bluuebunny/crossref_metadata_2025_split huggingface dataset:
2084. Importance of the Primary Care Physician in HIV PrEP Adherence During a Pandemic
Authors: Daudelin Isaac , McCarty Bret , Ahmad Chaustre Shawn K , Finkel Diana 
Published: December 2022

Abstract

Background
In 2015 emtricitabine-tenofovir (PrEP) was approved for use as a pre-exposure prophylactic medication for preventing HIV infections. In 2017, WHO declared PrEP to be an essential medicine, gaining widespread acceptance for outpatient care. In 2020, the COVID-19 pandemic disrupted the healthcare system, with several studies showing lower rates of PrEP prescriptions during the pandemic particularly among Black and Latinx groups.

Methods
Medical records at Rutgers New Jersey Medical School (NJMS) were queried for PrEP prescriptions from 2017-2021. All duplicate entries, and all patients prescribed emtricitabine and tenofovir as part of HIV treatment were removed. Years 2017-2019 were defined as “pre-pandemic” and years 2020-2021 were defined as “pandemic.”

Results
Average annual prescriptions for PrEP at NJMS decreased by only 13% (157 to 137 p=0.53) for all ages and 25% (29 to 22 p=0.38) for adolescents and young adults (ages 16-24) (AYA) from pre-pandemic to pandemic years. The annual number of AYAs who had their PrEP prescribed by the Division of Adolescent and Young Adult Medicine practice (DAYAM) remained the same during the pandemic while the annual number of AYAs who had their PrEP prescribed by the Infectious Disease practice (IDP) decreased by over 50% (p = 0.07). PrEP prescriptions for trans-identifying individuals (over 90% prescribed by the IDP) increased by 15% (p = 0.58).
PrEP Prescriptions for Adolescents and Young Adults
All PrEP Prescriptions at Rutgers NJMS

Conclusion
Despite the national decline in PrEP prescriptions during the COVID-19 pandemic, NJMS experienced a non-statistically significant decrease in PrEP prescriptions despite serving a majority Black and Latinx population who have elsewhere suffered the most disruption in healthcare during the pandemic. At NJMS, the IDP provides primary care for trans-identifying individuals, and DAYAM provides primary care for AYAs. Average annual PrEP prescriptions for trans-identifying individuals increased and AYA PrEP prescriptions by the DAYAM remained the same throughout the pandemic emphasizing the key role primary care physicians have in PrEP access during the pandemic and may play a significant role in the strong continuation of PrEP program provided at NJMS throughout the pandemic.

Disclosures
All Authors: No reported disclosures.
2099. Clinical frailty scale as a predictor of mortality of pulmonary infections in patients with hematological malignancies
Authors: Ortiz-Martínez Yeimer , Fajardo-Rivero Javier , Cadena-Sanabria Miguel , Figueroa-Pineda Claudia , Ruiz-González Carlos , Saul Zane 
Published: December 2022

Abstract

Background
Due to the poor outcomes reported in older patients with hematological malignancies (HM) and pulmonary infections, there is a need to identify patients at high risk of mortality.
Objective: This study aims to find the association between frailty and mortality in patients above 65 years of age with HM hospitalized with pulmonary infections.

Methods
A cross-sectional, retrospective study was conducted on the clinical data of 64 HM older patients with pulmonary infection hospitalized in a tertiary university hospital in Bucaramanga, Colombia, between January 2015 and December 2020. Patients were assessed using Clinical Frailty Scale (CFS) and were divided into three groups: CFS 1–4 fit; CFS 5–6 frail and CSF 7–9 severely frail. The association between frailty and in-hospital mortality was the primary outcome. All statistical analyses were performed using Stata/IC 14.0.

Results
The number of participants classified as fit, frail, and severely frail was 21 (32.8%), 22 (34.3%), and 21 (32.8%), respectively. 48.4% were women, and the mean age was 75.4 ± 6.85 years. A total of 45 patients (70.3%) died during hospitalization. We found a significantly higher in-hospital mortality rate among frail (23.8% vs. 90.9%; p &lt; .001) and severely frail patients (23.8% vs. 95.2%; p &lt; .001), when compared to fit patients. After multivariate analysis, high CFS score was an independent risk factor for mortality, OR was 6.8 (1.40–32.97, p = .001) for frail and 14.4 (1.76–117.32 p = .013) for severely frail compared to fit patients, after adjustment for sex, type of HM and the presence of comorbidities. Table 1Baseline characteristics of study participants.Image 1Kaplan-Meier survival estimate for mortality for patients ≥65 years with hematological malignancies and pulmonary infection.

