bluuebunny/crossref_metadata_2025_split huggingface dataset:
1235. Anti-HCV Prevalence and Associated Risk Factors in Patients of Psychiatry Hospitals in Latvia
Authors: Tolmane Ieva , Upmace Inga , Azina Inga , Rozentale Baiba 
Published: December 2022

Abstract

Background
According to previous epidemiological studies there is 2.4% prevalence of anti-HCV in Latvian population. Hepatitis C can lead to liver cirrhosis and HCC. There is available an effective HCV treatment with 100% reimbursement. WHO has settled a goal – to eliminate HCV as a public health threat by 2030. The biggest obstacle to achieve this goal is to find an infected persons.
The aim of this study was to screen and analyze the data of patients from Psychiatry hospitals (PH) in Latvia. Patients were screened for hepatitis C infection (anti-HCV) and analyze the possible risk factors.

Methods
795 patients of all PH in Latvia were tested, including 57.1% males and 42.9% females. The mean age was 49 years (range 18 - 93). Data were obtained by performing survey and rapid blood antibody tests. The questionnaire included demographic information and 10 questions on infection risk factors. Study was done from May till October 2021 by HIV Prevention Point workers in PHs of 7 PH in Latvia – Riga, Daugavpils, Liepaja, Strenci, Gintermuiza, Akniste and Vecpiebalga. Data were analyzed using MS Excel and IBM SPSS.

Results
24.8% of patients noted they have been sexually active in the last year, but only 9.9% admitted usage of condoms. 3.8% noted they are or have been used IV drugs. 11.2% of patients have a history of incarceration.
In total 6.8% of performed tests were positive for anti-HCV. Incarcerated persons were positive in 16% of cases, non-incarcerated – in 6%. IV drug users (IVDU) were positive in 49%, non-users – in 4.9%, all differences are statistically significant.

Conclusion
Patients in PH are at higher risk of HCV infection in comparison to population in Latvia. Besides already well known risk groups – IVDU and incarcerated people, we found 2.8 times higher anti-HCV prevalence in psychiatric hospital’s patients, with markedly higher prevalence in those previously incarcerated or IVDU. This study provides valuable data to better identify groups of individuals with higher risk of HCV infection. Latvia. PNC patients should further be tested, especially individuals who have been incarcerated, use or have used IV drugs.

Disclosures
All Authors: No reported disclosures.
1244. Inpatient vs. outpatient initiation of Hepatitis C treatment among hospitalized patients who inject drugs: Lessons from a quality improvement project
Authors: Madeline McCrary L , Roberts Katelyn , Jordan Robyn , Bowman Mary Catherine , Schranz Asher J 
Published: December 2022

Abstract

Background
Hepatitis C (HCV) diagnoses are rising, driven by infections in people who inject drugs (PWID). PWID are identified as a target population for treatment, but access to care is a barrier. At our institution, Addiction Medicine (AM) and Infectious Diseases (ID) routinely screen hospitalized PWID for HCV. Our novel quality improvement project assessed feasibility of starting HCV care processes for PWID inpatient. This included: (1) inpatient e-consults, (2) inpatient treatment initiation with direct acting antivirals (DAAs) when possible, and (3) post-discharge telehealth care.

Methods
The project was implemented at an academic hospital in the Southeast in August 2021, with results observed through April 2022. Patients seen by AM consultants with detectable HCV RNA and interest in treatment were eligible. AM recommended ID e-consults focused on HCV care, which began care coordination, including inpatient treatment initiation in select cases (based primarily on length of stay) (Fig 1). The primary outcome was “likely cure,” defined as treatment completion or SVR-4 (chosen due to concerns for loss to follow up). Cascades of care were constructed including: (1) completed HCV e-consult; (2) linkage to care (defined as telehealth visit for those not initiating inpatient); (3) treatment initiation; and (4) likely cure. Figure 1:Workflow

Results
Twenty patients had detectable HCV RNA and all were interested in treatment. Enrolled patients had a mean age of 33 years; 9/20 (45%) were female; and 17/20 (85%) were White. Of 20 patients (Fig 2), 16 (80%) were linked to care with 13 (81%, 65% overall) started on HCV treatment, of which 9 were started inpatient. Likely cure was achieved for 7, and 6 were still on treatment at the time of this report (Fig 2). Likely cure has so far been achieved in 66% of inpatient initiators (6 of 9), compared with 18% of others (2 of 11) (Figs 3 and 4). 6 patients were lost to follow-up. None of those initiating DAAs inpatient were lost.

