bluuebunny/crossref_metadata_2025_split huggingface dataset:
413. Cost effectiveness of rectal screening for ESBL producing organism in preventing urosepsis following transrectal prostate biopsy
Authors: Hines Laena , Munsiff Sonal , Obrien Jeanne 
Published: December 2022

Abstract

Background
Urosepsis following transrectal ultrasound guided prostate biopsy (TRUS PB) occurs in 0.3-3.1% of patients. Our center gives ciprofloxacin and ceftriaxone prophylaxis. With rise in urinary pathogens resistant to fluoroquinolones or producing extended spectrum beta lactam (ESBL+), prophylactic regimen might need changing. Studies have highlighted cost effectiveness of rectal screening for ESBL+ organism prior to TRUS PB to determine target antibiotic. We compare our center’s incidence of urosepsis admissions following TRUS PB to the expected rate and calculate cost-effectiveness of pre-procedure screening to prevent urosepsis admissions.

Methods
All patients with CPT billing code 55700 (biopsy, prostate; needle or punch, single or multiple, any approach) from January 2020 through January 2021 were identified retrospectively. Charts were queried for emergency department or urgent care visits and hospital admissions within two weeks of TRUS PB and admissions reviewed for evidence of urosepsis and ESBL+ cultures. Hospitalization cost was compared to the extrapolated cost of doing pre-procedural rectal swabs. Cost of rectal swab and culture was estimated at $39.02 per swab, and identification and susceptibility at $67 per isolate.

Results
33 of 1593 patients presented to our institution within 2 weeks of TRUS PB over a 13 month period. 3 were admitted for urosepsis post TRUS PB (2 with ESBL+ infection, 1 with no growth on culture), 12 had ED visits relating to their TRUS PB without urosepsis, (2 due to UTI with other organisms) and 18 visits were unrelated to TRUS PB. Our urosepsis admission rate was 0.19% (for ESBL+ 0.13%). Cost of the 3 hospitalizations was $37,910.92 ($27,063.76 for 2 ESBL+ infections). Rectal swabs would in theory have prevented 2 admissions. Cost of swab and culture would be $62,158.86. 50% of the swabs would need further testing to identify ESBL+ organism, for an additional cost of $53,365.50.

Conclusion
Given lower than expected urosepsis admission rates at our institution after TRUS PB, pre-procedure rectal swabs would not be cost effective, especially since some admissions may be unavoidable. The cost analysis is an underestimate as a visit some days prior to procedure would be scheduled and the staff resource utilization to collect the swab is not accounted for.

Disclosures
All Authors: No reported disclosures.
420. ­­Impact of Intensified Prevention Measures On Rates of Hospital-Acquired Carbapenem-Resistant Acinetobacter baumannii In Endemic Setting
Authors: Ben-David Debby , Cohen Yael , Yakovov Malka , Raviv Lili , Esmansky Ekaterina , Mazo Eduard , Belichkov Julia , Tasher Diana , Schwartz Orana , Maor Yasmin 
Published: December 2022

Abstract

Background
During the last decade, hospital-acquired carbapenem-resistant Acinetobacter baumannii (HA-CRAB) have become endemic in acute care facilities in Israel. Despite the increasing rates CRAB carriage among hospitalized patients in endemic settings, the role of active surveillance cultures (ASC) is still debated. The aim of the study was to evaluate the impact of different components of control measures conducted in an endemic acute care hospital

Methods
The study consisted of a 12-month baseline period (1 January 2019–31 December 2019; period 1), 12-month 1st intervention period (1 January 2020- December 2020; period 2); 6-month 2nd intervention period (1 January 2021-30 June 2021; period 3) and a 9-month follow-up period (1 June 2021–31 March 2022; period 4). During period 1, basic infection-control measures were implemented including contact precautions for CRAB carriers. During period 2, all CRAB carries were cohorted in a single ward and managed by dedicated health care workers. Enhanced environmental cleaning was conducted by a dedicated team. During periods 3 and 4, high-risk patients were screened on admission; weekly cultures were obtained in high-risk units. The incidence density rate (IDR) of HA-CRAB was defined as the per-patient number of first CRAB isolate from clinical specimens. Incidence rates ratios (IRR) were compared between the study periods.

