bluuebunny/crossref_metadata_2025_split huggingface dataset:
1336. Six-Year Clinical Experience of Pediatric Murine Typhus in Houston, TX
Authors: Taylor Margaret G , Bocchini Claire 
Published: December 2022

Abstract

Background
Murine typhus is a flea-borne rickettsial disease endemic to gulf states. It shares clinical features of Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C). We sought to explore the six-year experience with murine typhus among children living in Houston, TX.

Methods
We conducted a retrospective chart review to identify clinical and laboratory features of children with murine typhus from January 2015 to July 2021. Cases were identified by positive Rickettsia typhi serology with single IgG &gt;=1:256, single IgM &gt;=1:128, or increase in IgG from 1:64 to 1:28 in convalescent sera.

Results
162 cases of pediatric murine typhus were identified. Most cases (85, 52.5%) occurred in the summer. There was a bimodal distribution of age, with peaks at 4 and 17 years (Figure 1). Most children (96, 59.3%) required hospitalization; 11 were admitted to intensive care, and 3 required intubation. All children had fever; the mean duration of fever at presentation was 8.9 days (+/-2.9). Only 67 (41.4%) had a combination of fever, headache, and rash (Table 1). 64 (39.5%) had documented flea or opossum exposure. The most common laboratory abnormalities were elevated serum liver transaminases, hypoalbuminemia, thrombocytopenia, and hyponatremia (Table 1). Cardiac abnormalities were not uncommon: 20/59 (33.9%) had an abnormal electrocardiogram, 5/50 (10.0%) had troponin &gt;0.04 ng/mL, and 4/50 (8.0%) had b-type natriuretic protein &gt;100 pg/mL (Table 1). Most children (149, 92.0%) were diagnosed based on positive initial serological testing. Nine (5.6%) received intravenous immunoglobulin for a diagnosis of KD before typhus was diagnosed. The median duration of hospitalization was 3 days (IQR 2,5), and most children were treated with doxycycline (146, 90.1%). Figure 1.Histogram of age at time of murine typhus diagnosis.Table 1.Clinical and Laboratory Features of Children Diagnosed with Murine Typhus.

Conclusion
Murine typhus is a common cause of prolonged unexplained fever in children living in endemic areas and shares clinical features of KD and MIS-C. Cardiac abnormalities are not uncommon, and severity of illness can range from outpatient to intensive care. Lack of flea or opossum exposure or lack of headache or rash does not rule out infection. Therefore, a high index of suspicion is warranted, and initial serology testing may accelerate diagnosis in children with prolonged fever.

Disclosures
All Authors: No reported disclosures.
1651. In vitro synergy test and clinical outcome of antibiotics combination regimens for carbapenem-resistant Acinetobacter baumannii
Authors: Baek Jin Yang , Kim Hyemee , Kang Yu Ri , Kang Sujeong , Huh Hee Jae , Lee Nam Yong , Ko Jae-Hoon , Cho Sun Young , Kang Cheol-In , Chung Doo-Ryeon , Peck Kyong Ran , Huh Kyungmin 
Published: December 2022

Abstract

Background
Acinetobacter baumannii is one of the leading etiologic agents of serious hospital-acquired infections. A. baumannii is characterized by a high rate of carbapenem resistance, which often leads to treatment failure and poor outcome. Combination regimens of antibiotics are often used, but their clinical benefit and optimal target are yet unclear.

Methods
We selected carbapenem-resistant A. baumannii (CRA) isolates from the patients who received antimicrobial treatment for bloodstream infection (2012–2018) or pneumonia (2019–2020) and survived for ≥5 days. In vitro synergy was tested using checkerboard method and time-kill assay for colistin (COL) and tigecycline (TGC) with the following antibiotics: meropenem (MRO), ampicillin/sulbactam (A/S), minocycline (MIN), ciprofloxacin (CIP), and with each other. Clinical information was collected to compare the patient outcome between those who were treated with combination regimens with in vitro synergy and those who were not.

