bluuebunny/crossref_metadata_2025_split huggingface dataset:
2186. Risk Factors to predict one-year Community-Acquired Pneumonia in a Low-Middle Income Country: A Prospective Cohort Study
Authors: Ibáñez-Prada Elsa D D , Serrano-Mayorga Cristian C , Lozada Julian , Bustos Ingrid G G , Mendez Lina , Crispin Ana M , Reyes Luis Felipe F 
Published: December 2022

Abstract

Background
Community-acquired pneumonia (CAP) is the principal cause of mortality due to infectious diseases globally. Some risk factors have been identified for CAP, such as age, smoking, environmental exposures, malnutrition, previous CAP, chronic bronchitis/chronic obstructive pulmonary disease (COPD), asthma, functional impairment, poor dental health, and immunosuppressive therapy, among others. However, these studies were conducted in high-income countries and patients without comorbid conditions. Therefore, we aimed to identify the risk factors associated with CAP development within a one-year follow-up in a prospective cohort of patients with comorbid conditions in Colombia. Table 1.Logistic Regression Analysis

Methods
This prospective cohort of adult patients with chronic comorbidities between 2020-and 2022 in Bogotá, Colombia. Univariate analysis and multivariate logistic regression model were developed to identify the variables associated with CAP development within a one-year follow-up. The logistic regression model included variables with a p-value&lt;0.20 in the univariate analysis.

Results
A total of 810 patients were included in the program. Median [IQR] age was 63 [53-62] and the most common comorbidities were 52.2% [423/810] arterial hypertension, 21.7% [176/810] coronary disease, and 19.0% [154/810] congestive heart failure. To date, 678 follow-ups have been made. Thirty-four patients died before the 6-month follow-up, and 46 were lost, leaving 598 patients included in the analysis. The cumulative incidence of CAP was 4.3% [26/598] during one year. After adjusting the logistic regression model, the main risk factors associated with pneumonia development were COPD [OR 4.30, 95% CI 1.66-11.11, p&lt; 0.01], and previous antibiotic treatment [OR 4.08, 95% CI 1.08-15.29, p=0.04] (Table 1).

Conclusion
Patients with a history of COPD or previous antibiotic treatment have a more than 300% higher risk of developing pneumonia within one year. Robust vaccination programs for adults are needed in Colombia.

Disclosures
All Authors: No reported disclosures.
103. Evaluating The Appropriateness of Vaccine Administration in Patients with Splenectomy
Authors: Barsoum Barbara , Rayn Anan , Gozar Martin , Jain Sumeet , Ha Lawrence , Donaghy Henry , Doan Thien-Ly 
Published: December 2022

Abstract

Background
The spleen removes microorganisms from the bloodstream and produces antibodies for enhanced immune response. Patients with asplenia are at increased risk for infections caused by encapsulated organisms and have a 6-fold increased risk of sepsis compared to the general population. Those that acquire an infection have a mortality rate of 80%. The CDC recommends administering the meningococcal, influenza, pneumococcal, and Haemophilus influenzae type B (Hib) vaccine at least 2 weeks before or after splenectomy.

Methods
This retrospective chart review evaluated the appropriateness of vaccine administration for patients undergoing splenectomy at Long Island Jewish Medical Center (LIJMC) from January 2016 to June 2020. Patients were included if they were admitted to LIJMC, 18 years or older, and had splenectomy at LIJMC within previous 7 years. Patients were excluded if they were pregnant, admitted to an outside hospital for splenectomy, or had an unknown time of splenectomy. The primary objective was appropriateness of vaccine administration. Inappropriateness was defined as having at least 1 error with administration, including vaccine omissions, timing of vaccine, sequencing (Pneumovax®23 given before Prevnar13®), vaccine interaction (Menactra® given with Prevnar13®), or duplicated vaccines.

Results
Of the 174 patients screened, 29 patients were included in analysis, with a mean age of 58.2 ± 20.6 years. The splenectomy was elective in 69% of patients and emergent in 31% of patients. The vaccine regimen was given inappropriately in 96.6% of patients. The reasons for inappropriateness were vaccine selection (100%), timing (39.3%), vaccine sequence (39.3%), vaccine interaction (14.3%), and duplicate vaccines (7.1%). Excluding emergent splenectomies, 100% of patients received an inappropriate vaccine regimen. The vaccines were given at least 2 weeks before elective splenectomies in 40% of patients, peri-operatively in 30% of patients, and not given in 25% of patients.

