bluuebunny/crossref_metadata_2025_split huggingface dataset:
2643. Seasonality of infant respiratory syncytial virus associated bronchiolitis around the US since the onset of COVID-19: Results from four US health systems 2016-2023
Authors: Blatt Adam , Suh Mina , Wolf Zachary , Waddell Emory , Nelson Christopher B 
Published: November 2023

Abstract

Background
Respiratory syncytial virus (RSV) bronchiolitis (Br) is the leading cause of US infant hospitalizations and lower respiratory tract infections [1]. The historical seasonality of RSV in the US across all ages using passive laboratory surveillance has been described by the CDC (2014-17) [2] [3] and more recently by Staadegaard et al [4]. The objective of this analysis is to describe local variation in infant RSV-Br seasonality since the onset of COVID-19 in March 2020, across all facilities and all settings in four health systems across the US, and compare to trends from the recent pre-COVID-19 era.

Methods
From October 2015-April 2023 we conducted real-time surveillance across all facilities and all settings in the State University of New York (SUNY) Upstate Medical University Health System in Syracuse, NY; the Duke University Health System (DUHS) in Durham, NC; the University of South Florida Health and Tampa General Hospital (TGH) in Tampa, FL; and the Renown Regional Medical Center Health System (Renown) in Reno, NV. We assessed electronic health records (EHR) of infants (0-11 months) using ICD-10 codes for Br and RSV-Br and laboratory testing data to describe infant RSV-Br encounters. For additional methods see Movva N et al [5].

Results
During the recent pre-COVID-19 era, there was regional variation in seasonal onset and peak disease burden of infant RSV-Br (Figure 1). Onset and peak disease was earliest at TGH in the southeast and latest at Renown in the west. While occurring outside the historical seasonality timeframe, interseasonal 2021 and early seasonal 2022 infant RSV-Br was similar in duration and followed the same geographic pattern of onset to historical disease.

Conclusion
After the US onset of COVID-19 in March 2020, the geographic pattern of RSV-Br onset and peaks was preserved, despite the shift to interseasonal and early seasonal disease in 2021 and 2022, respectively. RSV surveillance is useful to determine whether RSV seasonality is returning to typical historic patterns. These results highlight the need for health system-level surveillance and can guide discussion regarding administration of candidate RSV vaccines and immunoprophylaxis and assessment of their impact.

Disclosures
Mina Suh, MPH, International Health, AstraZeneca: Grant/Research Support|Sanofi: Grant/Research Support|Sobi: Grant/Research Support ZACHARY Wolf, MBA, MS, AstraZeneca: Grant/Research Support|Sanofi: Grant/Research Support Emory Waddell, n/a, Sanofi: Research support Christopher B. Nelson, PhD MPH, Sanofi: employee|Sanofi: employee|Sanofi: Stocks/Bonds|Sanofi: Stocks/Bonds
2663. Comprehensive at-home Sexually Transmitted and Blood Borne Infection (STBBI) Testing Program: A Pilot Initiative
Authors: Christensen Brandon L , Shukalek Caley B , Kwon Grace (Juyoung) , Hill Nolan E , Church Deirdre L , Naugler Christopher T , Kim John , Somayaji Ranjani 
Published: November 2023

Abstract

Background
Sexually transmitted and blood borne infection (STBBIs) remain a growing concern in North America with rates increasing dramatically since 2000. Although self-testing has been demonstrated to be valid and acceptable, no fully remote STBBI testing programs are available in Canada. To evaluate feasibility and acceptability of at-home STBBI testing, we implemented a fully remote, web-based platform of risk-responsive, non-invasive STBBI diagnostics in a large Canadian health zone.

Methods
A web-based risk assessment and intake form was developed using RedCap software through a community-facing website (athomestitesting.ca) in partnership with a local sexual health centre. Demographic, sexual practices, and medical history were collected from interested participants through the platform. Diagnostic kits inclusive of testing for gonorrhea/chlamydia (urine and self-swabs of vagina/pharyngeal/rectal) and syphilis/HIV/Hepatitis C (dried blood spot) were mailed to participants based on their survey responses, along with instructions and supplies for collection and return. Outcomes to be assessed include feasibility and acceptability of the web-based platform, testing and positivity rates for STIs, and time to testing and treatment (for positive cases).

Results
In the first month to date with limited launch, eleven participants completed the intake survey and were mailed testing kits through the platform. Of the completed testing, no new STIs were identified. The median age of the cohort was 38 years old (IQR 32, 41) and six identified as men, four as women and one non-binary. Regarding gender identity, seven identified as gay/queer/bisexual and three as straight/heterosexual. In a follow-up survey, all participants to date stated reported satisfaction or extremely satisfaction with the online testing.

