bluuebunny/crossref_metadata_2025_split huggingface dataset:
2686. High HIV and STI Rates in Patients with MPOX Identified in a Large National Database
Authors: Alfego David , Dale Suzanne , Curanovic Dusica , Boles Deborah , Williams Jonathan , Harris Ayla , Urban Thomas J , Walworth Charles M 
Published: November 2023

Abstract

Background
In mid-2022, mpox virus infection emerged outside of African countries to which it is endemic. Infections increased worldwide and were identified in 16 countries by late June 2022, with the US documenting the highest number of cases. Here we report patient characteristics and assess coinfection rates between those who tested positive for mpox and those who tested negative.

Methods
On July 6, 2022, an FDA-approved PCR-based test for mpox (Orthopoxvirus) was launched with high-throughput modifications. The test is a qualitative assay that uses DNA extracted from swabs of the viral rash. Clinicians were instructed to swab or brush the base of the lesion for sample submission. Test volumes were evaluated, and mpox positivity rates were assessed by sex, age, and geography. Coinfection with HIV, HBV, HCV, and STIs was also assessed. Differences in coinfection rates were assessed for significance using chi square testing with Bonferroni correction for multiple comparisons.

Results
Between July 6 and November 30, 2022, 48,818 samples were tested for 38,388 unique patients; 12,045 (24.7%) samples and 8,247 (16.9%) unique patients were positive for mpox. The median age of patients who tested positive was 35 years and 96.5% were male. Patients who were positive for mpox compared to those who were negative had significantly higher rates of coinfection with HIV (22.9% vs 6.0%, p&lt; .0001), HBV (2.3% vs 1.6%, p&lt; .005), chlamydia (10.4% vs 7.5%, p&lt; .0001), gonorrhea (13.4% vs 7.3%, p&lt; .0001), or syphilis exposure (11.0% vs 2.9%, p&lt; .0001). In contrast, patients who tested negative for mpox compared to those with mpox had significantly higher rates of coinfection with HSV-1 (15.7% vs 1.7%, p&lt; .0001), HSV-2 (10.5% vs 3.2%, p&lt; .0001), VZV (14.1% vs 0.3%, p&lt; .0001) and exposure to HCV (5.0% vs 4.7%, p&lt; .0001). Testing rose rapidly, peaked by the end of July, and steadily declined by the end of November. Highest mpox positivity rates were seen in FL and GA, followed by NY, TX and CA.

Conclusion
The rates of HIV, HBV, and most STIs were significantly higher among those positive for mpox; the rates of HSV-1, HSV-2, VZV, and HCV were significantly lower. These data also highlight the need for a comprehensive evaluation of all vesicular lesions for non-mpox etiology.

Disclosures
Dusica Curanovic, PhD, Labcorp: employed by labcorp during study|Labcorp: Stocks/Bonds Deborah Boles, PhD, Laboratory Corporation of America: Stocks/Bonds
2692. Epidemiology and Risk Factors for Clostridioides difficile Infection after Pancreas Transplantation
Authors: Akhtar Haris , Yetmar Zachary A , Seville Maria T , Bosch Wendelyn , Beam Elena 
Published: November 2023

Abstract

Background
Clostridioides difficile infection (CDI) is a common and potentially life-threatening infection. Transplant recipients are vulnerable to CDI due to immune suppression and frequent antibiotic exposure. CDI can lead to serious complications in these patients, including allograft failure. In a population of pancreas transplant recipients, we aimed to identify epidemiologic characteristics and risk factors associated with CDI within 90 days of transplant.

Methods
We performed a retrospective cohort study of adults who underwent pancreas transplantation between January 1, 2010, and December 31, 2020, at three centers in Arizona, Florida, and Minnesota. Patients were excluded if they developed pancreas allograft failure within 48 hours of transplantation. The primary outcome was diagnosis of CDI within 90 days of transplantation and the secondary outcome was pancreas allograft failure. The main analyses were performed by Cox regression.

Results
A total of 482 patients were included, of which 35 (7.3%) developed CDI within 90 days (Table 1). Within the subset of 35 CDI patients, the median time to CDI was 17.0 (IQR 13.0–28.5) days (Figure 1) with most (83%) diagnosed with non-severe CDI. Most patients with CDI were on current systemic antibiotics (94%), primarily for prophylaxis (73%). CDI treatment was vancomycin for the majority of patients (71%) and metronidazole for the rest (29%). One patient had a fecal transplant for recurrence, and none required surgery. In multivariable cox regression of associations with 90-day CDI, significant associations were anastomotic leak (HR 3.04, 95% CI 1.2-7.4; p=0.015) and simultaneous pancreas-kidney transplantation (HR 8.70, 95% CI 1.15-66.7; p=0.036); age (HR 0.97, 95% CI 0.94-1.01; p=0.110) was not significant. In a secondary analysis, CDI was not associated with pancreas allograft failure (p=0.719).Table 1.Characteristics of 482 patients who underwent pancreas transplantation.

