bluuebunny/crossref_metadata_2025_split huggingface dataset:
2044. In Vitro Activity of Omadacycline Against 14,000 Bacterial Isolates from the United States by Infection Type (2020-2021)
Authors: Huband Michael D , Pfaller Michael , Streit Jennifer M , Sader Helio S , Castanheira Mariana 
Published: December 2022

Abstract

Background
Omadacycline (OMC) is a novel tetracycline class (aminomethylcycline) antibacterial FDA approved for treatment of acute bacterial skin and skin structure infection (ABSSSI) and community-acquired bacterial pneumonia (CABP) caused by indicated organisms. OMC is active against bacterial isolates expressing resistance to tetracycline, penicillin, fluoroquinolones, macrolides, and vancomycin. This study has been funded in whole or in part by Federal funds from the U.S. Department of Health and Human Services, Biomedical Advanced Research and Development Authority (BARDA) within the Office of the Assistant Secretary for Preparedness and Response, under Contract No. 75A50120C00001.

Methods
14,000 bacterial clinical isolates were collected from 31 medical centers in the USA (2020-2021) in the SENTRY Surveillance Program. Isolates were collected from the following infection types: bloodstream (24.1%), pneumonia in hospitalized patients (22.6%), skin and skin structure (SSSI; 22.4%), urinary tract (15.9%), intraabdominal (5.5%), community acquired respiratory tract (8.3%) and other (1.2%). Identifications were confirmed by MALDI-TOF. Susceptibility testing of OMC and comparators was conducted according to CLSI M07 (2018) and M100 (2022) guidelines. OMC MIC results were interpreted using FDA breakpoints (BPs).

Results
OMC demonstrated potent in vitro activity against S. aureus (MIC90, 0.12 mg/L; 99.0% susceptible [S]) from SSSI, including 98.0% of MRSA (Table). From RTI, 99.6% of MSSA were S. 97.6% of S. lugdunensis and 95.5% of S. anginosus group isolates from SSSI were susceptible to OMC. All S. pyogenes and E. faecalis (including vancomycin-resistant [R]) isolates from SSSI were S to OMC. 99.8% of S. pneumoniae isolates from RTI were S to OMC, as were 100% of penicillin-R and tetracycline-R strains. H. influenzae susceptibility to OMC was 99.8%. Susceptibility of E. cloacae and K. pneumoniae isolates from all infection types to OMC was 88.9% and 90.4%, respectively.

Conclusion
OMC demonstrated potent in vitro activity against staphylococci, streptococci, E. faecalis, H. influenzae, E. cloacae, and K. pneumoniae isolates, including drug-resistant strains, regardless of infection type.

Disclosures
Michael D. Huband, BS, AbbVie: Grant/Research Support|Melinta: Grant/Research Support Jennifer M. Streit, BS, MT(ASCP), Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Shionogi: Grant/Research Support Helio S. Sader, MD, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|Melinta: Grant/Research Support|Nabriva Therapeutics: Grant/Research Support|Pfizer: Grant/Research Support Mariana Castanheira, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support.
2360. Serum Cholesterol Variability and Mortality in PLWH On Lipid-Lowering Therapy
Authors: Drechsler Henning J , Ayers Colby , Bedimo Roger 
Published: December 2022

Abstract

Background
In people living with HIV (PLWH), consistent use of lipid lowering therapy (LLT) is associated with lower all-cause mortality and use of tenofovir disoproxil fumarate (TDF) with reduced serum cholesterol (C). In the general population, high cholesterol variability (CV) is independently associated with all-cause mortality. We explored the relationship between consistency of LLT/TDF exposure, cholesterol variability, and mortality in PLWH.

Methods
In a cohort of 15,860 PLWH who achieved undetectable viremia on ART between 2001 and 2011 we used multivariable Cox modeling, stratified by prevalent cardiovascular disease (CVD) to identify predictors of mortality and built multi-level marginal structural models for different LLT/TDF exposure levels based on percentage of days covered (PDC) over the past year, categorizing exposures into low (PDC &lt; 50%), high (50–93%), and consistent (≥94%). The latter two were further subdivided into single and dual exposures for a composite LLT model where we explored effect sizes before and after inclusion of time-updated absolute C values and its 1-year coefficient of variation (CoV). We also examined the relationship between consistency of LLT/TDF use and C variability in a mixed linear model.

