bluuebunny/crossref_metadata_2025_split huggingface dataset:
1257. Antiretroviral treatment failure in a prospective cohort of Persons Living with HIV in the Philippines
Authors: Dungca Nina Theresa , Schwem Brian , Arevalo Geraldine , Li Kingbherly L , Salvana Edsel Maurice 
Published: December 2022

Abstract

Background
Widespread access to antiretrovirals has resulted in improved survival among PLHIV in resource-limited settings. In a previous study, ART failure in the Philippines after one year was found to be 10.3%. However, this was done as a cross-sectional study and did not capture dropouts or pre-existing drug resistance (PDR). Treatment failure, taking into account PDR, dropouts, and long-term viral suppression has not been studied. As part of a transmitted drug resistance (TDR) study, we prospectively followed patients and documented long-term viral suppression.

Methods
We enrolled 227 treatment-naïve PLHIV without TDR on Sanger-based sequencing and measured viral load (VL) every 6 months. VL “&gt;”1000 copies/mL after initiation of treatment was considered treatment failure. An intention to treat analysis counting loss to follow-up as treatment failure was performed along with secondary analysis by subtype.

Results
Treatment failure at different time points are shown in Table 1. Of the 227 patients, 177 were subtype CRF01_AE, 30 were B, 14 were CRF01_AE/B recombinants, 2 were subtype CRF02_AG, 2 were CRF01_AE/B/F recombinants and one was an A1/D recombinant. Median VL was 295,000 copies/mL at baseline (range: 40 - 658,000 copies/mL). Seventeen PLHIV developed treatment failure over an observation time of up to 60 months, while 74 were lost to follow-up. Comparison between B and non-B subtypes showed a higher rate of failure among non-B subtypes (OR 2.868 95% CI 1.018 to 10.016 p=0.0380) at one year, but this was no longer significant at 24 months (p=0.1534) and 48 months (p=0.0716).

Conclusion
HIV viral suppression at one year of treatment is 65.6% in an intention to treat analysis. It is 63.4% at 24 months and 60.8% at 48 months. Excluding dropouts, viral suppression is 95.5%, 92.3%, and 89.0% at 12, 24, and 48 months, respectively. Non-B subtypes are more likely to fail than those with B subtypes in the first year of treatment. Loss to follow-up is a significant problem in the Philippines and needs to be addressed proactively in order to improve local efforts to reach the 90-90-90 thresholds of UNAIDS for control of HIV in the country.

Disclosures
Edsel Maurice Salvana, MD, MSD: Advisor/Consultant|MSD: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria.
1272. Impact of Rapid Initiation of Antiretroviral Therapy on Retention in Care in the Southern United States
Authors: Benidir Bailey , Ali T’shura , Sanchez Lucia Puga , Salunkhe Vidyulata , Gootee Steven , Arnold Forest W 
Published: December 2022

Abstract

Background
Rapid initiation of antiretroviral therapy (ART) is now a well-established approach for reducing time to viral suppression in persons newly-diagnosed with HIV. However, there is limited data examining the effect of rapid initiation of ART on retention in care—which is also crucial to reducing transmission—especially in the disparate populations of the southern United States. The goal of this study is to determine if rapid start ART increases retention in HIV care in this region.

Methods
This was a prospective population-based cohort study of newly-diagnosed HIV patients who established care at the 550 Clinic from July 2021 to April 2022. The intervention was utilizing a team to facilitate warm hand-offs of newly diagnosed patients to clinic, in contrast with standard of care, a faxed referral. All patients were enrolled in one of two arms: rapid prospective (ART initiated within 7 days of diagnosis) or non-rapid prospective (ART started &gt; 7 days of diagnosis). Data was also matched to a retrospective arm from historical data. Patients were followed at a visit 4-8 weeks from initiation then again in 8-12 weeks. Descriptive statistics were done to compare demographics, clinical characteristics and time to follow-up visit by study arm.

Results
Of the 105 patients enrolled, 41 were in the rapid prospective arm, 35 in the non-rapid prospective arm, and 29 in the retrospective arm. The median age was 31 years, 83% were male, 35% African American, and 12% Hispanic. In the rapid arm, time from initiation to first kept follow-up was significantly less compared to the non-rapid arm (44 days vs 70 days, p &lt; 0.001). From baseline to third visit, there was a 93% increase in the CD4 count among the rapid arm vs a 58% increase among the non-rapid arm. Additionally, 80% of rapid participants had an undetectable viral load by visit 3 vs 66.7% of non-rapid participants.

