bluuebunny/crossref_metadata_2025_split huggingface dataset:
2118. Patient Characteristics and Clinical Outcomes of Leptotrichia spp. Bacteremia
Authors: Ranganath Nischal , Challener Douglas , Schuetz Audrey , Stevens Ryan W , Shirley Joshua D , Shah Aditya 
Published: December 2022

Abstract

Background
Leptotrichia spp. are anaerobic, gram-negative bacilli that are part of the normal oral and intestinal microbiota. Although traditionally considered non-pathogenic, these bacteria can result in invasive infections including bacteremia in immunosuppressed patients, particularly those with neutropenia. There are limited published data to inform best management strategies in those with Leptotrichia bacteremia.

Methods
All cases of Leptotrichia spp. bacteremia between January 2012 and 2022 at our tertiary academic medical center were retrospectively reviewed to determine patient risk factors, clinical outcomes, and antimicrobial susceptibilities. Descriptive statistical methods were used. Antimicrobial susceptibilities were performed by agar dilution.

Results
26 cases of Leptotrichia spp. bacteremia were identified (Figure 1). The mean patient age was 55 years (SD 17), with 9 female patients (35%). All 26 patients were immunocompromised, predominantly due to hematologic malignancy (69%) or hematopoietic stem cell transplant (23%) (HSCT). 25 of 26 patients were actively neutropenic, with a median duration of neutropenia of 21 days (13-26) (Table 1). The most frequent sources of Leptotrichia bacteremia were gastrointestinal translocation (60%), followed by catheter-related infection (35%). 10 patients had polymicrobial bacteremia (38.5%). The primary antibiotics utilized to treat Leptotrichia bacteremia included metronidazole (42%), piperacillin-tazobactam (27%), and carbapenems (19%). Overall, the mean duration of treatment was 11 days, with a 60-day all-cause mortality of 19% (Table 1) with no cases of microbiologic relapse. In the 22 clinical isolates evaluated for susceptibility, Leptotrichia spp. were largely susceptible to metronidazole, penicillin, ertapenem, and piperacillin-tazobactam, but uniformly resistant to moxifloxacin (Table 2). Figure 1:Leptotrichia spp. identified as cause of bacteremia in 26 patientsTable 1:Baseline characteristics of patients with Leptotrichia bacteremia (n=26) between January 2012 to January 2022Table 2:Antimicrobial susceptibility profile of the Leptotrichia spp. (n=22)

Conclusion
Leptotrichia spp. may be a rare cause of bacteremia in neutropenic hosts, particularly those with underlying hematologic malignancies and HSCT. The pathogen has a favorable susceptibility profile to penicillins and carbapenems, but has high degree of resistance to fluoroquinolones.

Disclosures
All Authors: No reported disclosures.
2131. Performance of Dried Blood Spot (DBS) for the Diagnosis of Congenital Cytomegalovirus (cCMV) in a Single Center: A Real-World Experience
Authors: Del Valle Penella Ana P , Rochat Ryan H , Miller Jerry A , Demmler-Harrison Gail J 
Published: December 2022

Abstract

Background
The newborn DBS has been used for the retrospective diagnosis as well as a screening method for cCMV. We aimed to assess the sensitivity and specificity of this test compared to traditional methods, for the diagnosis of children suspected to have cCMV in the first 21 DOL.

Methods
In this single-center retrospective cohort study, all patients (N= 304) with a request for DBS testing between 2013 and 2021 were reviewed. Those with a DBS available for testing, a medical record at our institution, and at least one diagnostic test for cCMV obtained within the first 21 days of life (DOL) were included for review (N=86).
DBS were requested from the Texas State Health Department and sent to the Center for Disease Control for testing by DNA CMV PCR.
DBS results were compared to patients whose diagnoses were made via traditional testing with at least one accepted method (urine culture, urine PCR, blood PCR and/or saliva culture) obtained within the first 21 DOL. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated.

