bluuebunny/crossref_metadata_2025_split huggingface dataset:
1054. A Randomized Controlled Trial of Hepatitis B virus (HBV) Revaccination among Men Who Have Sex with Men and Were Born in the Era of Universal Neonatal HBV Immunization
Authors: Huang Yi-Chia , Sun Hsin-Yun , Chuang Yu-Chung , Huang Sung-Hsi , Liu Wen-Chun , Su Yi-Ching , Chang Sui-Yuan , Hung Chien-Ching 
Published: January 2021

Abstract

Background
People who have lost anti-HBs antibody decades after neonatal vaccination but are at high risk of acquiring HBV are recommended to undergo HBV revaccination. The optimal revaccination strategy remains unknown, however. We aimed to compare the efficacy of revaccination with standard- (20-μg) vs double-dose (40-μg) of HBV vaccine among men who have sex with men (MSM).

Methods
MSM aged ≥ 20 years who had undergone HBV vaccination at birth and tested negative for HBsAg and anti-HBc with anti-HBs titer &lt; 10 mIU/ml were randomized to receive standard- or double-dose HBV vaccine (1:1 ratio with a block size of 4) at weeks 0, 4, and 24. Plasma HIV RNA &lt; 50 copies/ml for ≥ 6 months was required for HIV-positive MSM. The primary endpoint was the proportion of participants achieving anti-HBs ≥ 10 mIU/ml at week 28. The secondary endpoints were high-titer response (≥ 100 mIU/ml) at weeks 28 and 48, serological response at week 48, and adverse events (AE).

Results
From Sep 2017 to Jun 2020, 161 HIV-positive and 77 HIV-negative MSM were enrolled. The serological response at week 28 was 86.2% for the standard-dose group and 94.9% for the double-dose group (p=0.070). The proportion of high-titer response was higher for the double-dose group than the standard-dose group at 28 weeks (84.6% vs 70.1%, p=0.041). The respective serological response and high-titer response at week 48 were 81.3% and 58.7% for the standard-dose group vs 94.2% and 78.3% for the double-dose group (p=0.023 and p=0.013, respectively). In generalized estimating equations model, double-dose HBV revaccination (aOR, 1.7; 95% CI, 1.1-2.8) and baseline anti-HBs ≥ 2.5 mIU/ml (aOR, 7.5; 95% CI, 4.3-13.5) were associated with high-titer responses. HIV infection was not associated with serological response (aOR, -1.2; 95%CI, -2.47-1.60) and high-titer response (aOR, -1.1; 95%CI, -1.95-1.49). The double-dose group had a higher rate of local AEs (27.2% vs 38.7%, p=0.118). One (0.8%) severe AE occurred in the double-dose group, which resolved without sequelae.
Table 1. Baseline characteristic of participants

Table 2. Serological response after revaccination

Table 3. GEE model of vaccine efficacy and associated factors

Conclusion
Double-dose HBV revaccination results in sustained serological and high-titer responses among MSM who were born in the era of universal neonatal HBV vaccination. Anti-HBs titer ≥ 2.5 mIU/ml at baseline is associated with high-titer response.

Disclosures
All Authors: No reported disclosures
1063. Healthcare Utilization and Opportunities for HCV Testing and Treatment among Persons under Community Supervision in Pawtucket, RI
Authors: Dickerson Collin , Patry Emily J , Bazerman Lauri , Martin Johanna , Moody Marc , Beckwith Curt 
Published: January 2021

Abstract

Background
The burden of hepatitis C virus (HCV) is disproportionately borne by persons involved with the justice system. To explore missed opportunities for HCV screening and treatment among a justice-involved population, we examined healthcare utilization and prior opportunities for HCV testing and treatment among persons under community supervision enrolled in an HCV testing and linkage to care study in Rhode Island (RI).

Methods
Two hundred and fifty individuals under community supervision were recruited from an RI probation and parole office. Participants underwent a rapid HCV antibody test (OraSure Technologies) and a baseline survey, which queried participants on justice involvement, demographics, substance use, healthcare utilization and prior HCV testing. A positive HCV antibody test and no report of previous HCV testing was classified as a missed opportunity for testing. Self-reported prior HCV diagnosis with no history of treatment was classified as a missed opportunities for HCV treatment.

