bluuebunny/crossref_metadata_2025_split huggingface dataset:
798. Life-years Gained among non-Hispanic Black and White Men who have Sex with Men in the United States with Improvements in the HIV Care Continuum A Simulation Modeling Study
Authors: Rich Katherine M , Reddy Krishna , Ahonkhai Aimalohi , Shebl Fatma , Pandya Ankur , Losina Elena , Freedberg Kenneth , Hyle Emily P 
Published: December 2022

Abstract

Background
Structural barriers and racism result in inequities across the HIV care continuum. We quantified the magnitude of racial disparities in life expectancy (LE) and the potential impact of interventions to improve the HIV care continuum among non-Hispanic Black and White men who have sex with men (MSM) in the US.

Methods
Using the validated CEPAC microsimulation HIV model, we projected LE among non-Hispanic Black MSM (BMSM) and White MSM (WMSM). We estimated average age at HIV infection (BMSM: 26.8y, WMSM: 35.0y) and time from infection to diagnosis (BMSM: 3.4y, WMSM: 3.0y) using US race-stratified data from the Centers for Disease Control and Prevention (CDC) (Table 1). To account for differences in the HIV care continuum, we calibrated input parameters to race-specific estimates of: 1) the proportion of time that MSM with diagnosed HIV are retained in care (BMSM: 75.2%, WMSM: 80.6%), and 2) the % of MSM with diagnosed HIV who attain virologic suppression (VS; BMSM: 82.0%, WMSM: 91.2%). To account for increased risk of non-HIV-related mortality, we adjusted race-stratified life tables for smoking. We then projected LE from age 15 in five scenarios: 1) status quo HIV care (2019 estimates of HIV testing, VS, and retention in care), 2) earlier diagnosis (via annual testing), 3) improved retention in care (95% retention via reduced loss to follow-up), 4) improved VS (95% VS among MSM in care), and 5) a combined strategy (annual testing, 95% retention, 95% VS).

Results
Among MSM in status quo HIV care, we projected LE from age 15 to be 52.2y (BMSM) and 58.5y (WMSM), a difference of 6.3 years (Figure 1). With annual testing, BMSM would gain 0.6 life-years (LY), and WMSM would gain 0.3 LY compared with status quo care. Improving retention in care to 95% would result in a gain of 1.4 LY for BMSM and 1.0 LY for WMSM. BMSM would gain 1.1 LY if VS increased to 95% among those in care, whereas WMSM would gain 0.3 LY. BMSM would gain 3.4 LY (LE from age 15: 55.6y) and WMSM 1.6 LY (LE from age 15: 60.1y) in the combined strategy.

Conclusion
Equity-focused solutions that specifically target investment in HIV care for Black MSM will be critical to reduce disparities in HIV care outcomes and improve LE.

Disclosures
Krishna Reddy, MD, MS, UpToDate, Inc.: Author Aimalohi Ahonkhai, MD, MPH, Bryan Allen Events LLC for Gilead: Advisor/Consultant|ViiV: Advisor/Consultant.
868. In Vitro Activity of Isavuconazole and Other Mould-Active Triazoles Against Aspergillus fumigatus With and Without cyp51 Alterations
Authors: Pfaller Michael A , Carvalhaes Cecilia G , Deshpande Lalitagauri M , Rhomberg Paul , Rhomberg Paul , Castanheira Mariana 
Published: December 2022

Abstract

Background
Azole resistance in Aspergillus fumigatus (AFM) is mainly associated with mutations in cyp51A and its promoter region or its homologue cyp51B. We evaluated the in vitro activity of isavuconazole (ISC), itraconazole (ITC), posaconazole (PSC), and voriconazole (VRC) against 660 AFM collected during 2017–2020.

Methods
Isolates from Europe (EU), North America (NA), Latin America (LA), and Asia-Pacific (APAC) were identified by MALDI-TOF and/or sequencing and tested by CLSI broth microdilution. CLSI epidemiological cut-off values (ECV) were applied. A PSC ECV of 0.5 mg/L was used. Non-wildtype (NWT) isolates to azoles were screened for alterations in the cyp51 genes using whole genome sequencing.

