bluuebunny/crossref_metadata_2025_split huggingface dataset:
1702. Disseminated Candidiasis after Candidemia: Epidemiology, Diagnostic Evaluation, and Risk Factors
Authors: Whitehurst Daniel , Murphy Catherine R , Teoh Zheyi , Brammer Caitlin N , Perkins Kerrigan , Paulsen Grant C , Danziger-Isakov Lara A , Miller-Handley Hilary , Otto William R 
Published: November 2023

Abstract

Background
In patients with candidemia, evaluation for disseminated disease with ophthalmological exam and diagnostic imaging is recommended but not standardized. This study sought to describe practice patterns in the diagnostic evaluation for disseminated disease after candidemia and identify risk factors associated with disseminated candidiasis to improve local management.

Methods
A retrospective study of all episodes of candidemia diagnosed in patients &lt; 25 years from 2013-2022 at Cincinnati Children’s Hospital Medical Center reported clinical characteristics, microbiology data, and diagnostic testing for dissemination. Disseminated candidiasis was defined as an ophthalmologic exam, echocardiogram or other imaging findings consistent with candidiasis or growth of Candida spp. from a sterile site besides blood. Mixed-effects logistic regression was performed to identify risk factors for disseminated disease.

Results
144 episodes of candidemia occurred in 124 patients , with C. albicans (35%) the most commonly identified species (Figure 1). 107/144 (74.3%) episodes underwent evaluation for disseminated candidiasis, with dissemination in 27/107 (25.2%). Of patients with only 1 positive culture, 5/34 (14.7%) had disseminated candidiasis compared to 22/73 (30.1%) with more than 1 positive culture (Figure 2). Ophthalmologic exams and echocardiograms were done in &lt; 70% of workups (Figure 3). History of prematurity (aOR 17.5, 95%CI 3.1-100.4) and solid organ transplantation (aOR 5.3, 95%CI 1.1-24.6) were associated with disseminated candidiasis when controlling for age, sex, underlying disease, and initial antifungal treatment. Each additional day of candidemia significantly increased the odds of dissemination (aOR 1.5, 95%CI 1.2-1.9).

Conclusion
In this single-center study, most patients with candidemia underwent diagnostic evaluation, though the extent varied. Disseminated disease was common. Prematurity and history of solid organ transplantation were independent risk factors for dissemination as was each additional day of candidemia. Patients with any candidemia should undergo evaluation for dissemination. Multicenter studies are needed to determine the optimal diagnostic evaluation in these high-risk patient groups.

Disclosures
Grant C. Paulsen, MD, Moderna: Grant/Research Support|Pfizer: Grant/Research Support Lara A. Danziger-Isakov, MD, MPH, Aicuris: Contracted Clinical Research|Ansun Biopharma: Contracted Clinical Research|Astellas: Contracted Clinical Research|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Contracted Clinical Research|Pfizer: Contracted Clinical Research|Roche Diagnostics: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: Contracted Clinical Research William R. Otto, MD, MSCE, Moderna: Grant/Research Support
1704. Stenotrophomonas maltophilia Infection in a Neonatal Intensive Care Unit (NICU): A Retrospective Study of Risk Factors and Outcomes in an Inner-City Hospital
Authors: Franco Susannah D , Hammerschlag Margaret , Abdelhemid Ashraf , Fordjour Lawrence , Kohlhoff Stephan 
Published: November 2023

Abstract

Background
Stenotrophomonas maltophilia is an aerobic, non-fermenting, Gram-negative bacillus associated with opportunistic and multi-drug resistant infections. The objective of this study was to identify risk factors and outcomes associated with S. maltophilia isolation or infection in a level IIIB neonatal intensive care unit (NICU).

Methods
This was a retrospective matched case-control study. Cases were matched 2:1 for birth weight, gestational age, and year of NICU admission. The Chi-square test and Fisher’s exact test were used for comparisons of categorical variables. Continuous variables were analyzed with the Mann-Whitney U test.