Results
Forty-five participants (18%) had reactive antibody tests. Of those 45, twenty-five (55%) reported previously being diagnosed with HCV, including thirteen who reported an HCV diagnosis over 10 years ago; none had received HCV treatment. In addition, 135 participants (61.1%) reported previously being tested for HCV; the most common site of prior testing was in jail/prison (n=87). Ten participants had missed opportunities for HCV testing, and 25 had missed opportunities for HCV treatment. Of participants with these missed opportunities, 97% had health insurance, 74% had been to a primary care provider in the past year, and 91% had ≥ 1 identifiable risk factor for HCV.
Flowchart of HCV Antibody Test Results and History of HCV Testing

Healthcare Utilization among Persons with Missed Opportunities

Conclusion
Screening for HCV at community supervision sites is an underutilized venue for HCV screening that can identify previously-undiagnosed HCV infections. Many persons under community supervision are aware of their HCV positive status but have never received treatment. Despite involvement in healthcare systems and adequate health insurance coverage, many patients with risk factors for HCV have not been tested for HCV or have only been tested for HCV while incarcerated. Investing in and implementing strategies to increase testing for HCV is necessary to maximize the care continuum in this priority population.

Disclosures
All Authors: No reported disclosures
80. Pharmacoeconomic Analysis Comparing the Empiric Utilization of Cefepime Versus Piperacillin/tazobactam
Authors: Olmack Kelsey , Collins Curtis D 
Published: January 2021

Abstract

Background
In the hospital setting, cefepime (CFP) and piperacillin/tazobactam (PTZ) are among the most commonly utilized antipseudomonal agents in the empiric treatment of nosocomial and healthcare-associated infections. Institutional preference of CFP or PTZ as the preferred antipseudomonal antibiotic varies. Recent literature suggests each may be associated with increased rates of harmful adverse effects including Clostridiodes difficile infection (CDI) and acute kidney injury (AKI). The objective of this study is to perform a pharmacoeconomic analysis comparing CFP versus PTZ for empiric antibiotic treatment in patients where Pseudomonas aeruginosa is a concern.

Methods
We performed a cost-utility analysis comparing CFP and PTZ for empiric utilization in the hospital setting by creating a decision analytic model from the hospital perspective. Model variables were populated utilizing published clinical and economic data including incidence of AKI and CDI, their associated costs and mortality, and the cost of antibiotic therapy. Secondary and univariate sensitivity analyses tested the impact of model uncertainties and the robustness of our model. A willingness to pay (WTP) threshold of $0 was utilized.

Results
Results of our base-case model predicted that the use of CFP dominated PTZ as empiric utilization was less expensive ($7690 vs. $9331) and associated with a higher quality-adjusted life-years (QALY) (0.9193 vs. 0.9191) compared to the use of PTZ. Several variables had the potential to impact base case results. PTZ became cost-effective at our WTP threshold if CFP nephrotoxicity rates increased to 17.3%, the PTZ nephrotoxicity decreased to 28.5%, or if the cost of nephrotoxicity was less than $17,457. No other model variables, including incidence of CDI, impacted base case results.
Sensitivity Analysis on Cefepime Clostridioides difficile Infection Incidence and Piperacillin/tazobactam Nephrotoxicity

Conclusion
Results of our model showed that CFP dominated PTZ for the empiric treatment of nosocomial infections. The model was sensitive to variation in CFP and PTZ nephrotoxicity rates.

Disclosures
All Authors: No reported disclosures
1070. Risk factors for failed linkage to Hepatitis C care
Authors: Palacios Carlo Fopiano , Hynicka Lauren , Schmalzle Sarah 
Published: January 2021

Abstract

Background
Many patients with Hepatitis C (HCV) who are referred to HCV care do not attend their HCV clinic appointments. As social determinants of health are known to affect HCV acquisition, we sought to evaluate their role on successful linkage to HCV care also.

Methods
A retrospective chart review was conducted on patients with both a positive HCV antibody or RNA test and a scheduled but not-attended infectious disease (ID) clinic appointment in 2017. Abstracted data included patient demographic, type of insurance, HCV test results, and risk factors that may impair outpatient HCV linkage. Descriptive statistics, chi-square, and Fisher exact tests were performed. We sought to identify the factors limiting patients with HCV from attending their first clinic visit.

Results
There were 161 out of 1539 patients (10%) who did not keep their HCV clinic appointment. The mean age was 48 years, 45% were female, and the majority were African American (61%). Most patients had insurance that was accepted by the HCV clinic (76%) and had been tested for HCV while admitted to the hospital (94%). Almost all patients had been tested both for HCV antibodies (98%) and viral RNA via PCR (97%). Risk factors known to contribute to unsuccessful linkage to care were common: substance use (85%), mental health diagnosis (71%), inadequate transportation (66%), housing insecurity (61%), history of medication nonadherence (61%), and alcohol use (52%). Seven patients (4%) died by the end of 2017. Patients alive at the end of 2017 were more likely to have insurance accepted at the ID clinic compared to those without accepting insurance (98% vs. 90%, p 0.06).

