bluuebunny/crossref_metadata_2025_split huggingface dataset:
2124. Active surveillance for Congenital Cytomegalovirus infections as part of institutional protocol for newborns with failed hearing screening
Authors: Reto Patricia Pichilingue , Manzar Shabih , Mankekar Gauri 
Published: December 2022

Abstract

Background
Congenital cytomegalovirus (cCMV) is the leading infectious cause of sensorineural hearing loss in newborns. Universal screening for cCMV is not recommended in the United States. It is important to establish effective strategies for early detection of newborns with cCMV, as most of them are asymptomatic at birth.

Methods
As per institutional protocol at Louisiana State University Health Sciences Center in Shreveport, every newborn who fails auditory brainstem response (ABR) hearing screen is referred to Audiology and is evaluated with CMV polymerase chain reaction (PCR) from urine samples to rule out cCMV before they are discharged home. We intended to evaluate the proportion of newborns failing hearing screening during a two-year period that are positive for CMV by urine PCR and that are referred to Pediatric Infectious Diseases for cCMV treatment.

Results
From January 1st, 2020, to March 6th, 2022, 4,010 newborns had ABR based hearing screening at birth, with 125 (3%) failing on two attempts. Subsequently, 85 of them, corresponding to 68%, passed repeat testing at Audiology clinic, while 25 did not show up for their appointments. Out of the 67 infants that passed repeat hearing test and were tested for cCMV, none had positive urine CMV PCR results. Among the 15 newborns who failed repeat hearing test in Audiology clinic, 2 (13%) had positive urine CMV PCR results, 9 had negative results and 2 infants did not have tests done (Figure 1). Both infants diagnosed with cCMV showed severe to profound sensorineural hearing loss and are being followed by Otorhinolaryngology. They are also receiving oral valganciclovir for cCMV infection with a plan to receive treatment for 6 months, being followed periodically by Pediatric Infectious Diseases.
Evaluations with urine CMV PCR in newborns with repeat hearing screening showed that all 67 that passed were negative; and out of the 15 infants that failed repeat testing, 2 had positive CMV PCR results.

Conclusion
Our institutional protocol recommends sending urine samples for CMV PCR in every baby that fails newborn ABR hearing screen, and this has helped identified neonates with cCMV infections in the setting of severe to profound sensorineural hearing loss. These patients diagnosed with cCMV are planned to receive treatment for 6 months. Our future goals involve evaluating if early treatment of cCMV for 6 months can prevent progression of hearing loss and help achieving improved audiological outcomes at 2 years of age.

Disclosures
All Authors: No reported disclosures.
2127. Is Routine TORCH Screening Necessary For Isolated Intrauterine Growth Restriction?
Authors: Wade Christine , Atkinson Naomi , Hui Lisa , Holmes Natasha 
Published: December 2022

Abstract

Background
Perinatal TORCH infections (Toxoplasma gondii, rubella, cytomegalovirus [CMV], herpes simplex virus [HSV]) cause significant fetal and neonatal morbidity and mortality. While perinatal infections are associated with a variety of clinical manifestations in the fetus, they rarely cause isolated intrauterine growth restriction (IUGR). TORCH screens are often ordered to investigate isolated IUGR, but there is limited evidence to support screening for these infections in the absence of other ultrasound abnormalities.

Methods
A retrospective review of antenatal TORCH testing between January 2014 and December 2018 was carried out at two hospitals in Melbourne, Australia. Records were reviewed to identify indications for testing, serology results, and subsequent antenatal investigations. Neonatal outcomes were also evaluated. Serology performed for stillbirth or pregnancy losses were excluded.

Results
Medical records of 718 pregnancies were reviewed, representing 760 fetuses. 82.5% of screens were ordered in the third trimester, with 43.5% ordered after 32 weeks gestation.
TORCH serology was performed for the following indications: isolated IUGR (71.2%), neurological abnormality (6.8%), echogenic bowel (3.4%), and maternal illness (1.7%). Screens ordered for isolated IUGR were positive in 7.4% (95% CI 5.5-10.0%).
TORCH screening identified 49 positive maternal IgM results (CMV = 34, toxoplasma = 15) Two acute maternal infections during pregnancy were diagnosed (CMV = 1, toxoplasma = 1). Both were identified due to symptomatic maternal illness. There was one confirmed neonatal CMV infection. Eight women did not have follow-up to determine the significance of a positive IgM result. No TORCH screen changed maternal management or neonatal outcomes.
Rubella IgM was ordered in 83.5% of women who had clearly documented evidence of prior rubella immunity. No acute HSV infections were identified.

