bluuebunny/crossref_metadata_2025_split huggingface dataset:
110. Improving Pneumococcal Vaccination in Patients Treated with Tumor Necrosis Factor-alpha Inhibitors: A Multidisciplinary Education-Based Quality Improvement Project
Authors: Curtin John M , Custer Benjamin L , Norwood Monique , Ayalew Memar , Costello Varea H , Blyth Dana M 
Published: December 2022

Abstract

Background
In 2012, pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23) were recommended for immunocompromised adults ≥19 years, but pneumococcal vaccination (PV) in these patients (pts) remains suboptimal. With a new PV (PCV20) allowing for simplified PV, we study rates of PV in pts on infliximab (INX) 1 year post-initiation of a pt and provider education-based quality improvement project aiming to increase PV in pts on Tumor Necrosis Factor-alpha inhibitors (TNF-αI).

Methods
Starting in 11/2020, pamphlets detailing PV indications were distributed to the Walter Reed National Military Medical Center infusion center and pharmacies to be given to pts prescribed/administered TNF-αI. Provider educational materials and pt pamphlets were given to services prescribing TNF-αI. Provider education was also offered to these services. Up to date (UTD) on PV was defined as receipt of PCV13 and PPSV23 (including additional PPSV23 dose ≥5 years post-initial PPSV23 if applicable). Ongoing INX (o-INX) was defined as INX initiation before 10/1/2020. Newly initiated INX (new-INX) was 10/1/2020-10/1/2021. One-year post implementation, we reviewed the PCV13 and PPSV23 immunization records of pts ≥19 years of age on INX from 1/1/21-12/31/21. This project was approved by the IRB under a non-research determination.

Results
111 pts prescribed INX between 1/1/21-12/31/21 met inclusion criteria (87 o-INX and 24 new-INX). Prior to the intervention, of 87 o-INX pts, 45 (52%), 45 (52%), and 18 (21%) pts had received PCV13, ≥1 PPSV23 dose, and were UTD on PV respectfully. Between 1/1/21-12/31/21, 14 o-INX pts had PV (1 PCV13 and PPSV23, 7 PCV13, and 6 PPSV23), with 7 newly UTD (10% of the 69 previously not UTD), totaling 25 (29%) o-INX pts UTD on PV (figure 1). Of 24 new-INX pts, only 12 (48%), 9 (36%), and 6 (24%) had had PCV13, PPSV23, and were UTD on PV as of 12/31/21. No services prescribing TNF-αI requested the offered PV educational talks.

Conclusion
Despite frequent healthcare in a system where vaccination has no out of pocket expense, guideline-concordant PV was low in this cohort. With new, simplified PV, next steps include updated pt and targeted provider education. However, with prior small gains using multidisciplinary education, additional efforts to remove PV barriers may be needed.

Disclosures
Benjamin L. Custer, MD, Beam Therapeutics: Stocks/Bonds|CRISPR Therapeutics: Stocks/Bonds|glaxo-smith-kline: Stocks/Bonds|Hologic: Stocks/Bonds|Moderna: Stocks/Bonds|Pfizer: Stocks/Bonds|Regeneron: Stocks/Bonds|sanofi: Stocks/Bonds|Vertex Pharmaceuticals: Stocks/Bonds.
LB1528B. Inhaled Fluticasone for Outpatient Treatment of Covid-19: A Decentralized, Placebo-controlled, Randomized, Platform Clinical Trial
Authors: Boulware David R 
Published: December 2022

Abstract

Background
The effectiveness of inhaled corticosteroids to shorten time to symptom resolution or prevent hospitalization or death among outpatients with mild-to-moderate coronavirus 2019 (Covid-19) is unclear.

Methods
ACTIV-6 is an ongoing, decentralized, double-blind, randomized, placebo-controlled platform trial testing repurposed medications in outpatients with confirmed SARS-CoV-2 infection. Non-hospitalized adults aged ≥ 30 years, experiencing ≥ 2 symptoms of acute infection for ≤ 7 days were randomized to inhaled fluticasone furoate 200 μg once daily for 14 days or placebo. The primary outcome was time to sustained recovery, defined as the third of 3 consecutive days without symptoms. Secondary outcomes included composites of hospitalization or death with or without urgent care or emergency department visit by day 28.

