bluuebunny/crossref_metadata_2025_split huggingface dataset:
2574. Serotype Distribution of Streptococcus pneumoniae and Pneumococcal Vaccine Coverage in Adults in Turkey between 2019 and 2022
Authors: Hasçelik Gülşen , Hasdemir Gökboğa Münevver U , Hazırolan Gülşen , Ay Altıntop Yasemin , Öksüz Lütfiye , Telli Murat , Özakın Cüneyt , Aydemir Sabire Ş , Baysan Betil Özhak , Birinci Asuman , Yaman Akgün , DURMAZ Gül , Gövde Özkaya Esra , Çizmeci Zeynep , Mete Mahmut , Özbek Özgen A , Uslu Hakan , Öztürk Candan , Güdücüoğlu Hüseyin , Duman Yücel , Zer Yasemin , Karadağ Öncel Eda , Karbuz Adem , Ceyhan Mehmet 
Published: November 2023

Abstract

Background
Streptococcus pneumoniae infections are challenging due to pneumococci having more than 100 serotypes. This ongoing study is aimed to evaluate serotype distribution of S. pneumoniae causing pneumococcal infections in adults ( &gt;18 years) and to provide a perspective regarding serotype coverage of both current and future pneumococcal vaccines.

Methods
Pneumococcal strains were collected from 22 centers between January 2019 and December 2022. Serogrouping was performed using latex particle agglutination, and serotyping was performed by the conventional Quellung reaction using commercial type-specific antisera (Statens Serum Institut, Copenhagen, Denmark).

Results
During the study period, 212 pneumococcal strains (156 males [73.6%] and 56 females [26.4%]) were collected from adults over 18 years of age. Of the isolates, 114 (53.8%) were from patients &lt; 65 years old and 98 (46.2%) were from patients ≥65 years old. The majority of isolates were obtained from blood (n=123, 58%) followed by bronchoalveolar lavage [BAL] (n=38, 17.9%) and cerebrospinal fluid (CSF) (n=25, 11.7%). The most frequently isolated serotypes were 3, 9N and 8. The vaccine coverage for PCV13, PCV15, PCV20, and PPV23 was 36.3%, 36.7%, 50.9%, and 56. 1%, respectively, in all isolates. The vaccine serotype coverage rates in the study group are shown in Table-1.

Conclusion
It has been observed in time that while vaccine serotypes are decreasing, serotypes not covered by vaccines are increasing. Accordingly, surveillance is essential to determine vaccination policy.

Disclosures
Mehmet Ceyhan, n/a, Pfizer Pharmaceuticals, Istanbul, Turkey: Advisor/Consultant|Pfizer Pharmaceuticals, Istanbul, Turkey: Grant/Research Support
2576. Piperacillin-Tazobactam or Cefepime for Treatment of Third Generation Cephalosporin Resistant Pneumonia in Intensive Care Unit Patients
Authors: DeLaurentis Clare , Hokunson Todd W , Nelson Brian , Annavajhala Medini K , Uhlemann Anne-Catrin , Gomez-Simmonds Angela 
Published: November 2023

Abstract

Background
Infections caused by Enterobacterales resistant to third generation cephalosporins (Ceph-RE) are rising in incidence. Carbapenems are frequently used to treat Ceph-RE infections based largely on studies of patients with bacteremia. Data evaluating alternative antibiotic options in pneumonia are limited. We assessed outcomes in intensive care unit (ICU) patients with Ceph-RE pneumonia treated with piperacillin-tazobactam (TZP) and cefepime (FEP) versus carbapenems.

Methods
Adult ICU patients with pneumonia and positive respiratory culture for Ceph-RE between 1/2015-7/2022 were identified from electronic records. The antibiotic given after sensitivity test results and for &gt; 72 hours (h) was termed the definitive agent. Patients who had polymicrobial pneumonia, severe infection at another body site, or were treated for &lt; 72h or with an agent other than a carbapenem, TZP, or FEP were excluded. Nanopore sequencing was used to identify β-lactamase genes (n=68), and TZP and FEP minimum inhibitory concentrations (MIC) were determined by broth microdilution (n=64). The primary outcome was survival to 30 days or hospital discharge. Outcomes were compared in univariable and multivariable analyses.

