bluuebunny/crossref_metadata_2025_split huggingface dataset:
154. Impact of Rapid Blood Culture Identification (BCID) PCR Panel on Optimal Antibiotic Use in Methicillin-Susceptible Staphylococcus aureus (MSSA) Bacteremia
Authors: Yetukuri Jahnavi , Patel Dimple , Bandali Aiman , Giordano Pamela 
Published: November 2023

Abstract

Background
Optimal anti-MSSA antibiotic choices are nafcillin, oxacillin, and cefazolin. Vancomycin, often used empirically for S. aureus infections, and other broad-spectrum β-lactam antibiotics, such as piperacillin/tazobactam and ceftriaxone, are linked with suboptimal outcomes compared to anti-MSSA β-lactam therapy. BCID PCR testing allows for faster pathogen identification, which may improve antibiotic use and clinical outcomes. The objective of this study was to assess the impact of BioFire BCID PCR panel implementation on antibiotic use and clinical outcomes in patients with MSSA bacteremia.

Methods
This was a retrospective chart review of adult inpatients with MSSA bacteremia during the pre-PCR (Jun 2018 - Dec 2019) and post-PCR (Jun 2020 - Dec 2021) study periods. Patients were excluded if they did not have PCR testing performed (post-PCR group only), never achieved optimal antibiotic therapy, had a polymicrobial infection, had positive blood cultures in the prior 90 days, underwent penicillin-skin testing or β-lactam desensitization, or were transitioned to comfort care or deceased within 24 hours of the gram stain. The primary endpoint was the difference in time to starting optimal MSSA antibiotic therapy (oxacillin or cefazolin) between the pre-PCR and post-PCR groups. Secondary endpoints included duration of anti-MRSA antibiotic use, in-hospital mortality, hospital and ICU lengths of stay, duration of bacteremia, and 30-day MSSA-related and all-cause readmissions.

Results
A total of 200 patients were included in the study, with 100 patients in each group. Time to optimal therapy was reduced by 19.9 hours in the post-PCR group (p &lt; 0.001). Fewer patients in the post-PCR group were initiated on empiric anti-MRSA antibiotic therapy than in the pre-PCR group (84% vs 98%, respectively, p = 0.001). PCR implementation was also associated with shorter empiric anti-MRSA antibiotic use and duration of bacteremia. There were no significant differences in length of stay, in-hospital mortality, or 30-day MSSA-related or all-cause readmissions (Table 1).
Table 1: Primary and Secondary Endpoints

Conclusion
In patients with MSSA bacteremia, BCID PCR panel testing decreased time to optimal MSSA antibiotic therapy and reduced durations of bacteremia and empiric anti-MRSA antibiotic therapy, including vancomycin.

Disclosures
All Authors: No reported disclosures
2660. Evaluating Risk for Bacterial Vaginosis Utilizing an Unsupervised Machine Learning Approach
Authors: Rodriguez Violeta , Pan Yue , Salazar Ana , Fonseca Nicholas , Raccamarich Patricia , Klatt Nichole R , Weiss Deborah Jones , Alcaide Maria L L 
Published: November 2023

Abstract

Background
Clustering methods using machine learning may be useful for identifying variables predicting clinical outcomes. Despite the need to better understand risk behaviors of Bacterial Vaginosis (BV), the most common cause of abnormal vaginal discharge linked to STI and HIV acquisition, machine learning methods have not been used to better understand BV. This study used an unsupervised machine learning algorithm, sidClustering and random forests, to identify clusters of risk behaviors of BV.

Methods
Participants were 402 cisgender women recruited in Miami, Florida, aged 18-45 (median age=31); over half of them were black (56%) and non-Hispanic (43.8%). Participants completed measures of demographics characteristics, sexual and medical history, and intravaginal practices (IVP), and underwent collection of vaginal samples. BV was diagnosed using Amsel or Nugent criteria; abnormal vaginal flora was defined as Nugent score of 4 or above. sidClustering and random forests were used to identify clusters and the most important variables in classifying clusters associated with BV; 135 behavioral variables (including substance use and number of partners) were subjected to analysis.