Results
A total of 72 isolates were selected. When combined with colistin, MRO showed the highest rate of synergy (20.8%), followed by A/S (16.7%), and MIN (13.9%). No antibiotics showed synergy with TGC in &gt;10% of the tested isolates. Most isolates with positive checkerboard test also tested positive with time-kill assay for COL (97.6%), but not for TGC (20.0%). Among 57 patients with monobacterial infection caused by the tested CRA isolates, nine (15.8%) received combination regimens with in vitro synergy. All patients received colistin, and carbapenem was the companion antibiotic in all patients in the synergistic combination group. There was no significant difference in all-cause 30-day mortality (55.6% vs 33.3%, p=0.266), treatment response, and microbiologic response. Multivariable analysis also demonstrated no significant difference in mortality by synergistic combination regimen (adjusted odds ratio, 4.59; 95% confidence interval, 0.73–33.88).

Conclusion
Checkerboard method showed an excellent concordance with time-kill assay for COL-based combinations, but not with TGC-based regimens. However, combination regimens with a proven in vitro synergy were not associated with better outcomes.

Disclosures
All Authors: No reported disclosures.
1355. An Acute Care Hospital’s Outbreak Response to Measles in an Afghan Refugee Population
Authors: Lapian Becky , Levorson Rebecca E , Downes Barbara L , He Lucy , Peninger Michelle , Peninger Michelle , Peninger Michelle 
Published: December 2022

Abstract

Background
The disruption of massive refugee evacuations in the fall of 2021 had subsequent downstream effects on the health care systems affected by such sudden human evacuations. Our 923-bed tertiary care facility in the Washington, D.C. metropolitan area admitted several refugees with acute measles infection. Gaps in surveillance for identifying infectious pathogens in our emergency department were identified and mitigation strategies were implemented in order to more rapidly identify suspected subsequent cases. Partnership with our local and state health departments were imperative in successfully identifying exposed persons, evaluating risk factors and administering post-exposure prophylaxis for at risk exposed persons.

Methods
Infection Preventionists identified exposed patients and team members, based on shared air spaces and time to include two hours after the infectious patient had left the area or had been placed on proper precautions. Following CDC and local health department guidance, over 500 charts of exposed patients were reviewed by a multidisciplinary team of physicians, nurses, pharmacists, and infection preventionists.

Results
Over 90 patients met criteria for and received post-exposure prophylaxis. 10 visitors, also refugees, were also given post-exposure prophylaxis. Standard operating procedures for hospital based measles exposure were further solidified through this exposure procedure. Written and verbal communications were updated for team members, patients and the community. No secondary cases of measles were seen in the hospitalized patients or in the community at large over the following 28 day observation period after last exposure. Numerous more cases of measles were noted in the refugee population evacuated over the following several weeks until MMR vaccination was widely distributed.

Conclusion
Consideration of infectious diseases in refugees with significant infectious exposure burden is imperative during times of massive refugee evacuations. Vaccination of refugees during evacuation and prior to resettlement is imperative. Evaluation for highly contagious diseases such as measles must be forefront in clinicians’ minds when encountering massive refugee evacuations.

Disclosures
All Authors: No reported disclosures.
1358. Establishing Genomic SARS-CoV-2 Surveillance at the National Level: Germany, 2021
Authors: Oh Djin-Ye , Hölzer Martin , Paraskevopoulou Sofia , Trofimova Maria , Hartkopf Felix , Budt Matthias , Wedde Marianne , Richard Hugues , Haldemann Berit , Domaszewska Teresa , Reiche Janine , Keeren Kathrin , Radonić Aleksandar , Calderón Julia Patricia Ramos , Smith Maureen Rebecca , Brinkmann Annika , Trappe Kathrin , Drechsel Oliver , Klaper Kathleen , Hein Sascha , Hildt Eberhard , Haas Walter , Calvignac-Spencer Sébastien , Semmler Torsten , Dürrwald Ralf , Thürmer Andrea , Drosten Christian , Fuchs Stephan , von Kleist Max , Kröger Stefan , Wolff Thorsten 
Published: December 2022

Abstract

Background
The COVID-19 pandemic has demonstrated the importance of pathogen genomic surveillance. At RKI, the German National Institute of Public Health, we established the Integrated Molecular Surveillance for SARS-CoV-2 (IMS-SC2) network to perform SARS-CoV-2 genomic surveillance.

Methods
SARS-CoV-2 positive samples from laboratories distributed across Germany regularly undergo whole-genome sequencing at RKI. This surveillance instrument enables (i) almost-real-time monitoring of SARS-CoV-2 genomic diversity and evolution, (ii) in vitro assessment of vaccine coverage against emerging variants and (iii) genome-based estimates of SARS-CoV-2-incidences.

