bluuebunny/crossref_metadata_2025_split huggingface dataset:
801. IDSA Featured Oral Abstract: 25 Years of Varicella Vaccination Program in the United States: Health Impact during 1995–2019
Authors: Marin Mona , Leung Jessica W , Lopez Adriana S , Melgar Michael , Anderson Tara C , Curns Aaron T , Dooling Kathleen L 
Published: December 2022

Abstract

Background
In 1995, the United States was the first country to introduce universal childhood varicella vaccination. High vaccine coverage was attained among young children, ≥ 90% since 2007. In 2007, the policy was changed from 1-dose to a 2-dose program. We describe the impact of 25 years of the U.S. varicella vaccination program on varicella disease nationally.

Methods
We reviewed published data and analyzed overall and age-specific trends for rates from the pre-vaccine period (1990–1994) through 2019 for varicella incidence using National Notifiable Diseases Surveillance System data, hospitalizations using National Inpatient Sample data, and deaths using National Center for Health Statistics data. We present trends in persons aged &lt; 50 years, which captures most varicella burden and avoids misclassified herpes zoster in older people. Outbreak (≥ 5 varicella cases epidemiologically linked) characteristics were assessed for 1995–2019 and were informed by published data and analysis of surveillance data reported to CDC.

Results
Within the 10 years of the 1-dose program, varicella incidence, hospitalization, and mortality rates declined dramatically (71%–90%) vs. pre-vaccine. However, limited transmission continued in school settings which informed the change to a 2-dose policy. By 2019, declines reached &gt; 97% for incidence and 94% and 97% for hospitalizations and deaths, respectively. The greatest decline occurred among persons aged &lt; 20 years, born during the varicella vaccination program, with 99%, 97%, and &gt; 99% reduction in incidence, hospitalizations, and deaths, respectively. The 2-dose program further reduced the number, size, and duration of outbreaks vs. the 1-dose program; over the entire program, the proportion of outbreaks with &lt; 10 cases increased from 28% to 73%.

Conclusion
The varicella vaccination program significantly reduced varicella morbidity and mortality in the U.S. Twenty-five years into the program, pediatric varicella hospitalization has become a rare event and varicella deaths in persons aged &lt; 20 years are practically eliminated in the U.S. Annually, &gt; 3.8 million cases, 10,500 hospitalizations, and 100 deaths from varicella are now prevented in the United States due to the varicella vaccination program.

Disclosures
All Authors: No reported disclosures.
874. Diagnostic Stewardship of Gastrointestinal Multiplex PCR Panels in Hospitalized Children
Authors: Cotter Jillian , Stokes Claire , Tong Suhong , Dominguez Samuel R 
Published: December 2022

Abstract

Background
The introduction of multiplex gastrointestinal panels (GIP) led to increased rates of children with stool testing, high rates of negative results, and no change in clinical outcomes for most children. We aimed to reduce overall stool testing and stool testing with negative results by 20%.

Methods
We engaged stakeholders and implemented multi-modal interventions including 1) education and development of a clinical pathway to guide testing, and 2) electronic medical record (EMR)-based testing changes including built in stool testing restrictions with optional approval process (Table 1), and quantification of stool caliber in the EMR by nursing using the validated Bristol Stool Scale (BSS). We included all hospitalized children who had stool testing performed at a large children’s hospital over 30 months (2018–2020). Outcomes included the rate of stool tests and negative stool results per 10,000 patient-days. We evaluated rates of BSS documentation and GIPs performed for children hospitalized for &gt; 96 hours as process measures. Balancing measures included the percent of ordered tests that were restricted, and percent of initially restricted tests that were approved. We compared the rate of actionable results (bacteria or parasite identified) between initially restricted but ultimately approved tests and non-restricted tests.

Results
There were 2,001 tests performed for 1,982 encounters (Table 2). After interventions, we found special cause variation with a 29% sustained decrease in the rate of stool testing and a 28% decrease in the rate of negative stool results (Figures 1,2). The rate of use of BSS was 81% and was sustained. There was a 33% decrease in the number of GIPs performed for children hospitalized for &gt;96 hours. 34% of ordered stool tests per month were restricted, and this did not change over time. 56% of initially restricted tests were ultimately approved with no change over time, and these tests had a lower rate of actionable results compared to non-restricted tests (25 vs 34%, p=0.02).

Conclusion
Education coupled with EMR-based testing restrictions resulted in reduced rates of overall stool testing and low-value stool testing. Sustained ordering of restricted tests over time suggests that EMR-decision support is needed and likely cannot be removed.

