bluuebunny/crossref_metadata_2025_split huggingface dataset:
1779. Trends in Anaplasmosis Over the Past Decade: A Review of Clinical Features, Laboratory Data and Outcomes
Authors: Katragadda Silpita , Yetmar Zachary A , Chesdachai Supavit , Ranganath Nischal , Wilcock Jonathan , Saleh Omar M Abu , Challener Douglas 
Published: November 2023

Abstract

Background
Human granulocytic anaplasmosis (HGA) is an emerging tick-borne illness endemic to the northeastern and midwestern United States. Risk factors for the severity of infection, predictors for hospitalization, temporal trends, co-infections, and outcomes are poorly studied.

Methods
We conducted a retrospective review of HGA at Mayo Clinic, Rochester, between 2011-2021. Cases were identified by positive Anaplasma PCR at our reference laboratory. Variables included patients’ characteristics, symptoms, risk factors for tick-borne illness, laboratory parameters, co-infections, treatment, and clinical outcomes.

Results
We identified 471 cases with a positive Anaplasma PCR, and 146 cases were included in this interim analysis. Table 1 shows a summary of the baseline characteristics. An increasing annual trend in diagnosis of HGA was noted from 2014 to 2016 with lower rates observed during COVID-19 pandemic (2020 to 2022) (Figure 1). Of the 146 patients, 19 (13%) were immunocompromised secondary to hematologic malignancies, solid organ malignancies, and pharmacological immunosuppression. Frequently reported symptoms included fever (79.5%), malaise (68.5%), chills (51.4%), and myalgia (50%). Tick exposure was documented in 79.2 % of cases. Forty-seven (33%) patients were hospitalized; older patients were more likely to be hospitalized (Table 2). The most common complications among the hospitalized patients included respiratory failure (50%), encephalopathy (44.4%) and renal failure (37.5%). One patient required ICU admission. Twenty-five patients (17.5%) and one patient (0.7%) were co-infected with Lyme and Ehrlichiosis, respectively. Higher rates of leukopenia and thrombocytopenia were associated with mono-infection with Anaplasma (p &lt; 0.001). Follow up data was available for 136 patients; all of them had favorable response to doxycycline.Table 1:Summary of baseline characteristics, labs and treatment.Table 2:Predictors of HospitalizationFigure 1:Annual Trends in Anaplasmosis from 2011-2021.

Conclusion
Our study demonstrated comprehensive clinical characteristics of patients with HGA. Interestingly, tick exposure history was common, yet most patients did not have other tick-borne co-infections. Furthermore, only a minority of patients developed severe diseases and required hospitalization. The recent decline in cases during the early part of the COVID-19 pandemic is worth further investigation.

Disclosures
All Authors: No reported disclosures
2884. Incidence of Invasive Fungal Infections After Pancreas Transplantation
Authors: Nair Vaisak , Yetmar Zachary A , Seville Maria T , Bosch Wendelyn , Beam Elena 
Published: November 2023

Abstract

Background
There is scarce data surrounding the epidemiology of invasive fungal infections (IFI) after pancreas transplantation (PT). Our centers’ PT protocols recommend universal fluconazole prophylaxis for at least 1 month, which is extended to 1 year for recipients who live in Coccidioides endemic areas. The purpose of our study was to evaluate the epidemiology of IFIs after PT while on our antifungal prophylaxis protocol.

Methods
A retrospective cohort study was performed among adult patients who underwent PT at Mayo Clinic sites in Arizona, Florida, or Minnesota between January 1, 2010 and December 31, 2020. IFI was defined based on EORTC/MSGERC criteria. The primary aim was to describe epidemiology and timing of IFI after PT, particularly in the context of the universal antifungal prophylaxis protocol.