Results
We report the results of our analyses of 3623 SARS-CoV-2 genomes collected between 12/1/2020 and 12/31/2021. All variants of concern were identified, at ratios equivalent to those in the 100-fold larger German GISAID sequence dataset from the same time period. Lineage distributions fluctuated over time, covering the rise of the Alpha and Delta, as well as the emergence of Omicron. Phylogenetic analysis confirmed variant assignments. Multiple mutations of concern emerged during the observation period. To model vaccine effectiveness in vitro, we employed authentic-virus neutralization assays, confirming that both the Beta and Zeta variants are capable of immune evasion. The IMS-SC2 sequence dataset facilitated an estimate of the SARS-CoV-2 incidence based on genetic evolution rates. Together with modelled vaccine efficacies, Delta-specific incidence estimation indicated that the German vaccination campaign contributed substantially to a deceleration of the nascent German Delta wave.

Conclusion
This example illustrates that pathogen genomics enables a proactive approach to controlling a pandemic as the virus evolves. Molecular and genomic SARS-CoV-2 surveillance will be crucial during the post-pandemic future, informing public health policies including vaccination strategies. Of note, the IMS-SC2 infrastructure can be adapted to many other pathogens, serving as a blueprint for future efforts to increase genomic pathogen surveillance.

Disclosures
All Authors: No reported disclosures.
1361. Lyme Borreliosis (LB) is a Significant Disease Burden in Germany: Estimated LB Incidence after Adjusting for Under-ascertainment by Public Health Surveillance, 2021
Authors: Olsen Julia , Brestrich Gordon , Pilz Andreas , Halsby Kate , Kelly Patrick , Malerczyk Claudius , Angulo Frederick , Stark James H 
Published: December 2022

Abstract

Background
Lyme borreliosis (LB), the most common tickborne disease in Europe, is endemic in Germany. Nine German states (with 42% of the German population) conduct LB surveillance with mandatory notification by clinicians and laboratories but an analysis of outpatient claims estimated that only one of every six LB cases in these states were reported. We estimated the LB incidence after adjusting for under-ascertainment of public health surveillance.

Methods
Nationally representative studies estimated the prevalence of antibodies against Borrelia burgdorferi sensu lato in adults and children in Germany. Published estimates of the asymptomatic proportion and the duration of antibody detection were used to estimate the number of LB cases from seroprevalence data in states that conduct LB surveillance. The number of estimated LB cases were compared to the number of surveillance-reported cases to derive under-ascertainment multipliers for adults and children. The derived multipliers were applied to the number of reported cases in 2021 to estimate the number and incidence of LB cases in the states that conducted surveillance in 2021. A sensitivity analysis evaluated the impact of different antibody durations.

Results
Using a 50% asymptomatic proportion and 10-year antibody duration, the estimated number (population-based incidence) of LB cases in states that conducted surveillance was 128,870 (408/100,000) in 2021. Since there were 11,051 reported cases in these states, these data indicate there were 12 LB cases in 2021 for every reported case in these states. Using 20-year or 5-year antibody duration, the estimated number (incidence) of LB cases in the states that conducted surveillance was 64,935 – 259,740 (204 - 816/100,000) in 2021, respectively.

Conclusion
Incidence of LB in states that conduct surveillance in Germany is higher than reported. Under-ascertainment of LB cases in states that conduct surveillance is even greater than that estimated in a claims data analysis of medically-attended LB cases. Enhancements of LB surveillance, including expanding nationwide, would facilitate further elucidation of the true LB disease burden in Germany. Disease prevention efforts, including availability of an efficacious vaccine, are needed to address this important public health problem.

Disclosures
Julia Olsen, BS, Pfizer: Employee Gordon Brestrich, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Andreas Pilz, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds|Pfizer: Stocks/Bonds Kate Halsby, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Patrick Kelly, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Claudius Malerczyk, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Frederick Angulo, DVM PhD, Pfizer: Employee|Pfizer: Stocks/Bonds James H. Stark, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds.
1368. Stakeholders Perceptions on Barriers and Facilitators to Opt-Out Infectious Diseases Care in Jails
Authors: Smyth Emma M , Lodolo Laura , Ngassa Yvane , Beckwith Curt , Wurcel Alysse Gail 
Published: December 2022

Abstract

Background
Despite national guidelines on infectious disease testing and vaccination in prisons, there is heterogeneity in operationalization. Previous literature has shown that using the “opt-out approach” to infectious diseases testing increases equitable access. Although opt-out testing is endorsed by national guidelines, there is little research on the acceptability from key stakeholders in jail healthcare. Additionally, perspectives on using the opt-out approach to vaccination are unknown.
Interview Themes
Themes and quotes that came out of semi-structured qualitative interviews.

