bluuebunny/crossref_metadata_2025_split huggingface dataset:
1434. Incidence of Tuberculosis after Transplantation: A Nationwide Cohort Study in South Korea, 2008-2020
Authors: Hyun JongHoon , Jeong Su Jin , Kang Ji-Man 
Published: December 2022

Abstract

Background
Tuberculosis (TB) is one of the leading causes of morbidity and mortality among transplant recipient. The purpose of this study is to evaluate the standard incidence ratios (SIRs) of TB in all transplant recipient and to compare which is more risk by transplant type.

Methods
We conducted a nationwide population-based retrospective study using data retrieved from the Health Insurance Review and Assessment Service. Active TB case were studied, and SIRs was calculated based on the most recent year, 2019. SIRs were computed as the ratio of observed to expected numbers of TB, based on national age and sex. All analyses were conducted by transplant type and age group.

Results
From 2008 to 2020, a total of 57,103 patients who underwent transplantation were included. 830 cases were confirmed with TB (1.45%) and median time to develop TB was 1.74 year following transplantation. When analyzing the cumulative incidence by transplant group, it was in the order of allogenic hematopoietic stem cell transplantation (HSCT), solid organ transplantation (SOT), and autologous HSCT (P&lt; 0.001). In SOT, liver transplantation had the highest incidence of TB, followed by lung, heart, and kidney (P&lt; 0.001). The cumulative incidence for the age group increased with age (P&lt; 0.001). Incidence of TB was markedly increased among transplant recipients compared with general population (SIR: 3.53, Confidence interval (CI): 3.38-3.67). SIR varied according to age group: age under 20 years (SIR: 4.98 CI: 3.16-7.47), age between 20 and 40 years (SIR: 5.83 CI: 5.22-6.49), age between 40 and 60 years (SIR: 4.66 CI: 4.42-4.92), age over 60 years (SIR: 2.05 CI: 1.89-2.21). Based on a multivariate analysis, male sex (hazard ratio (HR) = 1.398; P &lt; 0.001), previous TB history (HR = 1.515; P=0.014) were the common independent risk factors for TB after transplantation.
Baseline characteristics of study population
Cumulative incidence of TB following transplant
Risk factor of tuberculosis after transplanatation

Conclusion
The incidence of TB in transplant recipient is at least three times higher than the general population in South Korea. Regardless of the type of transplant, TB should be considered as a complication within 1 years of transplantation and special attention should be paid to patients with a history of previous TB history.

Disclosures
All Authors: No reported disclosures.
1435. Incidence of Tuberculosis Infection Among New Prisoners in Southern Thailand
Authors: Ruangchan Sujinda , Kiamkan Nongnuch , Kabinlapat Sumonta , Jeduman Nichareekorn , Kasa Aunjai , Silpapojakul Khachornsakdi 
Published: December 2022

Abstract

Background
Tuberculosis in prisons was reported to be 100 times higher than the normal population. Late diagnosis, overcrowding, and poor ventilation encourage the transmission of tuberculosis. Five percent of new tuberculosis infections turn into active disease within two years. This study was conducted to determine the incidence of tuberculosis infection among new prisoners in southern Thailand.

Methods
A prospective cohort study was planned for January 2020‒December 2021 at Songkhla Provincial Prison. However, due to the emerging COVID-19 pandemic, the study was terminated early in February 2021. All new prisoners aged ≥15 years were included. Subjects were excluded if they had any history of a previous diagnosis of tuberculosis, household contact with a tuberculosis patient, or a history of repeated imprisonment. Chest radiography together with a 2-step tuberculin skin test (TST) was done within 2 weeks after imprisonment and at 6 months using the one-step TST. A positive TST was defined by a skin reaction ≥1.5 cm. Prisoners with negative TST had a repeat TST at 6 months. New tuberculosis infection was defined by conversion of TST to positive after 6 months of imprisonment without evidence of active tuberculosis from chest radiography.

Results
The number of new prisoners during the study period was 602. All prisoners were men with an average age of 31.11 (range 18‒75) years Fifty-one prisoners were excluded. Three hundred and eighty-five prisoners completed the 2-step TST. A total of 11.07% (61/551) of subjects had initially tested positive. Three hundred and seventy prisoners were followed. The COVID-19 pandemic caused a total shutdown of the study because access to the prison was blocked. Therefore, only 53 (9.6%) prisoners completed the study protocol at 6 months. Five prisoners (9.4%) were tuberculin converters with no evidence of active tuberculosis from chest radiography

Conclusion
The incidence of tuberculosis infection in new prisoners was 9.4%. This study has limitations. Due to the emerging COVID-19 pandemic, 90.4% of subjects were lost to follow-up and some prisoners were released before 6 months, which caused low power of the study. Further studies are needed to identify the incidence of new tuberculosis infection in new prisoners.