Conclusion
Antenatal TORCH screening for IUGR is of minimal utility and is often performed as a reflex rather than in response to specific clinical syndromes. A more guided approach with selective testing is needed.

Disclosures
All Authors: No reported disclosures.
2128. Lack of Congenital Transmission in Infants Born of Female Patients with Chagas Disease who Became Pregnant During a Nifurtimox Study (CHICO and CHICO SECURE Study)
Authors: Jaime A L T C H E H , Ramirez Teresa , Sierra Victor , Moscatelli Guillermo , Dib Juan , Pinto Jimy , Ortiz Lourdes , Falaschi Andrea 
Published: December 2022

Abstract

Background
There is some concern about the safety of nifurtimox (NF) for the offspring of treated women. Potential genotoxicity of NF was reported in in vitro models. However, the evidence to support the risks in fetal development is lacking for humans. In addition, a preventative effect over transplacental transmission was reported in girls and women with T.cruzi infection treated before pregnancy (mainly with benznidazole).

Methods
A multicenter, randomized, double-blind phase 3 clinical trial (NCT02625974) was set up to evaluate safety and efficacy of NF. A total of 330 patients, younger 18 years old, were enrolled, 67 were females of child-bearing age.
The enrolled females of childbearing age agreed to use an effective method of contraception until 3 months after the last administration of NF. Pregnancy tests were performed at screening, during treatment and 30 days after end of treatment.

Results
No pregnancies were reported during treatment period. There were 5 pregnancies reported during the 1st year of post-treatment follow-up and another 21 pregnancies during the additional 3-year follow-up period. Two mothers did not consent to have their babies tested for T cruzi infection, and in one case an abortion was reported. Two women gave birth twice. There was information about transplacental transmission available in 18 babies. All mothers were T.cruzi RT-PCR negative at the end of the treatment period and remained negative during follow up.
All newborns were live, healthy full-term and of weight appropriate for their gestational age, and had no perinatal complications except one baby who was healthy but small for gestational age. T.cruzi infection was ruled out by a negative direct parasitological test during the first days of life in 12 infants , and /or by ELISA T.cruzi serology at 8 -12 months of age in 14 infants, which was negative in all cases.

Conclusion
Our results showed that treatment of females on childbearing age with nifurtimox may prevent transplacental transmission of CD as was reported previously for benznidazole.

Disclosures
Jaime ALTCHEH, Sr., MD,PhD, Bayer: Advisor/Consultant.
2129. Maternal Transmission of SARS-CoV-2-specific Antibodies, but not Cytokines/Chemokines to Neonates Following Infection and Vaccination During Pregnancy
Authors: Monroe Jonathon M , Punia Sohan , Quach Huy Quang , Enninga Elizabeth A , Fedyshyn Yaroslav , Fedyshyn Bohdana , Lemens Maureen , Littlefield Dawn , Sintim-Aboagye Elise , Mejia Plazas Maria C , Yamaoka Satoko , Ebihara Hideki , Pandey Akhilesh , Sun Jie , Johnson Erica L , Kennedy Richard B , Theiler Regan N , Chakraborty Rana 
Published: December 2022

Abstract

Background
Despite extensive studies of human immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) vaccination, research examining protective correlates of vertical transmission following maternal exposure in pregnancy remain limited. Here, we characterized antibody and cytokine responses in maternal and cord blood following infection or vaccination at various timepoints during gestation.

Methods
Spike S1 protein-specific binding antibodies and antibodies capable of blocking the interaction between the receptor binding domain (RBD) and the angiotensin converting enzyme 2 (ACE2) were measured in maternal and cord blood by ELISA. Serum concentrations of 74 cytokines/chemokines were measured by multiplex assay. Humoral responses and cytokine levels from matched maternal and fetal cord sera were compared and examined for potential correlations.

Results
We observed a highly significant correlation between Spike S1-specific antibody titer and RBD-ACE2 blocking antibody activity between maternal and fetal cord serum (p &lt; 2.2e-16, R &gt; 0.90). Blocking antibody activity was significantly higher for mothers infected during the 3rd trimester compared to earlier trimesters; however, vaccinated mothers developed and transferred higher antibody titers with greater RBD-ACE2 blocking antibody activity to their neonates than infected mothers. Furthermore, vaccine-induced Spike S1 IgG transfer ratios (fetal cord/maternal) were significantly higher than those induced by infection (p = 0.002). Multiplex assay showed significantly elevated levels of 33 cytokines/chemokines, mainly pro-inflammatory in infected maternal serum samples, while the paired fetal cord samples exhibited an anti-inflammatory cytokine predominance.