Methods
We developed an interview guide based on the Theoretic Domains Framework. Guided by the 7Ps framework for stakeholder engagement, we conducted semi-structured interviews with key stakeholders in jail healthcare, including people incarcerated in Hampden County jail, clinicians working in jail and community settings, corrections officers, and representatives from public health, government, and industry. All persons eligible to receive a stipend were offered $50 for participation. Interviews were offered in the jail in English and in Spanish.

Results
Between July 2021—March 2022, 48/108 (44%) of people approached agreed to be interviewed including 13 incarcerated men. Most stakeholders agreed that infectious diseases testing and vaccination in jails are essential tools for mitigating the spread of disease. Major themes that emerged from stakeholder interviews included confusion about the wording of the “opt-out” approach, reluctance to operationalize “opt-out” testing because of concerns for coercion, and concern that it gives people any “easy out” from taking the test or vaccines. People who supported the operationalization of opt-out testing were more often stakeholders from the community, including public health experts, researchers, and clinicians.

Conclusion
Although “opt-out” testing is evidence-based, we found that key stakeholders who work and are incarcerated in jails did not understand the concept and did not support implementation. Our work is further evidence that successful implementation of public health strategies requires vetting from all key stakeholders in jail healthcare, especially people working and incarcerated in jail when developing strategies to improve healthcare.

Disclosures
Curt Beckwith, MD, Gilead Sciences, Inc: Grant/Research Support.
1375. Validation of a Syndromic Surveillance Query for Lyme Carditis – New York, 2017-2021
Authors: Beeson Amy , White Jennifer , McCormick David , Gates Abigail , Hinckley Alison F , Marx Grace E 
Published: December 2022

Abstract

Background
Lyme carditis is a rare and potentially fatal manifestation of Lyme disease. Although Lyme disease is nationally notifiable, data on specific clinical manifestations are not collected systematically. We sought to use a novel syndromic surveillance query to identify patients with Lyme carditis in New York State (excluding New York City) during 2017-2021.

Methods
Using the National Syndromic Surveillance Program’s BioSense Platform, we developed a query using a combination of diagnosis codes and chief complaint terms to identify emergency department visits related to Lyme carditis. We systematically reviewed and abstracted key information in each identified individual medical record through New York’s regional health information exchange system, requesting supplemental records when needed. Two physicians independently assigned a clinical case status (confirmed; probable; not a case) to each abstracted record; when adjudications differed, an infectious disease physician provided a final adjudication. Positive predictive value for the query was calculated and characteristics of cases and non-cases were described.

Results
The query identified 175 individuals. Records were available for review for 139 individuals. Among these, 37% (n = 52) were classified as confirmed, 17% (n = 24) as probable, and 45% (n = 63) as not a case. In total, we identified 76 cases of confirmed or probable Lyme carditis for which records were available; the positive predictive value of the query was 45%. Cases occurred in 28 of New York’s 57 counties (excluding New York City); most (64%) occurred during May–September. Median age was 60 years for cases (IQR 33 – 73) and 67 years for non-cases (IQR 42 – 78) (p = 0.13); 29% of cases and 38% of non-cases were female (p = 0.23). Among cases, 76% had positive IgG or IgM immunoblots and 37% had second- or third-degree atrioventricular block.

Conclusion
Using a syndromic surveillance query, we detected 76 cases of Lyme carditis, a rare disease of public health importance. Syndromic surveillance using this query may provide a useful marker for Lyme-endemic states to use to detect changing disease patterns, including temporal or spatial clusters of severe Lyme disease manifestations.

Disclosures
All Authors: No reported disclosures.
1377. Bloodstream and Skin Infection MRSA Isolates, 2019-2021: Strain Differences and Phylogenetic Clustering in a Single Health System
Authors: Hofstetter Katrina , Jacko Natasia F , Gunoskey Jessica J , Talbot Brooke M , Read Timothy D , David Michael Z 
Published: December 2022

Abstract

Background
Methicillin-resistant S. aureus (MRSA) is a common antibiotic-resistant human pathogen that spreads from person to person. Asymptomatic host colonization precedes both skin and soft tissue infections (SSTI) and bloodstream infections (BSI), but it is not known how closely related MRSA strains are that cause infections at different body sites.

