bluuebunny/crossref_metadata_2025_split huggingface dataset:
2650. Characteristics of In-Hospital Care and Immediate Post-Discharge Care Status among Older Adults Hospitalized with Respiratory Syncytial Virus Infection, Seasonal Influenza, Acute Myocardial Infarction, and Stroke in the US
Authors: Sato Reiko , Judy Jennifer , Yacisin Kari , Begier Elizabeth , Sardana Poorva , Agrawal Neha , Goswami Anchita , Sharma Manvi 
Published: November 2023

Abstract

Background
Despite increased recognition of the morbidity, mortality, and economic burden of respiratory syncytial virus (RSV) in adults, few studies have documented the status of post-discharge care after RSV hospitalization. This study assessed in-hospital and immediate post-discharge care status in older adults hospitalized with RSV in the US and compared it with other serious medical conditions (influenza, acute myocardial infarction (AMI), and stroke) that have long-standing disease prevention efforts.

Methods
This retrospective cohort study used data from Premier Healthcare Database between January 1, 2015, to December 31, 2019. Adults aged ≥ 65 years hospitalized due to primary diagnosis of RSV, influenza, AMI, or stroke were included. Discharge statuses were used to categorize the levels of immediate post-discharge care as shown in Figure 1. Descriptive statistics and Sankey diagrams were used to summarize the four cohorts.

Results
Overall, 2,559 RSV, 174,826 influenza, 208,448 AMI, and 274,102 stroke hospitalizations were identified with similar mean patient ages of 79.8, 76.8, 76.3, and 78.0 years, respectively. Almost all patients ( &gt; 90%) had underlying comorbidities. The mean inpatient length of stay (LOS) was similar in the four cohorts (4.0, 4.4, 3.7, and 4.1 days, respectively), but the prevalence of mechanical ventilator use varied, i.e., 0.4%, 13.7%, 5.9%, and 1.4%, respectively. Intensive Care Unit (ICU) admissions during RSV hospitalizations were infrequent (3.0%) as compared to influenza (16.8%), AMI (24.5%), and stroke (20.5%). The mean ICU LOS for these four cohorts were 2.3, 2.8, 1.7, and 1.7 days in the same order. Immediately following discharge, moderate care was required for 23.9%, 22.9%, 14.1%, and 17.5% of RSV, influenza, AMI, and stroke hospitalizations, respectively. Elevated care was considerably more frequent for stroke hospitalizations (48.1%) than RSV (18.8%), influenza (21.4%), and AMI (19.3%) hospitalizations (Figure 2).

Conclusion
Older adults discharged from RSV hospitalizations require considerable care with needs comparable to influenza and AMI discharges. Given the substantial care requirements of RSV hospitalizations in older adults, focus on disease prevention efforts for RSV are needed.

Disclosures
Reiko Sato, PhD, Pfizer Inc: employee|Pfizer Inc: Stocks/Bonds Jennifer Judy, MS, PhD, Pfizer: Stocks/Bonds Kari Yacisin, M.D., Pfizer: Employee|Pfizer: Stocks/Bonds Elizabeth Begier, M.D., M.P.H., Pfizer: EB is an employee of Pfizer, the sponsor of this study|Pfizer: Stocks/Bonds Poorva Sardana, MSc, Pfizer Inc: Contracted Research Neha Agrawal, MA, Pfizer Inc: Contracted Research Anchita Goswami, MSc, Pfizer Inc: Contracted Research Manvi Sharma, RPh, MBA, PhD, Pfizer Inc: Contracted Research
2668. Real-World Test-of-Cure Practices for Oropharyngeal Gonorrhea in People with HIV
Authors: Wooten Darcy , Hill Eddie 
Published: November 2023

Abstract

Background
Most reported ceftriaxone-based treatment failures of gonorrhea occur in cases of oropharyngeal (OP) gonorrhea. Consequently, the CDC now recommends a test-of-cure (TOC) 7-14 days after initial treatment of OP gonorrhea. There is a lack of data on adherence to these guidelines. The purpose of this study was to examine the repeat testing practices for people with HIV (PWH) who were diagnosed with and treated for OP gonorrhea.