Conclusion
Our data support selective vertical transmission of potentially protective humoral responses against SARS-CoV-2, especially following vaccination in the 3rd trimester. The anti-inflammatory cytokine predominance in cord blood that persists despite maternal SARS-CoV-2 infection may offset the adverse outcomes of inflammation in pregnancy for the neonate.

Disclosures
All Authors: No reported disclosures.
2137. Effectiveness of Four Vaccines in Preventing SARS-CoV-2 Infection in Kazakhstan
Authors: Nabirova Dilyara , Horth Roberta , Nukenova Gaukhar , Smagul Manar , Yesmagambetova Aizhan , Singer Daniel , Henderson Alden , Tsoy Alexey 
Published: December 2022

Abstract

Background
In February 2021 Kazakhstan began offering COVID-19 vaccines to adults. Breakthrough SARS-CoV-2 infections raised concerns about real-world vaccine effectiveness. We aimed to evaluate effectiveness of four vaccines against SARS-CoV-2 infection.

Methods
We conducted a retrospective cohort analysis among adults in Almaty using aggregated vaccination data and individual-level breakthrough COVID-19 cases (≥14 days from 2nd dose) using national surveillance data. We ran time-adjusted Cox-proportional-hazards model with sensitivity analysis accounting for varying entry into vaccinated cohort to assess vaccine effectiveness for each vaccine (measured as 1-adjusted hazard ratios) using the unvaccinated population as reference (N=565,390). We separately calculated daily cumulative hazards for COVID-19 breakthrough among vaccinated persons by age and vaccine month.

Results
From February 22 to Sept 1, 2021 in Almaty, 747,558 (57%) adults were fully vaccinated (received 2 doses) and 108,324 COVID-19 cases (11,472 breakthrough) were registered. Vaccine effectiveness against infection was 78% (sensitivity estimates: 74–82%) for QazVac, 77% (72–81%) for Sputnik V, 71% (69–72%) for Hayat-Vax, and 69% (64–72%) for CoronaVac. Among vaccinated persons, the 90-day follow-up cumulative hazard for breakthrough infection was 2.2%. Cumulative hazard was 2.9% among people aged ≥60 years versus 1.9% among persons aged 18–39 years (p&lt; 0.001), and 1.2% for people vaccinated in February–May versus 3.3% in June–August (p&lt; 0.001).

Conclusion
Our analysis demonstrates high effectiveness of COVID-19 vaccines against infection in Almaty similar to other observational studies. Higher cumulative hazard of breakthrough among people &gt;60 years of age and during variant surges warrants targeted booster vaccination campaigns.

Disclosures
All Authors: No reported disclosures.
2143. Contact Investigation after Exposure to Active Pulmonary Tuberculosis in the Pediatric Cancer Center
Authors: Yoon Yoonsun , Choi Joon-sik , Yoon Hanpum , Cho Sun Young , Kim Yae-Jean 
Published: December 2022

Abstract

Background
The prevalence of tuberculosis (TB) in Korean children has decreased due to universal BCG vaccination and the national TB elimination project. However, exposure to TB in children has been consistently reported. There have been few reports of TB exposure in the pediatric hematology-oncology ward.

Methods
A mother of a pediatric cancer patient was diagnosed with active TB with a cavity. Contact investigation was performed on patients, their parents, and healthcare workers who were exposed to the index case. The criteria for close contact were exposure in the same space with the index patient for more than 8 hours continuously or a total of 40 hours in case of multiple exposures. The initial assessment was performed as soon as the index case was identified. The second evaluation was conducted 8–10 weeks after the initial exposure. Both tuberculin skin test (TST), TB Specific Interferon-Gamma (T-SPOT) tests, and chest radiography were used in immunocompromised pediatric patients. For immunocompetent adults, the QuantiFERON-TB Gold (QFT-G) test and chest radiography were performed.