Disclosures
All Authors: No reported disclosures.
1440. Local Antibiogram for Mycobacterium abscessus Shows Variability from Previously Published Susceptibility Data
Authors: McElroy Timothy , Starlin Richard , Van Schooneveld Trevor C 
Published: December 2022

Abstract

Background
Mycobacterium abscessus complex (MabsC) causes a wide variety of human disease and is frequently resistant to multiple agents. Empiric therapy is typically based on previously published susceptibility data which suggests amikacin (AMK), cefoxitin (FOX), clarithromycin (CLR), and imipenem (IPM) should be utilized. However, there is considerable variability in susceptibility patterns according to locale. We generated an antibiogram based on local MabsC isolates and compared it to previously reported susceptibility data to determine if local variation exists and assist in empiric therapy choice.

Methods
Non-duplicate local isolates of MabsC from 2011-2021 with in-vitro susceptibility data (via broth microdilution per CLSI guidance) available were included in the generation of a local antibiogram. This included standard 14 day incubation for inducible macrolide resistance. A review of the literature via PubMed search was undertaken to generate comparator susceptibility patterns with a focus on published reports with greater than 20 isolates.

Results
Sixty one unique local isolates of MabsC were identified, 44 of which were from lung, eight skin/soft tissue, five bone/joint, two blood, one urine, and one ascitic fluid. Susceptibilities are shown in Table 1. Twenty one manuscripts described susceptibility patterns with a range of isolates from 20 to 404 with a median of 70. These revealed susceptibility ranges for AMK range from 45-100%, FOX 0-72%, CLR 19-96%, and IPM 0%-71% as seen in Table 2.
Susceptibilities of Mycobacterium abscessus isolates
Results of antimicrobial susceptibility testing for 61 isolates of MabsC with percent resistant, intermediate, and susceptible shown, along with break points used per CLSI
Comparison of Drug Susceptibility Rates from Previous Studies

Conclusion
We found high local resistance rates to cefoxitin and imipenem in contrast to empiric therapy recommendations and greatest susceptibility to amikacin. Published data shows a wide variation of susceptibility patterns to the recommended therapies based on location. It would be clinically advantageous for institutions to generate an antibiogram based on their local resistance data to assist empiric therapy choices in MabsC infections. Our data suggests that such local antibiograms could lead to substantial changes from the recommended empiric therapy at the institutional level for these infections which are historically challenging to treat.

Disclosures
Trevor C. Van Schooneveld, MD, bioMerieux: Advisor/Consultant|bioMerieux: Grant/Research Support|Insmed: Grant/Research Support|Merck: Grant/Research Support|Thermo-Fischer: Advisor/Consultant.
1441. LTBI screening cascade for non-US-born persons in a large health system assessed using EMR data
Authors: Shapiro Adrienne E , Gupta Ayushi , Lan Kristine F , Nina Kim H 
Published: December 2022

Abstract

Background
The majority of tuberculosis (TB) diagnosed in the US is reactivation TB in non-US-born (nUSb) persons. Guidelines recommend screening persons born in high TB burden countries for latent TB infection (LTBI) and treating if positive. We evaluated the LTBI cascade in primary care among nUSb persons in a large academic medical system in Washington State.

Methods
We used electronic medical record (EMR) data to evaluate the LTBI screening cascade. nUSb individuals were identified using the primary language recorded in the EMR. Place of birth is not routinely collected in the EMR. All persons with a non-English primary language who entered care and attended one or more primary care visits in UW clinics between April 2016- April2021 were identified and considered eligible for LTBI screening. Persons with a documented IGRA or tuberculin skin test were considered screened for LTBI. Prescription records were reviewed to determine LTBI treatment.