Results
Among 482 pancreas transplant recipients, 35 developed IFIs (7.3%). All patients received antifungal prophylaxis per protocol for a median duration of 33 days (Figure 1). Median duration from time of transplant to IFI was 16 (IQR 10.5-28.2) days for Candida IFIs versus 529 (IQR 192.5-1195.0) days for non-Candida IFI. 20 IFIs (57.1%) were secondary to Candida species with 45% of these cases caused by either C. glabrata or C. krusei (Figure 2). 90% were on antifungal prophylaxis (85% fluconazole) at time of diagnosis of invasive candidiasis. All the Candida IFIs were intra-abdominal infections. Amongst the 15 non-Candida IFIs (42.9%), 9 were secondary to endemic mycoses and 4 were secondary to invasive molds.

Conclusion
Our study shows a high incidence of IFIs secondary to Candida, with few patients diagnosed with non-Candida IFIs (Figure 3). Non-Candida IFIs, mostly secondary to endemic mycoses, occurred more than a year after transplant. Patients are at highest risk for Candida IFIs within the first 30 days after PT, likely secondary to organ space surgical site infections, despite receipt of antifungal prophylaxis. Breakthrough invasive candidiasis occurred in 90% of cases. Though our study lacked a comparator group without prophylaxis, these data question the effectiveness of fluconazole prophylaxis after PT.

Disclosures
All Authors: No reported disclosures
1783. Acute Kidney Injury Associations with Antibiotics: A Pharmacovigilance Study of the US FDA Adverse Event Reporting System
Authors: Kochuparambil Jose J , Raju Jomel 
Published: November 2023

Abstract

Background
Antibiotic-associated acute kidney injury is found to be associated with many antibiotics like vancomycin, fluoroquinolones, penicillin combinations, and trimethoprim–sulfamethoxazole. Other antibiotics may also lead to acute kidney injury. Still, no study has systemically compared the cases of acute kidney injury reported to the US FDA Adverse Event Reporting System (FAERS) with the many available antibiotics. Therefore, the study aimed to evaluate the reporting associations between acute kidney injury and different classes of antibiotics through the analysis of the US FDA Adverse Event Reporting System (FAERS).

Methods
FAERS reports from 1 January 2015 to 31 December 2022 were included in the study. The Medical Dictionary for Regulatory Activities (MedDRA) was used to identify AKI cases. Reporting odds ratios (RORs) and corresponding 95% confidence intervals (CIs) for the reporting associations between antibiotics and AKI were calculated. A reporting association was considered statistically significant when the lower limit of the 95% CI was &gt; 1.0.

Results
A total of 2,042,801 reports (including 20,138 AKI reports) were considered. Colistin had the greatest proportion of acute kidney injury reports, representing 25% of all colistin reports. acute kidney injury RORs (95% CI) for antibiotics were, in descending order: colistin 33.10 (21.24–51.56), aminoglycosides 17.41 (14.49–20.90), vancomycin 15.28 (13.82–16.90), trimethoprim–sulfamethoxazole 13.72 (11.94–15.76), penicillin combinations 7.95 (7.09–8.91), clindamycin 6.46 (5.18–8.04), cephalosporins 6.07 (5.23–7.05), daptomycin 6.07 (4.61–7.99), macrolides 3.60 (3.04–4.26), linezolid 3.48 (2.54–4.77), carbapenems 3.31 (2.58–4.25), metronidazole 2.55 (1.94–3.36), tetracyclines 1.73 (1.26–2.36), and fluoroquinolones 1.71 (1.49–1.97).

Conclusion
This study found 14 classes of antibiotics having significant reporting associations with AKI. Among the antibiotics evaluated in this study, colistin had the highest acute kidney injury ROR and moxifloxacin had the lowest.

Disclosures
All Authors: No reported disclosures
1798. Vaccine Ambassadors: An Educational Model to Spread Awareness About Vaccines in Detroit
Authors: Schmidt Jennifer , Howson Sofia , Maples Catherine , McConnell Jack , Desai Soham , Chopra Teena , Seeger Matthew 
Published: November 2023

Abstract

Background
Since the COVID-19 pandemic, national vaccination rates show a dangerous decline with Detroit being amongst the lowest with only 41.3% of adolescents completing the vaccine series. The Vaccine Ambassador program was created to mitigate the decline in vaccination rates through the education and empowerment of youth via train-the-trainer model of education.