Conclusion
The platform model demonstrates feasibility in the early pilot phase with acceptability based on participant responses. Next steps include expanded launch of the platform and assessment of testing rates and feasibility of a web-based model for STI diagnostics.

Disclosures
Caley B. Shukalek, MD, MSc, MPH, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria|Merck Canada: Grant/Research Support|Merck Canada: Honoraria|PurposeMed Inc: Advisor/Consultant|PurposeMed Inc: Ownership Interest Ranjani Somayaji, M.D., CF Foundation: Grant/Research Support|CIHR: Grant/Research Support|Oncovir: Data and Safety Monitoring Board Fees|Vertex Pharmaceuticals: Advisor/Consultant|Vertex Pharmaceuticals: Grant/Research Support|Vertex Pharmaceuticals: Honoraria
2664. Patient Perspectives on Care Outcomes and Interactions with an Urban Emergency Department Health System for Mpox: A Quality Improvement Study
Authors: Dashler Gaby , Rudolph David , Brady Molly , Qiao Luxi , Jones Joyce , Hamill Matthew M , Gebo Kelly , Saheed Mustapha O , Heol Mun , Johnson Nyah , Rothman Richard E , Hsieh Yu-Hsiang , Hansoti Bhakti 
Published: November 2023

Abstract

Background
The Emergency Department (ED) is a safety net for vulnerable patients, and where almost 50% of patients with Mpox initially presented for care. We hypothesized that insufficient healthcare provider knowledge and expertise with Orthopoxvirus outbreaks, compounded by the social stigma experienced by patients at risk of acquiring Mpox, may impact the quality of care received by patients in this venue.

Methods
All patients who received Mpox care in Johns Hopkins Health System Emergency Departments (N=4) were invited to participate in a post-discharge telephonic interview approximately six months after their index visit. Study staff interviewed and coded patients using a semi-structured interview script with three overarching themes “system,” “clinical,” and “individual” level barriers and facilitators to care delivery.

Results
From July to November 2022, 47 patients received care for Mpox in the ED of which 13 agreed to participate; participants were mostly male (100%), living with concurrent HIV (54%) and identified as MSM (62%). Most patients were ultimately discharged from the ED (62%). The concern most often expressed by patients (n=7; 53%) was the lack of information regarding follow-up, isolation, and vaccine eligibility from the clinical staff, forcing patients to rely on the Internet and friends for information (n=5, 38%). Patients were also confused and frustrated about access to tecovirimat (n=4, 31%). Concerningly, experiences of stigma also played a significant role in patients' perception of access and quality of care from the ED (n=5, 38%).

Conclusion
Even though many patients with Mpox in the ED did not require hospitalization or treatment, the ED remained an important public health venue to help patients navigate this illness. Patients presenting to the ED often reported feeling stigmatized and uncertain about the next steps in their care post-diagnosis. Early, clear, concise public health messaging is critical to help improve provider and patient knowledge, as well as the patient experience. The ED is an important venue for risk communication and containment during an early outbreak response, especially for high-profile diseases that are under media scrutiny and where clinical uncertainty drive misinformation.

Disclosures
Matthew M. Hamill, MBChB, PhD, Roche diagnostics: Honoraria Kelly Gebo, MD, MPH, Pfizer: Advisor/Consultant|Spark HealthCare: Advisor/Consultant Richard E. Rothman, MD, PhD, CEPHEID: Advisor/Consultant|Cepheid: Grant/Research Support|Danaher: Grant/Research Support
2666. Rates of STI Testing and Diagnoses among Patients with Mpox in New York City, 2022
Authors: Gunaratne Shauna , Huang Simian , McLean Jacob , DeLaurentis Clare , Zucker Jason 
Published: November 2023

Abstract

Background
The 2022 global mpox outbreak occurred in the context of rising rates of sexually transmitted infections (STIs). We hypothesize that concurrent STI rates were underestimated due to inadequate testing during virtual visits and non-sexual health clinical settings.

Methods
We included data from all patients with confirmed mpox (through non-variola orthopoxviral PCR testing) from June 25 to October 17, 2022 at an urban tertiary academic center in New York. Manual chart review supplemented data extracted from the electronic medical record. We calculated descriptive statistics for HIV, syphilis, genitourinary, rectal, and pharyngeal gonorrhea/chlamydia (GC/CT) screening and diagnosis rates. We evaluated relationships between site-specific symptoms and extragenital testing.