Conclusion
Inpatient initiation of HCV treatment for PWID was feasible for patients with prolonged hospitalizations and may be effective at facilitating HCV treatment and cure among a vulnerable population with substantial barriers to care. Future steps should address inpatient barriers to DAAs, and examine models of HCV telehealth.

Disclosures
Asher J. Schranz, MD, MPH, UnitedHealthCare: Honoraria.
1322. Infectious Complications Following Pediatric Lawn Mower Injury: A Case Series
Authors: Weslander Erin , Doyle Joshua D , Nowalk Andrew , Bykowski Michael 
Published: December 2022

Abstract

Background
According to the National Electronic Injury Surveillance System, there are an estimated 9,400 riding lawn mower injuries in the United States in pediatric patients per year. Previous case series report a 7-12.5% infection rate after injury. We report our experience of lawn mower injury-related infections over a 4-year period.

Methods
Cases of lawn mower injury at our center were identified by the ICD-10 code W28.XXXA for contact with a powered lawn mower between 2017-2020. Patient demographics, injury background, microbial results, and antimicrobial use were collected via manual chart review.

Results
During the 4-year period, 25 patients presented to UPMC Children’s Hospital of Pittsburgh who had a diagnosis of lawn mower injury. The median age of the patients was 6.5 years old. Most cases sustained foot injury (68%, 17/25), followed by leg (24%, 6/25), and hand or arm (24%, 6/25). Perioperative antibiotics depended on the extent of the damage, intent to amputate or salvage a limb, and extent of obvious contamination. These included 24-48 hours of piperacillin-tazobactam for 44% (11/25) of patients, ampicillin/sulbactam for 32% (8/25) of patients, and cefazolin for 24% (6/25) patients. Four of the 25 patients (16%) had infection after the initial injury as defined as growth of organisms from a wound culture collected more than 48 hours after the initial injury and debridement. Antimicrobials for the treatment of infection were further tailored to the culture results. From the four patients with infection after initial debridement or amputation, pathogens included: Serratia marcescens, Staphylococcus aureus, Myroides odartus, Stenotrophomonas, Prevotella, Aeromonas, Coagulase negative Staphylococcus, Enterobacter cloacae, Sphingomonas, Bacillus species, Pseudomonas aeruginosa, Candida albicans, Rhizopus, and Trichosporon.

Conclusion
Infections after lawn mower injures are infrequent with early, aggressive surgical debridement. However, infections following lawn mower injuries are frequently polymicrobial and involve a wide variety of pathogens. Obtaining repeat cultures during subsequent surgical debridements can be useful to track persistent growth and identify new and uncommon pathogens.

Disclosures
All Authors: No reported disclosures.
1342. Serial Microbial Cell-Free DNA Next Generation Sequencing (NGS) As A Means of Diagnosis and Monitoring of Clinical Response To Treatment Of Invasive Fungal Infections (IFI) In Immunocompromised Pediatric Patients
Authors: Ashouri Negar , Nieves Delma , Nieves Delma , Singh Jasjit , Arrieta Antonio 
Published: December 2022

Abstract

Background
IFIs are a leading cause of morbidity and mortality in immunocompromised pediatric patients. Early diagnosis and initiation of therapy is critical for treatment success but is often hindered by difficulty obtaining tissue samples, lack of growth on culture and time required for culture positivity. Non-culture methods such as aspergillus galactomannan and 1-3 B-D glucan lack sensitivity and specificity.
NGS has shown promise in identifying a wide array of pathogens. The Karius test is a NGS which can identify viral, bacterial, and fungal infections by detecting cell free pathogen DNA in peripheral blood with a rapid turnaround time. Over the past few years we have used the Karius test as an adjunct to our standard of care in the workup and treatment of IFI in our oncology population

Methods
We report our experience in using serial NGS testing for diagnosis of IFI as well as a means for monitoring clinical response to treatment in our pediatric hematological malignancy population.

Results
Between 12/1/20-12/31/21, 5 patients had serial NGS for IFI. Most common indication for testing was prolonged fever and neutropenia with abnormal imaging. Initial diagnosis was made by NGS in all 5 patients. All had tissue biopsies with fungal elements seen on path in 4 of 5 patients. Culture was positive in 3 of 5 patients (2 days, 10 days and 12 days post NGS testing result). One patient with persistent positive NGS testing was found to have resistance to treatment drug on susceptibility testing and subsequently had negative NGS testing once appropriate antifungals were started. A second patient had sterilization of cultures with concomitant negative NGS results but developed increasing fungal copies on NGS testing followed by positive culture when chemotherapy was resumed and subsequently died due to his infection. 4 of 5 patients had serial negative follow up NGS and continue to do well.
Summary of Diagnostic Work-Up

Conclusion
In our small series of patients, NGS testing allowed for rapid diagnosis of IFIs and corresponded to clinical response to treatment. Future prospective studies will be needed to further evaluate the use of NGS in this patient population.

