bluuebunny/crossref_metadata_2025_split huggingface dataset:
2080. Differences in Hormonal Measures Among Transgender Individuals Assigned Male at Birth Switching from Tenofovir Disoproxil Fumarate/Emtricitabine to Tenofovir Alafenamide/Emtricitabine for Pre-Exposure Prophylaxis
Authors: Patel Nimish , Blumenthal Jill , Burke Leah , Chow Karen , Pacheco DeeDee , Stanczyk Frank , Morris Sheldon 
Published: December 2022

Abstract

Background
There are concerns among transgender (TG) individuals about the effect of changing pre-exposure prophylaxis (PrEP) products on hormone concentrations. The objective of this study was to compare hormone concentrations among TG individuals assigned male at birth (AMAB) who switched from tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) to tenofovir alafenamide/emtricitabine (TAF/FTC) for PrEP.

Methods
An observational cohort study was performed among a subset of TG individuals AMAB enrolled in a clinical trial evaluating TAF/FTC for PrEP. Inclusion criteria for this study were ≥18 years old, TG identity, HIV negative, use of both TDF/FTC and TAF/FTC for ≥12 weeks, and availability of stored blood samples for hormone measurement while on both medications. Estradiol, testosterone (total and free) and sex hormone binding globulin were quantified at two time points: once while on ≥12 weeks of TDF/FTC and after ≥12 weeks on F/TAF. Median hormone concentrations were compared using related-samples Wilcoxon Signed Rank Test.

Results
Thirty participants met inclusion criteria with mean age of 35.9 ± standard deviation 9.7 years. There were 20 (67%) participants who identified as TG female. The remaining identified as gender non-conforming. Most participants self-identified as either Caucasian (40%), Hispanic or Latino/a/x (33%), Black (13.3%) or Asian (13.3%). Gender affirming therapy was used by 20 (67%) participants. The median (interquartile range, IQR) duration of TDF/FTC use before switching to TAF/FTC was 48 (15 – 60) weeks. Hormone values during TDF/FTC and TAF/FTC by use of gender affirming therapy is displayed in the Figure.
Hormonal Values Before and After Switching PrEP Products, by Use of Gender Affirming Therapy

Conclusion
Switching to TAF-based PrEP was not associated with significant changes in hormone values among TG individuals AMAB.

Disclosures
Nimish Patel, PharmD, PhD, Gilead: Grant/Research Support Jill Blumenthal, MD, Gilead: Grant/Research Support Sheldon Morris, MD, Gilead: Grant/Research Support.
2100. Epidemiology and Risk Factors for Invasive Fungal Infections Among Patients with Hematological Malignancies In Colombia
Authors: Ortiz-Martínez Yeimer , Fajardo-Rivero Javier , Mendoza-Herrera Tania , Figueroa-Pineda Claudia , Ruiz-González Carlos 
Published: December 2022

Abstract

Background
Invasive fungal infection (IFI) is a potentially lethal complication in patients with hematological malignancies (HM). However, studies are scarce in this population, especially in developing countries. The aim of this study was to investigate the prevalence, epidemiology, predictive factors, and outcomes of IFI in patients with HM hospitalized in non-HEPA-filtered rooms (resource-limited settings) in a reference center in Colombia.

Methods
A cross-sectional, retrospective study was conducted on the clinical data of HM patients and pulmonary infection hospitalized in a tertiary university hospital in Bucaramanga, Colombia, between 2015 and 2020. The primary outcome was proven/probable IFI according to the EORTC/MSGERC criteria. A descriptive and group comparison analysis were performed between patients with IFI and patients with non-fungal infections. The main risk factors for the development of IFI were identified by multivariate stepwise logistic regression analysis. Table 1Statistically significant variables in the univariate analysis of patient characteristics compared between patients with invasive fungal infection and patients with non-fungal infection.Image 1Associated factors to develop invasive fungal infections (IFIs) in patients with HM. The graph shows the variables showed statistically significant difference in the multivariate analysis.

Results
In 201 patients, the prevalence of proven/probable IFI was 21.39% (43 cases). The most common IFI was caused by Aspergillus spp. (41.8%), followed by Candida spp. (34.8%), Mucor spp. (6.9%), Penicillium spp. (4.6%) and Cryptococcus neoformans (4.6%). The lung was the most commonly affected site (n=34; 81.3%); four patients (9.3%) developed fungal sinusitis and disseminated IFI, respectively. In-hospital mortality was 86% (37/43). Multivariate logistic regression analysis (area under the ROC curve=0.90) showed that antibiotic use ≥3 weeks (OR, 4.11; 95% CI, 1.26-13.31; p&lt; .001), history of pulmonary infection (OR, 5.75; 95% CI, 1.41-23.39; p&lt; .001) and neutropenia duration ≥21 days (OR, 5.88; 95% CI, 1.26-19.86; p &lt; .001) were independent risk factors for the development of IFI and mould-active prophylaxis (OR: 0.20; 95% CI: 0.060–0.705; p=0.012) was significantly associated with a lower occurrence of IFI.

