bluuebunny/crossref_metadata_2025_split huggingface dataset:
2678. Prevalence of gonorrhea, chlamydia and syphilis among males living with HIV attending the Antiretroviral Clinic, Hospital Santo Tomás, Panamá, November 2021-March 2022
Authors: Rodriguez Cristel , Rodríguez Ana Belén Araúz , Gabster Amanda , Jhangimal Monica , Henostroza German , Pascale Juan Miguel , Castillo Jorge , Martinez Alexander , Ortiz Alma 
Published: November 2023

Abstract

Background
Prevalence of gonorrhea, chlamydia and syphilis is unknown among people living with HIV (PLHIV) in Panama. Owing to the asymptomatic course and syndromic management of these infections, etiological diagnosis and epidemiological surveillance are often missed. The aim of the study was to determine the prevalence of Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and syphilis in HIV positive men, that receive care in the Infectious Diseases Clinic at Hospital Santo Tomás.

Methods
A cross-sectional study was conducted among male PLHIV who attended the antiretroviral therapy clinic for a routine clinical care during March and April 2022. Written consent was obtained from all participants. Blood samples were taken for syphilis screening using a rapid lateral flow test and consecutive RPR on all positive samples. First flow urine, as well as provider-collected oropharyngeal and participant-collected anal swabs were taken from the patients for PCR CT/NG testing. Statistical analysis was carried out using SPSS version 22.0 software. Chi-square test and odds ratio were done at 95% CI using significance level of p &lt; 0.05.

Results
A total of 221 male PLHIV were included. The prevalence of CT/NG at any anatomical site was 20.3%, 13.5% for CT and 9.0% for NG. The anatomical site with the highest prevalence was the rectal site, with a prevalence of 12.2% for CT/NG. Neisseria gonorrhoeae had a prevalence of 5.4% in oropharyngeal samples. An antibody syphilis test was positive in 51.1% of the patients. Logistic regression analysis revealed that men that reported to have had sex with another male in the past year was a risk factor for CT/NG positivity at any site(AOR = 4.95, 95% CI 1.46-16.76, p 0.004). Overall, 91.4 % of the patients had good acceptance for auto collection of the rectal sample among the study group.

Conclusion
There is a high prevalence of CT/NG, especially at the rectum site, and high prevalence of syphilis among HIV male atients in the antiretroviral clinic at the Santo Tomás Hospital in Panama. Most individuals with an STI w tested for, reported to be asymptomatic for these infections. Public health strategies need to be implemented to increase the screening and appropiate treatment with this population.

Disclosures
All Authors: No reported disclosures
2682. Opt-Out Syphilis Screening in an Urgent Care Center Increases Recognition and Treatment of Asymptomatic Syphilis Infection and Uptake of HIV Pre-Exposure Prophylaxis
Authors: Sweitzer Stephanie F , Sharp Joseph , Gruen Judah 
Published: November 2023

Abstract

Background
Atlanta, Georgia has an extremely high burden of both HIV and early syphilis. This syndemic is driven by a complex set of structural factors that result in striking healthcare inequities, further burdening communities with low access to primary care. These populations may instead utilize emergency departments and urgent care centers (UC) for medical care. UC visits represent a crucial opportunity for recognition and treatment of syphilis as well as connection to HIV prevention services. We describe a novel pilot of a universal, opt-out syphilis screening program offered to all adults in the Grady Urgent Care Center in Atlanta.

Methods
A retrospective chart review was performed on all patients 18 years and older who had a rapid plasma reagin (RPR) test collected from 9/1/21 to 12/31/21. Demographic data, syphilis diagnosis, syphilis treatment, and HIV testing and serostatus were abstracted from the electronic health record. Patients with reactive RPRs were contacted by a physician for diagnosis and potential syphilis treatment, sexual health counseling, and referral for HIV pre-exposure prophylaxis (PrEP) or HIV care.

