bluuebunny/crossref_metadata_2025_split huggingface dataset:
1972. Sources of COVID-19 Exposure Among Health Care Personnel in a Large Tertiary Care Medical Center.
Authors: Shaw Jana , Steigerwald Heidi , Suits Paul , Thomas Stephen J , Formica Margaret 
Published: December 2022

Abstract

Background
Introduction: Health care personnel (HCP) are at increased risk for SARS-CoV-2 exposure. However, the exposure sources among HCP are poorly understood.

Methods
Design: We conducted active surveillance for all employed HCP newly diagnosed with COVID-19 between March 2020 and February 2022. We inquired about their sources of exposure using a standardized health department checklist and CDC guidance for managing healthcare personnel with SARS-CoV-2 infection or exposure.

Results
Among all 8,766 HCP, 2,220 (25.3%) tested positive. Among positive cases, 749 (33.7%), 651 (29.3%), and 221 (10%) were among ancillary services HCP, RNs, and allied HCP, respectively (Table 1). The majority of the sources of exposures were unknown (57.8%), followed by household (26.2%), community (10.5%), and health care (5.5%), respectively. The incidence of COVID-19 increased with level of patient contact regardless of source of exposure. The majority of the cases, N=1054 (47.5%), occurred among HCP who were not up-to-date on COVID-19 vaccines and had unknown exposure, and vaccination status varied by source of exposure (Table 2). HCP COVID-19 cases mirrored transmission in the community (Figure). Table 1.Incidence of COVID-19 Among Employed HCP Overall and by Exposure Type (N=8766)Table 2.Vaccine status among Employed HCP Covid-19 Cases by Source of Exposure (N=2220)Figure.HCP COVID-19 cases by exposure type (Left Axis) in the Central New York region (Right Axis) between March 2020 and February 2022.

Conclusion
The majority of HCP cases had no known exposure to SARS-CoV-2 and were not up-to-date on COVID-19 vaccines highlighting the importance of vaccination as the single most effective mean to COVID-19 prevention among HCP.

Disclosures
Jana Shaw, MD,MS,MPH, Pfizer: Advisor/Consultant Stephen J. Thomas, MD, Clover: case adjudication committee (compensated for time)|EdJen: Advisor/Consultant|Icosavax: data monitoring (compensated for time)|Island Pharma: Ownership Interest|Merck: Advisor/Consultant|Moderna: chair, safety monitoring committee (compensated for time)|New Day Diagnostics: Honoraria|Pfizer: Advisor/Consultant|PrimeVax: Ownership Interest|Sanofi Pasteur: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: case adjudication committee (compensated for time)|Vaxxinity: data monitoring committee (compensated for time).
1975. Trends in the parents’ intention to vaccinate their children against COVID-19: A comparative study in Peru
Authors: Gonzales-Zamora Jose A , Soriano-Moreno David , Ponce-Rosas Linda , Alarcón Parra Mariano G , Morocho-Alburqueque Noelia , Murrieta-Ruiz Valentina , De-Los-Rios-Pinto Abraham , Soriano-Moreno Anderson , Caira-Chuquineyra Brenda , Ccami-Bernal Fabricio , Fernandez-Guzman Daniel , Alave Jorge 
Published: December 2022

Abstract

Background
Although COVID-19 vaccination has shown to be clearly beneficial in children and adolescents to reduce hospitalization and potentially transmission, there is still a lot of hesitation among parents due to concerns about vaccine safety and efficacy, especially in children under 12 years of age.

Methods
We conducted a comparative study in Peru to evaluate the trends in parents’ intention to vaccinate their children under 12 years of age against COVID-19, for which an online survey was administered. The survey was distributed through social networks (Facebook, Twitter, etc.), and was applied during two periods: 11/25/2021 to 12/06/2022 (Period 1) and 01/16/2022 to 01/24/2022 (Period 2). We also assessed the factors associated with the intention to vaccinate in each period through crude (cPR) and adjusted prevalence rates (aPR).

