BioFire (Grant/Research Support) Evan J. Anderson, MD, Sanofi Pasteur (Scientific Research Study Investigator)
759. Where can we find active TB? Case finding at community sites and alcohol based venues (ABVs) in rural South Africa
Authors: Choi Koeun , Shenoi Sheela , Moll Anthony , Friedland Gerald 
Published: January 2021

Abstract

Background
Community-based intensive case finding (CBICF) is an effective strategy for infectious disease case detection, particularly for hard-to-reach populations. Alcohol use is increasingly recognized as a risk factor for tuberculosis. We report on the association of alcohol use with tuberculosis case detection as part of a CBICF in a rural resource limited setting.

Methods
In rural KwaZuluNatal, South Africa, community health workers stationed outside ABVs, community centers, and public events conducted health education and voluntary confidential screening in a mobile clinic. A WHO endorsed TB symptom screen (with sputum collection for GeneXpert if ≥1 symptom), HIV rapid test, random glucose (elevated &gt;7mmol/L), and blood pressure (elevated &gt;140 or &gt;90mmHg) were offered. Community members with positive results were referred to their primary care clinic. Alcohol Use Disorder Identification Test (AUDIT) was used to identify hazardous drinking (score ≥8for men, ≥6for women). Here we report on TB screening results only.

Results
Among 1438 participants, 91.2% were screened at ABV, 72.3% were male, median age was 30 (IQR 22-46), 25.9% were employed, 92.0% had electricity but only 29.4% had running water. Among those screened at all sites, 43.1% reported hazardous alcohol use, 39.3% tobacco use, and 13.9% cannabis use. Overall, 5 people with active TB were identified representing a number needed to screen of 288 to identify one case of TB. Bivariate analysis showed TB cases were more likely to be associated with older age (p=0.03), cigarette use (p=0.06), and hazardous alcohol use (p=0.01). Among only men who were screened, older age (p=0.01) and hazardous alcohol use (p=0.04) were associated with active TB disease. The mean AUDIT score among TB cases was 13.8 (SD 4.09) compared to non-TB cases 6.8 (SD 7.5) (p=0.04).

Conclusion
CBICF is a useful way to detect people with active TB, especially for hard-to-reach rural populations. Focusing screening efforts among those at ABVs is high yield and can be a useful adjunctive strategy for TB case finding efforts. These findings highlight a need for comprehensive substance abuse services to assist those at high risk for TB acquisition.

Disclosures
All Authors: No reported disclosures
763. Correlates of Antiretroviral Therapy Initiation Among Newly Diagnosed Older People with HIV in Ukraine
Authors: Allen Amy J , Zeziulin Oleksandr , Rozanova Julia , Litz Taylor , Zaviryukha Irina , Postnov Oleksandr , Kiriazova Tetiana , Shenoi Sheela 
Published: January 2021

Abstract

Background
Ukraine has a high burden of HIV, with only 52% of people living with HIV receiving Antiretroviral Therapy (ART) despite test and treat policies and free medications. An underrecognized but significantly increasing proportion of older people with HIV (OPWH) contribute 15% of new HIV diagnoses and demonstrate increased mortality compared to the age-matched general population. To assess the impact of age on HIV treatment outcomes, we examined correlates of ART initiation among newly diagnosed HIV patients in Ukraine.

Methods
A retrospective chart review was conducted of 400 patients newly diagnosed with HIV between July 1, 2017- Dec 1, 2018 in Odessa, Ukraine. OPWH were defined as those ≥50 years old at the time of diagnosis, while ART initiation was defined as prescription and dispensing of medication. Outcomes were censored 6 months from diagnosis. Demographic, clinical characteristics, and ART outcomes were examined and multivariable logistic regression models were used to estimate correlates of ART initiation with adjusted odds ratios at 95% confidence intervals.

Results
Of the 400 included patients, 198 (49.5%) were &lt; 50 years old and 202 (50.5%) were ≥ 50 years old at the time of diagnosis. Patients ≥50 years old were more likely to have a lower CD4 count (median 148 (IQR 60-316) vs 295 (IQR 111-478), p=0.001). Correlates of ART initiation included age less than 50 and history of opportunistic infection within 12 months of diagnosis. After controlling for opportunistic infection history, OPWH were 51% less likely to receive ART than those &lt; 50 years old at the time of diagnosis (AOR 0.496, CI 0.301-0.816, p=0.006).

Conclusion
OPWH exhibit an ART gap associated with advanced disease at presentation compared to younger individuals newly diagnosed with HIV. This is the first clinical data examining OPWH in Ukraine. Interventions to improve linkage to care for OPWH are urgently needed in a population already at increased risk for HIV related mortality. The results of this study emphasize the need for further studies to examine patient and systemic causes of decreased ART initiation among Ukrainian OPWH.