Methods
We conducted a retrospective cohort study at the University of California at San Diego among PWH who tested positive for OP gonorrhea between 12/01/2020 and 09/05/2022. We measured the time elapsed between treatment of OP gonorrhea, ordering of repeat testing, and completion of repeat testing. We calculated the proportion of patients who had a repeat test completed within the guideline-recommended window of 7-14 days. We also measured the following secondary outcomes: 1) the rate of repeat tests that showed persistent positivity, and 2) the repeat testing completion rate after the roll-out of a home self-testing program on 01/31/2022.

Results
We identified 223 PWH who tested positive for OP gonorrhea. 10.3% (23/223) of patients completed repeat testing 7-14 days after treatment. The mean duration between treatment and repeat testing was 74.2 days (range 0-530 days). 4.3% (1/23) of patients who completed repeat testing within 7-14-days of treatment and 7.5% (15/200) of patients who completed repeat testing after this period showed persistent positivity (P-value 0.58). There was no difference in adherence to TOC guideline recommendations before versus after the implementation of the home self-testing program (13.3%, 14/105 versus 8.9%, 7/79; P-value 0.16).
Management Care Cascade of Oropharyngeal (OP) Gonorrhea in People with HIV (PWH)

Conclusion
We found that just one tenth of patients completed repeat testing 7-14 days after receiving treatment for OP gonorrhea. The rate of guideline-recommended repeat testing did not improve with the implementation of home self-testing kits for OP gonorrhea. These findings are concerning given the rising rates of antimicrobial-resistant gonorrhea and the impact that gonorrhea has on facilitating HIV transmission. Additional studies are needed to identify and understand the barriers impacting adherence to the CDC’s TOC recommendations.

Disclosures
All Authors: No reported disclosures
2669. Improving Trichomoniasis Screening Among Cis- and Transgender Women with HIV
Authors: Igwe Nnamdi , Goris Yuderka , Olivier Berlinda , Abrams-Downey Alexandra 
Published: November 2023

Abstract

Background
In 2020, the Primary Care Guidance for Persons with HIV added the recommendation for annual trichomoniasis screening. We identified a low trichomoniasis annual screening rate among cis- and transgender female patients living with HIV at the Institute for Advanced Medicine – Morningside Clinic, a New York State Designated AIDS Center with over 1200 patients with HIV in the Mount Sinai Health System in Manhattan. The primary aim of this prospective quality improvement pilot project was to increase the clinic’s annual trichomoniasis screening rate to 25% over the six-month intervention period.

Methods
A gap analysis identified lack of efficient workflow as the major reason for low trichomoniasis screening. We developed and implemented an intervention as outlined in Figure 1. The intervention began on October 15, 2022. The data was reviewed on April 19, 2023 after the intervention period ended.

Results
At baseline, there were 423 cis- and transgender women with HIV engaged in care at the Morningside Clinic eligible for annual sexually transmitted infection screening, including trichomoniasis. Pre-intervention screening for trichomoniasis was low at 13.7% (n=58). During the six-month intervention period, there were 280 cis- and transgender women with HIV who required annual trichomoniasis screening and seen at least once for a clinic visit with a primary care provider. Of these 280 eligible patients, 178 were tested for trichomoniasis, a significantly increased screening rate of 63.6%.

Conclusion
The intervention successfully increased the clinic’s annual trichomoniasis screening rate from 13.7% to 63.6% among women with HIV. The observed increase within six months was above our goal and demonstrates the effectiveness of a low-intensity and highly sustainable intervention to improve annual trichomoniasis screening rates among women with HIV. Despite the intervention, there are still a number of patients who remain unscreened for trichomoniasis as well as other sexually transmitted infections such as gonorrhea, chlamydia and syphilis. We will continue this intervention longitudinally and further identify and address barriers to sexually transmitted infection screening among people living with HIV.