Results
From 9/1/21 to 12/31/21, 5794 patients were triaged and 1381 underwent RPR screening (23.8%). Eighty (5.8%) had reactive RPRs, and 42 (52.5%) had active syphilis infection. Of those with active syphilis, 39 (92.9%) received treatment, and 35 (83.3%) completed treatment. Among all undergoing RPR screening, 37 (2.7%) were living with HIV. Of those who were not previously diagnosed with HIV, 1279 (93.9%) underwent concurrent HIV testing. Among all undergoing RPR screening, 41 expressed interest in PrEP, and 7 completed PrEP clinic intake. Of those with reactive RPRs, 16 expressed interest in PrEP, and 6 completed PrEP clinic intake.
Syphilis Testing and Treatment Among Patients 18 Years of Age and Older Who Had an RPR Collected in the Grady Urgent Care Center, 9/1/2021-12/31/2021
HIV Testing and PrEP Among Patients 18 Years of Age and Older Who Had an RPR Collected in the Grady Urgent Care Center, 9/1/2021-12/31/2021

Conclusion
Routine, opt-out syphilis testing was used to identify a substantial number of patients with active syphilis and connect a majority to treatment, underscoring the need for universal syphilis screening in this setting. It also provided an opportunity to deliver sexual health counseling and offer PrEP, although few patients completed PrEP clinic intake, suggesting that a more targeted approach to PrEP referral may be more effective.

Disclosures
All Authors: No reported disclosures
2684. Characteristics of mpox patients treated with Tecovirimat: a single center review
Authors: Vargas Robert , Fernandez Jennifer , Taylor David , Green Tondria , Won Sarah Y , Sha Beverly E , Guarin Laura Hernandez , Shankaran Shivanjali 
Published: November 2023

Abstract

Background
The 2022 mpox outbreak disproportionately affected men who have sex with men (MSM), and communities of color. Tecovirimat, which was FDA-approved for the treatment of smallpox in 2018, was made available to treat mpox via an Expanded Access Investigational New Drug protocol through the Centers for Disease Control (CDC). This retrospective chart review describes the demographics and characteristics of patients treated with tecovirimat at a single academic hospital in Chicago, IL.

Methods
The charts of patients with suspected or confirmed mpox infection who received tecovirimat were retrospectively reviewed. Demographics, HIV status, mpox vaccination, presentation and outcome were collected.

Results
Tecovirimat was prescribed to 22 patients. The average patient age was 38 years (26-55 years), 73% were nonwhite: 10 identified as Black and 6 as Hispanic. 91% were MSM, and 9% identified as heterosexual. 55% (12/22) had a known diagnosis of HIV: 42% (5/12) of this cohort were not on antiretroviral therapy, and 3 had a CD4 count &lt; 200. 73% of all patients had at least 1 additional sexually transmitted infection (STI), the most common were syphilis (7/22), gonorrhea (3/22) and/or chlamydia (3/22). 16 patients had not received any doses of the vaccine. 64% had &gt; 10 lesions, and 68% had systemic symptoms of headache, fevers or myalgias. 10 patients were treated as outpatients, 12 needed hospital admission and one needed an ICU stay for IV tecovirimat. Follow-up was available for 16 patients; all but two completed their treatment. Only one person stopped tecovirimat due to mild gastrointestinal side effects. Other than one patient who took &gt; 6 months to recover, symptoms had completely resolved at a median of 18 days (8-30 days) from positive test result.

Conclusion
At our institution, patients receiving tecovirimat were predominantly MSM and nonwhite. A majority had other STIs and/or had a diagnosis of HIV, emphasizing the importance of STI testing, and providing a potential opportunity to reengage people in HIV care. The retrospective nature of our study limits assessment for treatment efficacy. However, tecovirimat was well tolerated, with only one person having mild side effects. This suggests that tecovirimat may play an important role in the management of patients with mpox infection.
Image 1. Example of mpox lesions Image 2. Example of mpox lesions

Disclosures
All Authors: No reported disclosures
2685. Impact of Education and Clinic Site Champion on Extragenital Testing for Sexually Transmitted Infection
Authors: Cunningham Victoria , Smith Hayden L , Hurdelbrink Jonathan , Sittig Katherine , Veach Lisa A 
Published: November 2023

Abstract

Background
Over the last several years sexually transmitted infections (STIs) have been on the rise in the United States. A potential area for improving the diagnosis of STIs is appropriate testing of extragenital (EG) sites (i.e., throat or rectum). These sites may serve as a reservoir for infection and lead to increased transmission if not identified and treated. Prior studies have shown that in men who have sex with men, genital testing alone misses &gt;70% of STIs. In other patient groups, this may range from 10-40%. The aims of this project were twofold: to determine the proportion of patients receiving EG STI testing, and to observe the effect of a two-phase educational intervention on EG site testing.