Results
Of the 86 patients included, 59 had a diagnosis of cCMV established by conventional testing, with 50 of them having a positive DBS and 9 a negative result. DBS had a sensitivity of 84.7%, specificity of 100 %, positive predictive value of 100 % and a negative predictive value of 75%.
Those patients with a true positive DBS had a higher median level of viremia by CMV blood PCR (6487 IU/ml vs 471 IU/ml, p= 0.012) when compared to those with a false negative result.
All patients with cCMV and congenital hearing loss had a positive DBS (N=15). A significant difference was noted in the median viremia levels of those patients with cCMV with congenital hearing loss vs those with cCMV without congenital hearing loss (17,547 IU/ml vs 3,175 IU/ml, p=0.012)
Of those cCMV patients that developed late onset hearing loss (N=9), 8 had a true positive DBS and 1 had a false negative result.

Conclusion
DBS could be useful in the diagnosis of cCMV, and its performance may be related to the level of CMV viremia at birth. DBS appears to be able to accurately identify those patients with congenital hearing loss and those who will develop late onset hearing loss. Future studies are needed to determine the best population that can be identified by this test.

Disclosures
Ryan H. Rochat, MD, PhD, MS, Merck Sharpe & Dohme: Grant/Research Support Jerry A. Miller, MS, PhD, CPH, Merck: Grant/Research Support Gail J. Demmler-Harrison, MD, Elsevier: Book royalties|Merck: Grant/Research Support|Microgen: Advisor/Consultant|Microgen: Grant/Research Support|Moderna: Advisor/Consultant|UpToDate Wolters Kluwer Health: Royalties.
2136. Development of Recombinant Rotavirus Vaccine Carrying Herpes Simplex Virus 2 Gene Based on Reverse Genetics Technology
Authors: Kawamura Yoshiki , Komoto Satoshi , Fukuda Saori , Kugita Masanori , Tang Shuang , Pieknik Julianna , Enya Yasuko , Ihira Masaru , Nagao Shizuko , Krause Philip , Taniguchi Koki , Yoshikawa Tetsushi 
Published: December 2022

Abstract

Background
Herpes simplex virus type 2 (HSV-2) can cause genital herpes, which reduces the patient's QOL associated with pain. In addition, genital herpes can increase the risk of human immunodeficiency virus infection. Vaccine development has been attempted for many years, but it has not yet been put into practical use. Meanwhile, rotavirus (RV) is one of the major viral causes of severe gastroenteritis in infants and young children worldwide. Currently, two live attenuated vaccines are widely used to prevent severe RV infection in children. We have developed entirely plasmid-based reverse genetics systems of RV, which allowed the generation of recombinant reassortant RV containing a foreign gene.
In this study, we sought to develop simian RV (SA11), in which HSV-2 glycoprotein D (gD2) gene was inserted by reverse genetics system, as a herpes vaccine, and evaluated its immunogenicity in mice.
Construction of HSV-2 protein expressing rotavirus as a vaccine inducing mucosal immunity

Methods
Artificially synthesized gD2 DNA fragment was inserted into T7 expression NSP1 plasmids (pT7/NSP1-gD2). Using the plasmid, recombinant SA11-gD2 virus (rSA11-gD2) was generated. gD2 protein expression in infected MA104 cells was verified by Western blotting. rSA11-gD2 was orally inoculated into BALB/c suckling mice twice two weeks apart and into eight-week-old mice three times apart four weeks. Diarrhea score was evaluated for seven days after first inoculation in suckling mice. Serum IgG and IgA titers against RV and gD2 were measured by ELISA.

Results
Insertion of the gD2 gene and synthesis of gD2 protein were demonstrated by sequence analysis and Wester blotting analysis, respectively. Diarrhea occurred after the first inoculation of rSA11-gD2 in suckling mice. Although IgG and IgA antibodies against RV were induced, gD2 antibody was not detected in convalescent sera in the suckling mice. Meanwhile, in the eight-week-old mice inoculated with three times of rSA11-gD2, significant increases in not only IgG and IgA against RV but also IgG against gD2 were demonstrated.

Conclusion
Simian RV containing gD2 gene, which was developed by the reverse genetics, induced IgG antibody against gD2 in orally inoculated mice. This strategy can be used to develop genital herpes vaccine.