Results
A total of 15 S. maltophilia isolates were identified from 15 neonates between January 1, 2008 and April 1, 2020 and matched to 30 controls. Median birth weight and gestational age of the cases was 675 g (IQR, 522.5-997.5 g) and 26 weeks (IQR, 24.86-27.14 weeks), respectively. The trachea was the most frequent site of isolation (9 of 15 isolates); colonization was suspected in 2 cases. Other sites included blood (1 case), conjunctiva (2 cases), and peritoneum (3 cases). The following factors were associated with risk of isolation or infection in cases compared to controls: total days of antibiotic exposure (24 vs 15 days, P = 0.01), total number of antibiotic courses (3 vs 2.5, P = 0.043), total days of broad-spectrum antibiotic exposure (19 vs 9.25 days, P = 0.015), and total days of meropenem exposure (9 vs 3 days, P = 0.008). Total length of NICU stay was significantly longer among cases versus controls (134 vs 68.5 days, P = 0.006). Mortality rate was also significantly higher in cases versus controls (N = 15, 33.33% vs N = 30, 0%; P &lt; 0.001); 3 of 3 infants with peritoneal infection died. All 15 isolates were initially susceptible to levofloxacin, and 14 were susceptible to trimethoprim-sulfamethoxazole.

Conclusion
Broad-spectrum antibiotic exposure, especially to meropenem, may lead to selection of resistant bacteria and promote S. maltophilia colonization and infection. S. maltophilia isolation or infection was associated with increased length of NICU stay and mortality.

Disclosures
All Authors: No reported disclosures
1705. Comparative Analysis of Luminometry -vs- Fluorescent Marker Use for Cleaning and Disinfection Processes in a Pediatric Hospital
Authors: Londono-Ruiz Juan Pablo , Cruz-Acevedo Diego Andres , Gaitan-ayala Lina Paola , Prieto-Villarraga Liliana , Correa-Castro Claudia Patricia , Gutierrez-Tobar Ivan Felipe 
Published: November 2023

Abstract

Background
The cleaning and disinfection process (CDP) of hospital surfaces has proven to be an effective tool in preventing healthcare-associated infections. ATP bioluminescence meters have been established as the standard for CDP evaluation. The use of fluorescent markers has also been established as an alternative to this. The aim of this study was to assess the concordance between luminometry measurements and fluorescent marker use in the CDP of a pediatric hospital.

Methods
A diagnostic test study was conducted in which luminometry (Clean-Trace™ LX25 - 3M™) was compared with the use of a fluorescent marker (West Scan - West Química). Joint relative light units (RLU) were taken, and a subjective scale was used to define the erasure of the fluorescent marker after the cleaning and disinfection process (completely erased, partially erased, and intact). The process was established as adequate when less than 65 ATP units were obtained in critical sites and less than 175 in general hospitalization sites. The R program v 4.2.2 was used for data analysis.

Results
We performed 292 paired measurements: 222 (76%) in critical areas and 70 (24%) in non-critical areas. Measurements were taken from different high-contact surfaces such as crash carts, monitor screens, worktables, dressing carts, and defibrillators, among others. The luminometries carried out in 244 (83.5%) were adequate, and the measurements with fluorescent marker showed that 187 (64%) presented total erasure, 37 (12.6%) showed partial erasure, and 66 (22%) were intact. The Kappa index between both tests for total erasure was calculated as adequate, being 0.155 (p-value 0.002). When the tests with the criteria of partial or total erasure were compared as adequate, the Kappa index was 0.007 (p-value 0.6). When they were sub-analyzed according to the areas (critical and non-critical), a kappa value of 0.141 (p-value 0.02) was found for critical areas and 0.194 (p-value 0.03) for non-critical areas.

Conclusion
The correlation between the evaluation of the cleaning and disinfection process using a luminometer and a fluorescent marker showed slight agreement for total erasure. More studies are required to understand the reasons for this low correlation.

Disclosures
All Authors: No reported disclosures
1706. Risk factors for infections caused by extended spectrum beta lactamase (ESBL) producing and Carbapenem-resistant Enterobacterales (CRE) in pediatric critical care settings: A case control study
Authors: Omar Amr , Asmar Basim , Abdel-Haq Nahed M 
Published: November 2023

Abstract

Background
Infections due to Gram negative resistant bacterial pathogens are a major concern in intensive care units. The purpose of this study is to determine the risk factors for developing ESBL-producing and CRE infections in pediatric patients in critical care settings (PICU and NICU).

Methods
A retrospective case control study of infections due to ESBL-producing and CRE during a 5-year period (2016-2021) at Children’s Hospital of Michigan, Detroit. All patients had positive cultures during their PICU/NICU stay. Control cases were matched for age, infection site and year of infection but their cultures grew Enterobacterales that were non-ESBL or carbapenemase producers.