Results
Of 81 included patients, 56% were treated with a carbapenem and 44% received TZP or FEP. Patients receiving carbapenems had numerically higher Pitt Bacteremia Scores (PBS) and rates of severe sepsis (Figure 1). 52/68 isolates harbored an extended-spectrum β-lactamase gene; AmpCs were identified in 13 isolates and OXA-1 in 12. The majority of isolates were susceptible to TZP (91%) and FEP (64%). 73% and 92% of patients treated with TZP and FEP, respectively, met the primary outcome versus 67% of carbapenem recipients. In a multivariable model, only severe sepsis/septic shock was an independent predictor of poor outcome (OR 3.1, 95% CI 1.1-9.7, p=0.04); TZP or FEP use trended toward improved survival (OR 0.3, 95% CI 0.1-1.05, p=0.07). Survival did not differ based on the underlying resistance mechanism.

Conclusion
While ICU patients receiving carbapenems had more severe illness and worse outcomes, TZP and FEP appeared to be effective agents for patients with less severe pneumonia. Alternative therapies are essential to curb ongoing increases in carbapenem resistance.

Disclosures
Anne-Catrin Uhlemann, MD, PhD, Merck: Grant/Research Support
2591. Anxiety and depression among patients with non-tuberculous mycobacterial disease in Shanghai: A cross-sectional study
Authors: yuan zheng , Hu Bijie , ni sikang 
Published: November 2023

Abstract

Background
To understand the mental health status and its influencing factors among patients with non-tuberculous mycobacterial disease and to provide a reference for medical staff to formulate scientific and feasible intervention strategies.

Methods
A total of 114 patients diagnosed with non-tuberculous mycobacillosis during hospitalization in the Department of Infection from September 2020 to April 2021 were selected as the research participants. Participants’ mental health status and related factors were evaluated using a self-made general patient information questionnaire, self-rating Anxiety Scale (SAS), and self-rating Depression Scale (SDS).

Results
Among 114 patients with non-tuberculous mycosis, 61 (53.51%) exhibited depressive symptoms, and the SDS score was 51.15 ± 13.04, which was higher than the national norm of 41.88 ± 10.57 (P &lt; 0.05); further, 39 patients (34.21%) showed anxiety symptoms, and the SAS score was 45.75 ± 10.81, which was significantly higher than the national norm of 29.78 ± 10.07 (P &lt; 0.05). Body mass index and monthly household income had significant effects on depression in patients with non-tuberculous mycobacterial disease (P &lt; 0.05). Educational level had a significant effect on the anxiety state of patients with non-tuberculous mycobacterial disease (P &lt; 0.05).

Conclusion
Patients with non-tuberculous mycobacterial disease are prone to depression and anxiety. Nurses should pay attention to it in clinical work for the timely identification of and intervention for anxiety and depression and intervene.

Disclosures
All Authors: No reported disclosures
2605. Etiology of Community Acquired Lower Respiratory Tract Infection (LRTI) in Children
Authors: Yoo Byungsun , Yune Ilha , Kim Eu Suk , Lim Sungyoon , Yoo Sooyoung , Jung Seyoung , Kim Miyoung , Kim Junesung , Kim Daehwan , Lee Hyunju 
Published: November 2023

Abstract

Background
Community acquired lower respiratory tract infection (LRTI) is a leading cause for hospitalization in children and an important cause for antibiotics. Despite the large burden of LRTI, in many cases it is difficult to determine the pathogen. In this study, we aimed to describe the etiology of LRTI in children and analyze factors associated with bacterial or viral infection.

Methods
Electronic medical records of children &lt; 19 years of age diagnosed with LRTI (including pneumonia, bronchiolitis or bronchitis) at Seoul National University Bundang Hospital from January 2005 to June 2019 were retrospectively reviewed.