Disclosures
Samuel R. Dominguez, MD PhD, BioFire Diagnostics: Advisor/Consultant|BioFire Diagnostics: Grant/Research Support|Karius: Advisor/Consultant|Pfizer: Grant/Research Support.
876. Suggested Empiric Therapy for CoNS Identified by BioFire BCID2 – Making Mountains Out of Molehills?
Authors: Ryu HaYoung , Yu Diana , Lewis James S 
Published: December 2022

Abstract

Background
Coagulase-negative Staphylococci (CoNS), including mecA-positive Staphylococcus epidermidis (MRSE), are among the bacteria identified by BioFire blood culture identification (BCID2). After transition to BCID2 on 31 March 2021, our institution began providing a suggested empiric antimicrobial therapy (EAT) comment with rapid diagnostic results, whereas no suggestions were given with the prior platform. Limited data exist on the impact of EAT suggestions on antibiotic use when likely contaminants such as CoNS are identified.

Methods
This was a single center, observational, pre- and post-intervention study of patients aged ≥ 18 years with CoNS in the blood between 1 April 2020 and 30 September 2021. Patients with compromised immunity, intravenous drug use, polymicrobial cultures, or MRSE-active therapy use for a documented infection were excluded. Primary outcome was the rate of initiation or discontinuation of MRSE-active agent in response to the rapid diagnostic result. Secondary outcome was healthcare resource utilization such as Infectious Diseases consultation and delayed discharge.

Results
A total of 174 patients were included (pre-BCID2, n=93; post-BCID2, n=81). For all CoNS rapid diagnostic results, no significant difference was noted in MRSE-active agent initiation (33.3% vs. 37.0%, p=.90) and discontinuation (61.3% vs. 48.4%, p=.31). A subgroup analysis of S. epidermidis was performed with 64 and 46 patients in pre- and post-BCID2 groups, respectively; in the latter, BCID2 identified 31/46 (67.4%) as MRSE. In this subgroup, empiric MRSE-active agent was significantly less likely to be discontinued if EAT suggestion was reported with results (68.4% vs. 31.2%, p=.03). This change was not seen if Staphylococcus species were identified as the suggestion was to withhold EAT. There was no difference in healthcare resource utilization.

Conclusion
Providing EAT suggestion with BCID2 result for S. epidermidis unexpectedly encouraged continuing empiric MRSE-active agent for likely contaminants. In contrast, suggestion to withhold treatment had no impact on EAT use for other CoNS. The reason for this difference is unclear, but may be a result of the highlighted methicillin resistance in the BCID2 result reporting which is specific to S. epidermidis.

Disclosures
James S. Lewis, PharmD, FIDSA, Cidara: Advisor/Consultant|Merck: Advisor/Consultant|SeLux Diagnostics: Advisor/Consultant.
1518. Bacteremia due to Non-Staphylococcus aureus Gram-positive Cocci and Risk of Cardiovascular Implantable Devices Infection
Authors: Chesdachai Supavit , Baddour Larry M , Sohail Rizwan , Palraj Raj , Madhavan Malini , Tabaja Hussam , Fida Madiha , Lahr Brian D , DeSimone Daniel C 
Published: December 2022

Abstract

Background
Cardiovascular implantable electronic devices (CIED) infection carries significant morbidity, mortality, and financial burden. Bacteremia in patients with CIED increases risk of CIED infection. While several investigations have examined Staphylococcus aureus bacteremia and risk of CIED infection, data regarding non-S. aureus gram-positive coccal (non-SA GPC) bacteremia in patients with CIED has been both limited and dated. The current study examined the clinical characteristics of patients with CIED who developed non-SA GPC bacteremia and their proclivity of CIED infection.

Methods
We reviewed all patients with CIED who developed non-SA GPC bacteremia at Mayo Clinic between 2012–2019. Cases with a left ventricular assist device, non-hospitalization, and contaminated blood culture were excluded. The 2019 European Heart Rhythm Association International Consensus Document was used to define CIED infection.

Results
A total of 160 patients with CIED developed non-SA GPC bacteremia during the period. Ninety (56.2%) patients had CIED infection, with 60 (37.5%) classified as definite and 30 (18.8%) possible. This included 41/64 (64.1%) patients with coagulase-negative Staphylococcus (CoNS), 30/41 (73.2%) patients with Enterococcus, 13/19 (68.4%) patients with viridans group streptococci (VGS), and 6/36 (16.6%) patients with other non-SA GPC. The odds of CIED infection (with 95% CI) for CoNS, Enterococcus, and VGS bacteremia were 8.9 (3.2–24.6), 13.6 (4.5–41.6), and 10.8 (2.9–40.0) -fold higher, respectively, as compared to other non-SA GPC. Among those with infected CIED, 51 (56.7%) patients underwent complete device extraction after a median of 6 (IQR 3.5–10) days. In an unadjusted analysis of patients with CIED infection, the reduction in one-year mortality following device removal was not statistically significant (HR 0.59, 95% CI 0.26–1.33, p=0.198).

