bluuebunny/crossref_metadata_2025_split huggingface dataset:
1161. Increasing incidence of Sinogenic Intracranial Infections in Utah Children 2004-2019
Authors: McNamara Isabella , Pershing Nicole L , Wilkes Jacob , Bonkowsky Anne 
Published: December 2021

Abstract

Background
Intracranial extension of sinusitis is a rare complication. Non-specific presentations are a diagnostic challenge, and complications include long-term neurologic sequelae. Early recognition is critical, although optimal management remains poorly characterized.

Methods
We conducted a retrospective chart review of 123 patients admitted to Primary Children’s Hospital between 2004-2019 with ICD9 and ICD10 codes for sinusitis and intracranial suppurative infection. Chart review confirmed cases in patients &lt; 18 years with evidence of sinusitis and intracranial extension. Variables collected included: demographic data, clinical presentation, microbial profile, clinical management, and outcomes.

Results
We observed 84 pediatric sinogenic intracranial infections between 2004-2019. Incidence significantly increased over the interval. Median patient age was 12.8 years (IQR 10.5-14.7 years); most were male (n=52). The most common presenting symptoms were headache and fever. Most patients (n=80) required surgical management; 62 required neurosurgery. All but one patient survived. Most infections were polymicrobial (n=47). Streptococcus anginous group were most frequently identified (n=32). All patients were started on vancomycin empirically; only 10 required use for definitive management. Most patients were treated with a carbapenem (n=42) or ceftriaxone plus metronidazole (n=32). Average duration of antibiotics was 44 days (IQR 38-55 days). The most common complication was epilepsy (n=11). Patients with Streptococcus sp. infections were more likely to experience adverse outcomes (p= 0.04). We observed significantly decreased carbapenem use following introduction of an antimicrobial stewardship program in 2012, with no change in clinical outcomes.
Annual incidence of Sinogenic Intracranial Infections

Shown is the increasing incidence of sinogenic intracranial infections annually in the state of Utah/100,000 children.

Conclusion
Sinogenic intracranial infections are increasingly frequent severe pediatric infections with associated long term neurologic sequelae. Most patients require both surgical and long-term IV antibiotic treatment. Most infections are polymicrobial. Streptococcus sp. are commonly identified. Antibiotic resistant bacteria are rare. The combination ceftriaxone and metronidazole is appropriate for treatment of most infections.

Disclosures
Anne Bonkowsky, MD/PhD, BioFire Diagnostics (Consultant, Grant/Research Support, Other Financial or Material Support, I have intellectual property through the University of Utah in BioFire Diagnostics and the FilmArray and receive royalties through the University of Utah.)Merck (Advisor or Review Panel member)
1162. Antifungal Use in Immunocompromised Children in Europe: a 12-week Multicenter Modified Point prevalence Study (CALYPSO)
Authors: Chorafa Elisavet , Iosifidis Elias , Oletto Andrea , Warris Adilia , Castagnola Elio , Bruggemann Roger , Groll Andreas , Lehrnbecher Thomas , Ferreras-Antolin Laura , Mesini Alessio , Roilides Emmanuel 
Published: December 2021

Abstract

Background
While antifungal consumption in immunocompromised patients appears high, data on children are limited. We analyzed antifungal use in hospitalized immunocompromised children across Europe in order to better organize a European pediatric antifungal stewardship programs (pAFS).

Methods
A multicenter 12-wk modified point-prevalence study was conducted. All patients hospitalized in hematology-oncology (HO) or bone marrow/solid organ transplant (BMT/SOT) units across Europe and receiving systemic antifungals were included. Data on ward demographics and policies were collected once at the beginning; weekly ward and patient data were prospectively collected during the 12-wk study period and entered in REDCap. Systemic antifungals administered were recorded (doses, duration, reason for administration or discontinuation).

Results
Twenty-one HO and 10 BMT/SOT units from 18 hospitals in 11 European countries participated in the study and 572 antifungal prescriptions were recorded. The most common underlying conditions were: 69% malignancy (81% hematologic, 19% solid tumors), 20% BMT, 6% hematologic diseases except malignancy and 4% primary immunodeficiency. Indication of antifungals was prophylaxis for 439 (77%) and treatment for 133 (23%) prescriptions (62 empirical, 43 pre-emptive, 28 targeted). Most common reasons for empirical, pre-emptive and targeted treatment were antibiotic-resistant febrile neutropenia (52%), abnormalities on chest-CT with/without positive galactomannan (72%) and candidiasis (82%), respectively. For targeted treatment, the most frequent pathogens were C. albicans (50%), C. parapsilosis (11%) and A. fumigatus (11%). Overall, fluconazole and liposomal amphotericin B were the most frequently prescribed agents both for prophylaxis (31% and 21%) and treatment (32% and 23%). However, in BMT patients the most frequently prescribed antifungal agents were fluconazole or micafungin for prophylaxis and caspofungin and voriconazole for treatment (Table).
Antifungal agents used per underlying condition