Conclusion
This study identified preceding anastomotic leak as a risk factor for 90-day CDI after pancreas transplantation, likely due to subsequent intra-abdominal infection and antibiotic use. simultaneous pancreas-kidney transplantation is another risk factor due to additional comorbidity. Transplant providers should be cognizant of the risks of CDI and mitigate these risks as possible.

Disclosures
All Authors: No reported disclosures
2697. Fungal Infection Patterns in Hematopoietic Stem Cell Transplant Patients of a Tertiary Care Indian Cancer Hospital
Authors: Chatterji Soumyadip , Nag Arijit , Kumar Jeevan , Chattopadhyay Debranjani , Podder Dibakar , Nair Reena , Das Parijat , Bhattacharya Sanjay , Goel Gaurav , Chandy Mammen 
Published: November 2023

Abstract

Background
Fungal infections are a common and serious complication in patients undergoing Hematopoietic Stem Cell Transplantation (HSCT). Despite the use of prophylactic antifungal therapy, breakthrough infections can still occur and lead to significant morbidity and mortality. The emergence of antifungal resistance has further complicated the management of these infections. Therefore, there is a pressing need to understand breakthrough fungal infection patterns in HSCT patients.

Methods
In this record-based observational descriptive study, we attempted to understand the fungal infection patterns in HSCT patients in our hospital. Cases were analysed from 2012 to 2021. Diagnosis of invasive fungal infection (IFI) was done as per EORTC MSG criteria. For the patients who were on prophylactic antifungal agents, date of sample collection was tallied with the period of medication to determine eligibility for breakthrough invasive fungal infection (BIFI).

Results
Out of 563 recruited cases, 16 fungal infections were confirmed. Responsible pathogens were identified as Aspergillus sp. (11 by Galactomannan antigen test, 1 by DNA PCR from blood), Candida sp. (1 by PCR, 1 by blood culture, 1 by mannan antigen) and Fusarium sp. (1 by blood culture), see Fig.1.
Number of patients receiving (treatment/prophylaxis) each type of antifungal agent is shown in Fig. 2. Antifungal prophylaxis was administered in 544 patients (Fluconazole n=219, 40.3%; Voriconazole n=2, 0.4%; Posaconazole n=310, 57%; Amphotericin B n=13, 2.4%; see Fig. 3). Further analysis yielded 14 cases of BIFI (10 on Posaconazole and 4 on Fluconazole prophylaxis).
Number of patients receiving each type of antifungal
Percentage of patients on prophylactic antifungal drug

Conclusion
These results thoroughly describe the pattern of fungal infection in HSCT patients of the hospital for the first time.

Disclosures
All Authors: No reported disclosures
2703. Descriptive Epidemiology of Respiratory Syncytial Virus (RSV) Infection – a 10-year Review at the National Institutes of Health (NIH) Clinical Center
Authors: Forrester LaToya A , Odom Robin T , Henderson David K , Sinaii Ninet 
Published: November 2023

Abstract

Background
RSV can lead to severe infection in immunocompromised individuals. We performed a 10-year retrospective review of RSV infections to assess the pre-COVID-19 pandemic versus current RSV epidemiology. Asymptomatic patients were tested for RSV to clear isolation precautions and inadvertently, when testing for SARS-CoV-2 prior to aerosol–generating procedures or hospital admission.

Methods
Nasopharyngeal swabs and washes, bronchoalveolar lavages, and bronchial washes collected 1/2012-12/2022 were tested by multiplex PCR. Chart reviews were completed for RSV-positive patients to detect respiratory symptoms on admission through day 8 to delineate community- vs. healthcare-acquired cases, determine comorbidities, identify co-infection with other respiratory viruses, and stem-cell transplant recipients within the prior year. Data were analyzed using longitudinal models.

