bluuebunny/crossref_metadata_2025_split huggingface dataset:
2158. Monitoring of Varicella specific T-cell mediated immunity in pediatric allogenic hematopoietic stem cell transplant recipients
Authors: Kim Gahee , Lee Sanghoon , Lee Jina 
Published: December 2022

Abstract

Background
Varicella-zoster virus (VZV) infection is known to occur in 13-55% of patients within the first year after hematopoietic stem cell transplant (HSCT). The dynamics of recovery of VZV-specific T cell- mediated immunity (CMI) and its role for prevention and control of VZV reactivation are rarely reported in pediatric allogenic HSCT recipients.

Methods
From April 2019 to February 2020, subjects aged younger than 19 years who underwent allogenic HSCT with at least 1 year of follow up at Asan Medical Center Children`s Hospital were prospectively enrolled. All of them underwent VZV-specific enzyme-linked immune absorbent spot (ELISPOT) assays just before HSCT and then at 1, 3 months following HSCT. Extension study, which measures VZV-specific CMI before and after VZV vaccination at 24 months post-HSCT, is currently underway.

Results
A total of 32 HSCT recipients with a median age of 11years were enrolled. 37.5% underwent haploidentical HSCT and VZV R+ were in 78.1%. Antiviral prophylaxis was applied to all HSCT recipients, of which 65.6% were applied up to 365 days after HSCT. During this study period, only 1 patient (3.1%) experienced herpes zoster at 23 months following HSCT, whose VZV-specific ELISPOT assay showed 0, 1, and 0 spot-forming cells (SFC)/2.0x105 cells before HSCT, 1 and 3 months following HSCT, respectively. The presence of VZV-specific CMI ≥ 1 SFC/ 2.0 × 105 cells was observed in 62.5 % before HSCT, 65.6 % at 1 month, 59.4 % at 3 months, and 70% at 24 months after HSCT, respectively. However, only 18.8 % ,12.5 % and 21.9 % recovered VZV-specific CMI with ≥ 5 SFC/ 2.0 × 105 cells at 1, 3 and 24 months following HSCT. Meanwhile, all the 4 recipients who got the 1st VZV vaccination at 24 months following HSCT showed recovery of VZV-specific CMI with ≥ 5 SFC/ 2.0 × 105 cell. Recovery of VZV-specific CMI after HSCT was not associated with VZV serostatus, chickenpox history, type of HSCT, conditioning regimens, and GVHD.

Conclusion
Only a few pediatric allogenic HSCT recipients recovered VZV-specific CMI with ≥ 5 SFC/ 2.0 × 105 cell up to 2 years following HSCT. In addition, the association between VZV-specific CMI and VZV reactivation could not be analyzed because no one experienced VZV reactivation within 1 year after HSCT. More long-term large-scale multicenter study is mandatory to supplement these parts.

Disclosures
All Authors: No reported disclosures.
2166. Timely Antiviral Therapy for Influenza-Associated Hospitalizations in Pediatric Solid Organ Transplant Recipients in the United States
Authors: Amarin Justin Z , Haddadin Zaid , Spieker Andrew J , Godown Justin , Halasa Natasha B , Dulek Daniel 
Published: December 2022

Abstract

Background
Pediatric solid organ transplant (SOT) recipients are at high risk of complications from influenza and those with documented or suspected influenza should receive antivirals as soon as possible. We aimed to compare outcomes between pediatric SOT recipients who did or did not receive timely antiviral therapy for an influenza-associated hospitalization (IAH).

Methods
We linked the Pediatric Health Information System (PHIS) and Scientific Registry of Transplant Recipients (SRTR) databases and queried the merged database for single SOT recipients &lt; 18 years old who were transplanted between 1/1/2006 and 6/1/2016 and had at least one IAH within 3 years. We excluded children who contracted influenza or died during the transplant encounter and those who did not have follow-up data. We defined “timely” antiviral therapy as the receipt of antivirals no more than 2 days after hospitalization and compared the outcomes of children who did or did not receive timely antiviral therapy using Pearson’s χ2 test or the two-sample t-test with unequal variances, as appropriate.