Results
A total of 5,954 cases of LRTI were identified. Among them 74.3% were pneumonia and 25.7% were bronchiolitis or bronchitis. Mean age was 22 (IQR 38) months. 52.6% were &lt; 2 years of age and 29.7% were 2-4 years of age. Among all LRTI, 48% had a proven pathogen; 55.1% were viral, 46.3% were Mycoplasma pneumoniae and 1.3% were bacterial. Among viruses, respiratory syncytial virus (41.9%) was most common followed by influenza (7.8%), parainfluenza (7.1%) and adenovirus (4.1%). Among bacteria pneumonia, Streptococcus pneumonaie was most common which accounted for 58.1%. Among physical findings, wheezing, stridor, chest retraction and coarse breathing sounds were seen more commonly in viral infections (P&lt; 0.05, respectively), whereas decreased breathing sound was commonly found in both M. pneumoniae and bacterial infections (P&lt; 0.05, respectively). For treatment, 26.5% were treated with supportive care, 72.0% received antibiotics, 1.0% received antiviral agents and 5.6% were prescribed with steroids. Among patients 16.4% needed oxygen supply, 1.7% were admitted to the intensive care unit and 1.4% required respiratory support. There was one case of mortality (0.02%).

Conclusion
In children with LRTI, among cases where the pathogen was detected, more than half were due to viral infections, followed by M. pneumoniae, and a few cases of bacteria. In this study, we found a relatively large portion of children may have been treated with unnecessary antibiotics. LRTIs in children are a significant clinical burden and calls for a need for antibiotic stewardship.

Disclosures
All Authors: No reported disclosures
2609. Comprehensive cost assessment among families with children younger than 2 years-of-age hospitalized with RSV infection
Authors: Ampofo Krow , Heller Evan G , Adua Lazarus , Lovebridge Abbey , Miller Kaleb , Werdan Kathrine Lindsey , Gesteland Per H , Ruggieri Madelyn , Finelli Lyn , Choi Yoonyoung 
Published: November 2023

Abstract

Background
Respiratory Syncytial Virus (RSV) is a major cause of childhood lower respiratory tract infection (LRTI) in the U.S. While RSV hospital (direct) cost is well described, the impact on work productivity and additional RSV-related (indirect) costs are not known. We describe direct and indirect cost occurring to a family before, during, and after child’s RSV hospitalization.

Methods
We prospectively identified children &lt; 2 years of age hospitalized with laboratory-confirmed RSV LRTI at Primary Children’s and Riverton Hospitals, Salt Lake City, UT, from 12/2019 to 5/2022. RSV hospitalization-related cost consisted of 1) Hospital cost, 2) indirect costs occurring between a week before admission and up to 2 weeks post discharge, and 3) productivity loss of caregivers during child’s admission. We abstracted hospital financial data and surveyed caregivers using a questionnaire developed for the study, along with the Work Productivity and Activity Impairment Questionnaire: Child’s Hospitalization for Respiratory Illness instrument.

Results
During the study period, 684 children &lt; 2 years were hospitalized with RSV LRTI with a median length of stay 1.8 days (IQR 1-3.1 days) and mean hospital cost of 2023 USD $11703 (std: $25292). Of the 146 (21%) caregivers who participated in the survey, 140/146 (96%) reported at least one caregiver is currently employed and 123/146 (79%) were female. One week prior to admission, 109/146 (75%) visited a healthcare facility and spent a mean of $58 (std $129) out of pocket cost for the visits, medication, and additional childcare. Before RSV hospitalization, 81/140 (58%) employed caregivers lost work hours (hrs) (mean 15 hrs; std 15 hrs) and had an average productivity impairment score of 4.4 out of 10 (std 3.6) (10=worst impairment). After discharge, 68/146 (47%) children required a healthcare visit, 67/140 (48%) caregivers lost work hrs (mean 27 hrs; std 32 hrs) and spent a mean of $93 (std $206) out of pocket cost. (Table)

Conclusion
The hospitalization of children &lt; 2 years with RSV LRTI is associated with significant costs during and after hospitalization. These costs include caregivers’ loss of work hours and additional out-of-pocket costs. Our data support the need for RSV vaccines and immunoprophylaxis to prevent RSV hospitalization.