Conclusion
The overall prevalence of CIED infection following non-SA GPC bacteremia was higher than previously reported, particularly that due to CoNS, Enterococcus, and VGS. Further study with a larger cohort is needed to demonstrate the survival benefit from CIED extraction in patients with infected CIED due to non-SA GPC.

Disclosures
Larry M. Baddour, M.D., Boston Scientific: Advisor/Consultant|Botanix Pharmaceuticals: Advisor/Consultant|Roivant Sciences: Advisor/Consultant|UpToDate, Inc.: Royalty payments - authorship duties Rizwan Sohail, M.D., Aziyo Biologics: Advisor/Consultant|Boston Scientific: Advisor/Consultant|Medtronic: Advisor/Consultant|Philips: Advisor/Consultant|Philips: Honoraria Malini Madhavan, M.B.B.S., Biosense Webster: Advisor/Consultant|Biotronik Inc: Advisor/Consultant|Boston Scientific: Grant/Research Support|Convatec: Advisor/Consultant.
1519. Increased incidence of colorectal cancer in Veteran Health Administration hospital patients with pyogenic liver abscess: A matched cohort study
Authors: Kidder Ian , Goto Michihiko , Suzuki Hiroyuki 
Published: December 2022

Abstract

Background
Colorectal cancer (CRC) remains the third leading cause of death in the United States (US), and incidence has increased among patients &lt; 50 years of age over the last few decades. Although many patients with early CRC remain asymptomatic, infections such as Streptococcus gallolyticus bacteremia, can be an early finding. There is increasing evidence that pyogenic liver abscesses (PLA) may also be associated with CRC. However, studies of US populations remain limited.

Methods
We retrospectively evaluated patients with a diagnosis of PLA at Veteran Health Administration hospitals across the US from 2003 to 2020. For each case, up to three uninfected controls matched for age (+/- 5), gender, and healthcare facilities at the time of index infection from the outpatient population were selected. PLA patients and matched controls were followed for ten years. Our primary outcome was a new diagnosis of CRC after index infection. Stratified cumulative incidence function plots with Gray’s test for equality were used to examine CRC incidence. Then we used Fine-Gray sub-distribution hazard regression models with interaction terms using the logarithm of time to estimate cause-specific time-dependent hazard ratios (HRs) for CRC incidence while accounting for mortality.

Results
We compared 8,294 PLA patients to 23,111 matched controls. Median age was 65.7 in PLA patients and 66.0 in matched controls. The median number of colonoscopies was ten in PLA patients and five in matched controls over the study period (p &lt; 0.001). Our analysis revealed a 1.9% incidence of new CRC in the liver abscess group, compared to 0.8% in the matched cohort (p &lt; 0.001, Figure 1). The multivariate sub-distribution hazard regression model showed higher time-dependent HRs of CRC up to two years from diagnosis of PLA but not higher afterward (Table 1).
Incidence of colorectal cancer (CRC) in patients with liver abscess (dashed yellow line) compared to patients with no liver abscess (solid blue line). Our analysis revealed a 1.9% incidence of CRC in patients with liver abscess compared to 0.8% in the matched control cohort.

Conclusion
We found a significantly higher incidence of CRC for patients with PLA, especially during the first two years from diagnosis, although some of our findings may be explained by increased screening around the time of diagnosis. We believe our findings support the importance of CRC screening after the diagnosis of PLA.

Disclosures
Michihiko Goto, MD MSCI, Merck & Co.: Grant/Research Support.
1523. Association between Self-reported Masking Behavior and SARS-CoV-2 Infection Wanes from Pre-Delta to Omicron-Predominant Periods — North Carolina COVID-19 Community Research Partnership (NC-CCRP)
Authors: Tjaden Ashley H , Gibbs Michael A , Runyon Michael S , Weintraub William , Taylor Yhenneko , Edelstein Sharon 
Published: December 2022

Abstract

Background
Wearing a face mask is a primary public health method to reduce SARS-CoV-2 transmission. We assessed the association between self-reported mask use and risk of COVID-19 infection during three periods of the pandemic.