Results
During a median follow-up (f/u) of 4.3 years, there were 2,269 deaths. For 43% of f/u time patients were exposed to TDF, for 13% to non-statin LLT, and for 17% to statins. The hazard ratio (HR) of death for consistent use was 0.38, 95% confidence interval (CI) 0.32–0.45 for TDF, 0.40 (CI:0.28–0.58) for non-statin LLT, and 0.50 (CI:0.40–0.63) for statins (Fig 1). In the composite model, increasing LLT intensity was inversely associated with mortality risk but low C and high CV remained strong independent predictors of death. High HDL C values were protective (Table). The effect sizes for high LLT intensity and high HDL-CV moderately decreased when they were modeled jointly. Compared to unexposed patients, HDL CoV was significantly lower during consistent LLT exposures but higher for patients with low LLT exposure (Fig 2).

Conclusion
In PLWHA, intensity of LLT exposure is inversely related with all-cause mortality. The highest LLT intensity levels were associated with the lowest HDL-CV. This could serve as a partial explanation for the lower mortality.

Disclosures
Roger Bedimo, MD, Gilead Sciences: Advisor/Consultant|Janssen: Advisor/Consultant|Merck & Co.: Advisor/Consultant|Merck & Co.: Grant/Research Support|ViiV Healthcare: Advisor/Consultant.
2057. A Social Network Strategy for HIV Self-Test Kit Distribution through PrEP Program Clients
Authors: Doblecki-Lewis Susanne , Butts Stefani , Kanamori Mariano , Johnson Ariana , Rodriguez Edda L 
Published: December 2022

Abstract

Background
HIV testing allows care engagement of people living with HIV and PrEP for those who test negative. Social network strategy (SNS) interventions may facilitate distribution of HIV self-test (ST) kits to individuals who do not routinely test for HIV. The University of Miami pre-exposure prophylaxis (PrEP) program offers low-barrier PrEP/HIV prevention services through mobile and static clinics in Miami-Dade County. Current PrEP clients may be ideal distributors of HIV ST kits and PrEP information within their social networks.

Methods
Study activities occurred in Miami from November 2021 to March 2022. At PrEP visits, participants (n = 96) were given Ora-Quick oral fluid ST kits for distribution to their social network members. Participant surveys included demographics, feelings of closeness to network members, history of PrEP conversations, and intention for future PrEP conversations. Descriptive statistics included mean and range for continuous variables and frequencies for categorical variables. Network visualizations were constructed using UCINet and NetDraw. Bivariate and regression analysis, conducted in R, assessed the relationship between demographic characteristics of the client and the proportion of network members who discussed PrEP and plan to discuss PrEP in the future between and across networks.

Results
A network visualization displays clients (n=96) and their social networks (n=426). Clients and network members were a majority male (84.7%) and of Hispanic/Latinx ethnicity (78.8%). Within and between network analysis indicated that networks differed significantly in reported closeness and frequency of PrEP discussions (F = 2.97; p-value 0.01, F = 17.45; p &lt; 0.03, respectively). Age and average reported closeness of the ego were independently and jointly associated with an increase in the likelihood of future PrEP conversations (estimate = 0.02; p-value &lt; 0.01; estimate = 0.24; p –value &lt; 0.01, respectively). Figure 1:PrEP Discussion & Closeness
Node color reflects PrEP discussion and node size reflects client reported closeness

Conclusion
We demonstrate the feasibility of disseminating HIV ST kits and PrEP information through SNS. Emotionally closely linked networks, with similar characteristics (i.e., age) may be most effective for this SNS strategy.

Disclosures
Susanne Doblecki-Lewis, MD, MSPH, Gilead Sciences: Grant/Research Support.
2063. Implementation of a Rapid HIV Screening Program in the Emergency Department
Authors: Geringer Matthew , Lajeunesse Brooke A , Bettger Caitlin , Markelz Elizabeth , Arroyo Cazurro Miguel A , Trueblood Wesley E , Okulicz Jason F 
Published: December 2022

Abstract

Background
Guidelines recommend that human immunodeficiency virus (HIV) screening be performed for all patients evaluated for sexually transmitted infections (STIs). The current practice for STI evaluation in the Brooke Army Medical Center (BAMC) emergency department (ED) is to defer HIV testing to Primary Care Managers (PCMs), however PCM follow-up and HIV screening may not occur. This project evaluated HIV screening practices before and after implementation of rapid HIV testing in the ED.

Methods
The pre-intervention period (Aug – Oct 2021) included usual practice in the BAMC ED followed by the post-intervention period (Dec 2021 – Feb 2022) after implementation of rapid testing with the Determine™ HIV-1/2 Ag/Ab Combo test. ED providers were educated to include HIV rapid testing for patients with STI complaints. Patients with Neisseria gonorrhea/Chlamydia trachomatis (GC/CT) tests ordered in the ED pre-intervention (n=303) and post-intervention (n=268) were selected for chart review and demographic, clinical, and laboratory data were used to assess HIV screening practices.

