bluuebunny/crossref_metadata_2025_split huggingface dataset:
768. Digital Patient Education: A Tool to Improve Awareness of CMV
Authors: Larkin Amy , Nair Arun S 
Published: November 2023

Abstract

Background
More than half of US adults over the age of 40 have already been infected by CMV. Despite high prevalence, patient awareness and understanding of CMV is low. This study assessed the impact of online patient education on knowledge, confidence and intent to act regarding CMV.

Methods
The educational intervention consisted of 4 activities hosted on a dedicated learning center on WebMD Education from February-June, 2022. The activities were comprised of text, integrated visuals, and either a patient or healthcare professional (HCP) video commentary. Demographic questions were asked prior to each activity. Knowledge questions were asked both before and after to assess learning gains. Intent to change and confidence questions were asked at the end of each activity. Absolute improvements were calculated for pre/post questions.

Results
Activity 1: What is Cytomegalovirus (CMV)?
63,476 learners; 9,239 completers of all questions
72% female; 57% white, non-Hispanic; 18% 35-44 years of age
24% improvement in knowledge regarding complications of CMV infection; 50% intend to talk to HCP about CMV; 52% confident in talking to HCP about what CMV means for family
Activity 2: CMV: What You Can Do to Help Stop the Spread
61,818 learners; 3,583 completers of all questions
56% female; 40% black/African American; 22% 25-34 years of age
18% improvement in knowledge regarding the spread of CMV; 75% intend to talk to HCP about CMV; 90% confident in preventing spread of CMV
Activity 3: Pregnant, Thinking About Pregnancy, or Have a New Baby? What to Know About CMV
66,918 learners; 4,504 completers of all questions
91% female; 21% black/African American; 44% 25-34 years of age
38% improvement in knowledge regarding CMV in pregnancy and babies; 69% intend to talk to HCP about CMV; 76% confident in understanding how CMV effects pregnancy and babies
Activity 4: Are You at Risk for CMV?
2,802 learners; 368 completers of all questions
62% female; 51% white, non-Hispanic; 25% 35-44 years of age
17% improvement in knowledge regarding who is at risk for CMV infection; 61% intend to talk to HCP about CMV; 75% confident in understanding CMV

Conclusion
The outcomes gathered in this assessment are a strong indicator that online patient activities on WebMD Education improved knowledge and confidence and prompted intent to act related to CMV.

Disclosures
All Authors: No reported disclosures
831. Majocchi’s Granuloma – A Single Institution Retrospective Review
Authors: Montagnon Carmen M , Khodadadi Ryan B , Yetmar Zachary A , Johnson Emma F , Abu Saleh Omar M 
Published: November 2023

Abstract

Background
Majocchi’s granuloma (MG) is an uncommon deep fungal folliculitis predominantly caused by dermatophytes. Available data regarding predisposing comorbidities/risk factors, clinical characteristics, offending microbiologic pathogens, diagnostics, pathologic findings, and treatment approaches has been inferred from historical cases. Given these limitations in the existing literature of MG, we sought to conduct a detailed review of our institutional experience with biopsy-confirmed cases of MG.

Methods
Following IRB approval, we retrospectively identified and analyzed a multicenter cohort of adult patients diagnosed with MG between September 1992 and September 2022 at Mayo Clinic campuses (Figure 1). Data extracted included demographics, comorbid conditions, presenting clinical characteristics, diagnostic, microbiologic, and biopsy characteristics, treatment details, and outcomes.
Figure 1
Flow Diagram show exclusion of patients from the final cohort.

Results
A total of 147 patients with MG with the accompanying baseline characteristics met study criteria (Table 1). One-hundred and five patients were male with a median age of 55.6 years. Immunosuppressant and topical corticosteroid use were common prior to development of MG (Table 1). Dermatologic lesions and their sites of involvement did not differ based on the immune status of patients (Table 2). Trichophyton rubrum was the most common causative pathogen of MG, in addition to other dermatophytes and fungal organisms (Table 3a). Treatment duration for all prescribed agents was median 31.5 days. Oral terbinafine was the most frequently utilized agent and clinical resolution was achieved in 96.6% of cases (Table 3b).

Baseline Characteristics of 147 Patients with Majocchi’s Granuloma

Diagnostic, Microbiologic, and Biopsy Characteristics, Treatment Characteristics and Outcomes

Conclusion
While rare and clinically variable in presentation, the diagnosis of MG requires careful clinical examination and history-taking, histopathologic confirmation, and frequently fungal culture. Most cases of MG in our study responded well to a course of oral terbinafine at a median of 31.5 days of treatment.