Conclusion
Patients undergoing splenectomy received inappropriate vaccine regimens mainly due to omissions, timing, and sequencing. Prevnar13® should be given before Pneumovax®23 when both are indicated and vaccines should be administered at least 2 weeks before splenectomy.
An orderset was created to mitigate errors with vaccine selection for patients undergoing splenectomy.

Disclosures
All Authors: No reported disclosures.
2193. Epidemiology and clinical characteristics of Human adenovirus in Korean children over the past 12 years (2008-2019)
Authors: Ahn Bin , Song Seungha , Kim Ye Kyung , Yun Ki Wook , Choi Eun Hwa 
Published: December 2022

Abstract

Background
Human adenovirus (HAdV) is a common cause of respiratory tract infection (RTI) and clinical presentation varies by serotype. Serotypes 7 and 55 caused severe pneumonia in children during the early 2000s and in soldiers from 2014 to 2018, respectively, in South Korea. Recent data for the epidemiologic and clinical features of HAdV in Korean children are scarce.

Methods
Nasal aspirates were collected from patients aged 18 years or younger with suspected RTIs at Seoul National University Children's Hospital from 2008 to 2019. HAdV serotype was determined by partial sequencing of hexon gene. The demographics and clinical features were reviewed through medical records.

Results
A total of 186 HAdVs were randomly selected for serotyping among 503 isolates obtained for 12 years. The median age was 2.1 years (range 1 month -17.9 years) with a slight male dominance (60.8%). Ten different serotypes were identified, which included 1-7, 31, 34, 35, and 55. The most predominant serotype was HAdV-3 (n=73, 39.3%) followed by HAdV-2 (n=42, 22.6%). Lower RTI was common in children infected with HAdV-3 (n=40, 54.8%) and HAdV-2 (n=18, 42.9%). HAdV-3 showed an epidemic every three years. HAdV-7 which previously caused severe pneumonia, has not been detected since 2008. HAdV-55 (n=9, 4.9%) was sporadically detected by each one case in 2008, 2009, and 2014, while six cases were detected in 2017-18. Among children with HAdV-55 detected, most (66.7%) had upper RTI as clinical diagnosis and only two (22.2%) had a clinically considerable pneumonia.

Conclusion
Over the past 12 years, HAdV-3 and 2 were prevalent and played an important role in RTIs of Korean children. HAdV-55 infection in children was not clinically significant in comparison to the recent Korean military outbreak cases.

Disclosures
All Authors: No reported disclosures.
2194. Epidemiology, Clinical Features and Outcomes of Hospitalized Adult Patients with Respiratory Syncytial Virus Infections
Authors: Malik Ambreen , Sharma Mamta , Bhargava Ashish , Johnson Leonard B 
Published: December 2022

Abstract

Background
Respiratory Syncytial Virus (RSV) is a common cause of respiratory tract infection (RTI) in all age groups. In general, RSV causes more severe disease in the elderly and adults with underlying comorbidities. There are limited studies evaluating RSV disease among inpatient adults. Our study objective was to assess the epidemiology, clinical features and outcomes of RSV RTIs among hospitalized adults.

Methods
A multicenter retrospective cohort study was conducted on adult patients hospitalized for RSV RTIs in southeast Michigan from 1/1/19-12/31/21. Hospitalized patients were identified using ICD 10 codes for RSV related diseases. Electronic medical records were reviewed. We collected the following data: demographics, comorbid conditions, laboratory and radiology results, treatment received and outcomes (death, discharge, 30 day readmission).

Results
A total of 102 patients were identified and included for analysis. The mean (SD) age of the cohort was 68.8 ± 14.2 yrs, 61 (60%) were female and 60 (59%) were white. The mean body mass index of the cohort was 31 ± 9.5 kg/m2. The common comorbidities were chronic lung disease (75%), hypertension (69%), obesity (38%) and congestive heart failure (30%). The mean Charlson weighted index of comorbidity was 2.28 ± 2. Fever and hypotension were noted in 13% and 15% on admission respectively. Admission CXR were abnormal in 47% cases. RSV upper and lower RTI were present in 23 (22.5%) and 79 (77.5%) respectively. Antibiotics were given in 63% of patients. Infectious diseases consultation was obtained in 41% cases. Mechanical ventilation was required in 11%, intensive care in 23.5% patients and length of stay was 6.5 + 5.6 days. Other complications were encephalopathy in 17%, acute kidney injury in 21% and liver injury in 5%. Seven (6.8%) patients died.

Conclusion
Our study found that adults admitted with RSV tended to be elderly, have multiple comorbid conditions and a high incidence of lower RTIs. Admissions were frequently complicated by need for ICU stay, mechanical ventilation and death. Our study supports a need for RSV immunizations once available for this high risk population.