Results
A total of 58 patients with ESBL/Carbapenemase-producing Enterobacterales (cases) and 59 control patients were included. Majority of organisms were E. coli and Klebsiella species recovered from respiratory tract. There was no difference in both groups in regards to age, gender, race or length of hospital stay (p &gt;0.3). There was no difference in prior hospital admission, PICU or NICU stay during the previous 6 months, indwelling devices, comorbid conditions, or surgery in the last 6 months (p &gt;0.3). However, the presence of gastrostomy tube was more frequent in the cases group (29.3%) than the control group (15.3%) (p=0.078). Risk factors by univariate analysis included history of antibiotic use in last 6 months (93% in cases vs 73% in controls; p=0.006), cephalosporins use &gt; 14 days (67% vs 31.2%; p=0.006),Trimethoprim/Sulfamethoxazole treatment duration &gt; 14 days (11.1% vs 0%; p=0.012), carbapenem treatment duration &gt; 14 days (14% vs 1.9%; p=0.027), and vancomycin use &gt; 14 days (43.6% vs 21.6%; p=0.053). However, multivariate logistic regression analysis showed that antibiotic usage in the last 6 months was the single best predictor for cases with odds ratio of 5.02-fold (95% CI 1.56-16.13) (p=0.007).

Conclusion
Prior broad spectrum antibiotic usage was significantly associated with acquisition of ESBL and carbapenemase producing Enterobacterales. The study further underscores the need for optimizing antimicrobial stewardship practices to limit unnecessary and prolonged use of antibiotics to prevent the emergence of resistant pathogens.

Disclosures
All Authors: No reported disclosures
1707. New directions for infection prevention in the neonatal intensive care unit: A key informant exploration
Authors: Prestel Christopher , Barnes Laura , Kuhar David , Sinkowitz-Cochran Ronda 
Published: November 2023

Abstract

Background
Prolonged hospitalization and unique physiology of neonates and infants places them at risk for healthcare-associated infections (HAIs) in the neonatal intensive care unit (NICU). Development of infection prevention (IP) bundles led to decreases in HAIs in NICUs. We interviewed key informants to understand the IP challenges and opinions of NICU clinicians to inform unique IP needs in NICUs.

Methods
Participants were referred by the Vermont Oxford Network (VON), an interdisciplinary NICU quality improvement (QI) community. A standard set of questions were used for all interviews, which covered perceived IP gaps, opportunities for QI improvement, barriers, and implementation practices. Qualitative analysis was performed using NVivo software with three key questions coded using an immersion-crystallization technique. Transcripts were systematically reviewed by a team of three coders to maintain intercoder reliability.

Results
Eight subject matter experts (SMEs) were interviewed. Participants included five neonatologists, two pediatric infectious diseases physicians, and a pediatric critical care medicine physician. All participants practiced or held IP roles within a Level III or IV NICU; three were in the Northeast, three in the Midwest, and two in the Southeast region of the U.S. The most common themes to emerge across participant responses were poor hand hygiene compliance rates, inherent complexities of providing care in the neonatal population, and balancing family presence with IP concerns. The greatest opportunities for IP improvement described by SMEs were the development of novel supplemental IPC strategies to complement core practices, antibiotic stewardship in neonates, and the prevention of ventilator-associated pneumonia. The most cited barriers were a lack of evidence-based research, NICU staffing turnover and inexperience, and gaps in provider and family knowledge of IP practices.

Conclusion
Identified IP challenges within the NICU are unique and cross-cutting among patient, provider, and family needs. These may be mitigated through the development of new HAI prevention tools, education, and resources developed specifically for this complex care environment.

Disclosures
All Authors: No reported disclosures
1711. Prospective Environmental Surveillance of Floors in a Pediatric Emergency Department During a Respiratory Syncytial Virus Surge in Ottawa, Canada
Authors: Thampi Nisha , Moggridge Jason , Khov Engluy , Hinz Aaron , Castellani Lucas , Doukhanine Evgueni , Hug Laura , Kassen Rees , MacFadden Derek , Nott Caroline , Wong Alex , Fralick Michael 
Published: November 2023

Abstract

Background
Annual respiratory syncytial virus (RSV) epidemics disproportionately impact infants and young children. Clinical surveillance is often restricted to laboratory-confirmed hospitalizations. Built environmental surveillance through floor sampling may provide population-level insights into RSV transmission dynamics and inform public health action to blunt community outbreaks.Figure:Quantification of viral detection from floor swabs in the pediatric emergency department by multiplex PCR
Each point represents the number of viral copies, plus one, detected from a swab captured at a given location (y-axis) on a given date (x-axis). A value of one copy indicates non-detection of RSV.