Results
Of 228 individuals in the database, 98% were male at birth, the median age was 34 years. 40% were Hispanic and 27% Black. 50% were living with HIV. Only 41% were tested for other STIs in the two weeks prior to their mpox diagnosis.
At the time of their mpox visit, 62.7% of patients were tested for syphilis, with 45.5% showing evidence of active or previously treated syphilis. 67 persons without known HIV were tested for HIV, resulting in 3 new diagnoses within 2 weeks of mpox diagnosis. 57.5% of patients were screened with a genitourinary GC/CT nucleic acid amplification testing (NAAT), with 2.3% and 3.8% positive for gonorrhea and chlamydia, respectively. 46.5% were screened with a rectal GC/CT NAAT, with 16.0% and 6.6% positive for gonorrhea and chlamydia, respectively. 47.4% of individuals were screened with a pharyngeal GC/CT NAAT, with 7.4% and 0.9% positive for gonorrhea and chlamydia, respectively.
Site specific GC/CT NAATs were obtained from 52.2%, 55%, and 54% of patients with urinary, rectal and pharyngeal signs or symptoms, respectively. Without extragenital testing, 10 of 28 total gonorrhea cases (35.7%) and 3 of 13 total chlamydia cases (23.1%) would have been missed.

Conclusion
STI testing was insufficient in people with confirmed mpox, likely leading to under diagnosis of STIs. HIV testing was inadequate in at-risk individuals, and patients presenting with site-specific symptoms were too frequently not offered targeted testing.

Disclosures
All Authors: No reported disclosures
2681. National Outpatient Sexually Transmitted Infection Testing in Pregnant Patients in the United States, 2012 to 2019
Authors: Strey Kelsey , Mendoza Vidal M , Reveles Kelly 
Published: November 2023

Abstract

Background
Sexually transmitted infections (STI) continue to increase annually in the United States (US) with 2.5 million infections reported by the Centers for Disease Control and Prevention (CDC) in 2021. Pregnant patients are at risk for serious complications due to infection. It is recommended that pregnant women are screened early in pregnancy to avoid poor outcomes; however, few studies have used nationally representative data to assess STI testing in pregnancy in the US. This study aimed to estimate the utilization of preventative STI care on a national scale in pregnant patients.

Methods
This was a retrospective, cross-sectional study of outpatient visits in the CDC's National Ambulatory Medical Care Survey from 2012 to 2019. All patients reported as pregnant were included for analysis to assess STI testing (e.g., chlamydia, gonorrhea, hepatitis, HIV) overall. STI testing was described per 1000 total visits. Subgroup analyses were conducted by race, ethnicity and region. Multivariable logistic regression was used to identify predictors of receiving at least one STI test. Data weights were applied to analyses to generate national estimates.

Results
Over 232 million visits were included for analysis, of which 7.6% included an STI test. Overall, rates of receiving any STI test varied over the study period (39.6-136.0 per 1000 visits). Chlamydia testing was the most common, followed by gonorrhea, HIV, and hepatitis (48.5 v. 42.1 v. 39.5 v. 19.6 per 1000). Patients of non-Hispanic ethnicity, White race, and those in the West region had the lowest rates of STI testing (74.1 v. 55.8 v. 43.4 per 1000). Overall, Hispanic ethnicity (aOR 1.152, 95%CI 1.150-1.155), Black and more than one race (aOR 2.837, 95%CI 2.831-2.843 and aOR 3.06, 95%CI 3.04-3.09), government and private insurance (aOR 4.63, 95%CI 4.58-4.68 and aOR 4.71, 95%CI 4.66-4.76), metropolitan areas (aOR 1.865, 95%CI 1.859-1.871), and the Northeast region (aOR 2.449, 95%CI 2.442-2.455) were predictive of receiving any STI test.

Conclusion
STI testing in US outpatient physician offices varied over the study period and across test types, though was consistently low. Additionally, certain patient attributes, such as race, ethnicity, and payment source were predictive of testing.

Disclosures
Kelly Reveles, PharmD, PhD, Ferring Pharmaceuticals: Advisor/Consultant|Ferring Pharmaceuticals: Honoraria
2688. Characteristics of joint infections in solid organ transplant recipients
Authors: Abdow Victor P , Fraker John H , Kumar Rebecca , Beaulieu Ronald M 
Published: November 2023

Abstract

Background
There are sparse data surrounding joint infections in solid organ transplant (SOT) recipients, and this population is not specifically addressed in the Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines. We aim to provide microbiologic and treatment data to help inform future guidelines on managing joint infections in this unique patient population.

