bluuebunny/crossref_metadata_2025_split huggingface dataset:
903. A Real-world Study Assessing the Risk of Lipid Changes and Other Metabolic Effects Associated with Integrase Inhibitor-based Antiretroviral Therapy
Authors: Gruss Zachary , Stone Tyler , Johnson James , Morse Caryn , Williamson John 
Published: December 2021

Abstract

Background
Integrase inhibitor (INSTI)-based antiretroviral therapies (ART) are first-line for HIV infection. Recent studies have identified metabolic complications of INSTI regimens, especially when TAF is included. The objective of this study was to assess lipid changes associated with INSTI-based ART.

Methods
This was a retrospective, observational, single-center study. Patients age ≥ 18 with HIV infection, receiving care Jan 2004 to Jul 2019, and prescribed the same ART for ≥ 6 consecutive months were randomly selected from a computer-generated list. Unique ART regimens prescribed per patient were considered “exposures”. Patients were followed up to 2 years per exposure. INSTI-based exposures included an INSTI plus one or more NRTI. Non-INSTI-based exposures included a PI or NNRTI plus one or more NRTI. Lipid panel results were recorded before and during exposures. Lipid changes with INSTI and non-INSTI exposures were compared. Other metabolic outcomes were recorded.

Results
192 exposures were identified (99 INSTI, 93 non-INSTI) among 132 patients. The majority were Black (69.3%) and male (61.9%). Mean age and BMI were 42.0 ± 11.3 and 26.2 ± 5.5 kg/m2, respectively. 72 (37.5%) were ART-naïve. 53.5% INSTI recipients received BIC or DTG. Hypertriglyceridemia (HTG) occurred more often during INSTI exposures (13.1% vs 4.3%; p = 0.031). Mean change in TG concentration was +10.1 and -15.0 mg/dL for INSTI and non-INSTI regimens, respectively (p = 0.105). Patients receiving INSTIs were more commonly prescribed a new lipid-lowering therapy (LLT) or an increase in dose of preexisting LLT (14.1% vs 2.2%; p = 0.003). Of those that received an INSTI-regimen and either TAF, TDF, or no tenofovir, 17.4%, 10.3%, and 8.3% developed HTG, respectively (p = 0.49). There was no difference between groups in HDL or LDL changes. Among INSTI and non-INSTI groups, weight increased by +3.8 and +2.1 kg, respectively (p = 0.129). Mean weight change was less in INSTI recipients whose regimen included TDF (+1.4 vs +4.8 kg; p = 0.053).

Conclusion
Treatment with INSTI-based ART was associated with HTG. LLTs were utilized more often among INSTI recipients, and this limited our ability to fully characterize lipid changes in this real-world study. Weight gain among INSTI recipients may be attenuated if TDF is included in the regimen.

Disclosures
James Johnson, PharmD, FLGT (Shareholder) Caryn Morse, MD, Chimerix (Scientific Research Study Investigator)Covis Pharma (Scientific Research Study Investigator)Gilead Sciences Inc. (Scientific Research Study Investigator)Ridgeback Biotherapeutics (Scientific Research Study Investigator)Roche (Scientific Research Study Investigator)SCYNEXIS, Inc. (Scientific Research Study Investigator)Theratechnologies (Advisor or Review Panel member)Viiv (Advisor or Review Panel member)
913. Re-engagement using Historical Hepatitis C Antibody Results: Is it Worth the Effort?
Authors: Osborne William , Sheikh Noorann , Botterill Gemma , Bufton Sally , Mutimer David , Tahir Mamoona , Atabani Sowsan F 
Published: December 2021

Abstract

Background
The World Health Organisation aim to eliminate hepatitis C (HCV) as a public health concern by 2030. One aspect of Public Health England’s (PHE) strategy to meet this target is to use historical surveillance data of anti-HCV positive patients identified by PHE to re-engage with offers of PCR testing and treatment if RNA-positive. Operational Delivery Networks (ODN) are responsible for enacting this initiative across 22 regions in England. We present an interim analysis and evaluation of the effectiveness of using this data to re-engage HCV-infected persons in the West Midlands ODN of England.