Disclosures
Krow Ampofo, MBChB, Merck: Advisor/Consultant|Merck: Grant/Research Support Lyn Finelli, DrPH, MS, Merck&Co: Stocks/Bonds Yoonyoung Choi, PhD, MS, RPh, Merck: Employed|Merck: Stocks/Bonds
2623. Persistence of SARS-CoV-2 S IgG Antibodies in Children that suffered from COVID-19 and Association of Antibody Levels with Vaccination Status
Authors: Di Gregorio Federico , Tineo María S , Bonnin Florencia A , Torrado Lidia , Pavan María F , Ibañez Lorena I , Toledano Analía , Caratozzolo Ana , Acosta Patricio L , Contrini Maria M , Talarico Laura , López Eduardo L 
Published: November 2023

Abstract

Background
Serum levels of IgG antibodies against SARS-CoV-2 spike protein (S) in children who suffered COVID-19 have been found to last between 4 to 12 months. We aimed to characterize the antibody response against SARS-CoV-2 after 1 year of COVID-19 in unvaccinated and vaccinated children.

Methods
A cohort study included unvaccinated and vaccinated children (&lt; 18 years) with a previous SARS-CoV-2 infection. Blood samples were collected during the acute phase, in convalescence and 1 year after suffering the disease. For comparative purposes, vaccinated adult relatives who suffered COVID-19 in the same period were included. SARS-CoV-2 S IgG serum levels were determined by immunoassay. Neutralizing activity was determined by the decrease of GFP expression in SARS-CoV-2 S-pseudotyped lentivirus infected HEK-293T cells.

Results
Eighty-four children were included, median age 8 years (IQR 2-12), 54% (n=45) were females; 38% (n=32) were vaccinated. Also, 50 adults were studied, median age 35 years (IQR 29-44), 76% (n=38) were females. SARS-CoV-2 S IgG levels 1 year after COVID-19 decreased 2.2- to 10.8- fold compared to convalescent levels in unvaccinated children. SARS-CoV-2 S IgG titers positively correlated with neutralizing antibody titers in convalescence and 1 year after COVID-19 (p&lt; 0.05). SARS-CoV-2 S IgG levels were significantly higher in children with incomplete (p=0.0088) and complete/booster (p&lt; 0.0001) vaccination as compared to unvaccinated children. Children that received mRNA vaccines showed higher SARS-CoV-2 IgG titers than children that received an inactivated vaccine (p&lt; 0.0001). SARS-CoV-2 S IgG titers positively correlated with age in vaccinated children (rS=0.4303, p=0.014). SARS-CoV-2 IgG titers 1 year after COVID-19 did not associate with disease severity or the presence of comorbidities. No significant differences in SARS-CoV-2 S IgG levels were found between vaccinated children and adults, at the same vaccination level.

Conclusion
These findings highlight the importance of child vaccination to maintain a long-term humoral immune response against SARS-CoV-2 despite having been infected. Also, mRNA vaccines elicited a higher antibody response than inactivated vaccines against SARS-CoV-2 in children.

Disclosures
All Authors: No reported disclosures
2667. Bridging the Gap: Sexually Transmitted Infections Testing, Treatment, and Prevention at a Miami Syringe Services Program for Women Who Inject Drugs
Authors: Herrera Tara E , Faraldo Monica , Forrest David , Hervera Belén , Ciraldo Katrina , Tookes Hansel , Chueng Teresa A 
Published: November 2023

Abstract

Background
Women who inject drugs (WWID) remain understudied despite their compounded vulnerability to HIV. WWID experience increased mortality and multilevel barriers to care, including violence, homelessness, stigma, and competing priorities of childcare. In 2016, Florida passed the Infectious Disease Elimination Act (IDEA), legalizing IDEA Syringe Services Program (SSP) as the first in the state. Located in one of the country’s highest-incidence areas of HIV, IDEA SSP in Miami offers harm reduction and health opportunities outside of the traditional health care system. Previous IDEA SSP data show that WWID, representing 27% of participants overall, are more likely to report opioid injection, syringe sharing, injecting more than 5 times a day, sexual activity in the past 30 days, and transactional sex compared to their male counterparts.

