bluuebunny/crossref_metadata_2025_split huggingface dataset:
846. Pneumocystis Pneumonia in malignancy patients: Who is at risk?
Authors: Vasiloudes Kritos , Aslam Sadaf , Greene John 
Published: November 2023

Abstract

Background
Pneumocystis Pneumonia (PCP) is a respiratory pathogen that has been known to cause severe illness in the immunocompromised patients. The pathogen became well known in the HIV epidemic where much of the current standard of practice was first researched. However since the invention of antiretroviral therapy, and advances in cancer therapy the population affected by PCP has shifted to patients with malignancy or a medication induced immunocompromised state. Here we wish to better define the epidemiology and pathogenicity of PCP in the immunocompromised malignancy patients.

Methods
We utilized a retrospective review of 28 consecutive patients from January 1st 2012 to January 1st 2023 that had visited Moffitt Cancer Center with a diagnosis of confirmed or suspected PCP. We collected data on age, underlying malignancy, type of treatment, comorbidities, presenting symptoms, method of diagnosis and computed tomography findings.

Results
Hematologic malignancies comprised 90% of all cases, half of all cases were in patients’ with a type of non-hodgkin’s lymphoma (NHL). The most common malignancy was diffuse large B cell lymphoma 25%, followed by acute myelocytic leukemia treated with stem cell transplant (SCT) 14%, followed by multiple myeloma 11% (Figure 1). The therapy mostly implicated was glucocorticoids in 57% cases, followed by alkylating agents in 32%, and SCT in 25% (Figure 2). The most frequently reported symptoms was dyspnea in 71% of patients, followed by fever 39%, and cough 32%. Diagnosis was made in 21% of patients with serum 1,3-β -D-glucan, 68% were diagnosed following a bronchoalveolar lavage, 11% utilized both (figure 3). of The most common finding on CT was ground glass opacities in 79% of cases. Lymphopenia was present in 79% cases. PCP contributed or was the cause death in 17% cases.
Underlying Malignancy
Underlying Malignancy of those who developed PCP pneumonia, n=28 Diffuse large B Cell Lymphoma DLBCL, Acute Myelocytic Leukemia AML, Chronic Lymphocytic Leukemia CLL, Cutaneous T Cell Lymphoma CTCL, Acute T cell Leukemia/Lymphoma ATLL, Immune Thrombocytopenic Purpura (ITP)
Type of cancer treatment
Cancer Treatment of those who developed PCP pneumonia, multiple different therapies were often used in treatment, n=28
Method of Diagnosis of PCP

Conclusion
Our data shows that patients’ with NHL comprise half of the patients who developed PCP. Consistent with other studies, steroids were the most frequently implicated therapy, however the second most frequent were alkylating agents. Lymphopenia was commonly associated as well. We wish to bring to light that NHL, Alkylating agents, and particularly lymphopenia as risk factors for development of PCP and should prompt early concern of PCP, particularly those with NHL.

Disclosures
All Authors: No reported disclosures
848. Discordant Chest Radiography and Computed Tomography Findings in Patients with Hematologic Malignancy and Invasive Mucormycosis: What Are the Prognostic Implications?
Authors: Wurster Sebastian , Franklin Alexander D , Axell-House Dierdre B , Jiang Ying , Kontoyiannis Dimitrios P 
Published: November 2023

Abstract

Background
Invasive pulmonary mucormycosis (IPM) is a common and deadly mold infection in patients (pts) with hematological malignancies (HM). Comparing chest x-ray (CXR) to computed tomography (CT) in IPM offers the opportunity to evaluate the concordance of these two imaging studies and the clinical significance of discordant imaging.

Methods
We reviewed all HM pts with CT-positive probable/proven IPM at MD Anderson Cancer Center (2000-2020) who had a concurrent CXR performed within 5 days of the reference CT. Concordant imaging was defined as a consolidation or mass-like lesion on CXR matching the suspicious CT lesion. In addition to survival curve analysis, a multivariate Cox's proportional hazard model was used to identify independent predictors of 84-day all-cause mortality after IPM symptom onset.