Antifungal agents used per underlying condition

Conclusion
Most systemic antifungal prescribing across European HO and BMT/SOT units is for prophylaxis, and fluconazole is the main antifungal prescribed. Results from this multicenter study can be a first step to guide a Europe-wide pAFS.

Disclosures
Emmanuel Roilides, MD, PhD, ECMM (Research Grant or Support, Other Financial or Material Support, ECMM grant for this study)
1163. HIV-1 NAAT Pitfalls in B-cell Lymphoblastic Leukemia Patients Following CAR-T Cell Therapy
Authors: Alali Muayad , Christenson John , skiles Jodi 
Published: December 2021

Abstract

Background
CAR-T Cell Therapy is approved for the treatment of pediatric patients with relapsed/refractory B-ALL. Lentiviral vector technology, highly modified from HIV-1, is used to induce stable, long-term transgene expression by integration into the host genome. This integration may interfere with HIV-1 NAAT producing false-positive results.

Methods
A retrospective chart review of Pre-B ALL patients who underwent to CAR T cell therapy with KYMRIAH(tisagenlecleucel) at a single institution between January 2019 and May 2021 to assess for patients whose CAR-T infusion interfered with post-infusion HIV-1 testing. All patients had HIV NAAT pre and post CAR T-cell therapy (using platform, Roche COBAS AmpliPrep/Quantitative TaqMan HIV-1 T). Reactive HIV NAAT by Roche test were subsequently tested using different HIV-1 assay platforms to rule out or confirm HIV infection.

Results
We report three cases in which interpretation of HIV-1 NAAT testing was complicated by CAR T cell therapy. Case 1: 1-year-old male with refractory infantile leukemia was found to have a reactive HIV NAAT post CAR-T in routine infectious screening prior to SCT. Case 2: 3-year-old refractory ALL planned for SCT who had a reactive HIV NAAT 9 months post CART. Fourth-generation HIV-1 testing (targeting the p24 antigen and anti-HIV-1 antibodies) was negative pre and post CART. Viral loads were also undetectable indicating false-positive post-CAR-T HIV-1 NAT test results. Case 3: 21-year-old sexually active female with relapsed B cell ALL. Post CAR-T HIV NAAT was reactive, and a quantitative viral load was positive at 176 copies/mm3 one day prior to start of stem cell transplant conditioning regimen. Aptima HIV testing is typically used as confirmatory test for CAR-T associated false positive HIV NAT cases, but surprisingly, the Aptima test was also reactive. Additional testing with Abbott m2000 Realtime HIV-1 assay and 4th generation p24 antigen-based testing were both negative.

Table 1 Summary of reported patients with false-positive HIV-1 NAAT test results following CAR T cell therapy and Table 2, HIV platforms used for screening and diagnosis with interpretations following CAR T cell therapy.

Conclusion
Clinicians need to be aware of potential false-positive HIV testing after CAR-T therapy. HIV testing platforms with targets not used in lentiviral vectors (4th generation test/P24, or Abbott test/integrase region) are highly recommended to avoid delays in subsequent therapy and unwanted stress for the patients, families, and clinicians

Disclosures
All Authors: No reported disclosures
1166. Reverse Syphilis Screening and Adherence to The Congenital Syphilis Guidelines: Institutional Experience
Authors: Chatani Brandon , Chaparro Aida , Alvarez Patricia , Arheart Kristopher , Gonzalez Ivan , Moraru Gabriela 
Published: December 2021

Abstract

Background
This study is analysis the consequences of the reverse syphilis screening on the management of newborns exposed to maternal syphilis, and pediatric physicians’ adherence to the existing guidelines.

Methods
We conducted a 5-year retrospective review of the maternal population and their newborns diagnosed with syphilis. Women with positive results (TT+/NTT+) and discordant (TT+/NTT-/TT+) and their newborns were included in the analysis.