Disclosures
All Authors: No reported disclosures
2683. Follow-up Testing for Chlamydia trachomatis and Neisseria gonorrhea Infections in Female Basic Military Trainees
Authors: Townsend Lisa , Stahlman Shauna , Oh Gitaik , Escobar James , Osuna Angela , Casey Theresa , Winkler Erin , Kieffer John , Yun Heather , Okulicz Jason F , Marcus Joseph 
Published: November 2023

Abstract

Background
The Centers for Disease Control and Prevention recommends follow-up testing for Chlamydia trachomatis (CT) and Neisseria gonorrhea (GC) infections 3 months after initial positive test or within one year if repeat testing is not possible at 3 months. Follow-up testing compliance in the United States is incompletely understood and has been reported below 35%, even in universally insured populations. The rates of follow-up testing in military populations are unknown.

Methods
During the study period from January 1, 2006-December 31, 2021, all female Air Force Basic Military Trainees provided a urine sample which underwent nucleic acid amplification testing (NAAT) for CT and GC. Those who tested positive were evaluated to determine demographic information as well as follow-up testing rates. Patients who were evaluated with a repeat CT/GC NAAT test within 12 months after a positive CT/GC test result were considered to have received appropriate follow-up. Nominal variables were compared by the Chi-squared test. A p-value of &lt; 0.05 was considered significant.

Results
A total of 97,168 women were tested over the 16-year study period. Of those tested, 4,687 (4.8%) tested positive for either CT (n=4,584, 94.5%), GC (n=134, 2.7%), or both (n=131, n=2.7%). Of those who tested positive, 3,268 (69.7%) had repeat testing within 12 months of their initial positive test. There was no significant difference in follow-up by age, race, educational level, marital status, or organism. Compared to 2006-2009, 2018-2021 had significantly more follow-up testing (66.0% vs. 77.7%, p=&lt; 0.0001) (Figure).
Follow-up Testing Rates for Chlamydia trachomatis and Neisseria gonorrhea Infections in Female Basic Military Trainees 2006-2021

Conclusion
Follow-up testing among female Air Force Basic Military Trainees is significantly higher than in other universally insured populations and has been improving with time. However, this study shows remaining barriers to adherence to recommended guidelines. Future efforts should clarify remaining barriers to follow-up testing in both military and civilian populations.

Disclosures
Jason F. Okulicz, MD, Gilead Sciences: Advisor/Consultant
2693. Epidemiology of Infections with Multidrug-Resistant Organisms in Patients with Left Ventricular Assist Devices (LVADs)
Authors: Axell-House Dierdre B , Ranadive Radhikesh , Nisar Tariq , Kassi Mahwash , Guha Ashrith , Arias Cesar A 
Published: November 2023

Abstract

Background
Left ventricular assist devices (LVADs) constitute one of the limited options available to patients with refractory heart failure. Infection is the most common adverse event after LVAD placement, and difficult to eradicate when attributable to the LVAD itself. LVAD-attributable infections (LVADI) thus lead to significant antibiotic exposure and higher risk for antibiotic resistance. However, the epidemiology of multidrug-resistant organisms (MDROs) causing LVADI has not been described.

Methods
We conducted a retrospective cohort study of patients (pts) ≥18 years old with LVADs implanted from 2016 to 2022 at our institution. Infections were defined as LVADI if i) there was a positive culture from LVAD components, with or without concomitant blood cultures, or ii) there were positive blood cultures with radiologic evidence of LVADI. MDROs were defined according to the Centers for Disease Control (CDC) criteria. Primary outcome was mortality, and multivariate logistic models were built and adjusted for patient demographics and Charlson’s Comorbidity Index.