Methods
The program was implemented with eleven high school students who received education on the history and mechanism of vaccines, herd immunity, and how to effectively communicate. The program was created in collaboration with physicians in Infectious Diseases and a professor of communication at Wayne State University.
Ambassadors aimed to spread this knowledge to youth in Detroit communities through outreach events. The impact of the program was measured through a two-pronged approach—through a pre- and post-survey given to the Vaccine Ambassadors and through a pre- and post-test given to the youth at the events. The survey for the Ambassadors included thirty-one items that measured their knowledge about vaccines and immunity and were evaluated through a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). The test for the youth at the outreach events included seven items that tested knowledge about vaccines.

Results
The following prompt is an example from the survey given to the ambassadors: Inactive vaccines create a better immune response than live vaccines. Compared to the pre-survey, six participants (54.5%) indicated a less agreeable response. With regards to the youth outreach events, twenty-five youth participated in the pre- and post-test, and nineteen youth (76.0%) improved their score after the presentation. Post-test scores improved across all seven questions (Figure 1).
Comparison of Pre and Post Test Responses During Outreach Events
Representation of the percent correct questions before and after the Vaccine Ambassador presentation

Conclusion
Based on both pre-test responses, it is apparent that Detroit’s youth lack knowledge regarding vaccines. The Vaccine Ambassador program increased the ambassador’s depth of knowledge and reaffirmed their positive attitudes about vaccines. Not only are youth able to learn, but they are able to apply their knowledge and teach others. By teaching their peers, youth can make informed decisions when older and enact behavioral changes that promote healthier living.

Disclosures
All Authors: No reported disclosures
1837. Evaluation of Disparities in Beta-Lactam Allergies and Subsequent Antibiotic Use in Outpatients with Acute Bacterial Skin and Skin Structure Infections
Authors: Hall Ronald G , Shaw Chip , Cole Travis , Alvarez Carlos 
Published: November 2023

Abstract

Background
Black patients with skin and soft tissue infections are more likely to have a documented penicillin allergy and use of non-beta-lactams than white patients. We sought to compare the prevalence and risk factors for documented beta-lactam allergy (D-BLA) among racial and ethnic minorities (REM) and white patients and beta-lactam (BL) use for outpatient Acute Bacterial Skin and Skin Structure Infections (ABSSSIs).

Methods
We conducted a cohort study of adult outpatients (18-90 years) seen by the Texas Tech University Health Science Center Physicians group (2012-2021). All patients had an ICD-9 or ICD-10 code for an ABSSSI in the primary or secondary position. Descriptive statistics were reported. Logistic regression models were used to determine which factors were statistically associated with D-BLA and which factors were associated with BL use for the ABSSSI. Multivariable (MV) analysis results were reported as odds ratios (OR) and 95% confidence intervals (95%CI). All analyses were conducted in R.

Results
REM represented 38% of the 21,673 patients in the cohort. A D-BLA was present for 18% percent of all patients and was higher in white patients than REM (22 vs 13%). Factors associated with D-BLA on MV analysis of the total cohort were age (OR 1.01 per year, 95%CI 1.01-1.01), Medicaid (OR 1.18, 95%CI 1.04-1.34), or Medicare (OR 1.17, 95%CI 1.05-1.31). Factors associated with a lower likelihood of D-BLA on MV analysis of the entire cohort were REM (OR 0.55, 95%CI 0.51-0.60) and male sex (OR 0.56, 95%CI 0.52-0.60). Regarding BL use, white patients were less likely to receive a BL than REM (26 vs 30%). Factors associated with a reduced likelihood of BL use on MV analysis of the total cohort were D-BLA (OR 0.60, 95%CI, 0.54-0.67), Medicaid (OR 0.83, 95%CI 0.74-0.93), or Medicare (OR 0.64, 95%CI 0.58-0.70). Factors associated with BL use on MV analysis of the entire cohort were REM (OR 1.20, 95%CI 1.12-1.28), male sex (OR 1.45, 95%CI 1.36-1.54), or self-pay (OR 1.52, 95%CI 1.37-1.68). The interaction term between REM and D-BLA was not significant for BL use.

