bluuebunny/crossref_metadata_2025_split huggingface dataset:
1959. Lower B-Cell Responses Rather Than Circulating Antibody Titres Are Associated With SARS-CoV-2 Infection Post Third Dose COVID-19 Vaccination
Authors: Byrne Joanne , Gu Lili , Negi Riya , Garcia-Leon Alejandro , Alalwan Dana , Gaillard Colette Marie , Saini Gurvin , Leamy Kelly , Reynolds Bearach , O’Gorman Tessa , Kenny Grace , O’Broin Cathal , Feeney Eoin R , Yousif Obada , Cotter Aoife , de Barra Eoghan , Horgan Mary , Landay Alan , Doran Peter , Gautier Virginie , Mallon Patrick 
Published: December 2022

Abstract

Background
Which components of the immune response to SARS-CoV-2 vaccination best protect against subsequent infection remains unclear. We explored SARS-CoV-2 specific antibody and B-cell responses post 3rd dose vaccine and their relationship to subsequent SARS-CoV-2 infection.

Methods
In a multicentre prospective cohort, adult subjects provided samples before and 14 days (d14) post 3rd dose vaccine with Pfizer-BioNTech 162b2. At 18-22 weeks post vaccine, subjects self-reported SARS-CoV-2 infection (confirmed by PCR or antigen test). We used electrochemiluminescence assays to quantify antibodies to SARS-CoV-2 spike subunit 1 (S1), subunit 2 (S2) and receptor-binding domain (RBD) in plasma (reported in WHO IU/mL). In a subset of subjects, we assessed SARS-CoV-2 specific differentiated B-cell (plasma cell) and memory B-cell responses from peripheral blood mononuclear cells. Unstimulated plasma cells, and memory B cells stimulated with R848 and IL2, were seeded on plates coated with RBD or full Spike antigen and antigen-specific responses measured by ELISpot (Mabtech ELISpot, Sweden). We compared between group differences by Wilcoxon signed rank or Mann–Whitney tests. Data are median [IQR] unless specified.

Results
Of 133 subjects (age 43 [32-50], 81.2% female (table 1), 77 subjects in the B-cell subgroup (table 2)), 47 (35.3%) reported SARS-CoV-2 infection post 3rd vaccine. Antibody titres, plasma cell and memory B-cell responses all increased significantly at d14 post 3rd vaccine (Table 1 & 2, all P&lt; 0.001). Although d14 antibody titres did not differ in those with and without subsequent infection (table 1), those reporting subsequent infection had significantly lower d14 RBD-specific plasma cells and a lower proportion of RBD-specific memory B-cells (Figure 1a-b, both P&lt; 0.05). Similar results were observed with full-spike-specific memory B-cell responses (Figure 1d). The differences persisted when the non-infected group was restricted only to those reporting a confirmed close contact (n=26).

Conclusion
Infection following 3rd dose vaccine is associated with lower d14 circulating and memory B cell responses, but not antibody titres, suggesting B-cell responses better predict protection against subsequent SARS-CoV-2 infection.

Disclosures
All Authors: No reported disclosures.
1967. Receipt of Influenza Vaccination as Predictor of COVID-19 Vaccination among United States Veterans
Authors: Oda Gina , Sharma Aditya , Lucero-Obusan Cynthia A , Schirmer Patricia , Holodniy Mark 
Published: December 2022

Abstract

Background
Vaccine hesitancy has been a major barrier during the COVID-19 pandemic. Surveys administered to assess vaccine acceptance have indicated several factors associated with individual’s intention to receive COVID-19 vaccination, including risk perception, concern for side effects, political orientation, male sex, and having received an influenza (flu) vaccine. However, it is unknown whether these factors predict receipt of vaccination. We sought to determine factors that predicted COVID-19 vaccination in the Veterans Health Administration (VHA).

Methods
We extracted COVID-19 vaccine status among Veterans with any VHA outpatient or inpatient visit from 12/01/2020 - 12/01/2021 from the VHA Corporate Data Warehouse. To ensure participants were engaged in ongoing VHA care, deceased individuals, and those with no visits in the prior year were excluded. We estimated association of proportion of years of VHA care in which influenza vaccine was received in the preceding 5 years with COVID-19 vaccination by logistic regression, adjusting for age, sex, and rurality of home address.