Results
Overall 17,023 respiratory tests were sent during the 10-year period, with 537 RSV-positives from 286 patients, a 3.15% positivity. A decrease in RSV detection was observed between the pre-pandemic and pandemic time periods for all patients (p=0.007) and for adults (p=0.011). Cases were community-acquired (85% in pediatrics and 95% in adults). The rationale for testing was symptom-based for 82% of pediatrics and 91% of adults. Positive tests were observed in pediatrics with congenital immune deficiency diseases (53%) and in adults with hematologic malignancy (44%). 35% of pediatrics and 42% of adults had a stem-cell transplant within the prior year. 21% of pediatrics and 20% of adults were co-infected with atleast one other respiratory virus. Incidental screening of asymptomatic patients identified RSV in 24 patients. Cyclical changes in RSV occurred during the pre-pandemic years, and a substantial decrease and irregularity (p=0.007) were noted in the monthly frequency of RSV beginning in 2020.

Conclusion
RSV remains a common pathogen in immunocompromised patients. Persistent RSV positivity was identified in the absence of symptoms and after treatment for RSV infection. We observed a sharp decrease in RSV activity in 2020; the subsequent gradual increase has not reached pre-pandemic levels.

Disclosures
All Authors: No reported disclosures
159. Diagnostic Utility of Nasal Methicillin-resistant Staphylococcus aureus Polymerase Chain Reaction Testing in Head and Neck Infection
Authors: Smith Jake , Cummings Bailee , Dare Ryan K 
Published: November 2023

Abstract

Background
Methicillin-resistant Staphylococcus aureus (MRSA) is a clinically important pathogen that is responsible for significant morbidity and mortality worldwide. MRSA is a colonizer of human nasal passages. Prior studies have shown that lack of detection of MRSA via polymerase chain reaction (PCR) of nasal swab specimens can accurately predict absence of MRSA in certain infections. Currently, guidelines posed by the Infectious Disease Society of America make no mention of the utility of MRSA PCR swabs for empiric antibiotic choice in facial abscess. This study investigated the diagnostic performance characteristics of MRSA nasal PCR in patients undergoing various ear, nose, and throat surgeries.

Methods
A retrospective analysis was performed at UAMS looking at adult patients with; (1) Ear nose and throat (ENT) surgeries, (2) collection of nasal MRSA PCR, (3) operating room (OR) culture data from the surgery; all within the same admission. OR culture data was used as the reference standard for presence of MRSA in surgical isolates. MRSA PCR was the index test of interest. The primary outcome was the diagnostic performance characteristics of the assay. Secondary outcomes included diagnostic performance characteristics of PCR for methicillin-sensitive staphylococcus aureus (MSSA).Table 1:Baseline demographics and clinical characteristics of study cohort
1: Includes necrotizing fasciitis, neck mass, tracheo-esophageal fistula repair, and tracheal stenosis repair. Abbreviations: T2DM - Type 2 diabetes mellitus, COPD - chronic obstructive pulmonary disease, CAD - coronary artery disease, SSI - surgical site infection

Results
In 45 patients meeting inclusion criteria, MRSA was isolated in 4.4% of OR cultures. When compared to OR cultures, MRSA nasal PCR demonstrated 100% sensitivity and 93% specificity with a positive predictive value of 40% and a negative predictive value (NPV) of 100%. MSSA PCR testing showed a lower negative predictive value of 97.1% for presence of MRSA or MSSA.Table 2:Diagnostic characteristics of MRSA nasal PCR assayTable 3:Diagnostic characteristics of MSSA nasal PCR assay

Conclusion
In patients undergoing ENT surgeries, MRSA nares PCR assay has a high NPV for presence of MRSA and can be used to help guide vancomycin de-escalation.

Disclosures
All Authors: No reported disclosures
2724. Community-acquired Pneumonia in Immunocompromised Patients: Predictors and Outcomes Associated with Empiric Broad-spectrum Antibiotic Treatment
Authors: Saravolatz Louis , Gandhi Tejal N , Vaughn Valerie , Ratz David , Horowitz Jennifer K , Gupta Ashwin , McLaughlin Elizabeth , Weinmann Allison J , Paje David , Malani Anurag , Dumkow Lisa E , Flanders Scott A , Petty Lindsay A 
Published: November 2023

Abstract

Background
Immunocompromised patients (ICP) are at higher risk of infection, but are often excluded from trials for community-acquired pneumonia (CAP). Due to limited data on CAP treatment in ICP, the IDSA/ATS CAP guideline omits recommendations for ICP. We aimed to assess predictors and outcomes associated with empiric broad-spectrum antibiotic (BSA) use versus standard CAP treatment in ICP hospitalized with CAP without IDSA risk factors for drug-resistant organisms (DRO).