Conclusion
REM were at a reduced risk of a D-BLA in our cohort and were more likely to receive a BL for ABSSSIs. Payor status and sex also significantly impacted rates of D-BLA and BL use.

Disclosures
Ronald G. Hall, II, PharmD, MSCS, Merck: Grant/Research Support Carlos Alvarez, PharmD, MSc, MSCS, Boehringer Ingelheim: Grant/Research Support|Bristol Myer Squibb: Grant/Research Support|Merck: Grant/Research Support
2896. Oral PrEP Uptake among HVTN 704/HPTN 085 Participants: Implications for the Future of Biomedical HIV Prevention Trials
Authors: Cantos Valeria D , Neradilek Moni , Gillespie Kevin , Huang Yunda , deCamp Allan C , Karuna Shelly T , Edupuganti Srilatha , del Rio Carlos , Veloso Valdilea , Cohen Myron S , Donnell Deborah J , Corey Lawrence , Roxby Alison C , Kelley Colleen F 
Published: November 2023

Abstract

Background
The HVTN 704/HPTN 085 clinical trial (AMP study) assessed the efficacy of VRC01 broadly neutralizing antibody infusions for HIV prevention. It offered access to oral pre-exposure prophylaxis (PrEP) at no-cost to all participants as standard of HIV prevention care. Understanding PrEP initiation among trial participants and describing its impact on study endpoints can guide future HIV prevention trial design.

Methods
We characterized sociodemographic and geographic features of PrEP initiation (by self-report) using descriptive statistics. We used Cox models to identify factors associated with PrEP initiation and the association between PrEP initiation (as a time-dependent exposure) and HIV incidence.

Results
Of 2221 participants off PrEP at enrollment, 31.8% initiated PrEP during the trial. Median time to PrEP initiation was 60 days (range 1-673 days). Brazil had the highest proportion of PrEP initiation among their enrolled participants (83.2%) and Peru had the lowest (5.3%). In US sites, 54.2% initiated PrEP. Southern US sites had the highest proportion of PrEP initiation (68.8%) and the Midwest had the lowest (28.4%).
In multivariate analysis, prior PrEP use [HR (95% CI) = 2.2 (1.3-4.0)] was associated with PrEP initiation. Participants from Switzerland [0.5 (0.3-1.0)] and Peru [0.08 (0.06-0.1)] had lower likelihood of PrEP initiation compared to the US, while participants from Brazil had higher likelihood [2.6 (2.0-3.3)]. Age, race, gender, and sexual orientation were not associated with PrEP initiation. HIV incidence rate was 3.6/100 person-years (PY) before PrEP initiation, compared to 1.2/100 PY after PrEP initiation. PrEP initiators had 58% less risk of acquiring HIV after adjusting for behavioral risk score and treatment arm. In the US, higher local PrEP-to-need ratio was also associated with lower PrEP initiation [0.9 per 5 units (0.8-1.0)].

Conclusion
Providing PrEP access to AMP participants reduced HIV acquisition among PrEP initiators. Study endpoints were still met due to heterogenous regional PrEP uptake and lower PrEP effectiveness than expected. These data suggest that offering oral PrEP to HIV prevention trial participants as standard of care is a feasible option to consider for future efficacy HIV prevention trial design.

