bluuebunny/crossref_metadata_2025_split huggingface dataset:
1319. Microbiology and Epidemiology of Pediatric Ventriculoperitoneal Shunt Infections
Authors: Claunch Kevin M , Adams Daniel , Deperrior Sarah , Rajnik Michael 
Published: November 2023

Abstract

Background
Infections complicate approximately 10% of ventriculoperitoneal (VP) shunts in children, with considerable associated morbidity and mortality. Recent guidelines for empiric treatment of VP shunt infections recommend use of vancomycin combined with an anti-pseudomonal beta-lactam, but are based on low-quality evidence. We aimed to further characterize and update the microbiology of pediatric VP shunt infections using the U.S. Military Health System database.

Methods
Department of Defense beneficiaries less than 22 years-of-age admitted for VP shunt infection between Oct 1, 2008 and Sep 30, 2019 were included. VP shunt infection was defined using a combination of ICD-9-CM and ICD-10-CM codes, CPT codes for removal or replacement of a shunt (Table 1), and positive cultures from a normally sterile site (cerebrospinal fluid, blood, catheter tip, and peritoneum). Demographic data on age, sex, and year of admission were collected for each patient, as was microbiologic data including organism and specimen source.

Results
There were 32 qualifying admissions among 30 patients for VP shunt infection over the 10-year study period, with no discernable year-to-year trend identified. Half of all VP shunt infections occurred in patients less than 12 months of age (Table 2). Sixty-one unique positive cultures were identified among the 30 patients, 38 (62%) from CSF samples, and the remaining 23 (38%) from blood, peritoneum, and catheter tips (Figure 1). Coagulase-negative Staphylococcus (28%), Staphylococcus aureus (15%), and Enterococcus spp. (10%) were the leading causative pathogens (Figure 2). Enteric gram-negative rods accounted for 21% of positive cultures. Pseudomonas spp. were rarely isolated (3%), however, strict anaerobic pathogens made up 8% of positive cultures.

Conclusion
Empiric antibiotic treatment of VP shunt infections in children should cover gram-positive cocci and enteric gram-negative rods but need not cover Pseudomonas spp. Existing guidelines do not recommend anaerobic coverage, however, these data indicate empiric anaerobic coverage is prudent, especially when an intra-abdominal VP shunt infection is suspected.

Disclosures
All Authors: No reported disclosures
1334. Amino Acid Sequence Diversity of HIV-1 Viral Proteins Tat and Vpr in South African People Living with HIV: Implications for Neurocognitive Function
Authors: Williams Monray E 
Published: November 2023

Abstract

Background
The transactivator of transcription (Tat) and Viral protein R (Vpr) of HIV-1 have functional roles in the neuropathophysiology of HIV-associated neurocognitive disorders (HAND). Pre-clinical studies have identified specific amino acid substitutions, including Tat T24K, C31S, R57S and Vpr H45Y, A55T and R77Q, as crucial influencers of the neurovirulence of HIV-1 subtype C infection. However, there is limited clinical data on the amino acid sequence diversity of Tat and Vpr, particularly in South African people living with HIV (PLWH).

Methods
In this study, amino acid sequence diversity in Tat and Vpr was investigated in n = 70 treatment-naïve South African PLWH. RNA was extracted from plasma, reverse transcribed and DNA was prepared for PCR analysis. The Tat exon 1/Vpr (HXB2 position 4900–6351) was amplified using primer pair Vif-1/ CATH-4R. PCR products were sequenced by BigDye Terminator v.3.1 Cycle Sequencing Ready Reaction Kit and analysed on the ABI Prism 3130xl automated DNA sequencer. Bioinformatic analyses were applied to identify key amino acids in Tat and Vpr.

Results
Tat sequence data were available for n = 53 participants and Vpr sequence data was available for n = 63 participants. The most common amino acid at position 24 of Tat was K (37%), followed by N (28%) and P (9%). At position 31, S was the most common amino acid (66%), followed by C (11%). At position 57, the most common amino acid was S (53%), followed by R (9%) and A (8%). Regarding Vpr, the most common amino acid at position 45 was Y (53%), followed by H (33%). At position 55 of Vpr, T was the most common amino acid (70%), followed by A (19%). At position 77 of Vpr, Q was the most common amino acid (84%), followed by R (6%) and H (5%).