Results
5148 persons with non-English primary language attended primary care visits 2016-2021 and considered eligible for LTBI screening. Eligible persons were 58.5% female, median age 41 (IQR 30-58). Primary WHO regions of origin were Asia (37%), the Americas (36%), and Africa (19%), with a minority from North Africa, Middle East, and Europe. 1012 (20%) had a documented history of LTBI testing (Quantiferon-GOLD (N=949) or tuberculin skin testing (N=63)). Among 296 (29%) persons with a positive test for LTBI, 140 (47%) were treated for LTBI. The highest proportion of persons tested for LTBI were patients attending the HIV clinic (120, 66%) and the International/Refugee clinic (227, 81%). The majority of eligible patients were seen outside these clinics (N=4687) in whom the percent of persons tested ranged from 3-18% (14% overall).
LTBI cascade among non-US-born primary care patients
IGRA: interferon-gamma release assay; TST: tuberculin skin test.

Conclusion
Although this subset underestimates the number of non-US-born individuals (since many non-US-born individuals use English as their primary language) eligible for screening, it nonetheless highlights the significant gap between actual and guideline-recommended screening in primary care, as well as further drop-off on the cascade from positive LTBI test to LTBI treatment. EMR platforms could be leveraged to prompt LTBI screening and treatment initiations in primary care to help achieve TB elimination goals in the US.

Disclosures
Adrienne E. Shapiro, MD, PhD, Vir Biotechnology: Support as a trial site paid to my institution and non-financial support for medical writing GlaxoSmithKline third party funding to Vir support H. Nina Kim, MD, MSc, Gilead Sciences: Grant/Research Support.
1444. Pediatric Tuberculosis in Mexican Children: A Retrospective Analysis of 100 Patients
Authors: Villarreal Enrique G , Estrada-Mendizábal Ricardo J , Ramos-Barrera Emilia , Treviño-Valdez Pablo D , Tamez-Rivera Oscar 
Published: December 2022

Abstract

Background
Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis complex, mainly by M. tuberculosis. Annually, 1 million children develop TB disease and many more present a latent form of infection. The objective of this study is to define the epidemiological trends of the different clinical presentations of TB in pediatric population.

Methods
A retrospective, cross-sectional study, carried out at a pediatric referral hospital in Mexico between 2012-2021. Pediatric patients diagnosed with TB were included. Descriptive statistics were performed in order to summarize the demographic, clinical and paraclinical characteristics of pediatric patients with TB. A Chi-squared univariate analysis was performed evaluate the association between several variables of interest with mortality.
Diagnostic criteria for TB in children according to the Mexican Clinical Practice Guidelines

Results
A total of 100 patients were included in the study. Pulmonary TB was the most common presentation (51%), followed by ganglionic (21%), meningeal (14%), and milliary (7%). A male predominance was observed (54%). Mean age of presentation was 7.8 years ± 1.5, most lived in urban areas (79%) and had a positive COMBE (57%). Half of the patients had BCG vaccination. Fifty-two patients were successfully cured, 36 patients were receiving antituberculous treatment and fatality rate was 12%. Meningeal TB was the most fatal clinical presentation. Fever was the most common sign (65%), followed by cough (56%) and weight loss (37%). The most common sign of meningeal TB were generalized seizures (10/14), fever (10/14), and vomiting (7/14). Brain imaging was performed in all patients with meningeal TB: hydrocephalus (71.4%) and basal arachnoiditis (64.3%) were present. Cerebrospinal fluid analysis was also performed: 11 patients had pleocytosis, 10 had hyperproteinorrhachia, and 10 had hypoglycorrhachia. Clinical TB presentation (p=0.009) and immunodeficiency (p= 0.015) were significantly associated with mortality.
Epidemiological Characteristics According to TB Clinical Presentation.
Signs and symptoms in children according to their clinical presentation of TB.
Clinical, radiological and cerebrospinal fluid characteristics in meningeal TB.

Conclusion
Pediatric TB cases in this referral hospital indicated an equivalent proportion of pulmonary and extrapulmonary TB. Most of the patients with milliary and meningeal TB were not vaccinated; however, BCG vaccination was not significantly associated with mortality. Patients with extrapulmonary forms of the disease and with immunodeficiency were associated with mortality.
Clinical outcomes of children with TB according to their epidemiological characteristics

Disclosures
All Authors: No reported disclosures.
1662. Impact of a Documented Penicillin Allergy on Antibiotic Selection in Patients with Osteomyelitis
Authors: Li Caitlin Naureckas , Herman Katherine , Yim Ramy , Nakamura Mari M , Chu Esther , Wilder Jayme , Alfieri Maria , Ethier Benjamin , Esty Brittany 
Published: December 2022

Abstract

Background
Penicillin allergy is the most commonly reported drug allergy, affecting approximately 10% of patients. Although historically there has been concern about administering cephalosporins to patients allergic to penicillin, the rates of cross-reactivity are only approximately 2%. As cephalosporins are the first-line and safest treatment for many infections, unnecessary avoidance of cephalosporins places patients at risk of poor disease outcomes and antibiotic-associated harms. We assessed the relationship between penicillin allergy label and antibiotic selection in pediatric patients with acute osteomyelitis.

