bluuebunny/crossref_metadata_2025_split huggingface dataset:
1784. Prevalence of Community-onset Group A Streptococcal Infections across 10 Regional Midwestern Hospitals
Authors: Kuo Tiffany D , Bolon Maureen K , Malczynski Michael , Qi Chao , Zembower Teresa 
Published: November 2023

Abstract

Background
Group A Streptococcus (GAS) is a bacterium that can cause infections, including strep throat, skin and soft tissue infections, and necrotizing fasciitis. As of December 2022, a global outbreak of GAS infections has been noted among the pediatric population. Northwestern Memorial HealthCare (NMHC), containing ten regional hospitals, noticed a sharp increase in community-onset GAS infections affecting both children and adults. This study examines the epidemiological and clinical features of GAS infections among patients presenting to our medical system.

Methods
NMHC is an all 11-hospital system. This study focuses on the 10 regional hospitals and excludes the inpatient rehabilitation hospital. Across the health system NMHC has more than 132,000 inpatient admissions annually. All GAS infections resulted through the emergency department and inpatient locations across NMHC were extracted from the electronic medical record (EMR) between December 2022 and March 2023. Clinical and microbiological data, possible exposure source, and outcomes were determined through the EMR.

Results
261 GAS infections resulted across NMHC (Figure 1). Of those 261 cases, 116(44.4%) were less than 18 years of age (Table 1). In addition, 106(40.6%) patients were hospitalized due to their GAS infections. The GAS source for hospitalized patients could not be identified for 82(77.4%) cases, while 12(11.3%) were infections secondary to injury. Thirty patients admitted to the hospital were placed in intensive care units. Ten of the hospitalized patients, age 56 and older, died. Furthermore, 9(90%) patients died due to septic shock and 1(10%) to acute respiratory failure. All deaths were attributable to GAS infections.
Table 1: Clinical and Microbiological Characteristics

Conclusion
This observation of community-onset GAS infections demonstrates a high prevalence among both pediatric and adult populations. The severity of disease and increased mortality are more predominant in the adult population.

Disclosures
All Authors: No reported disclosures
1790. Characteristics of Patients with Mpox Treated with Tecovirimat during the 2022 Outbreak in Puerto Rico
Authors: Gonzalez Hector J Melendez , Rodriguez Melissa Marzan , Gerena Iris Cardona 
Published: November 2023

Abstract

Background
In June 2022, the first case of Mpox, was diagnosed in Puerto Rico, followed by a sharp increase in cases that peaked in August 2022. In total, 108 cases were confirmed during this period. Throughout this time period, Tecovirimat (Tpoxx) was already available upon request to the Puerto Rico Department of Health (PRDoH). In this report we aim to describe the clinical characteristics and outcomes of all the patients in Puerto Rico who received Tecovirimat.

Methods
A cross sectional study was conducted to describe clinical and epidemiological profile of Mpox patients who received Tecovirimat. We use the data collected from our institution (PRDoH), who was responsible for the approval, delivery and monitoring of Tecovirimat prescription during the outbreak. The analysis period ranges from August 2022 to November 2022. Univariate analysis was conducted, including the median and percentage, to provide a summary of the distribution of the variables of interest.

Results
We present the clinical characteristics of 27 male patients who received Tecovirimat for a diagnosis of Mpox during the outbreak in Puerto Rico. Most patients were treated during August and September (85%), followed by October and November 2022 (15%). Most received treatment in outpatient settings at private clinics (63%) followed by government clinics (37%). Of the patients that required Tecovirimat, 67% had human immunodeficiency virus (HIV) and the median age was 32 years. Prior immunization with smallpox vaccine was reported by two patients, while 70% were not immunized and the immunization status of 22% was unknown. The most common indications for Tecovirimat prescription were genital structure involvement (67%), severe pain (37%), oral cavity involvement (22%), proctitis (19%), and immunosuppression (11%). Only two patients received Tecovirimat while admitted to an acute care setting. No severe adverse events or deaths were reported among these patients, and there were no suspected cases of Tecovirimat resistance.