Conclusion
Our understanding of the impact of HIV-1 sequence variation on neurovirulence primarily stems from preclinical studies and research conducted on participants with subtype B. However, this study presents evidence of sequence variations in Tat and Vpr among South African PLWH, who are predominantly infected with subtype C. The predominant amino acids observed in Tat and Vpr of the investigated participants are known to be linked to lower neurovirulence. These findings may help elucidate the differing neurocognitive outcomes observed when comparing PLWH with subtypes B and C.

Disclosures
All Authors: No reported disclosures
1347. Do Class 3 Semaphorins Play a Role in COVID-19 Outcomes in Patients with Non-alcoholic Fatty Liver Disease?
Authors: Vargovic Martina , Gjurasin Branimir , Samadan Lara , Vince Adriana , Papic Neven 
Published: November 2023

Abstract

Background
Class 3 semaphorins are newly recognized regulators of T-lymphocyte differentiation, neutrophil migration, and the production of inflammatory cytokines, with a possible role in controlling COVID-19 “cytokine storm”. While non-alcoholic fatty liver disease (NAFLD) is associated with COVID-19 severity and outcomes, immunological mechanisms remain unclear. Since NAFLD is associated with semaphorin pathway dysregulation, this study aimed to determine the possible association of serum semaphorin concentrations with the severity of COVID-19 in patients with NAFLD.

Methods
This was a secondary analysis of the prospective observational study (CovidFAT) that recruited patients with severe COVID-19 during the delta wave of the pandemic. Upon admission, patients were screened for NAFLD, routine clinical and laboratory data were collected, and serum semaphorin -3A, -3C and -3F concentrations were analyzed by ELISA. Sixty SARS-CoV2 negative, age and sex-matched healthcare workers (30 with NAFLD) were included as controls.

Results
Eighty patients (44 males (55%); mean age of 58±12 years) with COVID-19 were included. Of them, 42 had NAFLD. There were no differences in age, sex, comorbidities, duration of symptoms, and disease severity at admission, except for BMI which was higher in the NAFLD group (32±8 vs 27±3 kg/m2). Patients with NAFLD had significantly higher CRP (123±70 vs 97±60 mg/L), IL-6 (92±59 vs 45±38 pg/mL), neutrophile-lymphocyte ratio (11±14 vs 6.5±2.6) and GGT (93±78 vs 54±47 IU/L). Patients with COVID-19 had significantly higher serum concentrations of SEMA3C and SEMA3F and lower of SEMA3A than healthy controls, as presented in Figure 1. Patients with COVID-19 and NAFLD had significantly higher SEMA3C and SEMA3F serum concentrations than patients without NAFLD. In ROC analysis, SEMA3A and SEMA3F showed good accuracy for differentiating moderate from severe/critical COVID-19 (AUC 0.75, CI95% 0.66-0.85 and 0.74, CI95% 0.54-0.84, respectively).
Serum semaphorin concentrations measured in healthy controls and patients with COVID-19. Shown are means with standard deviations and p-values (ANOVA test).

Conclusion
NAFLD is associated with distinct semaphorin profiles in COVID-19, possibly associated with disease severity and adverse outcomes.

Disclosures
All Authors: No reported disclosures
1379. Evaluation of Cardiovascular Disease Risk among People Living with HIV in Lebanon
Authors: Helou Remie El , Zaidan Mariam , Wehbe Saliba , Rizk Nesrine 
Published: November 2023

Abstract

Background
Since the introduction of antiretroviral therapy (ART), People Living with HIV (PLHIV) have become more prone to developing chronic illnesses, such as cardiovascular diseases (CVD), than to suffer from AIDS related conditions. The global burden of CVD associated with HIV has tripled over the last two decades, especially in low/middle income countries. Scarce data exist on the prevalence of CVD and CVD risk factors among PLHIV in the Middle East and North Africa (MENA) region. Therefore, we aim to examine the prevalence of CVD risk factors and calculate the CV risk in a cohort of PLHIV in Lebanon.