Disclosures
All Authors: No reported disclosures.
2198. Healthcare Utilization During Acute Medically Attended Respiratory Syncytial Virus (RSV) Episodes among Infants in the United States
Authors: Gantenberg Jason , van Aalst Robertus , Diakun David R , Limone Brendan L , Nelson Christopher B , Savitz David A , Zullo Andrew R 
Published: December 2022

Abstract

Background
Healthcare utilization during acute medically attended (MA) RSV-associated lower respiratory tract infection (LRTI) episodes remains poorly characterized, particularly among term infants without comorbidities. Describing the care incurred during these episodes may provide important information regarding the impact of MA RSV LRTI.
Objective: Estimate the occurrence and average number of outpatient, emergency department (ED), and inpatient visits during infants' first RSV season.

Methods
Using deidentified insurance claims data (MarketScan Commercial ®, MSC; MarketScan Medicaid ®, MSM; Optum Clinformatics ®, OC), we assembled a cohort of infants born in the United States between April 1, 2016 and February 29, 2020 and identified their first MA RSV LRTI episode during their first RSV season. We defined an RSV episode as the 7 days following an index RSV diagnosis (inclusive of the diagnosis date), allowing for two alternative definitions of the index diagnosis—a specific definition, based on ICD-10 codes explicitly indicating RSV, and a sensitive definition, including codes for unspecified bronchiolitis. We calculated the average number of outpatient, ED, and inpatient visits during this episode, stratifying estimates by gestational age and the presence/absence of comorbidities. We also calculated the proportion of episodes involving a given place of service.

Results
Using the specific (sensitive) definitions, infants averaged 1.11 (1.19), 0.90 (0.89), and 1.56 (1.39) outpatient visits during their first acute RSV episode, in the MSC, MSM, and OC datasets, respectively (Table). They averaged 0.35 (0.23), 0.51 (0.47), and 0.39 (0.23) visits to the ED and 0.28 (0.14), 0.25 (0.14), and 0.23 (0.11) inpatient stays. While MA RSV LRTI episodes among infants who were preterm and/or had other comorbidities (comorbidity groups B and C) were more likely to involve an ED or inpatient visit, up to 21% (10%) of episodes among otherwise healthy term infants involved an inpatient stay.

Conclusion
Up to 1 in 5 infants experiencing an MA RSV LRTI episode during their first RSV season visited an inpatient setting, including between 9% and 21% of otherwise healthy term infants.
This study was funded by Sanofi and AstraZeneca.

Disclosures
Jason Gantenberg, PhD, MPH, Sanofi: Grant/Research Support Robertus van Aalst, PhD, MSc, Sanofi: Stocks/Bonds David R. Diakun, BS, Sanofi: Employed by IBM Watson Health which was contracted by Sanofi to perfom outcomes research|Sobi: Employed by IBM Watson Health which was contracted by Sobi to conduct the study Christopher B. Nelson, PhD MPH, Sanofi: employee|Sanofi: Stocks/Bonds David A. Savitz, PhD, Sanofi-Pasteur: Grant/Research Support|Sanofi-Pasteur: Honoraria Andrew R. Zullo, PharmD, PhD, Sanofi: Grant/Research Support.
2211. High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae identified through routine screening for rectal, pharyngeal, and urethral infections within a HIV pre-exposure prophylaxis program in Hanoi, Vietnam
Authors: Adamson Paul C , Bui Hao , Pham Loc , Le Hai , Nguyen Trung , Le Giang , Klausner Jeffrey 
Published: December 2022

Abstract

Background
Pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention and is being scaled up globally. Patients on PrEP have high rates of bacterial STIs, like Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), thus routine screening is recommended. However, access to screening tests for STIs are limited in many low-resource settings. The objectives of this study were to determine the prevalence of CT and NG among participants in Vietnam’s first PrEP program.

Methods
From January through April 2022 participants in the PrEP program at the Sexual Health Promotion Clinic in Hanoi, Vietnam were recruited to study STI prevalence. Study participants completed a survey collecting demographic, behavioral and clinical characteristics. Participants self-collected urine, rectal, and pharyngeal specimens for nucleic-acid testing. Participants positive for NG had an additional specimen collected for culture and antibiotic susceptibility.