Results
During the baseline period, IDR of HA-CRAB was 4.9/10,000 patient days (PD). During period 2, no significant decrease was observed (IDR 3.9/10,000 PD, IRR 0.7 95% CI 0.49-1.16, p=0.15). In response to ongoing transmission in several wards, ASC program was initiated in January 2021. IDR during period 3 was 5.3/10,000 PD (IRR 1.1, 95% CI 0.74- 1.56, p=0.64). Since January 2021, 2.1% (78/3799) were found to be colonized on admission and 5.5% (100/1809) were detected by weekly screening. Among the 291 patients who were detected with CRAB during this period, 70.9% were identified by ASC. During period 4, IDR was 3.1/10,000 PD (IRR 0.60, 95% CI 0.40-0.88, p=0.007).

Conclusion
The comprehensive intervention that combined intensiﬁed control measures with routine ASC was effective in reducing the incidence of HA-CRAB in endemic setting.

Disclosures
Yasmin Maor, MD, MSD: Advisor/Consultant|MSD: Honoraria|Pfizer: Honoraria.
421. In vitro and in vivo synergistic antimicrobial activities of the combinations of meropenem, colistin, tigecycline, and ceftolozane/tazobactam against carbapenem-resistant Klebsiella pneumoniae
Authors: Yoon Young Kyung , Kim Jeong Yeon , Suh Jin Woong , Sohn Jang Wook 
Published: December 2022

Abstract

Background
The aim of this study was to evaluate the in vitro and in vivo activities of various antimicrobial combinations against carbapenem-resistant Klebsiella pneumoniae (CRKP).

Methods
The in vitro activity of six two-drug combinations against CRKP isolates collected from the rectal swab samples of patients with intestinal CRKP colonization was evaluated using the checkerboard method and time-kill assay to identify potential synergistic and bactericidal two-drug combinations against CRKP isolates. The in vivo efficacy of the combinations of colistin, meropenem and ceftolozane/tazobactam (C/T) as therapeutic options, was assessed in a mouse model of intraperitoneal CRKP sepsis. Antimicrobial susceptibility and genotypes of carbapenem-resistance were also analyzed.

Results
A total of 5 clinical isolates of CRKP were collected from nonduplicate patients with CRKP infection. Of 5 CRKP isolates, 4 carried the blaKPC-2-type carbapenem-hydrolyzing enzymes except 1 blaNDM-1-type. Antimicrobial susceptibility rates were tigecycline 80%, colistin 40%, and C/T 0%, respectively. The checkerboard assay showed that in vitro synergistic activity against CRKP isolates was 90% for the meropenem-tigecycline combinations and 20% for colistin-C/T combinations. None of the various combinations of the six antibiotics showed a synergistic effect in the time-kill assay. However, the meropenem-colistin (100%) and colistin-C/T (100%) combinations showed bactericidal effects in the time-kill assay (using an antibiotic concentration of 1× MIC) (Table). The survival rates of the mice was 80% (4/5) at 48 h in the treated group using low dose combinations of colistin (10 mg/kg) and C/T (25 mg/kg), unlike both antibiotics, which were 60% in a monotherapy with the same dose (Figure).
Comparison of checkerboard assay and time-kill assay
Comparison of checkerboard assay and time-kill assay associated with the bactericidal activity of two-drug combinations (1 × MIC) against each carbapenem-resistant Klebsiella pneumoniae isolate
In vivo survival tests for antimicrobial combinations
Comparison of the survival rates of the mice in the treated group using antimicrobial combinations

Conclusion
In conclusion, the present in vivo study demonstrated that the low-dose combination of colistin and C/T may be a promising alternative to nephrotoxic high-dose colistin alone for treating CRKP infections. However, it was difficult to predict this possibility in in vitro tests, and even there is great discordance of antimicrobial synergistic activities between the checkerboard microdilution and time-kill assays.