Results
Of 12,419 children, 379 (3.1%) had at least one IAH. The most common organ transplant was kidney (n=133 [35.1%]). Of 270 children (71.2%) who received antivirals, 225 (83.3%) received them within 2 days of hospitalization. Oseltamivir was the most frequently administered influenza-specific antiviral (n=268 [99.3%]). The outcomes of children who received timely antiviral therapy and those who did not are compared in Table 1. The proportion of children who received timely antiviral therapy increased over the study period from 33.3% in 2007 to 100% in 2019 (Figure 1). Table 1Outcomes of pediatric SOT recipients who did or did not receive timely antiviral therapy.Figure 1Proportions of pediatric SOT recipients who did or did not receive timely antiviral therapy.

Conclusion
Timely influenza-specific antiviral therapy was associated with better outcomes in pediatric SOT recipients with IAH. Importantly, more than one-third of children did not receive timely antiviral therapy. Further studies are needed to identify and address barriers to timely antiviral therapy.

Disclosures
Natasha B. Halasa, MD, Quidel: Grant/Research Support|Quidel: equipment donation|Sanofi: Grant/Research Support|Sanofi: HAI testing and vaccine donation Daniel Dulek, MD, Eurofins/Viracor: Grant/Research Support.
2177. Institutional Prevalence of Drug-Resistant Pathogens in Community-Acquired Pneumonia
Authors: Ding Helen , Loomis Jordan , Ortwine Jessica , Mang Norman S , Wei Wenjing , Prokesch Bonnie C , Shah Nainesh , O'Connell Ellen 
Published: December 2022

Abstract

Background
Community-acquired pneumonia (CAP) is a leading cause of hospitalizations and plays a major role in mortality. The previous Infectious Diseases Society of America (IDSA) definition of healthcare-associated pneumonia (HCAP) was found to be neither sensitive nor specific for identifying drug-resistant pathogens including methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PsA) as a cause of CAP, and use is no longer supported by current guidelines. The 2019 IDSA guidelines for CAP management emphasizes the need for clinician understanding of local epidemiology data to guide selection of appropriate treatment. The primary objective of this study was to determine the prevalence of MRSA and PsA CAP at our institution.

Methods
This was a retrospective observational study of patients admitted to our 870-bed public hospital with a CAP or HCAP diagnosis within 48 hours of admission between March 2016 and March 2021. The primary outcome of prevalence of CAP caused by MRSA or PsA was determined by comparing the number of blood and adequate sputum cultures with MRSA or PsA to total reviewed cases. Secondary outcomes included the percentage of initial antibiotic regimens involving a broad-spectrum agent, percentage of initial broad-spectrum regimens de-escalated within 72 hours if indicated, and duration of CAP antibiotic treatment.

Results
A total of 220 patients were included. MRSA or PsA was isolated in 1.36% of adequate sputum cultures collected (n=3/35) and in no collected blood cultures (n=0/208). The local prevalence of CAP caused by MRSA or PsA among the analyzed sample was 1.36% (n=3/220) (Table 1). MRSA nares screening tests were completed in 10% of cases, 4.5% of which were positive (n=1/22). Secondary end point results are presented in Table 2.Table 1.Prevalence of MRSA and PsA in CAP Based on Culture DataTable 2.Secondary Outcome Data

Conclusion
The overall prevalence of CAP caused by MRSA or PsA among admitted patients is low at Parkland Hospital. Further research is needed to identify local risk factors associated with CAP caused by drug-resistant pathogens.