Results
Azoles had similar activities against 660 AFM isolates. Overall, AFM displayed WT MIC values to ISC (92.7%), ITC (92.9%), PSC (97.3%), and VRC (96.7%). Only 66 isolates (10.0%) were NWT to 1 or more of the azoles, and 32 harbored one or more alterations in the cyp51 genes. Of these AFM, 29/32 (90.1%) were NWT to ITC, 25/32 (78.1%) NWT to ISC, 17/32 (53.1%) NWT to VRC, and 11/32 (34.4%) NWT to PSC. The most frequent alteration was CYP51A TR34/L98H, carried by 14 EU isolates, all NWT to ISC and ITC. Four isolates from NA carried the alteration I242V in CYP51A (all NWT to ITC; all WT to ISC). One NA isolate carried the CYP51A alteration G448S (NWT to ISC, VRC, and ITC) and one carried A9T (NWT to ISC). A single isolate from APAC carried a CYP51A G138C alteration and was NWT to all 4 triazoles. Multiple alterations in CYP51A were detected in 5 isolates: 4/5 NWT to ISC or ITC, 1/5 NWT to VRC, all WT to PSC. Alterations in CYP51B were noted in 7 isolates; 6/7 carried Q42L, 3 from NA (all NWT to ITC and 2 NWT to ISC), 2 from APAC (all NWT to VRC or ISC), and 1 from EU (NWT to ISC, ITC, and PSC). Among 34 NWT isolates without cyp51 alterations, 32.4% were WT to ISC, 47.1% WT to ITC, 85.3% WT to VRC, and 82.4% WT to PSC.

Conclusion
The majority of AFM were WT to azoles. Ten different cyp51 alterations were detected in 32/66 NWT isolates. Only EU isolates harboured the environmental alteration TR34/L98H that was associated with a NWT phenotype to ISC and ITC. Alterations in AFM cyp51 can have variable effects on the in vitro activity of the azoles that are best delineated by testing all triazoles.

Disclosures
Michael A. Pfaller, MD, Pfizer: Grant/Research Support Cecilia G. Carvalhaes, MD, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support Lalitagauri M. Deshpande, PhD, Melinta: Grant/Research Support|Pfizer: Grant/Research Support Paul Rhomberg, BS, MT(ASCP), Cidara: Grant/Research Support|Pfizer: Grant/Research Support Paul Rhomberg, BS, MT(ASCP), Cidara: Grant/Research Support|Pfizer: Grant/Research Support.
875. Guess Who’s Back: The Return of Seasonal Respiratory Viruses in the State of Wisconsin and Associated Changes in Antibiotic Prescribing for Respiratory Complaints
Authors: Lepak Alexander , Taylor Lindsay , Schulz Lucas , Hanson Erika , Temte Jonathan 
Published: December 2022

Abstract

Background
Return of infections caused by common respiratory viruses (RV) may be expected with the relaxation and/or removal of infection prevention measures instituted during the COVID-19 pandemic. Therefore, we examined respiratory virus detection (RVD) rates in Wisconsin during the COVID-19 period, and whether ambulatory antibiotic prescribing for respiratory complaints has increased with return of typical RVs.

Methods
The Wisconsin State Laboratory of Hygiene’s Viral Surveillance program collects RVD data from &gt;130 laboratories across the state for influenza (FLU), respiratory syncytial virus (RSV), seasonal coronaviruses (sCOR), parainfluenza virus (PARA), enteroviruses/rhinoviruses (E/R), and human metapneumovirus (hMPV). Data were collected from 1/1/2015 to 4/30/2022. Antibiotic prescribing for ambulatory care patients presenting with respiratory complaints was collected from our EHR, which utilizes a required order form for all ambulatory antibiotic prescriptions. Statistical analysis was performed using Mann-Whitney Rank Sum and Spearman’s rank correlation.