Disclosures
All Authors: No reported disclosures.
1366. Re-examining the Origins of Ebola virus Emergence
Authors: Judson Seth D 
Published: December 2022

Abstract

Background
Ebola virus (EBOV) is one of four ebolaviruses known to cause Ebola virus disease (EVD). It is widely thought that EVD outbreaks originate from spillover of ebolaviruses from wildlife into humans. However, phylogenetic analysis of EBOV sequences from recent EVD cases reveal genetic similarity to EBOV from prior outbreaks. Therefore, it is likely that these recent EVD outbreaks originated through human-to-human transmission instead of wildlife spillover. The aim of this study is to re-examine the origins and contexts of EVD outbreaks given this new knowledge.

Methods
All known EVD outbreaks and EBOV emergence events from 1976-2021 were analyzed via literature review. The primary and index cases for each outbreak were compared based on demographics and suspected sources of transmission. The diagnostic testing and treatment locations for each EVD index case were also investigated. Phylogenetic and epidemiologic relationships were examined to characterize whether outbreaks likely originated from separate spillover events or human-to-human transmission.

Results
Overall, 22 outbreaks caused by EBOV were identified from 1976-2021 (Table). 5/22 (22.7%) of outbreaks were possibly linked to previous EVD outbreaks, including the four most recent outbreaks. Possible sources for these outbreaks included relapse and delayed sexual transmission from survivors. 12/22 (54.5%) of outbreaks were linked to suspected spillover sources, which included contact with duikers, chimpanzees, gorillas, monkeys, and bats. The locations of these Ebola virus emergence events are shown in the Figure.

Conclusion
Recent EVD outbreaks have changed our understanding of the emergence of EBOV in humans. Most recent outbreaks have originated from human-to-human transmission rather than spillover from wildlife. Multiple large EVD outbreaks have created the potential for future resurgence among humans. Therefore, increased surveillance among humans as well as awareness among healthcare workers and traditional healers, who are often the first to encounter index cases, will be critical to preventing the next epidemic. Clinicians and researchers will need to carefully evaluate the origins of EVD outbreaks through epidemiological and phylogenetic analyses while also preventing stigma among survivors.

Disclosures
All Authors: No reported disclosures.
1372. Unprecedented West Nile Virus Outbreak — Maricopa County, Arizona, 2021
Authors: Kretschmer Melissa , Dale Ariella P , Ruberto Irene , Zabel Karen , Maldonado Keila , Townsend John , Will James , Busser Nicole , Damian Dan , Venkat Heather , Sunenshine Rebecca 
Published: December 2022

Abstract

Background
West Nile virus (WNV) causes a mosquito-borne disease that can lead to permanent paralysis or death. WNV became endemic in Maricopa County in 2003. The Maricopa County Department of Public Health (MCDPH) and Environmental Services Department Vector Control (MCESD VC) and Arizona Department of Health Services (ADHS) collaborated to monitor and respond to mosquito surveillance and human WNV cases. We describe an unprecedented WNV outbreak in 2021.

Methods
MCESD VC monitored vector complaints, mosquito vector positive traps, and vector index (VI) data. Reported human cases (using the CSTE/CDC case definition) were interviewed by MCDPH. MCDPH and ADHS sent surveillance alerts to healthcare providers regarding WNV symptomology and clinical testing guidance. MCDPH consulted with providers and/or Infection Preventionists during case investigations.

Results
The first WNV-positive mosquito trap occurred the week of May 1 (VI=0.235); VI peaked the week of September 11 at 53.608; the last positive trap was the week of November 20. MCESD VC fogged &gt;400,000 acres (∼2x the 10-year average) with adulticide, applied larvicide to ∼25,000 sites, and received ∼9,500 mosquito complaints (40% more than prior season). During the 2021 WNV season, 1,487 cases were reported, of which 960 (64.6%) had neuroinvasive illnesses (WNND) and 101 (6.8%) died (all were WNND cases). Median case age was 66 (IQR=53–75) years; for deaths, it was 79 (IQR=71-83) years. In total, 1,017 (68.4%) cases were hospitalized with a median length of stay (LOS) of 7 (IQR=4–10) days. WNND cases accounted for 91.2% of hospitalizations. Median LOS for hospitalized WNND cases was 7 (IQR=4-11) days, compared to 4 (IQR=2-6) days for non-neuroinvasive cases. Despite 3 surveillance alerts sent to providers and media coverage, providers were not consistently aware of the WNV outbreak or that serum can be tested for WNV.