Results
During period 1, there were 673 participants (69.7% women). In period 2, we had 1139 respondents (77.7% women). Regarding intention to vaccinate, 83.5% of parents intended to vaccinate their children under 12 years of age during period 1. This percentage was almost the same during period 2 (83.3%). During period 1, the factors associated with a decrease in this intention were to believe that the vaccine was not necessary (aPR 0.65; 95% CI 0.44 – 0.94, p=0.022), that it would not protect (aPR: 0.14; 95% CI 0.03 – 0.63, p=0.011), that it would not be safe (aPR: 0.80; 95% CI 0.70 – 0.92, p=0.001), that it could cause long-term side effects (aPR: 0.92; 95% CI 0.85 – 1.00, p=0.037), and to think it should not be mandatory (aPR: 0.89; 95% CI 0.80-0.99, p=0.038). During period 2, besides the factors identified in period 1, not knowing about COVID-19 infection risk in children (aPR: 0.92; 95% CI 0.85-1.00, p=0.042) was also associated with a decrease in the intention. Living on the highlands or jungle was associated with an increase in the intention in both periods.

Conclusion
A high rate of intention to vaccinate children under 12 years of age was noted among parents in Peru, which was maintained until the end of January of 2022, right before COVID-19 vaccination started for this age group. There was a perception in some parents that the vaccine might not be necessary or safe, leading to a lower intention to vaccinate their children.

Disclosures
All Authors: No reported disclosures.
1981. Alternatives to guideline directed therapy in bacterial endocarditis
Authors: Ruiz-Conejo Marice , El-Dalati Sami , Stoner Bobbi Jo 
Published: December 2022

Abstract

Background
Existing society guidelines recommend therapy with intravenous antibiotics for 4-6 weeks for most cases of endocarditis. Recent literature has demonstrated that partial oral antibiotic treatment is non-inferior to intravenous therapy and that partial treatment with dalbavancin or shorter durations of therapy in patients undergoing valve surgery can also lead to positive clinical outcomes. However, there is not currently a standardized approach to how these alternative treatments should be utilized.

Methods
A standardized protocol for use of shortened duration of antibiotic treatment post-operatively, oral antibiotic therapy, and dalbavancin was developed by the endocarditis consult service in conjunction with the University of Kentucky multidisciplinary endocarditis team. Subsequently, consecutive patients with endocarditis treated with these alternative therapies were identified and reviewed by study investigators. The primary outcomes were 90-day mortality, 30-day readmission, relapsed infection, and completion of therapy.

Results
Between September 7th, 2021 and April 15th, 2022 we identified 20 cases of endocarditis managed with one of the alternative treatment regimens. Fourteen patients had recent injection drug use. Twelve patients were initially treated with partial oral therapy. Five patients were initially treated with dalbavancin. Three patients received two-week courses of intravenous antibiotics after valve surgery. For all patients, 90-day mortality was 0% and 30-day readmission rate was 10%. Ten patients completed oral treatment. Three patients completed therapy with Dalbavancin with two patients transitioning to the oral group due to side effects. All three patients with shortened durations of therapy completed treatment. One patient treated with dalbavancin with crossover to oral therapy developed relapsed bacteremia with the same organism after self-discontinuing a suppressive oral antibiotic.

Conclusion
A systematic approach involving a multidisciplinary team can allow for successful utilization of alternative approaches to guideline directed treatment for endocarditis with high rates of therapy completion, low rates of mortality, re-admission, and relapsed infection, including in persons who inject drugs.

Disclosures
All Authors: No reported disclosures.
1986. Multicenter evaluation of Staphylococcus aureus prosthetic valve infective endocarditis with and without gentamicin treatment: Is it time to revisit?
Authors: Pham Tho H , Molina Kyle C , Erdman Grace , Miller Matthew A , Huang Vanthida 
Published: December 2022

Abstract

Background
Staphylococcus aureus prosthetic valve infective endocarditis (SA-PVIE) is associated with high mortality. Gentamicin (GEN) with anti-staphylococcal antibiotics and rifampin are guideline recommendations for SA-PVIE extrapolated from in vitro data. GEN can lead to acute kidney injury (AKI), meanwhile, the clinical benefit on infection-related outcomes remains unclear. Therefore, we evaluated the impact of GEN on outcomes in SA-PVIE.

Methods
This is a multicenter, retrospective cohort conducted at HonorHealth and UCHealth systems. Adults admitted between January 2014-2022 with definite/possible SA-PVIE by Duke Criteria were included if they received ≥2 days of treatment within 2 days of index culture. Cohorts were stratified by GEN receipt. The primary outcome was 90-day all-cause mortality. The secondary outcomes were treatment failure (change in antimicrobials, abscess development, new indication for cardiac surgery), 30-day all-cause mortality, and incidence of AKI by KDIGO Criteria.

