bluuebunny/crossref_metadata_2025_split huggingface dataset:
1610. Adherence to Antiretroviral Therapy and Its Effect on Quality of Life among Persons with HIV in the United States using Real-World Data
Authors: Hennessy Fritha , Prajapati Girish , Salmon Phoebe , Holbrook Tim , Tadese Bekana K 
Published: November 2023

Abstract

Background
Adherence to antiretroviral therapy (ART) is critical for persons with HIV (PWH) for achieving durable virologic suppression and minimizing drug resistance. This study aimed to characterize ART adherence and its effect on quality of life (QoL) among PWH using real-world data.

Methods
Data were drawn from the Adelphi HIV Disease Specific Programme™, a cross-sectional survey of physicians and PWH in the U.S., collected between July-2021 and March-2022. At consultation, each of 60 physicians reported demographics, clinical characteristics, ART adherence and satisfaction on 10 consenting PWH. These PWH were then invited to complete questionnaires reporting QoL (PozQol, EQ-5D). Physicians categorized adherence as completely adherent (C-Adh), mostly adherent (M-Adh), or less adherent (L-Adh). Comparisons were made using Chi squared test.

Results
Of 578 PWH with physician-reported adherence status; mean [SD] age 44.9 [12.8] years, 70.4% cisgender male, 50.5% White. A total of 389 (67%) were C-Adh, 155 (27%) M-Adh, and 34 (6%) L-Adh. L-Adh (55.9%) and M-Adh (46.5%) PWH had the higher proportion of ART side effects compared to C-Adh (29.3%); p&lt; 0.001. Also, L-Adh (75.8%) and M-Adh (50.8%) were more likely to report current HIV-associated symptoms than C-Adh PWH (29.3%); p&lt; 0.001. C-Adh PWH were perceived as very satisfied with their ART (68.4%), compared to M-Adh 39.4% and L-Adh 23.5%; p&lt; 0.001. Reasons for PWH skipping ART included forgetting, difficulties integrating into routine, and ART side effects (Figure 1). QOL survey was completed by 229 PWH. QoL was higher for C-Adh PWH, measured by PozQol score mean, (C-Adh;45.2, M-Adh ;40.7, L-Adh;42.0; p&lt; 0.05) and EQ-5D score mean (C-Adh; 0.91, M-Adh;0.77, L-Adh;0.66; p&lt; 0.001).

Conclusion
About one-third of PWH who were not fully adherent to ART, and this was correlated with having poorer QoL. These findings highlight the need to better understand factors leading to sub-optimal ART adherence, to provide targeted interventions to improve quality of life.

Disclosures
Girish Prajapati, M.B.B.S., MPH , Merck & Co., Inc.: Employee|Merck & Co., Inc.: Stocks/Bonds Bekana K. Tadese, PhD, MPH, Merck and Co Inc: Employee
1619. Epidemiology of Congenital Syphilis Infections in Northwestern (NW) Iowa Witnessing a Significant Increase- Experience of a Tertiary Care Center
Authors: Kaushik Ashlesha , Beal Kristen , Gupta Sandeep 
Published: November 2023

Abstract

Background
According to the CDC, STI (sexually transmitted infections) including syphilis infections in adults have recently increased in the upper Midwest. Studies evaluating epidemiology of Congenital syphilis (CS) are needed to facilitate prompt recognition to prevent sequelae.

Methods
We retrospectively studied epidemiologic, clinical characteristics and outcomes of neonates with CS at our tertiary care center which is the largest maternal/neonatal center in NW Iowa during 1/1/2021-12/31/2022 (labeled P2). Epidemiologic characteristics during P2 were compared with the period from 1/1/2019-12/31/2020 (labeled P1). Diagnosis and treatment for CS were in accordance with CDC/American Academy of Pediatrics Committee on Infectious Diseases Red Book guidelines.

Results
During P2, a total of 42 newborns were diagnosed with CS compared to 0 during P1 (p&lt; 0.05); 64% of infected newborns were White followed by Native American (21%), Hispanic (11%) and Black (2%). All (100%) neonates with CS were born to mothers infected during or after second trimester of pregnancy with negative first trimester RPR (Rapid Plasma Reagin) testing. Maternal RPR titers ranged from 1:1-1:256. Majority (62%) of newborns were diagnosed with proven/possible CS with RPR-titers &gt; 4-fold mother's titers /untreated or inadequately treated maternal infection and required 10 days of intravenous Aqueous crystalline penicillin G treatment and NICU care; 2 newborns had meningitis and 3 developed sensorineural hearing loss. Thirty-eight% received 1 dose of intramuscular Benzathine penicillin G. Need for cerebrospinal fluid syphilis testing and 10 days of intravenous penicillin treatment increased by &gt; 600% from P1 to P2 (p=0.02). CS evaluation/treatment in infected Native American neonates increased by &gt; 1000% in P2 (p&lt; 0.001). Mean hospitalization duration was 9.5 (±1.6) days. No infant died. Only 33% of infants followed up at 2 months for repeat testing. None of the Native American/Hispanic/Black neonates compared to 52% White neonates had follow-up testing (p&lt; 0.05).