Results
A total of 252 pts were implanted with new LVADs, with 104 (41.2%) pts developing LVADI. Of the 52 episodes of bloodstream infection (BSI) in 41 pts, 36.5% were caused by MDRO, with Methicillin-Resistant Staphylococcus aureus (MRSA) and MDR Pseudomonas aeruginosa most frequent. There were an additional 64 pts with 99 infections with positive LVAD component cultures, with a total of 115 pathogens isolated. Of these, 20% were MDRO, with MRSA and MDR Enterobacterales most frequent. Multivariate logistic models showed that pts with LVADI did not have higher odds of mortality (OR =1.61; 95% CI [0.92 – 2.81]; p=0.1), however pts with MDRO LVADI had a greater than 3 times odds of mortality (OR = 3.34; 95%CI [1.68 – 6.64]; p&lt; 0.001) compared to pts without MDRO LVADI.

Conclusion
Our review provides initial insight as to the burden of antibiotic resistance among bacteria causing LVADI. The frequency of LVADI in our cohort is higher than what has previously been reported, possibly due to higher vigilance. The MDROs MRSA, MDR Pseudomonas aeruginosa, and MDR Enterobacterales are prominent in this population. Further study is needed to elucidate the risk factors for acquiring MDRO LVADIs and contributing factors to mortality in LVAD pts.

Disclosures
All Authors: No reported disclosures
2699. Risk of Bacterial Bloodstream Infection from a Urinary Source Among Kidney Transplant Recipients
Authors: Eichenberger Emily , Karadkhele Geeta , Johnson Aileen C , Pouch Stephanie M , Larsen Christian P 
Published: November 2023

Abstract

Background
Bacteriuria is common among kidney transplant recipients (KTR). Bloodstream infection is a feared complication of bacteriuria. Risk factors and outcomes associated with bloodstream infection due to a urinary source (BSIU) in KTR are poorly understood.

Methods
In a single center retrospective review, we included all KTR at Emory Transplant Center who had bacteriuria between 06/2007-09/2022. BSIU included KTR with concordant positive blood and urine cultures. BN included KTR with bacteriuria who never developed a bloodstream infection (Figure 1). For subjects with more than one episode of BSIU or BN, only the first episode was included. Clinical characteristics were compared using Kruskal Wallis and fisher exact test. Multivariate logistic regression was used to determine factors associated with BSIU.

Results
Among 4071 unique KTR, 1133 developed bacteriuria of which 263 (23.2%) were BSIU and 870 (76.8%) were BN (Table 1). KTR with BSIU were older (median age 54 vs 50, p=0.002) and more likely to have diabetes mellitus as the primary kidney disease (35.4% vs 23.2%, p=0.0004) than those with BN. Males comprised 49.4% of BSIU vs 30.8% of BN (p &lt; 0.0001). Baseline renal function was significantly lower prior to BSIU than BN (glomerular filtration rate (GFR) 40.3 vs 46.8, p=0.0071). Enterobacterales caused 83.3% of BSIU vs 60.5% of BN, p &lt; 0.0001 (Figure 2), of which 19.3% and 11.5% were extended spectrum beta-lactamase producing, respectively (p=0.007). After adjustment, male sex, decreased GFR, primary kidney disease secondary to diabetes mellitus, and presence of Enterobacterales were significantly associated with BSIU (Male: aOR 2.66 (95%CI 1.94, 3.64), diabetes aOR 1.86 (95%CI 1.33, 2.60), GFR aOR 0.99 (95% CI 0.99, 1.00), Enterobacterales aOR 3.55 (95%CI 2.23, 5.64), Table 2).
30-day mortality was 3% for BSIU vs 0.9% for BN (p=0.0168). Rate of acute cellular rejection at 90 days and graft failure 1-year post culture did not significantly differ between BSIU vs BN (rejection: 1.9% vs 3.6%, p=1.000; graft failure: 5.3% vs 3.1%, p=0.1292).Figure 2.Microbial Etiology of bloodstream infection secondary to a urinary source (BSIU) compared to bacteriuria without bloodstream infection (BN) among Kidney Transplant Recipients

Conclusion
Male sex, history of renal disease due to diabetes mellitus, decreased GFR and Enterobacterales were associated with BSIU among KTR. Mortality among BSIU was low, and there was no increased risk of graft failure or rejection relative to BN.