Disclosures
All Authors: No reported disclosures.
423. Molecular Epidemiology of ESBL E. coli Over a 2 Year Period in Worcester Massachusetts USA
Authors: Hathaway Nicholas J , Ward Doyle V , Ellison Richard T 
Published: December 2022

Abstract

Background
Extended-spectrum beta-lactamase (ESBL) producing Escherichia coli are an increasing health burden contributing to a pandemic of resistant bacteria.

Methods
To better understand the population genomics of ESBL E. coli, 129 phenotypically identified ESBL isolates collected between 2017-04 to 2018-11 from a single academic medical center underwent whole genome sequencing with the presence of antibiotic resistance genes identified by screening against the CARD database. The odds of phenotypic resistance to beta-lactam agents were calculated for each known resistance gene. A novel approach based on k-mer-enrichment among antibiotic resistance gene groups was developed to predict genes associated with phenotypic resistance.

Results
Genomic analysis revealed that 60% of the ESBL isolates collected were pandemic strain ST131. All isolates contained at least 1 gene in the beta-lactamase family with a median of 3 different beta-lactamase genes being present. Ninety-five percent of isolates contained a CTX-M gene with 52% CTX-M-15, 43% CTX-M-27, 5% other CTX-M; 24% had OXA and 34% had TEM. The presence of CTX-M-15 significantly increased the odds of resistance to ampicillin-sulbactam (95% confidence interval 5.9-116.5, p-value &lt; 1e-7), ceftazidime (4.2-25.9, p&lt; 1e-6) and cefepime (3.6-20.1, p&lt; 1e-5) but not to piperacillin-tazobactam (0.9-6.3, p 1). CTX-M-27 decreased the odds of resistance to these 4 beta-lactams (0.003-0.07, p&lt; 1e-13; 0.04-0.3, p&lt; 1e-05; 0.06-0.4, p&lt; 0.001; 0.03-0.6, p 0.11). TEM-1 significantly increased the odds for ampicillin-sulbactam resistance (3.8-1036.7, p&lt; 1e-3) but not for other beta-lactams. Our de novo sequence approach was able to identify the known genes listed above and also identified a 683 bp open reading frame with unknown function that had increased odds of resistance to piperacillin-tazobactam resistance (2.1-43.6, p&lt; 1e-3). This 683 bp open reading frame did not share any homology with known beta-lactamases.

Conclusion
The majority of phenotypic ESBL isolates contain multiple beta-lactamase genes. The presence of CTX-M-15 appears to increase the odds of resistance to key beta-lactam agents. Our novel k-mer-enrichment approach identified a novel marker of piperacillin-tazobactam resistance.

Disclosures
All Authors: No reported disclosures.
424. Risk Factors for Infection or Colonization with Piperacillin-tazobactam (TZP) Resistant P. aeruginosa (PSA) with Increasing Degrees of β-lactam Resistance
Authors: Vita Angelina Jessica A , Rice Seth , Albin Owen , Patel Twisha S , Styron Charles N , Kaye Keith S , Pogue Jason M 
Published: December 2022

Abstract

Background
Resistance to β-lactams amongst PSA is common with roughly 20% of isolates demonstrating resistance to TZP. This can lead to delays in the time to appropriate empiric therapy. While rapid diagnostics can identify PSA at earlier time points, they fail to detect common β-lactam resistance mechanisms in this pathogen. Though risk factors for TZP resistance (TZP-R) amongst PSA have been identified, co-resistance amongst traditional anti-PSA β-lactams is common, so decisions to turn to other traditional anti-PSA or novel agents in the presence of such predictors are unclear. This study aims to find predictors unique to varying degrees of β-lactam resistance amongst TZP-R PSA to inform these decisions.