Conclusion
HM patients in resource-limited settings have a high prevalence of IFI with an elevated mortality. The use of mould-active prophylaxis is associated with a significantly lower occurrence of IFI. Cost-effective strategies for prevention and early diagnosis of IFI are required to improve survival in patients with HM.

Disclosures
All Authors: No reported disclosures.
2112. Incidence and outcomes of infections in liver transplant recipients during the first year post-transplant.
Authors: Alpizar-Rivas Rodolfo M , Palli Rohith , Croix Michael , Prasad Paritosh , Gupta Purba , Chuang Sally 
Published: December 2022

Abstract

Background
Despite the use of antimicrobial prophylaxis in liver transplant recipients (LTR), infection remains the most likely cause of death (18.94%) in the first year. There is limited data describing the characteristics, & infections of LTR while hospitalized in the first year post-transplantation. We aimed to review the incidence and outcomes of infections in LTR in the first year post-transplant during hospitalization or re-hospitalization. Graph 1.Y-axis; Number of cultures collected, X-axis; type of organism dived over time.
Site of bacterial infection Table 1.Number of bacterial infections divided by site/system, involved compared to timing of infection.

Methods
We performed a single-center retrospective cohort study at The University of Rochester. Electronic medical records of 298 first time adult LTR between 03/5/2011 and 04/01/2020 were reviewed. Demographic and comorbidity data was obtained at time of transplant. Microbiologic data and outcomes were obtained during the first year post-transplant. We compared mortality between those with infection and those without using log-rank survival analysis.
Graph 2. Y-Axis; Number of patients with diagnosed viral infection. X-axis virus divided over time.

Results
160 (53.7%) patients suffered at least 1 infection while hospitalized in the first year post-transplant. There were 178 bacterial infections in 130 patients of which 115 were intra-abdominal (table 1). The most common organism was Enterococcus sp. (n=102), 65 were vancomycin resistant (VRE). The most common site of fungal infection was abdominal (n=13) and the most common organism was C. glabrata (n=9). The most common viral infection was CMV at 7-12 months although other viral infections occurred between 1-6 months (graph 2).
In a univariate chi-square model, bacterial infection at any time was associated with all-cause mortality in the first year (CI 1.7-8.9 p-adj= 0.002). Fungal infection between 2-6 months was also associated with increased mortality (CI 2.7-12.2 p-adj= 0.0005).

Conclusion
Bacterial infections are the most common type of infection in LTR and occur more frequently during the first 6 months. Bacterial infection at any point was independently associated with increased mortality in the first year post-transplant. The most common organism was Enterococcus with a high rate of VRE which should be taken into consideration for empiric coverage at our institution. Fungal infection between 2 to 6 months was associated with increased mortality. We observed that early bacterial and fungal infections are markers of poor prognosis.

Disclosures
All Authors: No reported disclosures.
2117. Outcomes and Risk Factors Associated with Development of Pneumonia in Lung Transplant Recipients in the Year After Transplant
Authors: Gallagher Jason C , Roesch Torey , Giurintano Julie , Atwater Abby , Dinh Anya , Groninger Liesel , Hoang Julie , Shif Jennifer , Tanasy Erin , Wagner Jamie , Bandres Maria , Burnell Jacqueline 
Published: December 2022

Abstract

Background
Lung transplant patients (LTPs) experience considerable infection-related morbidity and mortality, including from pneumonia. Our institution performs the highest volume of lung transplants in the US, providing an opportunity to describe the scope and impact of pneumonia in LTPs.

Methods
We conducted a retrospective cohort study of all patients who received a lung transplant at our institution from late 2017 to early 2020. Patient records were reviewed from the pre-transplant period to 1-year after transplant for data pertinent to comorbidities, transplantation characteristics and complications, donor organ cultures, immunosuppression, prophylactic and therapeutic antibiotic regimens, pathogens, and outcomes. Cases of pneumonia were reviewed using standard criteria. The primary outcome was 1-year survival.

Results
320 patients received lung transplants and 121(38%) developed pneumonia. Characteristics are in Table 1.
Pneumonia developed a median of 66 days after transplant (IQR 15-142). Most frequent pathogens ( &gt;10 cases) were P. aeruginosa, S. aureus, and K. pneumoniae. The most common viral cause was RSV (5 cases). Patients with pneumonia had significantly lower 1-year survival rates than those without (100/120, 83.3% vs 186/199, 93.5%; p=0.004). Number of readmissions were higher in patients who had pneumonia (mean 3 ± 2.58 vs 2.04 + 3.18, p&lt; 0.001). Bronchial stents (p&lt; 0.001), past medical history of atrial fibrillation (0.003), and donor lung culture positive for E. coli (0.007) were independent risk factors for the development of pneumonia. Prophylaxis with piperacillin/tazobactam (0.032) prophylaxis with ciprofloxacin (0.008) were protective.

Conclusion
Pneumonia occurred within the first year of transplant in 38% of LTPs and was associated with lower survival.