Results
Per American Academy of Pediatrics (AAP), the 202 newborns were divided in two groups: proved or highly probable and possible congenital syphilis (Group A, n=102) and less likely and unlikely congenital syphilis (Group B, n=100). Except for the RPR, none of the other laboratory tests showed higher odds for predicting congenital syphilis. The RPR titers above 1:16 were only identified among newborns belonging to the Group A (5%); 32 patients (31%) in the Group A and 19 (9%) in the Group B had an RPR titer equal to or below 1:8. An RPR titer equal to or above 1:4 was almost three times more likely to be identified in patients from Group A (OR 2.91; CI 1.51- 5.59, p&lt; 0.05). The newborns with non-reactive RPRs represented 64% of the patients in the Group A and 47% of them were born to mother with non-reactive RPR also (mothers with discordant results). Among the Group B, 82% of the neonates had a non-reactive RPR and 54% were delivered to mother with non-reactive RPRs. Babies in Group B had additional work-up performed 69% (n=37) of the time; 15% of these babies were treated with intramuscular penicillin which does not follow established AAP guidelines.
Statistical analysis of the laboratory tests used for the congenital syphilis work-up

Result table comparing the two groups of newborns

Conclusion
The reverse syphilis screening and non-adherence to the guidelines led to additional screening to half of the newborns in both groups. This study highlights the need for a comprehensive maternal history at the time of delivery that is effectively communicated between the providers. This might lead to greater congruence with the established AAP guidelines.

Disclosures
All Authors: No reported disclosures
136. Impact of an OPAT Pharmacist on Guideline Adherence and Clinical Outcomes
Authors: Lin Alice , Nakasone Trisha S , Nguyen Nancy N , Yang Catherine 
Published: December 2021

Abstract

Background
Outpatient parenteral antibiotic therapy (OPAT) provides select patients a cost-effective alternative to completing intravenous (IV) antibiotic therapy outside the hospital. The Infectious Diseases Society of America (IDSA) OPAT practice guidelines and handbook recommend weekly laboratory monitoring and timely follow-up for OPAT patients. An analysis at VA Palo Alto Healthcare System (VAPAHCS) conducted prior to pharmacist involvement demonstrated that IDSA recommendations were not routinely followed, leading to a clinical cure rate of 62.7%. This led to the implementation of an OPAT pharmacist in 2019. This analysis aims to determine the impact of a pharmacist-managed OPAT program at VAPAHCS.

Methods
This comparative, retrospective analysis included patients who received OPAT at VAPAHCS between October 1, 2019 and September 30, 2020 and those who received OPAT in a prior analysis. Primary outcomes included rates of adherence to IDSA recommendations on follow-up visits and weekly lab monitoring during OPAT. Secondary outcomes included rates of clinical cure, 90-day readmission, and adverse events or complications. Data was analyzed using Fisher’s exact test and independent t-test.

Results
This analysis included 74 patients and 76 total OPAT episodes. Bacteremia was the most common diagnosis (n=35, 38.0%), and the most common organism was methicillin-susceptible Staphylococcus aureus (MSSA) (n=23, 29.9%). With respect to guideline adherence pre- and post- pharmacist-managed OPAT, 31.3% versus 93.4% of patients had follow-up within 7 to 14 days of discharge (p&lt; 0.001). Rates of weekly lab monitoring of CBC, BMP, and LFTs pre-pharmacist were 63.2%, 63.3%, and 49.5%, respectively, compared to post-pharmacist rates of 93.0%, 92.1%, and 83.6%, respectively. Clinical cure rates were 62.7% pre-pharmacist and 89.6% post-pharmacist (p&lt; 0.001). More adverse drug reactions were identified in the post-pharmacist period, of which 30% required pharmacist intervention.
Figure 1. Weekly Laboratory Monitoring of Antimicrobials (%)

Figure 2. Adherence to IDSA Guideline Follow-up Recommendation

Figure 3. Rates of Clinical Cure

Conclusion
Pharmacist involvement in OPAT significantly increased IDSA guideline adherence to lab monitoring and follow-up visits, and clinical cure rates. Identification of adverse drug reactions prompting pharmacist intervention further highlights the importance of follow-up in OPAT patients.

Disclosures
All Authors: No reported disclosures
1167. Hospital Readmissions among Infants Diagnosed with Early-Onset Neonatal Sepsis in Connecticut
Authors: Hudon Rebecca , Leung Vivian , Leung Vivian , Petit Susan , Banach David 
Published: December 2021

Abstract

Background
Early-onset neonatal sepsis, defined as sepsis within 72 hours of birth, results in significant infant morbidity and mortality. Readmissions associated with neonatal sepsis have not previously been well-described. Early-onset neonatal sepsis is a mandatory reportable condition in Connecticut, allowing for expanded data collection through public health surveillance to evaluate readmissions.

