bluuebunny/crossref_metadata_2025_split huggingface dataset:
1329. Pediatric Group A Streptococcus (GAS) Pharyngitis Incidence has Decreased During the COVID-19 Pandemic
Authors: Patel Ami B , McHugh Matthew , Shulman Stanford , Tanz Robert R 
Published: December 2022

Abstract

Background
The COVID-19 pandemic has affected respiratory disease epidemiology. Measures to reduce transmission of SARS-CoV-2 (e.g., masking, social distancing, school closures) have reduced the incidence of common infectious diseases. At least one early report described changes in rates of pediatric GAS pharyngitis. We sought to determine the difference in GAS pharyngitis rates before and after the onset of the pandemic at our children’s hospital.

Methods
Clinical pharyngeal specimens tested for GAS by rapid antigen tests (RADTs) or LAMP methodology (loop-mediated isothermal amplification of GAS DNA) from January 2019 to March 2022 at our children’s hospital were analyzed. Clinician’s evaluating patients for GAS pharyngitis perform a RADT, when positive the patient is treated for GAS pharyngitis. When the RADT is negative, a LAMP test is performed. Patients were considered test-positive if either test was positive regardless of clinical symptoms. Annual positivity rates were compared using statistical process control (SPC) charts with both 2019 and 2020 as baseline years (i.e., 2019 vs 2020-3/2022; 2020 vs 2021-3/2022). The change in GAS incidence rate (positive patients/1000 tested) between years was assessed by chi-square tests.

Results
9,896 patients had throat swabs tested for GAS from January 2019 through March 2022. Using SPC with 2019 as a baseline, there was a 15.1% decrease in mean GAS positivity through 3/2022. With 2020 as baseline, there was a 13.0% decrease in mean GAS positivity through 3/2022. The incidence of positive GAS tests decreased significantly: 2019 vs. 2020-3/2022 (x2 = 84.97, p ≤0.00001) and 2020 vs. 2021-3/2022 (x2 = 154.01, p ≤0.00001). Figure 1.

Conclusion
Using throat swab results, the incidence of pediatric GAS pharyngitis at our hospital has decreased significantly during the COVID-19 pandemic. Implications: Pandemic-related risk mitigation measures, such as masking, social distancing, and school closures, were associated with significantly decreased incidence of GAS pharyngitis. It is likely that GAS colonization and invasive infections were also affected.

Disclosures
All Authors: No reported disclosures.
1334. Radiographic Features Associated with Increased Microbiology Culture Yields in Pediatric Orbital Cellulitis
Authors: Cirks Blake T , Claunch Kevin , Deperrior Sarah , Adams Dan 
Published: December 2022

Abstract

Background
Orbital cellulitis is an invasive infection defined by its location posterior to the orbital septum and can result in severe clinical manifestations. Computed tomography (CT) is the recommended imaging modality to assess for extent of disease and the Chandler classification system is used. It has 5 stages (CS): I is preseptal; II has inflammation beyond the orbital septum; III has subperiosteal abscess; IV has orbital abscess; and V has cavernous sinus thrombosis. There is limited data in its association with microbiology culture results. As part of a larger study to capture epidemiological and microbiological trends in pediatric orbital we hypothesize that culture yields and identification of a causative pathogen would increase as CS increases.

Methods
We performed a retrospective analysis using the US Military Health System database. ICD9/10 codes identified Individuals ≤ 21 years from June 2009 to September 2019 with orbital cellulitis. We excluded ophthalmia neonatorum and any cases without radiographic confirmation of orbital involvement. Demographic data, co-morbid diagnoses, imaging studies, microbiology results, and antibiotics prescribed were collected. CT reports were reviewed, and cases grouped by Chandler stage, (CS II-V). Descriptive statistics and χ 2 tests were used for categorical variables when appropriate.

Results
130 cases met the inclusion criteria. 66.9% were male, the median age was 9 years old (IQR 4-17), and 55.4% had a prior diagnosis of sinusitis. 50.7% of cases were classified as CS II, 35.3% as CS III, 13.1% as CS IV, and 0.01% as CS V. Microbiology cultures were positive in 33.8% of cases. There was a significant difference between CS and any culture positivity with p = 0.011 and there was a significant trend between increasing CS and culture positivity with p &lt; 0.003. Staphylococcus aureus and Streptococcus intermedius were the two most commonly identified pathogens, with no significant difference or trend associated with CS.