Methods
We performed a nested case-control analysis within the NC-CCRP of adults ≥18 years who completed daily syndromic surveillance surveys from April 2020 through February 2022, comparing self-reported cases to controls who never self-reported a positive test. We matched up to 10 controls to each case on calendar time of self-reported positive test and corresponding daily survey entry. Not wearing a mask was defined as responding “no” at least once in the ten days preceding the match date to “In the last 24 hours, have you worn a face mask or face covering every time you interacted with others (not in your household) within a distance of less than 6 feet?” Conditional logistic regression models of risk of COVID-19 infection were adjusted for demographics, vaccination status, and recent known exposure to COVID-19. We tested any days not wearing a mask during the Pre-Delta (July 1 2020-June 30, 2021), Delta (July 1– November 30, 2021), and Omicron (December 1, 2021 – February 28, 2022) periods.

Results
Among 3,901 cases and 27,813 date-matched controls, there was a significant interaction between mask use and time period (p&lt; 0.001). Prior to July 2021, the odds of a reported SARS-CoV-2 infection was 66% higher (aOR=1.66, 95% CI=1.43 – 1.91) among participants reporting at least one day not wearing a mask compared to those who reported no days (1592 cases, 11717 controls). During the Delta-predominant period, the results were similar (aOR=1.53, 95% CI=1.23 – 1.89; 659 cases, 4649 controls). This association was attenuated during the Omicron-predominant period, where the odds of a reported SARS-CoV-2 infection was 16% higher (aOR=1.16, 95% CI=1.03 – 1.32; 1563 cases, 10960 controls).

Conclusion
While the effect of not wearing a mask remains significant, during the Omicron-predominant period we observed a decrease in the association between self-reported mask wearing and risk of SARS-CoV-2 infection. The increased transmissibility of Omicron, pandemic fatigue, and increasing population immunity are possible contributing factors.

Disclosures
Michael S. Runyon, MD, MPH, Abbott Laboratories: Grant/Research Support|Roche Diagnostics Operations, Inc: Grant/Research Support.
1538. Socioeconomic Risk Factors for Multidrug Resistance in Enterobacterales
Authors: Brown Dylan , Henderson Heather , Ruegsegger Laura , Moody James , van Duin David 
Published: December 2022

Abstract

Background
Multidrug resistance (MDR) in Enterobacterales is common; the impact of socioeconomic status (SES) on MDR prevalence is unclear.

Methods
Data from 2014–2021 was obtained from UNC Hospitals for all cultures with Enterobacterales growth (N=90129). ZIP-code level socioeconomic data for North Carolina was sourced from the 2020 5-Year American Community Survey and combined into an SES factor score assigned to each ZIP code (N=790). Prevalence ratios from generalized linear models were used to compare the relative MDR occurrence between SES quartiles.

Results
A significant inverse relationship between MDR and SES was observed (16%, 16.5%, 19.5%, and 20.7% MDR in the highest, medium-high, medium-low, and lowest quartiles, respectively; Table 1). The prevalence of MDR in Enterobacterales from patients residing in lowest-quartile ZIP codes was 32% higher (Table 1) relative to those from the highest quartile. This effect was significant across all measured antibiotic classes, with the largest absolute difference in penicillins (40.1% and 50.6% in the highest and lowest quartiles, respectively), and the smallest in aminoglycosides (5.6% and 7.3%; Figure 1). Temporally, the lowest quartile had the highest prevalence of MDR in all measured years.

Conclusion
Our findings show that in North Carolina from 2014–2021, MDR was consistently more prevalent in Enterobacterales from patients residing in lowest-quartile ZIP codes. These data emphasize the need to address the societal causes for disparities in clinical outcomes and can inform further study of the relationship between SES and MDR.

Disclosures
David van Duin, MD, PhD, Achaogen: Advisor/Consultant|Actavis: Advisor/Consultant|Allergan: Advisor/Consultant|Astellas: Advisor/Consultant|Entasis: Advisor/Consultant|Karius: Advisor/Consultant|MedImmune: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Neumedicine: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Qpex: Advisor/Consultant|Roche: Advisor/Consultant|Sanofi-Pasteur: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|T2Biosystems: Advisor/Consultant|Tetraphase: Advisor/Consultant|Utility: Advisor/Consultant|Wellspring: Advisor/Consultant.
1540. Clinical severity across five viral diarrheal pathogens in infants and young children Global Enteric Multicenter Study (GEMS)
Authors: Cates Jordan , Tate Jacqueline E , Parashar Umesh D , Mirza Sara , Nasrin Dilruba , Farag Tamer H , Panchalingam Sandra , Sur Dipika , Faruque Abu S G , Breiman Robert F , Jahangir Hossain M , Mandomando Inacio , Onyando Richard O , Nataro James P , Levine Myron M , Kotloff Karen L 
Published: December 2022