Conclusion
Results showed that addition of a warm hand-off and rapid initiation of ART improves linkage to care and increases adherence to follow-ups, as well as rates of viral suppression. This intervention was effective in improving outcomes, even among the medically vulnerable populations seen in the southern US. This data can therefore contribute to closing gaps in data on regional HIV care where ethnic minorities experience healthcare disparities.

Disclosures
Bailey Benidir, PharmD, AAHIVP, Gilead Sciences, Inc.: Grant/Research Support Forest W. Arnold, DO, MSc, Gilead Sciences, Inc.: Grant/Research Support.
1275. Leveraging Big Data to Understand and Improve Continuity of Care Among HIV-Positive Individuals with Criminal Charges in North Carolina
Authors: Arant Elizabeth C , Rosen David L , Kavee Andrew L 
Published: December 2022

Abstract

Background
Little is known about the impact of having criminal charges on HIV outcomes. We sought to understand the relationship between having criminal charges and viral suppression among people living with HIV (PLWH) in North Carolina (NC).

Methods
We linked statewide NC criminal court records to the state’s confidential HIV records (both databases: 2017-2020) to assess HIV viral suppression (viral load [VL] &lt; 200 copies/ml) in the 12 months before receiving and after resolution of criminal charges using the viral load most closely preceding and proceeding the charges. For each period, PLWH without a VL were coded as unsuppressed. We used generalized estimating equations to examine changes in viral suppression pre-post criminal charges, adjusting for other demographic and legal system factors.

Results
During the study period, 9,586 PLWH experienced criminal charges. Compared to others with charges, PLWH were more likely to be male (78% v 69%, p &lt; 0.001) report Black race (77% vs 37%, p &lt; 0.001) and be older (median age: 41 vs 36 years, p &lt; 0.001). The median duration of unresolved charges was longer for PLWH compared to others (68 vs. 37 days, p &lt; 0.001). The proportion with suppressed viral load pre- and post-charges was respectively 71% and 73%, p = 0.01. When adjusting for demographic and legal factors, the period following resolution of criminal charges was associated with an increased odds of viral suppression (adjusted odds ratio [aOR] 1.11; 95% Confidence Interval [CI] 1.03-1.19) compared to the period prior to charges. Factors negatively associated with viral suppression included Black race (aOR 0.60; 0.51-0.70), HIV acquisition via self-reported heterosexual contact (aOR 0.75; 0.62-0.91) or intravenous drug use (IDU) (aOR 0.51; 0.41-0.63) compared to men who report sex with men (MSM). Compared to those aged 18-29 years, those aged 60-69 were more likely to be suppressed (aOR 2.41; 1.78-3.25).

Conclusion
In the context of other risk factors for sub-optimal HIV suppression, the resolution of criminal charges was modestly associated with improvement in viral suppression. To further understand the mechanism underlying this association, future analyses will incorporate the role of additional factors such as charge type, incarceration, and state region.

Disclosures
All Authors: No reported disclosures.
1296. Customized Learning About Bettering Sterile Insertion (CLABSI): A Look at Reducing Hospital Acquired Line Infections
Authors: Abusalem Lana , Smith Jake , Fugere Tyler , Tilley Zachary , Savenka Tatsiana , Wright Caitlyn L , Liverett Hazel K 
Published: December 2022

Abstract

Background
Central line associated bloodstream infections (CLABSIs) are associated with significant clinical and economic impacts. A large portion of central venous lines (CVLs) placed at the University of Arkansas for Medical Sciences are done so by resident physicians. A formal education session focusing specifically on aseptic technique for residents has not been utilized so far.

Methods
Literature review and expert opinion was used to guide development of a multi-modal resident education session. The session consisted of a PowerPoint presentation, a video tutorial, and a CVL insertion checklist. More than 50% of the time was allotted to a hands-on session led by residents demonstrating how to aseptically place a CVL under the supervision of an Infection Preventionist. A Likert scale was utilized to assess the level of confidence residents had regarding eight CLABSI prevention metrics both before and after attending the session. Additionally, residents were polled to assess their preferred teaching modality. 66 internal medicine residents and 18 internal medicine-pediatrics residents participated in the study over a five-week period. The results were assessed for statistical significance with a two-tailed Mann-Whitney U-test.