Disclosures
Valeria D. Cantos, MD, Gilead Sciences: Grant/Research Support Srilatha Edupuganti, MD MPH FIDSA, Sanofi: Grant/Research Support Colleen F. Kelley, MD, MPH, Gilead Sciences: Grant/Research Support|Humanigen: Grant/Research Support|Moderna, Inc.: Grant/Research Support|Novavax, Inc: Grant/Research Support|Viiv Healthcare: Grant/Research Support
1854. Legionnaires’ Disease Case Exposure Classification Differs by Race and Ethnicity and Neighborhood Health — California, 2011–2021
Authors: Schember Cassandra O , Rutschmann Sarah , Kimura Akiko , Nguyen Alyssa , Vugia Duc , Jain Seema 
Published: November 2023

Abstract

Background
Legionnaires’ disease (LD) is a severe pneumonia caused by Legionella bacteria transmitted by inhalation of contaminated water droplets found in poorly maintained water systems. During 2012–2020, 53% of California LD patients were white and 14% were black; however, these groups account for only 39% and 6% of the population, respectively. Healthy Places Index (HPI) measures census tract health, which can affect risk for LD, by combining 23 indicators of social and environmental conditions. We assessed associations between race/ethnicity and neighborhood health, with LD case exposure classifications to establish priorities for decreasing LD disparities in California.

Methods
Using all California LD cases reported during 2011–2021 and six, individual modified Poisson regression models, we estimated incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for associations between race/ethnicity and neighborhood health (using HPI quartile) with three LD case exposure classifications (sporadic, healthcare-associated, or travel-associated). The most advantaged HPI quartile and non-Hispanic white race/ethnicity were the referent groups. All models controlled for birth sex, age, and year.

Results
Among 4,373 people with LD, 47% were white, 22% were Hispanic, 12% were black, and 22%–28% fell in each HPI quartile. Among cases, 78% were sporadic, 16% were travel-associated, and 5% were healthcare-associated. Black (IRR: 0.69; 95% CI: 0.55, 0.87) and Hispanic (IRR: 0.64; 95% CI: 0.52, 0.77) race/ethnicity were associated with decreased rates of travel-associated LD. Black (IRR: 1.06; 95% CI: 1.01, 1.11) and Hispanic (IRR: 1.11; 95% CI: 1.07, 1.16) race/ethnicity, and living in the least advantaged quartile (IRR: 1.05; 95% CI: 1.01, 1.10) were associated with increased rates of sporadic LD. Healthcare-associated LD was not associated with race/ethnicity or HPI.

Conclusion
We found evidence of racial and neighborhood disparities in sporadic LD, racial disparities in travel-associated LD, and no evidence of disparities in healthcare-associated LD. Efforts to increase uptake of water management programs in buildings in disadvantaged neighborhoods and travel accommodations might lessen LD burden and disparities in California.

Disclosures
All Authors: No reported disclosures
1863. Pediatric Nontuberculous Mycobacteria (NTM) Lymphadenitis: an Evolving Epidemiological Pattern in Northeast Ohio
Authors: Ackerman Aaron , Desai Ankita P , Shah Jay , Gropler Matthew 
Published: November 2023

Abstract

Background
This study describes the changing pattern of non-tuberculous, or atypical, mycobacteria (NTM) lymphadenitis over the past five years in Northeast Ohio and analyzes factors that may be associated with this change. Particular attention will be paid to any demographic or geographic associations that can be linked with this pattern, to assess for any changing epidemiology.

Methods
A retrospective chart review was completed including patients presenting to our tertiary medical center over the past five years. Patients with clinical presentation of lymphadenitis in the context of laboratory documented nontuberculous mycobacterial infection, or presumed infection, were included in the review.