Conclusion
Clinical Frailty Scale (CFS) could be used as a potentially useful tool in predicting mortality of pulmonary infections in elderly patients with HM. These results could suggest that the use of this score extends beyond evaluating the degree of frailty and could predict adverse outcomes and help decision making in complex clinical scenarios.

Disclosures
All Authors: No reported disclosures.
2102. Common co-occurence in the respiratory tract of Mucorales with Gram-negative rods in patients with hematologic malignancy and sinopulmonary mucormycosis
Authors: Egge Stephanie L , Wurster Sebastian , Axell-House Dierdre B , Jiang Ying , Miller William R , Kontoyiannis Dimiitrios P 
Published: December 2022

Abstract

Background
Mucorales (MCR) and Gram-negative rods (GNR) commonly infect patients (pts) with hematological malignancies (HM); however, their co-occurrence is understudied.

Methods
We retrospectively reviewed the records of 63 pts with HM and sinopulmonary MCR (proven or probable, EORTC/MSG criteria) at MD Anderson Cancer Center (Houston, TX) from 2008-2016. Co-occurrence was defined as a culture positive for GNR taken from sinuses or the lungs within 90 days (d) of a positive Mucorales culture or histology demonstrating Mucorales spp.

Results
Ninety percent of the 63 pts with MCR had leukemia or myelodysplastic syndrome (54% AML) and 10% had lymphoma/myeloma. Sixty-eight percent had undergone hematopoietic stem cell transplant. Sixty-seven percent were neutropenic at the time of MCR diagnosis. Thirty-five percent had received &gt; 600mg of prednisone within 30 days (d) prior to MCR diagnosis. Thirty-five percent were admitted to the ICU during the time of MCR treatment. MCR pts had sinusitis (42.9%), pneumonia (38.1%) and disseminated sinopulmonary disease (19.0%). Nearly all pts (92%) received empiric antimicrobials with activity against Pseudomonas prior to collection of their positive fungal cultures. Twenty-three pts (37%) had concurrent detection of GNRs (Pseudomonas in 10, Stenotrophomonas in 8) in samples from the sinopulmonary tract. Eight of 23 co-isolations of GNRs and Mucorales (35%) were found in same-day samples. Demographic and clinical characteristics of pts with and without co-occurrence of GNR were comparable. Pts with co-occurrence had less frequently received antibiotics with activity against Stenotrophomonas 7 (30.4%) vs 23 (60%, p=0.024). Ninety-day all-cause mortality was high and comparable in pts with (83%) and without (78%) GNR detection (p = 0.75).

Conclusion
Over a third of heavily immunosuppressed pts with sinopulmonary MCR harbor GNRs in their respiratory tract, most commonly Pseudomonas. Although no impact on survival outcomes was seen in a background of high mortality, pathogenesis studies are needed to understand the mutualistic interplay of GNR and Mucorales spp. and their influence on host responses.

Disclosures
William R. Miller, MD, Entasis Therapeutics: Grant/Research Support|UpToDate: Royalties - Topic Contributor Dimiitrios P. Kontoyiannis, MD, ScD, PhD (hon), AbbVie: Advisor/Consultant|Astellas Pharma: Advisor/Consultant|Astellas Pharma: Grant/Research Support|Astellas Pharma: Honoraria|Cidara Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria|Merck: Advisor/Consultant.
2103. Comparison of Antibiograms Across Solid Organ Transplant Services Within a Medical Center
Authors: Kim Annie , MacDougall Conan 
Published: December 2022

Abstract

Background
Antibiograms summarize localized antimicrobial susceptibilities and are used to guide empiric antibiotic therapy. Antibiograms for subpopulations may offer more meaningful clinical data, especially in immunocompromised hosts who may be at higher risk for multidrug-resistant organisms. However, population-specific antibiograms are uncommon. The purpose of this study is to evaluate whether service-specific antibiograms provide more useful information than hospital-wide antibiograms.