Results
Responses were received from 54 residents prior to the simulation lab session, and from 56 residents after the simulation lab session. The total resident response rate was 66.67%. A statistically significant improvement in resident confidence was found in all eight surveyed CLABSI prevention metrics. The majority of responding residents found workshop style sessions, peer-to-peer teaching and educational videos to be the most useful modalities to deliver information.
Bar Graph Demonstrating a Side by Side Comparison of Resident Reponses Pre- and Post-Intervention
Bar Graph Demonstrating a Side by Side Comparison of Resident Reponses Pre- and Post-Intervention
Resident Responses to Preferred Methods of Learning about CLABSI's Pre- and Post-Intervention

Conclusion
Attendance of a two-hour multimodal resident-driven educational session improved the confidence of residents in their knowledge and implementation of CLABSI prevention metrics. Participants preferred learning via workshop style sessions and educational videos. We recommend a multi-modal approach to resident education, and the consistent involvement of an Infection Preventionist. We hope to expand our curriculum to involve residents in other departments and explore the variation in preferred learning modalities and its overall impact on hospital CLABSI rates

Disclosures
Hazel K. Liverett, MD, Merck: Stocks/Bonds.
1301. ID Fellows Cup: Developing Confidence Through Content Creation
Authors: Kahn Mauricio J , Walker Jeremey , Yagnik Kruti J , Chiosi John , Herrera Lauren Nicholas N , Chavez Miguel A , Dong Sara W , Willig James , Nolan Nathanial S 
Published: December 2022

Abstract

Background
The ID Fellows Cup (IDFC) is a multiple-choice question set delivered via the Kaizen Education software, which uses gamification to enhance engagement. Questions are directed to ID fellows worldwide, but all learners can participate. In the inaugural year, 541 individuals (344 fellows) played in ≥1 of 3 rounds. Content creation by learners is known to enhance knowledge and confidence with material. We hypothesized that inviting trainees to author questions would enhance their perceived ID knowledge and confidence in creating Free Open Access Medical Education (FOAMed) content.

Methods
We invited trainees to write questions for the 10/2021 and upcoming 5/2022 games (105 questions) through an online volunteer call. They received a brief lecture and outline on question development. Mentors (early faculty or other fellows) reviewed their content and gave constructive feedback. We developed a 22-item survey targeted to writers and mentors using input from the literature and involved educators. Items included demographics, prior experience, perceptions of benefit, and areas to improve. We distributed it by email after question submission.

Results
Thirty-eight of 54 (70%) writers and mentors completed the survey. 1 asked to remove their responses from research. 35 (94.6%) participants answered all survey questions. Table 1 shows their demographics. Before the IDFC, 18 (48.6%) respondents had never written a board-style ID question; 21 (56.8%) had never created FOAMed content, and 23 (63.9%) had low confidence in creating it. 35 (97.2%) found that writing a question was an effective use of their time, and 36 (100%) felt it increased knowledge of the assigned topic. 33 (91.7%) found it increased their confidence as near-peer educators, and 31 (86.1%) that it increased confidence in creating future FOAMed content (Table 2).

Conclusion
Crowdsourcing questions through a mentored process allows for an enhanced educational experience for trainees and early faculty. Authoring board-style questions was felt to increase ID knowledge and was rated as effective use of time. Many authors had limited experience in FOAMed content creation but gained skills and confidence from the process. Similar initiatives may support and empower early educators to step into the global digital education platform.

Disclosures
All Authors: No reported disclosures.
1313. Clinical significance of Rickettsia rickettsii antibody testing among children in Eastern Long Island, New York
Authors: Wang Joye , Handel Andrew S 
Published: December 2022

Abstract

Background
Rocky Mountain spotted fever (RMSF) is a tickborne illness caused by Rickettsia rickettsii (Rr). Diagnosis is challenging due to non-specific symptoms and reliance on convalescent antibodies (Ab) for definitive diagnosis. Early doxycycline administration reduces poor outcomes but is sometimes prescribed without clear exposure or suggestive symptoms. Confusion also arises from positive Ab testing in patients lacking RMSF symptoms. Our study aims to describe Rr Ab results and clinical impact in a low incidence region. Specific objectives were to describe signs and symptoms of children tested for RMSF, false-positive Ab rates, and unnecessary antibiotic administration.