Conclusion
Significant barriers are present among patients with HCV who were not successfully linked to a scheduled HCV appointment. Patients with HCV should be provided additional support as appropriate to address the social determinants of health that may limit their linkage to HCV care. Lack of accepted insurance at the ID clinic was associated with mortality and warrants further investigation into its causes.

Disclosures
All Authors: No reported disclosures
1074. Understanding Screening Practices for Hepatitis B Prior to Starting Biologics at an Academic Medical Center
Authors: Jhaveri Tulip A , Higgs James B , Hopkins Mary J 
Published: January 2021

Abstract

Background
It is estimated that 0.3% of the US population has chronic hepatitis B (HBV) infection, most of whom are asymptomatic. When a patient receives a biologic medication, chronic HBV can reactivate with mortality rates as high as 40%. We aim to understand HBV screening practices prior to starting biologics at a single tertiary academic medical center.

Methods
We retrospectively reviewed over 500 patient charts. These patients aged ≥ 18 years were prescribed a biologic medication at one of the three clinics (Dermatology, Rheumatology, or Gastroenterology) at Tufts Medical Center from January 2016 to April 2019. To determine the rate of HBV screening compliance, we reported the proportion of patients who had appropriate HBV serologies (HBV surface antigen and HBV core antibody) drawn prior to initiation of the biologic therapy. A survey was sent to providers from these departments to understand their current practices of HBV screening.

Results
133 of 541 patients (25%) had been appropriately screened for HBV within six months prior to starting biologic therapy. 207 of 541 (38%) had been screened with appropriate serologies within ten years prior to starting a biologic. 23 providers participated in the survey, 7 each from the department of Rheumatology and Gastroenterology, and 9 from Dermatology. One-third of the providers were currently in training, another third were practicing for &lt; 5 years, and the remainder had &gt; 5 years of experience. 57% of the providers said they would screen everyone for HBV before starting a biologic. 78% of them chose the appropriate serologies. The time interval for rescreening was evenly spread amongst different providers, ranging from 3 months to 5 years. If a patient was switched to a new biologic, 48% of physicians would repeat screening only if the patient was determined to be at risk of reactivation or new acquisition of HBV. The major barrier to screening was uncertainty regarding who to screen and which tests to order.

Conclusion
This data reveals that there is inadequate screening for HBV prior to biologic therapy. The survey highlighted areas for quality improvement, including the need for wider dissemination of screening guidelines and development of a protocolized approach to ordering the correct tests.

Disclosures
All Authors: No reported disclosures
1077. Infectious complications after second allogeneic hematopoietic cell transplant (allo-HCT) in adult patients with hematological malignancies
Authors: Maurer Stephen , Linder Kathleen A , Kauffman Carol A , McDonald Philip , Arcobello Jonathan T , Velasco Jon Karl D , Chandrasekar Pranatharthi , Revankar Sanjay , Miceli Marisa H 
Published: January 2021

Abstract

Background
A 2nd allo-HCT is received by some adults after relapse of their underlying malignancy, development of a second malignancy, or graft failure. Few studies have reported on infectious complications in adults given a 2nd HCT

Methods
This is a retrospective review of infectious complications and overall mortality of 60 adult patients who received a 2nd HCT from Jan. 2010 - Dec. 2015. Data were collected for 2 years post-HCT for each patient. Infections were separated into &lt; 30 days (d) post-HCT, 30-100d post-HCT, and &gt;100d post-HCT.