Results
A similar proportion of patients in the pre-intervention period presented with an STI chief complaint (13.5% vs. 17.2%), tested positive for GC/CT (13.5% vs. 10.8%), and received empiric treatment for GC/CT (38.3% vs. 34.3%) compared to the post-intervention period (Table 1). HIV screening in the ED significantly increased both overall (4.3% vs. 19.8%; P&lt; 0.001) and in the subgroup treated empirically for GC/CT (9.7% vs. 30.4%; P&lt; 0.001, Table 2). Among patients treated empirically for GC/CT who did not receive HIV screening in the ED, PCM follow-up was low in both the pre- and post-intervention periods (20.7% and 34%, respectively; P&lt; 0.001) and HIV screening was not commonly performed by PCMs during those visits (6.2% vs. 8.4%, respectively; P=0.350).

Conclusion
STIs are considered biologic markers of HIV risk, including acquisition and forward transmission. Implementation of a rapid screening protocol in the ED resulted in a nearly 5-fold increase in HIV screening, however HIV screening by PCMs remained low. Although rapid HIV testing can be a useful tool, continued education and training of ED providers and PCMs is also needed to improve uptake of HIV screening.

Disclosures
All Authors: No reported disclosures.
2070. Risk Factors Affecting PrEP Offering and Uptake Among At-Risk Youth in an Area of High HIV Prevalence
Authors: Stillman Jared , Coughlin Emily , Espinosa Claudia M 
Published: December 2022

Abstract

Background
New HIV cases are steadily reported in our community among at-risk youth despite the availability of highly effective pre-exposure prophylaxis (PrEP). Although providers regularly offer PrEP during sexually transmitted disease (STD) screening visits, PrEP utilization rates remain low among those patients. The primary outcomes of this study are determining the rates of PrEP offering and uptake in high-risk individuals seeking care for STD screening at local youth clinics and whether these rates differ by demographic factors.

Methods
A retrospective chart review was conducted on 218 charts of patients ages 18 - 24 years with risk factors for HIV infection who sought care at a youth clinic in Tampa, FL between 2018 and 2020. PrEP offering and utilization rates were compared across demographic and risk factor variables using Chi-square tests for categorical variables and Mann-Whitney U tests for continuous variables.

Results
Of 218 patients, 86 (39.4%) were offered or had a documented discussion of PrEP at their visit but uptake occurred only in 22 (10.1%). Factors associated with offerings are depicted in table 1. Factors associated with uptake are depicted in table 2. Age at first visit, insurance type, level of education, and employment did not significantly impact PrEP offering or uptake. Additionally, there was no significant difference in PrEP uptake associated with race or ethnicity.
PrEP Offerings
Demographic characteristics associated with offering and uptake of PrEP among young people screened for STD in a high prevalence of HIV area
PrEP Uptake
Demographic characteristics associated with uptake of PrEP among young people screened for STD in a high prevalence of HIV area

Conclusion
This study highlights differences in offering and uptake of PrEP among young adults with a high risk of acquiring HIV living in a high prevalence of HIV area. Males and MSM are offered more PrEP and also use it more. Black patients are less likely to be offered PrEP. These differences emphasize the need for interventions to improve the rate of PrEP discussions among female and black patients at risk for HIV and to improve adherence to PrEP among young individuals at risk of HIV infection. Interventions targeting these demographics may lessen disparities and incidence of HIV in the community. Moving forward we will continue to investigate additional data collected on PrEP compliance at 6mo and at 12mo follow-ups among our patient population. Future studies with qualitative data identifying barriers to use PrEP will provide important information on this topic.

Disclosures
All Authors: No reported disclosures.
2364. FACEing Infectious Disease Fellows: Growing and Culturing Clinician Educators
Authors: Welford Elliott , Jagannath Anand D , Wooten Darcy 
Published: December 2022

Abstract

Background
Infectious diseases (ID) fellows are increasingly interested in clinician-educator (CE) careers. However, dedicated structured curricula for subspecialty fellows are uncommon due to limiting factors such as time, resources, and faculty expertise. At the University of California San Diego, we recruited fellows and faculty across several Internal Medicine subspecialties to develop a Fellow As Clinician Educator (FACE) course. We taught a core CE skillset and assessed its effects on self-reported confidence, content knowledge, and scholarly productivity.