Results
Of those eligible for the fluticasone arm, 656 were randomized to and received inhaled fluticasone; 621 received concurrent placebo. There was no evidence of improvement in time to recovery with fluticasone compared with placebo (hazard ratio [HR] 1.01, 95% credible interval [CrI] 0.91–1.12; posterior probability for benefit [HR &gt; 1]=0.56). Twenty-four participants (3.7%) in the fluticasone arm had urgent care or emergency department visits or were hospitalized compared with 13 (2.1%) in the pooled, concurrent placebo arm (HR 1.9, 95% CrI 0.8–3.5; posterior probability for benefit [HR&lt; 1]=0.03). Three participants in each arm were hospitalized, and no deaths occurred. Adverse events were uncommon in both arms.

Conclusion
Treatment with inhaled fluticasone furoate for 14 days did not result in improved time to recovery among outpatients with Covid-19 in the United States during the delta and omicron variant surges.

Disclosures
All Authors: No reported disclosures.
LB1576. High Prevalence of Oral Treponema pallidum by PCR among US Adults with Early Syphilis
Authors: Dionne Jodie , Giacani Lorenzo , Romeis Emily , Boutwell Alexander , Newman Lori , Workowski Kimberly , Hook Edward 
Published: December 2022

Abstract

Background
Treponema pallidum (T. pallidum) is transmitted from person to person by direct contact with widespread dissemination early after acquisition. Current syphilis diagnostic testing is limited to darkfield microscopy from visible lesions and serologic antibody detection. T. pallidum molecular diagnostics are urgently needed.

Methods
As part of a multicenter US syphilis treatment trial that completed enrollment in March 2022 (NCT 3637660), we randomized 249 adults with early syphilis infection to 1 vs 3 weekly doses of benzathine penicillin G to compare treatment response at 6 months. In a small substudy (n=32) presented here, consenting participants at the University of Alabama at Birmingham (UAB) and Emory University had pre-treatment oral (buccal mucosa and posterior pharynx) and lesion swab samples collected. Following DNA extraction, T. pallidum burden in samples was quantified by targeting the tp0574 gene. Syphilis was staged by experienced providers according to physical examination and serology.

Results
Study participants were men (100%) and most were living with HIV (91%) with mean CD4 count 477 cells/mm3. Syphilis stage was categorized as primary in 6 (19%), secondary in 18 (56%) and early latent in 8 (25%). Oral swab qPCR positivity rates were 17% in primary disease, 44% in secondary disease, and 63% in early latent disease (see Figure). Lesion PCR positivity was similar in primary and secondary syphilis (40% and 38.5%). Mean treponemal burden was highest on oral swabs of participants with early latent syphilis (13,128,969) and lesion swabs of participants with secondary syphilis (2,033,309).

Conclusion
Among adult males, many living with HIV, data suggest a role for oral and lesion swabs for the molecular detection of T. pallidum. Widespread availability of PCR, the relative ease of oral specimen collection, and the opportunity to directly demonstrate T. pallidum in persons with early latent syphilis suggest the opportunity for PCR testing to enhance and refine syphilis diagnostic testing. The elevated proportion of positive oral samples and significant organism burden in secondary and early latent syphilis is consistent with potential for transmission.

Disclosures
All Authors: No reported disclosures.
LB1577. Outcomes of Pregnant Women Exposed to Sotrovimab for the Treatment of COVID-19 in the Omicron Predominant Era (PRESTO)
Authors: Tuan Jessica , Sharma Manas , Kayani Jehanzeb , Davis Matthew W , McManus Dayna , Topal Jeffrey E , Ogbuagu Onyema 
Published: December 2022

Abstract

Background
Sotrovimab, a monoclonal antibody with efficacy against SARS-CoV-2 including certain Omicron variants, has been used in treatment of mild-moderate COVID-19. Limited data exists regarding its use in pregnant women.

Methods
Electronic medical record review of pregnant COVID-19 patients treated with sotrovimab from 12/30/21-1/31/22 (Yale New Haven Health Hospital System [YNHHS]) was performed. Included were pregnant individuals ≥ 12 years, weighing ≥ 40 kg, with positive SARS-CoV-2 test (within 10 days). Those receiving care outside YNHHS or receiving other SARS-CoV-2 treatment were excluded. We assessed demographics, medical history, and Monoclonal Antibody Screening Score (MASS). Clinical outcomes assessed included emergency department (ED) visit &lt; 24 hours, hospitalization, ICU admission, and/or death within 29 days of sotrovimab. Pregnancy and neonatal outcomes were assessed until 8/15/22.