Results
We identified 4 clusters explained most of the variation in behaviors, and variables were ranked by importance in distinguishing these clusters. Results showed that clusters associated with BV were composed of women who 1) engaged in IVP primarily using water and fingers (Cluster 1: n = 108 (26.9%)], 2) engaged in IVP using multiple methods [water, rags, etc.; Cluster 2: n = 127 (31.6%)]; 3) engaged in a combination of IVP and other risk behaviors [Cluster 3: n = 119 (29.6%)]; and 4) those who did not engage in IVP but engaged in other high-risk behaviors [Cluster 4; n = 48 (11.9%)]. Clusters were related to abnormal vaginal flora (p &lt; .001). Cluster 2, the cluster with most frequent IVP, had the highest prevalence of BV (64.9%, compared with Cluster 1 (38.0%), Cluster 3 (50.4%), and Cluster 4 (39.6%).

Conclusion
Machine learning methods may be particularly useful in identifying specific clusters of high-risk behaviors, and in developing interventions intended to reduce BV and IVP, and ultimately to reduce the risk of HIV infection among women.

Disclosures
Maria L L. Alcaide, MD, Discidium Biosciences: Board Member|Gilead: Honoraria|Merk & Co: Honoraria|Senhwa Biosciences: Honoraria|Virology Education: Honoraria
2665. Health Care Provider Characteristics Associated with Anal Cancer Screening in an Academic Medical System
Authors: Gore Daniel , O’Donoghue Ashley , Dechen Tenzin , Zerillo Jessica A , Multani Ami , Krakower Douglas 
Published: November 2023

Abstract

Background
Anal cancer disproportionally affects persons living with HIV (PWH), sexual and gender minorities, and those with gynecologic cancers, condyloma acuminata, and solid organ transplantation. While expert guidance on anal cancer screening exists for PWH, there are no national guidelines for screening any of these populations. We analyzed clinician characteristics associated with anal cancer screening among providers who care for high-risk populations at an academic medical center including infectious disease (ID) specialists, primary care providers (PCPs), and obstetrician/gynecologists (OBGYNs).

Methods
We retrospectively reviewed medical charts for patients with HIV, gynecologic cancers, condyloma acuminata, solid organ transplantation, and sexual or gender minority status at Beth Israel Deaconess Medical Center and two affiliated clinics from 01/01/2015 - 08/01/2022. We extracted provider specialties, clinic locations, patient panel demographics, and dates of anal cytology and human papillomavirus (HPV) screening tests. We used chi-squared tests to identify provider factors associated with screening.

Results
Of 1,093 providers, at least one anal cytology test was performed by 93.8% (75/80) of ID providers, 55.2% (376/681) of PCPs, 28.3% (41/145) of OBGYNs, and 24.1% (45/187) of other providers (p &lt; 0.001); among screeners, anal HPV co-testing was performed equally across specialties (54.2%, p = 0.23). Providers were more likely to screen if they cared for PWH (91.8% with 10-49 PWH vs 3.7% for no PWH, p &lt; 0.001), majority cis-men (55.2%, p=0.003), or majority publicly insured patients (51.8%, p &lt; 0.001). Providers were less likely to screen if they cared for majority cis-women (40.9%, p&lt; 0.001) or majority privately insured patients (24.0%, p&lt; 0.001). Screening practices did not differ by the racial composition of providers’ patient panels (p=.21).

Conclusion
While many ID specialists performed anal cancer screenings, other providers were less likely to screen. Providers caring for many PWH, cis-men, or publicly insured patients were more likely to screen. Additional research is needed to clarify screening guidance and optimize screening practices for all higher-risk populations, especially non-PWH groups.

Disclosures
Douglas Krakower, MD, Gilead: Grant/Research Support|Merck: Grant/Research Support|U. North Texas Health Sciences Center: Funding for mentoring|UAB: Advisor/Consultant|UpToDate, Inc.: Royalties|Virology Education: Honoraria
155. Use of MRSA PCR and Antimicrobial Stewardship Intervention to Limit Anti-MRSA Therapy in Respiratory Tract Infections at a Community Teaching Hospital
Authors: Politis Paula A , Chen Alice , Oravec Michael J , England Matthew , Tan Michael , File Thomas M 
Published: November 2023

Abstract

Background
Patients admitted to the hospital with respiratory tract infections (RTIs) who are at risk for MRSA are often treated empirically with anti-MRSA agents such as vancomycin or linezolid. While pre-treatment respiratory culture is recommended, it is not always feasible. An alternate, more easily obtainable test is the MRSA nasal PCR, which is used to detect nasal colonization. While a positive nasal MRSA PCR cannot determine MRSA pneumonia, a negative MRSA PCR result strongly correlates with lack of MRSA pneumonia providing a useful antimicrobial stewardship tool for de-escalation or avoidance of empiric anti-MRSA therapy. Our Antimicrobial Stewardship Program (ASP) routinely follows patients admitted with RTIs and provides recommendations for appropriate therapy based on culture and test results, including the MRSA PCR. The purpose of our quality improvement project was to assess the practice and clinical impact of reduction of specific MRSA therapy associated with a negative nasal MRSA PCR.