Methods
A dataset of historical anti-HCV positive antibody patients provided to the West Midlands ODN by PHE was cross-referenced with HCV RNA data from 01/01/1996 to 01/01/2019 from 5 regional laboratories and regional treatment databases. If HCV RNA positive, letters were sent to the general practitioner and to the patient to invite them for further testing and, if necessary, treatment to achieve SVR. This received no additional funding or support and occurred in addition to the routine clinical workload.

Results
From a dataset of 4,540 anti-HCV antibody results, 31.7% (n=1,440) had a PCR result: 48.1% (n=693) were PCR positive for HCV RNA with no evidence of cure. 693 letters were sent to GPs from Oct 2019 to Feb 2020 with responses from 14.2% (n=99). From July to Oct 2020 only 212 patient letters were sent (due to significant interruption due to the COVID-19 pandemic) and 11.3% (n=24) replied by May 2021. 17 presented for PCR testing and 4 were found to be viraemic. To date, one patient has achieved SVR and three have completed treatment awaiting SVR.
Re-Engagement Process

Flow diagram of re-engagement of patients with historical antibody-positive results for hepatitis C virus. * Of the 17 deemed not suitable to contact by the GP: 4 treated elsewhere, 3 had negative PCR elsewhere, 1 was unknown reason, 2 were under care of another hospital, 7 had died

Conclusion
The use of historical anti-HCV antibody results to re-engage people into testing and treatment for hepatitis C in this format is low yield. Rollout was limited by ongoing clinical work and the COVID-19 pandemic. Dedicated time and resources with a less restrictive cohort might improve yields.

Disclosures
All Authors: No reported disclosures
921. Acute HAV Infection in an Inpatient Psychiatry Unit
Authors: Weston Gregory , Boland-Reardon Carmel , Rhoden Renee , Ogbonna Rose , Sirichand Surksha , Gendlina Inessa , Gendlina Inessa , Corpuz Marilou 
Published: December 2021

Abstract

Background
The incidence of hepatitis A virus (HAV) infection has been rising in the US since 2016, and in New York State since 2019. New York City has also seen an increase of HAV infection among high risk populations. We present a case of acute HAV infection in an inpatient psychiatry unit which has its own unique isolation and management challenges.

Methods
A patient was admitted on 3/21/21 from a group home. He developed abdominal pain, diarrhea and vomiting on 4/15, with elevated liver function tests (LFT). He was transferred to Medicine on 4/17 and HAV IgM and IgG resulted positive on 4/18. Visitation to the unit has been halted for over a year, and no outside food has been allowed. The patient has not been observed to have any sexual exposure to others.

Investigation
Exposure window: 15 days prior to start of symptoms. Patients in the unit were screened for symptoms, tested for HAV IgM/IgG, LFTs. Discharged patients were contacted and referred straight for vaccination (difficult to have multiple visits). Staff members with contact to the unit were screened, via email and phone calls. If no previous vaccination and there was presence of exposure or symptoms, staff were referred to Occupational Health Services (OHS). Other Measures: The unit was terminally cleaned and daily enhanced cleaning with bleach ensued. Daily assessment of patients and staff for symptoms. Admissions were held for 2 days until all the patients were tested and given vaccine. Further admissions were screened for HAV.

Results
32 inpatients screened. One patient was positive for HAV IgM, but was asymptomatic with normal LFTs. On investigation, patient had acute hepatitis in February 2021. Patients with no immunity were vaccinated. Two immunocompromised patients were also given HAV immunoglobulin. On chart review, 6 out of 29 discharged patients had evidence of immunity. 133 staff were screened and 54 referred to OHS (see table).
Exposure Investigation

Conclusion
As evident with numerous COVID outbreaks in inpatient Psychiatry units, communicable diseases are difficult to control. Patients are in an interactive communal setting and participate in group sessions. For better care and safety of patients and staff, our unit will screen and offer HAV vaccine to new admissions.