Disclosures
All Authors: No reported disclosures.
2181. Outcomes of Patients with Community Acquired Pneumonia Using the Pneumonia Severity Index Versus the CURB-65 as Severity Assessment Tool in Routine Practice of Emergency Departments
Authors: Kaal Anna G , de Hoek Linde op , Hochheimer Davinia T , Brouwers Corline , Joost Wiersinga W , Snijders Dominic , Rensing Katrijn , van Dijk Christel E , Steyerberg Ewout W , van Nieuwkoop Cees 
Published: December 2022

Abstract

Background
The Pneumonia Severity Index (PSI) and the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB-65) score can assess the severity in patients with community acquired pneumonia (CAP). We compared the clinical performance of both prognostic scores according to clinical outcome and admission rates.

Methods
A nationwide observational cohort study was conducted using claims data from adult patients presenting to the emergency department (ED) with CAP in 2018 and 2019. Dutch hospitals were divided into three categories: ‘CURB-65 hospitals’ (n=25), ‘PSI hospitals’ (n=19) and hospitals using both (‘no-consensus hospitals’, n=15). Main outcomes were number of hospital admissions, intensive care unit (ICU) admissions, length of hospital stay, and all-cause 30-day mortality. Multilevel logistic and Poisson regression analysis were used to adjust for potential confounders, including age, gender, comorbidities, medical specialism, and type of hospital.

Results
Of the 51.241 included patients with CAP at the ED, 21.233 were treated in CURB-65 hospitals, 17.389 in PSI hospitals and 12.619 in no-consensus hospitals. The 30-day mortality rate was 8·6% in CURB-65 hospitals versus 9·7% in PSI hospitals. Adjusted odds ratios (aORs) for 30-day mortality were lower in CURB-65 hospitals than in PSI hospitals (aOR 0·88, 95% confidence interval (CI): 0·82-0·95, p = 0·002). The admission rates in CURB-65 and PSI hospitals were similar (77·2% and 79·9%, aOR 0·81, 95% CI:
0·64-1·02). No-consensus hospitals had slightly higher admission rates on average compared to the CURB-65 and PSI hospitals combined (78·4% and 81·5%, aOR 0·79, 95% CI: 0·62-1·0).

Conclusion
The routine use of CURB-65 for risk assessment in CAP patients presenting to the ED in the Netherlands is associated with lower 30-day mortality. After further confirmation, the CURB-65 may be recommended over the use of the PSI.

Disclosures
W. Joost Wiersinga, PhD, AstraZeneca: Honoraria|GSK (DSMB): Honoraria|Pfizer: Honoraria|Sobi: Honoraria.
2185. Pulmonary Non-Tuberculosis Mycobacteria (NTM) Infections in Adult Patients at a Tertiary Care Hospital in Saudi Arabia
Authors: AlMahasnah Reem , AlMohaizeie Abdullah , AlRajhi Abdulrahman , AlMaghrabi Reem , AlThawadi Sahar , AlFattani Areej 
Published: December 2022

Abstract

Background
Burden of Non-tuberculous Mycobacteria (NTM) disease is increasing in both developed and developing countries. Local data is needed to guide our understanding of the epidemiology and outcome of NTM management in our population. The main objectives of the study are to describe management of patients with NTM infection and determine treatment outcomes in adult patients. Also, to explore the epidemiology of mycobacterial species associated with pulmonary NTM.

Methods
A 10-year (2010-2020), retrospective cohort study was conducted at a tertiary care hospital in Saudi Arabia. All patients with positive NTM culture were screened. Adult patients (≥ 18 years old) diagnosed with pulmonary NTM disease and received treatment for ≥ two months were included. Clinical data was collected from the patient’s chart using standardised form. The primary end points were overall cure rate (clinical, microbiological, and radiological cure), recurrence, relapse, and re-infection rate. The secondary end points were mortality and hospital admission rate for NTM infection. The Chi-square test was used to compare parameters. Univariate then multivariable logistic regression were used to model the effect of the outcome.
Screening of patients with positive Non-tuberculous Mycobacteria culture for eligibility