Conclusion
Our results show an alarming increase in CS in NW Iowa and underline the need for urgent preventive measures including STI prevention education, adequate maternal/ neonatal testing and follow-up, especially among marginalized populations.

Disclosures
All Authors: No reported disclosures
1635. Assessing the Potential Reduction in Morbidity and Mortality Attainable by Delayed Influenza Vaccine Strain Selection
Authors: Kissler Stephen M , Joshi Keya , Van de Velde Nicolas , Vicic Nevena , Park Yoonyoung , Rudin Deborah , Ghaswalla Parinaz 
Published: November 2023

Abstract

Background
To allow time for production, seasonal influenza vaccine target strains must be chosen up to 8 months before the start of the influenza season. Antigenic drift during these months can lead to mismatch between the circulating and vaccine strains, negatively impacting vaccine effectiveness (VE). mRNA vaccines can be produced more quickly than standard vaccines, raising the possibility of delaying influenza vaccine strain selection by up to 3 months, thus potentially improving VE. This is especially important for the H3N2 subtype, which is generally more severe than other subtypes and causes most human infections. The potential reductions in morbidity and mortality attainable by delayed influenza vaccine strain selection, especially for H3N2 subtype, have not yet been examined.

Methods
We assessed the match between circulating and vaccine strains (only H3N2 subtype) using influenza phylogenetic data and associated predictions of antigenic distance (difference in log-2 HI titer) from 2011-2019 obtained from GISAID and analyzed using NextStrain. We then developed a mathematical model to estimate the potential reduction in symptomatic cases, hospitalizations, and mortality attainable by a 3-month delay in influenza vaccine strain selection. A direct estimation of final epidemic size, trained to historical data on influenza burden from the US Centers for Disease Control and Prevention, was used to parametrize the model.

Results
In 2011-2019, a 3-month delay in strain selection could have detected the emergence of antigenically distinct H3N2 strains ( &gt; 2 predicted log-2 HI titer difference from the vaccine) on 3 occasions: Mar (June) 2012, Sep (Dec) 2014, and Sep (Dec) 2017 (Figure). Improved strain selection in 2012 and 2017 may have had only a limited impact: VE in the NH 2012-13 season remained high despite the suboptimal match, and circulation of influenza in the SH in 2018 was low. However, in 2014, improved strain selection could have yielded substantial benefits, with model-estimated reductions in hospitalizations and mortality between 15-20%.

Conclusion
Delayed seasonal influenza vaccine strain selection, made possible by mRNA vaccine technology, could improve vaccine strain match and potentially yield reductions in hospitalizations and mortality in some seasons.

Disclosures
Stephen M. Kissler, PhD, ModernaTx: Advisor/Consultant Keya Joshi, PhD, Moderna, Inc.: Employee|Moderna, Inc.: Stocks/Bonds Nicolas Van de Velde, PhD, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Nevena Vicic, MSc, Moderna, Inc.: Employee|Moderna, Inc.: Stocks/Bonds Yoonyoung Park, ScD, Moderna, Inc.: Employee|Moderna, Inc.: Stocks/Bonds Deborah Rudin, MD, Moderna, Inc.: Employee|Moderna, Inc.: Stocks/Bonds Parinaz Ghaswalla, PhD, Moderna, Inc: Employee|Moderna, Inc: Stocks/Bonds
1640. Acyclovir use in infants and children (0-18 years) in Pediatric hospitals in Australia and New Zealand for suspected herpes simplex virus infection
Authors: Berkhout Angela , Clark Julia , Jones Cheryl , McMullan Brendan , Lim Selina , Yeoh Daniel , Britton Philip , Wong Shirley , Grimwood Keith , Cheng Daryl , Palasanthiran Pamela , Gwee Amanda , Cross Jack , Nguyen Tran , Jeffs Emma , Walls Tony , Mahony Michelle , Yan Jennifer , Nourse Clare 
Published: November 2023

Abstract

Background
Non-specific presentations of severe herpes simplex virus (HSV) infections and high risk of adverse outcomes have driven empiric acyclovir use. We therefore audited acyclovir prescribing in Australia and New Zealand for suspected HSV infection.