Results
In the first year after COVID-19 onset, E/R and sCOR were detected at low levels while other RVs were essentially nil. After 4/2021, when infection prevention measures (i.e. mask mandates) were significantly relaxed or removed, RVDs increased for all viruses. At present, RVDs have returned to typical rates (except of FLU, Fig. 1) and seasonality variation (except of RSV, Fig. 1). Antibiotic prescribing for respiratory complaints has increased 57% in this period (3.5 to 5.5 prescriptions/1000 encounters, Fig. 2) and continues to trend up with RV activity. Prescribing rates are strongly correlated with RVD rates, but most strongly correlated with non-FLU, non-RSV RVD rates (Spearman correlation 0.71).
The dashed vertical line represents relaxation/discontinuation of public infection prevention measures (e.g. masking).
The dashed vertical line represents relaxation/discontinuation of public infection prevention measures (e.g. masking).
* Parainfluenza virus, human metapneumovirus, enterovirus/rhinovirus, or seasonal coronavirus.

Conclusion
In general, RVs have returned to pre-pandemic rates with seasonality. Interestingly, this return was associated with the relaxation/removal of infection prevention measures in the second year post-COVID-19 onset, and does not appear to be impacted by ongoing COVID-19 waves. Antibiotic prescribing in ambulatory care continues to be highly associated with RV activity, indicating this should remain a high priority of ambulatory stewardship education and intervention.

Disclosures
All Authors: No reported disclosures.
1521. Non-faecium Non-faecalis enterococcal bloodstream infections in patients with cancer
Authors: Axell-House Dierdre B , Egge Stephanie L , Tran Cecilia , Shelburne Samuel A , Arias Cesar A 
Published: December 2022

Abstract

Background
Non-E. faecium non-E. faecalis (NFF) enterococci are a heterogeneous group of organisms consisting of enterococci with intrinsic low-level vancomycin resistance as well as several other species known to infect humans. Patients with cancer are at increased risk for bloodstream infections (BSIs) with NFF enterococci, but their optimal treatment and outcomes have not been extensively described.

Methods
We conducted a retrospective review of patients (pts) with blood cultures positive for all NFF by searching the microbiology database at a major cancer center in Houston, TX from 2016 to 2021. Patients were included if they were ≥ 18 years old, had ≥ 1 blood culture with NFF enterococci, and had a repeat blood culture within 7 days (d) of the index culture, to permit outcome analysis. Outcomes were a) in-hospital mortality, b) microbiological failure (blood culture clearance &gt;4 d after index culture), and c) recurrence of bacteremia (new positive blood culture &lt; 14 d after eradication).

Results
Sixty-two unique pts had NFF enterococcal BSI. Patients with hematological malignancy made up 53.2% of the cohort (78% had leukemia). The majority (83%) of solid malignancies were pancreatic, biliary, or intestinal in origin. In the 30 d preceding NFF enterococcal BSI, 79% of pts had exposure to antibiotics. The NFF species isolated were E. gallinarum (50%), E. casseliflavus (30.6%), E. avium (11.3%), E. raffinosus (3.2%), E. hirae (3.2%), and E. durans (1.6%). Only 23.3% of NFF enterococci were susceptible to vancomycin, and 53.8% were susceptible to linezolid. Most (62.9%) pts received combination therapy; the most frequent was daptomycin plus a beta-lactam (33.9%). Bacteremia recurred in 8.1% of pts, 27.4% had in-hospital mortality, and 4.8% had microbiological failure.

Conclusion
This retrospective review provides preliminary insight into the treatments, and outcomes of cancer pts with NFF enterococcal BSIs. The NFF enterococci isolates in this study had a higher rate of linezolid non-susceptibility than previously reported. Molecular investigation of these NFF enterococcal isolates is needed to elucidate the mechanisms and transmission of antibiotic resistance. Comparison of BSIs caused by NFF enterococci to E. faecium/E. faecalis will provide insight to physicians caring for these pts.