Methods
Principles from the Kern model were used to structure and build curricular content (Figure 1). Validated medical education survey methodology was used to create a survey to assess fellows’ confidence in 10 medical education domains. Content knowledge of foundational medical education principles was assessed using multiple choice questions. Fellows answered the survey and content questions before and after the course. Differences in self-reported confidence and content knowledge were assessed using paired, two-tailed t-tests. Medical education scholarly projects completed within one year of the course were also tracked.

Results
Thirteen fellows from ID (7), Geriatrics (3), and Pulmonary/Critical Care (3) participated in this course. Eleven (85%) completed both pre and post-course surveys. Confidence in giving an effective lecture, teaching on the wards and clinic, giving a chalk talk, giving feedback, and achieving career success as an educator increased significantly after the course (p&lt; 0.05, Figure 2). Content knowledge in giving a lecture and teaching clinical reasoning increased significantly after the course (p&lt; 0.05, Figure 3). Nine fellows participated in medical education scholarship in the year after the course with curriculum development, manuscript publication, and abstracts representing the areas of greatest participation (Figure 4).

Conclusion
The FACE course successfully utilized multidisciplinary faculty to teach and improve fellows’ confidence in and content knowledge across multiple core medical education domains and increased scholarly output. Future directions for this course will include formal evaluation of participants’ teaching skills and CE career trajectories.

Disclosures
All Authors: No reported disclosures.
2105. Early-onset and Late-onset BK Polyomavirus-associated Nephropathy: A 10-year Retrospective Analysis
Authors: Thiandech Vichitra , Kantachuvesiri Surasak , Bruminhent Jackrapong 
Published: December 2022

Abstract

Background
Polyomavirus-associated nephropathy (BKVAN) is one of the serious causes of allograft dysfunction and allograft loss in kidney transplant (KT) patients. Most of the patients were diagnosed with BKVAN within the first year after transplantation but some more cases of BKVAN occur later. A study focused on the differentiation between early and late-onset BKVAN is needed.

Methods
We conducted a retrospective cohort study among KT recipients at Ramathibodi Hospital between January 2010 – December 2020. The incidence of early-onset (diagnosed within 1 year) and late-onset (diagnosed after 1 year) BKVAN, as well as composite kidney allograft outcomes, were compared.

Results
From 1032 KT recipients, 645 (62.5%) were screened for BK viral infection. BKVAN was diagnosed in 83 (12.8%) patients. Of those, 46 (55.4%) and 37 (44.6%) were diagnosed with early-onset and late-onset BKVAN, respectively. Composite kidney allograft outcomes of GFR decline≥ 40% from baseline, graft loss or death were greater in early-onset BKVAN compared to late-onset BKVAN (7.5 vs 5.52 per 1000 person-months; hazard ratio 0.47; 95%CI, 0.23-0.95; P=0.037). In multivariate analysis, female gender and living-related kidney transplantation (LRKT) were independently associated with late-onset BKVAN compared to early-onset BKVAN. The more advanced the BKVAN diagnosis, the worse the allograft outcome occurs, even with optimizing immunosuppressive drugs and adjunctive therapy.

Conclusion
BKVAN could occur later after one-year post-transplantation, although relatively better composite kidney outcomes were observed compared to early-onset BKVAN. Female individuals who underwent living-related KT should be considered for BK virus preemptive monitoring beyond one year to detect this late-onset BK virus infection.

Disclosures
All Authors: No reported disclosures.
2108. Evaluation of Bezlotoxumab for the Prevention of Recurrent Clostridioides difficile Infection in Patients Living With Cancer at a Large Comprehensive Cancer Center
Authors: Peña Jaime A , Vuong Nancy N , Okhuysen Pablo C , Munsell Mark F 
Published: December 2022

Abstract

Background
Bezlotoxumab is a fully human monoclonal antibody that binds and neutralizes Clostridioides difficile toxin B. Administration of bezlotoxumab along with standard of care antibiotic (SoC) treatment of C. difficile infections (CDI) is associated with lower rates of CDI recurrence (rCDI). We aimed to determine the real-world incidence of rCDI in patients with cancer within 12 weeks after receiving bezlotoxumab.

Methods
This is a retrospective, single-center, descriptive study of patients with cancer that received bezlotoxumab from Jan 2018 through Oct 2021 at a large cancer center. rCDI was defined as a clinical illness associated with a positive stool nucleic acid amplification test with or without a confirmatory toxin assay for which CDI SoC was prescribed.