Results
Among 44 included pts, 31 (70%) were neutropenic (&lt; 500/µL). Only 24 pts (55%) had a matching lesion on CXR while the remaining 20 (45%) had discordant imaging. 20/29 pts (69%) with consolidation on CT and 9/12 pts (75%) with reverse halo sign or nodules with cavitary lesions had concordant CXR findings, whereas nodules without these features were rarely associated with concordant CXR findings (7/26, 27%). Although infection severity at baseline (APACHE II scores 15 vs. 16) was comparable, pts with concordant CXR lesions tended to have higher rates of intensive care unit admission during IPM therapy (67% vs. 45%, p = 0.15) and higher 84-day mortality (92% vs. 65%, p = 0.06) than those with discordant imaging. This difference was corroborated by survival curve analysis (Fig. 1A, p = 0.008), even when restricted to the 31 neutropenic pts (Fig. 1B, p = 0.049). APACHE II score &gt; 18 at IPM diagnosis (adjusted hazard ratio [aHR] 3.09, p = 0.003), neutrophil recovery (aHR 0.29, p = 0.007), and presence of a concordant CXR lesion (aHR 2.61, p = 0.011) were independent predictors of 84-day mortality (Table 1).
Figure 1
Table 1

Conclusion
Even when accounting for neutropenia status, a known confounder of radiographic imaging in IPM pts, visualization of IPM on CXR concordant to CT was an independent predictor of poor outcomes, possibly as a surrogate of extensive lesions and high fungal burden. If confirmed in larger cohorts, CXR might be used as a supportive prognostic staging tool in IPM pts, especially in resource-poor settings.

Disclosures
Dimitrios P. Kontoyiannis, MD, MS, ScD, PhD, AbbVie: Board Member|Astellas: Grant/Research Support|Cidara: Board Member|Gilead: Grant/Research Support|Merck: Advisor/Consultant|Scynexis/MSGERC: Board Member
858. Diagnostic Accuracy of Monocyte Distribution Width as a Sepsis Biomarker in a Large, Urban Emergency Department
Authors: Crew Jordan , Hunter Ben , Desai Armisha 
Published: November 2023

Abstract

Background
Sepsis is a leading cause of hospital and emergency department (ED) mortality, and early identification is crucial. Procalcitonin (PCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) are increasingly being utilized to aid in the early identification of septic patients. Recently, monocyte distribution width (MDW), a measure of the range in size of monocytes in the blood, has shown promise as an additional sepsis biomarker; levels &gt; 20 have been correlated with an increased risk of sepsis. This investigation sought to determine the diagnostic accuracy of MDW as a marker of sepsis, and compare the accuracy to that of PCT, CRP, and ESR.

Methods
This is a retrospective chart review of adult ED patients from 4/1/2022 to 7/31/2022 in whom an MDW was resulted. During this time, MDW was included as part of all CBC reports. We collected PCT, CRP, and ESR results if obtained within 48 hours of the MDW. Sepsis diagnoses were based on a primary ICD-10 diagnosis of sepsis (A40-A41) at ED or hospital discharge. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for MDW in all patients, MDW only in patients with PCT also ordered (regardless of PCT result), PCT, CRP+ESR, and MDW+PCT for the sake of comparison. MDW was considered “positive” for sepsis if &gt; 20.

Results
There were 10,654 patient encounters with MDW reported. The mean age was 51 years old, and 55% of patients were female. Of the 10,654 encounters, 269 (2.5%) had a sepsis diagnosis on discharge. Diagnostic test results for MDW, PCT, and ESR and CRP are displayed in Table 1. Among all ED patients with a CBC, MDW had a sensitivity, specificity, PPV, and NPV of 82%, 69%, 6.7% and 99%, respectively. In 847 patients where infection was being considered (based on the independent ordering of PCT), MDW sensitivity, specificity, PPV, and NPV were 85%, 53%, 29% and 94%, respectively. MDW was more sensitive but less specific than PCT. In cases of both positive MDW and PCT, the PPV for sepsis was 43%.