Disclosures
All Authors: No reported disclosures.
98. A nationwide intervention to improve pneumococcal vaccination rate among immunocompromised individuals
Authors: David Shirley Shapiro Ben , Shamai-Lubovitz Orna , Mourad Vered , Goren Iris , Iunger Erica Cohen , Alcalay Tamar , Irony Angela , Greenfeld Shira , Adler Limor , Cahan Amos 
Published: December 2022

Abstract

Background
Immunocompromised individuals (ICI) are at high risk for infections, some of which are preventable by vaccines. The Israeli MOH recommends PCV13 and PPSV23 vaccines for ICI, but vaccine coverage is suboptimal. The aim of this study was to assess the effectiveness of a project to improve pneumococcal vaccination (PV) rate among ICI in outpatient settings.

Methods
An automated validated, population-based registry of patients with ICI was developed in an Israeli health organization, Maccabi Healthcare Services, serving over 2.5 million members. Included in the registry were patients aged 18 and above, receiving immunosuppressive therapy (IT); patients living with HIV (PLWH); solid organ and bone marrow transplant recipients (TR); patients with advanced kidney disease (AKD); and patients with asplenia. Based on the registry and the Israeli MOH vaccination guidelines, a nationwide quality improvement project aimed at improving PV was implemented which began in October 2019. As part of the project, ICI were waived the need for preapproval for PCV13. During an eligible patient visit, physicians and nurses were prompted with an EHR alert reminding them to consider providing pneumococcal vaccine. In addition, eligible patients were invited via their patient health record (both desktop and mobile) to vaccinate. Vaccination rates during pre- and post-intervention periods were compared using the Chi square test.

Results
A total of 32,297 ICI were identified. Of them, 22,721 were on IT, 1651 PLWH, 1829 were TR ,5267 had AKD, and 1920 were asplenic. During the period October 2019 to October 2021, PCV13 vaccination rates went up from 12% to 54.1% (p&lt; 0.0001), and PPSV23 vaccination rate improved from 44.7% to 62.6% (P &lt; 0.0001).

Conclusion
Using one of the first real-world automated registries for ICI and implementation of targeted automated patient and provider alerts, markedly improved pneumococcal vaccine uptake was observed in this vulnerable population. Similar interventions may be used to increase the adherence for other vaccines, including COVID-19 vaccines.

Disclosures
Shirley Shapiro Ben David, MD, pfizer: Grant/Research Support Limor Adler, MD, pfizer: Grant/Research Support.
2147. Multi-modal Quality Improvement Study to Reduce C. difficile Detection and Infections in Hospitalized Children
Authors: Cotter Jillian , Tong Suhong , Stokes Claire , Dominguez Samuel R 
Published: December 2022

Abstract

Background
Our institution identified rising rates of Clostridiodes difficile (C. difficile) results and infections, which coincided in part with the introduction of gastrointestinal panels (GIP) testing. We aimed to reduce the rate of positive C. difficile results and hospital-acquired infections (HAI) by 20%.

Methods
We engaged key stakeholders to identify key drivers, develop interventions, and evaluate outcomes through several plan-do-study-act cycles. We conducted a multi-modal intervention that involved 1) provider education, 2) C. difficile clinical pathway development, 3) improved preventative cleaning measures, and 4) electronic medical record (EMR)-based GIP changes including a) added option for GIP with or without C. difficile (run on same testing platform, but C. difficile results were suppressed if not ordered), and b) built in testing restrictions with optional approval process (Table 1). Our population included all hospitalized children (&lt; 18 years old) who had a stool test performed at a large quaternary-care children’s hospital over 30 months (2018-2020). Our primary outcomes were 1) rate of C. difficile positive results and 2) C. difficile HAI rates (defined as a positive test and symptom onset on or after day three of admission; adjudicated in real-time as part of routine surveillance) per 10,000 patient-days (PDs). Our process measure was the rate of testing capable of detecting C. difficile per 10,000 PDs. As a balancing measure, we evaluated the proportion of suppressed results that were ultimately released based on judgement of a infectious disease specialist who monitored these results in real-time for 7 months.