Methods
Phase I (Jul-Dec 2021) included four urgent care clinics within a Midwest health system. Retrospective baseline data was ascertained for all adults receiving STI testing for Chlamydia trachomatis (CT) and Neisseria gonorrhea (GC) at these clinics. Next, all four clinics received access to an educational presentation regarding the importance of EG testing for STI detection. Two of these clinics served as pilot sites for the implementation of patient self-collection kits. Data was compiled for all adults undergoing STI testing at these clinics for a 6-month period. Phase II (Jul 2022-Mar 2023) involved further expansion and utilization of a site champion at several family medicine clinics including on-site promotion of multi-site testing and patient self-collection. Educational materials as in Phase I were provided to site champions

Results
Phase I baseline data indicated that less than 1% of samples from patients receiving STI testing were obtained from EG sites. There was a small increase in EG site testing after the educational intervention and implementation of self-collected swab kits (Table 1). Phase II data showed an increase in EG testing after the utilization of a clinic site champion and the sharing of testing data in family medicine clinics (Table 2).

Conclusion
Rates of STIs have reached an all-time high in the United States. EG infections serve as potential sources for STI transmission. Adequate multi-site testing is necessary. Implementation was most effective when a clinic site champion was identified, and clinic testing data was provided to them.

Disclosures
All Authors: No reported disclosures
2687. Tetracycline Resistance in Neisseria gonorrhoeae Isolates Among Transgender Women and Men Who Have Sex with Men — eGISP and SURRG, 2018–2021
Authors: Wondmeneh Sarah , Learner Emily , Schmerer Matthew W , Harvey Alesia , Mauk Kerry , Quilter Laura A , St. Cyr Sancta 
Published: November 2023

Abstract

Background
Doxycycline, a tetracycline analog, is being considered for use as post-exposure prophylaxis (PEP) to reduce bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (MSM) and transgender women. Pre-existing tetracycline resistance may contribute to the varied effectiveness of doxycycline in preventing Neisseria gonorrhoeae (GC). We examined trends in tetracycline resistance (TetR) and tetM plasmid-mediated high-level tetracycline resistance (TetHLR) among GC isolates collected from MSM and transgender women through national sentinel surveillance.

Methods
Genital (urethral, urine, vaginal or endocervical), pharyngeal and rectal GC isolates were collected from MSM and transgender women during 2018–2021 at 12 Enhanced Gonococcal Isolate Surveillance Project (eGISP) and 8 Strengthening the U.S. Response to Resistant Gonorrhea (SURRG) sites. We determined overall prevalence of TetR and TetHLR (minimum inhibitory concentration, MIC ≥2 µg/mL and MIC ≥16 µg/mL, respectively) among MSM and transgender women by anatomic site of infection and described annual trends among MSM.

Results
Among 10,853 isolates collected from 8,667 MSM, overall TetR prevalence was 31% (genital: 31%, pharyngeal: 32%, rectal: 29%), and annual TetR prevalence decreased during 2018–2021 (Table 1). Overall TetHLR prevalence among MSM was 13% (genital: 13%, pharyngeal: 12%, rectal: 12%) and annual TetHLR prevalence for genital and pharyngeal infections increased during 2018–2021. Among 108 isolates collected from 89 transgender women, overall TetR prevalence was 23% (genital: 19%, pharyngeal: 23%, rectal: 25%) and TetHLR prevalence was 9% (genital: 0%, pharyngeal: 10%, rectal: 12%), though numbers were small.

Conclusion
Approximately 1/3 of GC isolates collected from MSM and 1/4 of GC isolates collected from transgender women were tetracycline resistant. Prevalence of tetracycline resistance was similar across anatomic sites. Providers should continue to follow recommended screening and treatment guidelines for gonorrhea among persons using doxycycline as STI PEP. Additionally, given high levels of TetHLR, enhanced tetracycline resistance surveillance is needed with implementation of doxycycline as STI PEP.

Disclosures
All Authors: No reported disclosures
157. Implementation of multidisciplinary diagnostic stewardship for Clostridioides difficile infection during the COVID-19 pandemic at a small Japanese hospital
Authors: Sasaki Yasuhiro , Yano Masataka , Umehara Ayumi , Tagashira Yasuaki 
Published: November 2023

Abstract

Background
Clostridioides difficile infection (CDI) is a common, healthcare-associated infection. However, its incidence has reportedly declined in the United States owing to the COVID-19 pandemic. On the other hand in Japan, testing for CDI has been infrequent, suggesting that this disease may be underdiagnosed. The present study examined the implementation of multifaceted, diagnostic stewardship for CDI in a small Japanese hospital during the pandemic.