Methods
We performed a retrospective review of inpatients at our quaternary children’s hospital diagnosed with osteomyelitis between 2011 and 2021. During this period, the institutional osteomyelitis clinical pathway recommended clindamycin for patients with cephalosporin but not penicillin allergy. We compared rates of antibiotics used as definitive therapy between patients with and without documented penicillin allergy.

Results
Of 365 patients hospitalized with a diagnosis of osteomyelitis, 41 (11.2%) had a documented penicillin allergy. First-generation cephalosporins were administered less frequently to penicillin-allergic patients compared with those without documented penicillin allergy (37% vs. 58%, p=.009), while clindamycin was administered more frequently (22% vs. 10%, p=.02). There was no significant difference in vancomycin use (2% vs. 9%, p=.17).

Conclusion
Patients with osteomyelitis and a penicillin allergy label were significantly less likely to receive a first-generation cephalosporin and significantly more likely to receive clindamycin. Given higher regional resistance rates and more frequent adverse effects, including Clostridioides difficile infection, of clindamycin relative to first-generation cephalosporins, these data support the need for quality improvement work to increase cephalosporin use in patients with penicillin allergy labels.

Disclosures
Mari M. Nakamura, MD, MPH, Gilead: Grant/Research Support.
1461. The Impact of Universal Varicella Vaccination on Herpes Zoster Incidence in the United States
Authors: Leung Jessica W , Dooling Kathleen L , Marin Mona , Anderson Tara C , Harpaz Rafael 
Published: December 2022

Abstract

Background
The varicella vaccination program was implemented in the United States in 1995 and has resulted in large reductions in varicella disease burden. At the start of the varicella vaccination program, impacts on herpes zoster (HZ) epidemiology were unknown. We used a large claims database to examine national HZ incidence during 1998–2019 in cohorts of persons born before and after varicella vaccine introduction.

Methods
Medical claims data were obtained from 1998–2019 IBM® MarketScan® Research Databases. We identified HZ based on first outpatient service with an HZ ICD-9/10 code (053.xx/B02.xx) and calculated age-specific incidence for persons aged ≥30 years (all born pre-vaccine) and persons aged 1–29 years (includes persons born post-vaccine).

Results
Among persons aged ≥30 years, HZ incidence increased with age and calendar time (Fig. 1); incidence in the two oldest age groups (60–69 and ≥70 years) started to decelerate in 2007. Among persons aged 1–29 years, HZ incidence increased early in the study period for the oldest age groups (born pre-vaccine, i.e., born after 1990), but later declined once each age group was comprised of persons born in the post-vaccine period (children and adolescents) (Fig 2); the peak incidence occurred in progressively-earlier calendar years among progressively younger age groups.

Conclusion
HZ incidence in persons aged ≥30 years increased early in the study period for all age groups followed by declines starting with the oldest cohorts. The U.S. data do not support previous modelled predictions that reduced VZV exposure would result in increased HZ incidence among adults. The patterns of decline in HZ incidence in persons aged 1–29 years can likely be explained by the success of the U.S. varicella vaccination program and increasingly uncommon latent infection with wild type varicella-zoster virus. These data suggest that continued declines in age-specific HZ incidence are likely as varicella vaccinated cohorts age. The reduction of HZ resulting from the varicella vaccination program, should ultimately extend to the entire U.S. population over time.

Disclosures
All Authors: No reported disclosures.
1663. Risk-benefit assessment of cefazolin use for surgical site infection prevention among patients allergic to penicillins and cephalosporins
Authors: Jeffres Meghan N , Porter Melissa , Ricco Madison , Norvell Miranda , Hogan Craig , Bassler Eric , Koonce Ryan 
Published: December 2022

Abstract

Background
Prosthetic joint infection (PJI) is a devastating complication following knee and hip arthroplasty. Perioperative antibiotics are routinely used in an effort to decrease the risk of surgical site infections (SSI), including superficial skin infections and deep PJI. The American Academy of Orthopedic Surgeons recommend cefazolin as standard of care for SSI prophylaxis. However, non-beta-lactams are often used in patients labeled as allergic to penicillins or cephalosporins due to concern of increased hypersensitivity reactions (HSR).