Results
Total 23 patients and 29 parents were exposed. The median exposure duration of patients was 3 days (1–8 days). The initial evaluation did not detect TB infection in pediatric patients. However, at the second evaluation, five patients (17.4%) were diagnosed with latent TB infection (LTBI, three with positive TST and two with positive T-SPOT), and two patients (8.7 %) were diagnosed with active TB infection (lymphadenitis and pulmonary TB). Among the 29 parents, 11 individuals (37.9%) were diagnosed with LTBI at the initial evaluation, which was considered as preexisting LTBI before this exposure. No additional case of TB infection was identified in the second evaluation. Among exposed 24 healthcare workers, two (9.1%) were eventually confirmed as newly diagnosed LTBI.

Conclusion
TB exposure in pediatric hematology-oncology ward and outpatient chemotherapy clinic caused active TB or LTBI cases with an attack rate of 26% in children. The high LTBI rate, up to 38% among parents even before this exposure, needs further intervention such as routine LTBI evaluation and treatment for families of pediatric cancer patients to prevent a similar event.

Disclosures
Joon-sik Choi, MD, MS, Ministry of Trade, industry and Energy, Republic of Korea: Grant/Research Support Yae-Jean Kim, MD, PhD, Janssen: Grant/Research Support|Korean Society of Pediatric Infectious Diseases: Grant/Research Support|Ministry of Trade, Industry and Energy: Grant/Research Support|MSD: Grant/Research Support.
2144. Duration of perioperative antibiotic prophylaxis in ventriculoperitoneal shunt surgery in children
Authors: Tada Ayumi , Ihara Satoshi , Suwa Junichi , Taniguchi Kimihiro , Shibata Meiwa , Funakoshi Hanako , Horikoshi Yuho 
Published: December 2022

Abstract

Background
Placement of ventriculoperitoneal (VP) shunt is an important treatment for pediatric hydrocephalus. Although prolonged perioperative antibiotic prophylaxis has theoretically no benefit in reducing device-associated infections, duration of antibiotic prophylaxis for VP shunt placement in pediatrics is not well established. As a part of antimicrobial stewardship program (ASP), our ASP team recommended to stop perioperative antibiotic prophylaxis for sterile medical placement within 48 hours following surgery in April 2017.
Our aim of this study was to evaluate rate of VP shunt-associated infections following shunt placement between children received &lt; 48 hours and ≧ 48 hours of perioperative antibiotic prophylaxis.

Methods
Children aged 15 years old or younger who underwent VP shunt insertion between April 2014 and November 2021 were enrolled at Tokyo Metropolitan Children's Medical Center. Children with co-existing infection at time of surgery were excluded. Rates of VP shunt-associated infections following 1 month and 6 months of post-surgical periods were compared between children who received &lt; 48 hours and ≧ 48 hours of perioperative antibiotic prophylaxis.

Results
A total of 110 children were identified. Among them, 11 cases with VP shunt-associated meningitis and 15 cases with other infections were excluded. Girl ratio was 44%. Median age was 4.5 months old (IQR 8-40). Numbers of children with cefazolin and vancomycin-contained regimen were 83 (98.8%) and 1 (1.2%), respectively. Numbers of children who received perioperative antibiotic prophylaxis for &lt; 48 hours and ≧ 48 hours were 43 (51.2%) and 41 (48.8%), respectively. Incidence of VP shunt-associated infections for 1 month of post-surgical period in &lt; 48 hours and ≧ 48 hours antibiotic prophylaxis groups were 4.65% (2/43) and 12.2% (5/41), respectively. (P=0.211)　Incidence of VP shunt-associated infections for 6 months of post-surgical period in &lt; 48 hours and ≧ 48 hours antibiotic prophylaxis groups were 11.6% (5/43) and 12.2% (5/41), respectively. (P=0.936).

Conclusion
Shorter duration of &lt; 48 hours of perioperative antibiotic prophylaxis did not increase rates of VP shunt-associated infections among children in short and long terms.

Disclosures
All Authors: No reported disclosures.
2146. Impact of MRSA colonization pressure on MRSA acquisition and MRSA infection in pediatric intensive care unit
Authors: Kim Gahee , Lee Sanghoon , Lee Jina 
Published: December 2022

Abstract

Background
Methicillin-resistant Staphylococcus aureus (MRSA) colonization pressure (CP) is a useful indicator for measuring the extent of MRSA reservoir in healthcare settings. The purpose of this study is to determine the MRSA colonization rate and invasive MRSA infection rate in severely ill pediatric patients requiring pediatric intensive care unit (PICU) stay, and to evaluate the association between MRSA CP and MRSA acquisition/invasive infection.