Results
Among 22 subjects, median age was 32 years and body mass index was 27 kg/m2. Sixty-three percent were Caucasian, 9% Hispanic, 14% African-American, and 9% Asian. Nine percent had diabetes and sickle cell disease. Five percent had well-controlled HIV. Eighteen percent, 46%, and 36% received sotrovimab in trimester 1, 2, and 3, respectively. No infusion/allergic reactions occurred. MASS values were &lt; 4. Only 12/22 (55%) received complete primary vaccination (46% mRNA-1273; 46% BNT162b2; 8% JNJ-78436735); none received a booster.
There were no ICU admissions nor deaths. One subject was hospitalized for post-partum pyelonephritis; another had an ED visit for post-partum vaginal bleeding. Median gestational age at birth was 38.9 weeks. Nine percent had premature labor and premature rupture of membranes, respectively. Median infant birth weight was 3220 g. One neonate required an ICU stay due to prenatally diagnosed omphalocele (before sotrovimab) in a mother with congenital defect history. There were no abortions, fetal loss, or other birth/neurodevelopmental defects.

Conclusion
Pregnant COVID-19 patients receiving sotrovimab at our center tolerated it well with good clinical outcomes. Pregnancy and neonatal complications did not appear sotrovimab-related. Though a limited sample, our data helps elucidate the safety and tolerability of sotrovimab in pregnant women.

Disclosures
All Authors: No reported disclosures.
LB1578. Fully Automated Real-Time PCR for Detection of Candida auris
Authors: Jiang Alice , Lin Mike , Barakat Nesreen , Clark Craig 
Published: December 2022

Abstract

Background
Candida auris is an emerging fungus that presents a serious global health threat. It is often multidrug-resistant and difficult to identify with standard laboratory methods. C. auris outbreaks have been associated with high mortality in healthcare settings. Rapid and accurate screening for C. auris is crucial for preventing transmission and directing treatment. This study evaluated a new fully automated, lab-developed real-time PCR assay for the detection of C. auris.

Methods
Nasal swabs collected with Aptima Multitest swabs were used as a representative clinical matrix to evaluate C. auris detection using the Open Access™ functionality on the Panther Fusion® instrument. It provided fully automated nucleic acid extraction, amplification, and detection workflow. The primers and probe are published sequences designed by CDC which target the internal transcribed spacer 2 (ITS2) region of the C. auris ribosomal RNA gene. Analytical studies evaluated assay sensitivity, specificity, and inclusivity. An internal control is also included to ensure assay validity.

Results
The limit of detection (≥ 95% detection rate) of the Candida auris real-time PCR assay is 5 CFU/mL for nasal swabs. Eleven C. auris strains from CDC clinical isolates were reactive for inclusivity study. No cross reactivity or interference was observed from 60 microorganisms of closely related yeast, bacteria and viruses typically present in skin and groin samples.

Conclusion
A fully automated and high throughput real-time PCR test for C. auris with internal control, utilizing primers and probe sequences published by CDC, demonstrated excellent sensitivity, specificity, and inclusivity. This lab developed test (LDT) provides a rapid, sensitive, and scalable method for detection of C. auris. The results are crucial for timely detection, transmission prevention and targeted treatment of the multidrug-resistant C. auris.

Disclosures
All Authors: No reported disclosures.
113. Knowledge, Attitudes, and Practices towards HPV vaccination among reproductive-age women in an HIV hotspot in the US
Authors: Paz Aasith Villavicencio , Nogueira Nicholas Fonseca , Kelsey Gray , Zukerberg Julia , Salazar Ana S , Hernandez Lucila , Raccamarich Patricia , Jones Deborah L , Alcaide Maria L L 
Published: December 2022

Abstract

Background
Human papillomavirus (HPV) is the most common STI in the US, responsible for cervical cancer and increased risk of HIV acquisition. Despite an effective HPV vaccine, women’s HPV vaccination coverage and rates remain far below desired levels. This study aimed to evaluate HPV knowledge, screening, and vaccination practices as well as factors associated with HPV vaccination among women of reproductive age living in Miami, Florida, a Southern US city with a high incidence of STIs and low HPV vaccination coverage.