Conclusion
These findings suggest that, as a marker for sepsis, MDW has comparable test characteristics to ESR and CRP, with higher sensitivity but lower specificity than PCT. The combination of a positive MDW and PCT was most predictive of sepsis.

Disclosures
Ben Hunter, MD, Beckman Coulter: Honoraria
863. ELISpot-BK virus assay for the assesment of BK virus cell-mediated immunity in kidney recipients
Authors: Herrera Sabina , Sempere Abiu , Egri Natalia , Maurandi Javier Bernal , Cofan Frederic , Marcos María Angeles , Pascal Mariona , Bodro Marta 
Published: November 2023

Abstract

Background
The pre and post-transplant monitoring of BKV-specific T cells could be a useful marker to identify renal receptors at risk of BKV reactivation and consequently develop BKV nephropathy.

Methods
We performed a prospective multicenter study between October 2020 and December 2021. BKV-ELISPOT was performed before and two months after kidney transplantation in included patients. Other variables such as demographic, immunosuppressive therapy, presence of biopsy-proven rejection, lymphopenia, CD4 count levels and development of BK infection and nephropathy were prospectively recorded.

Results
We included 66 patients during the study period of whom median age was 56 (SD 16) and 60% were men. Twenty-nine percent of them received a prior transplantation, 17% was a living donor and 74% needed haemodialysis prior transplantation. Ninety-two percent received induction therapy and 86% maintenance therapy was with 3 drugs. Fifty-one percent of patients presented lymphopenia at 2 months post transplantation with a median CD4 count levels of 298 (IQR 176-899). Prior transplantation 30% of patients presented a reactive ELISPOT-BKV test, whereas at 2 months post transplantation only 21% of them tested positive. Five patients presented a BK infection and 2 of them a BK nephropathy, all of them presenting with impaired graft function at one year post transplantation.Twenty-eight percent of them presented a biopsy-proven acute rejection. All patients that presented a BKV infection presented a non-reactive ELISPOT-BKV test prior transplantation and at 2 months post transplantation. After performing multivariate analysis, neither lymphopenia, acute allograft rejection nor ELISPOT-BKV test were related to BKV infection, probably due to low incidence of BKV infection in this subgroup of kidney recipients.

Conclusion
BKV-ELISPOT test could be a valuable tool to predict BKV infection or nephropathy and could be useful to implement preventive measures such pre-emptive reduction of immunosuppressive therapy in kidney recipients.

Disclosures
All Authors: No reported disclosures
872. Characterizing Plasma Microbial Cell-Free DNA Sequencing Detections of Public Health Important Pathogens
Authors: Park Sarah Y , Chang Eliza J , Lau Constance , Berman David , Nolte Frederick S 
Published: November 2023

Abstract

Background
Timely pathogen identification is critical for meaningful disease surveillance to facilitate effective public health responses. However, public health important pathogens are often diagnostically challenging (e.g., indeterminate serological results, multiple samples separated by long intervals, lengthy turnaround times) and at odds with public health needs. We describe detections of public health important pathogens by the Karius Test®, a validated plasma microbial cell-free DNA (mcfDNA) sequencing test, providing real-time pathogen detection.

Methods
We identified nationally notifiable infectious diseases (NNID)-associated and selected state reportable pathogens detected and quantified as DNA molecules/μl (MPM) in US patients’ plasma samples submitted to the Karius CLIA certified/CAP accredited laboratory for mcfDNA sequencing between 4/1/18–4/30/22. We evaluated and characterized these detections based on result and test requisition form data. We reviewed gender and immunocompromised status of a subset of patients linked deterministically to the Premier Healthcare Database (PHD), a US hospital-based, all-payer database.

Results
Plasma mcfDNA sequencing yielded 520 detections of 62 microbes associated with 27 NNIDs and 449 detections of an additional 12 microbes, including public health important parasites, amoebae, endemic mycoses, and selected bacteria, across 27 US states. MPM and patient age varied widely across microbes from 9–300+ million and 0–89 years, respectively (Table 1). For the 167 (17%) PHD-linked detections, 71% were associated with male and 72% with immunocompromised patients.