Disclosures
All Authors: No reported disclosures
847. Cryptococcal disease in HIV and non-HIV-infected patients: clinical features and outcome
Authors: Roman-Montes Carla M , Velez-Pintado Mariana , Seoane-Hernandez Lisset , Rangel-Cordero Andrea , Martínez-Gamboa Rosa Areli , Crabtree-Ramírez Brenda , Ruiz-Herrera Vida V , Sifuentes-Osornio Jose , Ponce-de-Leon Alfredo , González-Lara Fernanda 
Published: November 2023

Abstract

Background
Cryptococcosis is an emerging fungal infection, particularly in patients without HIV. Yet, late diagnoses and worse prognoses are seen. We aimed to compare clinical characteristics and outcomes in patients with cryptococcosis.

Methods
We conducted a retrospective cohort (2001-2021) of patients with cryptococcosis, comparing HIV+ and non-HIV groups in a tertiary center in Mexico. The primary outcome was 20-week mortality. We used descriptive statistics and logistic regression for mortality.

Results
We found 107 patients, 51.5% (55) in HIV+ and 48.5% (52) non-HIV. HIV+'s median CD4+ count was 25 (IQR 12-47). In the non-HIV group, patients were older (median 53.5 vs. 40 years, p=&lt; 0.02), less frequently male (40% vs. 89% p=0.01), and more with autoimmune diseases (41% vs. 0%, p= &lt; 0.01) were found; only 6% were immunocompetent.
The most frequent presentation was disseminated (51% vs. 35%, p=0.08), followed by meningeal (38% vs. 33%, p=0.5). The pulmonary disease was frequent in non-HIV group (27% vs. 4% p=0.001). The most frequent isolated species was Cryptococcus neoformans (89% HIV+ vs. 98% non-HIV group, p=0.06), followed by C. neoformans var grubii (9% HIV+ vs. 2% non-HIV p=0.10) and C. gattii (2% HIV+ p=0.32) and was most frequently isolated from cerebrospinal fluid (CSF) in the HIV+ (64% vs. 38% p=0.009). Serum cryptococcal antigen was less frequently positive in the non-HIV group (44% vs. 88% HIV, p=0.007). The median days from symptom onset to diagnosis were longer in HIV+ (25 vs. 7, p&lt; 0.01).
Both groups received similar antifungal treatment (87% vs. 94% HIV, p=0.16). No difference in mortality in both groups (31% vs. 31% p=0.9). In multivariate analysis, diabetes mellitus (DM) was associated with increased mortality (OR 6.9 (95%CI 2.1-22.7), while antifungal treatment was associated with reduced mortality (OR 0.11 95%CI 0.02-0.59).Table 1.General characteristics in Cryptococcal disease in HIV and non-HIV infected patients. Abbreviations. CSF: cerebrospinal fluid, ICU: intensive care unit, IQR: interquartile range.

Conclusion
In this retrospective cohort, non-HIV with Cryptococcosis were mostly females with autoimmune diseases and pulmonary involvement, compared with younger males with cryptococcal meningitis among HIV+ patients. A late presentation was frequent in HIV+. We found no difference in mortality at 20 weeks between both groups. DM was associated with increased mortality, and the proportion of patients with DM and a worse outcome is a relevant finding.

Disclosures
All Authors: No reported disclosures
868. Early Organism Identification by Matrix Assisted Laser Desorption Ionization Time Of Flight Mass Spectrometry (MALDI TOF MS) Decreases the Time to Optimal Antibiotic Therapy for Common Bacterial Infections
Authors: Keri Vishakh C , Gupta Ankesh , Kumar Das Bimal , Mohapatra Sarita , Soneja Manish , Kapil Arti , Xess Immaculata , Wig Naveet 
Published: November 2023

Abstract

Background
MALDI-TOF helps in precise identification of microorganisms from positive cultures. It is based on the principle of proteomics and obviates the need for the use of biochemicals. It reduces the turnaround time for reporting microbiologic cultures. Early identification and reporting of the organism, before the availability of antimicrobial susceptibilities, may reduce the time to first antibiotic modification and impact the clinical outcomes of patients.