Methods
This is a retrospective chart review conducted between 2018 and 2023 at an HIV clinic in a tertiary care center in Lebanon. The study population includes adult subjects receiving ART and with at least 6 months of undetectable viral loads. Data included demographics, laboratory values, HIV-specific data, and review of traditional CVD risk factors. Atherosclerotic Cardiovascular Disease (ASCVD) risk score was calculated using the American College of Cardiology Risk Estimator Plus, to estimate patients’ 10-year risk for developing ASCVD. Descriptive statistics were implemented to summarize the cohort’s characteristics and the prevalence of CVD risk factors.

Results
A total of 85 HIV-infected subjects were included in the analysis. Subjects’ characteristics are summarized in table 1. The majority were males (89.4%), and the mean age was 43.31±12.28 years. The prevalence of smoking, alcohol consumption, and illicit drug use was 70.6%, 54.1%, and 20%, respectively. The mean BMI was 26.1±5 kg/m². Additionally, 20.2 % of subjects had dyslipidemia, 6% had diabetes, and 15.5% had hypertension. The mean current CD4 cell count was 687.83 ±356 cells/ml. The cohort had a mean ASCVD risk score of 8.8%, higher than that of age-matched population (mean ASCVD risk score of US firefighters aged 40-44 years is 1.8%).

Conclusion
This study shows the prevalence of traditional CVD risk factors among PLHIV receiving effective ART in Lebanon. The cohort mean ASCVD risk score indicates an intermediate risk for developing CVD over the next decade. in the MENA region, we need larger studies to inform on the prevalence of CVD among PLHIV, and to develop guidelines to mitigate the risk.

Disclosures
All Authors: No reported disclosures
1392. An observational study to test efficacy of oral fluconazole in pediatric cases of Cutaneous Leishmaniasis
Authors: Mitra Debdeep 
Published: November 2023

Abstract

Background
Cutaneous Leishmaniasis(CL) is the commonest form of Leishmaniasis with a worldwide incidence of about 0.7 to 1.2 million cases per year and 90% of these cases are in Asia, the Middle East, South America, and North Africa. Pentavalent antimony medications are still the most effective treatments for leishmaniasis, however, due of the severe side effects and the need for parenteral administration, other therapies, such as oral medicines for cutaneous leishmaniasis, have been sought. Given the extended duration of the illness and the disfiguring impact of unhealed skin lesions, a well-tolerated oral medication would be beneficial. In vitro, certain azole antifungal medications exhibit cidal action against leishmania. Fluconazole, a triazole antifungal drug available for oral administration, has clinical efficacy against leishmania but very limited data is available to support this.

Methods
To test the efficacy of oral fluconazole in CL in children we treated 14 Indian patients of age less than 12 years with once daily doses of fluconazole for four weeks. Patients less than 12 years old with clinically and smear positive confirmed cases were included in the study. Immuno-compromised patients were excluded.

Results
In the majority of patients, a parasitological smear was used to confirm the diagnosis, and in a few cases, histological testing was used. 10 patients were male, and mean values (SE:Standard error) at study entry were: age, 7(2) years; weight, 20 (3) kg; duration of illness, 2·4 (0·4) months. All children were prescribed fluconazole dispersible tablet at the dose of 3-5 mg/kg body weight to adjust doses in multiple of 50 mg of dispersible tablet daily. No drug discontinuation or any case drop out was noted as the drug was well tolerated and there was good noticeable clinical response. Intermittent nausea and occasional diarrhea was the most common side effect (7% of cases). Clinical cure was noted with complete clearance of skin lesions in all 14 cases and no appearance of any new lesions was observed over next 3 months. The average treatment response time was 43 days

Conclusion
There are very limited studies on the use of fluconazole in pediatric CL in endemic areas and this study suggests a very safe and effective treatment option.

Disclosures
All Authors: No reported disclosures
1396. Performance of a Telemedicine Travel Clinic
Authors: Pomeranz Adam , Zohar Iris , Caliari Gabriele , Orbach Nili , Mizrachi Yulia , Mimon Hadar , Ben-David Debby , Maor Yasmin 
Published: November 2023

Abstract

Background
International travel has become easier and more accessible, with increasing numbers of people embarking trips to diverse destinations worldwide. This trend is accompanied by elderly individuals and families venturing to remote locations, as well as digital nomads. As a result, there is a growing demand for pre-travel medical consultations, which current medical resources in Israel are not able to meet. To address this, we launched a telemedicine-based travel clinic that aims to improve accessibility for Israeli residents.