Methods
Retrospective chart review of patients ≤ 21 years old tested for Rr Ab within the Stony Brook Medicine system from 2010-2020. Patients were identified by ICD-9/-10 RMSF diagnosis code and/or Ab test results. Charts without clinical notes were excluded. Data collected included demographics, symptoms, laboratory results, treatments, and outcomes. Patients were classified as RMSF confirmed, probable, suspected, unlikely, or negative based on symptoms and Ab results, per CDC definitions (Table). Results recorded in Qualtrics. Descriptive statistics were calculated. ‘Unlikely RMSF’ cases were considered false positive Ab and ‘proven’ or ‘probable’ cases were considered true positive Ab.
Case definitions based on CDC Rocky Mountain spotted fever (RMSF) case surveillance definition
Abbreviation: Rr - Rickettsia rickettsii

Results
172 charts were included. Average age was 14 years. 56% were male. Of RMSF classic triad symptoms, 52% had fever, 41% rash, and 44% headache. Of RMSF case categories, 2 (1.2%) were confirmed, 3 (1.7%) probable, 10 (5.8%) suspected, 14 (8.1%) unlikely, and 143 (83%) negative. Both confirmed cases had fever, rash and headache. False positive and true positive Rr Ab rates were 8.9% (n=5) and 2.9% (n=5), respectively. 5 patients with false positive Ab received doxycycline within 14 days of Ab collection date.

Conclusion
Among children in a low-incidence region, Rr Ab were frequently obtained without signs of infection, including half without fever. The cause of false positive Rr Ab in patients lacking RMSF symptoms is unknown, but may be due to non-severe infection or cross-reactivity with other Rickettsia. Focused testing on those with suggestive symptoms may avoid unnecessary treatment and anxiety.

Disclosures
All Authors: No reported disclosures.
1315. Dental Discoloration and Enamel dysplasia after Tetracyclines Exposure in Children: A Nationwide Population-Based Study in Korea
Authors: Lee Ji Young , Kim Eun Hwa , Lee Myeongjee , Shin Je Hee , Lim Sung Min , Jung In Kyung , Ahn Jong Gyun , Kang Chung-Min , Kang Ji-Man 
Published: December 2022

Abstract

Background
Tetracycline (TC) is not recommended for pediatric use due to the risk of permanent teeth discoloration and enamel dysplasia. We aimed to assess the incidence of dental abnormality in Korean children and investigate whether the risk was greater in tetracycline-exposed children compared to the general population.

Methods
This nationwide, population-based study using Health Insurance Review and Assessment service database included children (aged 0-12 years) who were prescribed tetracycline for at least a day between January 2008 and December 2020. We evaluated the incidence rate of children who were inserted diagnosis codes for dental discoloration and enamel dysplasia after at least 6 months after prescription as the primary outcome. Standardized incidence ratio was analyzed to determine whether the risk of dental abnormalities was greater in the exposed group compared to the general population in Korea.

Results
A total of 56,990 patients with TCs exposure were included, 3% were under the age of 8 (n=1,735) while the majority of 97% were between ages of 8 and 12 (n=55,255). The incidence rate in 0-7 year old age group was 734 cases per 100,000 person-years, which was about five times higher than the 143 cases per 100,000 person-years of the 8-12 year old group with statistical significance (P&lt; 0.001). The 5-year cumulative incidence rate in the 0-7 years old age group was 4.1 % (95% CI, 3.0-5.7%) and 5.7% (95% CI, 4.1–7.8%) in 10-year period. In the 8-12 year old age group, 5-year cumulative incidence was 0.8% (95% CI, 0.7-0.9%) and 1.3% (95% CI, 1.1-1.4%). The risk of dental abnormalities was not significantly increased in the TC-exposed group of 0-7 year old age group compared to the general population (SIR = 1.08; 95% CI, 0.69-1.60).

Conclusion
The incidence of tooth discoloration and enamel dysplasia was lower than previously suggested, particularly between the ages of 8 and 12 and as low as one-fifth of those under the age of 8, suggesting a reconsideration of limiting use of TCs in children if clinically indicated.

Disclosures
All Authors: No reported disclosures.
1318. Etiology of Infectious Conjunctivitis in Children: A Multi-Center Case-Controlled Study
Authors: Frost Holly M , Sebastian Thresia , Jenkins Timothy C , Keith Amy , Kurtz Melanie , Meece Jennifer K , Dominguez Samuel R , Savor-Price Connie 
Published: December 2022

Abstract

Background
Acute infectious conjunctivitis (AIC) is a common pediatric infection affecting one in eight children annually. The etiology of AIC is poorly understood but important to inform treatment and return to school recommendations. Additionally, the association of bacteria isolated from the conjunctiva with the development of clinical AIC is not well defined. We aimed to determine the bacterial and viral causes of AIC in children.