Disclosures
Gregory Weston, MD MSCR, Allergan (Grant/Research Support) Inessa Gendlina, Nothing to disclose
938. Azole Resistant Aspergillus Species in Lung Transplant Recipients: A 10 Year Experience
Authors: Marschalk Nicholas A , Samanta Palash , Kwak Eun Jeong , Nguyen Minh-Hong 
Published: December 2021

Abstract

Background
Invasive aspergillosis (IA) causes significant morbidity and mortality in lung transplant (LTx) recipients. Antifungal resistance in Aspergillus species is on the rise globally with specific concern in Europe related to the TR34/L98H mutation in the cyp51A enzyme that induces pan-azole resistance. Azole exposure is a known risk factor for development of resistant Aspergillus, but this is less well described in LTx population.

Methods
We reviewed the electronic medical records of LTx patients with respiratory cultures positive for Aspergillus species known to be inherently resistant or any Aspergillus species tested to be resistant to one or more triazole from 2010 to 2019. For available isolates, Sanger sequencing was performed on cyp51A with primers targeting the promoter region and 3 known hotspot areas.

Results
Twenty eight patients met inclusion criteria and 2.7% (28/1026) Aspergillus isolates were azole-resistant during study period (Figure 1). Median time from LTx to resistant Aspergillus growth was 196 days (range 14 - 3146). There was a cluster of positive cultures within 1-year post-Tx period (13/28). Azole exposure varied, from 7 to 2443 days (median 128). There was no change in incidence over the study period. The most common species was Aspergillus calidoustus (Figure 2). Twenty cases were deemed colonization, vs 5 probable IFI and 3 proven IFI. Mortality of IFI with resistant Aspergillus was 38% (3/8), higher than azole-susceptible IA (p=0.05). Twelve isolates were available for sequencing; none carried TR34/L98H mutation. There was wide variation in mutations, ranging from 1 to 12 point mutations in the cyp51 enzyme, many of them SNPs previously described as engendering an azole resistant phenotype (Figure 3).
Aspergillosis-free Survival by Resistant and Susceptible Isolates

Development of azole-resistant aspergillus colonization/infection was rare relative to common occurrence of colonization/infection with susceptible isolates in the lung transplant recipient population
Azole Resistant Aspergillus Species Isolated from Lung Transplant Recipients

The most commonly isolated species were A. calidoustus and ustus. Only 4/28 isolates were A. fumigatus.
Azole Resistant Aspergillus Genotypic Analysis

Sequenced isolates showed wide variability in point mutations. M220V, G54, and G448 were the only mutations observed more than once. 3 isolates were wild type.

Conclusion
Azole resistant Aspergillus infections remain an uncommon problem in LTx. The majority of isolates were deemed colonization, but mortality was high when IFI was present. Most isolates had mutations within the hot spot regions of cyp51A known to induce azole resistance. There were no TR34/L98H mutants found in our patient population.

Disclosures
Minh-Hong Nguyen, MD, Merck (Grant/Research Support)
114. Prospective Trial of Passive Diversion Device to Reduce Blood Culture Contamination
Authors: Arnaout Sami , Ellison Richard T , Greenough Thomas C , Wedig Azalea , Mitchell Michael J , John Lauren St , Stock Shannon 
Published: December 2021

Abstract

Background
Blood culture contaminants can lead to inappropriate antibiotic use, prolonged length of stay, and additional hospital costs. Several devices have been developed to reduce the risk of blood culture contamination by diverting a portion of the initial blood sample from the blood culture bottle. We have assessed the effectiveness of one blood diversion device in a prospective trial performed at the two separate emergency departments (EDs) of a three-campus Academic Medical Center.

Methods
A multi-phase prospective crossover trial was performed with the blood diversion device initially in use at one ED (Memorial) and standard equipment at the other ED (University) for 10 weeks. After a washout phase, a second 10-week study phase used the blood diversion device in the other ED (University) and standard equipment at the first ED (Memorial). Contaminants were identified by the clinical microbiology lab using standard criteria, and further defined by independent retrospective review by 3 infectious disease physicians prior to statistical analysis. An intention-to-treat analysis was performed, and Chi-square tests were used to compare contaminant rates among samples obtained using the blood diversion device versus standard equipment.