Methods
This is a retrospective, single-center study that included bacterial isolates from all body sites collected between 2017-2020. Antibiograms were created in accordance with the Clinical and Laboratory Standards Institute guidelines, with susceptibilities reported as a percentage and a 95% confidence interval. A combined solid organ transplant (SOT) antibiogram and individual antibiograms based on the transplanted organ (heart, lung, liver, and kidney) were compared to a hospital antibiogram with a difference of ≥ 10% considered clinically significant.

Results
In the combined SOT antibiogram, Escherichia coli, Klebsiella aerogenes, and Klebsiella pneumoniae susceptibilities were lower for antibiotics such as ceftriaxone, ceftazidime, and ciprofloxacin compared to the hospital antibiogram. Overall susceptibilities for Pseudomonas aeruginosa in the SOT antibiogram were comparable to that of the hospital antibiogram; however piperacillin-tazobactam susceptibilities were substantially lower among lung and heart transplant patients. Among Staphylococcus aureus isolates, clindamycin susceptibilities were similar between the SOT antibiogram and hospital antibiogram. This was a result of lower susceptibilities among lung transplant patients, offset by greater susceptibility in liver, kidney, and heart transplant patients.

Conclusion
Clinically significant differences were seen in susceptibilities for several antibiotics against gram-negative and gram-positive pathogens in various transplant antibiograms. The combined SOT antibiogram minimized substantial between-service differences. Through population-specific antibiograms, providers may be able to improve empiric antibiotic therapy selection for their patient population.

Disclosures
Conan MacDougall, PharmD, MAS, Merck: Advisor/Consultant.
2116. Long-term (2-year) outcomes and complications of COVID-19 in solid organ transplant (SOT) recipients
Authors: Burack Daniel , Pereira Marcus R , Verna Elizabeth 
Published: December 2022

Abstract

Background
The long-term complications of COVID-19 infection in the general population include mortality, re-infection, secondary infection, persistent organ dysfunction, and symptoms of long-COVID. The prevalence of these outcomes and impact on graft function in solid organ transplant (SOT) remain uncertain. We aim to describe these complications in a large series of SOT with COVID-19 with 2 years of long-term follow up.

Methods
We retrospectively studied all adult (age &gt;18) SOT from a single center hospitalized with SARS-CoV-2 diagnosed by nasopharyngeal swab between 3/10-5/30/2020. Patients with early mortality within 28 days were excluded. Outcomes including mortality, allograft rejection, allograft failure, secondary infections, COVID-19 re-infections, post-COVID complications (oxygen requirement, chronic renal or cardiac dysfunction), and symptoms of long-COVID were analyzed. Re-infections were characterized by severity and likely variant based on local variant predominance.

Results
117 SOT recipients were hospitalized with COVID-19 in the study period. 94 survived the first 28 days and were followed for a median of 751 (742-760) days post-infection. 9 (9.57%) died within 1 year of infection and 14 (14.9%) within 2 years. 21 (22.3%) had ≥1 episode of allograft rejection and 21 (22.3%) had allograft failure. 11 (9.4%) were re-infected with COVID-19 at a median of 603 (389-642) days following initial infection, of whom 2 (18.2%) were hospitalized and 0 died. 43 (45.7%) had secondary infections and 18 (19.1%) with multi-drug resistant organisms. 32 (34.0%) developed new chronic kidney disease or end-stage renal disease, 25 (26.6%) had new cardiovascular disease, and 8 (8.51%) had a prolonged oxygen requirement following infection. Of reported long-COVID symptoms, fatigue (26, 27.7%), dyspnea (18, 19.1%), and cough (11, 11.7%) predominated with 25 (26.6%) having &gt;1 symptom.

Conclusion
In this large cohort of SOT recipients hospitalized during the first wave of the COVID-19 pandemic, long-term 2-year follow-up showed high rates of mortality, allograft rejection, allograft failure, secondary infection, organ dysfunction, and symptoms consistent with long-COVID. Ongoing study of the impact of these complications will be crucial to improving outcomes in SOT recipients.