Methods
This was a retrospective case-case-case-control study of all non-cystic fibrosis patients with PSA isolated from a culture from 2015-2021 at Michigan Medicine. Four study groups were created based on the susceptibility profile of PSA: TZP susceptible (TZP-S), resistance to TZP only (TZP-R ONLY), resistance to TZP in addition to 1 or 2 other traditional anti-PSA β-lactams (TZP-R PLUS), and resistance to all traditional anti-PSA β-lactams (pan β-lactam resistance, PBR). Bivariate and multivariate analyses were performed to compare each degree of TZP resistance to the TZP-S group. Results were then compared across models to assess uniqueness to a given resistant phenotype.

Results
2365 patients were included, and results of the multivariate analyses are listed in the table. The sole predictor of TZP-R ONLY was recent ceftriaxone or cefotaxime use. Independent predictors unique to TZP-R PLUS were community acquired infection, recent ICU residence, and recent exposure to TZP or aztreonam. Most risk factors identified were either unique to PBR or shared between PBR and TZP-R PLUS including history of PSA, history of TZP-R PSA, and recent exposure to multiple antibiotics.
Multivariate Models for TZP-R ONLY, TZP-R PLUS, and PBR

Conclusion
This analysis demonstrates that previously identified risk factors for TZP-R P. aeruginosa are predictors of PSA with greater degrees of resistance. Given these findings, consideration needs to be given to escalation to novel agents in the presence of risk factors at the time of PSA isolation, rather than to other traditional anti-PSA β-lactams.

Disclosures
Owen Albin, MD, Charles River Laboratory: Advisor/Consultant|Cipla Pharmaceuticals: Advisor/Consultant|Shionogi Inc: Advisor/Consultant Keith S. Kaye, MD, GSK: Advisor/Consultant|merck: Advisor/Consultant|merck: Stocks/Bonds|Qpex: Advisor/Consultant|Shionogi: Advisor/Consultant|Spero: Advisor/Consultant jason M. Pogue, PharmD, consultant to Venatorx, Merck, Shionogi, QPex Biopharma, Utility, GSK, and Entasis.: Advisor/Consultant.
435. Investigation of the cause of low measles seroprevalence among young healthcare workers in South Korea
Authors: Joo Jiyeon , Chung Hyemin , Kim Sun-Kyung , Kim Eun Ok , Kim Min Jae , Jung Jiwon , Kim Sung-Han 
Published: December 2022

Abstract

Background
After a large measles outbreak in 2000∼2001, national measles vaccination program was implemented in Korea, and more than 95% of people born after 1985 have been vaccinated with 2-dose MMR. But sporadic outbreaks have continued to occur mainly in adults in their 20’s and 30’s in 2014 and 2019. Although low prevalence in young adults have been reported, there are limited data regarding the cause of low seropositivity (positive vaccine failure vs. secondary vaccine failure). We aimed to evaluate the cause of low seroprevalence of measles.

Methods
This study was performed in a 2743-bed tertiary-care hospital in South Korea. At 1-month after MMR vaccination in healthcare workers (HCWs) who were seronegative for measles, we performed measles antibody test(enzyme immunoassay), IgM/IgG index ratio, and avidity test.

Results
Of the 1,698 new HCWs in 2020 and, 1,686 in 2021, 54 HCWs with negative measles IgG at their entering at our hospital were enrolled in this study. Of these, 36(67%) were female, and the median age was 25 (IQR, 24-27) years. Of 43 HCWs who measured IgM/IgG index 1 month after MMR vaccination, 38 HCWs had IgM/IgG index of less than 1 and remaining 5 had negative IgG results (seroconversion rate of 88%). All 54 healthcare workers who performed avidity test showed high avidity index Measles vaccination record in KCDA showed that 45 had documented vaccination record during their childhood (of these, 11 received MMR vaccine again during their adult age) and remaining 9 had no documented vaccination record during their childhood. Of these 9 healthcare workers without record in their childhood, 3 had a history of vaccination at adult. Analyzing 48 healthcare workers with vaccination record, they received MMR vaccination median 18 years (IQR, 7-20) before. Therefore, at least 48 received at least 2 dose MMR vaccination, and 11 received at least 3 dose MMR vaccination.