Results
Forty-five patients met the study inclusion criteria. 60% were male with a median age of 53. The most common comorbidities were malignancy and bronchiectasis. NTM species were Mycobacterium simiae (35%), Mycobacterium avium Complex (27%), and Mycobacterium abscessus (18%). Overall cure rate was 95%, with 85%, 85% and 74% of microbiological, clinical, and radiological rate achieved, respectively. Greater number of patients were treated before the recent pulmonary NTM guideline. Regimens were based on general treatment for NTM infection with clarithromycin, ethambutol, and rifampicin utilized the most. 69% of regimens were adjusted after speciation. The median duration of treatment was 36 weeks. Relapse, recurrence and reinfection rate was 20%, 9%, and 2%, respectively. NTM related hospital admission rate was 34%.
Baseline characteristics of Patients with Pulmonary Non-tuberculous Mycobacteria (n=45)
Primary and secondary outcomes
Clinical Presentation, diagnosis and treatment of Patients with pulmonary Non-tuberculous Mycobacteria (n=45)
This table is showing the clinical course of all patients included in the study with subgroup analysis per each specie of Non-tuberculous Mycobacteria

Conclusion
Pulmonary NTM disease in our patients was mainly due to three species in 80%. High overall cure rate and low recurrence rate were achieved. The findings of this study will serve as a guide for the management of pulmonary NTM disease in Saudi population.

Disclosures
All Authors: No reported disclosures.
2215. Pre-pregnancy STI Counseling and HIV Testing Among Married Women: PRAMS 2016-2019
Authors: Jang Eun Ji , Gjelsvik Annie , Amanullah Siraj 
Published: December 2022

Abstract

Background
Chlamydia, gonorrhea, and syphilis are one of the most reported and curable sexually transmitted infections (STIs) in the US, but rates continue to rise. STI during pregnancy can lead to perinatal infections. The best time to address this is at pre-conception. This study aims to examine health care visit practices among women before pregnancy and compare pre-pregnancy STI counseling and HIV testing rates among married women.

Methods
We utilized the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016-2019, a population-based survey of postpartum women. Mothers self-reported if any health care worker talked to them about STIs or tested for HIV during any health care visit in the 12 months before pregnancy. Marital status was obtained from birth certificate records. Multivariable logistic regression analysis was performed adjusting for age, race, Hispanic ethnicity, education, insurance, income, and previous live birth.

Results
Of the the162,558 surveyed women, only 66.1% had any health care visit within 12 months pre-pregnancy (Figure1). Among those with a health care visit and STI screening response (n=104,256), approximately 70% of women reported never receiving pre-pregnancy STI counseling or HIV testing. Puerto Rico and D.C. had the highest pre-pregnancy screening rates while Utah had the lowest (Figure 2). Married women were less likely to receive pre-pregnancy STI counseling (OR 0.6: 95% CI 0.56, 0.64) or HIV testing (OR 0.65: 95% CI 0.61, 0.69) compared to unmarried women (Figure 3). Other risk factors for missing pre-pregnancy STI screening were older age, having more education, private insurance, higher income, and previous live birth. Black and Hispanic women were 2-3 times more likely to receive STI screening compared to White women. Figure 1:Any health care visit and visit type within 12 months before pregnancy (n=162,558)Figure 2:Pre-pregnancy STI counseling and HIV testing across 43 states, DC, NYC, and PR (n=104,256)Figure 3:Adjusted odds of receiving pre-pregnancy STI counseling and HIV testing among recent mothers, PRAMS 2016-2019 (n=104,256)

Conclusion
Married women were less likely to receive pre-pregnancy STI counseling and HIV testing. Our study highlights the lack of preconception care among women who recently gave birth. Marital status, demographics, and socioeconomic factors continue to affect a woman’s likelihood of receiving STI screening. Risk-based, selective STI screening creates gaps and missed opportunities to address STIs before pregnancy. Universal screening should be adopted for all women regardless of their preconceived risk or assumptions.