Methods
IDEA SSP offered sexually transmitted infection (STI) testing and treatment July 1, 2022 through March 31, 2023. This descriptive study included women of childbearing age (18-44 years old) who injected drugs and were SSP participants (N=47).

Results
Among chlamydial infections, 2.1% had oropharyngeal, 4.3% had urethral, and 6.4% had rectal involvement. Three women (6.4%) experienced both gonococcal pharyngitis and urethritis. Rectal gonorrhea was detected in four of the 47 women (8.5%), with half testing positive twice within a 3-month period. 14 women (29.8%) demonstrated reactive syphilis testing.
Of 37 women consenting to testing, three screened positive for pregnancy (8.1%). One had gonococcal pharyngitis, proctitis, and urethritis and two had other STI co-infections.
Within this cohort of 47 women, 31 of the 32 HIV-negative participants initiated pre-exposure prophylaxis (PrEP) of HIV at IDEA SSP. Of the 12 with HIV, 83% reported adherence to antiretroviral therapy (ART). Three women had unknown HIV status.

Conclusion
Despite high HIV/STI co-infection and stigma precluding care in traditional health settings, WWID accessing IDEA SSP engaged with PrEP/ART and STI screening, including 100% of women receiving treatment for gonorrhea, chlamydia, and syphilis. Tailoring STI services at an SSP where WWID access nonjudgmental care caters to a historically neglected but key cohort in Ending the HIV Epidemic.

Disclosures
Hansel Tookes, III, MD, MPH, Gilead sciences: Grant/Research Support|Viiv: Grant/Research Support
2673. Clinical and Demographic Characteristics of Suspected and Confirmed Monkeypox Patients: An Observational Cohort Study
Authors: Kundro Mariana A , Viloria Guillermo , Pastor Isabel , Serena Marina Alonso , Losso Marcelo H 
Published: November 2023

Abstract

Background
Monkeypox (mpox) infection is a re-emergent disease of public health concern worldwide.

Methods
All the patients with suspected mpox infection attending a large public sexual health clinic in Buenos Aires, were included in this single center, observational cohort study. Confirmed case of mpox was defined as a positive real time PCR of either skin lesions or anal/oropharynx swab samples. We aimed to describe clinical features and evolution of confirmed cases and to compare characteristics of confirmed and unconfirmed individuals during a mpox outbreak in Argentina.

Results
Of the 85 patients (96.47% male, 90.12 % MSM, mean age 34 years) with suspected mpox between July 2022 and March 2023, 60 (70.48%) had a confirmed diagnosis. All the patients presented skin and/or mucous rash with a median time from the onset of symptoms of 6.0 (IQR 4-7) days. Lesions were most commonly distributed on genital area (57% of confirmed cases), followed by perianal region in 37% of patients. Dysphagia was reported in 31.7% vs. 20% of confirmed and unconfirmed subjects respectively (p: 0.27) , whereas proctitis symptoms were more often in mpox cases (35.0 vs 12.0%; p: 0.01). Syphilis was diagnosed in 60% of the cohort. Compared to unconfirmed patients, mpox patients were more likely to be MSM (98.3% vs. 88%; p: 0.04) and PrEP users (50.0 vs. 18.7%; p:0.03) . We found no differences among groups regarding HIV status (30% vs. 36%; p: 0.58). Main alternative diagnoses in unconfirmed patients were syphilis in 44% and HIV infection in 8% of individuals.
Hospitalization rate was 4.25 % (5/85). Admissions in mpox group were due to: cellulitis (n:1), pain control (n:1), tonsillar abscess (n:1) and infectious mononucleosis/acute HIV coinfection (n:1). Other complications reported were penile edema (n:3) , skin sobreinfection (n:2), severe dysphagia (n:1) and conjunctivitis (n:1) One patient was admitted in the unconfirmed group due to severe sepsis. There were no fatal cases.