Results
Thirteen patients with NTM lymphadenitis presenting in Northeast Ohio were identified during the five years from 2017 to 2022. Three patients (23.1%) presented between 2017 and 2019, while ten patients (77%) presented between 2020 and 2022. The median age on presentation was 16 months old (range of 12 to 40 months). Six were male (46.2%) and seven were female (53.8%). Nine (69.2%) had positive wound cultures for Mycobacterium avium complex (MAC) and four (30.8%) were managed presumptively. Four (30.8%) were managed with medication alone, four (30.8%) were managed with surgical excision alone, and five (38.5%) were managed with both medication and surgical excision. Seven (53.8%) were treated with rifampin and azithromycin, one was treated with clarithromycin and rifabutin, and one was treated with azithromycin and ethambutol. Eight (61.5%) underwent surgical excision. Five (38%) lived within 4 miles of Lake Erie and 8 (62%) lived within 7.5 miles of Lake Erie.

Conclusion
Thirteen cases of NTM lymphadenitis were identified over a five-year period in Northeast Ohio. The incidence increased from the years 2017-2019 (23.1%, n=3) to 2020-2022 (77%, n=10). Of the patients, 30.8% (n=4) responded to medication alone and 30.8% (n=4) responded to surgical excision alone, with 38.5% (n=5) requiring both medication and surgical excision. Medical therapy included combination therapy with macrolide in all cases. It is unclear if the geographic proximity to Lake Erie is contributing to the cases of NTM lymphadenitis in our area, but this needs to be further elucidated.

Disclosures
All Authors: No reported disclosures
1880. Comparative Analysis Between Elderly And Non-Elderly Tuberculosis Patients
Authors: Hammami Fatma , Koubaa Makram , Rekik Khaoula , Chakroun Amal , Smaoui Fatma , Marrakchi Chakib , Jemaa Mounir Ben 
Published: November 2023

Abstract

Background
Tuberculosis (TB) remain a public health issue worldwide. All ages might be involved. With the rise of the elderly population, which is more susceptible to TB disease, an increase of TB among this age group is reported. We aimed to compare clinical features and treatment outcomes between elderly and non-elderly TB patients.

Methods
We conducted a retrospective study including all patients hospitalized in the infectious disease department for extrapulmonary TB between 1990 and 2022. Patients aged ≥ 60 years were considered as elderly TB patients.

Results
We encountered 488 non-elderly patients (79%) and 130 elderly patients (21%). Previous medical history of personnel TB (13.8% vs 6.6% ; p=0.007), cancer (10.8% vs 3.7% ; p=0.001) and diabetes mellitus (13.8% vs 3.3% ; p&lt; 0.001) were significantly more frequent among the elderly group. Fever (55.4% vs 54.1% ; p=0.794), loss of appetite (49.2% vs 43.1% ; p =0.213), weight loss (38.5% vs 41% ; p=0.603) and night sweats (33.8% vs 30.8% ; p=0.506) were the revaling symptoms among elderly and non-elderly group. Osteoarticular TB (24.6% vs 11.3% ; p&lt; 0.001) and urogenital TB (20% vs 8.4% ; p&lt; 0.001) were significantly more frequent among the elderly group. Lymph node TB was significantly less frequent among the elderly group (37.7% vs 50.9% ; p=0.007). The elderly patients received separate tablets of antitubercular therapy more frequently (63.1% vs 49.8% ; p=0.007). Side effects of treatment were reported among the elderly (30.8%) and the non-elderly (34.6%), with no significant difference (p=0.408). Complications (22.3% vs 19.3% ; p=0.440), sequelae (13.8% vs 11.9% ; p=0.545), relapse (1.5% vs 4.5% ; p =0.119) and death (2.3% vs 1.8% ; p=0.723) were noted among elderly and non-elderly group, with no significant difference.

Conclusion
Although the elderly had more comorbidities, the revealing symptoms and the disease evolution of extrapulmonary TB were similar in comparaison with the non-elderly patients. Osteoarticular and urogenital TB were more frequent among the elderly. Strategies to maintain a close follow-up and adequate social support are maindatory in order to garantee a favorable evolution of TB.

Disclosures
All Authors: No reported disclosures