Results
A total of 131 patients were included in the study (median age of 63 years, 47% male, 77% Caucasian, 21% ICU admission), with 31% having one or more CDI episodes ≤ 6 months prior to receiving bezlotoxumab. The most common primary cancer type was leukemia (36%) followed by a solid organ tumor (35%), lymphoma (21%), and myeloma (8%). Cytotoxic chemotherapy or immune checkpoint inhibitors were prescribed within 6 months in 78% of cases and 60% of patients were given antibiotics not related to CDI. Fidaxomicin was most frequently administered as SoC (56%), followed by oral vancomycin (44%) with or without intravenous metronidazole. Within 12 weeks following bezlotoxumab treatment, rCDI occurred in 14 (10.7%, 95% Cl 5.4% to 16.0%) patients. Using univariate analysis, patients with rCDI were more likely to have received levofloxacin before and during bezlotoxumab treatment (86% versus 47%; OR 6.76, 95% CI 1.45 - 31.56, p=0.009).

Conclusion
In this real-world study, the rate of rCDI following use of bezlotoxumab during SoC antibiotics was comparable to that seen in clinical trials. Use of levofloxacin as prophylaxis for prolonged neutropenia in hematologic malignancies was associated with significantly higher rates of rCDI in patients that received bezlotoxumab. Our study suggests that neutropenia and antibiotic induced dysbiosis are risk factors for rCDI despite bezlotoxumab administration.

Disclosures
Pablo C. Okhuysen, MD, AstraZeneca: Stocks/Bonds|Beam Therapeutics: Stocks/Bonds|Biontech: Stocks/Bonds|Deinove: Grant/Research Support|Ferring: Advisor/Consultant|Glaxo Smith Kleine: Stocks/Bonds|Johnson and Johnson: Stocks/Bonds|Melinta: Grant/Research Support|Merck Sharp & Dohme Corp: Grant/Research Support|Moderna: Stocks/Bonds|Napo Pharmaceuticals: Advisor/Consultant|Napo Pharmaceuticals: Grant/Research Support|Novavax: Stocks/Bonds|Pfizer: Stocks/Bonds|Summit: Advisor/Consultant|Summit: Grant/Research Support.
2113. Infectious endocarditis in patients with hematologic malignancy at the University of Wisconsin
Authors: Scolarici Michael J , Berman Leigh R , Saddler Christopher , Smith Jeannina 
Published: December 2022

Abstract

Background
Infective endocarditis (IE) is a highly morbid complication of blood stream infections (BSIs) involving neutrophil and platelet activation. Patients with hematologic malignancies have frequent BSIs but a low incidence of IE. We sought to evaluate the microbiology of BSIs and rates of IE in hospitalized patients with hematologic malignancies.

Methods
Patients admitted to the University of Wisconsin Hospital hematology ward between 2018 and 2020 were included if blood cultures obtained grew Streptococcus spp., Staphylococcus spp., Enterococcus spp., Streptococcus-like bacteria, and fungi. Two investigators recorded patient demographics, BSI microbiology, and hospital course. Using the Duke’s criteria each BSI was classified as definite, possible, or rejected cases of IE. Cases of possible IE were reviewed for evidence of missed IE within 90 days of hospital admission based on readmission with repeat positive blood culture and new signs or symptoms of IE. Definite cases were reviewed by two additional investigators to corroborate cases of IE.

Results
Our study included 101 unique patients with hematologic malignancy: 35.6% female, mean age 58.4, and 10.9% had multiple BSIs during our study period. Of 111 distinct BSIs, 82.6% were neutropenic, 37.4% community acquired, and 21.7% polymicrobial. Of 129 positive blood cultures, 41.0% isolated Streptococcus spp., 5.4% Staphylococcus aureus, 17.8% other Staphylococcal spp., 7% Enterococcus faecalis, 9.3% other Enterococcus spp., 9.3% Gamella spp., and 4.7% Candida spp. Of 111 BSI, 2 were classified as definite cases, 39 as possible, 70 as rejected. After further review, only 1 was considered a true cases of IE and they were not neutropenic. The 90-day survival rate for all patients was 76.2%.

Conclusion
We found a very low incidence of IE in our study. Low rates of IE in our population aligns with previous reports showing rare cases of IE in neutropenic and malignancy patients with BSIs and raises questions about the utility of invasive IE workups in neutropenic patients with hematologic malignancies. Further studies are needed to identify patient or microbiologic factors that can be used to guide appropriate use of transesophageal echocardiography to evaluate IE in patients with hematologic malignancy.

Disclosures
All Authors: No reported disclosures.