Conclusion
Plasma mcfDNA sequencing detected many different public health important pathogens across many states, especially among immunocompromised patients. These patients pose a heightened public health concern given their increased risk for more severe disease and potential for longer infectious periods and greater likelihood of atypical or nonspecific presentations, leading to greater risk of unrecognized disease spread. Plasma mcfDNA sequencing, an unbiased test, may contribute to rapidly identifying disease outbreaks and spread, and facilitate timely interventions to improve public health.

Disclosures
Constance Lau, MPH, Karius, Inc.: Stocks/Bonds David Berman, DO, Precision Health Solutions, St. Petersburg, Florida: Advisor/Consultant Frederick S. Nolte, PhD, Karius: Stocks/Bonds
883. The Current State of Access: Inequitable Access to Infectious Disease Physicians in the Time of the COVID-19 Pandemic and Declining Fellowship Match Rates
Authors: Fuller Benjamin P , Strumpf Andrew , McManus Kathleen A 
Published: November 2023

Abstract

Background
Equitable access to specialty care is a key component of population health. Guidelines recommend specialty care within a 60-minute (min) drive. In 2017, 80% of United States (US) counties had no Infectious Diseases (ID) physicians. In the setting of the COVID-19 pandemic and declining fellowship match rates, we characterized inequities in geographic access to ID physicians in the US.

Methods
We geocoded the location of ID physicians from 2020 Medicare Provider Utilization and Payment Data. For people in the contiguous US, we conducted a cross-sectional analysis of one-way drive times to the closest ID physician overall and by age, gender, racial, and ethnic subgroups using 2020 US Census data. We calculated the median drive times and the proportion of each subgroup within x minutes to the nearest ID physician.

Results
We identified 6000 ID physicians at 2582 locations (Fig 1). Fig 2 demonstrates one-way drive times. In the US, 7.9% of people live &gt; 60 min from ID specialty care. When stratified by rural/urban, 46.7% of rural people and 1.6% of urban people live &gt; 60 min from the closest ID physician (Fig 3). Rural people had a median drive time of 57.2 min (95% CI 56.6-57.9) while urban people had a median drive time of 10.9 min (10.8-11.0). For people who identify as American Indian and Alaska Native (AIAN), 70.3% in rural areas and 8.8% in urban areas live &gt; 60 min from the closest ID physician. For rural AIAN populations, median drive time was 95.1 min (86.0-104.1). For rural populations, the median drive time was &gt; 60 min for those who identify as Native Hawaiian and Other Pacific Islander (69.1; 64.5-75.8), multiple races (65.5; 63.7-67.6), or Hispanic (66.9; 65.0-68.7).

Conclusion
Access to ID specialty care is inequitable. The largest disparities exist between rural and urban populations. Significant disparities exist for the AIAN population. In ID, we need recruitment and retention of our current workforce and recruitment of people who will serve rural and AIAN communities. If telemedicine continues to be supported, it could help to reduce disparities. This is also dependent on equitable access to high-speed internet, which is concentrated in urban/suburban areas. Without initiatives to expand the ID workforce and to increase internet access in rural areas, disparities in access will not improve.

Disclosures
Kathleen A. McManus, MD, MSCR, Gilead Sciences, Inc.: Stocks/Bonds
884. The Role of a Novel Inpatient Consultation Service for Persons Experiencing Homelessness in Detroit, Michigan: Finding Ways to Close the Gap
Authors: Joshi Seema , Elewa Nedda , Failla Andrew J , Mervis Madison , Furman Katerina , Ghanshani Sanjna , Leonardi Nyla N , Ilagan Roxanne , Zervos Marcus , Bryce Richard 
Published: November 2023

Abstract

Background
People experiencing homelessness (PEH) face inequitable social determinants of health that impact primary care prevention, complications related to infectious diseases (ID), and hospitalizations. The purpose of Street Medicine Organizations is to provide accessible medical care to PEH where they reside. We describe a uniquely developed hospital consult service (HCS) targeted for PEH.