Methods
We retrospectively reviewed all adult SOT recipient admissions in our ten-hospital system for native or prosthetic joint infection between January 2015 and December 2021. Eighty-one patients were included based on ICD-9 or ICD-10 codes and were excluded if they were &lt; 18 years old, did not have a SOT on immunosuppression, were transferred prior to treatment, or did not have a large joint infection (total n=33).

Results
There were 33 joint infections in 25 patients. The overall median time from transplant to joint infection was 3.7 years; heart and multivisceral occurred earlier (1.3 and 0.8 years, respectively). More than 77% of native joint infections required surgical intervention (n=17); 16 required washout. All 11 prosthetic joint infections required surgical intervention: two-stage revision was required in 7 of these cases, and debridement, antibiotics and implant retention (DAIR) procedure was performed only once. Just 15% of patients (n=5) had a resistant organism; the most common was methicillin-resistant Staphylococcus aureus (n=3). The median duration of antibiotics was 6.0 weeks. Only 42% of patients had resolution of the joint infection (n=14). Other outcomes included chronic suppression (n=7), recurrence (n=5), new infection (n=3), death (n=3), and amputation (n=1).

Conclusion
This study found that joint infections typically occur more than a year out from transplant. IDSA guidelines for surgical management of prosthetic joint infections advocates for DAIR or single-stage revision where feasible. However, most of our SOT patients required two-stage revision, suggesting a possible need for more aggressive intervention in this population. Additionally, most patients did not have multi-drug resistant organisms, indicating that multi-drug resistant coverage (i.e. carbapenems) is not necessarily needed in this population.

Disclosures
Rebecca Kumar, MD, Astra Zeneca: Grant/Research Support|Astra Zeneca: Honoraria|Regeneron: Grant/Research Support
2706. Effectiveness and Safety of Shingrix Vaccination in Solid Organ Transplant Recipients at a Large Urban Transplant Center
Authors: Halkett Megan , Ison Michael 
Published: November 2023

Abstract

Background
The varicella zoster virus (VZV) recombinant subunit vaccine, Shingrix, was found to be safe in solid organ transplant recipients (SOTR) and is now approved and recommended for all immunocompromised patients. Given limited efficacy data, we preferred a single center retrospective study to demonstrate safety and effectiveness of the Shingrix vaccine in solid organ transplant recipients.

Methods
After IRB approval, clinical data from all SOTR at Northwestern Memorial Hospital (NMH) who received the Shingrix vaccine after their transplant, between January 1, 2017 and March 1, 2022 was collected from our Enterprise Data Warehouse (EDW). Extracted data includes age, race, ethnicity, date of transplant, organ transplanted, and date(s) of vaccine administration(s). Clinical outcomes were assessed by diagnosis of acute allograft rejection and/or HZ made post-vaccine administration. Descriptive statistics were utilized. This project is supported by the IDSA G.E.R.M. program.

Results
309 of 338 eligible SOTR were included in the analysis of this study (characteristics and reasons for exclusion in Table 1). Only 1 (0.32%) patient experienced a new episode of acute allograft rejection within 3 months of Shingrix administration. 18/309 (5.8%) were diagnosed with HZ after vaccination with Shingrix. This represents a reduction in VZV reactivation events compared to the 9.1% incidence found in the 2021 meta-analysis of HZ in the general solid organ transplant population [Kwon, Transpl Infect Dis., 2021].Table 1.Characteristics of 338 solid organ transplant patients who received Shingrix vaccine.

Conclusion
The Shingrix vaccine, when administered to SOTR post-transplant, is safe and likely effective in reducing the rate of herpes zoster. This data supports the current recommendation to vaccinate all SOTR with Shingrix. Larger, multi-center data are needed to inform the true efficacy of the vaccine in SOTRs.

Disclosures
All Authors: No reported disclosures
2744. A 5-Year Single-Center Review of Strongyloides Seropositivity in Kidney Transplant Candidates in Rural Central Texas
Authors: Snellings Robin , Telchik Collin M , Padakanti Sowmya , Negron-Diaz Juan , Cahuayme-Zuniga Lizbeth 
Published: November 2023

Abstract

Background
The American Society of Transplantation recommends screening for Strongyloides stercoralis for people from or with extended travel to endemic areas including tropical regions of Southeast Asia and the Appalachian region of the United States. Asymptomatic carriers without risk factors can potentially be missed during screening assessments. Consequently, they can develop deadly hyperinfection and disseminated disease with immunosuppressive therapy. The aim of this study is to identify demographics and characteristics among our population of Strongyloides-infected kidney transplant candidates in rural Central Texas.