Disclosures
All Authors: No reported disclosures
766. Everything Old is New Again-A Case Series of New World Leishmaniasis in African Children in Portland, Maine
Authors: Jubulis Jennifer , Goddard Amanda , Seiverling Elizabeth , Kimball Marc , McCarthy Carol A 
Published: January 2021

Abstract

Background
Leishmaniasis has many clinical manifestations and treatment regimens, dependent on species and host. Old world leishmaniasis is found primarily in Africa and Asia, and is associated with visceral disease, while new world disease, seen primarily in Latin America, is more commonly mucocutaneous. We present a case series of pediatric African patients with New World cutaneous leishmaniasis (NWCL).

Methods
Data extraction was performed via chart review, analyzing travel history, clinical presentation, diagnosis, and management in children with cutaneous leishmaniasis presenting to the pediatric infectious diseases clinic in Portland, ME. Biopsy specimens were sent to the federal CDC for identification by PCR and culture.

Results
Five cases of NWCL were diagnosed in pediatric patients in Maine from November 2018 through February 2020. Median age of patients was 10 years (range 1.5-15 years). Four cases (80%) occurred in children from Angola or Democratic Republic of Congo, arriving in Maine via Central/South America, with one case in a child from Rwanda who arrived in Maine via Texas. Three patients had multiple skin lesions and two had isolated facial lesions. Leishmaniasis was not initially suspected resulting in median time to diagnosis of 5 months (range 1-7 months). Four patients were initially treated with antibacterials for cellulitis and one was treated with griseofulvin. After no improvement, patients underwent biopsy with 2 patients diagnosed with L panamensis, 1 with L braziliensis, 1 with mixed infection (L panamensis and L mexicana), and 1 with Leishmania species only. One patient was managed with surgical excision, 3 with ketoconazole, and 1 was observed off therapy. Four patients were referred to otolaryngology. All continue to be followed in infectious disease clinic.

Conclusion
We present five cases of new world cutaneous leishmaniasis in African pediatric patients arriving to Maine through Latin America or Texas. Patients were diagnosed with cellulitis, tinea corporis or atopic dermatitis initially, underscoring importance of high index of suspicion in migrant patients. Detailed travel history and epidemiologic knowledge is essential to diagnosis, as patients may present with illness not congruent with country of origin. Optimal therapy remains unclear.

Disclosures
All Authors: No reported disclosures
768. Malaria in a Non-Endemic Setting: A Retrospective Review of Malaria Hospitalisations in Ireland over a Four Year Period
Authors: Moynan David , Reidy Niamh , O’Connell James , Reidy Paul , de Barra Eoghan 
Published: January 2021

Abstract

Background
With globalisation fuelling the fire for infectious diseases, it’s important for general physicians to be aware of the tropical infections presenting to hospitals. Malaria, with over 400,000 deaths annually worldwide, has an Irish notification rate of 1.2 per 100,000 of the population, the seventh highest incidence rate of imported malaria globally. This analysis aims to examine the demographics and outcomes of Irish patients with malaria over a four year period.

Methods
A retrospective analysis of all patients with malaria admitted to Irish hospitals between January 1st 2016 and December 31st 2019 was performed. Data was obtained from the National Quality Assurance Improvement System (NQAIS), a national electronic database that collates data from hospital admissions. This was analysed using STATA. Patient demographics, hospital length of stay and documented malaria subspecies are described.

Results
Between January 1st 2016 and December 31st 2019 there were 289 cases of malaria admitted to Irish hospitals, 13/289 (4.5%) requiring high dependency care. 197/289 (68%) were male. The mean age was 35 years (95% CI 33.3 – 37). 220/289 (76%) of all cases resulted from Plasmodium falciparum infection, 16/289 (5.5%) Plasmodium ovale, 11/289 (3.8%) Plasmodium vivax and 2/289 (0.7%) Plasmodium malariae, while 40/289 (13.8%) were unspecified. The median length of stay was 3 days (IQR 1-4 days) and 72/289 (25%) were admitted under an Infectious Diseases team, although this had no significant impact in length of stay (3.1 days versus 3.4 days, p=0.68). 117/289 (40%) were admitted in the months of August and September. There were no reported deaths.

Conclusion
This report gives a clinical context to the 2016 – 2019 NQAIS data, particularly with regards to inpatient length of stay, malaria species diagnosed and numbers requiring critical care. The majority of all cases in the four year period were P. falciparum, reflective of the dominant African region of exposure in most cases. Interestingly, 43% of all cases were from hospitals outside of the Dublin City catchment area, reflecting a diversification of travel and population demographics in Ireland. This highlights the importance of malaria awareness in all regions in Ireland, not simply the major urban centres.

