bluuebunny/crossref_metadata_2025_split huggingface dataset:
1370. Role of Clindamycin Versus Linezolid for Serious Group A Streptococcal Infections
Authors: Heil Emily , Heil Emily , Basappa Sapna 
Published: December 2021

Abstract

Background
Streptococcus pyogenes can cause severe illnesses such as toxic-shock syndrome and necrotizing fasciitis due to pyrogenic exotoxins. Clindamycin is added to penicillin for treatment of severe S. pyogenes infections as it is a bacterial protein synthesis inhibitor which reduces toxin production. However, clindamycin is associated with several adverse effects including C. difficile infection. Linezolid is a bacterial protein synthesis inhibitor that has been shown to provide excellent coverage of S. pyogenes including toxin inhibition in vitro, but clinical evidence is lacking. We compared outcomes of patients treated with linezolid versus clindamycin for serious S. pyogenes infections.

Methods
This was a retrospective study of patients with necrotizing fasciitis or toxic shock syndrome caused by S. pyogenes admitted to the Shock Trauma Center at University of Maryland Medical Center treated with at least 48 hours of either clindamycin or linezolid. Data collected included Sequential Organ Failure Assessment (SOFA) and Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) severity scores, time to resolution of infection, number of surgeries, C. difficile infection, other antibiotic associated adverse effects, and mortality. Associations between patient characteristics, antibiotic groups, and outcomes were analyzed using the chi-square test, Fisher’s exact test and t-test or Wilcoxon rank-sum test as appropriate (SAS v 9.4).

Results
52 patients were included, 26 treated with clindamycin and 26 with linezolid. Most patients (85% clindamycin and 96.2% linezolid) were treated for necrotizing fasciitis. Baseline characteristics, including SOFA and LRINEC scores, were similar between the groups. There was no difference in mortality between patients treated with clindamycin versus linezolid (11.5% vs. 7.7%, p = 0.22), and resolution of infection was similar between the groups (92.3% vs. 88.5%, p = 1.0). There was no difference in adverse effects between the clindamycin and linezolid groups, including C. difficile infection (3.9% vs. 0% p = 1.0) and thrombocytopenia (30.8% vs. 42.3%, p = 0.4).

Conclusion
Linezolid could be an alternate to clindamycin for the treatment of serious toxin producing S. pyogenes infections. Further prospective studies are needed.

Disclosures
Emily Heil, PharmD, MS, BCIDP, Nothing to disclose
1371. Identification of Risk Factors to Predict Gram negative bacteria in Patients with Upper Extremity Infections
Authors: Zhitomirsky Sophia , Sy Hendrik , Yassin Arsheena , Stavropoulos Christine , Farkas Andras 
Published: December 2021

Abstract

Background
Gram negative bacteria (GNB) have been identified as a cause of upper extremity infections and empiric treatment directed to both gram positive and negative organisms is often recommended. Risk-based approaches to establish need for gram-negative coverage may help to minimize unnecessary drug exposure, but further information on such methods are currently lacking. The aim of this study was to identify risk factors associated with the isolation of GNB in patients with upper extremity infections.

Methods
We reviewed records of patients with upper extremity infections treated in two urban hospitals between March 2018 and July 2020. Prosthetic joint infections were excluded. Baseline demographic, clinical, surgical and microbiology data was collected. Multivariable logistic regression models were screened using Akaike Information Criterion to establish the best model and risk factors associated with isolation of a GNB.

Results
We identified 111 patients, the majority of whom were male with frequent history of IV drug use. Deep wound cultures in 30 (33.3%) individuals yielded a GNB, and 80% of these cases were polymicrobial. Among the GNB, most prevalent were Enterobacterales (10.4%), HACEK group (6.39%), and Pseudomonas spp. (4.5%) (Tables 1. and 2.). Infections were mostly limited to the soft tissue structures of the hand and the forearm, with involvements of the joint and bone being second and third most common. The final model identified the use of IV medications (OR 4.14, 95% CI 1.3 - 14.46) together with prior surgery at the site of infection within the last year (OR 5.56, 95% CI 1.06 - 30.98), and having an open wound on presentation (OR 3.03, 95% CI 1.04 - 9.47) as factors independently associated with isolation of a GNB (Table 3). AUROC of 0.702 indicates acceptable model discrimination.
Table 1: Baseline characteristics

Table 2: Bacterial isolates

Table 3: Final model

Conclusion
Our logistic regression model identified significant predictors for isolation of GNB in upper extremity infections within this population. Results of this study will assist clinicians in making a better informed decision for the need of empiric gram negative coverage aimed to support the reduction of patient exposure to unnecessary antimicrobial coverage. External validation of the model is warranted prior to application to clinical care.
Figure 1: AUROC