Methods
All children (0-18 years) prescribed intravenous (IV) acyclovir for suspected HSV infection in eight paediatric hospitals in Australia and New Zealand between 1 January 2019 and 31 December 2019 were included. Clinical data were extracted from patient records.

Results
IV acyclovir was prescribed for 1426 suspected cases, of whom 114 (8%) subsequently had proven HSV infection; 0.8% severe (9 encephalitis, 3 disseminated) and 7.2% (102) non-severe. Median age of the 1426 suspected cases was 4-months (IQR 0-49, range 0-223); 30% being neonates (&lt;28 days), 17% aged 29 days-to-3 months and 53% aged &gt;3-months. Suspected encephalitis (55%) and disseminated disease (29%) were the most common indications for prescribing acyclovir. 88% lacked risk factors and 90% had no potential identifiable source. 57% had CSF obtained, 25% and 13% had &gt;1 surface swab and blood sent for HSV PCR testing respectively, whilst 20% had no HSV investigations. 34% were admitted to an intensive care unit. Median IV acyclovir duration was 1-day (IQR 1-2; range 0-81); 0.5% experienced nephrotoxicity and 2% had an extravasation injury. The median length-of-hospital stay was 4-days (IQR 2-9, range 0-307), 92% were well at discharge. Non-HSV infections (47%) and seizure disorders (15%) were the most common discharge diagnoses.

Conclusion
This study suggests frequent unnecessary empiric acyclovir use, with 8% of children having proven HSV infection; minority severe (0.8%) and 20% of children not having any HSV investigations.
National algorithms identifying high-risk age groups and clinical features of neonatal HSV infection and HSV encephalitis are needed to better guide acyclovir use and limit unnecessary treatment.

Disclosures
All Authors: No reported disclosures
1649. Tracking and reporting antibiotic use: Rising antibiotic prescriptions for URI illness in children during the COVID-19 pandemic.
Authors: Clemons Emily , Whiteman Matthew , Garavaglia Lisa , Gupta Shipra 
Published: November 2023

Abstract

Background
During COVID-19 there was an increase in antibiotic utilization across all settings. West Virginia has the highest outpatient antibiotic prescribing rate in the country. As part of our outpatient antibiotic stewardship initiative, we developed and utilized a dashboard to track and report prescribing data in two pediatric clinics in a large health system.

Methods
We reviewed prescribing data from Oct 2020- Mar 2022 in two outpatient pediatric clinics using a dashboard within the electronic medical record. Both clinics are affiliated with a large health system but clinic A was academic and clinic B was non-academic clinic. We also collected data on total number of visits and visits that had antibiotics prescribed. We reviewed prescription data on visits that were diagnosed with upper respiratory tract illness (URI) like acute otitis media, acute sinusitis, acute pharyngitis etc. We compared URI antibiotic prescriptions in Jan 2021-Mar 2021 with Jan 2022- Mar 2022.

Results
There were more than 15,000 visits during the study period. A steady increase in antibiotic prescriptions written per visit was noted in both clinics (Figure 1). There was a significant increase in percentage of prescriptions for URI in the respiratory season for 2021 and 2022 (30.2% vs. 47.7%, p&lt; 0.0001). The most common diagnosis for antibiotic prescription in both clinics was acute otitis media (67 and 72%, respectively). However, clinic B wrote cefdinir prescriptions for 38 % cases of otitis media vs. 12% in clinic A.

Conclusion
There was an increase in overall prescriptions for antibiotics and prescriptions for URI in both clinic sites. This was most likely due to the prolonged viral season following cessation of COVID-19 mitigation measures. There were significant differences noted in prescribing practices, like cefdinir overuse for treatment of otitis media, which will guide our antimicrobial stewardship interventions in future.

Disclosures
All Authors: No reported disclosures
1650. Caregiver Perspectives on Educational Materials Used for Paediatric Community-Acquired Pneumonia and Antibiotic Stewardship in the Emergency Department: A Qualitative Study
Authors: Huang Nelson , Murphy Lara , Kandasamy Sujane , Wahi Gita , Pernica Jeffrey 
Published: November 2023

Abstract

Background
The objective of this study was to determine the best modality for educating caregivers on paediatric community-acquired pneumonia (CAP) and antibiotic stewardship within the emergency department (ED) setting. This was to inform the design of educational materials used in a prospective study (PIONEER study, NCT 05114161) testing a novel care pathway for treating non-severe paediatric CAP that aims to reduce unnecessary antibiotic prescriptions.

