bluuebunny/crossref_metadata_2025_split huggingface dataset:
1438. Prevalence and Risk Factors for Extended Spectrum Betalactamases Among Hospitalized Patients with Community Acquired Pyelonephritis in Colombia
Authors: Rodríguez Mariana Franco , Cortes Jorge 
Published: December 2021

Abstract

Background
Urinary tract infections (UTI) are the most frequent bacterial infection in hospitalized patients. Extented spectrum betalactamases (ESBL) producing bacteria causing UTI have become more prevalent. Escherichia coli (E. coli) is the most frequent ESBL producing bacteria isolated in UTI. This drug resistant organisms are associated with poorer outcomes for patients. In low income countries, approaching to and treating ESBL E. coli, represent a major challenge for health care centers.

Methods
A retrospective cohort of adult patients with community acquired pyelonephritis caused by Escherichia coli was identified in a tertiary hospital in Colombia. Susceptibility was performed with Vitek (BioMerieux, France); extended spectrum beta lactamase (ESBL) production was defined phenotypically. Inclusion criteria were adult patients hospitalized with a positive urine culture for E. coli. Demographic and clinical characteristics were searched in electronic records. Risk factors associated with ESBL production were identified by using a multivariate logistic regression analysis.

Results
During 7 years 817 patients with pyelonephritis caused by E. coli were identified. 79 (9.7%) of them were caused by ESBL producers. Women were 66% and 408 (74.8% of them) had menopause. Mean age was 64.2 years (standard deviation of 19.1). Of the cohort, 481 (561.1%) had at least some comorbidity and was frequent to find diabetes (18.5%), immunosuppression due to oncologic disease or medications (18.4%), urolithiasis or previous surgical procedures (17%). After logistic regression, risk factors identified to predict ESBL production, were: being a man (aOR 5.4, 2.1-18.2), a woman with menopause (aOR 2.9, 1.3 -9.9), and the Charlson score (aOR 0.83, 0.73 – 0.96). Previous antibiotic use was not related to ESBL infection.

Conclusion
In this relatively large cohort of patients with pyelonephritis caused by E. coli, ESBL production risk factors were not clearly identified other than sex and menopause. Curiously, Charlson score predicted a lower risk of resistance. Other factors (food consumptions and others) might be driving the resistance in the community in E. coli.

Disclosures
Jorge Cortes, MD, Pfizer (Research Grant or Support)
1442. Spatiotemporal Clusters of Varicella and the Regional Risks through Bayesian Approach: A National Five-year Cohort Analysis
Authors: Hong Kwan , Kim Jeehyun , Yum Sujin , Gómez Gómez Raquel Elizabeth , Chun Byung Chul 
Published: December 2021

Abstract

Background
Since varicella epidemics repeatedly occurred in Korea, it is essential to control varicella outbreaks preemptively in the targeted region. Therefore, we aimed to reveal spatiotemporal clusters of varicella and the regional risk factor of varicella incidence at the national level.

Methods
All varicella cases (defined as ICD-10 codes, B01-B09) from 2013 to 2017 in Korea were extracted from National Health Insurance Service. Of the total, 566,978 cases were realigned spatially by 250 administrative districts of Korea and temporally by a week. Spatial autocorrelation was tested using the global Moran’s I statistics using Monte Carlo simulation. Kulldorff’s prospective space-time scan statistics were used to reveal space-time clusters of varicella. Possible risk factors were extracted from the Korean Statistical Information Service and Community Health Survey of Korea, including hand hygiene perceptions, alcohol and smoking status, the proportion of children under 15 years old, the number of households, and household income by regions. After selecting significant risk factors through non-spatial generalized linear models, a conditional autoregressive spatiotempoal model with Bayesian extension was applied to estimate the regional factors affecting varicella incidence.

Results
There was spatial autocorrelation using Global Moran’s I statistics (P&lt; 0.01). When the maximum cluster size was limited to 10% of the population, 17 spatiotemporal clusters were detected in specific regions in Korea (figure 1). Low perception of hand hygiene, the high proportion of alcohol drinking and cigarette smoking, high children proportion, low number of familial member, and low household income were associated with varicella spatiotemporal incidence (odds ratio: 0.97, 1.01, 2.31, 1.10, 0.99, 0.99, respectively; 95% credible intervals of all risk factors did not include 1).
Figure 1. Space-time prospective clusters of varicella in Korea using varicella incidence from 2013 to 2017.

Relative risks ratio of each cluster is described at the point.