Disclosures
All Authors: No reported disclosures
1375. Professional Status of Infectious Disease Specialists in Korea: A Nationwide Cross-sectional Study
Authors: Kim Bongyoung , Eun Byung Wook , Lee Eunjung , Kim Tae Hyong , Park Suyeon , Park Se Yoon 
Published: December 2021

Abstract

Background
Emergence of more antimicrobial-resistant pathogens and repeated occurrence of infectious disease (ID) outbreaks highlight the importance of ID specialists. This study aimed to assess the working status of ID specialists and identify problems faced by ID professionals in Korea.

Methods
An online-based survey was conducted over 11 days (from December 17–27, 2020), targeting all active adult (n=281) and pediatric (n=71) ID specialists in Korea (total=352). An online-based survey link was forwarded to them via text messages and e-mails by the office of the Korean Society of Infectious Diseases and the Korean Society of Pediatric Infectious Diseases. Questions regarding the practice areas of the specialists were divided into five categories: (1) clinical practices of outpatient care, inpatient care, and consultations; (2) infection control; (3) antibiotic stewardship; (4) research; and (5) education and training. We investigated the weekly time-use patterns for these areas of practice.

Results
A total of 144/281 (51.2%) adult ID specialists and 51/71 (71.8%) pediatric ID specialists participated in the survey. Among them, 144 (73.8%) respondents were involved in all practice categories investigated. The most common practice area was outpatient service (93.8%), followed by consultation (91.3%) and inpatient service (87.7%)(Table 1). Specialists worked a median of 57 (interquartile range: 50–65) hours weekly: patient care, 29 (14–37) hours; research 11 (5–19) hours; infection control 4 (2–10) hours; antibiotic stewardship, 3 (1–5) hours; and education/training, 2 (2–6) hours (Table 2).

Conclusion
We identified areas of practice and patterns of time use among adult and pediatric ID specialists in Korea. Most experts were in charge of all necessary areas (including treatment, education, research, infection control, and antibiotic stewardship) in medical institutions with limited resources. It is expected that these problems can be solved by appropriately compensating individuals and medical institutions for their invisible activities (including infection control and antibiotic stewardship) and by securing additional human resources.

Disclosures
All Authors: No reported disclosures
1376. Cryptococcal Infection Presenting Solely as a Pleural Effusion
Authors: Alpizar-Rivas Rodolfo M , Chuang Sally , Gupta Purba 
Published: December 2021

Abstract

Background
Cryptococcal infections are frequently seen in immunosuppressed hosts. To date, few cases of cryptococcal infections presenting solely as pleural effusion have been described in liver transplant recipients. To our knowledge, this is the first case of cryptococcal pleuritis presenting with acute respiratory failure early post liver transplant.

Methods
51- year old male with non- alcoholic cirrhosis complicated by chronic right hydrothorax underwent deceased donor liver transplantation with methylprednisolone induction. A week later, he developed acute respiratory failure requiring intubation. Pleural fluid was exudative with lymphocyte predominance; aerobic culture grew C. neoformans. Serum cryptococcal antigen was initially negative (prozone phenomenon was excluded) and subsequently turned positive titer 1:16. He was started on liposomal amphotericin and flucytosine, but developed acute kidney injury; induction therapy was changed to fluconazole with flucytosine for 2 weeks followed by fluconazole consolidation for 8 weeks. He remains on maintenance therapy. Donor serum cryptococcal antigen was negative, and recipients of other organs from the donor were clinically well.

Results
Pleural effusions are common in cirrhotic patients with ascites from hepatic hydrothorax. Although rare, Cryptococcal infection can manifest as isolated pleural effusion. Our patient was diagnosed with Cryptococcal empyema early post-transplant, though likely had subclinical or latent infection pre-transplant; evaluation for donor-derived infection was negative. Diagnosis of isolated pleural disease may be missed if only serum Cryptococcal antigen is tested, as antigen may not be detectable. Diagnosis is mainly established by pleural fluid culture and may be delayed, as pleural fluid is not routinely cultured when effusions are attributed to hepatic hydrothorax. Cryptococcal antigen in the pleural fluid may have a better diagnostic yield.

Conclusion
Cryptococcal infection should be considered in patients with cirrhosis and liver transplant recipients presenting with pleural effusion without any other abnormalities on chest imaging. Diagnosis may be missed if only serum cryptococcal antigen is used.