Methods
Patients age 6 months-18 years with AIC at Denver Health (Denver, CO) and Marshfield Clinic (Marshfield, WI) from 2019-2021 were included. Age-matched healthy and upper respiratory infection (URI) controls without conjunctivitis were enrolled within 30 days of each case. Patients had a conjunctival flocked swab (Eswab®, Copan Diagnostics) obtained. Nucleic acids were extracted using the NucliSENS® easyMAG® system (Quidel, San Diego, CA) per manufacturer’s instructions. Multiplex RT-PCR for S.pneumoniae, H.influenzae, M.catarrhalis, S.aureus , and 11 respiratory viruses were completed using Lyra® (Quidel, San Diego, CA) and AnDiaTec® assay kits (Quidel Germany GmbH, Kornwestheim, Germany, Table). Nucleic acid amplification and detection was completed on the Applied Biosystems® (ABI) 7500 Fast Dx Real-Time PCR Instrument. Odds ratios were computed for each organism.

Results
A total of 78 cases and 71 controls (33 healthy, 38 URI) were included (Table). Bacteria were detected in 59 (75.6%) cases and 36 (50.7%) of controls (OR 14.3; 4.7,33.7). Respiratory viruses were infrequently detected (cases 2, 2.6%; controls 6, 8.5%), including in the pre-pandemic period. Of bacteria detected in cases, H.influenzae was the most common (56.4%) and had the highest association with conjunctivitis (OR 11.8; 4.8, 29.1) followed by M.catarrhalis (35.9% cases, OR 2.5; 1.2, 5.3). S.pneumoniae was detected more often in controls than cases (33.8% v 26.9%).

Conclusion
H.influenzae is likely the most important pathogen associated with AIC in children. Though data have suggested marginal benefit of antibiotic treat for conjunctivitis overall, studies specifically looking at benefit by organism would advance the field. A rapid diagnostic test for H.influenzae and possibly M.catarrhalis could help direct antibiotic treatment to children most likely to benefit.

Disclosures
Samuel R. Dominguez, MD PhD, Biofire DIagnostics: Advisor/Consultant|Biofire DIagnostics: Grant/Research Support|DiaSorin Molecular: Advisor/Consultant|Karius: Advisor/Consultant|Pfizer: Grant/Research Support.
1326. Mupirocin Resistance in Staphylococcus aureus in Pediatric Patients for Ten Years
Authors: Park Hwanhee , Kim Doo Ri , Kim Kyung-Ran , Kim Jong Min , Huh Hee Jae , Lee Nam Yong , Kim Yae-Jean 
Published: December 2022

Abstract

Background
Mupirocin has been recommended for decolonization in methicillin-resistant Staphylococcus aureus (MRSA) carriers for recurrent skin and soft tissue infections and treatment for impetigo. However, the indiscriminate use of mupirocin causes mupirocin resistance, associated with decolonization failure. The aim of the study was to investigate the epidemiology of mupirocin resistance and to identify clinical characteristics among children in a single center.

Methods
From January 2011 to October 2020, we retrospectively analyzed the epidemiology of antibiotic resistance and clinical characteristics of pediatric patients under 19 years old in whom S. aureus was firstly isolated at any body site.

Results
Of the 3,414 S. aureus isolates, 46% (1569/3414) were methicillin-resistant, and 20.3% (692/3414) were mupirocin resistant. Among MRSA, Mupirocin-resistant (MupR) was 22.6% (354/1569), and among methicillin-sensitive S. aureus (MSSA), MupR was 18.3% (338/1845) (P&lt; 0.001). The median age of MupR MRSA patients was 0.14 years (interquartile range 0.04-0.79), and the median age of MupR MSSA patients was 5.0 years (interquartile range 2.0-8.1) (P=0.000). Of 692 MupR S. aureus, 94.2% (652/692) were mainly detected in the skin. MupR MRSA was most frequently isolated in the neonatal intensive care unit (40.1%, 142/354), but MupR MSSA was most frequently isolated in the outpatient setting (81.4%, 275/338) (P&lt; 0.001). Of these, 43% (119/275) patients were diagnosed with atopic dermatitis. By age, mupR MRSA was the more commonly isolated in infants younger than one year (77.4%, 274/354), and MupR MSSA was more commonly isolated in children older than three years old (65.4%, 221/338) (P&lt; 0.001). The frequency of MupR MRSA and MSSA showed an increase in trend over time (P&lt; 0.001). Among other topical agents, 6.5% (102/1569) of MRSA was resistant to fusidic acid.

Conclusion
As mupirocin resistance gradually increases, a test for mupirocin susceptibility should be performed before applying the skin lesions or decolonization for MRSA. In addition, clinicians should carefully prescribe mupirocin to prevent the development of MupR S. aureus.

Disclosures
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.