Methods
We collected data from non-ICU adult ICP hospitalized with CAP [Table 1] between 1/2017 to 12/2022 at 69 Michigan hospitals who received either BSA on hospital day 1 or 2 or a standard CAP regimen. BSA included anti-MRSA and anti-Pseudomonal antibiotics. We excluded patients with moderate/severe COPD, structural lung disease, pulmonary complications, and IDSA risk factors for DRO. Collected data included patient characteristics, laboratory results, antibiotic data, and 30-day outcomes via phone follow up. Logistic regression was used to assess predictors of empiric BSA accounting for hospital-level clustering. We assessed the association of empiric BSA vs. empiric standard CAP treatment with 30-day outcomes using regression models adjusted for variables associated with probability of treatment and known predictors of each outcome.

Results
Of 40,882 patients with CAP, 2719 were ICP. Of 2719 ICP with CAP, 41% (N=1115) received standard empiric CAP coverage. Compared to ICP who received standard empiric CAP coverage, those who received empiric BSA had a higher incidence of severe sepsis, higher Pneumonia Severity Index, and hospitalization or IV antibiotics in prior 90 days [Table 2]. The most common CAP pathogen identified was Pseudomonas (2.0% (22/1115) standard CAP vs 2.5% (40/1604) BSA) [Table 3]. Of ICP started on BSA, median duration of BSA was 4.4 days [SD 3.4]. After adjustments, receipt of empiric BSA was associated with increased readmission, transfer to ICU and longer hospitalization compared to standard empiric CAP coverage [Table 4].

Conclusion
ICP hospitalized with CAP often received empiric BSA but few had identified DRO. Empiric BSA use for CAP in ICP without IDSA risk factors for DRO was associated with worse patient outcomes compared to standard empiric CAP coverage.

Disclosures
Elizabeth McLaughlin, MS, RN, Blue Cross Blue Shield of Michigan: Support provided through the Value Partnership Program
2737. Real World Evaluation of Antifungal Prophylaxis in Allogeneic Hematopoietic Stem Cell Transplant (aHSCT) Patients, Is Routine Antifungal Prophylaxis Needed?
Authors: Perreault Sarah , Schiffer Molly , Roeder Heidi , McManus Dayna , Topal Jeffrey E 
Published: November 2023

Abstract

Background
Invasive fungal infections (IFI) are a known complication in aHSCT patients. Risk factors for IFI post aHSCT include history of IFI, high intensity conditioning regimens, prolonged neutropenia, and degree of donor matching. Guidelines recommend anti-Candida prophylaxis in low risk patients and anti-mold prophylaxis in high risk patients through day 75. Yale New Haven Health’s practice is to use fluconazole in all patients unless they have a history of a mold infection. For patients receiving tacrolimus/sirolimus, antifungal prophylaxis is not recommended due to significant azole drug interactions. The goal of this study is to compare outcomes in patients who receive fluconazole prophylaxis versus those who did not receive antifungal prophylaxis.

Methods
This is a retrospective review of aHSCT patients from January 1, 2015 to July 1, 2022. Exclusion criteria were prior history of IFI requiring anti-mold treatment, concurrent prolonged neutropenia, death prior to day 75 from non-fungal etiologies or &lt; 18 years old. Infections were diagnosed based on EORTC criteria. A subgroup analysis was performed in patients who did not receive any steroids prior to day 75. These patients were then stratified by conditioning regimen and IFI risk factors. The primary endpoint is overall breakthrough IFI rate to day 75. Secondary endpoint is the rate of IFI stratified by IFI risk group.

Results
439 patients underwent aHSCT and 94 patients were excluded. Of the 345 patients included, 7 (2%) had breakthrough IFIs prior to day 75. All 7 IFIs occurred in patients who were not receiving high dose steroids. See table 1 for IFIs stratified by conditioning regimen and risk status for IFI. P values were not statistically significant. The details of the individual IFIs are further described in Table 2.
Patient Analysis
Breakthrough Fungal Infections

Conclusion
This study revealed a low incidence of IFIs (2%) which did not correlate with the number of risk factors. Of the breakthrough IFIs, only 1 IFI could have been potentially prevented by fluconazole prophylaxis. Overall mortality was low with one patient death due to C. albicans who received fluconazole prophylaxis and one due to Rhizopus spp. Due to the low incidence of IFIs in the absence of corticosteroid use, the use of antifungal prophylaxis in aHSCT patients up to day 75 should be re-evaluated in future studies.