Methods
Infants with early-onset neonatal sepsis born in Connecticut during 2007–2016 were identified from statewide surveillance data and matched with a statewide hospital discharge database. We describe readmission rates, causes and timing of readmissions, and demographic and clinical factors associated with readmission among this group.

Results
Among 250 infants with early-onset neonatal sepsis matched to discharge data, 208 (82%) infants survived their initial hospitalization at birth. During the first year of life, 49 (23.6%) infants were readmitted. The most frequent reasons for readmissions were pulmonary complications (19%), systemic symptoms (17%), and gastrointestinal illness (13%). Infants with initial hospitalizations lasting longer than 30 days after birth were associated with higher rates of readmission compared to those discharged within 30 days after birth (35% vs. 19%, p=0.02). Higher readmission rates were observed among non-white infants (29% vs. 18%, p=0.06).
Summary of early-onset neonatal sepsis cases and return hospital visits in Connecticut, 2007-2016

Demographic and clinical factors for Connecticut neonatal sepsis cases, 2007-2016

Reason for one-year readmissions of Connecticut neonatal sepsis cases, 2007-2016

The top three reasons for readmission include pulmonary (19%), systemic (17%), and GI problems (13%).

Conclusion
Given the high proportion of infants diagnosed with early-onset neonatal sepsis who are readmitted within the first year of life, further efforts are needed to prevent readmissions among this vulnerable patient population. Non-white infants and infants with prolonged initial hospitalizations after birth might be at higher risk for readmission. These groups warrant intensified strategies to prevent readmission.

Disclosures
Vivian Leung, MD, Nothing to disclose
1169. Revenge of the Syph(ilis): Investigating Congenital Syphilis at a Tertiary Care Center Amidst a Rising Epidemic
Authors: Ness Tara , Rochat Ryan H , Bocchini Claire , Mary Healy C 
Published: December 2021

Abstract

Background
Congenital syphilis is a chronic infection acquired by the fetus in utero from a mother infected with Treponema palladium. It has a large spectrum of disease manifestations from asymptomatic infection to blindness, abnormal bone and teeth formation, deafness, or even death. Despite antenatal screening and the availability of effective treatment the incidence of congenital syphilis has risen since 2012, with 23.3 cases per 100,000 live births in 2017 according to the Centers for Disease Control. We sought to investigate the epidemiology, clinical manifestations, and treatment outcomes of congenital syphilis.

Methods
We undertook a retrospective review of individuals born at Texas Children’s Hospital from January 1, 2010 to May 15, 2021 to evaluate compliance with current diagnostic and treatment recommendations. Diagnostic and billing codes for congenital syphilis were used to generate a list of subjects. Patient demographics and clinical details were abstracted from the electronic medical record (EMR). Statistics were performed using Microsoft Excel.

Results
107 children (52% male, 48% female) were identified from diagnostic and billing codes in the EMR under the SNOMED-CT diagnosis of “congenital syphilis” and were less than two years of age at the time of diagnosis. All received penicillin within one month of diagnosis. 94 of these had a skeletal x-ray performed, with 11 (12%) having an abnormal skeletal x-ray consistent with congenital syphilis. 88 (82%) had a lumbar puncture done with a quantitative CSF VDRL obtained. 88 received aqueous penicillin G for proven/highly probable or possible syphilis. Four patients were deceased at the time of data inquiry. Of those with abnormal skeletal x-rays, “metaphyseal lucency” was the most common finding.

Conclusion
Congenital syphilis remains a significant concern in the United States and carries the risk of significant long-term morbidity for infants and children. Antenatal screening with appropriate treatment in pregnancy and adequate follow-up would decrease the need for neonatal evaluation and treatment.

Disclosures
C. Mary Healy, MD, Dexcom (Shareholder)Intuitive (Shareholder)Quidel Corporation (Shareholder)Up to Date (Other Financial or Material Support, Honorarium)Vapotherm (Shareholder)
1170. Do Rotavirus Strains Affect Vaccine Effectiveness? A Systematic Review And Meta-analysis
Authors: Cates Jordan , Amin Avnika , Tate Jacqueline , Lopman Ben , Parashar Umesh D 
Published: December 2021

Abstract

Background
Rotavirus causes 215,000 deaths from severe childhood diarrhea annually. Two rotavirus vaccines – a monovalent vaccine containing a single rotavirus strain (RV1) and a pentavalent vaccine containing 5 rotavirus strains (RV5) – are used in routine immunization programs of nearly 100 countries. Concerns exist that rotavirus vaccines may be less effective against rotavirus strains not contained in the vaccines which could subsequently cause selective pressure and strain replacement. We estimated the vaccine effectiveness (VE) of RV1 and RV5 against vaccine (homotypic) and non-vaccine (partially and fully heterotypic) strains.