Conclusion
Overall, our findings demonstrated microbiology yield being low but increases with radiographic characteristics and CS stage. Identification of causative pathogens could increase the likelihood for tailored definitive antimicrobial therapy in pediatric patients with orbital cellulitis.

Disclosures
All Authors: No reported disclosures.
1339. Utility of Next Generation Sequencing Cell Free DNA Testing in Pediatric Patients for Diagnosis and Excluding Infection
Authors: Downey Rachel , Karim Zuena , Russo Susan M , Fernandez Marisol , Murphey Donald , Hauger Sarmistha Bhaduri 
Published: December 2022

Abstract

Background
Next-generation sequencing of microbial cell-free DNA (NGS cfDNA) testing has the potential to quickly diagnose multiple pathogen types. Negative predictive value of NGS cfDNA is not well characterized, but this test has been described as helpful in excluding infection diagnosis.

Methods
This is a retrospective chart review study of 93 consecutive patients with first-time NGS cfDNA testing at a freestanding children’s hospital. Case results and exclusion are in figure 1. Each case was manually reviewed and then adjudicated as useful or not useful to the plan of care by two providers for agreement. Demographics, health history, diagnostics, and treatments were reviewed. Test results were considered useful if the NGS cfDNA test identified the causal pathogen and resulted before conventional testing, or if the test was actionable to help exclude infection. Figure 1.Case inclusion and overall categorization

Results
NGS cfDNA testing identified a pathogen responsible for illness exclusively, or before conventional testing in 15 cases (16%). In 67% (10) of these cases the patient had underlying oncology or congenital cardiac disease. In 11 cases, NGS cfDNA testing was used to change antibiotics (new antibiotic started in 7 cases; changed or deescalated in 2 cases; stopped in 2 cases). NGS cfDNA was used in 24 cases (26%) to help exclude infection as a diagnosis (5 positive for low level pathogens; 19 negative). In 5 cases, the NGS cfDNA test was negative, but conventional testing identified causative pathogens, which are detectable in this test. Of these, 3 were identified in cerebrospinal fluid and not in blood. Figures 2 and 3 describe NGS cfDNA findings. Figure 2:(2A) Demographics (2B) Underlying diagnosis and % positive and usefulFigure 3:Clinical utility of positive and negative tests.

Conclusion
NGS cfDNA testing identified pathogens quickly and correctly in 16% of cases. The test was more often diagnostic in cases with underlying cardiac or oncology diagnosis, rather than in previously healthy patients. It was considered useful for its negative predictive value. However, in 5% of cases, the diagnosis was missed by NGS cfDNA testing. NGS cfDNA testing can provide valuable information regarding diagnosis. We caution against using this test as a single evaluative measure to exclude infection, particularly in cases where disease is suspected outside the bloodstream.

Disclosures
All Authors: No reported disclosures.
1341. Risk Factors for Candidemia after Cardiac Surgery in Pediatric Patients with Congenital Heart Defects
Authors: Kahan Yaara , Tope Samantha G , Ovadia Adi , Shpring Adi , Shatzman-Steuerman Rachel , Sherman Gilad , Barkai Galia , Mandelberg Avigdor , Tasher Diana 
Published: December 2022

Abstract

Background
Candidemia is a serious complication in children with congenital heart defects (CHD) after cardiac surgery. Data on risk factors for postoperative candidemia in this high-risk population remains limited. This study aimed to identify the incidence, outcome, and risk factors for candidemia in this population.

Methods
This retrospective case-control study was carried out at two different pediatric intensive care units between 2004-2019. Candidemia cases were matched with control patients without candidemia. Univariate and multivariable logistic regression analyses were conducted to identify risk factors for postoperative candidemia.

Results
Overall, 105 patients were included. Thirty-five candidemia cases were matched to 70 control cases. The overall incidence of candidemia was 6.3/1000 admissions. The median age of candidemia cases was 4 months (range 16 days to 9.4 years). Crude 30-day mortality of candidemia cases was 43%. Risk factors independently associated with candidemia included cumulative antibiotic exposure for ≥4 days (OR 4.3, 95% CI 1.3-14.6; p =0.02), the need for total parenteral nutrition (TPN) or peritoneal dialysis (OR 6.1, 95% CI 2-18.8; p =0.001), male gender (OR 6.2, 95% CI 1.8-21.6, p=0.04) and delayed sternal closure ≥ 2 days (OR 3.2, 95% CI 1-11.2; p =0.05). The areas under the receiver operating characteristic curves for cumulative antibiotic exposure ≥ 4 days, the need for TPN or peritoneal dialysis, delayed sternal closure ≥ 2 days, male gender, and overall, were 0.74 (95% CI, 0.64-0.84), 0.75 (95% CI, 0.65-0.85), 0.65 (95% CI, 0.53-0.77), 0.65 (95% CI, 0.55-0.77) and 0.87 (95% CI, 0.81-0.94) respectively, which is for overall an excellent discrimination.
Receiver Operating characteristic (ROC) curves for cumulative antibiotic exposure ≥ 4 days, the need for TPN or peritoneal dialysis, delayed sternal closure ≥ 2 days, male gender and overall