Disclosures
All Authors: No reported disclosures
2708. Infectious Complications Among CD19 Chimeric Antigen Receptor T-cell Recipients
Authors: Huggins Jonathan , Messina Julia A , Saullo Jennifer , Andermann Tessa , Smith Melody , Schrum Daniel , Eberwein Erin , Kennedy Erin , Rowe-Nichols Krista , Kelsey Christopher , Choi Taewoong , McKinney Matthew , Galal Ahmed , Kang Yubin 
Published: November 2023

Abstract

Background
Current data on infectious complications of chimeric antigen receptor (CAR) T-cell therapy are limited to single center retrospective cohort studies. Presented here is a subset of patients from a multicenter retrospective cohort study including recipients of CAR T-cell therapy at Duke University, University of North Carolina at Chapel Hill, and Stanford University.

Methods
In a retrospective cohort of 66 patients who received CD19 CAR T-cell therapy Duke University between January 1, 2018 and August 31, 2021 rates and characteristics of bacterial, viral, and fungal infections within the first year after CAR T-cell infusion are described. Demographic, baseline clinical, and outcome variables are compared between patients who developed infection and those who did not.

Results
Forty-nine total infections occurred in 29 (43.9%) patients within 1 year of CAR T-cell infusion. Patients who developed infection were more likely to have an underlying malignancy other than diffuse large B-cell lymphoma (34% vs 8%, p = 0.031), and to have developed immune effector cell-associated neurotoxicity syndrome (62% vs. 32%, p = 0.016). Viral (23/49, 46.9%) and bacterial (20/49, 40.8%) pathogens predominated and infections most often involved the bloodstream (19/49, 38.8%) and lung (18/49, 36.7%).There were no statistically significant differences between rates of bacterial and viral infection based on time since CAR T-cell infusion (≤30 days vs 30 – 90 days vs &gt;90 days), though fungal infections only occurred after 90 days in patients with relapse of their underlying disease.

Conclusion
Infectious complications after CAR T-cell therapy are common within the first year of infusion. Bacterial and viral infections predominate while fungal infections are rare and occurred only in patients with relapsed disease.

Disclosures
Melody Smith, MD, MS, BMS: Advisor/Consultant Krista Rowe-Nichols, RN, MSN, AOCNS, Bristol Myers Squibb: Advisor/Consultant|Kite Pharmaceuticals: Advisor/Consultant|Kite Pharmaceuticals: Speaker Bureau Christopher Kelsey, MD, Colgate-Palmolive: Expert Testimony|Johnson and Johnson: Expert Testimony Taewoong Choi, MD, Janssen biotech: Honoraria Matthew McKinney, MD, ADC Therapeutics: Advisor/Consultant|ADC Therapeutics: Honoraria|Beigene: Grant/Research Support|Beigene: Honoraria|Epizyme: Advisor/Consultant|Genentech: Advisor/Consultant|Genentech: Grant/Research Support|Genentech: Honoraria|Gilead/Kite: Advisor/Consultant|Gilead/Kite: Honoraria|Incyte: Grant/Research Support|Novartis: Advisor/Consultant|Seagen, Inc.: Advisor/Consultant|Takeda: Advisor/Consultant|TG therapeutics: Advisor/Consultant
160. Measuring the Impact of PCR-based MRSA Nares Screening on Vancomycin Use and Duration of Vancomycin Among Pneumonia Patients at an Academic Medical Center
Authors: Stromberg Joseph , Jones Travis , Mavrogiorgos Nikolaos , Marx Ashley H 
Published: November 2023

Abstract

Background
The benefits of PCR-based MRSA nares screening for de-escalation of pneumonia therapy are well-established. In late 2022, UNCMC introduced a PCR-based MRSA nares screen for inpatient use, replacing a chromogenic culture-based screen. The improved turnaround time of the PCR-based test was hypothesized to increase adoption of screening for empirical de-escalation. This project assessed adoption of this diagnostic and measured impact on patients with pneumonia who comprise a cohort followed by the ASP using a visualization dashboard.