Results
In total, 108 participants were enrolled, median age was 24 years (IQR: 22– 28). All were male and reported having sex with men in the prior 12 months. The median number of sex partners in the prior 1 month was 1 (IQR: 1 – 2). Symptoms within the prior week were reported by 41.7% (45/108) – 19.4% reported rectal, 15.7% reported urethral, and 26.9% reported pharyngeal symptoms. The overall prevalence of CT or NG infections was 31.5% (34/108). The prevalence of CT was 24.1% (26/108); by anatomic site, there were 17 (15.7%) rectal, 10 (9.3%) pharyngeal, and 6 (5.6%) urethral infections. The prevalence of NG was 13.0% (14/108); there were 12 (11.1%) pharyngeal, 9 (8.3%) rectal, and 0 urethral infections. Among participants reporting any symptoms, CT prevalence was 26.7% (12/45) and NG prevalence 13.3% (6/45). All infections were treated.

Conclusion
The prevalence of CT and NG was very high among this population of young MSM in a PrEP program in Hanoi, Vietnam. A high proportion of CT infections were rectal (65%) and 86% of NG infections were pharyngeal. These findings highlight the need for expanded access to extragenital nucleic-acid testing among PrEP programs in low- and middle-income countries. Studies demonstrating the benefit of CT/NG screening and treatment within PrEP programs are urgently needed.

Disclosures
Jeffrey Klausner, MD MPH, Cepheid: Advisor/Consultant|Cepheid: Grant/Research Support|Cepheid: Research equipment and supplies.
106. High Maternal Tdap Vaccine Uptake During Early Part of Vaccination Window: Implications for Future Maternal Vaccines
Authors: Law Amy W , Judy Jennifer , Willis Sarah J , Shea Kimberly M 
Published: December 2022

Abstract

Background
Maternal vaccines to prevent respiratory syncytial virus (RSV) among infants are in development. Uptake of existing maternal vaccines can be used to predict uptake of future maternal RSV vaccines and may be used to inform vaccine policy decisions. Previous reports of maternal vaccination rates do not estimate vaccine uptake by gestational week (wGA) of pregnancy, which is needed for precise estimation of vaccine impact. This study estimated the uptake of maternal Tdap vaccination overall and by wGA in a large electronic health records (EHR) database representing both privately and publicly insured patients over a recent 5-year period.

Methods
We identified pregnant women aged 15 – 44 years who had a live birth delivery between 01/01/2017 – 9/29/2021 in the Optum EHR database. Continuous activity for 6 months pre-conception through 1 day after delivery were required. Patients with &gt;1 type of pregnancy outcome within 7 days and/or unidentifiable wGA were excluded. We utilized recently published gestational age algorithms to estimate the uptake of maternal Tdap vaccination overall and by wGA of pregnancy. Results were reported by year.

Results
The population included 1,056,488 live births among 919,510 pregnant women during the study period. The average age at delivery was 29.7 years (SD: 5.6), 72% were white, 82% were non-Hispanic; 58% had private insurance, and 38% had Medicaid. Overall, 56% of the pregnancies included a Tdap vaccine during their pregnancy. Among vaccinated pregnancies, the majority (68%) of Tdap vaccines were administered during the first 6 weeks of the recommended 10-week vaccination window (CDC recommends Tdap vaccination from 27-36 wGA) (Table). Table.Timing of Maternal Tdap Vaccination among Pregnant Women, by Year

Conclusion
In this analysis using a large EHR database, the overall uptake of maternal Tdap vaccination was consistent with previously published estimates. Notably, the majority of Tdap vaccination occurred during the earliest weeks of the recommended vaccination period. These results may have important implications for estimating potential impact of future maternal vaccines.

Disclosures
Amy W. Law, PharmD, Pfizer: Employment|Pfizer: Stocks/Bonds Jennifer Judy, MS, PhD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Sarah J. Willis, PhD, MPH, Pfizer: Pfizer supported research at Harvard Pilgrim Health Care Institute (paid to Institute)|Pfizer: Employment Kimberly M. Shea, Ph.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds.
2222. 3-Day Ceftriaxone vs. Longer Durations of Therapy For Inpatient Treatment of Uncomplicated UTI
Authors: Elajouz Balsam , Dumkow Lisa E , VanLangen Kali , Worden Lacy , Jameson Andrew 
Published: December 2022

Abstract

Background
In the outpatient setting, IDSA guidelines recommend a 3-day course of highly bioavailable oral antibiotics (abx) for treatment of uncomplicated urinary tract infections(uUTI); however, hospitalized patients often receive IV abx and longer durations. Ceftriaxone (CRO) is well tolerated and has a favorable spectrum of activity making it an ideal antibiotic for inpatient uUTI treatment. The purpose of this study was to compare a short, 3-day course of ceftriaxone with longer durations of therapy for inpatients with uUTI.