Methods
The digital clinic is located within a 700-bed medical center in central Israel and offers telemedicine consultations scheduled online. After the appointment, customers receive recommendations and prescriptions via email. They can then make an appointment to receive vaccinations at our on-site in person clinic or at other travel clinics in Israel. From February 1st to March 31st, 2023, we analyzed all cases that receive a digital consultation. Data included demographics, travel destinations, vaccination recommendations, and attendance to the in-person vaccination clinic.

Results
239 customers received a telemedicine consultation. Mean age was 33±17 years, 122 (51.0%) were females, 40 (16.7%) were minors. 18.4%44 () resided outside the pooling area of the hospital. Of these, 81.8%36 () lived in central Israel but had closer clinics to their place of residency requiring personal attendance, 18.2%8 () lived in the North or South of Israel (figure 1). Travel destinations are presented in figure 2. 219 (91.6%) customers received a recommendation for at least one vaccine. 53.0%116 () attended or scheduled an appointment to the vaccine clinic. 103 (47.0%) did not schedule an appointment despite having a recommendation to receive vaccines.

Conclusion
About 50% of patients did not attend or schedule an appointment to the in-person clinic to receive the recommended vaccines. Personal attendance decreased as the residence distance from the hospital increased ( &gt;30 Km), suggesting that customers found closer clinics for vaccination. The telemedicine-based travel clinic simplified pre-travel medical consultations and for 10% of clients who did not need to get vaccines enabled them not to attend the hospital in person.

Disclosures
Yasmin Maor, MD, Astra Zeneca: Advisor/Consultant|Astra Zeneca: Honoraria|Gilead: Honoraria|GSK: Honoraria|kamada: Honoraria|Medison: Honoraria|MSD: Advisor/Consultant|MSD: Honoraria|Pfizer: Grant/Research Support|Pfizer: Honoraria
1997. Risk Factors and Outcomes of Mycobacterium abscessus Complex (MABC) Acquisition after Lung Transplantation
Authors: Nick Sophie E , Yarrington Michael E , Reynolds John M , Anderson Deverick J , Baker Arthur W 
Published: November 2023

Abstract

Background
Lung transplant recipients are at increased risk of MABC acquisition. The objective of this study was to analyze risk factors and outcomes of early post-transplant MABC acquisition.

Methods
We conducted a single center retrospective case-control study of patients who underwent lung transplant from 1/1/2012 – 12/31/2021. Cases were patients with de novo MABC acquisition within 90 days post-transplant. Controls had no positive MABC cultures and were matched 1:3 with cases based on age and transplant date. Recipient demographics, pre-/peri-operative characteristics, and outcomes for 1-year post-transplant were analyzed.
Conditional logistic regression was used to determine independent risk factors for MABC acquisition. The reference model included all variables with a P value ≤ 0.2 in univariate analysis after accounting for collinearity and epidemiologic plausibility. Confounding variables and variables with an adjusted P value ≤ 0.05 were included in the final model.

Results
79 cases and 237 controls were identified out of 1,145 lung transplants. The median time to MABC isolation was 33 days (IQR 11 – 59) after transplant. The first positive culture was pulmonary for 70 (89%) cases; 59 (75%) cases were treated with antibiotics targeting MABC.
Univariate analysis found cases were more likely than controls to have CMV mismatch (D+/R-), bilateral transplant, higher end-match allocation score, increased ventilator time pre- and post-transplant, and days in the hospital before MABC index date (Table 1). IPF diagnosis and receipt of azithromycin were protective. Multivariable analysis showed only post-transplant ventilation for ≥ 2 days was independently associated with MABC (Table 2).
Compared to controls, cases required more days of hospitalization after the MABC index date (28 vs. 12 days; p=0.01) and had decreased 1-year post-transplant survival (78% vs. 89%; p=0.02) (Figure 1). When stratified by subspecies, 1-year survival was 69% for M. abscessus and 89% for M. massiliense (p=0.10).
Table 1.
Lung transplant recipient characteristics
Table 2.
Conditional logistic regression model constructed via backward elimination to determine independent predictors and confounders of MABC acquisition
Figure 1.
Kaplan-Meier survival curve comparing cases and controls for 1-year after transplant

Conclusion
In this large case-control study, post-transplant ventilator duration was associated with MABC acquisition, which in turn was associated with increased hospital days and mortality. Further studies are needed to determine the best strategies for MABC prevention and surveillance.