Disclosures
Cesar A. Arias, MD, PhD, Entasis: Grant/Research Support|MeMed Diagnostics Ltd: Grant/Research Support|Merck: Grant/Research Support.
1522. Penicillin plus ceftaroline against Enterococcus faecalis blood isolates lacking ampicillin plus ceftriaxone activity
Authors: Nwoye Angella , Bocanegra Jessica , Khan Ruhma , Shah Zeel , Cusumano Jaclyn A 
Published: December 2022

Abstract

Background
Enterococcus faecalis infective endocarditis standard of care treatment, ampicillin plus ceftriaxone, unfortunately has been unable to decrease mortality rates and additionally increases patient risk for vancomycin-resistant enterococci (VRE). Recent data also demonstrates decreased ampicillin plus ceftriaxone activity in E. faecalis isolates with an elevated penicillin MIC of 4 mcg/mL. Penicillin plus ceftaroline is a promising alternative but limited data is available to support.

Methods
Seven E. faecalis clinical blood isolates and one wild-type E. faecalis isolate (i.e., JH2-2) were tested against penicillin plus ceftaroline utilizing 24-hour in vitro time-kill assays. All isolates were penicillin susceptible with minimum inhibitory concentrations (MIC) of either 2 (n=4) or 4 (n=4) mcg/mL, and ceftaroline MICs ranged from 1 to 8 mcg/mL. Penicillin and ceftaroline were tested at subinhibitory concentrations (0.25x and 0.5xMIC) as monotherapy and in combination. Antibacterial activity was described as bactericidal or bacteriostatic, defined as a ≥ 3-log10 colony-forming units (CFU)/mL or &lt; 3-log10 CFU/mL decrease from initial inoculum, respectively. Synergy was defined as a ≥ 2-log10 decrease in CFU/mL at 24 hours from the most active single agent.

Results
Penicillin and ceftaroline monotherapy did not demonstrate any antibacterial activity, except for ceftaroline 0.5xMIC where four isolates demonstrated bacteriostatic activity (Table 1). Penicillin plus ceftaroline was synergistic in all isolates except JH2-2 (penicillin MIC of 2 mcg/mL) due to the bacteriostatic activity of ceftaroline alone. Synergistic and bactericidal activity was also more frequently observed in isolates with a penicillin MIC of 4 mcg/mL with penicillin plus ceftaroline than ampicillin plus ceftriaxone.

Conclusion
Penicillin plus ceftaroline demonstrates synergistic activity against clinical E. faecalis blood isolates including isolates with a penicillin MIC of 4 mcg/mL, where ampicillin plus ceftriaxone less frequently demonstrated synergy. Further research is warranted to support utilization in patients with E. faecalis infective endocarditis.

Disclosures
Jaclyn A. Cusumano, PharmD, BCIDP, Shionogi: Advisor/Consultant.
1527. Use of a SARS-CoV-2 Strand-specific Assay to detect Relapse or Ongoing Infection at a Tertiary Care Center, California 2020–2022
Authors: Contreras Anez Gustavo A , Ferguson Jessica , Contag Caitlin A , Tompkins Lucy S , Shepard John , Rosenthal Ayelet , Subramanian Aruna , Pinsky Benjamin A , Salinas Jorge 
Published: December 2022

Abstract

Background
Determining if a patient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains infectious can be challenging in patients with severe disease or those profoundly immunosuppressed. We use an assay that detects minus-strand RNA as a surrogate for actively replicating SARS-CoV-2. Here, we describe a cohort of patients who had strand-assay reversion: a detectable minus strand-specific assay after having had an undetectable value which may signify relapse of infection or reinfection.

Methods
We used a 2-step rRT-PCR specific to the minus strand of the SARS-CoV-2 envelope gene. The strand-specific assay is used to evaluate for infectivity in asymptomatic patients with a positive screening admission or pre-procedural test or in cases when ongoing infection was suspected (critical illness or profound immunosuppression). We collected minus strand-specific assays performed at Stanford Healthcare during August 2020–April 2022. We describe basic demographics and clinical characteristics for patients who reverted from undetectable to detectable using the minus strand-specific assay.

Results
A total of 2,505 strand-specific tests were collected from August 2020–April 2022 from 2,064 patients. A total of 292 (14%) had two or more strand-specific tests. Of them, 19 (7%) had an undetected minus strand-specific assay followed by a subsequent detectable value. Of them, seven (37%) had a minus strand-specific CT value of &lt; 33. Most were male (n=4), median age was 54 (range: 8–62). All were profoundly immunosuppressed: Four had hematologic malignancies and three were post transplantation (kidney, lung, bone marrow). Median time from onset of symptoms or first positive test to reversion was 41 days (range:27–159). Median time from undetectable to detectable minus strand specific test was 26 days (range:4–34). All cases were considered relapses or ongoing infection rather than a new infection.