Conclusion
This study provides relevant clinical information on the use of Tecovirimat in patients with Mpox during the outbreak in Puerto Rico. These findings may have important implications for the clinical management of future outbreaks of Mpox and other related infections.

Disclosures
Iris Cardona Gerena, MD, Valneva: Honoraria
2885. Increased incidence of fluconazole-resistant Candida parapsilosis bloodstream infections in Atlanta, Georgia 2021
Authors: Witt Lucy S , Misas Elizabeth , Farley Monica M , Thomas Stepy , Jenkins Emily N , Fridkin Scott , Chow Nancy A , Lockhart Shawn R , Lyman Meghan 
Published: November 2023

Abstract

Background
Since 2020, outbreaks of fluconazole-resistant Candida parapsilosis (FR-CP) infections have proliferated around the world. An increase in FR-CP bloodstream infections (BSI) in the Atlanta metropolitan area in 2021 was identified during routine surveillance through the Georgia Emerging Infections Program supported by the Centers for Disease Control and Prevention (CDC). We describe the genomic relatedness and epidemiologic associations between resistant and susceptible isolates.

Methods
Active laboratory- and population-based surveillance for candidemia was conducted in Atlanta during 2018-2021. Fluconazole susceptibility testing of CP isolates was performed at the CDC in accordance with CLSI breakpoints. Whole-genome sequencing was completed on 82% of all viable CP isolates from 2021. Clinical and epidemiologic data was abstracted from medical records. Bivariate analysis was performed using Wilcoxon-rank sum and chi-squared (or Fisher’s) test as appropriate.

Results
A total of 60 confirmed cases of CP BSI were characterized in 2021. Incidence of CP BSIs increased along with the proportion of FR-CP isolates in 2020-21(Figure 1). FR-CP isolates were genetically closely related (0-39 SNPs), and all contained the Y132F substitution in the Erg11 gene (Figure 2). FR-CP BSI (n = 19) were more common in patients who were admitted to a long-term acute care hospital (LTACH) in the last 90 days (p= &lt; 0.01) and those who were mechanically ventilated in the 30 days prior (p=0.02). FR-CP was less common in patients who were in a short-term acute care hospital at the time of diagnosis (p=0.01) or who had a malignancy (p=0.03) (Figure 3). Patients with FR-CP isolates interacted most frequently with a unique set of healthcare facilities as compared to susceptible isolates (data not shown).Figure 1.Rate of incident Candida parapsilosis bloodstream infections by year with percent of fluconazole-resistant isolatesFigure 2.Neighbor-joining phylogeny of Candida parapsilosis, isolates from 2021.
Branch length indicates the number of SNPs and taxa nodes’ color indicates fluconazole-susceptible/resistant phenotype; no-circle taxa indicate the reference isolate. External orange squares flag isolates with the mutation Y132F in the Erg11 gene.Figure 3.Characteristics of patients with Candida parapsilosis infections in Atlanta, GA 2021 by fluconazole susceptibility

Conclusion
Overall rates of Candida parapsilosis BSIs in Atlanta increased in 2020 during the COVID-19 pandemic and highly related isolates of FR-CP emerged in 2021, associated with significant recent past exposure to LTACHs and mechanical ventilation. Network analysis is underway to further evaluate patterns of transmission that may inform infection prevention efforts.

Disclosures
All Authors: No reported disclosures
1791. Use of pathogen genomics to monitor global emergence of extensively drug-resistant Salmonella Serotype Typhi
Authors: Mikanatha Nkuchia M , Fu Yezhi , Yin Xin , Carr Christopher E 
Published: November 2023

Abstract

Background
Whole-genome sequencing (WGS) has transformed surveillance and outbreak detection. However, its use to complement resource-intensive epidemiologic investigations of emerging pathogens is limited. Here using WGS data of S. Typhi, we investigate the global spread of an emerging pathogen.

Methods
We used NCBI pathogen detection to search for SNP clusters of ceftriaxone-resistant S. Typhi (CRT) reported in the US and the National Antimicrobial Monitoring System (NARMSNOW) to analyze antibiotic-resistant trends of S. Typhi.