Conclusion
Varicella incidence shows spatiotemporal clustering patterns in specific regions. Since regional factors such as the perception rate of hand hygiene, child proportion, alcohol drinking, cigarette smoking, and low household income affect varicella’s spatiotemporal incidence, strategies for targeted control of high-risk regions are strongly recommended.

Disclosures
All Authors: No reported disclosures
1443. Seroprevalence of HTLV-I/II in a Tertiary-Level Hospital in Newark, NJ
Authors: Robledo Jorge , O’Shaughnessy Michael , Varughese Tilly , Finkel Diana 
Published: December 2021

Abstract

Background
Human T-cell lymphotropic virus type I (HTLV-I) remains amongst the most neglected tropical diseases in the medical field due to its low prevalence in developed countries and the low incidence of its associated diseases, Adult T-cell lymphoma/leukemia (ATLL) and tropical spastic paraparesis (TSP). We proposed a higher prevalence of infections with this virus in Newark given its significant percentage of foreign-born residents of HTLV-endemic countries such as Jamaica, the Dominican Republic, Peru, and Brazil.

Methods
Descriptive study from secondary data. We obtained the total number of HTLV-I/II tests performed at University Hospital in the last 2 years (05/2018-10/2020). Subsequently, medical charts were reviewed to obtain epidemiological and clinical data.

Results
A total of 89 patients underwent screening for HTLV-I/II, of whom 4 (4%) were positive. The test was more frequently ordered in male (61%) and foreign-born (84%) individuals. The main reasons for testing were positive Strongyloides antibody in transplant candidates (20%), neurological symptoms (20%) and hematological symptoms (20%). In most cases, the test was ordered by Infectious Diseases (58%) and Neurology (18%). Being foreign-born was significantly associated with being tested in the case of non-transplant candidates (93% vs 56%, p&lt; 0.001). Amongst the patients with positive serology, there were 2 cases of ATLL and 2 of TSP. Three of them had their country of origin registered (Ecuador, Barbados and Ghana). Family testing was only offered to one of the positive HTLV-I/II participants. Interestingly, this was the only case referred to Infectious Diseases.

Conclusion
There is low but significant seroprevalence of HTLV-I/II in our screened population. Most of the seropositive patients were lost to follow up and their relatives were not offered testing, demonstrating the need to raise awareness for this disease in health care workers.

Disclosures
All Authors: No reported disclosures
164. Antimicrobial Susceptibility of Urogenital and Extragenital Neisseria gonorrhoeae Isolates Among Men Who Have Sex with Men – SURRG and eGISP, 2018–2019
Authors: Quilter Laura , Cyr Sancta St , Hong Jaeyoung , Asbel Lenore , Bautista Ilene , Carter Bonnie , Casimir Yanick , Denny Michael , Ervin Melissa , Gomez Raquel , Harvey Alesia , Holderman Justin , Johnson Kimberly , Kohn Robert , Learner Emily , Mauk Kerry , Menza Timothy William , Mettenbrink Christie , Nettleton William , Nicosia Karen , Pham Cau D , Ried Christopher , Schlanger Karen , Schneider Annah , Soge Olusegun O , Tabidze Irina , Taylor Stephanie N , Tilghman Winston , Toler Cindy , Weinstock Hillard , Torrone Elizabeth 
Published: December 2021

Abstract

Background
Extragenital gonococcal infections are common among men who have sex with men (MSM); however, data comparing antimicrobial susceptibilities of urogenital and extragenital Neisseria gonorrhoeae isolates are limited. We investigated differences in gonococcal antimicrobial susceptibility by anatomic site among cisgender MSM using specimens collected through CDC’s enhanced Gonococcal Isolate Surveillance Project (eGISP) and Strengthening the U.S. Response to Resistant Gonorrhea (SURRG).

Methods
During January 1, 2018–December 31, 2019, 12 eGISP and 8 SURRG sites collected urogenital, pharyngeal, and rectal isolates from cisgender MSM in STD clinics. Gonococcal isolates were sent to regional laboratories for antimicrobial susceptibility testing by agar dilution. To account for correlated observations, linear mixed-effects models were used to calculate geometric mean minimum inhibitory concentrations (MICs) and mixed-effects logistic regression models were used to calculate the proportion of isolates with elevated or resistant MICs; comparisons were made across anatomic sites.

Results
Participating clinics collected 3,974 urethral, 1,553 rectal, and 1,049 pharyngeal isolates from 5,456 unique cisgender MSM. There were no significant differences in the geometric mean MICs for azithromycin, ciprofloxacin, penicillin, and tetracycline by anatomic site. For cefixime and ceftriaxone, geometric mean MICs for pharyngeal isolates were higher compared to anogenital isolates (p&lt; 0.05). The proportion of isolates with elevated ceftriaxone MICs (≥ 0.125 µg/ml) at the pharynx (0.67%) was higher than at rectal (0.13%) and urethral (0.18%) sites (p&lt; 0.05).