Disclosures
Marcus R. Pereira, MD, Hologic: Grant/Research Support|Merck: Grant/Research Support|Moderna: Grant/Research Support|Shire/Takeda: Grant/Research Support|Takeda: Advisor/Consultant|Union Therapeutics: Advisor/Consultant Elizabeth Verna, MD, Salix: Grant/Research Support.
2125. Determinants of Placental Transfer of HSV-specific Antibodies and the Impact of SARS-CoV-2 Coinfection
Authors: Mahant Aakash Mahant , Estrada Fatima , Aguilan Jennifer , Sidoli Simone , Herold Betsy , Herold Betsy 
Published: December 2022

Abstract

Background
Primary versus recurrent herpes simplex virus 1 or 2 (HSV-1 or HSV-2) infection during pregnancy carries a higher risk of neonatal herpes. Murine and clinical studies demonstrate that antibody dependent cellular cytotoxicity (ADCC) provides greater protection against disseminated neonatal disease. To quantify relative transfer of HSV specific Abs with different functions and targets and whether SARS-CoV-2 coinfection modified transfer, we conducted a prospective cohort study of mother-infant dyads prior to and during COVID-19.

Methods
Total and HSV lysate, glycoprotein D (gD) and glycoprotein B (gB)-specific IgG, IgG1 and IgG3, nAbs and ADCC were quantified in paired 3rd trimester maternal and cord blood. IgG1 and IgG3 subclass and gD or gB-specific Abs were isolated by column purification and glycan profiles were assessed using mass spectrometry. The pre-COVID study population included 21 term and 15 preterm dyads who were HSV seropositive and the pri-COVID cohort included 25 HSV seropositive term dyads whose mothers were also SARS-CoV-2 PCR and COVID Ab positive at delivery.

Results
HSV-specific Ab and neutralizing Ab transfer ratio (TR) were higher in term compared to preterm pre-COVID dyads (all p&lt; 0.05), but the ADCC TR was &lt; 1.0 for both groups. To determine if the low ADCC TR reflected antigenic target, subclass and/or glycans, we enriched for anti-gD and anti-gB specific and IgG1 and IgG3 Abs. The anti-gD Abs were exclusively IgG, had only neutralizing activity and had glycans associated with FcRn binding. In contrast, anti-gB Abs were both IgG1 and IgG3; had both neutralizing and ADCC activity and expressed glycans associated with both FcRn and FcγRIIIa binding. There was no significant difference in HSV-specific IgG TR in pre-COVID vs COVID dyads (0.42) but the nAb TR was lower (p=0.018) and ADCC TR higher (p&lt; 0.001) in COVID compared to pre-COVID patients. Placental immunohistochemistry showed an increased colocalization of FcRn and FcγRIIIA in SARS-CoV-2 positive mothers, which would favor transfer of ADCC Abs.

Conclusion
Defining the determinants of ADCC transfer has implications for future vaccine and monoclonal Ab strategies to prevent/treat neonatal herpes. We speculate that increasing the transfer of ADCC may be a key element in providing immune protection

Disclosures
Betsy Herold, MD, Viracor (Eurofins): Advisor/Consultant|X-Vax, Technologies: Advisor/Consultant|X-Vax, Technologies: Grant/Research Support|X-Vax, Technologies: Serve on Scientific Advisory Board for X-Vax, Technologies and receiving reserach funding for related worl. Betsy Herold, MD, Viracor (Eurofins): Advisor/Consultant|X-Vax, Technologies: Advisor/Consultant|X-Vax, Technologies: Grant/Research Support|X-Vax, Technologies: Serve on Scientific Advisory Board for X-Vax, Technologies and receiving reserach funding for related worl.
2156. Impact of Asymptomatic Upper Respiratory Viral Shedding in Pediatric Cardiothoracic Surgical Patients
Authors: Fischer Laura J , Castera Mark R , Chin Hannah , Lee Junghyae , Simonsen Kari 
Published: December 2022

Abstract

Background
Intraoperative and postoperative complications associated with symptomatic upper respiratory infections in young children are well-documented; however, asymptomatic upper respiratory viral shedding is frequent and may be prolonged. Necessary pediatric cardiac surgical procedures could be delayed with recognition of asymptomatic viral shedding. This study aimed to assess if a positive preoperative respiratory viral panel PCR (+ RVP) impacted postoperative length of stay in the pediatric intensive care unit (PICU) or hospital and assessed for an association among + RVP and adverse clinical events.

Methods
Patients &lt; 3 years old presenting to a freestanding children’s hospital for cardiothoracic surgery from March 2018-March 2020 were enrolled. Within 24 hours before surgery, an RVP via nasopharyngeal swab for PCR was collected from subjects. Chart review was completed after hospital discharge. Mean difference between RVP status and length of stay for PICU and hospital was assessed with an independent, two group, sample t-test. Logistic regression was used to test association between RVP status and adverse clinical events (VAP, SSI, prolonged fever, ventilator use, or antibiotics), adjusted by complexity of surgical procedure using the Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) score.