Methods
This is a prospective observational two-arm comparative study conducted at a tertiary care centre in North India, with a sample size of 50 patients in the conventional arm and 100 patients in the interventional arm. The workflow of both arms are depicted in figure 1&2. The study population included patients in the medical ward and intensive care units (ICU) with positive cultures. The primary objective of this study was to compare the average time to first antibiotic modification post-culture positivity in the conventional and interventional arms and to compare clinical outcomes of patients in both arms. Escalation, de-escalation and any modification in antibiotics were also recorded.

Results
The median time to first antibiotic modification was significantly shorter in the intervention arm compared to the conventional arm (2010 mins vs 2905 mins, p=0.002). Overall 44/100 antibiotic modifications were made in the interventional arm out of which 43.2% (19/44) were made based on the MALDI report alone without awaiting susceptibilities. The major type of modification was the de-escalation of antibiotics (47.4%). Mortality rates were 32% in the conventional arm and 27% in the intervention arm, but the difference was not statistically significant (p=0.52) (table 1).

Conclusion
MALDI-TOF helps in the early modification of antibiotics. The major utility is in the de-escalation of unnecessary antibiotics. Coupled with a robust antimicrobial stewardship programme, this modality can help in reducing antibiotic use.

Disclosures
All Authors: No reported disclosures
876. Real-world impact of a novel host response test for distinguishing between bacterial and viral infections in pediatric patients at ten Urgent Care Centers
Authors: David Shirley Shapiro Ben , Rahamim-Cohen Daniella , kalmovich Boaz 
Published: November 2023

Abstract

Background
Antibiotic misuse is a major driver of antimicrobial resistance and is prevalent in the urgent care setting. A leading cause of misuse is uncertainty regarding infection etiology. MeMed BV® (MMBV) is an FDA-cleared test designed to aid physicians in differentiating between bacterial and viral infections based on computational integration of the blood levels of three host proteins into a score. Here we examined the real-world impact of integrating MMBV in the urgent care workflow on clinical decision-making.

Methods
A retrospective cohort study. MMBV test was ordered as part of the routine care for clinically appropriate pediatric patients at ten Maccabi Healthcare Services outpatient urgent care centers in Israel. MMBV results were interpreted based on manufacturer’s instructions as viral or bacterial infection or equivocal.
As part of MMBV evaluation, physicians who ordered the test were immediately and automatically asked to complete a short questionnaire reporting their initial etiological diagnosis and likelihood to prescribe antibiotics. Upon discharge, physicians completed a second questionnaire to report if MMBV impacted their decision-making process.
The physician’s intent, MMBV results and final antibiotic prescription practice were compared to evaluate the impact of MMBV on antibiotic misuse.

Results
Between 04-12/2022, 2,265 patients were enrolled and 1,759 had fully filled out questionnaires (Figure 1, Table 1). In 1,566 cases, a bacterial or viral MMBV result was received.
Among the 449 cases for whom physicians initially intended to prescribe antibiotics, 320 (71.7%) had viral MMBV results and in 198 cases (61.9%) the physician did not prescribe antibiotics. Conversely, among the 805 cases for whom physicians did not initially intend to prescribe antibiotics, 153 (19%) had bacterial MMBV results and the physician prescribed antibiotics in 93 (60.8%) cases.
Physicians reported uncertainty with regard to antibiotic prescription in 312 (19.9%) cases and acted in accordance with MMBV results in 236 (75.6%). Overall, physicians reported that MMBV aided in their patient management for 82.4% of cases.

Conclusion
Physicians incorporate MMBV into their real-world decision-making in the urgent care center setting and report that it aids in patient management.

Disclosures
All Authors: No reported disclosures
886. Impact of Race on the Early Diagnosis and Treatment of Lyme Disease
Authors: Starke Samuel J , Rebman Alison , Miller John , Aucott John 
Published: November 2023

Abstract

Background
Previous studies using single-state and Medicare surveillance data found that Black patients with Lyme Disease (LD) are more likely to present outside of the typical summer months and have higher rates of disseminated disease at diagnosis. We further explored differences in clinical presentation and early treatment of Lyme Disease by self-reported race among a large cohort of patients at an academic research clinic.