Results
We identified 5,700,590 Veterans with outpatient/inpatient visits during the study period, with median age 66 years, of whom 5,131,617 (90%) were male. A total of 3,704,617 (65%) received at least 1 COVID-19 vaccination. Individuals who received influenza vaccination during each year in care had more than 4 times the odds of receiving COVID-19 vaccination than those who never received influenza vaccination. (Table 1). Age groups 50-64 years had twice the odds, and years 65-74 and over 75 had 3 times the odds of receiving COVID-19 vaccination versus those 18-49, while Veterans living in rural and highly rural areas had lower odds of receiving COVID-19 vaccination versus those in urban areas. Table 1.Multiple logistic regression analysis of predictors of COVID-19 vaccination among Veterans cared for in the Veterans Health Administration, December 2020 – December 2021. N=5,700,590
Abbreviations: aOR = Adjusted Odds Ratio, CI = Confidence Interval.
1 Proportion of years in care influenza vaccine received was calculated by dividing the total number of years a Veteran received influenza vaccine by the total number years the Veteran received care for the 5 years prior to the study time period.
2 VHA uses the Rural Urban Commuting Areas (RUCA) system to define rurality (RURAL VETERANS - Office of Rural Health (va.gov)

Conclusion
Influenza vaccination on a regular basis (i.e., annually) was strongly linked to receipt of COVID-19 vaccination, indicating that prior influenza vaccine acceptance predicted COVID-19 vaccination. Public health efforts to reduce vaccine hesitancy (including targeted messaging to younger individuals, and those in rural areas) are important to increase vaccine acceptance in preparation for the next pandemic, as well as to decrease annual disease burden.

Disclosures
All Authors: No reported disclosures.
2353. Distance and Time to Clinic Are Associated with Increased Risk of Detectable HIV-1 Viral Load at a Peripheral Health Center in Rural Western Uganda
Authors: Hendren Cate , Ndizeye Ronnie , Mumbere Nobert , Rubinstein Rebecca J , Baguma Emma , Muhindo Rabbison , Goel Varun , Shook-Sa Bonnie E , Ntaro Moses , Siedner Mark , Mulogo Edgar , Boyce Ross M 
Published: December 2022

Abstract

Background
Antiretroviral therapy (ART) improves the health of people living with HIV (PLHIV) and reduces HIV transmission. While availability and efficacy of ART have improved in sub-Saharan Africa (SSA), access remains a challenge. Travel burden, measured as travel time, distance, and cost, has been posited as a potential barrier to ART. For example, a previous study at a large, urban referral center in Uganda showed GPS-measured distance was associated with clinic absenteeism. However, others suggest that PLHIV are willing to travel farther for HIV care because of stigma or for higher quality care. Less is known about the effect of travel burden in rural settings where transportation infrastructure is sparse, and there are few transportation options. Therefore, the objective of this study funded by the IDSA GERM Program was to explore potential associations between distance- and time-to-clinic in a highland area of rural western Uganda with HIV outcomes including viral suppression.

Methods
We enrolled 129 adult participants receiving care at the Bugoye ART clinic. Using a handheld GPS device, we mapped routes between participants’ home and clinic recording trip distance, time, and mode of transportation. We abstracted clinical outcomes from participant medical records. Modified Poisson regression with robust error variance was used to estimate risk ratios of associations between main exposures (e.g., distance to clinic, time to clinic) and primary outcomes (e.g., detectable viral load, missed an ART dose, and history of opportunistic infection [OI]).

Results
Distance and time to clinic were significantly and positively associated with probability of detectable viral load. In adjusted analyses, for every 10-km increase in distance, participants were almost twice as likely to have detectable viral loads (PR: 1.95 [95% CI 1.12, 3.41]). For every 10 additional minutes spent traveling, risk of viral non-suppression increased by almost 40% (PR=1.39 [95% CI 1.08, 1.78]). Neither distance nor time to clinic was associated with increased risk having missed an ART dose or history of OI.