Results
5,675 blood samples were obtained with 5,661 samples analyzed after 14 were deemed inconclusive by the ID physician review. There were 1,719 samples obtained at Memorial ED and 3,942 at University ED, with 2,836 samples collected during diversion device periods and 2,825 during standard equipment periods. Based on the ID physician review, the contaminant rates were 1.9% in diversion device periods versus 2.9% in standard equipment periods (P = 0.018). There was a marked difference in blood culture contamination rates between the two EDs with contaminant rates at the Memorial ED of 1.1% and 1.4% (P=0.57), and at the University ED of 2.3% and 3.5% (P=0.024) for the diversion device and standard equipment periods, respectively.

Conclusion
The blood diversion device was able to significantly lower blood culture contamination rates overall by 1% at the institution’s two EDs (34% relative reduction), with a stronger effect noted at the campus with both a level 1 trauma center and transplant programs.

Disclosures
All Authors: No reported disclosures
948. Ventricular Assist Device Infection due to Non-tuberculous Mycobacteria Leading to Successful Heart Transplantation: A Case Report and Literature Review
Authors: Saldana Carlos s , Rehm Susan J , Rehm Susan J , Koval Christine E , Unai Shinya , Tong Zhen-Yu (Michael) 
Published: December 2021

Abstract

Background
A 59-year-old man with acute myelogenous leukemia and matched allogeneic hematopoietic stem-cell transplant and non-ischemic cardiomyopathy requiring a left ventricular assist device (LVAD; HeartMate II™) was admitted after the spontaneous rupture of an abdominal fistula in his lower abdomen, and cloudy discharge from the driveline (DL) exit site for months. Figure 1 Denied systemic symptoms but had leukocytosis. CT scan of the abdomen revealed soft tissue enhancement around the LVAD DL Figure 2. Cultures from DL discharge grew Mycobacterium chelonae. He underwent incision and drainage (I&D) of the abdominal fistula, with unroofing of the tissue over the DL. Antimicrobial course is summarized in Table. He was thought to be an appropriate heart transplant candidate one month later. Cultures from the LVAD sites were negative. He completed antimicrobials for 10 weeks after transplant. 32 months after heart transplant he has no signs of M. chelonae infection.

Figure 1. Driveline exit site with scant cloudy discharge and a shallow 3 x 2-centimeter open lesion inferior to the umbilicus. Driveline track in dotted line.

Figure 2. CT scan of the abdomen revealed soft tissue enhancement (red arrows) around the LVAD driveline in the lower abdomen.

Methods
We performed a literature review of all published cases involving Non-Tuberculous Mycobacteria (NTM) and LVADs. Collected: date, sex and age, onset, organism, type of LVAD, transplant, surgical debridement, antimicrobials, outcome.

Results
A total of 11 patients with LVAD infection due to NTM have been described in the literature. Four cases of NTM LVAD infection culminated in heart transplantation. Cases are summarized in Table 1. All transplanted cases had an indolent presentation and driveline discharge, without systemic symptoms. All underwent I&D and/or de-roofing of the driveline and were treated with at least two active antimicrobials for an extended course ranging from 4 months and up to 17 months after transplant. All cases did well from the infection standpoint. One died within 12 months from transplant rejection.

Conclusion
Treatment with a combination with at least two active agents is recommended and continued for many months. Effective surgical debridement of affected tissue and unroofing of the driveline beyond the affected velour, along with the removal of the infected device at the time of cardiac transplant, is key to success.

Disclosures
Susan J. Rehm, MD, Lilly (Individual(s) Involved: Self): Shareholder; Merck (Individual(s) Involved: Self): Shareholder; Pfizer (Individual(s) Involved: Self): Shareholder
966. ID Fellows Cup: Leveraging Gamification and Social Media to Enhance Clinical Infectious Diseases Education
Authors: Herrera Lauren Nicholas , Nolan Nathan , Chavez Miguel A , Kahn Mauricio J , Cleveland John D , McCarty Todd P , Escota Gerome , Kulkarni Prathit A , Patel Mukesh , Rodriguez Jorge M , Hunsinger Hillary P , Dempsey Donald , Willig James , Walker Jeremey 
Published: December 2021

Abstract

Background
We hypothesized that we could leverage social media to recruit learners to a gamification-infused ID knowledge competition, and entice them to explore additional online educational resources.