Conclusion
Based on data collected from multi-jurisdictional sentinel surveillance projects, antimicrobial susceptibility patterns of N. gonorrhoeae isolates may differ among MSM at extragenital sites, particularly at the pharynx. Continued investigation into gonococcal susceptibility patterns by anatomic site may be an important strategy to monitor and detect the emergence of antimicrobial resistant gonorrhea over time.

Disclosures
Olusegun O. Soge, PhD, Hologic Inc. (Grant/Research Support)SpeeDx Inc. (Grant/Research Support) Stephanie N. Taylor, MD, GARDP - GC Antibiotic Development (Scientific Research Study Investigator, To my institution.)GlaxoSmithKline (Grant/Research Support, Funds to my institution.)
LB10. Impact of SARS-CoV-2 Delta Variant on the Spectrum of Pediatric COVID-19 Disease in Arkansas
Authors: Romero Jose R , Warden Donald E , Cima Michael 
Published: December 2021

Abstract

Background
Pediatric SARS-CoV-2 infection is generally thought to be asymptomatic or result in mild COVID-19 disease, with a paucity of severe outcomes. However, SARS-CoV-2 variants, notably B.1.617.2 (WHO Delta), have changed the clinical landscape of COVID-19 in the United States. Delta became the dominant variant in Arkansas (AR) the 1st week of July 2021. Schools contributed to pediatric infections during the January 2021 surge in COVID-19 infections even with physical mitigation measures (PMM) that were removed in March 2021. We present preliminary data suggesting a shift in the clinical presentation of children with Delta variant infection.

Methods
Pediatric (ages ≤ 18 years) case records for the 3 months representing key inflection points of the COVID-19 Pandemic in AR were reviewed. Outcomes (hospitalizations, ICU admission, mechanical ventilation, death) were recorded by the Arkansas Department of Health (ADH) in a statewide database. Fisher’s Exact Test was used with p-values &lt; 0.05 indicating statistical significance.

Results
During July 2020, 3,268 pediatric cases were reported to ADH with 55 hospitalizations, 6 ICU admissions, 2 mechanical ventilations, and no deaths. A second peak in January 2021 included 11,735 pediatric cases, a 259.1% increase. Increases were also seen in hospitalizations (n=74), ICU admissions (n= 11), and mechanical ventilations (n=2). No deaths reported. The beginning of an exponential growth in cases during July 2021, before the opening of schools, included 8,031 pediatric cases. Despite 31.6% fewer cases than the previous peak, hospitalizations increased 41.9% (n=105) (p &lt; 0.0001) and included increases in ICU and ventilator use of 68.6% (n=18) (p 0.0016) and 300% (n=8) (p 0.0034), respectively. One pediatric death was reported. (Tbl 1)

Conclusion
In the absence of PMM and despite the summer closure of schools, pediatric COVID-19 cases and severe outcomes increased significantly. Initial analysis of the AR July 2021 Delta variant surge indicates a statistically significant increase in pediatric COVID-19 disease and severity as indicated by a proportional increase in hospitalizations, ICU, and ventilator use. Further studies are warranted to better define Delta related childhood disease. Our findings also have implications for school PMM efforts.

Disclosures
All Authors: No reported disclosures
LB11. Preliminary Findings from a HIV Self-Testing Program among People Who Use Drugs
Authors: Rose Michelle , Guy Laura , Shamblen Steve , Guest Greg , Gilbertson Adam , Peiper Nicholas 
Published: December 2021

Abstract

Background
People who use drugs (PWUD) remain at significantly high risk for HIV infection. It is estimated that the majority of all new HIV infections are through injection drug use, with an estimated 2,500 new infections occurring annually among people who inject drugs. Although new HIV infections have been quickly rising over the past year, the Center for Disease Control and Prevention (CDC) preliminarily reported a 50% to 70% intra-pandemic decline in HIV testing. Within Kentucky, an ultra-high-risk state, multiple health departments reported all HIV testing stopped during the early stages of the COVID-19 pandemic (March-July 2020). Once testing resumed, appointments were sparse.

Methods
To address low rates of HIV testing among PWUD, we evaluated the acceptability of a HIV self-testing program (OraQuick In-Home HIV Test by OraSure Technologies, Inc.) implemented at a health department in Louisville, Kentucky that services PWUD. Descriptive statistics were calculated for testing location, testing self-efficacy, reasons and motivations, ease of use, and preferences for future services.