Methods
This study is a single-center, retrospective chart review of patients aged 18 or older who underwent evaluation for kidney transplant at our institution in rural Central Texas between January 1, 2018 and December 31, 2022 and tested equivocal or positive for serum Strongyloides IgG antibody.

Results
Out of the 1653 patients who underwent Strongyloides screening during their evaluation for kidney transplant within the study period, 182 (11.0%) returned as either equivocal or positive. Demographics of this Strongyloides-infected population are noted in table 1. 86.3% of these patients were born in the United States or Canada, 6.6% from Mexico, and 3.3% from Asia. 33.0% reported no international travel outside the United States (table 1). Comorbidities and symptoms of our population are listed in table 2. 83.5% were asymptomatic. Laboratory data and other risk factors for Strongyloides infection are noted in table 3. Only 6.0% had eosinophilia at time of diagnosis (considered as greater than 0.00 - 0.76 10*9/L). None of our population tested positive for human T-lymphotrophic virus (HTLV-1). Out of the 69 patients who were asked, 71.0% reported a history of walking outside barefoot.
Demographic information and international travel outside the United States
Patient comorbidities and symptoms

Laboratory data and other risk factors

Conclusion
Importantly, 11.0% of our population were found to have an equivocal or positive Strongyloides serology. Of those, 33.0% had no apparent risk factors for Strongyloides infection including international travel, suggesting local acquisition of the infection in rural Central Texas. More research is needed to identify unique risk factors for this population including environmental studies of this underserved population.

Disclosures
All Authors: No reported disclosures
2753. Real-World Use of Cefiderocol Treating Non-COVID Patients with Confirmed Gram-Negative Infections in US Hospitals During January 2020-June 2022
Authors: Cai Bin , Zhou Yun , Slover Christine M , Copeland Jennifer D , Nguyen Sean T 
Published: November 2023

Abstract

Background
Cefiderocol (CFDC) has broad activity against Gram-negative (GN) pathogens. This study describes the CFDC usage in treating non-COVID patients with microbiology data in US hospitals from Jan 2020-Jun 2022.

Methods
This retrospective multicenter observational study included adult non-COVID hospitalized patients treated with CFDC consecutively for ≥3 days after laboratory confirmed GN infections between Jan 2020 to Jun 2022, as captured by Premier Healthcare data. This study describes the patient characteristics, microbiological profile, and overall, as well as 14-day and 28-days, in-hospital all-cause mortality (IHACM). Index culture was defined as the first clinical culture with GN pathogens. Index pathogens were all pathogens identified from the index culture.

Results
Patient characteristics of 275 hospitalized patients who received ≥3 days CFDC after the microbiological results are shown in Table 1. For index culture, 61.1% were taken ≤3 days of admission, 53.1% were taken during ICU stay, 45.8% involved respiratory culture, followed by urinary (19.6%), wound (18.2%) and blood (16.4%). Also 65.8% of patients had one index pathogen and 34.2% had ≥2 index pathogens. The most common index pathogens were Pseudomonas aeruginosa (48.7%), Acinetobacter baumannii (23.6%), Klebsiella pneumoniae (14.2%), and Stenotrophomonas maltophilia (13.1%). On the index culture day, 62.2% of patients had one pathogen from a single site and 37.8% had either one pathogen identified in multiple culture sites or multiple pathogens from ≥1 culture site.
CFDC was used as monotherapy in 92 (33%) patients, though 253 (92%) had used other GN antibiotics before starting CFDC. A total of 135 (49.1%) patients started CFDC ≤ 5 days of index culture, 108 (39.3%) patients between 6-20 days, and 32 (11.6%) patients &gt; 20 days.
Crude overall IHACM was 16.4% (95%CI:12.0%-20.7%): 10.4% for those who started CFDC ≤ 5 days of index culture, 19.4% for 6-20 days, and 31.3% for &gt; 20 days. Crude 14-day and 28-day IHACM from index culture or starting CFDC had the same trend and were lower than overall IHACM (see Table 2).

Conclusion
The study demonstrated that CFDC is effective in treating patients with GN infections. Patients receiving CFDC earlier had lower IHACM than those receiving CFDC later but need further investigation.

Disclosures
Bin Cai, MD, PhD, Shionogi Inc.: Shionogi employee Christine M. Slover, PharmD, Shionogi,INC: Employee Jennifer D. copeland, MS, Shionogi, Inc.: Employee (Medical/Micro) Sean T. Nguyen, PharmD, Shionogi: Employee|Shionogi, Inc: Employee