Methods
In April 2022, HIV-negative, cisgender, sexually active women aged 18-45 years were referred from a study evaluating HIV risks. Surveys assessed socio-demographics and sexual behaviors. Validated questionnaires assessed HPV knowledge, screening, and vaccination practices. A cumulative HPV knowledge score was generated. Factors associated with HPV vaccination were analyzed by Chi-square, Fisher’s exact test, studentized t-test, and multivariate logistic regression (MLR).

Results
A total of 67 participants were enrolled, and 54 who knew their vaccination status were included in the analysis: median age was 26 (IQR 22-34.5) years; 50% were White, 26% Black, and 33% were Hispanic. Median age at first sexual encounter was 18 (16-18) years, the mean number of sexual partners in the previous month was 1.45 (±1.44), and 33% had previous pregnancies. Mean HPV score was 13.4 (±8.84) out of 29, 43% reported a history of HPV/Pap smear screening. Barriers to HPV vaccination included: 28% low-risk perception, 24% healthcare barriers, and 41% vaccine hesitancy. In MLR, a one-point increase in HPV knowledge score increased the odds of vaccination by 21.5% (0.8-3.67%; p&lt; 0.01). Age, number of sexual partners, and pregnancy history were not significant predictors of HPV vaccination.

Conclusion
Findings suggest low HPV knowledge among women of reproductive age in a high-risk area, and suggest that increasing knowledge may reduce barriers to HPV vaccination and increase vaccine uptake.

Disclosures
Maria L L. Alcaide, MD, Gilead: Advisor/Consultant.
122. Streptococcus pneumoniae Nasopharyngeal Colonization in a Colombian Cohort of Patients with Comorbid Conditions
Authors: Ibáñez-Prada Elsa D D , Serrano-Mayorga Cristian C , Fuentes Yuli V , Lozada Julian , Bustos Ingrid G G , Mendez Lina , Crispin Ana M , Reyes Luis Felipe F 
Published: December 2022

Abstract

Background
Community-acquired pneumonia (CAP) remains the first cause of infectious death and morbidity worldwide. Nevertheless, its etiological pathogen is only isolated in almost 30% of cases, and its most representative bacteria is S. pneumoniae. Some researchers have proposed that the nasopharyngeal colonization by S. pneumoniae could risk developing CAP. However, the prevalence of nasopharyngeal colonization in patients with chronic comorbid conditions in Latin America is unknown, where vaccination rates are low. This study aims to determine the rate of S. pneumoniae colonization in a Colombian cohort. Figure 1.Pneumococcal vaccination and colonization in the whole cohort.

Methods
This is a prospective cohort study in 3 centers in Colombia carried out between 2020 and 2022. According to the world health organization guidelines, the nasopharyngeal aspirate (NPA) samples from each participant were obtained. Samples were incubated with 5% CO2 in blood agar, and MALDI-TOFF identified the colonies obtained. We compared the number of S. pneumoniae isolated and stratified by anti-pneumococcal vaccination status.

Results
The cohort was composed of 810 patients. The median [IQR] age was 63 [53-62] and the most common comorbidities were 52.2% [423/810] arterial hypertension, 21.7% [176/810] coronary disease, 19.0% [154/810] congestive heart failure, and 17.4% [141/810] chronic kidney disease. Nasopharyngeal colonization by S. pneumonie was only documented in the patients' 2.1% [15/723] (Figure 1). Moreover, 10.7% [87/810] patients from the cohort were vaccinated against S. pneumoniae, and none were colonized.

Conclusion
Nasopharyngeal colonization by S. pneumoniae in our cohort of adults with chronic comorbidities was low. Notably, all the colonized patients were not vaccinated, at higher risk of developing the invasive pneumococcal disease. More robust vaccination policies should be implemented for adults in Colombia.

Disclosures
All Authors: No reported disclosures.
123. The change of meningococcal carriage rate and serogroup among military trainees since the introduction of meningococcal vaccine, and the genetic characterization of the carriage isolates
Authors: Heo Jung Yeon , Oh Hong Sang , Kim Young Rong , Yoo Jin Sae , Kim Eun Jin , Choi Young Hwa , Kim Min Young 
Published: December 2022

Abstract

Background
Monovalent meningococcal conjugate vaccines against serogroups A or C have resulted in significant reduction of pharyngeal carriage rates against the vaccine serogroups. However, the effect of the quadrivalent meningococcal conjugate vaccine on meningococcal carriage has not yet been evaluated.