Results
Pathogen Detection Outbreaks of CRT infections were first reported in the US in 2018. We found that the US CRT isolates formed two distinct clusters linked to travel destinations, having close genetic relatedness with those found in Pakistan or Iraq. Specifically, three US CRT isolates (linked to travel to Iraq) only differed from 10 Iraq isolates (2021-2022) by an average of 3 SNPs (Figure). Further, two US CRT isolates (linked to travel to Pakistan) only differed from one Pakistan isolate (2022) by an average of 5 SNPs.
NARMS Now
Using 2012-2022 NARMS Now data, we analyzed trends in decreased susceptibility to ciprofloxacin (DSC) and resistance to ≥3 antibiotics recommended for treatment (MDR) among S. Typhi. We also compared the resistance trend pre-pandemic and after 2020. Our analysis included a total of 3,633 S. Typhi isolates. The percentage of DSC isolates increased from 68.5% (2012) to 85.1% (2022), while the percentage of MDR isolates increased from 8.9% to 20.1%. The 3-year (2017-2019) pre-pandemic DSC average was 77.5% and 80.5% after (2020-2022). For MDR isolates, it was 12.4% and 21.8%.
Close genetic relatedness between three US outbreak associated ceftriaxone-resistant Typhi strains (linked to travel to Iraq; highlighted in red) and 10 strains isolated in Iraq (highlighted in red).
Note the strains are collected in different years. The single nucleotide polymorphism (SNP) tree is automatically generated in the NCBI Pathogen Detection database when sequencing data are submitted to the database. The average SNP distance for the red highlighted isolates in the tree is three (SNP distance range 0∼9).

Conclusion
The SNP clusters indicate the likely international spread of resistant S. Typhi strains in travelers. Resistance to ciprofloxacin is increasing as is resistance to multiple antimicrobials. Travel restrictions imposed during the pandemic did not appreciatively alter resistance trends. These findings indicate the need for global cooperation in addressing antimicrobial resistance and emerging pathogens.

Disclosures
All Authors: No reported disclosures
1792. SARS-CoV-2 Genomic Surveillance System Development as a Model for Other Emerging Pathogens in Texas
Authors: Rai Saroj , Milleron Rania , Lee Rachel , Hanson Blake M , Hardy Marlisa , Boerwinkle Eric , Kubin Grace , Pont Stephen J , Shuford Jennifer A 
Published: November 2023

Abstract

Background
Texas is the second largest state in the country and has significant geographic and demographic diversity placing it at the forefront for identifying and responding to emerging infectious diseases. Therefore, it is critical to establish pathogen surveillance programs with statewide reach and local impact to meet public health needs. The Texas Department of State Health Services (DSHS) partnered with the University of Texas Houston School of Public Health (UTSPH) to create a statewide SARS-CoV-2 variant surveillance monitoring network project (the Network). This Network can be a model for monitoring other emerging pathogens in Texas.

Methods
A network was formed among DSHS, six academic centers, two commercial laboratories, and one public health laboratory for high throughput SARS-CoV-2 sample procurement, sequencing, and analysis for Texas. The program developed sample procurement and sequencing capacity across the state and electronic genomic data reporting to DSHS. Partners were selected based on expertise and area of geographic need. Protocols were established to meet high data quality and reporting standards. Working committees and shared data visualization tools were established to ensure collaboration among partners. The steering committee and workgroups were established to support network activities and enable DSHS to monitor epidemiological dynamics and transmissibility and respond to SARS-CoV-2 variants across each public health region.

Results
The Network has successfully established a state-wide system for sample collection, whole genome sequencing, reporting and analysis of data. At a regular cadence, the six academic centers acquire SARS-CoV-2 samples, sequence them in their respective labs and report the corresponding sequence or test data to DSHS and UTSPH. As of April 21, 2023, a total of 17,257 samples have been collected (Figure 1) and a total of 14,080 samples have been sequenced (Figure 2).

Conclusion
The network of public, academic and private partners has effectively met the need for SARS-CoV-2 sequence surveillance in this large and diverse state. With this established infrastructure in place, expanding to study other emerging pathogens in Texas is feasible.