Methods
We abstracted data from all patients with untreated or post-treatment LD seen at the Johns Hopkins Lyme Disease Research Center (LDRC)—either for clinical care or research participation. Patients self-reported their demographics, and clinical information regarding their initial Lyme presentation was either recorded at the time of diagnosis or was abstracted from prior, external medical records. We examined the distribution of race across initial LD clinical presentations—categorized as 1) erythema migrans (EM) rash only, 2) disseminated disease, or 3) non-specific symptoms only—using chi-squared or Fisher’s exact test and fit logistic regression models. We compared racial differences in time to appropriate treatment using a one-sided Mann-Whitney test.

Results
Of 1363 individuals seen at the LDRC, 93% were white, 3% were Black, 2% were Asian, and 3% self-identified as either ‘other’ or more than one race. Compared to white patients, Black patients were less likely to present with erythema migrans (EM) rash (p &lt; 0.0001) and more likely to present with disseminated disease or non-specific symptoms (p=0.009, p=0.019, respectively). Black patients were more likely to have received a course of inappropriate antibiotic therapy ( 16.7% vs 8.0 %, p= 0.058). Also, Black patients with EM rash experienced longer time to appropriate treatment (16.3 days vs 4.0, p=0.062).
Number of asterisks indicates degree of statistical significance. N/S means "non-significant"

Conclusion
We identified several racial disparities in the early detection and treatment of Lyme Disease, highlighting the need for increased awareness of Lyme and its early manifestations among patients of color and the front-line clinicians who care for them. Because darker skin tones are generally under-represented in medical textbooks and patient education materials, we include several examples of EM rashes from Black patients seen at the LDRC (Figure 2).

Disclosures
John Aucott, MD, Pfizer, Inc.: Advisor/Consultant
900. The Epidemiology of Viral Coinfections within Households with Children
Authors: Ibiebele Jessica C , Martin Emily T , Monto Arnold , Callear Amy 
Published: November 2023

Abstract

Background
Improvements in virus detection using molecular assays, such as multiplex polymerase chain reaction, has led to more common identification of viral coinfections. The incidence of viral coinfections may depend on population factors, such as age structure, distribution of chronic respiratory conditions, geographic location, and setting of the study population (e.g., community, in-patient admission), which has new relevance given observations of coinfections involving SARS-CoV-2. Household-level data on mild to moderate illnesses offer an important complement to other coinfection data that are largely measured in clinical settings.

Methods
The Household Influenza Vaccine Evaluation (HIVE) study is an ongoing prospective cohort study of households with children in Southeast Michigan that began in 2010. Active acute respiratory illness (ARI) surveillance is conducted, and participants with eligible ARI’s are tested for a range of respiratory pathogens. Descriptive statistics were used to characterize viral coinfections within this cohort for a period prior to the COVID-19 pandemic (2010-2020) and will be performed for a period during the pandemic (2020-2022). The consequences of these coinfections in terms of symptoms and household transmission are under evaluation.

Results
There were 6,245 virus-positive ARI’s in the cohort from 2010-2020, with multiple viruses detected in 896 (14.3%) ARI’s. Of the coinfections, rhinovirus/enterovirus most frequently appeared (58.15%), followed by common CoV (38.84%), and AdV (24%) (See Figure 1). The most common virus combination was a coronavirus (229E, OC43, NL63, or HKU1) along with rhinovirus/enterovirus, making up 12.05% (n=108) of coinfections. Eight infections were made up of four or more viruses. Similar analyses will be conducted for pandemic-period data.

Conclusion
While awareness of viral coinfections has grown since the start of the COVID-19 pandemic, coinfections within the HIVE cohort were not uncommon prior to the pandemic. Coronaviruses were the second leading viruses identified in coinfections, which aligns with observations noted during the pandemic. These results contribute important information about coinfections and expand the understanding of respiratory virus dynamics within households.

Disclosures
Emily T. Martin, PhD, MPH, Merck: Grant/Research Support Arnold Monto, MD, Roche: Advisor/Consultant|Roche: Honoraria
902. Incidence of Influenza-Related Medical Encounters Among Adults in The United States During the 2015-2020 Influenza Seasons
Authors: McGovern Ian , Cappell Katherine , Bogdanov Alina , Haag Mendel 
Published: November 2023

Abstract

Background
Research on the burden of influenza often focuses on the most impacted groups; children and older adults (65 years of age and older). This study aimed to evaluate how age impacted incidence of influenza-related outpatient visits, emergency room (ER) visits, and hospital admissions by broader adult age groups (18-49, 50-64, and 65 years and older) as well as within more granular 5-year age increments.