Results
From May to June 2021, a total of 230 PWUD engaged with the program (average of 18 per day). Most participants (87.8%) self-tested at the health department with the help of study staff, while the other 12.2% tested at home and returned at a later time. Approximately 77% of participants reported the self-test kit made them feel better able to keep track of their HIV status compared to standard testing methods. The most common reasons for testing were wanting to know their status (85%), the test was free (37%), fast results (31%), more privacy (23%), and recent high-risk drug use and sexual behaviors (17%). Virtually all (97%) reported the test kits were very easy to use. For future availability of self-test kits through the health department, 33% reported they would use them monthly, 28% every three months, 22% every six months, and 17% annually. In terms of preference for future testing modality, 72% indicated a preference for taking the kits home, while the other 28% indicated a desire to test at the health department with help from staff.

Conclusion
Program participants found the self-test kits to be acceptable and easy to use. Implications for program implementation and future research will be discussed.

Disclosures
Michelle Rose, MBA, Gilead Sciences Inc. (Grant/Research Support) Laura Guy, BS, CCRC, GILEAD Sciences (Grant/Research Support, Research Grant or Support)
LB12. Exebacase Shows Rapid Symptom Resolution in a Phase 2 Study in Adult Patients with Staphylococcus aureus bacteremia
Authors: Cassino Cara , Das Anita F , Lipka Joy 
Published: December 2021

Abstract

Background
Exebacase (EXB), a recombinantly-produced lysin (cell wall hydrolase), is the first direct lytic agent to advance into Phase 3 of clinical development for the treatment of bacteremia including infective endocarditis due to Staphylococcus aureus. The microbiologic attributes of EXB, including pathogen-targeted rapid bacteriolysis, and biofilm eradication are distinct from and synergistic with those of traditional antibiotics and underpin the therapeutic potential for EXB.

Methods
The Phase 2 trial was a randomized, double-blind, placebo-controlled multinational study. Patients were randomized (2:1) to receive a single 2-hour infusion of EXB or placebo (PBO) in addition to standard of care antibiotics. Time to resolution of symptoms (shortness of breath, sweating, fatigue and confusion) attributable to the bacteremia was analyzed using Kaplan-Meier methods. Time to resolution was defined as the number of days until all attributable symptoms were absent. If a new (not present at baseline) attributable symptom was present before the baseline symptoms resolved, this new symptom also had to be absent for symptoms to be considered resolved.

Results
A total of 86 patients (53 EXB and 33 PBO) had at least one attributable symptom present at baseline. Of these, symptoms resolved in 94.3% and 87.9% of EXB and PBO patients, respectively. The median time to resolution was 3 days for EXB and 6 days for PBO patients. Median days to symptom resolution in the MRSA group was 3 and 7 days for EXB and PBO patients, respectively, and 3 and 5 days for EXB and PBO patients in the MSSA group, respectively. Time to symptom resolution in MRSA patients in presented in Figure 1.
Figure 1. Time to Resolution of Symptoms in Patients with MRSA Bacteremia including Infective Endocarditis

Conclusion
The majority of EXB and PBO patients had symptom resolution. However, EXE patients achieved symptom resolution in 3 days compared with 6 days for PBO patients overall, and 7 days for PBO patients with MRSA. These data suggest that rapid bacteriolysis may translate to a clinical benefit for patients receiving EXB and aligns with a median length of hospital stay of 6 and 10 days among US MRSA patients that received EXE and PBO patients, respectively. (Fowler, et al, 2020).

Disclosures
Cara Cassino, MD, ContraFect Corporation (Employee) Anita F. Das, PhD, Adagio (Consultant)AN2 (Consultant)Cidara (Consultant)ContraFect (Consultant)Iterum (Consultant)MicuRx (Consultant)Paratek (Consultant)Union (Consultant) Joy Lipka, MS, ContraFect Corporation (Consultant)
165. Emergence of Extensively Drug-Resistant Salmonella enterica Serotype Typhi Infections—United States, 2008–2020
Authors: Medalla Felicita , Watkins Louise Francois , Hughes Michael , Birhane Meseret , Dorough Layne , Griffin Chelsey , Reynolds Jared , Caidi Hayat , Webb Hattie E , Mintz Eric , Gutelius Bruce , Langley Gayle 
Published: December 2021

Abstract

Background
Typhoid fever, caused by Salmonella Typhi, is fatal in 12%–30% of patients not treated with appropriate antibiotics. In 2016, a large outbreak of extensively drug-resistant (XDR) Typhi infections began in Pakistan with cases reported globally, including the United States. In 2021, the Centers for Disease Control and Prevention (CDC) issued a health advisory on XDR infections among U.S. residents without international travel. We describe resistance of Typhi infections diagnosed in the United States to help guide treatment decisions.