Disclosures
Saroj Rai, PhD, MPH, Novartis: retirement in form of stock|Novartis: Stocks/Bonds
1797. Pneumococcal Vaccination in Veterans 65 years and older with Pneumococcus in the Veterans Health Administration (VHA) since November 2021
Authors: Schirmer Patricia , Lucero-Obusan Cynthia A , Oda Gina , Holodniy Mark 
Published: November 2023

Abstract

Background
Pneumococcal infection is a vaccine-preventable illness caused by Streptococcus pneumoniae. In October 2021, the Advisory Committee on Immunization Practices updated pneumococcal vaccine guidelines in all adults &gt;65 years and for adults 19-64 years with certain medical conditions or risk factors. Pneumococcal vaccination among patients &gt;65 years is a national VHA performance measure. We reviewed vaccine status in patients &gt;65 years with pneumococcal infection since guidelines changed.

Methods
Demographics, pneumococcal vaccination in relation to time of infection and laboratory testing (culture, molecular and urinary antigen) during 11/1/2021-4/11/2023 were retrieved from VHA data sources. Patients aged &gt;65 years with pneumococcus were evaluated and compared to VHA’s electronic quality measurement (eQM) for national pneumococcal vaccination rates.

Results
1,128 cases (1,108 unique patients) were identified (Table 1). 20 patients had recurrent infections. Median age was 74 years (IQR 69-77) with non-Hispanic Blacks (14.1%) slightly overrepresented compared to VHA’s Black population (12.7%); primary infection sites were pulmonary (68.4%) and blood (23.5%). 1,006/1,128 (89.2%) of cases in patients &gt;65 years had at least 1 pneumococcal vaccine. VHA’s national pneumococcal vaccination of patients &gt;65 years for fiscal years 2022-23 was 65.3%-65.9% per eQM. Of cases not vaccinated, 22.1% were non-Hispanic Black patients. Median time of vaccination before infection was 4.7 years (IQR 2.8-6.5). Most recent vaccination prior to infection for the overall cohort and those with recurrent infections was 23-valent pneumococcal polysaccharide vaccine (PPSV23) (56.5% and 57.9% respectively). In addition, 108/1,128 (9.6%) cases were vaccinated after their pneumococcal infection (17/108 were not previously vaccinated). 71/108 (65.7%) vaccines given after illness were 20-valent pneumococcal conjugate vaccine (PCV) (PCV20).

Conclusion
In VHA patients &gt;65 years with pneumococcal infection, nearly 90% had had at least 1 pneumococcal vaccine which was mainly PPSV23 and given on average almost 5 years before infection. VHA could target non-Hispanic Black patients with pneumococcal vaccination efforts and ensure providers are utilizing PCV20 or PCV15+PPSV23 vaccines.

Disclosures
All Authors: No reported disclosures
1799. Patients Who Inject Drugs (PWID) and Unstable Housing are Associated with Invasive Group A Strep Infection: A retrospective collaboration between two large, quaternary care hospital systems in Philadelphia
Authors: Loeven Nicole , Altneu Eric , Spivack Stephanie , Halpern-Cohen Virginie , Dyer Kelly , Sullivan Kaede Ota , Epstein Shara , da Silva Daniel Teixera , Meisner Jessica , Schultz Sara K 
Published: November 2023

Abstract

Background
Invasive infections involving Group A Streptococcus (iGAS), defined as infections beyond simple skin and soft tissue infection or pharyngitis, are rising nationally. We report an increase in incidence of iGAS at two urban, quaternary care health systems that contain 6 hospitals in the city of Philadelphia.

Methods
All blood, sterile fluid, and tissue cultures that yielded Streptococcus pyogenes were identified using the laboratory information systems at the Temple University Health System and the University of Pennsylvania Health System. Two cohorts were compared: cases diagnosed between January 1, 2019 and December 31, 2019, and between January 1, 2021 to December 31, 2021. We excluded 2020 data to avoid analysis of disease incidence when hospital admission patterns may have been highly biased due to COVID-19 pandemic. Electronic health records were reviewed and data pertaining to demographics, month of infection, culture site, HIV status, HCV status, housing status, and injection drug use were abstracted. Descriptive statistics were used to summarize findings.