Methods
Patients 18 years of age or older in the United States were evaluated retrospectively in five seasonal cohorts (2015-2016 through 2019-2020 seasons). Patient-level electronic medical records linked to pharmacy and medical claims were used to ascertain outcomes. Influenza-related medical encounters were identified based on influenza-related diagnostic codes (ICD-10 codes J09*–J11*). Incidence was evaluated among the overall population as well as among people with no (low-risk) and 1 or more (high-risk) risk-factors for severe outcomes following influenza infection.

Results
Between 887,260 and 3,628,168 patients were included per season. When evaluated in 5-year increments, influenza-related outpatient visit incidence was highest among people 18-35 years old, and then declined with increasing age (figure 1). For ER visits, incidence tended to be elevated for patients 18-34 and then stayed somewhat flat from 35 (or 40) through 60 years of age and increased quickly after 60. Hospital admission incidence stayed somewhat flat until around 50 years of age and then increased with age. The prevalence of risk factors increased with age, with the number of patients with 1+ risk factors increasing from 38% for 18-49, 62% for 50-64, and 80% for 50-64. Across outcomes, high-risk patients consistently had higher incidence than low-risk patients, but differences were smaller than the differences in incidence between age groups. Although similar trends were observed in the broader age groups (figure 2), the 5-year age increments provided more granular insights into the effects of age on incidence of influenza.

Conclusion
This analysis demonstrates that changes in influenza incidence often occur gradually as patients age increases. For the most severe outcomes (hospitalizations), the incidence begins to increase around 50 years of age rather than the more common cutoff of 65 years of age.

Disclosures
Ian McGovern, MPH, CSL Seqirus: Employment|CSL Seqirus: Stocks/Bonds Katherine Cappell, PhD, CSL Seqirus: Advisor/Consultant Alina Bogdanov, MA, Moderna, Inc.: Advisor/Consultant|Veradigm: Salary Mendel Haag, PhD, PharmD, CSL Seqirus: Stocks/Bonds
915. Prevalence and Treatment of Genital Herpes in a United States Administrative Claims Database
Authors: Viscidi Emma , Jain Purva , Embry Alan , Arakaki Brent , Estevez Irisdaly , Marcum Zachary 
Published: November 2023

Abstract

Background
Herpes simplex virus type-2 (HSV-2) is the most frequent cause of genital herpes (GH) in the United States (US). There is no cure for HSV-2, but antiviral drugs can reduce outbreaks. Limited epidemiologic data exist on the contemporary burden of GH and treatment. The objective of this study was to estimate the annual GH prevalence and antiviral treatment rates.

Methods
This observational study utilized cohorts to calculate annual period prevalence rates of GH and included US administrative claims data from HealthVerity medical and pharmacy claims of continuously enrolled insured individuals. The crude and age-sex standardized prevalence rates of GH and recurrent GH were calculated from 01/01/2019 to 12/31/2021, by calendar year. GH was defined as &gt;1 ICD-10 diagnosis code. Recurrent GH was defined as &gt;2 GH diagnosis codes, at least 28 days apart, or &gt;1 GH diagnosis code followed by at least 2 non-overlapping antiviral drug claims. Among those with GH, the proportion of patients untreated or on episodic or suppressive antiviral treatment was estimated. Episodic treatment was defined as &lt;6 months of antiviral treatment, and suppressive treatment was defined &gt;6 months of antiviral treatment, within each calendar year. Analyses were stratified by age, sex, and immunocompromised status.

Results
From 2019 to 2021, the age-sex standardized prevalence rates of GH ranged from 236 to 280 per 100,000 person-years (py) and from 81 to 98 per 100,000 py for recurrent GH. The prevalence rates of GH and recurrent GH were highest among females, those 25-29 years of age, and in immunocompromised individuals. Approximately one-third of patients with GH were untreated (32%-35%) in a given year. Among those treated for GH, the majority received episodic antiviral treatment (80%) rather than suppressive treatment (20%).

Conclusion
GH prevalence rates were 236 to 280 per 100,000 py and recurrent GH was one-third of this. GH and recurrent GH were more common in females, young adults, and immunocompromised individuals. Approximately two-thirds of GH patients were treated with antivirals, and the majority of these received episodic treatment.

Disclosures
Emma Viscidi, PhD, MHS, Moderna: Employee|Moderna: Stocks/Bonds Alan Embry, PhD, Moderna Therapeutics: Stocks/Bonds Brent Arakaki, BS, Aetion, Inc.: Employee