Methods
Typhoid fever is a nationally notifiable disease. Health departments report cases to CDC through the National Typhoid and Paratyphoid Fever Surveillance system. Isolates are submitted to the National Antimicrobial Resistance Monitoring System for antimicrobial susceptibility testing (AST) using broth microdilution. AST results are categorized by Clinical and Laboratory Standards Institute criteria. We defined XDR as resistant to ceftriaxone, ampicillin, chloramphenicol, and co-trimoxazole, and nonsusceptible to ciprofloxacin.

Results
During 2008–2019, of 4,637 Typhi isolates, 52 (1%) were ceftriaxone resistant (axo-R); 71% were ciprofloxacin nonsusceptible, 1 azithromycin resistant (azm-R), and none meropenem resistant. XDR was first detected in 2018, in 2% of 474 isolates and increased to 7% of 535 in 2019. Of the 52 axo-R isolates, 46 were XDR, of which 45 were from travelers to Pakistan, and one from a non-traveler; 6 were not XDR, of which 4 were linked to travel to Iraq. In preliminary 2020 reports, 23 isolates were XDR; 14 were from travelers to Pakistan, 8 from non-travelers, and 1 from someone with unknown travel status. Among those with XDR infection, median age was 11 years (range 1–62), 54% were female, and 62% were from 6 states.

Conclusion
Ceftriaxone-resistant Typhi infections, mostly XDR, are increasing. Clinicians should ask patients with suspected Typhi infections about travel and adjust treatment based on susceptibility results. Carbapenem, azithromycin, or both may be considered for empiric therapy of typhoid fever among travelers to Pakistan or Iraq and in uncommon instances when persons report no international travel. Ceftriaxone is an empiric therapy option for travelers to countries other than Pakistan and Iraq.

Disclosures
All Authors: No reported disclosures
LB16. Surveillance Rates of Cefiderocol Heteroresistance Correlate With All-cause Mortality in the APEKS-NP and CREDIBLE-CR Trials
Authors: Choby Jacob E , Ozturk Tugba , Satola Sarah W , Jacob Jesse T , Weiss David 
Published: December 2021

Abstract

Background
Cefiderocol is a recently FDA approved, novel siderophore beta-lactam antibiotic. Conventional antimicrobial susceptibility testing (AST) suggests that a variety of Gram-negative pathogens, including carbapenem-resistant (CR) isolates, are overwhelmingly susceptible to cefiderocol.. This antibiotic performed well in the APEKS-NP trial for the treatment of nosocomial pneumonia caused largely by carbapenem susceptible isolates. However, in the CREDIBLE-CR trial involving exclusively CR Gram-negative bacteria, cefiderocol was associated with a higher rate of all-cause mortality. We hypothesized one explanation for these discrepant data might be undetected cefiderocol heteroresistance (HR).
HR is a form of antibiotic resistance in which an isolate harbors a minority resistant subpopulation of cells co-existing with a majority susceptible population, and is often undetected by standard AST. Isolates exhibiting undetected HR, with as low as 1 in 1 million resistant cells, can cause treatment failure in in vivo models.

Methods
We quantified HR to cefiderocol by population analysis profile (PAP) of 161 Acinetobacter, 180 Klebsiella, and 108 Pseudomonas isolates collected in Georgia, USA.

Results
We observed CR isolates exhibited a high frequency of HR, which was largely undetected by standard AST, and correlated with all-cause mortality in the CREDIBLE-CR study (Table). Carbapenem-susceptible isolates exhibited no or low rates of cefiderocol HR (Table). Cephalosporin-resistant bacteria mostly exhibited increased rates of cefiderocol HR, but below those of CR strains. These differences in rates of cefiderocol HR correlated with the mortality data from the APEKS-NP and CREDIBLE-CR trials, across the bacterial species tested (Table).
Table: Surveillance rates of cefiderocol heteroresistance correlate with all-cause mortality in the APEKS-NP and CREDIBLE-CR trials

Conclusion
These data suggest that the lower rates of cefiderocol HR in carbapenem-susceptible isolates that predominated the APEKS-NP trial may explain the enhanced efficacy of the drug in that study as compared to the CREDIBLE-CR trial. Importantly, the widespread, undetected cefiderocol HR observed among CR pathogens may explain the discordance between this drug’s excellent in vitro susceptibility profile and increased patient mortality in the CREDIBLE-CR trial.

Disclosures
All Authors: No reported disclosures