Results
We identified 2,001 stool tests performed for 1,982 encounters (Table 2). After education and EMR-based changes, we found special cause variation with a 44% decrease in the rate of positive C. difficile results and 55% decrease in HAI rates (Figures 1,2). There was a 44% decrease in testing for C. difficile, and only 2% (2/89) of suppressed results were ultimately released based on expert monitoring. The majority of patients (76%) with suppressed C. difficile results had a coinfection or were &lt; 1 old.

Conclusion
Education coupled with EMR-based testing changes resulted in an impactful and sustained decrease in C. difficile detection and HAI rates.

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.
99. COVID-19 Vaccine related Attitudes and Beliefs among Black and/or Hispanic respondents in Brooklyn, NY: Lessons Learned
Authors: Parameswaran Lalitha , Mulligan Mark , Park Yangjin 
Published: December 2022

Abstract

Background
Vaccine hesitancy remains a significant barrier against COVID-19 vaccination uptake in Black/Hispanic population. The objectives of our study were to assess attitudes such as trust in the process of vaccine development, its approval and its stakeholders and mistrust due to racial discrimination to determine their relationship to vaccine receipt.

Methods
We collected close-ended survey responses in English/Spanish among participants self-identifying as Black/Hispanic in ambulatory clinics affiliated to NYU Langone Health across Brooklyn in June 2021. The survey consisted of demographic questions, and those assessing components outlined in objectives.

Results
A total of 156 participants answered the survey; majority being women (77%), &lt; 50years old (62%), employed full time (51%), annual household income &lt; $75,000 (75%). A vast majority reported trusting their healthcare providers (91%). Of the respondents, 67% (105) self-reported receiving the COVID-19 vaccination, which was higher than the prevailing rate at that time in this population in Brooklyn. Significant proportions of vaccinated group compared to unvaccinated group reported (Table1): understanding how vaccines worked overall (85% vs 53%); trusted their healthcare providers’ advice to get vaccinated (82% vs 50%); trusted the scientists who created and tested the vaccine (80% vs 48%); agreed that it was very important that the community gets vaccinated (82% vs 27%), and it was people’s responsibility to get vaccinated to stop the spread of virus in their community (96% vs 70%); agreed that confidence in the vaccine’s safety (86% vs 50%) and effectiveness (85% vs 52%) were very important. Unvaccinated group reported concerns about the side effects of vaccines, and greater doubt about adequacy of testing for safety and effectiveness of vaccine in their racial/ethnic group, and mistrust with government.

Conclusion
Despite higher self-reported COVID-19 vaccine uptake rate in Black/Hispanic study respondents in June 2021, significant mistrust and concerns about the vaccine remain. The effect of racial discrimination and mistrust can mitigated by greater trust in healthcare team, and future interventions can test this hypothesis in order to improve vaccine uptake in these populations.

Disclosures
All Authors: No reported disclosures.
2154. Comparing the Clinical Outcomes of Human Rhinovirus/Enterovirus to Influenza and Respiratory Syncytial Virus Among Children in an Outpatient Setting
Authors: Jones Milissa U , Montgomery Agnes S , Coskun Jennifer , Marcelo Raymundo , Raiciulescu Sorana 
Published: December 2022

Abstract

Background
Human Rhinovirus/Enterovirus (HRV/ENT) infections are common among children and their full clinical impact is still being studied. We aimed to compare the clinical outcomes of children with HRV/ENT infection to other common respiratory viruses in the outpatient setting.

Methods
We conducted a retrospective analysis of nasopharyngeal samples positive for HRV/ENT, Influenza A/B (FLU), or Respiratory Syncytial Virus (RSV) from patients ≤ 17 years, submitted for testing via Multiplex polymerase chain reaction, between 2016 and 2019. Samples positive for more than one virus or arising from the same patient within 3 months were excluded. Outcome measures within proximity to the positive result were assessed via chart review and were: days of symptoms; outpatient visits for respiratory symptoms; bacterial diagnosis; and hospital admission. Between the 3 viruses: multivariable linear regression was used to compare the number of days of symptoms; Kruskal-Wallis test was used to compare the number of outpatient visits; and multivariable logistic regression was used to compare bacterial diagnosis as well as hospitalization.