Conclusion
These results suggest travel burden may adversely affect achievement of 90/90/90 goals, and novel, decentralized ART distribution mechanisms may be required.

Disclosures
All Authors: No reported disclosures.
1984. Implementation of an integrated infectious disease and substance use disorder team for the treatment of severe injection-related infections
Authors: Seo Grace , Hervera Belén , Bartholomew Tyler , Chueng Teresa A , Chueng Teresa A , Suarez Edward , Forrest David , Hernandez Salma , Rodriguez Allan , Tookes Hansel , Doblecki-Lewis Susanne , Serota David P 
Published: December 2022

Abstract

Background
Hospitalizations for severe injection drug use-related infections (SIRIs) are characterized by high costs, frequent patient-directed discharge, and high readmission rates. Beyond the health system impacts, these admissions can be traumatizing to people who inject drugs (PWID), who often receive inadequate treatment for their substance use disorders (SUD). The Jackson SIRI team was developed as an integrated infectious disease/SUD treatment team for patients hospitalized at a public safety-net hospital in Miami, Florida in 2020. In order to facilitate implementation of this team, we conducted a qualitative study of patients and providers to identify barriers and facilitators to the team’s success.

Methods
Participants were patients with history of SIRIs (n=7) at the Jackson Memorial Hospital (JMH) and healthcare providers (HCPs) (n=8) at JMH. Semi-structured qualitative interviews were performed with a guide created using the Consolidated Framework for Implementation Science (CFIR). Interviews were transcribed and double coded by study team members using determinants adapted from the CFIR.

Results
Key barriers to SIRI team success included: 1) complexity of SIRI and SUD care requiring multidisciplinary teams and resources; 2) lack of resources for PWID experiencing homelessness, financial insecurity, and uninsured status; 3) stigma and lack of knowledge around addiction and medications for SUD; and 4) suspected understaffing and underfunding for the team. Facilitators of team success included: 1) holistic, integrated care being more efficient and effective than fragmented care; 2) the team’s advocacy for PWID as a means of institutional culture change; 3) provision of close post-hospital follow-up for an often-abandoned population; 4) non-judgmental, harm reduction-oriented approach; and 5) addressing diverse needs such as housing, insurance, and psychological wellbeing.

Conclusion
Integration of infectious disease and substance use disorder treatment is a promising approach to managing patients with SIRIs; however, success depends on institutional buy-in, holistic care beyond the medical domain, and an ethos rooted in harm reduction.

Disclosures
Susanne Doblecki-Lewis, MD, MSPH, Gilead Sciences: Grant/Research Support.
1985. Infective Endocarditis in Enterococcus faecalis Bloodstream Infection: Prevalence, Risk Factors, and Patient Outcomes
Authors: Engers Drew , Siddiqui Madiha Naqsh , Abunayla Ali , Jagarlamudi Rajasekhar 
Published: December 2022

Abstract

Background
A substantial proportion of gram-positive infective endocarditis (IE) is caused by Enterococcus species, which renders significant mortality risk. Recent European studies have attempted to identify clinical variables beyond Duke’s criteria and develop risk assessment tools. This study aimed to evaluate the prevalence of IE in our patient population with E. faecalis bloodstream infection (BSI), risk factors predictive of IE, and clinical outcomes.

Methods
This retrospective cohort study included adult, hospitalized patients with E. faecalis BSI in 1 tertiary and 3 community Michigan hospitals from January 1, 2018 through December 31, 2020. The primary objective was evaluation of comorbidities, clinical variables, and a previously validated NOVA (N-number of positive blood cultures, O-origin unknown, V-valvular heart disease, A-auscultation of cardiac murmur) scoring system for their association with IE using bivariate analysis and logistic regression. The secondary aim was to describe the mortality and readmissions rates with E. faecalis BSI and IE.

