bluuebunny/crossref_metadata_2025_split huggingface dataset:
1303. Pelvic Acute Hematogenous Osteomyelitis in Children, from 2012-2020
Authors: Clemente Adriana Sarmiento , Chase McNeil J , Hulten Kristina G , Vallejo Jesus G , Kaplan Sheldon L 
Published: November 2023

Abstract

Background
Pelvic osteomyelitis has been reported to account for 1-11% of acute hematogenous osteomyelitis (AHO) cases in children. Higher complication rates and need for longer antibiotic courses have been suggested by experts, but recent data is lacking. In our retrospective study from 2012-2020, pelvis and tibia were the most frequent AHO sites (24.6% of cases each). We describe the clinical course of children admitted to Texas Children’s Hospital (TCH) with pelvic AHO.

Methods
A retrospective review of patients with diagnosis of AHO admitted to TCH from Jan. 2012 - Dec. 2020 was conducted. Patients 6 mo-&lt; 19 years-old and with ≤ 14 days of symptoms on admission were eligible. Patients with sickle cell disease or those immunocompromised were excluded. Wilcoxon rank sum test for continuous variables and Fisher’s exact for categorical variables were performed using STATA 17.

Results
103 cases of pelvic AHO were compared to 315 cases of non-pelvic AHO (Table 1). The pelvis areas involved were reviewed (Fig. 1). Fever was present in 91 cases of pelvis AHO (88.4%), localized pain in 78 (75.7%) and refusal to bear weight in 64 (62.1%). All patients with pelvic AHO had an abnormal C reactive protein ( &gt; 0.5 mg/dl).
Patients with pelvic AHO had overall similar microbiology (Fig. 2), length of stay and complication rates as non-pelvic AHO. Pelvic AHO patients had pyomyositis more often (29.1 vs 9.2%) and bone abscess less often (22.3 vs 46.3%). Need for bone debridement or bone abscess drainage was less common (17.5 vs 51.1%), but muscle abscess drainage (16.5 vs 5.1%) and percutaneous bone biopsy (22.3 vs 13.7%) were more common in pelvic AHO. 22 cases of pelvic AHO had bone biopsy only, leading to identification of etiology in 27% of them with no complications.
Patients were treated with antibiotics for a similar time (median 41 vs. 38 days). 21 patients with pelvic AHO (20.4%) were treated for ≤ 30 days with no complications (2 were lost to follow up).
Figure 1.
Percentage of each area of pelvic bone involved in patients with pelvic AHO. Patients may have more than one area involved.
Figure 2.
Causative organism recovery and etiology of pediatric cases with pelvic and non-pelvic acute hematogenous osteomyelitis, Texas Children’s Hospital 2012-2022.

Conclusion
Pelvic AHO in children may be more frequent than previously reported but is not associated with more chronic complications. MRI use can aid in the prompt identification of associated pyomyositis and timely intervention. A conservative approach of bone biopsy in cases with a small bone abscess and no pyomyositis should be considered. 4 weeks of therapy may be sufficient.

Disclosures
J. Chase McNeil, MD, Allergan: Grant/Research Support|Nabriva Therapeutics: Grant/Research Support Kristina G. Hulten, PhD, Pfizer: Grant/Research Support Sheldon L. Kaplan, MD, MeMed: Grant/Research Support|Pfizer: Grant/Research Support|Pfizer: Honoraria
1311. Mycoplasma and Ureaplasma Septic Arthritis - A Diagnostic Challenge
Authors: Murugan Lalithaa Thirunavukarasu , Cober Eric , Johnson Lucileia 
Published: November 2023

Abstract

Background
Mycoplasma and ureaplasma septic arthritis (MUSA) is difficult to diagnose as these usually require special media or polymerase chain reaction (PCR) to identify. Empiric antibiotics for septic arthritis do not cover these organisms, causing treatment delays. We aimed to study the characteristics and outcomes of patients with MUSA.

Methods
This is a retrospective review of patients (pts) with MUSA admitted to Cleveland Clinic from January 2005 to June 2022. We included pts, 18 years or older, with culture or PCR positive for mycoplasma or ureaplasma from joint tissue or synovial fluid (SF). 7 pts met inclusion criteria.