Disclosures
Arthur W. Baker, MD, MPH, Insmed: Grant/Research Support|Medincell: Advisor/Consultant
1434. Analysis of hand hygiene techniques using the artificial intelligence (AI)-based analysis tool SCORE!
Authors: Kakeya Hiroshi , Okada Yasuyo , Fujita Akiko , Nakaie Kiyotaka , Imoto Waki , Shibata Wataru , Yamada Koichi 
Published: November 2023

Abstract

Background
Hand hygiene is the most important technique for controlling nosocomial infections. While quantitative evaluations based on the amount of hand sanitizer used and qualitative evaluations such as compliance rates based on direct observation are commonly used to evaluate the effectiveness of this education, more objective evaluation indicators are needed. Here, we evaluated the effectiveness of hand hygiene education by scoring hand hygiene techniques using an artificial intelligence (AI)-based analysis tool.

Methods
Hand disinfection (proper spreading of fluorescent paint) and hand washing (proper rinsing of fluorescent paint) techniques were scored before and after a hand hygiene education video training using the AI-based analysis tool SCORE!Ⓡ(Moraine Corporation, Tokyo).
Images were taken with an iPhone before and after hand disinfection and washing. The image data were divided into 72 parts, including the wrists and the backs of the right and left palms. Hand hygiene techniques for each part were evaluated using AI. The effectiveness of the training was also evaluated by job categories.

Results
The pre- and post-education scores of 935 participants (128 physicians, 484 nurses, 56 nursing assistants, 93 other medical staff, and 174 administrative staff) increased for hand disinfection (P &lt; 0.01) and decreased for hand washing (P &lt; 0.01). The scores for hand disinfection increased for all occupations, while those for hand washing decreased for all occupations except nursing assistants, indicating that hand disinfection was highly effective in education but hand washing was less effective. In a comparison by job categories, there was a large difference in scores between the job categories in terms of the highest and lowest scores for both hand disinfection and hand washing. In the site-specific evaluation, the back of the hand scored higher in hand disinfection, with no significant difference between left and right hands. On the other hand, the palm and left hand scored higher in hand washing, differing from the hand disinfection results.

Conclusion
Evaluating hand disinfection scores using “SCORE!” allows for the assessment of even minor changes that may be difficult to detect visually and provides information on individual techniques that may require improvement.

Disclosures
Hiroshi Kakeya, MD, PhD, Asahi Kasei Pharma Corporation: Honoraria|Merck Sharp & Dohme: Honoraria|Sumitomo Pharma Co., Ltd.: Honoraria
1438. Hand Hygiene Compliance and Monitoring among Healthcare Workers at an Urban Hospital in the Caribbean.
Authors: Nwaogu Ezinne U M 
Published: November 2023

Abstract

Background
Hand hygiene is one of the most effective ways to prevent the spread of infections in the Hospital.
To promote quality care, simple procedures like hand hygiene are of paramount importance.
To prioritize clean hands in health facilities, people at all levels need to believe in the importance of hand hygiene by acting as key players in achieving appropriate behaviors and attitudes towards it.

Methods
A cross-sectional observational study was used, by direct observation technique. 'Secret shoppers' employees, were used to monitor colleagues' hand hygiene compliance each time they enter or exit a patient's room.
Role modeling, make it part of our rounding/just-in-time education, infection prevention, and control (IPC) monthly hand hygiene compliance updates/feedback, and incentives. We mention it in every huddle, especially Healthcare-Associated Infections (HAI) meetings, Electronic platforms, mandatory training and education for all Employees.

Results
The findings of this study showed that our hand hygiene compliance rates increased from 52% to 87% across most of the units - ICU, IMCU, Medical Surgical unit, Maternity, Emergency Room, OR and by all employees ranging from physicians to nurses, patient care technicians and others.
Healthcare workers, now aware they are being monitored, by secret shoppers, work in competition with other units to improve their compliance because they would be given the recognition " hand hygiene champions. "

Conclusion
In conclusion, using secret shoppers and positive recognition helped our Hospital to achieve a higher degree of compliance with hand hygiene.
More will still need to be done, to get our compliance closer to 100%
Clean Hands Save Lives! Together, we can achieve it.

Disclosures
All Authors: No reported disclosures