Methods
A prospective environmental surveillance study was conducted in Ottawa, Canada from November 24, 2022 to March 24, 2023. Floors were swabbed in six areas of the emergency department (ED) of the sole pediatric acute care facility in Eastern Ontario. Samples were tested for RSV by a validated multiplex PCR assay. Floor swab positivity was compared to hospitalization data of patients with laboratory-confirmed RSV using Pearson’s correlation analysis to determine the degree of their association.

Results
Over an 18-week period, 432 floor swabs were collected in the ED and 250 pediatric patients were hospitalized. RSV was detected in 65% of floor swabs, with more viral copies detected in congregate areas (waiting rooms, triage) (Figure). The correlation between swab positivity and RSV hospitalizations was 0.64 (95%CI 0.23-0.86).

Conclusion
RSV was frequently detected on floors in the hospital-built environment and correlated somewhat with hospitalizations, likely reflecting community viral prevalence rather than severe RSV disease. Having real-time floor signals in different areas of the ED allowed for spatial resolution of the signal intensity, identifying higher RSV burden in areas where patients with infectious symptoms were more likely to congregate for prolonged periods of time. Floor sampling may be useful in developing spatially-refined approaches to infection prevention and control measures, particularly in indoor areas with increased respiratory viral transmission risks.

Disclosures
Evgueni Doukhanine, MSc, DNA Genotek: DNA Genotek provided sampling swabs in-kind for this study in an unrestricted fashion. Michael Fralick, MD, ProofDx: Advisor/Consultant
1713. B-Cell Subsets in Children and Adolescents Living with Perinatally-Acquired HIV
Authors: Contreras German , zakhour ramia g , Heresi Gloria , Murphy James 
Published: November 2023

Abstract

Background
To gain insight into the mechanisms of immune deficits persisting in children and adolescents living with perinatally-acquired HIV (PHIV) on ART at 4, 6, and 10 years.

Methods
We determined four B-cell subpopulations by flow cytometry after initiation of ART -classical, plasma blast activated, and tissue-like memory B cell MBCs. Macrophage activation was assessed by measuring plasma levels of sCD14. Baseline characteristics and clinical data of study participants were extracted from medical records. Categorical and continuous variables were compared by the Fisher or Wilcoxon rank-sum test.

Results
Eleven PHIV and 22 HIV- were studied. The median age at ART initiation was 4.5 (interquartile range [IQR], 3.2–12.4) years, median CD4% was 23.4 (IQR, 18–31), and plasma median HIV RNA was 4.3 (IQR, 3.1–5.2) log10 copies/mL. Median CD4% and plasma HIV RNA log10 copies/mL at 4, 6, and 10 years were 28 and 3.2; 27.9 and 2.9; and 29.5 and 2.4.
HIV (+) compared to HIV (-) had significantly lower percentages of classical MBCs but higher percentages of plasmablast, activated, and tissue-like MBCs (Figure). Moreover, these differences persisted through 10 years (Figure). Of note, the distribution of the B-cell subpopulations did not change during the six years of evaluation for the PHIV, despite progressive control of HIV replication and immune activation measured as sCD14. (Figure).

Conclusion
Children and adolescents living with perinatally acquired HIV had persistent abnormal B-cell subpopulation distribution despite an effective HIV viremia control and CD4 % restoration following ART initiation. The linkage between the observed persistent immune activation and abnormalities observed within the B cell compartment deserves investigation. The abnormalities in B-cell subpopulations might explain our population's low immune response to vaccines.

Disclosures
All Authors: No reported disclosures
1715. Use of a validated tool to assess transition readiness to adult care of adolescents living with HIV in Rwanda
Authors: Rogo Tanya , Mushimiyimana Febronie , Unyuzumutima Juliette , Tuyisenge Lisine , Kantor Rami 
Published: November 2023

Abstract

Background
Recent African studies report that only 11-60% of transitioned adolescents living with HIV (ALHIV) were successfully retained in care after healthcare transition (HCT) from pediatric to adult care settings. HCT without adequate pre-transition preparation can result in loss of follow-up and poor treatment adherence. Transition guidelines recommend longitudinal transition readiness assessment using an objective measure, a practice not routinely implemented.