Methods
We assessed changes in pharyngeal carriage rates of Neisseria meningitidis after introduction of the quadrivalent meningococcal conjugate vaccine in Korean military trainees. Two rounds of oropharyngeal swabs of Korean military trainees were obtained, at the beginning and the end of the army training period. The first oropharyngeal swabs were collected prior to vaccination; the second round was performed 5 weeks later.

Results
In 2013, the overall N. meningitidis carriage rate was higher at the end of the training period (13.8%, 60 of 434 participants) than upon entry into military service (8.9%, 39 of 434 participants). Although the carriage rates of nongroupable and serogroup X isolates increased over the 5-week interval, carriage of the serogroup strains included in the quadrivalent meningococcal vaccine was reduced, from 7 to 2 isolates, after vaccination. However, in 2014, the overall carriage rate of N. meningitidis was significantly lower at the end of the training period (5.2%, 23 of 443 participants) than on entry into military service (12.6%, 56 of 443 participants) (p = 0.028). Carriage of vaccine serogroups isolates was significantly decreased, compared to that of non-vaccine serogroup B over the 5-week interval. Carriage isolates belonging to the ST-178, ST-31 and ST-41/44 were frequently identified clonal complex.
Meningococcal carriage rate before and after Meningococcal vaccination in Korean military trainees

Conclusion
Meningococcal vaccination in Korean military trainees could lead to reduce pharyngeal carriage rates of vaccine serogroup meningococci. Therefore, the quadrivalent meningococcal conjugate vaccine is likely to prevent carriage acquisition of meningococci in closed populations such as military trainees.

Disclosures
All Authors: No reported disclosures.
130. Bacteremia among patients with cancer in a Latinamerican country, clinical and molecular data
Authors: Cruz-Vargas Sergio A , García-Muñoz Laura , Cuervo-Maldonado Sonia I , Cortés Jorge A , Álvarez-Moreno Carlos , Saavedra-Trujillo Carlos , Álvarez-Rodríguez José C , Arango-Gutiérrez Angélica , García-Guzman Katherine , Leal-Castro Aura , Garzón-Herazo Javier , Martínez-Vernaza Samuel , Guevara-Pulido Fredy 
Published: December 2022

Abstract

Background
Infections are common complications in patients with cancer. Data on antimicrobial resistance is important to guide empirical antimicrobial therapy. However, resistance rates varies among different regions and countries and, in general, is higher in Latin America. There are limited data from these patients in this region.
The aim of this work is to determine the frequency and antibiotic susceptibility profiles, as well as to identify the most frequent genes related to resistance, among microorganisms implicated in bacteremia in patients diagnosed with cancer

Methods
A cross-sectional multicenter study conducted in six hospitals in Colombia. An active laboratory search was carried out for adult patients with cancer and bacteremia. Data was obtained from the electronic medical records, and according to the resistance of the microorganisms, molecular tests were performed in a standardized way to identify genes related to methicillin-resistance, extended spectrum beta lactamases and carbapenemases. In addition, an exploratory multivariate analysis was performed using a logistic regression method to predict mortality

Results
195 patients from 6 hospitals were included in the study. The clinical variables of the patients are described in Table 1. Gram-negative bacteria were more common and their resistance rates were high. The genes found in the different resistant bacterial isolates are described in Table 2; The main resistance genes identified were blaCTX-M and blaKPC, generating ESLB-type beta-lactamases and carbapenemases, respectively. 30 day-mortality was 26%, which is similar to other studies. Multivariate analysis showed that adequate antibiotic treatment (OR: 0.26 (95%CI 0.1-0.63)) and higher number of platelets (per 10,000, OR: 0.97 (95%CI 0.94-0.99)) were associated with survival. Mortality was associated with patients in palliative care (OR 3.51 (95%CI 1.05-12.04)).

Conclusion
Gram-negative bacilli are frequently found in patients with cancer and bacteremia. A high level of resistance was identified. The frequency of the genes identified varies from what has been described in other regions of the world. Appropriate and prompt treatment in these patient would improve the outcomes.

Disclosures
Jorge A. Cortés, MD, pfizer: Grant/Research Support Carlos Saavedra-Trujillo, MD, pfizer and merck: Grant/Research Support.