Methods
This retrospective cohort study included adult inpatients receiving abx for symptomatic uUTI with a positive urine culture between July 1, 2015 and June 30, 2021. The primary objective was to compare clinical cure between patients treated with 3-days of CRO (CRO 3-day) vs longer durations of abx therapy (Longer DOT). Clinical cure was defined as resolution of uUTI symptoms at completion of abx and no new documented symptoms within 24 hours following completion. Secondary outcomes included comparing hospital length of stay (LOS), 30-day return visit due to UTI, and development of Clostridiodes difficile within 30 days of abx treatment. Patients empirically treated with an anti-pseudomonal abx, microbiological resistance to CRO, co-infection, or complicated UTI were excluded.

Results
A total of 100 patients were included in the study (CRO 3-days, n=51; Longer DOT, n=49). Baseline characteristics were similar between groups. There was no difference in the primary endpoint between groups as all patients in the sample population achieved clinical cure (p=1.0). Additionally, no differences in median hospital LOS (5 [4-7] vs 4 [3-6.5] days, p=0.372), 30-day return visit due to UTI (13.7% vs 6.1%, p=0.319), or development of C. difficile within 30 days of treatment (2% vs 6.1%, p=0.357) were observed between the CRO 3-days vs Longer DOT groups, respectively.

Conclusion
There were no differences in efficacy or safety endpoints between short-course CRO and longer durations of therapy. Short-course IV CRO is likely an effective treatment strategy for inpatient treatment of uUTI and may limit prolonged antibiotic durations.

Disclosures
All Authors: No reported disclosures.
2229. Antibiotic Resistance in Gram-Negative Community-Onset Urinary Tract Infections Among Adults Presenting to Hospitals, United States, 2012-2020
Authors: Li Deana , Baggs James , Wolford Hannah , Kutty Preeta K , McDonald L C 
Published: December 2022

Abstract

Background
Choosing empiric therapy for patients with community-onset urinary tract infections (CO-UTI) presenting to hospitals for treatment is challenging without understanding local antimicrobial susceptibility patterns. We investigated changes over time in antimicrobial resistance among CO-UTI pathogens and identified patient-level factors associated with higher levels of resistance.

Methods
We used non-duplicate positive urine cultures in the 2012-2020 Premier Healthcare Database as a proxy for CO-UTI in patients ≥ 18 years old presenting to hospitals receiving care categorized as community-onset inpatient (CO-INPT) or observation/emergency department (OBS/ED). We included cultures positive for Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa obtained within 3 days of admission. Phenotypes investigated include resistance to extended-spectrum cephalosporins (ESC), fluoroquinolones (FLQ), and trimethoprim-sulfamethoxazole (TMP-SX). Logistic regression analyses were performed.

Results
Among 1,987,605 urine cultures meeting study criteria from 432 hospitals, &gt; 66% were E. coli. Antibiotic resistance (AR) was highest to FLQ among CO-INPT E. coli (31.7%) and P. mirabilis (29.3%) in 2020. ESC resistance increased from 2012 to 2020 among E. coli and K. pneumoniae in both CO-INPT and OBS/ED (p&lt; 0.001). TMP-SX resistance remained &gt; 20% among E. coli in CO-INPT and OBS/ED and P. mirabilis in CO-INPT throughout the study period. All AR phenotypes were significantly higher among CO-INPT than OBS/ED (p&lt; 0.001), and higher among males than females (p&lt; 0.001). FLQ resistance among E. coli, P. mirabilis, and P. aeruginosa was &gt; 20% among males (28.2%, 30.4%, 21.9% respectively) but not females (17.5%, 15.1%, 14.5%) in OBS/ED, while it was &gt; 20% among both males (37.2%, 37.3%, 24.6%) and females (31.2%, 33.9%, 21.9%) in CO-INPT. Figure 1.% Resistance to extended-spectrum cephalosporins by year and acute care setting.Figure 2.% Resistance to fluoroquinolones by year and acute care setting.Figure 3.% Resistance to trimethoprim-sulfamethoxazole by year and acute care setting.

Conclusion
Resistance to TMP-SX in both CO-INPT and OBS/ED, and FLQ in CO-INPT, was elevated suggesting alternative empiric therapy might be necessary for CO-UTI presenting to hospitals. Increasing resistance to ESC among pathogens in CO-INPT cultures warrants further evaluation of local resistance levels. Gender and need for inpatient therapy are factors to consider in developing local treatment recommendations.

Disclosures
All Authors: No reported disclosures.