Conclusion
Secondary vaccine failure may be the reason for vaccine failure in young adults in Korea. Therefore, HCWs with negative measles antibody who were born after 1985 may receive 1 dose booster vaccination rather than 2 dose vaccination.

Disclosures
All Authors: No reported disclosures.
438. An Observational Study Evaluating the Seroprotection of HepB-alum Vaccine and HepB-CpG Vaccine in Adults Living with HIV
Authors: Reilly-Evans Brenna , Dudzik Beatrix , Costlow David J , Hartmann Carlos , Khalsa Ann M , Kassis Christelle , Zmarlicka Monika 
Published: December 2022

Abstract

Background
Hepatitis B virus (HBV) vaccine seroprotection rates with conventional aluminum adjuvanted recombinant HBV vaccines (HepB-alum) among people with HIV (PWH) are varied. HepB-CpG, a novel adjuvanted recombinant HBV vaccine, has shown higher seroprotection rates in immunocompetent patients but is not well studied in PWH. There are no published studies comparing seroprotection rates between HepB-alum and HepB-CpG in PWH. The purpose of this study was to evaluate and compare the seroprotection incidence of HepB-CpG versus HepB-alum in adults at least 18 years of age with HIV.

Methods
This retrospective, observational, cohort study screened for inclusion adults diagnosed with HIV who received a 3-dose series of HepB-alum or a 2-dose series of HepB-CpG between January 1, 2015 through December 31, 2021 at a community health center in Phoenix, Arizona. Patients who had a confirmed diagnosis of HIV and a hepatitis B surface antibody &lt; 10 IU/L at the time of the first vaccine dose were included until an adequate sample size was achieved. The primary outcome was to compare seroconversion incidence of HepB-CpG and HepB-alum in PWH. Secondary outcomes included identifying factors associated with an increased likelihood of response to HBV vaccination. Seroconversion incidence data was analyzed using Fisher’s exact test using BlueSky Statistics.

Results
A total of 121 patients were included in this study, 59 in the HepB-alum cohort and 61 in the HepB-CpG cohort. In the HepB-alum cohort, 57.6% (34/59) achieved seroconversion, compared to 93.4% (57/61) in the HepB-CpG group (p &lt; 0.001). Univariate comparisons of comorbidities among the vaccine cohorts found no significant differences in sex, body mass index, diabetic status, kidney/liver disease, CD4 count, HIV viral load, or active/prior history of substance use.

Conclusion
Among PWH at a single community health center, HepB-CpG provided a statistically higher incidence of seroprotection against HBV compared to HepB-alum. The higher seroprotection rate for HepB-CpG versus HepB-alum patients is not due to differences in group demographics or reported comorbidities.

Disclosures
Carlos Hartmann, MD, Viiv Pharmaceuticals: Speaker.
440. Assessing Motivators and Barriers in Anal Cancer Screening for People with HIV
Authors: Geba Maria C , Kalluri Divya , Cardenas Benjamin , Mitchell Emma , Flickinger Tabor , Dillingham Rebecca , Thomas Tania A 
Published: December 2022

Abstract

Background
There is a rising prevalence of anal cancer in people with HIV (PWH) with recent evidence showing efficacy of screening procedures in preventing progression to anal cancer. A recent retrospective cohort study in our Ryan White HIV/AIDS Program (RWHAP) clinic evaluating engagement and retention in anal cancer screening services identified a significant gap in engagement in care among those eligible. This highlighted a need to identify and address barriers to engagement in screening services.