Methods
We performed a retrospective review of patients admitted to our institution with MRSA PCRs performed for the purpose of RTI workup from November-December 2022. We compared patients with negative MRSA PCRs (not detected or MSSA) with and without ASP intervention and assessed differences in patient characteristics and outcomes. If ASP intervention occurred, intervention and acceptance data was collected. Characteristics were compared using descriptive statistics.

Results
Shown in Table 1 and 2. There was no significant difference in age, sex, duration of MRSA therapy, SCr, length of stay, or readmission between groups. When looking at ASP intervention for 1. discontinuation of MRSA therapy or 2. ordering/collecting MRSA PCR, a total of 73 interventions occurred with a 100% acceptance rate. This encompassed 34% (52/155) of patients on MRSA therapy with a negative PCR result.

Conclusion
While no significant difference was found between groups in terms of duration of MRSA therapy, the slightly shorter duration in the non-ASP group was likely due to prior discontinuation of MRSA therapy thus not necessitating ASP intervention. Those with slightly longer duration received ASP intervention which led to discontinuation of unnecessary MRSA therapy.

Disclosures
Thomas M. File, Jr., MD, MSc, MACP, FIDSA, HealthTrackRx: Advisor/Consultant|NAbriva Therapeutics: Advisor/Consultant|ThermoFisher Scientific: Advisor/Consultant
2670. Sexual Health Evaluation Among People Tested for Mpox in an Urban Health System
Authors: Jones Joyce , Garneau William , Dashler Gaby , Kwon Nathan , Gilliams Elizabeth , Hamill Matthew M , Rudolph David , Keruly Jeanne , Klein Eili , Hansoti Bhakti , Gebo Kelly 
Published: November 2023

Abstract

Background
The predominant mode of transmission in the 2022 mpox outbreak was sexually associated. Best practices for mpox evaluation include a sexual history, an anal and/or genital exam and STI testing. We hypothesized that the quality of clinical evaluation (QoC) for mpox varied by clinical setting.

Methods
A retrospective chart review was conducted on all patients in the Johns Hopkins Health System (JHHS) who tested for mpox from June 15 through December 15, 2022. Outcome measures included three QoC metrics (record of sexual history, anal and/or genital exam and concomitant STI testing). Fisher’s exact test was used to compare the frequency of QoC indicators by location of mpox testing (emergency department/urgent care [ED/UC], HIV/sexual health clinic [HIV/SH] or non-HIV/SH outpatient clinic [non-HIV/SH]).

Results
Of 269 patients tested for mpox, median age was 37 years, 48% were Black, 8% Latino, 71% assigned male sex at birth, 2% transgender women and 25% living with HIV (Table 1). Location of mpox testing was ED/UC (n=165), HIV/SH (n=50), or non-HIV/SH (n=54). Rates of mpox diagnosis and documentation of a sexual history, anal and/or genital exam and concomitant STI testing varied by site and were statistically significantly different (Table 2). HIV/SH had the highest rate of mpox test positivity (58%) and were most likely to meet these QoC indicators (96%, 78% and 82%, respectively) followed by ED/UC (74%, 50%, 57%, respectively) and HIV/SH clinics (68%, 32%, 30%).

Conclusion
In a high-volume tertiary care health system, only 50% of individuals tested for mpox had a documented anal and/or genital exam and 57% had concomitant STI testing. QoC indicators for mpox evaluation were highest in clinics where sexual health assessments are routine (HIV/sexual health), intermediate in ED/urgent care settings and lowest in non-HIV/sexual health settings. These findings support other studies that demonstrate a lack of consistent sexual health evaluation among individuals at risk for STIs. Strategies that decrease barriers to completed sexual history, exam and STI testing should be explored including audio-computer assisted patient report of sexual history, patient self-collection of STI testing and provider training.