Disclosures
All Authors: No reported disclosures
1377. Impact of Pre-Transplant Infectious Diseases Wellness Visit on Vaccine Uptake in Solid Organ Transplant Candidates
Authors: Parraga Tommy J , McCorquodale Jennifer , Greenlee Sage , Osborn Zachary , Hanna Zachary W , Williams Jonathan D , Lanfranco Odaliz Abreu , Mayur Ramesh , Alangaden George J 
Published: December 2021

Abstract

Background
Despite published guidelines, vaccine uptake in solid organ transplant candidates (SOTc) remains suboptimal. We established an Infectious Disease pre-transplant clinic (IDPT) to perform a wellness visit for all SOTc. The visit was conducted by a nurse practitioner (NP) primarily and included pre-transplant assessment and optimization of vaccinations. We report the preliminary results of this pilot project on vaccine uptake in SOTc.

Methods
Retrospective review was done on all SOTc referred to the IDPT from January 2020 to February 2021 at Henry Ford Transplant Institute in Detroit, MI. SOTc were patients listed for different types of transplants. Sociodemographic data, comorbidities, vaccination status for influenza, pneumococcus, hepatitis B, Tdap, Td, and varicella zoster were assessed from electronic medical records and the Michigan Care Improvement Registry that includes vaccination records. Follow up was at least 3 months after IDPT visit. Binomial analysis was performed comparing vaccine uptake in a previous institutional cohort of 530 SOTc from January 2015 to December 2016 in which there was no IDPT visit. Data was analyzed using EpiInfo ver. 7.2.4.0.

Results
A total of 183 SOTc were evaluated in IDPT. Baseline characteristics are shown in Table 1. Median age was 57 years, mean Charlson Comorbidity Index was 4.1. Majority of IDPT visits were done by the NP and most were video visits given the COVID-19 pandemic. Vaccine uptake improved post IDPT for all vaccines and most notably for hepatitis B, varicella zoster and pneumococcal 13V vaccines (Table 2). Of the SOTc, 38 (20.8%) received their vaccines during the IDPT visit or shortly after. Compared to the prior cohort, all vaccines rates improved with the post IDPT visit (p&lt; 0.001) (Table 3).

IDPT and vaccines - ID week 2021 - Table 1

IDPT and vaccines - ID week 2021 - Table 2

IDPT and vaccines - ID week 2021 - Table 3

Conclusion
IDPT clinic visits significantly improved vaccine uptake in SOTc at our institution. Approximately one in five SOTc had vaccines administered at the time of IDPT visit or shortly after. Implementation of an Infectious Diseases wellness visit as a requirement for all SOTc can provide opportunities to greatly optimize vaccine completion before transplantation.

Disclosures
All Authors: No reported disclosures
1378. Impact of Cytomegalovirus Prophylaxis on Clinical Outcomes in Kidney Transplantation: A United States Renal Data System-Medicare Linked Database Study
Authors: Raval Amit D , Ganz Michael , Saravanan Priya , Tang Yuexin , Santos Carlos 
Published: December 2021

Abstract

Background
Guidelines recommends cytomegalovirus (CMV) prophylaxis by CMV serostatus/risk status, as the currently available antiviral agents may lead to myelosuppressive events in kidney transplant recipients (KTRs). Limited data exist for the United States (US) on the such clinical outcomes with CMV prophylaxis KTRs especially stratified by CMV risk strata. We examined the associations between clinical outcomes and CMV prophylaxis among adult KTRs stratified by CMV risk strata.

Methods
We employed a retrospective cohort design using the US Renal Data System registry-linked Medicare data (2011-2017). The cohort included 22,918 adult KTRs with continuous Medicare Part A & B coverage for ≥ 6-month pre and ≥ 12-month post KT and Part D coverage for ≥ 12-month post- KT. CMV prophylaxis was defined as ≥ 1 prescription fill or medical claim for valacyclovir or valganciclovir at prophylaxis doses within 28 days post-KT.

Results
CMV prophylaxis was utilized by 75% of the cohort. In no CMV prophylaxis group, 52.2% and 34.2% of high and intermediate risk KTRs received valganciclovir (as either pre-emptive or deferred therapy), respectively. Among high risk KTRs, CMV prophylaxis group had significantly lower proportions of KTRs with CMV infection, opportunistic infections (OIs) including bacterial, and fungal infections, and new onset of diabetes mellitus (NODAT) compared to no prophylaxis group. There were no differences in the rates of acute rejection or death; however, a trend towards lower rate of graft-failure at 12-month post-KT. Nearly 40% of high-risk KTRs had myelosuppressive events (leukopenia: 18%; neutropenia:15% thrombocytopenia :19%); however, their differences were non-significant except for thrombocytopenia by CMV prophylaxis status (Table 1). CMV infection and myelosuppressive event rates were higher in high-risk than intermediate/low risk KTRs irrespective of CMV prophylaxis status.