Methods
The following interventions were introduced at Tama-Nambu Chiiki Hospital, a small community hospital in Tokyo: 1) criteria for CDI testing were added to the hospital's guidelines; 2) clinical pharmacists and nurses assessed the need for CDI testing in patients with nosocomial diarrhea and made recommendations for CDI testing to physicians; 3) a tutorial on CDI testing was given to physicians, nurses, and pharmacists; 4) data on the density of CDI testing and the CDI incidence in the hospital were provided to healthcare workers every three months. The outcomes were CDI testing frequency and the CDI incidence per 10,000 patient days. Segmented regression in interrupted time-series analysis (ITSA) was performed before the pandemic (2018/04-2020/03), after the pandemic (2020/04-2022/03), and after the intervention (2022/04-2023/03).

Results
The frequency of CDI testing tended to increase before the pandemic (+0.16/10,000 PD, P=0.28) but decreased significantly after the pandemic (-0.79/10,000 PD, P=0.02), then increased significantly immediately after the intervention (+29.6/10,000 PD, P&lt; 0.01). Similarly, the incidence of CDI increased significantly before the pandemic (+0.23/10,000PD, P=0.02) but decreased significantly after the pandemic (-0.45/10,000PD, P=0.01). Implementation of the intervention resulted in an immediate, significant increase in the CDI incidence (+6.8/10,000PD, P&lt; 0.01).

Conclusion
Multifaceted, diagnostic stewardship involving multiple specialists was effective in improving CDI testing, suggesting that appropriate testing can contribute to the accurate diagnosis of CDI.

Disclosures
All Authors: No reported disclosures
2689. Utility of Bronchoalveolar Lavage for Diagnosis and Management of Pneumonia in Immunocompromised Children
Authors: Green Amanda M , Flerlage Tim , Hijano Diego , Abraham Afreen 
Published: November 2023

Abstract

Background
Determining the etiology of acute respiratory illness (ARI) in immunocompromised children is challenging. The wide variety of infectious and non-infectious causes makes it difficult to optimize empiric antimicrobial treatments, leading to broad, lengthy antimicrobial courses with potential antimicrobial overuse, increased side effects, and interruptions to chemotherapy treatments. The diagnostic yield and safety of bronchoalveolar lavage (BAL) in these patients has long been debated.

Methods
We conducted a retrospective chart review of BAL procedures performed on immunocompromised children with ARI at St. Jude Children’s Research Hospital between 2017-2021. Microbiological and molecular study results were reviewed, including next generation sequencing (NGS) studies obtained from BAL, upper respiratory, and blood specimens within 7 days of the BAL. Etiology determined by the clinical team, changes in antimicrobial clinical management, and adverse events following the BAL were collected.

Results
82 BAL procedures from 57 patients are presented. The most common underlying diagnosis was hematologic malignancy, and 39 (48%) had undergone hematopoietic cell transplant. BAL identified one or more potential respiratory pathogen in 62.2% of ARIs, including viruses (54%), bacteria (48%), and fungi (37%). Of the 12 patients with BAL NGS, 8 (67%) identified likely respiratory pathogens, 5 (42%) correlated with other testing, and 3 (25%) were unique to NGS. 58 (71%) of BALs led to a change in antimicrobial management, either by discontinuation of broad-spectrum antimicrobials (65%) or narrowed antimicrobial regimen (41%). In 7 (12%) patients with suspected infectious etiology, BAL confirmed alternate etiology and avoided initiation of antimicrobials. 12 (15%) of patients underwent new intubation, and 22 (27%) had increased ventilatory requirements within 24 hours of BAL. No patients required new ICU transfer due to the procedure.

Conclusion
BAL is a valuable, well tolerated procedure that can aid in the diagnosis of pulmonary disease in pediatric immunocompromised patients. These preliminary findings highlight the benefits of BAL and its potential impact on decision making and clinical management, including avoiding antimicrobial overuse.

Disclosures
All Authors: No reported disclosures
2695. Lung Transplant Recipients With High Risk Cytomegalovirus Mismatch Donors Managed Using A Multimodality Regimen: A Five-Year Study
Authors: Banga Amit , Kanade Rohan , Bollineni Srinivas , Kaza Vaidehi , Mohanka Manish , Timofte Irina , Lawrence Adrian , Torres Fernando 
Published: November 2023

Abstract

Background
Lung transplant (LT) recipients with high risk cytomegalovirus (CMV) mismatched donors (recipient negative, donor positive or R-/D+) have been found to have worse early and late outcomes. In our institution, high risk CMV mismatch patients are managed in a protocolized manner consisting of proactive utilization of antiviral agents (ganciclovir/valganciclovir) and immune augmentation with CMV immune globulin.