Methods
From January 2016 to December 2020, pediatric patients admitted to 2 PICUs with a total of 25 beds were retrospectively analyzed. Routine nasal and/or endotracheal cultures were performed on MRSA at the time of PCIU admission and thereafter, every week. MRSA CP was defined as the ratio of the monthly MRSA positive number of patients to 100 patient days. Among MRSA colonizers, MRSA obtained after 2 days of PICU admission was defined as an acquired colonizer, and imported colonizer was defined when it was confirmed as an MRSA colonizer at the time or within 2 days of entry. When MRSA was cultured in a normally sterile body fluids, it was defined as an invasive MRSA infection.

Results
Of the total 6,907 patients admitted to the PICUs during this study period, 8.4% (487/6,907) were MRSA colonizers; 30% (139/487) were acquired colonizers, and invasive MRSA infections occurred in 3.3% (16/487). During the stay in the PICUs, the MRSA acquisition rate was 4.1%. A total of 22 invasive MRSA infections occurred during this study period, with an incidence rate of 3.1/1,000 patient days, of which 72.7% (n=16) occurred to the patients with MRSA colonization. Invasive MRSA infection occurred in 2.4% (8/348) of imported colonizers, and 5.2% (8/139) of acquired colonizers (p=0.108). The median duration from the time of colonization to invasive infection was 24 days(IQR; 2.25-49.75). Although MRSA CP was not correlated with the incidence of invasive MRSA infection (p=0.101), MRSA CP itself affected MRSA acquisition in PICU (p&lt; 0.001).

Conclusion
MRSA CP influenced the new acquisition of MRSA during PICU stay, and newly acquired colonizers are more likely to experience invasive MRSA infection. Continuous multi-faceted efforts to minimize MRSA CP can provide opportunities for reducing MRSA colonization and infections rates in PICU settings.

Disclosures
All Authors: No reported disclosures.
2150. Surgical Prophylaxis in Pediatric Liver Transplant Recipients: Variations in Protocol and Impact on 30-Day Surgical Site Infections
Authors: Marshall Nicholas P , Foster Charles B , Arakoni Venkatraman , Hashimoto Koji , Radhakrishnan Kadakkal , Gonzalez Blanca E 
Published: December 2022

Abstract

Background
Children undergoing liver transplantation are at risk for surgical site infections (SSI). IDSA/ASHP/SIS/SHEA guidelines recommend surgical prophylaxis with a third-generation cephalosporin plus ampicillin or piperacillin-tazobactam alone. The study objectives were to describe the surgical prophylaxis used at our institution, obtain data on whether prophylactic antimicrobials are adjusted for multidrug resistant organisms and to determine whether adjustments correlate with SSI.

Methods
Pediatric liver transplant procedures, with associated peri-operative and intra-operative antimicrobials, were extracted from our institutions’ Anesthesia Record Keeping System (ARKS) between 2005-2022. Medical records were reviewed for demographics, microbiological data (e.g., colonization), protocol deviations and 30-day CDC/NHSN SSIs.

Results
Seventy-one procedures were performed in 69 patients, median age 3 years (range, 5 months- 17 years), where 89% had a pre-transplant infectious disease consultation. Variations from protocol occurred in 39% (n=28), of which 3 were consult-directed. Sixteen were colonized with an organism prior to transplant (3 MDRO and 1 Candida spp.), of which 10 had a protocol adjustment (p&lt; 0.001). The most common additional antimicrobials were vancomycin (n=17) and fluconazole (n=8). Reasons for fluconazole were fulminant liver failure (n=2), surgeon concern (n=3), colonization or prolonged antimicrobials prior to transplant (n=2) and continuation of prophylaxis (n=1). Ten procedures were complicated by an SSI (14%). SSI rates did not differ in those with and without protocol adjustments (p=0.50).

Conclusion
Adjustments to guideline concordant surgical prophylaxis recommendations occurred in 39% of pediatric liver transplant procedures, with the most common being addition of vancomycin or fluconazole. Adjustments were based on a pre-transplant infectious disease consult recommendations in 11% of cases. Protocol adjustment correlated with any pretransplant microbiology culture result, but not with either MDRO colonization or subsequent SSI. Antimicrobial stewardship efforts may be indicated to address variations in antimicrobial prophylaxis in pediatric liver transplant patients.

Disclosures
All Authors: No reported disclosures.