Results
There were 95 subjects included, approximately 50% female, 75% Caucasian; 39% had + RVP (Table 1). There was no statistical association between RVP status and length of PICU (p=0.35) or hospital stay (p=0.28) (Table 2). Odds ratio for extubation in the operating room was significantly associated with +RVP, though small sample size and wide confidence intervals limit generalizability of this observation (Table 3). There were no clinically significant associations between RVP status and adverse events. Table 1.Subject DemographicsTable 2.Mean Difference in Length of Stay by RVP StatusTable 3.Odds Ratios of Clinical Adverse Events by RVP status

Conclusion
This limited, single-center study suggests that preoperative RVPs in pediatric cardiac surgery candidates identified asymptomatic viral shedding in 39%, though provided no detectable clinical benefit. Larger studies are needed to fully explore specific adverse clinical events and individual viral pathogen impacts. Institutional policies requiring preoperative RVP screening for pediatric cardiac surgery should be discouraged.

Disclosures
Kari Simonsen, MD, MBA, MedImmune: Grant/Research Support|Melinta Therapeutics: Grant/Research Support|Pfizer: Grant/Research Support.
2157. Low Interferon-γ and Interleukin-13 Levels in the Respiratory Tract are Related to Life-threatening Respiratory Syncytial Virus Infection in Previously Healthy Infants.
Authors: Ferolla Fausto M , Toledano Analía , Caratozzolo Ana , Talarico Laura B , Acosta Patricio L , Theiler Graciela , Yfran Eduardo W , Matute Javier , Mascardi Normando , Neira Pablo , Contrini María M , López Eduardo L 
Published: December 2022

Abstract

Background
The mechanisms of interindividual susceptibility to respiratory syncytial virus (RSV) are not clearly understood. Viral load (VL), an exaggerated immune response or T-helper 2 (Th2) bias were postulated as playing a role in the severity of RSV infection. We aimed to analyze VL, cytokine profiles and their association with life-threatening disease (LTD).

Methods
Prospective cohort study including previously healthy full-term infants &lt; 12 months old, hospitalized with a first RSV infection in 2017-2019. Nasopharyngeal aspirates were performed on admission to assess VL (by qRT-PCR) and cytokines levels (using a Bioplex panel). Cytokines were grouped according to their functional classification: proinflammatory (TNF-α), regulatory (interleukin [IL]-10), Th1 (interfereron-γ [IFN-γ]), Th2 (IL-4, IL-5, IL-9, IL-13) and Th17 (IL-17a). Patients were defined to have LTD when required admittance to the intensive care units and ventilatory support.

Results
One hundred and nineteen patients were studied, 68 (57%) were male; median age was 3 months. Nineteen (16%) infants developed LTD, with no significant differences in socioeconomic, pregnancy and infant variables compared with other RSV cases. Virus subtypes were not related to LTD (p= 0.77). VL was not associated with LTD (p= 0.51). Patients with LTD had significantly lower levels of IFN-γ (mean 0.08 pg/ml [standard deviation -SD- 0.06] vs. 0.32 pg/ml [SD 0.4]; p= 0.001) and IL-13 (mean 0.03 pg/ml [SD 0.04] vs. 0.05 pg/ml [SD 0.07]; p= 0.02), fig 1. IFN-γ and IL-13 inversely correlated with days of hypoxemia (p&lt; 0.001 and p= 0.002, respectively). VL, IFN-γ and IL-13 did not correlate with duration of symptoms before admission. No relationship was observed between IFN-γ, IL-13 and age, sex or breastfeeding. In 102 (86%) samples, IL-4 was under the limit of quantitation. TNF-α, IL-5, IL-9, IL-10 e IL-17a were not related to LTD.
IFN-γ and interleukin-13 levels according to clinical outcome.

Conclusion
To our knowledge, this is the first study to relate low IL-13 levels to LTD in previously healthy infants. Patients with LTD had 4-fold lower levels of IFN-γ. The severity of RSV infection may be the result of a deficient immune response rather than a higher viral load or an overactive immune response. These findings provide additional evidence for the development of preventive and therapeutic strategies.

Disclosures
All Authors: No reported disclosures.