Results
Median age at diagnosis was 29 years (range 23 - 59). 4/7 pts were male. All had one or more underlying immunocompromising condition and received immunosuppressants within a year prior to diagnosis, 4/7 received rituximab. Immunoglobulin G levels were checked in 5/7 pts within a month around diagnosis, and 3/5 had a level below 500 mg/dl (reference range 717 - 1411).
It took a median of 54 days (range 3 - 402) from initial encounter concerning septic arthritis to diagnosis of MUSA. 5/7 had monoarticular MUSA. 4/7 had native joint arthritis and 3 had periprosthetic joint infection.
SF study closest to diagnosis had a median total nucleated cells of 126,000/µL (range 59 – 204,498), with median neutrophil of 86% (range 62 - 98). Diagnosis was made by culture and PCR in 5 and 2 pts, respectively. Median C- reactive protein around diagnosis was 10.5 mg/dl (range 1.5 - 29.7).
Of the 7 pts, 6 required surgical intervention, with 3 requiring multiple surgeries. Gross purulence was a hallmark intra-operative finding in all patients. 1 out of 7 pts was on indefinite doxycycline suppression. Another one died of advanced AIDS after 2 days of MUSA treatment. Remaining 5/7 received antibiotics for a median of 108 days (range 61 – 1027), of which 3 received dual antibiotics. Excluding the patient who died of AIDS, the remaining recovered completely without relapse during a minimum 4-year follow up.

Conclusion
To our knowledge, this is the largest case series of MUSA. All affected patients were immunocompromised, highlighting the need for high index of clinical suspicion in this population to avoid diagnostic delays. Although challenging to diagnose, it appears that MUSA can be effectively treated.

Disclosures
All Authors: No reported disclosures
1315. Clinical, Radiological and Serologic Characteristics of Patients with Subarachnoid Neurocysticercosis: A Large Series from a Single Center in New York City
Authors: Berto Cesar G , Sacchi Robert , Levitt Alexander , O’Connell Elise , Coyle Christina 
Published: November 2023

Abstract

Background
Subarachnoid neurocysticercosis (SANCC) is the most severe and difficult-to-treat form of neurocysticercosis (NCC).

Methods
We describe the clinical, radiologic, and serologic characteristics of the largest series of patients with SANCC in a non-endemic area by reviewing the medical records of patients seen at Jacobi Medical Center in New York.

Results
From 313 cases of NCC, 103 patients (32.9%) had subarachnoid involvement. Most individuals were male (65.1%) and born in Mexico (37.9%); the mean age was 41.4 years. Thirty-seven patients had only subarachnoid involvement, 50 patients had both parenchymal and SANCC, 5 patients had both intraventricular and SANCC, and 11 patients had all three spaces involved. Seventy-one patients (68.9%) presented with headaches. Of these, 35 patients had intracranial hypertension, and 27 required shunt placement. Thirty patients (29.1%) presented with seizures, most of whom had concomitant parenchymal disease. Fourteen patients (13.6%) presented as an ischemic event, 12 patients (11.7%) had symptoms due to spinal disease, and 8 patients (7.8%) had aseptic meningitis. Screening for spinal disease was performed on 61 patients. Of these, 14 patients (23.0%) had asymptomatic spinal involvement. Delay in diagnosis was found in 48 patients (49.0%) with a median of 12 months; chronic headache was the most common missed symptom (48.2%). Calcified SANCC was found in 37 patients (35.9%). Of these, 18 patients (18.4%) did not receive previous antiparasitic. Based on both CT scans and MRIs, 14 of these patients were categorized as completely calcified, and 23 patients were partially calcified with a cystic component seen on MR T2 images. The cysticercosis antigen in serum and CSF were negative in all cases of completely calcified and only in one partially calcified SANCC.

Conclusion
This is the largest series of SANCC reported from a single center in the US and highlights the clinical spectrum. Our data also shows an important under-recognition of this severe form by the clinician and reports that calcified SANCC is common and can occur before and after treatment.

Disclosures
All Authors: No reported disclosures
1330. Characteristics and Outcomes of External Ventricular Drain Infections
Authors: Tran Lucy B , Converse Curtis , Costales-Cantrell Jessica 
Published: November 2023

Abstract

Background
External ventricular drain (EVD)-related ventriculitis is a serious complication associated with poor patient outcomes. We aim to: (1) characterize patient-level factors and outcomes of individuals with EVD-related ventriculitis and (2) identify differences by type of infection and indication of EVD-placement.