Results
In 2021, there were 301 unique cases of iGAS (148 involving bacteremia) compared to 169 in 2019 (with 70 cases of bacteremia). This represented an overall increase in iGAS of 178% and a 211% increase in cases involving bacteremia. Of the cases in 2021, 210 (69.8%) were PWID compared to only 54 (32%) in 2019, a 388% increase. In 2021, 7.5% of patients had a diagnosis of HIV compared to 8.9% in 2019, but a large percentage did not have an HIV test (37% in 2019 and 19% in 2021). HCV Antibody positivity was 52.3% in 2021 versus 26.6% in 2019. Housing instability was recorded in 151 cases (50.2%) in 2021 and 31 (18.3%) in 2019, a 487% increase.
Table 1
Demographic and clinical characteristics of iGAS cases in 2019 and 2021
Table 2
Age and Sex data in PWID

Conclusion
From 2019 to 2021, there was an increase in iGAS infections among an adult population in a large metropolitan city. We noted a 178% total increase in iGAS during our study period, with a 388% increase among PWID and 487% increase among those unstably housed. As the overdose crisis continues, public health practitioners and medical providers should be aware of the increase in iGAS when providing empiric treatment for PWID with infections and utilize local and national resources to report and manage cases.

Disclosures
Sara K. Schultz, MD FACP FIDSA, AbbVie: Advisor/Consultant
1808. Burden of infectious diseases and bacterial antimicrobial resistance in China, 2019: a systematic analysis
Authors: Zhang Chi , Liu Yi-Qi , Zhao Hong , Wang Gui-Qiang 
Published: November 2023

Abstract

Background
Whether on a global scale or within China, the issue of bacterial antimicrobial resistance (AMR) has become a pressing concern. This study aimed to comprehensively investigate the disease burden of infectious diseases and AMR in China.

Methods
Data on infectious diseases and AMR were collected by the Global Antimicrobial Resistance Burden study 2019 database. Our analysis steps consisted of 5 broad components: estimating the disease burdens of the total and 12 infectious syndromes by age and sex; describing the burden caused by 43 pathogens; calculating the burden caused by bacterial AMR in two scenarios (AMR associated deaths, AMR attributable deaths), respectively; estimating the AMR burden of 22 bacteria; calculating the burden of AMR by 22 bacteria and 19 antibiotics combinations.

Results
In 2019, there were an estimated 1.3 million (95% UI 0.8-1.9) infection-related deaths in China, accounting for 12.1% of the total deaths for that year. Males were 1.5 times more affected than females. Bloodstream infections was the largest fatal burden syndrome, associating with 521392 deaths (286307-870583), followed by lower respiratory infections (373175 deaths), and peritoneal and intra-abdominal infections (152087 deaths). These five leading pathogens were S aureus, A baumannii, E coli, S pneumoniae, and E spp., which were associated with 41.2% (502658/1218693) of all infection-related deaths. The pathogens of different infectious syndromes exhibit significant heterogeneity. In 2019, 602561 deaths were associated with bacterial AMR, including 145465 deaths attributable to bacterial AMR. Six leading pathogen-drug combinations were responsible for more than 0.5 million deaths in 2019: macrolides resistance S aureus, fourth-generation cephalosporins resistance A baumannii, carbapenems resistance A baumannii, third-generation cephalosporins resistance A baumannii, aminopenicillin resistance E coli, macrolides resistance S pneumoniae.Figure 1:Number and rate of deaths by pathogens in China, 2019. (A) Number; (B) Rate per 100000 populationFigure 2:Number of deaths associated with bacterial antimicrobial resistance by pathogen-drug combination in China, 2019

Conclusion
This study provides the comprehensive assessment of the burden of infectious diseases and bacterial AMR in China. The annual death toll of 1.3 million infection-related deaths, including 600000 deaths related to antibiotic resistance, requires sufficient attention.

Disclosures
All Authors: No reported disclosures