Results
We identified 167 patients with E. faecalis BSI, 65% were female, and the mean age was 71.6 (standard deviation +/- 14.8). Echocardiography was done in 68.2% of patients. There was evidence of IE in 11.9% of cases. The origin of infection was community acquired in 93.4%, an unknown source in 5.4%, and monomicrobial infections in 73.6% of patients.
The comorbidities of valvular heart disease (50% with IE vs. 20.4% without IE, p=0.01) and a cardiac implantable electronic device (CIED) (35% with IE vs. 11.5% without IE, p=0.01) were associated with IE. Community acquired origin, an unknown source of infection, and NOVA scores were not associated with IE status. Patients with a CIED were more likely to have IE, with an odds ratio of 3.45 (95% confidence interval 1.06 to 11.17; p=0.04). The 30- and 60-day mortality rates were 16.7% and 19.7% with E. faecalis BSI. The 30- and 60-day readmission rates were 19.1% and 28.1%. Mortality and readmission rates did not differ among patients based on IE status.

Conclusion
This study revealed a significant IE prevalence of 11.9% in patients with E. faecalis BSI. Of the many previously identified risk factors for IE, patients with valvular heart disease and a CIED had the greatest risk for IE.

Disclosures
All Authors: No reported disclosures.
1991. Q fever endocarditis is on the rise
Authors: Alahmad Mohamad Alhoda Mohamad 
Published: December 2022

Abstract

Background
Q fever is a reportable zoonotic febrile bacterial infection caused by Coxiella burnetii. In patients who are symptomatic, acute manifestations with hepatitis, pneumonia or fever represent the majority. Elderly men and immunocompromised populations usually present with chronic disease, usually infective endocarditis (IE). Herein, we study the inpatient prevalence of Q fever.

Methods
We used Nationwide Readmissions Database (NRD) and included hospitalizations of adults (≥18 years old) with a diagnosis of Q fever between January and November 2016-2019. Survey procedures were applied to accommodate for complex sampling design of NRD. Chi-square and means least-square were used for categorical and continuous variables, respectively. Jonckheere-Terpstra test was used to study the trends over the years. SAS 9.4 was used for data mining and analysis.

Results
A total of 1,289 hospitalizations with a diagnosis of Q fever were included, among which 172 (13%) cases had a concurrent diagnosis of infective endocarditis. The mean age of patients was 58 years, a third were female. Our analysis demonstrated that infective endocarditis was the most common cardiac complication associated with Q fever (96%) followed by pericarditis and myopericarditis (5 and 4% respectively). There is a trend of an increase in cases of inpatient Q fever with or without endocarditis over the years (from 30 and 165 cases in 2016 to 50 and 401 cases in 2019 respectively, p-value 0.04). Although there was no significant increase in mortality or 30-day readmission between patients with or without endocarditis, patients with IE had longer inpatient stays (mean of 19 vs. 11 days, p-value &lt; 0.001) and subsequently higher hospital charges (mean of $242,615 vs. $136,989, p-value &lt; 0.001).
Q fever trend from 2016-2019 (%).
Increase in percentage of inpatient cases of Q fever with and without endocarditis across the years (cases in a year/ all cases in 2016-2019).
Q fever trend from 2016-2019.
Increase in the number of inpatient cases of Q fever with and without endocarditis across the years.

Conclusion
Physicians should be aware of an increasing trend of hospitalized patients with Q fever. Further studies are needed.

Disclosures
All Authors: No reported disclosures.
1993. Serratia is a rare cause for Infective Endocarditis of the Tricuspid Valve
Authors: Talib Samer I , Raoof Nazar , Kovacs Jonathan , Raoof Natalia , Khashan Abdallah , Daliparty Vasudev , Poudel Srijana 
Published: December 2022

Abstract

Background
Serratia marcescens is a Gram-negative motile bacillus that is a facultative anaerobe and non-lactose fermenting. Serratia can be isolated from water, soil, plants, and the intestinal microbiome. Serratia produces a unique Identifying reddish pigment called prodigiosin. Serratia is responsible for only 0.14% of infective endocarditis cases, with a mortality rate of 85%.