Methods
This HCS took place in an 877-bed quaternary care hospital in Detroit, MI and occurred from 07/2022 – 03/2023. Inclusion criteria were PEH (defined as living unsheltered, sheltered, or with unstable housing). Figure 1a describes HCS timeline and objectives and aims of the HCS are shown in Figure 1b. The HCS template is shown in Figure 2. Healthcare screening (HS) recommendations were provided to the primary team, and discharge support including harm reduction education and community resources were provided to the patient. The outcomes evaluated included HS and vaccine orders and follow-up success on street medicine runs.

Consult note template

Results
60 patients were evaluated with the HCS from 09/2022 – 03/2023. Of those, 43 consults were completed prior to patient discharge. Patient characteristics are shown in Table 1. Median population age was 50 years, 44 (73.3%) were men and 46 (76.7%) were Black. Majority of patients seen (48.8%) were unsheltered. 31 patients (76.7%) had last seen a primary care provider &gt; 12 months ago. Patient were more inclined to receive the influenza (30.2%) and pneumococcal (30.2%) vaccine compared to the COVID-19 vaccine (7%). 25 patients (58.1%) admitted to polysubstance use. There were recommendations placed for 23 (53.4%) of patients in which 11 (47.8%) were executed successfully prior to discharge. 17 (39.5%) patients had a scheduled follow up visit at a specific location and time on the street.

Conclusion
We describe the implementation of a unique HCS with a targeted needs assessment for PEH in hospital. Challenges regarding the HCS included frequent reeducation of HCS members to provide recommendations and sign-out. One major patient barrier included lack of phone for follow-up. However, specific gaps for this population within ID expertise have been identified. HCS future goals are to focus on harm reduction education, STI prevention, and addressing vaccine hesitancy in PEH.

Disclosures
Marcus Zervos, MD, Contrafect: Advisor/Consultant|GSK: Grant/Research Support|Johnson and Johnson: Grant/Research Support|Pfizer: Grant/Research Support
885. Promoting Diversity, Equity and Inclusion with a quarterly virtual Grand Rounds for the Pediatric Infectious Diseases Society
Authors: Rogo Tanya 
Published: November 2023

Abstract

Background
The Inclusion, Diversity, Access and Equity (IDA&E) Taskforce was created by the Pediatric Infectious Diseases Society (PIDS) in 2020. A 2021 survey of the PIDS membership to assess perceptions of diversity, equity and inclusion (DEI) revealed several areas of concern: perceptions of bias against and lack of support for international medical graduates (IMGs); lack of diversity in PIDS leadership; and perceived exclusivity in PIDS social and networking events. There is evidence that implicit bias can be alleviated by education that both increases awareness and provides bias reduction strategies. The Taskforce introduced a quarterly virtual Grand Rounds for the PIDS membership to provide DEI education. This abstract describes the first year of this initiative.

Methods
A proposal for a quarterly IDA&E Grand Rounds was approved by the PIDS Executive Committee in February 2022. A member of the IDA&E Taskforce assumed the role of course director. Four webinars were held in March, June, and September 2022, and January 2023. The topics addressed were under-representation in Pediatric Infectious Diseases, career challenges faced by IMGs, leadership development, and career pathways within Pediatric Infectious Diseases. A feedback survey link was provided to attendees of each Grand Rounds.

Results
The four Grand Rounds had an average of 172 registrants (range 130-204). Feedback survey completion was low (average 8 per webinar, range 4-18). Survey respondents reported affirmation of personal experiences; increased awareness of the topic discussed; and desire for more content related to career pathways, and IMG and visa-related concerns. Respondents commented on low attendance by division heads and fellowship program directors and recommended promotion of Grand Rounds attendance among persons in leadership positions.

Conclusion
Specialty-specific DEI education can be provided at the national level by a medical society through periodic webinars. The hour-long virtual format is limited in ability to address topics in-depth and should be the bare minimum of the work needed by institutions, training programs, and individual practitioners to support workforce diversity in Pediatric Infectious Diseases.

Disclosures
Tanya Rogo, MD, AstraZeneca: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support