Methods
Using Illumina whole genome sequencing, we compared the strain types and genomes of MRSA isolates from 132 SSTIs and 145 sequential BSIs at 3 Philadelphia hospitals in 7/2018-1/2021. We investigated the epidemiological links and genomic clusters among isolates causing BSI and SSTIs.

Results
Abscesses were the most common type of SSTIs (65/132, 49%). Clonal complex (CC) 8 was the most identified CC among both SSTI strains (102/132, 77%) and BSI strains (73/145, 50%). While CC5 was more commonly found among BSIs than SSTIs (50/145, 34% vs. 19/132, 13%). Outbreak clusters with 15 or fewer SNPs were identified. Three clusters that contained only strains from SSTIs were all CC8, and the five clusters that only contained strains from BSIs had three CC5 clusters and two CC8 clusters. Among eight clusters that included at least one SSTI and one BSI strain, only one was composed of CC5 and the others were all CC8 strains. Within these eight clusters the SSTIs were from cellulitis infections (4/8), an abscess (3/8), or an infected ulcer (1/8).

Conclusion
We found that CC8 strains were the most common among both SSTIs and BSIs. CC5 strains, however, were more commonly found in BSIs than SSTIs, and among outbreak clusters in the BSI strains. Eight outbreak clusters were identified that linked strains causing SSTIs or BSIs, seven of the clusters contained only CC8 strains. While abscesses were the most common infection type to cause an SSTI, within the outbreak clusters containing strains from both SSTIs and BSIs, both cellulitis and abscess were equally identified.

Disclosures
Michael Z. David, MD PhD, Contrafect: Grant/Research Support|GSK: Advisor/Consultant|Johnson and Johnson: Advisor/Consultant.
1655. Factors Associated with Acceptance of Telehealth-based Antimicrobial Stewardship Program Recommendations in a Community Hospital Health System
Authors: Shively Nathan R , Jacobs Max W , Moffa Matthew A , Schorr Rebecca E , Walsh Thomas L 
Published: December 2022

Abstract

Background
Telehealth-based antimicrobial stewardship programs (TeleASPs) have led to reduced broad-spectrum antimicrobial utilization. Data on factors associated with acceptance of stewardship recommendations are limited.

Methods
A TeleASP, facilitated by remote infectious disease physicians and local pharmacists, was implemented in 2 community hospitals from February 2018 through July 2020. Variables potentially affecting acceptance of TeleASP recommendations were tracked. Odds ratios of acceptance were determined utilizing multiple logistic regression.

Results
During the 30 month period, 4863 (91.2%) of the total 5333 recommendations were accepted. Hospitalist and Critical Care Medicine services had significantly higher odds of acceptance in univariable analysis, while General Surgery, Private Practice Primary Care Physician, Pulmonology, and Urology had lower odds of acceptance. Only Critical Care Medicine remained significant on multivariable analysis (OR 3.23, 95%CI 1.4–7.5). Other factors associated with a higher odds of acceptance in multivariable analysis were recommendations for antimicrobial dose/frequency adjustment (OR 2.63, 95%CI 1.6–4.3) and order for labs/tests (OR 3.30, 95%CI 2.1–5.2), while recommendations for antimicrobial de-escalation (OR 0.75, 95%CI 0.60–0.95) and antimicrobial discontinuation (OR 0.57, 95%CI 0.42–0.76) were associated with lower odds of acceptance. Female physicians were more likely to accept recommendations compared to males (93.1% vs 90.3% acceptance, OR 1.65; 95%CI 1.3–2.2). Compared to physicians with less than 3 years of experience, who had the highest acceptance rate (96.3%), physicians with 21 or more years of experience had the lowest (87.1%, OR 0.26; 95%CI 0.15–0.45).

Conclusion
TeleASP recommendations were accepted at a high rate. Acceptance rates were higher among female physicians, and recommendations to stop or de-escalate antimicrobials led to lower acceptance. Recommendations made to the most experienced physicians were the least accepted, which may be an important factor for stewardship programs to consider in education and intervention efforts.

Disclosures
Thomas L. Walsh, MD, Accelerate Diagnostics: Honoraria.