Methods
This study is a single center, case series of adults hospitalized with a diagnosis of EVD-related ventriculitis between January 2018 to February 2023. EVD-related ventriculitis was defined as having a positive cerebrospinal fluid culture from an EVD consistent with CDC/NHSN criteria for ventriculitis. Several covariates were extracted from patient charts to characterize patient outcomes. Further stratification by type of infection (gram-positive versus gram-negative ventriculitis) and indication (traumatic versus non-traumatic EVD placement) were performed to identify any differences in characteristics between the two groups.

Results
Twenty-two patients were identified in the study. The majority of patients were infected with gram-positive bacteria (54.5%) rather than gram-negative bacteria (41%) with 1 case of fungus. The most common indication for EVD placement was trauma (59%) and most were placed at bedside (91%) rather than an operating room (9%). The mean length of stay (LOS) was 42.14 days. (Table 1)
There was a statistically significant difference in the CSF to serum glucose ratio between gram-negative and gram-positive infections with gram negative ventriculitis having a lower ratio compared to patients with gram positive ventriculitis (0.23 vs 0.59, p=0.0005). However, LOS, interval from catheterization to infection, and other CSF parameters were similar between the two groups as well as those whose EVDs were placed in the setting of traumatic vs non-traumatic settings. (Table 2 and 3)Table 1.Demographics and characteristics of 22 patients with EVD-associated infectionsTable 2.Characteristics stratified by bacterial organism type
Characteristics stratified by trauma vs non-trauma patients

Conclusion
Patients with EVD-related ventriculitis had double the LOS compared to neurosurgical patients without EVD-related ventriculitis reported in the literature. Patients with gram-negative ventriculitis had a lower CSF to serum glucose ratio than those with gram-positive ventriculitis. Otherwise, patient characteristics and outcomes were similar when stratified by type of infection and indication.

Disclosures
All Authors: No reported disclosures
1343. Drug Education Needs of HCPs and Patients During the COVID-19 Pandemic Based on Over 60,000 Unsolicited Medical Information Requests Globally Over 3 Years (2020-2022)
Authors: Sandhu Sonia K , Chen Linda 
Published: November 2023

Abstract

Background
The COVID-19 pandemic has resulted in 600 million cases and 6 million deaths globally since December 2019. Medical Information (MI) departments are critical during public health emergencies, providing factual, balanced and non-promotional information to healthcare providers (HCPs) and patients on new treatments, in compliance with industry codes of conduct.

Methods
Unsolicited MI requests for COVID-19 treatment from Jan 2020 to Dec 2022 were analyzed to show the customer journey and evolving needs for drug education. Data gathering and metric analysis were collected from MI databases with interaction dates, countries, contact channels, and responses.

Results
MI received 60,000+ unsolicited requests globally from Jan 2020 to Dec 2022, including 4,400 from patients. Pharmacists (60%) and physicians (15%) were the primary HCPs who contacted MI. Japan and US had the highest number of HCP questions. Changes in HCP questions over time reflected external events such as regulatory approvals and guideline updates, with initial questions related to medication access and clinical trials in 2020, transitioning to medication dosing and preparation in 2021, and new interests emerging in special populations including renal impairment, pediatrics, and pregnancy in 2022. These results suggest that HCPs used MI to help make clinical decisions about which medications are right for their patients.
Patients preferred to contact MI by phone (71%), followed by email (25%) and digital channels (4%). Most patient questions came from US, Mexico, and India. Patients were interested in safety, drug interactions, ingredients, and mechanism of action. Nonclinical topics included drug availability, cost, clinical trial enrollment, and patient assistance programs. Increased patient questions were observed during changes in the medical landscape due to external events (label changes, data updates, and new variants).

Conclusion
Analyzing MI requests is a valuable tool for understanding and meeting the evolving customer needs for drug education. MI insights provide valuable information that informs targeted communications, data-generation priorities to address unmet needs, and educational opportunities that impact clinical decision making and lead to improved patient outcomes.

Disclosures
All Authors: No reported disclosures
1358. Persistence of Omicron-Related Long COVID: Examining Prevalence and Impact at 12 Months Post-Acute Infection
Authors: Kim Yoonjung , Kim Shin-Woo , Chang Hyun-Ha , Bae Sohyun 
Published: November 2023

Abstract

Background
As the COVID-19 pandemic continues, there is a growing interest in the long-term effects that follow COVID-19 infection, commonly known as long COVID. However, there is limited research on the long-term effects of the Omicron variant. Therefore, this prospective cohort study aimed to investigate the clinical characteristics of long COVID symptoms related to Omicron infection 12 months after the initial acute infection.