Conclusion
This was the largest WNV outbreak in Maricopa County. It taxed an already stressed healthcare system during the COVID-19 pandemic with over 1,000 hospitalized cases, including nearly 100 in people without WNND. During WNV season, clinicians should consider WNV testing of both serum and CSF in severely ill patients with and without evidence of neuroinvasive disease.

Disclosures
Ariella P. Dale, PhD, MPH, Infectious Disease Society of America - Arizona Chapter: Honoraria Karen Zabel, MSN RN, Express Scripts: Immediate family member employment.
1380. Impact of Doxycycline Prophylaxis on Skin and Soft Tissue Infections in Naval Special Warfare Trainees
Authors: Spiro Jeffrey , Wisniewski Piotr , Schwartz Julia , Smith Alfred G , Burger Sara , Tilley Drake , Maves Ryan C 
Published: December 2022

Abstract

Background
Several severe cases of SSTIs caused by salt-water associated Gram-negative pathogens (mainly Shewanella algae) among U.S. Naval Special Warfare (NSW) trainees prompted introduction of doxycycline prophylaxis during the highest risk portion of training, “Hell Week”. We present analysis of this intervention’s impact on disease incidence and hospital admission for serious SSTI.
Necrotizing fasciitis caused by Vibrio harveyi in an NSW trainee during “Hell Week” prior to introduction of doxycycline prophylaxis.

Methods
We performed a retrospective cohort study examining data from hospital admissions for SSTI in trainees between 2013-2020. We assessed hospital admission rates for SSTIs, hospitalization rates per SSTI diagnosed at the clinic level, overall rates of SSTI, length of hospital stays and blood and wound culture data. We then compared data from pre- and post-intervention cohorts.

Results
3371 NSW trainees participated in “Hell Week” training during the study period with 284 SSTIs diagnosed overall, 29 of which led to hospital admission. After introduction of doxycycline prophylaxis, admission rates for SSTI decreased from 1.37 to 0.64 admissions per 100 trainees (p=0.036). Overall SSTI rates diagnosed at the clinic level remained stable from 7.42 to 8.86 SSTI per 100 trainees (p=0.185). Hospitalization rates per diagnosed SSTI decreased from 18.4% to 7.2% (p=0.009). Average length of hospitalization decreased from 9.01 days to 4.33 days (p=0.034). Blood and wound culture data showed a notable decrease in SSTI from salt-water associated Gram-negative rods (Shewanella algae and Vibrio spp.).
Total number of SSTI diagnosed at Naval Special Warfare Center (NSWCEN) medical clinic each “Hell Week” training period with corresponding percentage of NSW trainees diagnosed with SSTI in each class. Date of doxycycline prophylaxis initiation labeled for reference.
Wound and blood culture (Cx) data from the pre-intervention and post-intervention cohorts

Conclusion
Doxycycline prophylaxis during “Hell Week” training for NSW trainees was associated with decreased frequency and severity of hospitalization for SSTI, as well as near elimination of infection with invasive salt-water associated pathogens.

Disclosures
All Authors: No reported disclosures.
1393. Body Mass Index Change In People Living With HIV During The COVID-19 Pandemic In New York
Authors: Chang Kai-Ming , Ramirez Guillermo , Vikraman Praveen , Nadi Lemar , Sison Cristina , Oey Michael 
Published: December 2022

Abstract

Background
People living with HIV (PLHIV) suffer from adverse outcomes of metabolic syndrome. We hypothesized the COVID-19 pandemic, particularly with the stay-at-home status in 2020, resulted in physical inactivity and dietary changes leading to increases in weight and body mass index (BMI).

Methods
This retrospective observational chart review evaluated PLHIV at an infectious diseases clinic with a documented BMI from 2017 to 2020. Data on patients’ demographics, comorbidities, and antiretroviral therapy (ART) as of 2020 and the yearly values of BMI, A1c, and LDL from 2017 to 2020 were collected.