Abstract

Background
Viruses are a leading cause of pediatric diarrheal illness, resulting in over 200,000 childhood deaths annually worldwide. Rotavirus is the most common viral cause of moderate-to-severe diarrhea in low to middle-income countries, but adenovirus 40/41, norovirus, sapovirus, and astrovirus are increasingly recognized as important contributors to the global viral gastroenteritis burden. Comparisons of clinical severity between these five viruses among infants and young children are currently limited.

Methods
The objective of this analysis was to describe the clinical severity of rotavirus, adenovirus 40/41, norovirus, sapovirus, and astrovirus among children enrolled in the Global Enteric Multicenter Study (GEMS). Stool samples from children younger than 5 years of age with moderate-to-severe diarrhea at four sites in Africa and three in Asia were tested by enzyme immunoassays (rotavirus, adenovirus) and multiplex reverse transcriptase polymerase chain reaction (norovirus, sapovirus, astrovirus). A modified Vesikari score (MVS) to assess clinical severity was calculated based on symptoms and clinical characteristics.

Results
Among 3,305 viral diarrhea cases, rotavirus had the highest median MVS (9 [interquartile range [IQR: 7,11]) followed by adenovirus 40/41 (8 [IQR]: 6,10]); sapovirus and astrovirus had a similar MVS distribution to norovirus (7 [IQR: 6, 9]). The proportion of patients experiencing &gt; 3 episodes of vomiting was high for those with rotavirus (66.3%) and adenovirus 40/41 (55.7%); astrovirus (40.8%), sapovirus (40.0%), and norovirus (35.9%) patients also experienced substantial episodes of vomiting. A high proportion of cases with adenovirus 40/41 (54.0%) and rotavirus (46.3%) experienced ≥ 7 episodes of diarrhea within 24 hours. While hospitalization or intravenous fluids were required most frequently for patients with rotavirus (42.1%), the proportion was also high in those with adenovirus 40/41 (30.6%).

Conclusion
These findings demonstrate the clinical severity of viral diarrheal pathogens besides rotavirus, in particular adenovirus 40/41, warranting the continued development of vaccines and therapeutics to prevent morbidity and mortality due to viral enteric pathogens.

Disclosures
All Authors: No reported disclosures.
1163. Age, Poverty and Inequity are Key Determinants of Dengue Severity in Colombia
Authors: Acevedo-López Doménica , Cardona-Ospina Jaime A , Molton Mia , Collins Matthew H , Rodríguez-Morales Alfonso J , Álvarez-Amaya Valeria , Díaz-Henao William , Ramírez Daniel , Rojas-Gallardo Diana , Castañeda Camilo 
Published: December 2022

Abstract

Background
Age has been a major risk factor for death and complication due to dengue infection (DENV). Although antibody-dependent enhancement (ADE) has been proposed as an explanation, other variables could shape disease outcomes. We aimed to analyze the role of age as a risk factor for disease severity across departments (ﬁrst administrative level), and epidemic years in Colombia considering poverty and inequity indexes.

Methods
We conducted a retrospective study analyzing DENV epidemiological data from Colombia between 2012 to 2017, and monetary poverty, extreme poverty, and GINI indexes. Total cases, incidence, incidence of severe DENV, mortality, case- fatality rates (CFR), and complication rates (CR) were calculated for each department and year. The effect of age, department, year of infection, monetary poverty, extreme poverty, and GINI on CR and CFR was evaluated by using a generalized additive model.

Results
After adjustment, age (p&lt; 0.001), GINI (p&lt; 0.001), monetary poverty (p&lt; 0.001), and extreme poverty(p&lt; 0.001) indexes were signiﬁcantly associated with the CR, but age was the only variable signiﬁcantly associated with CFR (p&lt; 0.001). Our results revealed a ﬁrst peak of CR in patients younger than 5 years old, the second peak in patients between 27 to 34 years old, and a third peak after 45 years old.

Conclusion
Our work has important implications for future designing of human cohorts analyzing the risk of complications in adults and provides evidence for improving clinical DENV risk assessment. Our ﬁndings are consistent with similar observations linking ADE with severe DENV in childhood and suggest protective antibody decay during adulthood. The interplay of biological and socioeconomic factors shaping clinical outcomes in DENV is complex and should be further analyzed

Disclosures
All Authors: No reported disclosures.