Results
Mean age at 2nd HCT was 49+13; 60% were men. The most common reason for the 1st HCT was acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) (73%,n= 44) The 2nd HCT was for relapse of original malignancy (62%,n=37), graft failure (27%,n=16), and new malignancy (10%,n=6). The 2nd HCT was received a median of 344d (range 29-8248) after 1st HCT. Neutrophil engraftment occurred by 13+4d in 50/60 patients.
Fifty-eight patients (97%) had at least one infection during the study period. A total of 183 infections were reported: 75 (41%) were &lt; 30d, 56 (31%) 30-100d, and 52 (28%) &gt;100d post-HCT. Bacterial infections, primarily C. difficile, vancomycin-resistant Enterococcus, and coagulase (-) Staphylococcus caused 90 (49%) infections and were seen throughout the post-HCT period. Viral infections, predominantly CMV and BK virus, caused 60 (33%) of infections, peaking at 30-100d post-HCT. Only 19 (10%) infections were fungal, most of which were mold infections and occurred &gt;30d post-HCT.
Thirty-nine (65%) patients died by 2 years post-HCT, 27 within the first year. Cause of death was infection in 16 (41%), graft failure, relapse, or GVHD in 16 (41%), other in 7 (18%). At &lt; 30d post-HCT, 5 deaths (71%) were from infection 4 of which were bacterial. At 30-100d post-HCT, 6/9 (69%) deaths were from relapse/graft failure/GVHD. All 6 deaths from fungal infections were &gt;100d post-HCT. Bacterial Infections and engraftment failure within 100d post-HCT were associated with increased mortality (p .05 and &lt; .001, respectively).

Conclusion
All but 2 patients receiving a 2nd allo-HCT developed an infection. Most deaths at &lt; 30d post-HCT were from infection. Overall 2-year mortality was 65% and 41% of deaths were related to infection.

Disclosures
Marisa H. Miceli, MD, FIDSA, SCYNEXIS, Inc. (Advisor or Review Panel member)
1088. Extracorporeal Photopheresis and Infectious Complications in Patients with Chronic Graft Versus Host Disease
Authors: Ashraf Nida , Dias Ajoy , Clough Lisa A , Ni Yonghui , Chalise Prabhakar , Atrouni Wissam El 
Published: January 2021

Abstract

Background
Extracorporeal photopheresis (ECP), is a cell-based immune-modulatory therapy used in the treatment of steroid refractory chronic graft versus host disease (cGHVD). It is unclear whether ECP is associated with an increased risk of infections compared to alternative treatment. We aimed to study the infectious complications in patients who are on ECP post allogeneic hematopoietic stem cell transplant (alloHSCT).

Methods
We conducted a retrospective cohort study of adult patients with cGVHD post alloHSCT who were initiated on ECP or second line immunosuppressive agents (SLIS). The study period was from March 1, 2014 to October 1, 2018. Each subject in the ECP arm was matched to the SLIS arm according to gender, age, underlying disease, and date of diagnosis of cGVHD. All subjects were followed for one-year post treatment. The main outcome was incidence of each type of infection (event rate/ person-years). Kaplan Meier analysis was used, evaluating time to infection with log rank test. The spectrum of infectious complications was described.

Results
Seventy-seven patients were included (36 in ECP and 41 in SLIS arm). Median age was 57.4 years (18.1 -73.4), and 59.7% of patients were male. The most common underlying diseases were acute myeloid leukemia (45.4%), myelodysplastic syndrome (20.8%) and non-Hodgkin’s lymphoma (15.6%). A total occurrence of 94 infections was observed in the ECP arm, compared to 118 in SLIS arm. Bacterial infections accounted for majority of the infections in ECP arm (50%) compared to SLIS arm in which viruses were most common (49.2%). Bacterial pneumonia was the most common clinical syndrome (34% and 27.3%, in the ECP and SLIS arms, respectively). Bacteremia accounted for 12.8% of infections in the ECP arm compared to 16.4% in the SLIS arm. There was no difference in the event rates of infections among the two groups [2.58/ person-years in ECP group vs 3.60/person-years, p = 0.3766], or the probability of infection at any time between the ECP and SLIS group on Kaplan Meier (log rank test, p-value=0.36)(Figure 1).
Kaplan-Meier plot of time to the earliest infection diagnosis between ECP and control group

Conclusion
Bacterial and viral pneumonia were the most common infections in patients undergoing ECP. Overall, ECP does not confer an increased risk of infectious complications compared to second line IS agents.

Disclosures
Wissam El Atrouni, MD, ViiV (Advisor or Review Panel member)
1095. Investigation of Risk Factors Associated with Serious Bacterial, Viral and Invasive Fungal Infections in Hematologic Patients on Ibrutinib
Authors: Holowka Thomas , Cheung Harry , Malinis Maricar F , Perreault Sarah , Isufi Iris , Azar Marwan M 
Published: January 2021

Abstract

Background
Ibrutinib is a tyrosine kinase inhibitor used to treat hematologic malignancies that may increase the risk of serious infection including invasive fungal infections (IFI). In a study of 378 patients with hematologic malignancy on ibrutinib, serious infection and IFI occurred in 11% and 4% respectively (Varughese et al. Clin Infect Dis). The primary aims of our study were to determine the incidence of serious infection and associated risk factors in patients on ibrutinib.