Results
Among 256 HIV-infected persons, mean age±SD was 48.5±13.1 (median=51; Q1-Q3: 39.5-57.5; range: 20-78) and 95 (37%) were female. Mean BMI were 28.19±6.32, 28.44±5.95, 28.57±5.91, and 29.00±6.09 for 2017, 2018, 2019, and 2020 respectively. Unadjusted and adjusted analysis showed a significant difference in BMI across time, where the mean BMI in 2020 was significantly higher than in 2017 (p&lt; 0.0001), 2018 (p&lt; 0.0001), and 2019 (p&lt; 0.0001). Furthermore, for each consecutive year prior to 2019, there was no significant difference in mean BMI (2017 vs. 2018, p&lt; 0.3464; 2018 vs. 2019, p&lt; 0.4671; 2017 vs. 2019, p&lt; 0.0861). There was a significant difference in A1c when adjusting for age, sex, race, and ART (Geometric Mean: 5.64, 5.68, 5.68, 5.78 for 2017 through 2020), with the visit year 2020 being significantly higher than 2017 (p&lt; 0.003) and 2019 (p&lt; 0.023) but not 2018 (p&lt; 0.092). There were no significant differences in annual LDL using the same variables for adjustment.
Body mass index (BMI) increased over time from 2017 to 2020
Mean BMI were 28.2±6.3, 28.4±5.9, 28.6±5.9, and 29.0±6.1 for 2017, 2018, 2019, and 2020 respectively.
Pairwise comparison of BMI from 2017 to 2020
Unadjusted and adjusted analysis showed a significant difference in BMI across time, where the mean BMI in 2020 was significantly higher than in 2017 (p&lt;0.0001), 2018 (p&lt;0.0001), and 2019 (p&lt;0.0001). Furthermore, for each consecutive year prior to 2019, there was no significant difference in mean BMI (2017 vs. 2018, p&lt;0.3464; 2018 vs. 2019, p&lt;0.4671; 2017 vs. 2019, p&lt;0.0861).

Conclusion
Among PLHIV at our clinic, there was a substantial BMI increase in 2020, possibly due to the stay-at-home status in early 2020. A previous study utilized questionnaires to estimate the weight change in this patient population but this is the first report of documented BMI in the clinic setting. It is important to note that the magnitude of these differences was small and should be interpreted with caution. On the other hand, depending on a person’s initial height and weight, a one-unit change in BMI may translate to a substantial weight gain, which can be meaningful.

Disclosures
All Authors: No reported disclosures.
1412. Racial Differences in Candidemic Patients at a Southern California Teaching Hospital
Authors: Grant Victoria C , Zhou Anna Y , Abdul-Mutakabbir Jacinda C , Tan Karen K 
Published: December 2022

Abstract

Background
Racial disparities in diagnosis and management of infectious diseases in the US healthcare system have been reported. Candidemia is a leading healthcare associated bloodstream infection and is associated with significant mortality. Further, global rates of azole-resistant C. parapsilosis have dramatically increased. Nonetheless, literature describing racial and ethnic differences among candidemic patients is limited. The objective of this study was to describe infection characteristics and outcomes among non-Hispanic White (n-REM) and racially and ethnically minoritized (REM) patients with candidemia.

Methods
Adult patients hospitalized with ≥ 1 positive blood culture growing Candida between 1/2020 and 12/2021 were included. Based on documented race and ethnicity, patients were dichotomized into the n-REM or REM group. Pertinent data was collected and then compared between groups using univariate analysis. Significance was defined as P ≤0.05.

Results
86 unique episodes of candidemia were included. REM patients were significantly younger (mean age 54 vs 62 years; P = 0.017) and had more risk factors for candidemia (median 4 vs 3). REM patients were also more likely to present with sepsis/septic shock (87% vs 81%) and require an ICU stay (57% vs 53%). Time to detection of candidemia was shorter in the REM group (median 38.5 vs 43 hours); however, time to initiation of active antifungal therapy was longer (median 48 vs 44 hours). Additionally, hospital LOS was longer in the REM group (median 25.5 vs 19.5 days). Central line infection was the most common source of candidemia. Despite similar documented sources of infection, microbiological differences were noted. Candida glabrata was more often isolated in n-REM patients (50% vs 27%; P = 0.04), whereas C. parapsilosis was more often isolated in REM patients (17% vs 3%; P = 0.048).

Conclusion
Despite being younger, REM patients were at an increased risk for candidemia. Furthermore, C. parapsilosis, a globally growing species of concern due to azole resistance, was more frequently isolated among REM patients. Rapid detection and speciation of candidemia may be particularly important among REM patients to ensure early initiation of optimal therapy. Further research exploring racial differences among candidemic patients is needed.

Disclosures
All Authors: No reported disclosures.