Methods
During March-April 2023, HCT readiness was assessed in a cross-sectional study of Rwandan ALHIV age ≥ 18 years attending the University Teaching Hospital of Kigali pediatric HIV clinic and about to transition to adult care. Transition readiness was assessed using the validated Transition Assessment Readiness Questionnaire (TRAQ 5.0), consisting of 20 questions in five subscales: Appointment Keeping; Tracking Health Issues; Managing Medications; Talking with Providers; and Managing Daily Activities. Responses were graded on a Likert scale of 1-5 (1 being “No, I do not know how” and 5 being “Yes, I always do this when I need to”). Scores less than 4 indicate need for education.

Results
In 32 perinatally-infected ALHIV, mean age at diagnosis was 3.7 years (SD 2.7) and at antiretroviral therapy initiation 5.2 years (SD 3.3). Mean number of clinic visits in the prior 12 months was 4 (S.D 0.48, range 3-6). Half were still in high school, and most (88%) lived with their biological parents. The mean TRAQ scores were Appointment Keeping 3.82 (SD 0.61); Tracking Health Issues 3.43 (SD 0.93); Managing Medications 4.56 (SD 0.59); Talking with Providers 4.71 (SD 0.4); and Managing Daily Activities 4.52 (SD 0.46).

Conclusion
In a first-of-its-kind study in East Africa, a validated HCT assessment in Rwandan ALHIV suggests overall readiness in managing medications, daily living tasks and communication with providers. Needs for further education in tracking health and keeping appointments were identified, important for independent self-management of chronic disease. Longitudinal follow-up and comparison to other populations (now feasible due to using a validated tool) are needed, to develop and further evaluate the impact of needed interventions on post-transition outcomes.

Disclosures
Tanya Rogo, MD, AstraZeneca: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support
1719. Duration of antibodies after immunization with the quadrivalent influenza vaccine in children after hematopoietic stem cell transplantation or chemotherapy compared to healthy children
Authors: Cho Yoon Kyung , Ahn Bin , Choi Sujin , Kim Ye Ji , Kang Kyu Ri , Kang Hyunmi , Kang Jin Han 
Published: November 2023

Abstract

Background
Children that have undergone hematopoietic stem cell transplantation (HSCT) are at a higher risk for severe influenza. The purpose of this study was to compare the duration of antibodies after immunization with the quadrivalent influenza vaccine (QIV) in children after hematopoietic stem cell transplantation or chemotherapy compared to healthy children.

Methods
This was a prospective study of children below 18 years old that received the QIV influenza vaccine during the 2021-2022 influenza vaccination season. Children were divided into 3 groups as follows: a) post-HSCT, b) post-chemotherapy, and c) immunocompetent children as a healthy control. Blood samples were taken immediately before immunization, at 1 month, 3 months, 6 months, and 12 months after immunization. Hemagglutination Inhibition (HI) assays were performed. Seropositive rate was defined by the percentage of patients with HI titer ≥1:40. Seroconversion rate (SCR) was defined as follows: 1) in patients with a pre-vaccination HI titer &lt; 1:10, rise in post-vaccination HI titers ≥1:40, or in patients with pre-vaccination HI titers ≥1:40, a 4-fold increase.

Results
A total of 60 children were included in the preliminary analyses, n=20 in each of the three groups. The SPR at post-vaccination 1 month for both A/H1N1 and H3N2 exceeded 80% in all three groups. The SPR remained above 60% at 3 months post-immunization for both A antigens. However, by 6 months post-vaccination, the SPR dropped to 50% in the post-chemotherapy group for the A/H1N1 antigen, and the geometric mean titers (GMTs) were 26.39. For B/Victoria and B/Yamagata, the SPR was below 40% in the post-HSCT and post chemotherapy group at 1 months and below 20% by 3 months. The GMTs were also below 1:40 for both antigens. In the normal control group, the SPR for B/Victoria was 50% at 1 months and 45% at 3 months post-immunization, and for B/Yamagata, 50% at 1 months and 55% at 3 months post-immunization. However, the GMTs were below 1:40 by 3 months post-immunization.

Conclusion
For A/H1N1, the SPR and GMTs at 6 months in the post-chemotherapy was low. In both the post-HSCT and chemotherapy group, HI titers were low for both B antigens at 1-month post-vaccination, and GMTs showed &lt; 1:40. B antigens contained within QIV need to illicit better protection against Influenza in children.

Disclosures
All Authors: No reported disclosures