Methods
This was a phenomenologically-informed qualitative study involving interviews with caregivers of young children in Hamilton, Ontario. Caregivers were presented with four educational materials on appropriate antibiotic prescribing for paediatric pneumonia management. The four materials included: a video of a physician presenting the information, a caregiver discussing her own experiences with antibiotic use for her children, an animated video with audio alongside written information and illustrations, and a brochure. Following this, participants were asked open-ended questions about how they felt about the effectiveness of the materials shown.

Results
Eleven caregivers were interviewed. Most caregivers preferred the combination of the animated video and brochure to the use of either the didactic physician or caregiver video. Participants reported that the stress of the ED environment may hinder their ability to easily process information in the moment. As such, some participants preferred the simpler visuals of the animated video as well as the brochure which they could refer to following their child’s discharge. One caregiver expressed a desire for increasing the diversity of racial identities represented in the educational materials. Although our study focused on paediatric CAP, these findings may have implications in the larger context of caregiver education in the ED.

Conclusion
The findings from this study emphasize the importance of providing clear and concise information to caregivers in the ED environment. Educational aids with simple visuals and concise information which can be referenced following the ED visit are preferred. Additionally, increasing diversity in educational materials can help promote a more inclusive care experience.

Disclosures
Jeffrey Pernica, MD, MSc, FRCPC, DTMH, MedImmune: Grant/Research Support|Merck: Grant/Research Support
1657. Evaluating the Effectiveness of Biofire® FilmArray® BCID2 Sepsis Panel in Pediatric Antibiotic Stewardship Program: Less time and more control
Authors: Londono-Ruiz Juan Pablo , Betancur Juan Pablo , Casadiego-Payares Stephanie , Castellanos-Leguizamon Daniela , Gutierrez-Tobar Ivan Felipe 
Published: November 2023

Abstract

Background
The use of molecular biology tools has allowed for a decrease in the time required for effective therapy in bacteremia. Integrating these tools into Antimicrobial Stewardship Programs (ASP) can improve clinical outcomes. The aim of this study is to describe the impact of using a molecular biology platform for sepsis as part of an ASP in a pediatric hospital.

Methods
This descriptive study collected data from positive blood cultures that underwent Biofire® FilmArray® BCID2 testing for sepsis from January 2021 to February 2023. In our hospital, taking this molecular test is indicated in all blood cultures positive for Gram-negative bacilli, in Gram-positive cocci only when there is a pyogenic focus or both sets are positives, additionally in patients with immunosuppression or who present with septic shock. Clinical and microbiological characteristics of the samples were described, along with the impact of the ASP after receiving the test results. Data analysis was performed using the R program.

Results
A total of 119 positive blood culture bottles were included in the study, in which the molecular test was performed. Gram-positive cocci were identified in 82 (68.9%) bottles, while Gram-negative bacilli were identified in 37 (31.1%). The mean detection time for Gram-positive cocci was 13 hours and 33 minutes (range: 11-18 h), while for Gram-negative bacilli it was 11 hours and 30 minutes (range: 9-13 h). The most frequently detected germs are presented in Table 1. Among the 119 patients, the FilmArray test result prompted a change in antibiotic therapy in 54 cases (45.3%). In an additional 28 cases (23%), a change was made after the final culture result. Only 6 patients (5%) experienced clinical deterioration after the FilmArray® test, requiring changes prior to the definitive culture result.Table 1:Different microorganisms, diagnosis times and concordance with the definitive culture

Conclusion
In conclusion, our study demonstrates that the use of molecular tools in positive blood culture bottles, guided by an ASP, allowed for rapid changes in nearly half of the cases. Few patients experienced deterioration after the completion of the FilmArray® test, requiring empirical changes in the antibiotic. These findings suggest that incorporating molecular tests into ASPs can significantly improve the management of bacteremia, leading to more effective and timely treatment decisions.

Disclosures
All Authors: No reported disclosures
1667. Patterns of Inpatient Antibiotic Use by Race and Ethnicity at US Children's Hospitals
Authors: Wattles Bethany , Campbell Jeffrey I , Feygin Yana , Jawad Kahir S , Stevenson Michelle D , Davis Deborah , Porter Jennifer , Jones V Faye , Smith Michael J 
Published: November 2023

Abstract

Background
Racial and ethnic variations in antibiotic prescribing to children are well-reported in outpatient settings. However, little is known about racial prescribing patterns in hospital settings. We sought to describe national inpatient antibiotic utilization among children by race and ethnicity.

Methods
We utilized Pediatric Health Information System (PHIS) data from 49 children’s hospitals across the US. All inpatient and observation-status visits from 2022 for children &lt; 18 years were included. An “antibiotic visit” was defined as any inpatient admission in which an oral, parenteral, or intramuscular antibiotic was prescribed. Antibiotic visits, severity, length of stay, and cost of stay were stratified by patient race and ethnicity (as collected by each hospital). Diagnoses and severity were classified by All Patients Refined Diagnosis Related Groups (APR-DRG).