Disclosures
Matthew M. Hamill, MBChB, PhD, Roche diagnostics: Honoraria Kelly Gebo, MD, MPH, Pfizer: Advisor/Consultant|Spark HealthCare: Advisor/Consultant
2672. Understanding the Barriers to Sexual Health in Middle Eastern Immigrant Women
Authors: Kazanji Noora , Masri Hana , Power Laura 
Published: November 2023

Abstract

Background
Sexually transmitted infections (STI) are often considered taboo in the life of women living in the Middle East and North Africa (MENA), and few studies have evaluated how to raise awareness of sexual health (SH) for these women. There are no studies that have aimed to understand if social norms, stigmas, and misconceptions surrounding seeking SH care continue for women who have immigrated to the United States (US) from MENA countries. The primary goal of this study is to determine existing cultural barriers to seeking SH care among US-living women who have emigrated from MENA or whose parents have emigrated from MENA.

Methods
From April 2021 to August 2021, 18 semi-structured interviews were conducted in women who emigrated from MENA or whose parents emigrated from MENA. We used thematic content analysis to identify the main themes and subthemes around barriers to seeking SH care. We then developed a conceptual model to depict how different themes interact to influence attitudes and beliefs towards SH care of MENA immigrant women.

Results
The primary themes that emerged were (a) reduced knowledge about SH resources and STI, (b) judgement, (c) lack of discussion in the community and household, (d) circumvention, and (e) call to action. The subtheme of cultural expectation of abstinence before marriage was a cross-cutting theme brought up by 16 of the 18 participants. One of the subthemes within the theme of judgement was the preference to seek SH care outside the community. Participants felt there was a barrier with discussing SH concerns with physicians who are of the same community due to the perception of judgement from that physician with whom the participant identifies. Call to action highlights several solutions shared by participants to reduce barriers to SH care.

Conclusion
We identified several themes underlying barriers to SH care for MENA immigrant women living in the US. We hope this project will fuel future research and policy efforts to raise awareness of SH in this vulnerable population. Appropriate and targeted interventions will ultimately help to prevent morbidity and mortality from diseases of SH in these women.

Disclosures
All Authors: No reported disclosures
2674. Disparities in Mpox Care: Use of the Social Vulnerability Index to Predict Mpox Infections
Authors: Leonard Michael , Fairman Robert , Polk Christopher , Inman Michael , Passaretti Catherine , Sampson Mindy 
Published: November 2023

Abstract

Background
The 2022 mpox outbreak disproportionately impacted minoritized populations especially in the US South, where 60% of infections were in Black men. Social vulnerability may explain some of the disproportionate disease burden as minoritized populations are at higher risk for infections such as mpox. The goal of this study is to examine what social vulnerabilities predict mpox infection.

Methods
We performed a retrospective chart review of all patients tested for mpox between July 24 and September 28, 2022 within the largest healthcare system in the Carolinas. Demographic information, medical and sexual history, and patient geocoding was obtained from extracted data. Patient location was then joined to the CDC and Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) data at a census tract level. Logistic regression models predicting mpox test results were then constructed.

Results
Of 319 individuals tested for mpox during the study period, those who identified as Black, men who have sex with men, having multiple sexual partners, and those known to be living with HIV were more likely to test positive for mpox (p&lt; 0.001, see Table 1). In assessing the social vulnerability sums, there were statistically significant differences in the household composition and disability sum of those who tested positive for mpox (mean=1.6952, std=.0663) and those who did not (mean=1.8495, std=.5712, p=.0349), as well as a statistically significant difference in the means of minority status and language sum (p=.0001). Being in a census tract that is 90th percentile for multi-unit housing (p=.0003), as well as a census tract that is in the 90th percentile for unemployment (p=.0393) are associated with testing positive for mpox, but overall SVI was not predictive of mpox diagnosis (see Table 2).

Conclusion
Being diagnosed with mpox primary occurred among those who are Black, men who have sex with men, and those living with HIV. Though some social vulnerabilities predicted mpox diagnoses, overall, social vulnerability did not predict mpox diagnoses.