Methods
Semi-structured qualitative interviews were performed on people eligible for anal cancer screening in the RWHAP clinic at the University of Virginia. Participants were at least 35 years old and receiving HIV care in the clinic. Recruitment was carried out by convenience sampling via internal clinic advertising and a tailored mobile app. Interviews were constructed using the health belief model and themes explored included perceived risks, benefits, and barriers to screening, as well as self-efficacy and cues to action.

Results
Prominent barriers to engaging in anal cancer screening services included lack of awareness about screening procedures and stigma associated with sexual practices and sexual orientation. Notable motivators to engaging in screening services were education and familiarity with cancer prevention as well as trust in RWHAP clinic providers and staff.

Conclusion
Our findings highlight the importance of eliciting patient perspectives as a critical and powerful tool when evaluating and improving on a screening program’s performance. There is a resounding need to promote awareness of anal cancer screening among PWH in order to empower those at risk to seek effective preventative services. Raising awareness will involve careful and thoughtful messaging to de-stigmatize and normalize anal cancer screening in PWH.

Disclosures
Rebecca Dillingham, MD, MPH, WHT, INC: Advisor/Consultant.
445. High HCV Treatment Success among People Living with HIV - Kyrgyzstan, 2018-2021
Authors: Kyzy Nasyat Kemelbek , Horth Roberta , Karagulova Aida , Alaverdyan Sevak , Mergenova Gaukhar , Otorbaeva Dinara , Nabirova Dilyara 
Published: December 2022

Abstract

Background
People living with HIV (PLHIV) with viral hepatitis C (HCV) co-infection have higher risk of liver failure and mortality. Globally, &gt;2 million people globally have HIV/HCV co-infections. Central Asia is one of the regions most affected by HCV. Since 2018, Kyrgystan has provided HCV treatment free of charge to 427 PLHIV. We analyzed factors associated with HCV treatment success among PLHIV in Kyrgystan.

Methods
We conducted retrospective cohort survey among PLHIV &gt; 18 years old on HIV antiretroviral treatment that completed viral hepatitis C treatment before September 2021. We defined treatment success as having RNA PCR &lt; 15 IU/mL post-treatment and negative DNA PCR 12 and 24 weeks post-treatment. We abstracted demographic, clinical, and laboratory data from the national registry and interviewed consenting participants using structured questionnaires. We used logistic regression to identify factors associated with treatment success.

Results
Of 302 participants, 81% were ≥ 40 years old, 79% were male, 72% had ever injected drugs, 53% had ever been incarcerated, and 15% were on methadone. Treatment outcomes were classified as success among 86%. Reluctance to seek healthcare services due to fear of HIV status disclosure was reported by 39% of participants and was associated with reduced odds of treatment success (adjusted odds ratio [AOR]: 0.4, 95% CI: 0.2-1.0). Participants receiving SMS counseling (64%) had increased odds of treatment success (AOR: 2.4, 95% CI: 1.2-5.4) as did those who followed an HCV diet (AOR: 31, 95% CI: 1.4-6.8). Participants with an opportunistic infection (32%) and or HIV stage 3 or 4 (49%) also had decreased odds of treatment success (AOR: 0.3, 95% CI: 0.1-1.3; and AOR: 0.1, 95% CI: 0.01-0.5, respectively). Initiation of care in 2020 (COVID-19 pandemic beginning) was also associated with reduced odds (AOR: 0.3, 95% CI: 0.1-1.0).

Conclusion
Our study found high HCV treatment success in a difficult-to-treat population including during the COVID-19 pandemic. Programs that reduce stigma towards people living with HIV, promote early engagement in care, and provide SMS-based counseling could help increase treatment success for PLHIV in groups at higher risk for non-retention in care.

Disclosures
All Authors: No reported disclosures.