Methods
We reviewed our institutional LT database. The study group consistent of all patients who underwent single or bilateral lung transplant between January 2012 to December 2016 (n=319). The CMV serostatus of both recipients and donors was reviewed and patients were classified into two groups: High risk CMV mismatch (R-/D+): n=82 (25.7%) and non-high risk CMV mismatch (n=237). We compared patient demographics, co-morbidities, pre and port-transplant variables among the two groups. Three-year survival was analyzed as the primary outcome variable. With three-year survival as the dependent variable, we analyzed the association of CMV status with survival using multivariate logistic regression analysis.

Results
There was no difference in the baseline and post-transplant characteristics of LT recipients with and without CMV mismatch donors. Overall one-year and three-year survival was 89.96% and 72.7% respectively. Recipients transplanted with CMV mismatch status and managed with a proactive CMV prophylaxis protocol experienced similar one one-year (92.7% vs 89%, p=0.4) and three-year survival (73.2% vs 72.6%, p=1.0) as the non-CMV mismatch recipients.
After adjustment for demographics, comorbidities and post-transplant course, CMV mismatch was not associated with three-year survival. Post-LT development of AKI the only independent variable to be independently associated with three-year survival (adjusted OR: 2.1, 1.13-3.87; p=0.019). Kaplan Meier analysis (see Fig) showed very similar survival curves for recipients with and without CMV mismatched donors.

Conclusion
Use of a proactive multimodality CMV prophylactic regimen consistent of antiviral agents (ganciclovir/valganciclovir) and immune augmentation with CMV immune globulin may improve outcomes among high risk CMV mismatch LT recipients.

Disclosures
All Authors: No reported disclosures
2700. Reducing the Dose of Mycophenolate in Solid Organ Transplant Recipients Diagnosed with SARS-CoV-2 Infection Increases the Risk of Severe COVID-19
Authors: Gillcrist Marion , Waller Stephen , Taylor Ryan M , Bahr Nathan C , Cibrik Diane M , Shah Zubair , Eid Albert 
Published: November 2023

Abstract

Background
Most of the available COVID-19 outcome data in solid organ transplant (SOT) recipients does not suggest a higher mortality rate in the SOT population. Though theoretically immunosuppressive medications might be associated with worse outcome, its immunomodulatory effect might be beneficial.

Methods
We retrospectively analyzed the effect of dose-reduction of mycophenolate, tacrolimus, and prednisone on the severity of COVID-19 in SOT recipients diagnosed with COVID-19 at the University of Kansas Medical Center between January 1, 2020 and December 31, 2022. Severe COVID-19 was defined by development of hypoxia while the patient was on room air during a 21-day period following COVID-19 diagnosis. To evaluate the effect of dose changes after the diagnosis of COVID-19 on the odds of developing severe COVID-19, we subset our data based on whether patients were taking mycophenolate (n = 449), tacrolimus (n = 537) or prednisone (n = 386) at the time of diagnosis. Within each subgroup, we fit a logistic regression model with severe COVID-19 as the response variable and adjusted for the relevant immunosuppressant and a set of covariates (age, sex, race, body mass index, hypertension, diabetes mellitus, prespecified time period of COVID-19 diagnosis during the pandemic, chronic heart disease, chronic lung disease, malignancy, end stage renal disease, cirrhosis, smoking, receipt of COVID-19 vaccine, and receipt of SARS-CoV-2 monoclonal antibodies).

Results
In our SOT population, 570 patients were diagnosed with COVID-19 (458 kidney, 73 liver, 54 heart, 43 pancreas, and 8 lung recipients). The median patient age was 54 years, 59% were male, and 70% were white. After adjusting for other covariates, a mycophenolate dose-reduction of &lt; 50% was associated with an odds ratio of 2.01 (95% CI: 1.03 - 3.90; p = 0.04) for developing severe COVID-19. Similarly, decreasing the dose of mycophenolate by ≥ 50% was associated with an odds ratio of 2.65 (95% CI: 1.09 - 6.41, p = 0.03) for developing severe disease. Tacrolimus dose reduction did not increase the risk of severe COVID-19, nor did a dose increase or decrease of prednisone.

Conclusion
A mycophenolate dose reduction when a SOT patient is diagnosed with COVID-19 should be discouraged, especially if the patient has mild disease.

Disclosures
All Authors: No reported disclosures