Disclosures
Christopher Polk, MD, ViiVHealthcare: Job change to work for ViiV as Medical Director
2675. Concurrent HIV and Sexually Transmitted Infections in People with Mpox in Guatemala City
Authors: Marroquin Hugo , Farfán Alvaro J Mazariegos , Pinzón Rodolfo , Samayoa Johanna 
Published: November 2023

Abstract

Background
High rates of HIV and sexually transmitted infections (STIs) among people with mpox have been reported. Guatemala has the highest number of mpox cases reported in Central America. Data on this topic in the region is lacking. We report the prevalence of STIs and HIV in people evaluated for mpox at Hospital Roosevelt in Guatemala City.

Methods
We conducted a cross-sectional analysis of confirmed mpox cases with outpatient care at our institution between July 2022 and January 2023. Sociodemographic and clinical data was retrospectively collected. This analysis includes new diagnoses of HIV, syphilis, chlamydia, gonorrhea, mycoplasma genitalium infection and herpes virus simplex (HSV) infection. Diagnoses were confirmed by serology or nucleic acid amplification tests. Rates of HIV/STIs were assessed and association with sociodemographic, behavioral and clinical characteristics was analyzed through non-parametric statistical tests.

Results
Sixty participants with mpox were included. All cis-gender male, 34 (56.6%) younger than 30 years old, 52 (86.6%) were residents of Guatemala City, 57 (95%) men who have sex with men (MSM), 51 (85%) had above secondary education, 36 (60%) with known HIV-positive status. Recent participation in group sex was reported in 9 (15%) participants and inconsistent or no condom use in 49 (81.6%). Among participants with known HIV-positive status 34 (94.4%) had CD4 count &gt; 200/µL and 32 (88.9%) had a HIV viral load &lt; 200 copies/ml. Two previously undiagnosed HIV infections were detected. Overall, 27 new STIs were found in 20 (33.3%) participants (5 had more than one STI). Comparisons between participants with concurrent STIs and those without are shown in Table 1. Nine cases of syphilis were detected. Eighteen STIs involved mucous membranes (oropharyngeal, genital or anorectal). Rates by site are shown in Table 2.

Conclusion
At least one STI was detected in a third of the mpox cases with syphilis being the most frequent. Almost half of STIs cases involved the anorectal site. People with previously known HIV-positive status had a significantly higher rate of STIs. HIV/STI care is key to an appropriate mpox management.

Disclosures
All Authors: No reported disclosures
2676. Development of the World's First Automated Phenotypic Antibiotic Susceptibility Test System for Neisseria gonnorrhoeae
Authors: Newton Mitchell D , Puttaswamy Sachidevi , Isakson Andrew , McPeake Jared , Hadfield Ted , Swiger Roy 
Published: November 2023

Abstract

Background
With the increasing prevalence of antibiotic resistance of Neisseria gonorrhoeae (NG), clinical reliance on empiric treatment is no longer an option. Providing clinicians with fast, accurate, susceptibility results for directed patient treatment of NG cannot be ignored anymore. Here we describe the development of the world’s first phenotypic automated Antibiotic Susceptibility Test system specific to NG. The system is reliable, seamlessly integrates into existing sample workflows, and provides full customization. This yields a user-friendly device for rapid and actionable patient treatment.

Methods
The system consists of Hardware; Software & Firmware; and Consumables that are single-use disposable. The system allows the growth of fastidious Neisseria gonorrhoeae while continuously monitoring for growth or lack thereof in the presence of antibiotics in real time, displaying reports via a user-friendly interface. The samples tested include QC strains and challenge strains of N. gonorrhoeae along with select isolates across multiple antibiotics of relevance at multiple concentrations. All testing has been done in parallel with the phenotypic broth dilution method for verification in-house and/or compared against expected or published results.

Results
The results of the analysis of gonococcal strains are generated in as little as four (4) hours and are based on phenotypic and broth dilution methodology. We show (a) results from analysis of quality control strains, and CDC/FDA Antibiotic Resistance (AR) Bank and (b) a demonstration of easy integration using clinical laboratory sample workflow. In 100% of cases, our method produced a clear selection of the MIC and corresponding S/I/R interpretations allowing for calculated Categorical Agreement.

Conclusion
This data demonstrates not merely the feasibility but realizability of an automated, phenotypic AST for NG. The results here demonstrate that it is possible to make informed treatment decisions for cases of gonorrhea.

Disclosures
All Authors: No reported disclosures