Results
Overall, 38 patients with definite (40%) and possible SA-PVIE (60%) met inclusion (13 GEN, 25 without GEN [no-GEN]). At baseline, 15 (40%) patients were in an ICU, median Pitt bacteremia score was 2, and methicillin-susceptible S. aureus predominated (71%). A total of 10 (26%) patients had valve surgery; median bacteremia duration was similar between GEN and no-GEN (4 vs 3 days, p = 0.26). Common antibiotics were vancomycin (95%), cefazolin (63%), and nafcillin (21%); rifampin was more common in GEN than no-GEN (20% vs 77%, p &lt; 0.001). Baseline AKI (44% vs 46%) and renal impairment (8% vs 0%) were not different between GEN and no-GEN, respectively. GEN was initiated a median 3 days after index culture, most commonly as intermittent strategy (69%) with 3 mg/kg daily equivalent (84.6%). There was no statistical difference in treatment failure (23% vs 24%, p=0.17), 30-day mortality (20% vs 39%, p=0.22), or 90-day mortality (28% vs 43%, p=0.263) between GEN and no-GEN, respectively. Three in the (23%) GEN group experienced AKI, compared to 10 (40%) in no-GEN.

Conclusion
We did not find that the addition of GEN to SA-PVIE therapy enhanced mortality benefit, yet patients without GEN may live to experience adverse events. Further studies were warranted.

Disclosures
All Authors: No reported disclosures.
1989. Prognostic Factors Associated With In-hospital Mortality In Patients With Infective Endocarditis In 4 Colombian Hospitals From 2007 To 2017
Authors: Pérez María Alejandra , Zuluaga Juan , Dennis Rodolfo , Kock Joshua , Millán Henry , Noreña Ivan , Uribe Luis , Ospina Leonardo , Gerson Arias 
Published: December 2022

Abstract

Background
In Colombia there are few studies on the behavior of this disease, with incidence reports of 8.3 patients per 100,000 inhabitants per year. This study is the first to be carried out in several centers in the country with the aim of reaching a representative number of patients with endocarditis, and thus reflect the behavior of this pathology in Colombia, determining possible associations with prognostic factors for mortality.

Methods
Observational, multicenter, analytical, historical cohort study, which was carried out in 4 high-complexity hospitals in Colombia from 2007 to 2017. The target population was adult patients hospitalized between 2007 and 2017 in the hospitals of: Fundación cardioinfantil (Bogotá), Hospital Mayor de Méderi (Bogotá), Shaio Clinical Foundation (Bogotá), and the Cardiovascular Foundation of Colombia (Bucaramanga) with a diagnosis of definitive infective endocarditis. As inclusion criteria, patients over 18 years of age hospitalized in these institutions and who met the definitive infective endocarditis criteria according to the modified Duke criteria were taken into account. Those patients without complete information in the clinical history for the collection of variables were excluded.

Results
308 patients were included In hospital mortality was 32.7%. The main prognostic variables were: Complication with renal replacement therapy OR 6,669 CI 3.77 - 12.17, p&lt; 0.001, moderate mitral compromise OR 3.9 CI 1.02-17.5, p=0.057, renal replacement therapy (RRT) prior to hospitalization OR 3.72 CI 1.89 - 7.51, p &lt; 0.001 and central nervous system embolism OR 2.6 CI 1.53 - 4.44, p&lt; 0.001. As protective factors: surgery during hospitalization OR 0.39 CI 0.24 - 0.64, p&lt; 0.001 and tricuspid involvement OR 0.39 IC 0.15 - 0.87, p=0.032.
Multivariate analysis of mortality with prehospital variables in patients with infective endocarditis.
Abbreviations: GFR, Glomerular Filtration Rate. CKD-EPI, Chronic kidney disease epidemiology collaboration. LVEF, Left Ventricular Ejection Fraction
Multivariate analysis of mortality with hospital variables in patients with infective endocarditis
Abbreviations: RRT, renal replacement therapy. CNS, Central nervous system, mm: millimeters.
ROC curve of the mortality prediction model with pre-hospital variables

Conclusion
Both the epidemiological characteristics and in-hospital mortality are similar to those reported in international studies. The main prognostic factor associated with in-hospital mortality was the development of acute kidney injury with indication for RRT.