Conclusion
We found that almost a third of participants had no confirmed diagnosis of mpox infection despite high clinical suspicion in this cohort. MSM and PrEP users were more likely to be diagnosed with mpox. The elevated rate of concomitant syphilis reflects that patients should always be tested for other STIs.

Disclosures
All Authors: No reported disclosures
2679. Assessment of Sexually Transmitted Infection Incidence, Screening and HIV PrEP Uptake Among US Veterans with Opioid Use Disorder in Long Island, New York
Authors: Srivastava Pronoma , Modi Viraj , Lier Audun J 
Published: November 2023

Abstract

Background
Rates of sexually transmitted infections (STI) are on the rise in the US. Persons who inject drugs (PWID) and persons with opioid use disorder (OUD) are at an increased risk for acquisition of STI via high-risk sexual behavior concurrent with substance use. This study aims to compare rates of STI screening and diagnosis, hepatitis vaccination history, and receipt of HIV pre-exposure prophylaxis (PrEP) between PWID and non-PWID with OUD who presented to the Northport Veterans Affairs Medical Center (NVAMC).

Methods
Data was collected from a retrospective chart review of US Veterans (USV) aged &gt;18 years who presented to the NVAMC between 2010-2020 and carried an ICD9 or ICD10 diagnosis of OUD. Rates of STI screening and diagnosis, hepatitis A (HAV) and B (HBV) vaccination status, and receipt of PrEP were compared between PWID and non-PWID using either a two-sample T-test or Chi-square analysis.

Results
We identified 502 USV with a diagnosis of OUD. Mean age was 52.6 years, 469 (92.4%) were male, 396 (78.9%) were white, 172 (34.8%) were employed and 216 (43%) had health insurance. A total of 337 (67.1%) USV had a history of cocaine use and 216 (43%) had a history of injection drug use. An STI was diagnosed in 51 (10%) USV, most frequently herpes simplex virus 1 or 2 (n=19, 3.8%), followed by syphilis (n=9, 1.8%). There was no difference in rates of STI between PWID and non-PWID USV. Eleven (2.2%) USV had HIV and 144 (28.7%) had HCV. A total of 411 (81.9%) USV received screening for HIV, 438 (87.3%) for HCV, 371 (74%) for syphilis, 160 (31.9%) for gonorrhea, and 169 (33.7%) for chlamydia. PWID were more likely to be screened for HIV (93.5% PWID vs. 73.1% non-PWID, p&lt; 0.001), HCV (95.8% PWID vs. 80.8% non-PWID, p&lt; 0.001) and syphilis (80.0% PWID vs. 69.2% non-PWID, p = 0.006) and to be vaccinated against HAV (73.6% PWID vs. 44.1% non-PWID, p&lt; 0.001) and HBV (77.7% PWID vs. 54.3% non-PWID, p&lt; 0.001). PrEP was prescribed in 4 (0.8%) USV.Table 2.STI screening rates and diagnoses among US Veterans with OUD, stratified by injection substance use. PWID, persons who inject drugs. STI, sexually transmitted infection. HAV, hepatitis A virus. HCV, hepatitis C virus. HSV, herpes simplex virus. PrEP, pre-exposure prophylaxis.Figure 1.Rates of STI Screening among PWID and non PWID with OUD who presented to Northport VAMC. STI, sexually transmitted infection. PWID, persons who inject drugs. OUD, opioid use disorder.

Conclusion
Among USV with OUD screening rates for gonorrhea and chlamydia occurred less frequently than for syphilis, HCV and HIV. PWID were more likely to be screened for HIV, HCV, and syphilis than non-PWID. There were low rates of PrEP uptake. USV with OUD may benefit from increased STI screening as well as linkage to PrEP evaluation and treatment.

Disclosures
All Authors: No reported disclosures