Conclusion
Among patients with SARS-CoV-2 infection and consecutive strand-specific testing, a small proportion reverted from negative to positive. Most were profoundly immunosuppressed. The strand-specific assay can be an important tool in the evaluation of suspected cases of relapse or reinfection.

Disclosures
Aruna Subramanian, MD, Gilead Sciences: Grant/Research Support|Regeneron, Inc: Grant/Research Support.
1536. Hepatitis C Care Cascade Before and After Lifted Insurance Restrictions In Birth Cohort and Non-Birth Cohort Patients
Authors: Aleger Nathan , Aleger Nathan , Aleger Nathan , Jenkins Melissa O , Jenkins Meliisa , Gielach Michael , Battle Brittany , Avery Ann A 
Published: December 2022

Abstract

Background
In 2016, the MetroHealth System implemented a system-wide hepatitis C (HCV) screening initiative in novel settings. We previously showed that those born 1945–1965 (birth cohort, BC) had higher rates of linkage to care (LTC) and sustained virologic response (SVR) rates compared to non-BC (not born 1945–1965). Since 2019, restrictions on fibrosis, sobriety and prescriber have been loosened. We hypothesized that gaps in care cascade between BC and non-BC patients (including LTC rates) would lessen in those diagnosed after 2019.

Methods
We compared the HCV LTC rates and care cascade in patients diagnosed from Jan 1, 2016 to June 30 2017 (early group) to those diagnosed July 1, 2019 to Dec 31, 2020 (late group) as well between BC and non-BC patients. We performed logistic regression to evaluate the impact of race, gender, known prior HCV positivity, site of HCV diagnosis, HIV, insurance, active injection drug use (IDU), remote IDU, psychiatric disorder, BC status and early/late diagnosis on LTC.

Results
The study population comprised 2103 HCV+ patients (1349 non-BC, 754 BC). There were 1026 patients in the early group and 1077 patients in the late group. 1353 patients were HCV RNA+. Of those, 914 (67.6%) were white, 306 (22.6%) African American; 872 (64.4%) male; 990 (74.5%) Medicaid; 822 (60.7%) outpatient diagnosis. On multivariable analysis, factors affecting.
LTC were: BC (aOR 1.71, 95%CI 1.19–2.45, p=0.003); diagnosed inpatient (aOR 0.45 (0.32–0.66), p&lt; 0.0001), emergency department (aOR 0.55, (0.35–0.89), p=0.0142) or jail (aOR 0.23, (0.13–0.4), p=0.23); active IDU (aOR 0.22, (0.14–0.35),p&lt; 0.0001); remote IDU (aOR 0.60, (0.4–0.89)p=0.01); and diagnosis in the late group (aOR 0.67, (0.51–0.8), p=0.005). The care cascade improved in the late group, but gaps remained in non-BC vs BC (Table).

Conclusion
The non-BC continued to have lower rates of LTC compared to BC in the late group.Overall LTC was decreased in the late group for both non-BC and BC likely due to COVID-19. However, improvement in medication approval was shown in the late group, and most patients who were prescribed treatment completed it. Active IDU remained a barrier to non-LTC, but did not fully explain the differences between BC and non-BC patients.

Disclosures
Melissa O. Jenkins, Meliisa Jenkins, Gilead Sciences: Grant/Research Support.
1165. Ascertainment of anthropometric thresholds to identify glucose intolerance in HIV-endemic African populations: results from a population-based survey in rural KwaZulu-Natal, South Africa
Authors: Castle Alison , Siedner Mark 
Published: December 2022

Abstract

Background
Improved screening and diagnostic algorithms are needed to achieve 2030 targets proposed by the Global Diabetes Compact. We sought to explore anthropometric thresholds to optimally screen and refer individuals for glucose intolerance testing in an HIV-endemic rural South African population.