Methods
We created the ID Fellows Cup, a knowledge-based trivia competition, to engage Infectious Diseases fellows. The game was crafted via Kaizen-Education, a software platform developed at the University of Alabama at Birmingham, that uses gamification to engage learners. Multiple choice questions including figures and/or text are presented to learners, followed by detailed teaching explanations. 60 questions emphasizing high-yield concepts were delivered over 4 weeks. Questions were written by fellows and reviewed by faculty at three programs. Elements of gamification (virtual rewards, leaderboards, etc.) were included to enhance engagement. Recruitment strategies included Twitter, program director emails, and peer-to-peer. We measured game statistics and participation. Learners were invited to complete a post-game survey about their experience.

Results
Table 1 shows our game statistics with broad geographic reach including 42 programs. Most fellows matriculated in 2019 or 2020; the number of US ID fellows equaled 17% of those completing ID in-training exam. Recruitment sources included 44% co-fellow, 42% Twitter, and 15% Program Director. Through 20 days with questions, we had 155 daily average users. Overall, fellows answered 11,419 total questions, representing 89% of all released questions. Of 103 responses to post-game survey (table 2) 97% would participate again and all felt the game was a good use of their time. Over 80% of participants reported some engagement with linked resources included in the answer explanations. In general, 78% felt engagement with online resources increased subsequent to participating in the game, including learning about at least one new online resource.

Conclusion
We leveraged social media and gamification to effectively engage, and stimulate ID learners to explore additional online educational resources. Technology enriched learning, helps supplement and globalize ID education, making it as diverse and engaging as our field.

Disclosures
Todd P. McCarty, MD, Cidara (Grant/Research Support)GenMark (Grant/Research Support, Other Financial or Material Support, Honoraria for Research Presentation)T2 Biosystems (Consultant) Prathit A. Kulkarni, M.D., Vessel Health, Inc. (Grant/Research Support)
975. Posaconzole for Treatment of Blastomycosis: An Academic Medical Center’s Experience
Authors: Baca Alec , Daniels Anne R , Sanchez Joyce L 
Published: December 2021

Abstract

Background
Blastomycosis is a serious environmentally acquired infection that is endemic to parts of North America. Treatment with antifungal agents is recommended for all patients with blastomycosis. Current guidelines recommend treatment with amphotericin B in severe disease and triazoles such as itraconazole, voriconazole, or fluconazole. All of these agents are known to have considerable toxicities. To date, only isolated case reports have been published describing the use of the newer, generally well-tolerated, posaconazole for this indication. Here we describe an academic medical center’s experience treating patients with blastomycosis in Wisconsin using posaconazole.

Methods
A retroactive chart review of electronic medical records was conducted of patients diagnosed with blastomycosis at Froedtert and The Medical College of Wisconsin. Nine blastomycosis patients were identified as being treated with posaconazole. Information was collected regarding patient demographics, comorbidities, risk factors, diagnostics, treatment history and clinical outcomes.

Results
The most common reasons for switching from itraconazole or voriconazole to posaconazole were adverse effects or inadequate triazole serum concentrations. Patients were relatively equal in gender and had an average age of 46 years old. All except one patient had an underlying immunocompromising condition, most commonly solid organ transplant. Two patients reported fatigue, weight gain, and memory problems after initiation of posaconazole. No patients had the drug discontinued due to adverse effects. Four patients were confirmed to be cured from blastomycosis, though some remained on long-term prophylactic therapy. Duration of treatment with posaconazole ranged from 1 to 60 months. Two patients died from causes unrelated to their infection or treatment.

Conclusion
Overall, the results of this study support posaconazole as a potential alternative to fluconazole, voriconazole, and fluconazole in the treatment of blastomycosis. Randomized controlled trials are needed to determine the efficacy and tolerability of posaconazole in comparison to other triazoles recommended in the current treatment guidelines.

Disclosures
All Authors: No reported disclosures