Conclusion
We found that postoperative candidemia in patients with CHD is an uncommon complication, occurring mostly in young infants. In our population, cumulative antibiotic exposure ≥ 4 days and the need for TPN or peritoneal dialysis were the strongest independent discriminative risk factors. However, adding previously unreported risks such as gender and delayed sternal closure strengthen the discrimination. Our results may help to define which patients with CHD should be given prophylactic or presumptive antifungal therapy.

Disclosures
All Authors: No reported disclosures.
1344. Infectious Morbidity and Mortality of HIV-Exposed, Uninfected Infants Compared with HIV-Unexposed Uninfected Infants in Botswana
Authors: Dubois Melanie , Jao Jennifer , Sun Shan , Legbedze Justine , Jacobson Denise L , Schenkel Sara , Mmasa Nicholas , Kgole Samuel W , Masasa Gosego , Happel Anna-Ursula , Iwase Saori , Moyo Sikhulile , Jaspan Heather , Powis Kathleen 
Published: December 2022

Abstract

Background
Studies have shown increased risk for infection-related hospitalizations among infants HIV-exposed-uninfected (HEU) compared to infants HIV-unexposed-uninfected (HUU). However, limited data exist during an era of expanded antiretroviral therapy (ART) and improved healthcare access in pregnancy.

Methods
The Tshilo Dikotla study prospectively enrolled pregnant women ≥ 18 years old, both living with HIV (WLHIV) and HIV-seronegative, in Botswana, following mother-infant pairs through 3 years postpartum. Pregnant WLHIV received tenofovir/lamivudine or emtricitabine plus efavirenz or dolutegravir. For this analysis, the primary outcome, infectious morbidity, was hospitalization or death due to an infectious cause for infants in the first 12 months of life. Log-binomial models were fit to assess the association between in utero HIV exposure status and infectious morbidity. Subgroup analysis among infants HEU was performed to assess associations between timing of maternal ART initiation (pre-conception vs. during pregnancy) and infant infectious morbidity.

Results
Of 464 infants, 314 (67.7%) were HEU. Maternal age was higher among WLHIV (30.3 vs. 24.6 years; p &lt; 0.01), as was gravidity (3.0 vs.1.0; p &lt; 0.01). The proportion of WLHIV reporting senior secondary or tertiary education was lower (43.3% vs 72.0%; p&lt; 0.01). A total of 35 (7.5%) infants were hospitalized/died due to infectious causes [26 (8.3%) HEU vs. 9 (6.0%) HUU (p=0.38)]. The most frequent infections were pneumonia and diarrhea/gastroenteritis. There was no significant difference in infectious morbidity by infant HIV exposure status [adjusted Odds Ratio (aOR), 1.17; 95% Confidence Interval (CI), 0.49, 2.81] after adjusting for maternal age, gravidity, income, and education. No association was found between timing of maternal ART initiation and infectious morbidity (aOR 0.60; 95% CI, 0.25, 1.40) among infants who were HEU, after additionally adjusting for maternal CD4 count and HIV viral load.
Characteristics of infants by in utero HIV exposure status

Conclusion
In this small sub-Saharan African cohort, no detectable associations were observed by infant HIV exposure status or timing of maternal ART initiation and infant infectious morbidity. Larger studies are needed to confirm these findings.

Disclosures
All Authors: No reported disclosures.
1346. Viral Suppression Rates Among Children and Adolescents Living with HIV in Baringo County, Kenya
Authors: Rono Robert 
Published: December 2022

Abstract

Background
Annually, 220,000 infants are infected with HIV globally. Kenya has 139,000 children living with HIV and among this, 78.9% know their HIV status, 93.2% are on ART and 67.1% are virally-suppressed. Achieving viral suppression is challenging in children and adolescents residing in resource limited settings. Contributing factors include variability in weight and anti-retroviral pharmacokinetics, pre-treatment drug resistance and poor palatability of drugs. Adolescents’ developmental stage does affect their psychosocial and emotional functions which can have an adverse effect on their health seeking behavior and adherence to ART care and treatment. The study objective was to determine the viral suppression rates among children and adolescents in Baringo county Kenya for the period 2016-2020.