Methods
We analyzed data from the cross-sectional Vukuzazi study that enrolled adults living in rural KwaZulu-Natal, South Africa. We assessed screening thresholds for waist circumference (WC), body mass index (BMI), and waist hip ratio (WHR) to detect glucose intolerance (hemoglobin A1c &gt;6.5%) using weighted, non-parametric ROC regression analyses. We then assessed the diagnostic validity of traditional obesity thresholds, explored optimal thresholds for the South African population, and fit models stratified by sex, age, and HIV.

Results
In the total cohort (n=17,868), the prevalence of glucose intolerance was 7.8% (95% CI 7.4–8.2) and HIV prevalence was 33.8% (95% CI 33.1-34.5). WC outperformed BMI and WHR in detecting glucose intolerance (males p&lt; 0.001; females p&lt; 0.001). Whereas guideline WC thresholds for females performed well for glucose intolerance (Sensitivity 91% [95% CI 89.5-92.5], positive predictive value [PPV] 14.9%), substantially lower thresholds were needed to achieve acceptable sensitivity and positive predictive values among men. We found significant sub-groups effects by sex and age, but HIV status did not affect WC thresholds for identifying glucose intolerance.

Conclusion
Waist circumference improves anthropometric screening for glucose intolerance in South Africa. Guideline-based WC thresholds are appropriate for females, but male-derived WC cutoffs were optimized at lower thresholds. HIV did not affect the performance of WC thresholds in either sex. In rural African populations, thresholds that maximize specificity and PPV for efficient resource allocation may be preferred.

Disclosures
All Authors: No reported disclosures.
1183. Serotype Prevalence and Antimicrobial Resistance Patterns of Streptococcus pneumoniae in Ecuador
Authors: Salazar Grace Johanna , Galarza Margarita , Soria Carmen , Zurita Jeannete , Salgado Johana 
Published: December 2022

Abstract

Background
Streptococcus pneumoniae is a leading cause of pneumonia and meningitis in the world, and it is under-researched in Ecuador. Reported mortality in this country was 280 cases per year. The national policy of the country established the obligatory application of the pneumococcal vaccine to infants in 2010, but there is no such law for adults. The serotypes' distribution and resistance patterns are unknown. This study aims to describe the serotypes and resistance patterns of Strepcococcus pneumoniae isolations in Ecuador.

Methods
A retrospective study of all positive cultures for Streptococcus pneumoniae (blood, other sterile liquids, respiratory, ocular, and ear samples) was conducted in three hospitals and one reference laboratory in Ecuador. Serotype data, E-test results for penicillin and ceftriaxone, resistance patterns and susceptibility to other antibiotics by the Kirby-Bauer test were collected.

Results
A total of 214 samples were evaluated: 18.8% (39) were tracheal secretions, 36.7% (76) sputum, 5.7% (11) cerebrospinal fluid, 17.4% (36) blood, 2.9% (6) pleural fluid, and 27.9% (37) others: ocular, abdominal, and ear secretions.
A wide distribution of serotypes was observed. The most prevalent were 19A, 14 and 3.
Figure 1 shows penicillin resistance increased per year. However, 93,3% (166) of the strains were ceftriaxone susceptible and 100% of the isolates tested showed susceptibility to vancomycin. Susceptibility to levofloxacin was 99.2%; only one isolate was resistant. No microorganism tested for linezolide was resistant. For other antibiotics, a high level of resistance was identified; 69.3% (54) for trimethoprim sulfamethoxazole, 47.5% (107) for erythromycin and 37.6% (104) for clindamycin. Figure 1.S. pneumoniae penicillin susceptibility percet by year in Ecuador

Conclusion
It is important to know the resistance patterns and serotypes of S. pneumoniae for therapeutic and epidemiologic decisions. In countries with more than 12% ceftriaxone resistance to Streptococcus pneumoniae, it is suggested for use as an empiric vancomicyn. Nowadays, in Ecuador, the resistance patterns don’t apply to extended vancomycin use. We do not recommend the empirical use of trimethoprim sulfamethoxazole, macrolides and clindamycin for S. pneumoniae infections.

Disclosures
All Authors: No reported disclosures.