Disclosures
All Authors: No reported disclosures.
1990. Prognostic factors for long-term mortality in left-sided infective endocarditis after surgical treatment
Authors: Ju Lee Se , Ho Kim Jung , Jae Lee Hi , Kim Jinnam , Hyun Lee Ki , Ah Lee Jung , Hyup Kim Chang , Yeom Joon-sup , Yong Choi Jun , Jin Jeong Su , Ahn Jin Young , Su Ku Nam , Hyun Lee Seung 
Published: December 2022

Abstract

Background
Infective endocarditis is not a prevalent disease but has a high mortality rate. Especially left-sided infective endocarditis (LSIE) shows a higher mortality rate than right-sided infective endocarditis. Surgical treatment is occasionally considered for LSIE, but not much data is available on the long-term prognostic factors for LSIE after surgical treatment. This study investigated the risk factors for long-term mortality in LSIE patients who underwent surgical treatment.

Methods
This retrospective study enrolled adult patients with LSIE admitted to Severance Hospital in South Korea and underwent surgical treatment from November 2005 to August 2017. The primary outcome was overall all-cause mortality. Multivariate Cox regression analyses were performed to assess the risk factors for long-term mortality of LSIE with surgical treatment.

Results
239 cases with LSIE who underwent surgery were enrolled in this study. The median follow-up period was 6.2 years, and there were 34 deaths (14.2%) during the period. The mortality group showed older age (61.0 [53.0-72.0] vs 51.0 [39.0-61.0] years, P = 0.001), more chronic kidney disease (17.6% vs 3.9%, P = 0.007), more chronic liver disease (CLD) (14.7% vs 3.4%, P = 0.017), more cerebral embolisms (58.8% vs 26.8%, P &lt; 0.001), less isolated mitral valve involvement (29.4% vs 52.7%, P = 0.020), and higher Sequential Organ Failure Assessment score (2.0 [1.0-4.0] vs 1.0 [1.0-2.0], P = 0.014). The survivor and mortality groups showed no statistical difference in the time to surgery. Multivariate Cox analyses demonstrated cerebral embolism (Hazard ratio (HR): 3.62, 95% Confidence Interval (CI): 1.79-7.31, P &lt; 0.001), CLD (HR: 4.24, CI: 1.53-11.76, P = 0.005), and age (HR: 1.03, CI: 1.00-1.06, per 1 year, P = 0.021) as risk factors for overall mortality. Kaplan-Meier survival curve showed significant difference between the patients with and without cerebral embolism (P &lt; 0.001, log-rank). Figure 1.Kaplan-Meier survival curve for overall mortality

Conclusion
Cerebral embolism, CLD, and older age were associated with the long-term mortality in LSIE patients who underwent surgery. Preventive strategies for cerebral embolism are essential for the improvement in LSIE treatment.

Disclosures
All Authors: No reported disclosures.
1994. The use of whole body PET scans in management of infective endocarditis
Authors: Park Jason , Simpson Kaitlyn , Riddell James , Neils Megan E 
Published: December 2022

Abstract

Background
Whole-body 18F-FDG PET/CT (WBP) can have diagnostic utility in evaluating extracardiac sites of metastatic infection in patients with infective endocarditis (IE). However, the IE patient population that most benefits from this test is not certain. The purpose of this study is to investigate the clinical characteristics of patients with IE who had WBP performed and to evaluate how WBP results impacted management.

Methods
We performed a retrospective cohort study at a tertiary care center evaluating patients with suspected IE who were discussed at an internal multidisciplinary endocarditis conference between June 2018 and January 2022. Adult patients with suspected IE who also had a WBP during their inpatient stay were included. Patient demographics, IE risk factors, and WBP details were collected.

Results
114 patients with suspected IE had a WBP out of 431 (26.5%). The majority (n=107, 93.9%) had definite or possible IE by mDuke criteria. Prosthetic valves and endocardial devices were present in 83 (72.8%) and 34 (29.8%) patients respectively. There were 67 (60.5%) patients with 2 or more days of bacteremia and 21 (22.1%) patients with over 7 days of bacteremia. Causative pathogens included S. aureus (n=26, 24.2%), Enterococcus (n=26, 24.2%), and Streptococcus species (n=24, 22.4%). Among the 70 (61.4%) patients with indications for cardiac surgery, 38 (54%) had cardiac surgery performed. Common WBP findings were bone/joint infections (n=18, 15.8%), pulmonary infection (n=32, 28.1%), and skin/soft tissue infection (n=15, 13.2%). WBP changed the management in 44.7% (n=51) of patients, including antibiotic change (n=11, 9.7%), source control procedure (n=12, 10.5%), and further workup of infectious or non-infectious findings (n=33, 29.0%). Six-month all-cause mortality was 25% and hospital readmission was 48.1%.