Conclusion
CMV prophylaxis was associated with lower rates of CMV infection, OIs, NODAT and graft failure compared to no prophylaxis, however, the burden of CMV infection, OIs and myelosuppression was greater in high-risk KTRs indicating further research is needed on factors associated with greater disease burden in high-risk KTRs.

Table 1

Disclosures
Amit D. Raval, PhD, Merck and Co., Inc. (Employee) Yuexin Tang, PhD, JnJ (Other Financial or Material Support, Spouse’s employment)Merck & Co., Inc. (Employee, Shareholder)
1379. Vaccination Rates among Liver Transplant Recipients at a Tertiary Care Hospital in Newark, NJ
Authors: Varughese Tilly , Song Michael , Sackey Joachim 
Published: December 2021

Abstract

Background
Transplant candidates and recipients are at increased risk of infectious complications of vaccine-preventable diseases due to their longstanding immunosuppressive regimens. We assessed the rates of vaccination in our liver transplant patients at University Hospital (UH) in Newark, NJ.

Methods
Retrospective chart-review including patients &gt; 18 years old who underwent liver transplantation at UH for a 3-year period from 01/01/2017 to 07/20/2020. Data collected included demographics, clinical outcomes, eligibility and receipt of vaccinations before and after transplantation, protection titers after administration of hepatitis vaccinations and presence of an ID outpatient consultation. We looked at the following receipt of vaccinations: Prevnar-13, Pneumovax-23, Influenza, TDaP, Shingrix, Varivax, Havrix and Engerix/Heplisav. Characteristics of study participants was analyzed using descriptive statistics and Chi-Square/Fisher’s Exact tests were used to test associations.

Results
119 unique medical charts were reviewed and no patients were excluded. Of those patients who were eligible to receive Hepatitis A vaccination, only 44.8% were documented to receive vaccination and of those eligible to receive Hepatitis B vaccination, only 47.8% received it. Influenza vaccination pre-transplantation was 46% and 66.1% in post-transplant recipients. For the other vaccinations, during the pre-transplant period, 17.6 % of patients received Prevnar-13, 36.1% Pneumovax-23 and 20.2% TDaP and 26.1% received Shingrix. Patients who had ID consultation were significantly more likely to receive appropriate Hepatitis A and Hepatitis B vaccinations (p values 0.026 and 0.005).

Conclusion
We are not meeting national vaccination standards set by the American Society of Transplantation (AST) for optimal vaccination in this population. Our study can inform of possible solutions to increase vaccination rates in this population such as the simple addition of a smartphrase within EMR notes to remind providers to order appropriate vaccinations and eventually, a more long term solution of creation of a dedicated vaccination clinic and/or routine ID pre-transplant evaluations for all transplant candidates.

Disclosures
All Authors: No reported disclosures
1380. Real-world Effectiveness and Complications of Valganciclovir (VGC) Prophylaxis for Kidney Transplant (KT) Recipients at High Risk for Cytomegalovirus (CMV) infection (CMV Donor (D)+/Recipient (R)-)
Authors: Roumpz Caroline G , Kohl Josh , Hughes Kailey L , Raval Amit D , Tang Yuexin , Clancy Cornelius J , Nguyen Minh-Hong 
Published: December 2021

Abstract

Background
CMV infection is common post-kidney transplant (KT). Valganciclovir (VGC) prophylaxis (Px) has lessened CMV infection among high-risk (CMV D+/R-) KT recipients (KTRs), but VGC can induce neutropenia. We quantified the burden of CMV infection among CMV D+/R- KTRs and healthcare resources required to manage these patients (pts).

Methods
Retrospective study of pts undergoing KT between Jan 2014-Dec 2018. Study and control groups (gps) were CMV D+/R- and R+ KTRs, respectively. Standard post-KT immunosuppression was tacrolimus and mycophenolate mofetil (MMF). D+/R- and R+ KTRs received VGC Px (900 mg/day) for 6 and 3 months (mos), respectively.