Methods
After conducting a systematic review, we meta-analyzed 31 case-control studies (N=27,293) conducted between 2006 and 2020 using a random-effect regression model.

Results
In high-income countries, RV1 VE was 10% lower against partially heterotypic (p-value=0.04) and fully heterotypic (p-value=0.10) compared to homotypic strains (homotypic VE: 90% [95% CI: 82, 94]; partially heterotypic VE: 79% [95% CI: 71, 85]; fully heterotypic VE: 80% [95% CI: 65, 88]; Figure 1). In middle-income countries, RV1 VE was 14 to 16% lower against partially heterotypic (p-value=0.06) and fully heterotypic (p-value=0.04) compared to homotypic strains (homotypic VE: 81% [95% CI: 69, 88]; partially heterotypic VE: 67% [95% CI: 54, 76]; fully heterotypic VE: 65% [95% CI: 52, 75]; Figure 1). Strain-specific RV5 VE differences were less pronounced (Figure 2). Limited data were available from low-income countries.
Figure 1. Vaccine effectiveness by country income level and strain type, for RV1.

Figure 2. Vaccine effectiveness by country income level and strain type, for RV5.

Conclusion
Vaccine effectiveness of RV1 and RV5 was somewhat lower VE against non-vaccine than vaccine strains. Ongoing surveillance is crucial to continue long-term monitoring for strain replacement, particularly in low-income settings where data are limited.

Disclosures
All Authors: No reported disclosures
1172. SARS-CoV-2 Vaccine Hesitancy in Caregivers of Hospitalized Children
Authors: Orbea Marisa , Cunningham Rachel , Mary Healy C , Boom Julie A , Bocchini Claire 
Published: December 2021

Abstract

Background
SARS-CoV-2 vaccine hesitancy (VH) is hindering nationwide vaccination efforts; little is known about caregiver SARS-CoV-2 vaccine acceptance for children. We aimed to identify associations with SARS-CoV-2 VH in caregivers of hospitalized children.

Methods
We conducted a prospective cross-sectional survey in English and Spanish of caregiver COVID-19 knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 months - 18 years at a large pediatric medical institution. Parents were approached daily, averaging 4-5 days/week, from 12/8/2020--4/5/2021. VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey; PACV score ≥50 denoted VH. Descriptive statistics and multivariable logistic regression were used. Responses were categorized.

Results
295/307 (96%) of approached caregivers enrolled; 79% were ≥ 30 years, 68% were married/ living with a partner, and 57% had at least some college. 36% identified as white, 19% Black, and 46% Hispanic/ Latino. 53% of caregiver children had public insurance. 91% of caregivers self-reported their children were up to date with routine vaccines. 17% of caregivers were vaccine-hesitant overall. 50% of caregivers were willing to receive COVID-19 vaccine themselves. Figure 1 shows intention to vaccinate their child by PACV score.
65% knew someone who was hospitalized for COVID-19. 67% were scared of their child getting COVID-19. However, 49% were scared of their child getting the vaccine, 28% did not want to vaccinate their child and 27% were neutral in the intention to vaccinate their child. Caregivers who did not intend to vaccinate their child were more likely to be Black (27% vs. 16%, p=0.04) and less likely to be Hispanic/ Latino (33% vs. 49%, p=0.02). Table 1 shows attitudes, beliefs, and behaviors surrounding the COVID-19 pandemic and vaccine in caregivers who did or did not intend to vaccinate their child.
Figure 1

COVID-19 vaccine uptake by PACV score
Table 1

Caregiver attitudes, beliefs, and behaviors surrounding the COVID-19 pandemic and the COVID-19 vaccine

Conclusion
The majority of caregivers believe that SARS-CoV-2 vaccine will help control the pandemic, but less than half plan to vaccinate their children. A quarter of caregivers expressed uncertainty regarding the vaccine and therefore may be amenable to education and discussion. COVID-19 VH is different from VH towards routine vaccinations. More research is needed to address COVID-19 specific VH.

Disclosures
C. Mary Healy, MD, Dexcom (Shareholder)Intuitive (Shareholder)Quidel Corporation (Shareholder)Up to Date (Other Financial or Material Support, Honorarium)Vapotherm (Shareholder)