Disclosures
All Authors: No reported disclosures.
2217. Sexually Transmitted Infection (STI) Therapy Compliance Pre and Post Centers for Disease Control and Prevention (CDC) STI Treatment Guideline Update
Authors: Sunagawa Shawnalyn , Baack Krysta , Gomez Leigh , Nichols Heather , Lewis Terese , Zeger Wesley 
Published: December 2022

Abstract

Background
In December 2020, an update to the CDC STI Guidelines was published for the treatment of uncomplicated Neisseria gonorrhoeae (GC) and the common co-infection of Chlamydia trachomatis (CT). These prescribing changes reflect goals of antimicrobial stewardship and antimicrobial susceptibility. Previous studies assessed guideline prescribing adherence; however, there is no current literature to assess the impact of these updates. The results will be used to further evaluate the impact of the 2021 CDC STI Treatment Guidelines on prescribing patterns in the Emergency Department (ED).

Methods
This study was a single-center, retrospective cohort study which included patients treated for an STI (GC/CT) in the ED at an academic medical center between February 1, 2020 and August 31, 2021, &gt; 19 years of age, and discharged from the ED. The primary endpoint is to determine if the updated guidelines contributed to a reduced incidence of appropriate guideline directed therapy for ED treatment of STIs. Secondary endpoints include ED patients still in need of STI treatment 30-days post-ED discharge, ED patients lost to follow-up within 30 days post-ED discharge and repeat ED visit for STI within 30 days.

Results
A total of 1049 patient encounters were screened for inclusion with 338 patient encounters in the Pre-CDC update cohort (PRE) and 346 patient encounters in the Post-CDC update cohort (POST). Results for the primary outcome indicate a statistically significantly reduced incidence of appropriate guideline directed therapy for ED treatment of STIs (PRE = 98.2% vs POST = 62.7%, p&lt; 0.0001). Results for the secondary outcomes were not statistically significant.

Conclusion
The update to the CDC STI Treatment Guidelines led to decreased guideline directed therapy prescribing in an academic medical center ED. There was no difference in ED patients still needing treatment, lost to follow-up, or repeat ED visits for STI within 30 days post ED discharge.

Disclosures
All Authors: No reported disclosures.
2231. Assessing Clinical Cure of Empiric Piperacillin-Tazobactam for ESBL Urinary Tract Infections (ACCEPT-UTI)
Authors: Stefanos Sylvia , Gant Jessie , Kermeen Sydney , Sakaan Sami , Samarin Michael , Gelfand Michael S , Cleveland Kerry O , Hobbs Athena L V 
Published: December 2022

Abstract

Background
While literature supports use of carbapenems over piperacillin-tazobactam (TZP) for extended spectrum beta-lactamase (ESBL) bacteremia, data is limited regarding the use of TZP for ESBL urinary tract infections (UTIs). The objective of this study is to determine if patients have similar clinical outcomes when empirically treated with TZP versus carbapenems for ESBL UTIs.

Methods
This IRB-approved, retrospective, non-inferiority study evaluated adult patients admitted to a 5-facility healthcare system from January 1, 2016 to June 30, 2021. Patients who received a carbapenem or TZP empirically for at least 48 hours with a urine culture positive for an ESBL, urinary symptoms or leukocytosis, and isolate susceptibility to the empiric antibiotic of choice were included. The primary outcome was clinical success within 48 hours defined as resolution of temperature (36-38 °C), resolution of symptoms or leukocytosis (WBC &lt; 12 x103/μL) in the absence of symptoms, and the absence of readmission for an ESBL UTI within 6 months. Secondary outcomes included time to clinical success, hospital length of stay (LOS), and 30-day all-cause mortality.