Disclosures
All Authors: No reported disclosures
771. Prospective validation of the universal vital assessment (UVA) score to predict the in-hospital mortality of patients with acute illness admitted to a government district hospital in KwaZulu-Natal, South Africa
Authors: Ahmed Amiya A , Ladines-Lim Joseph B , Moore Christopher , Malinga Sipho , Moll Anthony , Eksteen Francois J , Shenoi Sheela 
Published: January 2021

Abstract

Background
Critical illness is a frequent cause of mortality in resource-limited settings. Improved triage on admission could improve mortality, but existing tools depend on variables that often are not available. We prospectively evaluated the universal vital assessment (UVA) score to predict mortality among patients admitted to a district hospital in rural, highly HIV-prevalent South Africa.
Figure 1. Receiver operator characteristic (ROC) curves for the UVA and qSOFA scoring tools.

Methods
In February-March 2020, adults admitted to the medical wards were enrolled, prior to interruption by covid19, and 30-day mortality assessed. Clinical parameters including temperature, heart and respiratory rates, systolic blood pressure, oxygen saturation, Glasgow Coma Scale score, and HIV status were collected within 24 hours of admission as part of routine care. Lower respiratory tract infections (LRTI) included pneumonia and suspected pulmonary tuberculosis. To evaluate the predictive ability of the UVA score, area under the receiver operating characteristic curve (aROC) and age-sex adjusted binary logistic regression models were generated, and compared to the sequential organ failure assessment (qSOFA).

Results
Sixty one patients were enrolled; outcomes were available for 56 patients. Patients had a mean age of 52 (SD+17), 51% were women, and 46% were HIV infected. The 30-day mortality was 16.1% (9/56) with infections and non-communicable diseases comprising 47% and 47% of admission diagnoses, respectively. The most common admitting diagnosis was LRTI (24.6%). The median (+IQR) UVA score was 2 (+3) accounting for 36% of participants. Medium-risk (2-4) and high-risk (&gt;4) UVA groups were not associated with 30-day mortality, although the high-risk score trended towards significance (p=0.07). However, a UVA score &gt; 3 was significantly associated with 30-day mortality, both alone and after adjusting for age and sex (aOR 6.2, 95% CI 1.2-33.1; p=0.03). The aROC (95% CI) for the UVA score was 0.74 (0.55 – 0.93), which performed better than qSOFA (aROC 0.59, 95% CI 0.37-0.81) and is shown in Figure 1.

Conclusion
In this resource-limited, HIV-prevalent setting, the UVA score predicted mortality better than the qSOFA score. A moderate-risk UVA score (&gt;3) was predictive of 30-day mortality, though needs to be confirmed in larger studies.

Disclosures
All Authors: No reported disclosures
779. Clostridiodes difficile: Is it time for surveillance! Cost-benefit analysis
Authors: Yassin Mohamed , Donskey Curtis , Arbulu Ricardo , Dixon Heather , Smith Kenneth 
Published: January 2021

Abstract

Background
Clostridiodes difficile infection (CDI) has substantial morbidity, mortality and expense. Hospital surveillance to detect CD carriers could affect antibiotic use and determination of community-associated vs hospital-associated CDI.

Methods
A decision tree examined the cost-effectiveness of hospital CD surveillance compared to current practice (testing as indicated). Costs for CD testing, community-associated CDI and hospital-associated CDI came from US databases. CD carrier and infection probabilities came from literature and local data. Analyses examined potential benefits from 1) knowledge of CD carrier status affecting antibiotic use (healthcare perspective) and 2) avoiding penalties for hospital-acquired CDI (hospital perspective).

Results
From the healthcare perspective, if antibiotic use is unchanged by CD status, surveillance costs $39/patient than current practice with unchanged CDI risk. However, if knowing CD status changed antibiotic prescribing such that CDI risk decreased by 10% or 20%, then cost/CDI avoided becomes $15,519 and $3,822 respectively, with CD surveillance becoming cheaper and more effective current practice if CDI risk decreased ≥30%. From the hospital perspective, using published CDI incidence (2.7%) and a hospital-associated CDI penalty of $30,000, surveillance cost $336/patient less than current practice if patients colonized on admission were not considered hospital-associated CDI and $476/patient less with local data (incidence 4.2%).

Conclusion
Hospital CD surveillance is potentially a cost-effective or cost-saving strategy depending on perspective taken and clinical usage of these data. This strategy could be implemented hospital-wide or in high-risk populations. CD surveillance could be both cost-saving and decrease CDI risk if more appropriate antibiotic use results from its use.

Disclosures
All Authors: No reported disclosures