Methods
This study examined the frequency of SSI and HSR after receipt of perioperative cefazolin compared to clindamycin and/or vancomycin (C/V) within adult patients labeled as allergic to penicillins or cephalosporins. Patients were included if they underwent primary total hip or knee replacement surgery between January 2020 and July 2021 within the University of Colorado Health system. The outcome of SSI was assessed up to 90 days after surgery. The outcome of HSR was assessed up to 60 minutes after the conclusion of surgery.

Results
The cohort included 1,128 patients (cefazolin, n=809; C/V, n=319). Baseline characteristics were similar between groups except the proportion of patients with a history of immediate allergy symptoms was greater in the C/V group (59.6%) compared to the cefazolin group (35.8%). The frequency of SSI was lower in the cefazolin group compared to the C/V group (0.9% vs. 3.8%, p &lt; .01). The cefazolin group included 7 SSI, consisting of 6 superficial SSI and 1 deep PJI. The C/V group included 12 SSI, consisting of 6 superficial SSI and 6 deep PJI. HSR were not significantly different between patients receiving cefazolin vs. C/V (0.2% vs. 1.3%, p=.06). HSR in the cefazolin group consisted of skin involvement (n=1) and self-reported allergy in post-operative window (n=1). Both patients had a non-descript history of penicillin allergy. HSR in the C/V group consisted of skin involvement (n=2) and hemodynamic instability (n=2). Three of the four patients had a history of immediate cephalosporin allergy.

Conclusion
Among penicillin or cephalosporin allergic patients, the use of cefazolin was associated with a lower frequency of PJI without an increase in HSR during surgery.

Disclosures
All Authors: No reported disclosures.
1468. Cidofovir Prescribing Patterns and Outcomes in Hospitalized Adults and Children
Authors: Lefemine Amanda , Meredith Jacqueline , Patel Rupal , Fotiadis Chris , Shahid Zainab , Gajurel Kiran , Roshdy Danya 
Published: December 2022

Abstract

Background
Cidofovir (CDV) dosing is based on limited clinical evidence and varies by indication. The optimal dose to achieve a virologic response has not been established. Routine lab monitoring, renal dose adjustments, and co-administration with intravenous (IV) fluids and probenecid are recommended to limit CDV-associated nephrotoxicity but lack a standard approach.

Methods
This was a retrospective evaluation of patients admitted to Atrium Health’s Carolinas Medical Center or Levine Children’s Hospital who received at least one dose of CDV from August 1, 2014 through June 30, 2021. The primary objective was to describe CDV prescribing patterns. Secondary objectives included evaluating virologic response, nephrotoxicity, and IV fluid and probenecid use.

Results
A total of 38 adult and 26 pediatric patients were included and received 44 and 60 CDV doses, respectively. Adult dosing was variable, but the most common regimens for BK virus infections included CDV 0.5 mg/kg every other week for solid organ transplant recipients (Figure 1A-B) and 1 mg/kg weekly for stem cell transplant recipients (Figure 1C). Dosing for adenovirus infections was inconsistent (Figure 1D). All but one of the adult patients evaluated had a decrease in viral load during the first two weeks (Figure 2A-D). In pediatric patients, the most common CDV dose was 1 mg/kg three times weekly which was used in 67% of patients across all indications (Figure 1E-I). Three evaluated pediatric patients had an increase in viral load (Figure 2E-H), but no similarities in dosing or indication were noted. The rate of nephrotoxicity based on pre-defined increases in serum creatinine was 29% for adults and 14% for pediatric patients. Use of IV fluid boluses and probenecid was inconsistent in both adult and pediatric patients (Table 1). Of the patients that did not receive probenecid, only 16.7% of adults and no pediatric patients received a CDV dose &gt; 1 mg/kg.

Conclusion
Evaluation of virologic response to CDV was limited by small sample size. However, high variability in prescribing patterns highlights the need for standardized, indication-specific dosing. Standardization of IV fluid and probenecid use along with guidance on CDV dose adjustments in patients with renal insufficiency may help decrease the risk of CDV-associated nephrotoxicity.

Disclosures
All Authors: No reported disclosures.