Disclosures
All Authors: No reported disclosures
2738. Two-step sulfonamide antibiotic challenges in patients who require treatment with trimethoprim-sulfamethoxazole at an academic medical center: Outcomes in a largely immunocompromised population
Authors: Samhan Aya , Joshi Shyam , Ham YoungYoon 
Published: November 2023

Abstract

Background
Sulfonamide antibiotic allergy is the second most reported medication allergy. The allergy label limits the use of trimethoprim-sulfamethoxazole (TMP-SMX), the antibiotic of choice for pneumocystis jirovecii pneumonia (PJP), Toxoplasma, and many types of urinary tract infections. Immunocompromised patients, including solid organ transplant recipients, are considered to be at a higher risk for developing an infection. While penicillin allergies are commonly tested and patients delabeled, sulfonamide challenges are not as prevalent. Patients who are tested following a transplant may be on medications that lower the negative predictive value of the challenge, raising questions about whether they truly passed the challenge or whether mild reactions were masked.
Methods: Thirty-seven patients labeled with a sulfonamide allergy who were evaluated and challenged with two doses of TMP-SMX were included. Adults (≥18 years) with a sulfonamide antibiotic allergy were evaluated and challenged between June 2020 and May 2023. Data collection included the number of patients challenged and delabeled, number of patients who had reactions and what type of reaction, and proportion of patients who completed the treatment or prophylaxis course for which TMP-SMX was the first-line antibiotic.

Results
Thirty-seven patients were challenged, of which twenty-seven patients were immunocompromised (73%). Thirty-four (92%) passed the sulfonamide challenge and were delabeled, and thirty-two (86%) completed the full course of TMP-SMX prophylaxis or treatment. Nineteen patients (51%) were tested following immunosuppression or antihistamine treatment due to a new transplant. Five patients were not able to be delabeled due to mild or delayed reactions to the challenge or treatment, including two patients that passed the sulfonamide challenge and were delabeled but had a mild reaction during SMX-TMP therapy and were relabeled.

Conclusion
The benefits of sulfonamide antibiotic allergy testing can have great effects in immunocompromised patients in preventing the use of second-line antibiotics. Sulfonamide challenges were shown to be safe and effective in immunocompromised patients in delabeling the sulfonamide antibiotic allergy and leading to the completion of treatment with TMP-SMX.

Disclosures
Shyam Joshi, MD, Cogent: Honoraria|Leo Pharma: Honoraria|Nectar Allergy: Advisor/Consultant|Nectar Allergy: Stocks/Bonds|Sanofi/Regeneron: Advisor/Consultant|Sanofi/Regeneron: Honoraria|Takeda: Honoraria
2771. Antibiotic Prescription Practices and Perceptions Among Physicians in Bangladesh
Authors: Harun Md Golam Dostogir , Sumon Shariful Amin , Islam Md Saiful 
Published: November 2023

Abstract

Background
Antimicrobial resistance (AMR) is a global public health threat, especially in low-resource settings. Irrational and inappropriate use of antibiotics in healthcare settings has led to widespread drug resistance. Antibiotics are widely and inappropriately used without adherence to international guidelines in Bangladesh, which may contribute significantly to the development of antimicrobial resistance (AMR). With the rapid raising of AMR, it is important to assess antibiotic prescribing perceptions and practices among physicians in Bangladesh.

Methods
From September to December 2020, a hospital-based cross-sectional survey was conducted among 517 physicians in 11 tertiary care hospitals across Bangladesh. Face-to-face interviews were done to collect information. Descriptive statistics were performed to analyze the data and for interpretation

Results
Nearly two-thirds (66 %) of the physicians considered AMR a significant concern. Over three-fourths (77%) opined that easy access to antibiotics without a prescription was the most important contributor to AMR, followed by overuse/inappropriate use (68%); whereas 42% of physicians reported inadequate diagnostic tests and one-fifth blamed poor infection control measures as the cause of rising AMR. The majority (77 %) of the participants reported following senior physicians’ guidance to prescribe antibiotics while 41.6% prescribe considering the affordability of patients and antibiotic cost. All (100%) physicians stated that updated antibiotic use guidelines are necessary for the appropriate and rational use of antibiotics

Conclusion
The assessment's findings can aid policymakers in the development and implementation of a national guideline for ensuring the rational use of antibiotics and enforcement of drug regulations at all stages, including the dispense of antibiotics in Bangladesh.

Disclosures
All Authors: No reported disclosures