Methods
A report was generated of patients with admission ICD-10 codes compatible with pneumonia for January-March of 2022 (pre-PCR) and 2023 (PCR). Electronic medical records of included encounters were reviewed to collect respiratory culture data, validate vancomycin exposure days within the context of the patient’s renal function, and confirm presence of clinical pneumonia. For 2022 data, MRSA screen results were manually collected from the medical record, while for 2023 data, encounters were matched with MRSA PCR results. Fisher’s exact was used to analyze categorical data.

Results
46 and 68 patients, respectively, were included for 2022 and 2023. There was a trend increase in the percentage of patients who were screened for MRSA (28% to 51%, p = 0.68; Table 1). Median turnaround time decreased from 2,022 min to 112 min. The frequency of respiratory sputum cultures, MRSA positivity, and empiric vancomycin therapy were similar. Median duration of vancomycin exposure decreased among all vancomycin recipients (3 to 2 days; Table 2). The percentage of vancomycin recipients who received just one day of coverage increased from 22% to 46%, a trend observed regardless of MRSA screening (Figure 1).

Conclusion
The PCR-based MRSA nares screen for inpatients with pneumonia has trended toward wider adoption compared to the prior screening method, and PCR has been associated with decreased durations of vancomycin therapy. However, similar trends were present in patients who did and did not undergo MRSA screening, suggesting both the new MRSA screen and broader institutional factors have contributed to a shift away from empirical anti-MRSA coverage for pneumonia.

Disclosures
All Authors: No reported disclosures
2723. High Mortality and Resistance in Patients with Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections (MBI-LCBI)
Authors: Salazar Grace Johanna , Reyes Flavio , Salgado Johana , Galarza Margarita , Peralta Amy 
Published: November 2023

Abstract

Background
Since its definition, MBI-LCBI is a pathology increasingly studied and frequent, however, with the growing threat of multidrug resistance (MDR), it is very important to have pharmacological resources for the treatment and local epidemiology. The economic constraints that many institutions suffer in lower middle-income countries may result in worse outcomes in MBI-LCBI and carbapenem-resistant Enterobacteriaceae (CRE) patients. In Ecuador, only ceftazidime/avibactam is available for the CRE treatment, and it is not considered in the Ecuadorian National formulary (EFN), that means it is not available in public health institutions.

Methods
A retrospective study was conducted in two cancer reference hospitals in Ecuador, from January 2019 to December 2021. All patients with MBI-LCBI according to CDC criteria were included. Demographic, diagnostic, and microbiological isolation data were collected. Strains identification and susceptibility were performed on Vitek 2 system and Kirby Bauer, following CLSI 2022 recommendations and cut-off points. The CRE resistance mechanism was confirmed by PCR. Thirty-day episode mortality was assessed, and compared between susceptible and MDR cases. Data are shown with means, and Chi-Square test was used to evaluate differences between mortality. SPSS version 25 was used.

Results
148 episodes of MBI-LCBI in cancer patients were detected. Figure 1 shows etiology and susceptibity of strains. Sixty one (41.3%) MBI-LCBI causing microorganisms were MDR; 25 (68.8%) were BLEE/AmpC isolates and 19 (31.1%) were CRE. The mortality rate of MBI-LCBI patients was 48.6% (72). There was no difference between deaths from BLEE/AMPc versus susceptible bacteremia (22,2% vs. 27,6% p=0,44), however, mortality from CRE strains was higher compared to susceptible strains (20,8% vs. 2,6% p=0.001) figure 2. The risk of dying with MBI-LCBI with CRE strains was OR: 4.5 (95% CI;1.3-15; p=0.01).

Conclusion
There is a high percentage of resistance and mortality in MBI-LCBI, more notorious when the cause is CRE. This alerts us to the need of further research in this pathology and its appropriate treatment. Ecuadorian health authorities should consider review the EFN to include new active drugs for treatment CRE infections.

Disclosures
All Authors: No reported disclosures