Results
A total of 223 patients were included with 123 (55%) patients receiving TZP and 100 (45%) patients receiving a carbapenem. Patients were predominantly female (65%) and Caucasian (52%) with a median (IQR) age of 70 (58, 81) years. Baseline characteristics were similar between the groups with no difference in complicated cystitis (60%), pyelonephritis (27%), or concomitant bacteremia (25%) (Table 1). There was no difference in the primary outcome of clinical success between the carbapenem and TZP group (60% vs 59%, respectively; p=0.92). Additionally, there was no difference in median (IQR) time to clinical success [39 (21, 52) vs 40 (25, 57) hrs, p=0.53], median hospital LOS [7.0 (5.1, 10.6) vs 6.8 (4.7, 9.2) days, p=0.12], or 30-day all-cause mortality (4% vs 2%, p=0.72) between the carbapenem and TZP groups, respectively (Table 2).

Conclusion
In this large, multi-center study, we found no difference in clinical outcomes in patients with UTIs caused by ESBL-producing organisms treated empirically with TZP versus carbapenems. Clinicians could consider using TZP in patients with ESBL UTIs susceptible to TZP.

Disclosures
Michael S. Gelfand, MD, AbbVie: Expert Testimony|La Jolla: Expert Testimony Kerry O. Cleveland, MD, AbbVie: Honoraria|Cumberland: Honoraria|Merck: Honoraria|Pfizer: Honoraria.
107. Identification of state-level variables associated with changes in vaccination coverage rates in adults aged 18 to 64 in the United States
Authors: Eiden Amanda , Hunter Shannon , Garbinsky Diana , Price Mark A , Russo Jon N , Hartley Louise C , Nyaku Mawuli , Bhatti Alexandra 
Published: December 2022

Abstract

Background
Despite the recognized value of life-course vaccination, adult vaccine uptake remains low. State-level vaccination coverage disparities may be associate with state-level variables (e.g., policies, programs, practices, and population characteristics). The objective of this study was to identify state-level variables associated with increased adult vaccination coverage rates (VCR) in the US for influenza, tetanus, herpes zoster (HZ), and pneumococcal vaccines over time.

Methods
Retrospective, exploratory database analysis of 2011-2019 Behavioral Risk Factor Surveillance System (BRFSS) data was used to calculate state-level VCRs for adults 18-64 years old. Using publicly available data, state-level variables associated with increases in VCRs were identified via a systematic variable selection. The multivariable regression models included variables meeting the criteria: correlations &gt; 0.4 or &lt; -0.4 (continuous) or Kruskal-Wallis Test p-value &lt; 0.2 (categorical).

Results
Final multivariable regression models included 5 variables: Medicaid expansion status, accountable care organizations in place, health homes program, percentage of adults who report not seeing a doctor in past 12 months because of cost, and percentage of adults who report participating in any physical activity.
In the multivariable models, the following state-level variables were significantly associated with changes in VCR: Influenza: percentage of adults who report participating in any physical activity (p = .01)Pneumococcal: percentage of adults who report not seeing a doctor in the past 12 months because of cost (p = .02)HZ: health homes (p = .04); percentage of adults who report participating in any physical activity or exercise (p = .01); percentage of adults who report not seeing a doctor in past 12 months because of cost (marginally significant, p = .056)Tetanus: none

Conclusion
Few state-level variables demonstrated an association with changes in VCR but some significant findings were observed in final models. Associated variables may not have a direct relationship but may be associated with public health infrastructure supporting vaccination ecosystems. Further research is underway to better understand the factors affecting adult vaccination.

Disclosures
Amanda Eiden, PhD, MBA, MPH, Merck & Co., Inc.: Stocks/Bonds Mark A. Price, MA, MEd, Merck: Advisor/Consultant|Merck: I am an employee of RTI Health Solutions. Merck has contracted with my company to conduct the study described in the abstract. Alexandra Bhatti, JD, MPH, Merck & Co. Inc.: Grant/Research Support|Merck & Co. Inc.: Stocks/Bonds.