Conclusion
Many patients who underwent WBP had prolonged bacteremia, a history of cardiac prostheses, and had complicated IE with indications for cardiac surgery. WBP results changed treatment in some cases, but true clinical impact on morbidity and mortality is uncertain. We plan to do further research to compare outcomes between patients who get WBP and those who do not and to determine which patients may most benefit from this test.

Disclosures
All Authors: No reported disclosures.
1995. A Study of Amoebic Liver Abscesses from Mumbai, India
Authors: Kaneria Mala V , Shetty Nishant 
Published: December 2022

Abstract

Background
Microbial contamination of the liver parenchyma leading to liver abscess can occur via the bile ducts or vessels or directly, by contiguity. In India, amoebiasis is endemic and amoebic liver abscess (ALA) is the most common extraintestinal site of involvement. The epidemiology and characteristics of ALA have changed and the distinguishing features between pyogenic and amoebic liver abscess are unclear.

Methods
32 consecutive patients presenting with liver abscess were included over a period of 18 months. Their demographic profile, comorbidities, characteristics of the abscesses on imaging (number, size, liquifaction, lobe involved, etc), complications, treatment given (both medical and interventional) were recorded. The abscess size was monitored by periodic sonography, both for liquification and response to therapy.

Results
A male preponderance was observed. 50 abscesses were noted in the 32 patients. 29 patients (90.63%) had ALA, 2 pyogenic (6.25%) and 1 cholangitic (3.125%). Fever and right hypochondrial pain were common complaints. Chronic diarrhoea was noted in only 4 (12.5%) patients. 92% were in the right lobe. Majority were unliquified / partially liquified at presentation. All underwent percutaneous drainage. 11 (34.375%) had rupture, with majority (25%) being in the perihepatic space. This local complication was associated with large and/or multiple abscesses. All ALA were treated with metronidazole for 3-4 weeks and a luminal amoebicide, with a good response. Only 2 patients expired, due to their comorbidities.

Conclusion
The traditional belief that amoebiasis causes solitary abscess and bacteria cause multiple abscesses does not hold true anymore. Leucocytosis is seen with ALA too. Alcoholism and underlying comorbidities are not prerequisites for developing liver abscess. A combination of medical and interventional therapy produces good results, even in multiple abscesses.

Disclosures
All Authors: No reported disclosures.
2000. Clinical characteristics and prognosis of patients with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome and encephalopathy: a nationwide observational study in Japan
Authors: Myojin Shota , Michihata Nobuaki , Shoji Kensuke , Takanashi Jun-ichi , Matsui Hiroki , Fushimi Kiyohide , Miyairi Isao , Yasunaga Hideo 
Published: December 2022

Abstract

Background
Shiga toxin-producing Escherichia coli (STEC) may cause hemolytic uremic syndrome (STEC-HUS) and encephalopathy which possibly lead to neurological sequelae and mortality. However, the detailed epidemiology of this disease remains unclear due to its low frequency. This study aimed to describe the characteristics, demographics, and mortality of patients with STEC-HUS using a nationwide database.

Methods
We performed a retrospective cohort study using the Diagnosis Procedure Combination database, which includes approximately half of acute-care inpatients across Japan. We enrolled patients who were hospitalized for STEC-HUS from July 2010 to March 2020. We defined patients with unfavorable outcomes as any of the following at discharge: in-hospital death within three months, tracheostomy, mechanical ventilation, dialysis, and rehabilitation.

Results
This study included 655 patients with STEC-HUS (median age, 7 years). 62 patients (9.5%) were admitted to intensive care units within 2 days of admission. A total of 125 (19.1%) patients had any one of the composite unfavorable outcomes: 24 (3.7%) in-hospital death within 3 months, 9 (1.4%) tracheostomy during hospitalization, 24 (3.7%) mechanical ventilation at discharge, 22 (3.4%) dialysis at discharge, and 95 (14.5%) rehabilitation at discharge. Thirty-one patients (4.7%) developed STEC-HUS related acute encephalopathy.

Conclusion
Regardless of advances in multidisciplinary medicine, we found STEC-HUS remains a poor prognostic condition.

Disclosures
All Authors: No reported disclosures.