Methods
This was a cross sectional study where retrospective data was analyzed. The study sites were Baringo County hospital (BCRH) and Marigat sub-county hospital comprehensive care clinics (CCC). Electronic medical records of children and adolescents currently enrolled in care were retrieved from the Kenya EMR system. Data collected included demographics, clinical and laboratory data. Descriptive analysis was carried out.

Results
A total of 54 cases were retrieved. Mean age was 8.5 years (SD=5.4), males being 15/29 (52%). Majority, 51/54(94%) had WHO Stage 1 classification, while 4/54 (7.4%) had TB co-infection. The most widely-used treatment regimen was ABC/3TC/LPV/r 19/54 (35%). Regarding viral suppression status, 31/54(57%) were suppressed 10/54; (18.5%) had virologic failure and 13/45 (24%) had missing viral load tests. Majority, 45/53(85%) were retained in care; 4/53(7.5%) lost to follow up and 1/53 (2%) having died.

Conclusion
Viral-suppression was low with significant TB-HIV co-infection while retention to care was good. We recommend intensification of TB screening and improved viral load monitoring rates in this age-cohort. Treatment plans need to be designed to meet the clients’ specific needs. Community ART groups should be optimized and treatment peer champions engaged to support drug distribution and psychosocial support. Learning institutions should be involved in addressing barriers in accessing treatment by school-going children.

Disclosures
All Authors: No reported disclosures.
1348. I can see myself there: Messages of inclusion on ID fellowship program websites
Authors: Tischendorf Jessica S , Filipiak Rachel 
Published: December 2022

Abstract

Background
Fellowship program websites are a key means of recruitment, particularly during all-virtual interview seasons. Perceptions of the value placed on diversity, equity and inclusion (DEI) influence applicant interest in training programs. To attract candidates from diverse backgrounds, infectious disease (ID) fellowship program websites should reflect the importance of diversity to patient care and program culture. Here we describe the current landscape of DEI elements within ID fellowship program websites.

Methods
Data for all ID fellowship programs that participated in the 2022 match were gathered from the NRMP, FREIDA and program websites, including: location, population, census region, university or community affiliation, visas accepted, and number of positions offered. ID fellowship program websites were reviewed for elements that reflect values of DEI, including: 1) presence of a program mission statement and whether it included inclusive language, 2) presence of inclusive language elsewhere, 3) separate DEI webpage, 4) fellow and faculty photographs and biographies on fellowship or division website, 5) statement of nondiscrimination in hiring, and 6) formal programming or support for underrepresented in medicine (URM), women, LGBTQ or disabled trainees.

Results
153 programs participated in the 2022 ID fellowship match; 149 have dedicated websites. Fifty-three programs had fellowship-specific mission statements, of which 14 had language oriented toward DEI. Forty-two (28%) had inclusive language reflected anywhere on their website; 14 (9%) maintained a separate section for DEI. Disclosure of non-discrimination was identified on 74 (50%) of websites. Fellow photos and biographies were available on approximately 60% of division or fellowship websites and faculty photos and biographies on approximately 90% of fellowship or division websites. Mention of formal programming or support for URM (6), women (4), LGBTQ (2) and disabled trainees (2) was uncommon.

Conclusion
Most ID fellowship program websites lack elements that reflect DEI as a priority. Program websites should incorporate inclusive language to attract and support URM, women, LGBTQ and disabled trainees.

Disclosures
Jessica S. Tischendorf, MD, MS, Merck: Grant/Research Support.
1363. Moving from Public Health Outbreak Response to Mitigation for a Regional Outbreak of Highly-Resistant New Delhi Metallo-β-Lactamase-Producing Acinetobacter baumannii in California, May 2020 – April 2022
Authors: Holden Diana , Mitsunaga Tisha , Ahanya Shantala , Trausch Kristy , Haridass Vikram , Levit Rachel , Velasquez Kiara , Garcia Erin , Sardana Neha , Cabral Ashya , Garcia Elias Geraldo , Schneider Emily C , Epson Erin 
Published: December 2022

Abstract

Background
Since May 2020, the California Department of Public Health and 12 local health jurisdictions (LHJ) have responded to a regional outbreak of highly-resistant New Delhi metallo-β-lactamase-producing Acinetobacter baumannii (NDM AB). Starting in October 2021, public health shifted from outbreak response to resource-conscious long-term mitigation in affected healthcare facilities, and prevention of spread to interconnected facilities.