Methods
The study included 94 adult patients diagnosed with COVID-19 between February 1, 2022, and March 2, 2022. Participants were scheduled to visit the study hospital four times, at 3, 6, 9, and 12 months after the acute COVID-19 infection, in order to assess their symptoms, quality of life, and mental health. The study investigated the clinical characteristics of the patients, self-reported long COVID symptoms, and measured quality of life using the EuroQol 5-dimension 5-level (EQ-5D-5L) index.

Results
Out of the 94 respondents, 80 (85.1%) completed the study visits. Among them, 63 (78.8%) were female, and the median age was 36.0 [27.5; 48.5]. Long COVID symptoms still affected 42 (52.5%) patients 12 months after the acute infection. Four (5.0%) patients were diagnosed with new diseases following their COVID-19 infection. The most commonly reported long COVID symptoms after 12 months were fatigue, concentration difficulties, and amnesia (Figure 1). Insomnia and depression showed a gradual improvement in symptoms over time (Figure 2). Although the EQ-5D-5L index for the anxiety/depression dimension improved over time, it still affected 15.0% of the respondents (Figure 3).Figure 1.Distribution of 40 symptoms or signs at 12 months after acute COVID-19 infectionFigure 2.Prevalence difference of long COVID over time: acute COVID-19 period, 3, 6, 9, and 12 months from acute COVID-19 infectionFigure 3.Assessment of quality of life (EQ-5D) at 3, 6, 9 and 12 months after acute COVID-19 infection

Conclusion
This study highlights that neuropsychological symptoms may persist for a long time, even after Omicron variant infection. The study suggests that these symptoms can continue to be problematic, despite changes in the virus variant.

Disclosures
All Authors: No reported disclosures
1387. Vaccination against respiratory pathogens during pretravel consultations at US Global TravEpiNet Sites: interventions and missed opportunities.
Authors: Kakoullis Loukas , Rao Sowmya R , Ryan Edward T , LaRocque Regina C , Chen Lin H 
Published: November 2023

Abstract

Background
We sought to evaluate the contribution of Global TravEpiNet (GTEN) sites in providing influenza and pneumococcal vaccinations during pretravel visits.

Methods
We analyzed prospectively-collected data from 31 GTEN sites between 07/01/2012 -06/31/2022 and included demographics, travel-related characteristics and vaccines administered at the visit. Vaccine eligibility was based on CDC recommendations. Influenza seasonality at the destination was determined based on WHO data1. We conducted descriptive analyses on vaccinations and reasons for non-administration (SAS v9.4; Cary, NC).

Results
The 10-year study period included 116,865 pretravel visits during which clinics administered 1,732 pneumococcal and 15,658 influenza vaccines (Table 1) and referred an additional 3,588 patients to their PCPs for pneumococcal and 6,955 for influenza vaccination.
Of travelers eligible for pneumococcal vaccination, 49.9% were not recognized as having indications for vaccination. In the case of influenza, the vaccine was not offered to 14.3% of eligible travelers due to unavailability (6.9%) or because the provider did not consider it to be indicated based on the itinerary (7.4%).
Among 66,056 travelers with an itinerary falling within an area with active influenza transmission, the vaccine was unavailable for 10% and not considered indicated in 9.5% (Figure 1). These issues occurred mostly during the summer months in the USA. Specifically, 89.8% of travelers for whom there was no available vaccine, and 83.4% of travelers not recognized as eligible for the vaccine, were traveling between April and September.

Conclusion
GTEN clinics provide routine vaccinations against respiratory pathogens, but some missed opportunities are identified. GTEN providers often referred patients to their PCPs for pneumococcal vaccination, perhaps reflecting issues of insurance coverage. The influenza vaccine expiration dates lead to lack of the vaccine for almost 3 months, during summer in the USA. Finally, persons traveling between April and September or to areas with year round transmission may not be recognized to have potential influenza exposure, despite traveling to destinations with active influenza transmission.
References:
1. WHO Global Influenza Programme. https://www.who.int/tools/flunet

Disclosures
Lin H. Chen, MD, Merck: Honoraria|Sanofi: Honoraria|Shoreland Inc: Advisor/Consultant|Valneva: Advisor/Consultant
1388. Patients´ perceptions on barriers that prevent and promote the use of telemedicine for HIV care in the public health system of Buenos Aires
Authors: Kierszenowicz Tomas , Bullo Manuela , Acosta Maria C , Rolon Maria Jose , Oshiro Graciela , Cecchini Diego , Rodriguez Claudia Gabriela , Scapellato Pablo , Bottaro Edgardo Gabriel , Losso Marcelo H 
Published: November 2023