Methods
A 37 YO female with a history of Intravenous heroin abuse was admitted with fevers and dyspnea. Vital signs were BP 76/50, HR 140, RR 26, temp 102 F, and SpO2 98% on room air. She was toxic-appearing.
Labs: WBC 26000(4,000 – 11,000 /uL) with 14% bands, Hb 5.6 (12.6 – 17.0 g/dL), PLT 15*10^3(150-372*10^3/uL), creatinine 2.5 (0.50 - 1.60 mg/dL), lactic acid 15.8 (0.5-2.2 mmol/L). We started vancomycin, piperacillin-tazobactam, and norepinephrine for septic shock. A transthoracic echo showed a large mass on the tricuspid valve, and a transesophageal echo depicted it as vegetation. Blood cultures grew Serratia. She underwent excision of anterior and posterior tricuspid valve leaflets with reconstruction and ring annuloplasty. She reported washing her syringes with tab water and reusing them again. Serratia has a predilection for left-side heart valves even in the IVDU population but this patient presented with a tricuspid valve endocarditis.

Results
Serratia is a rare cause for IE in the ICE study; out of 2.761 definite IE cases identified over five years, only forty-nine instances were due to gram-negative bacilli. Of those, only four cases were due to Serratia. The clinical presentation of Serratia includes constitutional symptoms, new-onset murmur, and cutaneous and neurologic manifestations. Serratia produces multiple pathogenic factors allowing Serratia to result in valvular destruction and perivalvular complications, and distant septic emboli metastasis.

Conclusion
Serratia is sensitive to third and fourth-generation cephalosporins, monobactams, carbapenems, fluoroquinolones, and aminoglycosides. Treatment is complex due to the production of AmpC B-lactamase, which hydrolyzes third and fourth-generation cephalosporins. The 2005 IDSA suggested a combination of B-lactam and an aminoglycoside for Serratia endocarditis, and these are not guidelines but merely recommendations.

Disclosures
All Authors: No reported disclosures.
1999. Cefpodoxime for Spontaneous Bacterial Peritonitis Prophylaxis: Incidence of Breakthrough Infection
Authors: Sung Peter , Lee Tiffany , Simonds Lauren 
Published: December 2022

Abstract

Background
Guidelines recommend use of fluoroquinolones and sulfamethoxazole-trimethoprim (SMX-TMP) for spontaneous bacterial peritonitis (SBP) prophylaxis based on data demonstrating a decrease in one-year incidence of SBP. Our institution frequently utilizes cefpodoxime for its favorable safety profile despite the lack of robust clinical experience. We sought to compare rates of breakthrough SBP with the use of cefpodoxime compared to previously reported incidence rates with the use of SMX-TMP and fluoroquinolones.

Methods
This is an IRB-approved, retrospective, single-center cohort analysis. The electronic medical record at the Hospital of the University of Pennsylvania was utilized to identify cirrhotic patients newly started on cefpodoxime for SBP prophylaxis from March 1, 2016, to December 31, 2020. The primary endpoint was the incidence of breakthrough infections within 1 year in patients who received cefpodoxime for primary or secondary SBP prophylaxis. Secondary endpoints included 1-year all-cause mortality and any microbiologic data from suspected or confirmed SBP during the study timeframe. Descriptive statistics were utilized to analyze baseline characteristics and collected data points.

Results
Overall, 90 patients met inclusion criteria within our timeframe. The study population consisted of mostly men (65.6%) with a mean age of 59 years. The majority of patients were taking cefpodoxime for primary prophylaxis (66.7%). A large proportion of the patients also had diabetes (44.4%). Alcohol use (53.3%) was the most common cause of cirrhosis, and the mean MELD score was 20.3. Breakthrough SBP occurred in 4 (4.4%) out of 90 patients within 1 year of cefpodoxime initiation. Of the 19 patients who completed a full year of cefpodoxime, 1 (5.2%) patient experienced breakthrough SBP. Microbiologic data was significant for the growth of Citrobacter spp., Streptococcus spp., Enterococcus spp., and Candida glabrata. One patient experienced culture-negative SBP. All-cause mortality at one year in our study was 41.1%.

Conclusion
Cefpodoxime is a viable option for primary or secondary prophylaxis of SBP based on comparable rates of breakthrough infection. Cefpodoxime does not frequently appear to encourage colonization and infection with resistant gram-negative pathogens.

Disclosures
All Authors: No reported disclosures.