Methods
We performed a retrospective analysis of patients with hematologic malignancy prescribed ibrutinib for ≥ 1 week at Yale New Haven Hospital from 2014 to 2019 to identify serious infections defined as those requiring inpatient management. We collected demographic, clinical and oncologic data. Chi-squared tests were used to determine factors associated with an increased risk of infection.

Results
A total of 254 patients received ibrutinib including 156 with CLL, 89 with NHL and 9 with other leukemias. Among these, 21 underwent HSCT, 9 complicated by GVHD. There were 51 (20%) patients with serious infections including 45 (17.7%) bacterial, 9 (3.5%) viral and 5 (2%) IFI (1 pulmonary cryptococcosis, 4 pulmonary aspergillosis). Anti-mold prophylaxis was prescribed to 7 (2.8%) patients, none of whom developed IFI. Risk factors associated with serious infection included ECOG score ≥ 2 (OR 4.6, p &lt; 0.001), concurrent steroid use (≥ 10 mg prednisone daily for ≥ 2 weeks; OR 3.0, p &lt; 0.001), neutropenia (OR 3.6, p &lt; 0.01), lymphopenia (OR 2.4, p &lt; 0.05) and maximum ibrutinib dose of 560 mg (OR 2, p &lt; 0.05). There was a dose dependent increase in infections based on number of chemotherapy regimens prior to ibrutinib initiation: 14.3% with 0, 19.7% with 1-2 and 28.7% with ≥ 3 prior treatments.

Conclusion
The incidence of serious infection in hematologic patients on ibrutinib was higher than previously reported (20% versus 11%) but the rate of IFI was lower (2% versus 4%). High ECOG score, leukopenia, steroids, and higher ibrutinib doses were associated with an increased risk for serious infection. Targeted antimicrobial prophylaxis should be considered for patients on ibrutinib with these risk factors. Improving functional status may also reduce the risk of infection in patients on ibrutinib.

Disclosures
All Authors: No reported disclosures
1107. Third Generation Cephalosporins Monotherapy Experience in Pediatric Patients with High-Risk Febrile Neutropenia
Authors: Gutierrez Valentina , Claverie Ximena 
Published: January 2021

Abstract

Background
Fever during neutropenia is common in children with cancer. The updated guidelines recommend empirical antibiotic monotherapy using an antipseudomonal ß-lactam, a fourth generation cephalosporin or a carbapenem for high-risk febrile neutropenia. However, local epidemiology and resistance patterns should be evaluated regularly. In our hospital there are not Pseudomonas aeruginosa isolates in oncology pediatric patients, therefore, we use ceftriaxone as monotherapy in high risk febrile neutropenia without other risk factors. The goal of our investigation is to describe the experience of using third generation cephalosporins in these patients.

Methods
Descriptive study of high-risk febrile neutropenia episodes in patients admitted to the Pediatric Oncology Unit of Hospital Dr. Sótero del Río, Santiago, Chile. We included patients ≤15 years from June 2016 until December 2019.

Results
We found 140 episodes in 53 patients, 42 (79%) were leukemia and 11 (21%) solid tumor patients. Of the 140 episodes, 97 (69%) had clinical signs at admission, mostly respiratory in 48 (49%) of the cases. Ninety one (65%) cases started ceftriaxone at admission, 27 (30%) maintained ceftriaxone for 7 days of treatment. Sixty four (70%) cases changed treatment: 38/64 (42%) started second line antibiotics for clinical worsening, 19/64 (20%) required second and third line antibiotics for persistent fever and clinical worsening, and 7/64 (8%) received third line antibiotics from the start for past microbiological history. Eighteen (13%) cases evolved with sepsis requiring intensive care unit management.We had 32 (23%) episodes with positive blood culture, 13 (41%) due to gram positive bacteria, 16 (50%) gram negative bacteria, and 3 (9%) cases of fungal infections. Of the gram negative bacteria, 7 (44%) were ESBL producers, without Pseudomonas aeruginosa isolates.One case died (0.7%) for refractory sepsis due to gram negative bacteria.

Conclusion
Monotherapy with ceftriaxone is not a good option as initial therapy for high risk febrile neutropenia patients due to the spread of ESBL strains. The empiric therapy has to be evaluated regularly and should always be based in local epidemiology.

Disclosures
All Authors: No reported disclosures