Abstract

Background
In October 2020, a research consortium by four HIV and infectious diseases units of general acute public hospitals of Buenos Aires city began an implementation study aimed to analyze obstacles and facilitators on telemedicine (TM) use in the care of people living with HIV(PLHIV). TM visits were conducted through phone or videocalls

Methods
This research aims to analyze shifts in patient´s perception on factors that prevent and promote the utilization of telemedicine after 6 months of implementation of this strategy. We prospectively collected qualitative data through an electronic semi-structured survey delivered at and 6 months after the first teleconsultation. Surveys were anonymous and self-administered. Data was stored in Redcap® platform. These tools collected data on barriers and benefits of this strategy

Results
Between October 2020 and October 2022, 45% (1871) of total enrollees (4118) answered baseline survey. Second tool was completed by 24.5% (1019) of participants. 662 participants answered both surveys. 3% (20) and 5.7% (20) in the baseline and follow-up surveys respectively, reported troubles with technological devices. This perceived barrier increased in 2.7% and this difference was statistically significant (p=0.01).
Avoiding exposures to COVID-19 and other nosocomial viruses was perceived as a benefit by 65% (1216) of patients at baseline measurement. This proportion was reduced to 57% (580) at second survey. The proportion of patients that reported avoiding commuting time as a benefit increased from 44% (823) to 52% (530) between both measurements.

Conclusion
Beyond resource-limited contexts, these preliminary results illustrate a straightforward implementation of telemedicine. During COVID-19 pandemic, main benefits perceived by patients might be related to avoiding exposures to this and other viruses. After the COVID-19 sanitary situation was normalized, a higher percentage of patients reported that avoiding travel time to the hospital would be one of the main benefits of this strategy.

Disclosures
All Authors: No reported disclosures
1996. Invasive Fungal Infections in Orthotopic Heart Transplant: Incidence and Risk Factors in the Modern Era
Authors: Hasan Lana , Brizendine Kyle D 
Published: November 2023

Abstract

Background
Incidence of invasive fungal infections (IFI) in orthotropic heart transplant (OHT) is reported as 3.4–10%. Guidelines from The International Society for Heart and Lung Transplantation recommend considering prophylaxis for invasive molds based on risk factors and local epidemiology. Data defining the risk factors for IFI in OHT patients are lacking. The aim of this study is to describe the epidemiology of IFI in OHT patients and analyze risk factors.

Methods
A retrospective chart review identified all OHT patients who were transplanted at the Cleveland Clinic from 2010-2020. Patients were divided into two groups for comparison: definite or probable IFI within the first year after transplant, and no IFI. We compared the groups to determine independent risk factors for IFI.

Results
We identified 565 OHT patients in the study period; 33 met criteria for IFI with an incidence of 5.8% (95% CI, 4.2–8.1%). Table 1 shows the characteristics of both patient groups. Among 33 patients with IFI, there were 17 (51%) Candida, 9 (27%) Aspergillus, 4 (12%) non-Aspergillus mold, and 3 (9%) Cryptococcus infections. Median time to IFI (IQR) was 44 days (10–238.5). Specifically, for Candida it was 12 days (1-271) and Aspergillus was 90 days (8-335). One-year survival was significantly lower in the IFI group (76 vs. 94%; p =&lt; 0.01). Using multivariable logistic regression analyses, as reported in Table 2, increased odds of IFI were observed with pre-transplant fungal colonization/infection (OR 19; 95% CI, 2-163) and left ventricular assist device (LVAD) infection (OR 2.3; 95% CI, 0.9-6.0). Post transplant reoperation (OR 4.7; 95% CI, 2-11), and extracorporeal membrane oxygenation (ECMO) (OR 2.6; 95% CI, 1.0-6.7) were also associated with increased odds of IFI.

Conclusion
In a large, modern cohort of OHT patients, we observed a significant incidence and increased odds of IFI associated with specific, identifiable risk factors during the pre-transplant and post-transplant periods. These results merit additional study of targeted antifungal prophylaxis with agents offering broad yeast and mold activity in OHT patients with certain risk factors.

Disclosures
All Authors: No reported disclosures