Results
There were 1359 positive samples analyzed; 746 HRV/ENT, 304 FLU, and 309 RSV. After controlling for comorbid conditions and age, children with FLU had 29% fewer days of respiratory symptoms prior to testing versus HRV/ENT [β -0.34; 95% CI -0.54,-0.15; p &lt; 0.001] (Fig1A) and had fewer outpatient visits (median [M] = 1) for respiratory symptoms in proximity to a positive result versus HRV/ENT (M=2) or RSV (M= 2) (Fig 1B). After adjusting for age and comorbid conditions, children with FLU had ∼ 80% decreased odds of hospitalization versus children with HRV/ENT and those with RSV infection had 3 times the odds of bacterial infection than children with HRV/ENT (Fig 2).

Conclusion
We highlight the clinical significance of HRV/ENT in the outpatient setting. Children with HRV/ENT had more outpatient visits and higher odds of hospitalization as compared to those with FLU. Outcomes between HRV/ENT and RSV were similar, with the exception of bacterial infection. Clinicians should have a high level of vigilance when managing children with HRV/ENT infections given the potential for clinical outcomes similar to, and in some cases, worse than established pathogenic viruses.

Disclosures
All Authors: No reported disclosures.
100. Differences in influenza vaccination by gender identity and state-level gender equity policies: Data from the Behavioral Risk Factor Surveillance System, 2015-2019
Authors: Cox Sarah N , Fajans Mark A , Frivold Collrane J , Littman Alyson J , Balkus Jennifer E 
Published: December 2022

Abstract

Background
It is estimated that 1.4 million people identify as transgender and over 700,000 people identify as non-binary in the United States, many of whom face significant health disparities impacting health care access. Although previous studies have reported greater vaccine uptake in women compared to men, national-level estimates of influenza vaccine uptake among transgender and non-binary people are unknown. This study aims to characterize differences in influenza vaccination by gender identity and examine associations between vaccination status and state-based gender equality policies.

Methods
We used cross-sectional data from adults aged 18 and older who participated in the 2015-2019 United States Behavioral Risk Factors Surveillance System surveys. Weighted prevalence differences (PDs) and associated confidence intervals (CIs) of being unvaccinated against influenza by self-reported gender identity were estimated using generalized linear regression models. We identified state policies on gender identity (Figure 1) as a potential effect modifier a priori and assessed through stratification. Figure 1.U.S. states implementing the SOGI module in Behavioral Risk Factors Surveillance System between 2015-2019, classified as having restrictive versus protective policies on gender equality (N = 38)

Results
A total of 1,016,012 individuals met the inclusion criteria. Compared to cisgender women (unvaccinated prevalence=57.3%), the prevalence of being unvaccinated was significantly higher among cisgender men (64.4%; PD=7.0 per 100, 95% CI: 6.7-7.4), transgender women (65.4%; PD=8.1 per 100, 95% CI: 4.0-12.2), transgender men (64.6%; PD=7.3 per 100, 95% CI: 2.7-11.8), and non-binary individuals (64.6%; PD=7.2 per 100, 95% CI: 1.3-13.2). This pattern was similar among individuals living in protective states with more favorable gender-related policies compared to restrictive states with less favorable policies (Figure 2). Figure 2.Weighted prevalence of U.S. adults unvaccinated against influenza by gender identity, Behavioral Risk Factors Surveillance System, 2015-2019

Conclusion
Our results provide evidence of a disparity in influenza vaccine uptake by gender identity. To improve vaccine uptake among transgender and non-binary individuals, future research should focus on identifying barriers to and facilitators of vaccination by gender identity. These findings could be used to inform policies and public health interventions to improve vaccine uptake co-designed and implemented in partnership with the transgender and non-binary communities.

Disclosures
All Authors: No reported disclosures.