Methods
We defined a case as a patient identified with an NDM AB clinical isolate, or NDM positive colonization screening and epidemiologic linkage. In October 2021, we lengthened the screening interval and changed the screening population in outbreak skilled nursing facilities (SNF) and long-term acute care hospitals to only include high-risk patients (total dependence for activities of daily living, having wounds or indwelling devices, or ventilated); we continued to screen ventilator units in ventilator-equipped SNF, and epidemiologically-linked unit(s) in acute care hospitals. Concurrently, public health initiated a prevention collaborative focused on improving environmental services (EVS) practices in the most affected LHJ, including 3 outbreak and 4 non-outbreak SNF to promote sustainable EVS practice improvement and peer-to-peer learning.

Results
Whereas we identified 170 cases during the outbreak response period May 2020 – September 2021, since October 2021 we identified only 43 cases. Screening test percent positivity decreased from 3.0% (105/3542) through September 2021 to 1.4% (21/1505) since October 2021. During the outbreak response period, we completed 42 infection prevention and control (IPC) onsite assessments that identified poor adherence to core EVS practices; since October 2021, we completed 29 assessments, including 14 for the EVS prevention collaborative.

Conclusion
Long-term mitigation of regional, multifacility novel multidrug-resistant organism outbreaks is possible by implementing a coordinated package of interventions including proactive targeted IPC assessment and support at interconnected facilities, and continued routine public health follow-up at outbreak facilities.

Disclosures
All Authors: No reported disclosures.
1369. Ten Year Trends of Typhus Fever in North Texas: Epidemiologic Characteristics and Clinical Manifestations
Authors: Hopkins Brian J , Hanna John J , Lehmann Christoph U , King Helen L , Medford Richard J 
Published: December 2022

Abstract

Background
Murine Typhus remains endemic in southern California and in southern Texas where it is transmitted by fleas, with opossums serving as the amplifying host. In Texas, the disease is increasingly recognized in municipalities outside its historic rural range and is spreading in a northward distribution. Since its expansion, we have observed increased cases in the Dallas-Fort Worth (DFW) area and aim to describe murine typhus in North Texas from 2011-2021.

Methods
Leveraging the electronic health record, we retrospectively identified 482 individuals tested for murine typhus by Rickettsia typhi (R. typhi) serology in 2 Dallas hospitals. We subsequently collected epidemiologic characteristics, clinical features, and outcomes of 58 patients with positive R. typhi serologies ( &gt;1:64).

Results
Of the 58 patients with positive R. typhi serology, 39 (67%) were male, 45 (78%) were White, and 23 (40%) were Hispanic. Seventy-nine percent had symptom onset between May and November, and 36/58 (62%) were diagnosed in 2020 and 2021. Twenty-six (45%) had exposure to dogs, 18 (31%) to cats, and 13 (22%) to opossums. Twelve (21%) patients were immunocompromised. Fifty-two (90%) had fever, 35 (60%) headache, 26 (45%) nausea and vomiting, 26 (45%) rash, 25 (43%) myalgia, 20 (34%) cough, and 17 (29%) abdominal pain. In 2020 and 2021, 35/36 (97%) patients were additionally tested for COVID-19, and 29/35 (83%) patients had more than one negative SARS-CoV-2 test prior to R. typhi serologies being sent. Twenty-one out of fifty (42%) had an abnormal chest x-ray (CXR) and 28/30 (93%) had an abnormal chest computed tomography (CT). Nine (16%) had hypoxia, 9 (16%) required an intensive care unit, and 3 (5%) required mechanical ventilation. No patients died within 30 days of diagnosis.

Conclusion
Our study highlights the expansion of murine typhus in North Texas (Figure 1) and demonstrates the heightened need for clinicians to be aware of this disease in the appropriate epidemiologic and clinical settings. We also describe increasing rates of respiratory findings, demonstrated through over half of patients having at least one respiratory symptom, and 93% having an abnormal chest CT (findings traditionally associated with severe disease). Figure 1:Heatmap Distribution of Murine Typhus Cases in the Dallas-Fort Worth Metroplex (2011-2021)

Disclosures
Christoph U. Lehmann, MD, FAAP, FACMI, FIAHSI, Celanese: Stocks/Bonds|Markel: Stocks/Bonds|Springer: Honoraria Helen L. King, MD, Gilead Sciences: Grant/Research Support.