Results
Antibiotic visits by race-ethnicity ranged from 38.4% (Non-Hispanic [NH] Black children) to 45.0% (NH American Indian) (Table 1). NH White children made up the largest group (45.2% of all visits) and had an antibiotic visit rate of 42.4%, followed by Hispanic (27.1% of all visits) and NH Black (19.2%). Antibiotic visits for children &lt; 2 months ranged from 19% (Asian) to 39.4% NH American Indian. The largest gap in antibiotic visits between NH White and NH Black children was in ages 5 to 11 years (49% and 40.6%, respectively). Differences between NH White and NH Black children were highest in the northeast (44.7% vs. 36.6%, respectively), and lowest in the south (40.1% vs. 38.9%, respectively). In NH White and Hispanic children, antibiotic visits decreased with increasing income and Child Opportunity Index; for NH Black children, a reverse relationship was observed. Severity was similar for NH White, Hispanic and NH Black children. NH Black children had the highest proportion of stays &gt;14 days (6.6%) but lower cost of stays. Antibiotic visits and diagnoses of interest are reported in Table 2.Table 1.Demographics and Antibiotic Visits by Race and Ethnicity. NH = Non-Hispanic; Child Opportunity Index (a neighborhood measure of resources and conditions for healthy development) and Income were assigned using patient zip code.Table 2.Antibiotic Visits and Outcomes by All Patients Refined Diagnosis Related Groups (APR-DRG). All Visits, Antibiotic Visits = row %; Severity = column %

Conclusion
Antibiotic utilization in children’s hospitals differs by race and ethnicity. Antibiotic stewardship programs should stratify antibiotic use data by race-ethnicity and examine policies and practices that may contribute to disparities in treatment for hospitalized children.

Disclosures
Bethany Wattles, PharmD, MHA, Merck: Grant/Research Support Michael J. Smith, M.D., M.S.C.E, Merck: Grant/Research Support|Pfizer: Grant/Research Support
1674. 10 Year p-OPAT Experience In A Tertiary Pediatric Center In Singapore
Authors: Aoyama Rie , Chan Si Min , Leow Olivla , Ang Samantha , Quek Belinda 
Published: November 2023

Abstract

Background
Outpatient parental antibiotic therapy is safe and effective. Our institution is one of two tertiary public hospital pediatric centers in Singapore. We aim to describe characteristics and outcomes of pediatric OPAT (p-OPAT).

Methods
We retrospectively reviewed p-OPAT patients from May 2013-Dec 2022. Clinically stable inpatients were referred to the pediatric infectious disease team for assessment, caregiver training, and weekly review. Two main delivery models were used; daily bolus/short infusion at an outpatient unit, and home self-administration via elastomeric device. Electronic medical records were analyzed for demographics, clinical and microbiological data, treatment, and outcomes. Institutional review board approval and written informed consent were waived.

Results
219 patients completed 249 p-OPAT episodes; 46.6% female, 53.3% male. Median age was 8 years 5 months (range 11 days-29 years). Patient ethnicities were 53.9% Chinese, 12.3% Indian, 20.5% Malay, 13.3% others.
53/219 (24.2%) patients were immunocompromised; three had primary immunodeficiency, 50 had acquired immunodeficiency. 89/219 (40.6%) patients had chronic illness.
176/249 (70.7%) episodes had only one pathogen identified (Tab 1). Pathogens were gram positive (21.7%), gram negative (38.2%), fungal (5.2%), mycobacterial (5.6%) (Tab 2). 18.9% episodes were culture-negative, 1.6% episodes had no cultures. Infection sites varied considerably; osteoarticular infection +/- bacteremia were most common (Tab 3). Ceftriaxone was the most frequent antimicrobial (105, 42.3% episodes). Peripherally inserted central catheter was most commonly used (138, 55.4% episodes).
Complete success, partial success, and failure were seen in 174 (69.9%), 43 (17.3%) and 32 (12.8%) episodes respectively. Main adverse events (AE) were vascular site dermatitis, infection, and line dislodgement. 235 (94.4%) episodes achieved infection cure. Mean p-OPAT duration was 16.9 days (range 1-177 days), saving 4208 admission bed days.

Conclusion
We describe one of the largest series of children receiving p-OPAT over 10 years and report good outcomes for a broad spectrum of infections. Vascular access issues were common AEs despite preventive measures.

Disclosures
All Authors: No reported disclosures