Results
Clinical characteristics did not differ between D+/R- (n=131) and R+ (n=140) pts. Median VGC Px duration was longer for D+/R- (183 vs 104 days, p&lt; .01). Within the first 6 mos post KT, a higher proportion of D+/R- KTRs received ≥1-course of granulocyte-stimulating factor (G-CSF) (15% vs 6%, p=.02). VGC Px was stopped prematurely/intermittently in 20% and 10% of D+/R- and R+, respectively, due to neutropenia (p=0.02); corresponding data for stopping MMF for ≥1 mos were 32% and 21% (p=.05). 50% of D+/R- pts received &lt; 3 mos Px. Leukopenia prompted hospitalization in 3% of D+/R- vs 0% of R+ pts (p=.05). CMV infections did not differ between gps (7% vs 6%, p=.80); however, VGC-resistant CMV was higher in D+/R- gp (3% vs 0%, p=.05). Between 6-12 mos post-KT, D+/R- KTRs had higher rates of CMV infection (24% vs 4%,p&lt; .01), VGC resistance (5% vs 0%, p=.01), hospitalization due to CMV (11% vs 2%, p=.01), MD intervention (22% vs 2%,p&lt; .01), and infectious disease (ID) referral (8% vs 2%,p= .04). 57% of CMV resistance was observed in pts who prematurely stopped VGC. Hospitalizations were longer for CMV infections in D+/R- KTRs (8 vs 1 d, p&lt; .01). There was a trend toward higher rejection for D+/R- KTRs (13% vs 6%, p=.09).

Conclusion
Universal VGC Px in D+/R- KTR remains challenging and requires significant resources for monitoring and intervention for neutropenia, including MD involvement and ID referral. Intermittent/premature stop of VGC may have led to VGC-resistant CMV,and stop of MMF may have led to a trend of higher cellular rejection at 1 yr. There is critical need for new CMV agents with a better safety profile.

Disclosures
Amit D. Raval, PhD, Merck and Co., Inc. (Employee) Yuexin Tang, PhD, JnJ (Other Financial or Material Support, Spouse’s employment)Merck & Co., Inc. (Employee, Shareholder) Cornelius J. Clancy, MD, Merck (Grant/Research Support) Minh-Hong Nguyen, MD, Merck (Grant/Research Support)
1382. A Prospective Epidemiological Study BK Polyomavirus DNAuria and DNAemia within the First Year after Kidney Transplantation
Authors: Mongkolrattanakul Pannawat , Bruminhent Jackrapong , Siripoon Tanaya , Wiwattanathum Punlop , Worawichawong Suchin , Kantachuvesiri Susarak 
Published: December 2021

Abstract

Background
Screening and early detection for the preceding BK polyomavirus (BKV) DNAuria and DNAemia to prevent the occurrence of BK polyomavirus BKV-associated nephropathy (BKPyVAN) among kidney transplant (KT) recipients has not been universally utilized and never assessed in a setting where the resource is limited. Therefore, we aimed to investigate this entity’s incidence, risk factors, and outcome with this intervention at our institution.

Methods
A prospective study of KT recipients at a tertiary care transplant center in Bangkok, Thailand, was conducted between January 2019 and March 2020. All patients underwent preemptive monitoring of urine and plasma BKV DNA load, measured by quantitative real-time PCR at 1, 2, 3, 6, 9, and 12 months post-KT. Low- and high-level BKV DNAuria was defined as urine BKV DNA load of &lt; and &gt; 7log10 copies/mL, respectively. Low- and high-level BKV DNAemia was defined as plasma BKV DNA load of &lt; and &gt; 4log10 copies/mL, respectively. The incidences were calculated by Kaplan-Meier analysis. The chi-square or student’s T-test compared clinical characteristics between those with and without high-level BKV DNAuria as appropriate. Risk factors of high-level BKV DNAuria were analyzed using Cox proportional hazard model.

Results
Among 99 evaluable KT recipients, a mean (SD) age was 42 (11) years, 64.6% were male, and 69.6% received an induction immunosuppressive therapy. Within 12 months post-KT, the incidences of low-level BKV DNAuria, high-level BKV DNAuria, low-level BKV DNAemia, and high-level BKV DNAemia were 22.63%, 13.14%, 9.49%, and 5.11%, respectively. High panel reactive antibody (PRA) was associated with high-level BKV DNAuria at 6 and 12 months, (HR 1.02 [95% CI (1.00-1.04)], P=0.019) and (HR 1.02 [95% CI (1.00-1.04)], P=0.023), respectively. Underlying diabetes mellitus was associated with high-level BKV DNAuria (HR 3.49 [95% CI (1.28-9.51)], P=0.015) at six months; however, not at 12 months. There was no allograft rejection directly related to a reduction of immunosuppression for BKV infection observed.

Conclusion
BKPyV infection is also prevalent among KT recipients in a resource-limited setting, however, without unfavorable consequence. Those with high-level PRA and underlying diabetes could be at risk of high-level BKV DNAuria after KT.

Disclosures
All Authors: No reported disclosures