Disclosures
Jason C. Gallagher, PharmD, Merck: Advisor/Consultant|Merck: Grant/Research Support|Qpex: Advisor/Consultant|Shionogi: Advisor/Consultant|Spero: Advisor/Consultant.
2120. Respiratory Viral Infections in Patients with Hematologic Malignancies
Authors: Cardenas Jorge Luis , Raja Mohammed , Camargo Jose F , Morris Michele I , Natori Yoichiro 
Published: December 2022

Abstract

Background
Respiratory virus infections (RVI) are an important cause of pneumonia with increased risk of morbidity and mortality in patients with hematologic malignancies (HM) especially after stem cell transplantation. However, data on RVI in this population without stem cell transplant is still lacking. Here we aim to look at trends of RVI in HM population.

Methods
We conducted a retrospective cohort study of adult patients with HM diagnosed with RVI at our institution. We analyzed data from multiplex qualitative PCR-based respiratory viral panel (RVP) samples taken from January 2016 to June 2020. Lower respiratory tract infection (LRTI) was defined as abnormal chest radiography with positive RVP.

Results
Fifty-seven unique episodes were analyzed out of 54 patients. Thirty (52.6%) were females and the most common underlying malignancy was Non-Hodgkin’s Lymphoma (21, 36.8%). Median age was 61 (range 23-92) years old and 44/57 (77.1%) patients received chemotherapy within 30 days prior to RVI. Patient characteristics are summarized in Table 1. Most common viruses included Rhinovirus/Enterovirus (25, 43.8%), Influenza A/B (14, 24.5%) and RSV A/B (7,12.2%), respectively. Out of 39 patients who underwent chest imaging, 13/39 (33.3%) had evidence of LRTI. Out of 45 cases diagnosed as outpatients, 11/45 (24.4%) required hospital admission. ICU admission and mechanical ventilation were required in 5/57 (8.7%) and 2/57 (3.5%), respectively. Bacterial and fungal co-infection were seen in 1 (Pseudomonas spp) and 3 (Aspergillus spp.), respectively. Of note, only 1/57(1.8%) died at 30 days after RVI diagnosis.

Conclusion
Only one third developed LRTI after RVI in HM patients with very low 30-day mortality. However, we still found several bacterial and fungal co-infections. Thus, adequate diagnosis for RVI and co-infections with proper treatment should be required. Further studies with larger sample size are still needed.

Disclosures
All Authors: No reported disclosures.
2148. No Device, But Still a Problem: A Five Year Review of Healthcare Associated Bloodstream and Urinary Tract Infections in a Children’s Hospital
Authors: Schafenacker Amanda , Gornick Wendi , Huff Beth , Singh Jasjit 
Published: December 2022

Abstract

Background
Central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) continue to be the focus of external reporting of healthcare associated infections based on CDC-NHSN criteria. As facilities decrease CLABSI and CAUTI, we sought to understand our non-central line bloodstream infections (NCLABSI) and non-catheter urinary tract infections (NCAUTI).

Methods
We retrospectively reviewed total healthcare associated bloodstream infections (HABSI) (NCLABSI + CLABSI) and healthcare associated urinary tract infections (HAUTI) (NCAUTI + CAUTI) from July 1, 2016 to June 30, 2021 at our 334-bed quaternary care Children’s Hospital. CLABSI and CAUTI were both defined using CDC-NHSN criteria. Epidemiologic and microbiologic data, total antibiotic days related to infection, and mortality were analyzed for each subgroup.

Results
In a 5-year period, 255 patients were identified with HABSI and HAUTI; 164 were HABSI (26% NCLABSI, 74% CLABSI) and 91 were HAUTI (79% NCAUTI, 21% CAUTI). While our NCLABSI, CLABSI, and CAUTI infections per fiscal year (FY) have remained relatively stable, our NCAUTIs have increased since FY17 (Figure 1). Total antibiotic days for NCLABSI versus CLABSI and for NCAUTI versus CAUTI were similar (Figure 2). Staphylococcus aureus was the predominant pathogen in all HABSIs (16% CLABSI, 31% NCLABSI). Pseudomonas aeruginosa was seen in 15% of CLABSIs but in no NCLABSIs. P. aeruginosa was seen in both CAUTI (32%) and NCAUTI (11%). Escherichia coli was the predominant pathogen in NCAUTI (39%) (Figure 3). There were 2 NCLABSI (5%), 16 CLABSI (13%), 2 NCAUTI (3%) and 2 CAUTI (11%) patient deaths during hospitalization.

Conclusion
Our data shows that non-device related healthcare associated infections are a significant proportion of our total healthcare associated infections, comprising one quarter of HABSIs and three quarters of HAUTIs. In addition, P. aeruginosa, typically an important pathogen in device-associated infections, also contributes to non-device associated infections. We feel that total HABSI and HAUTI may provide more objective measures to report. Infection prevention measures to decrease NCLABSI and NCAUTI also need attention.

Disclosures
All Authors: No reported disclosures.
2149. Risk of dental abnormalities after tetracycline exposure in children: A retrospective, population-based study in Korea, 2003-2015
Authors: Kim SeoJung , Kim Eun Hwa , Lee Myeongjee , Shin Je Hee , Lim Sung Min , Jung In Kyung , Ahn Jong Gyun , Kang Ji-Man , Kang Chung-Min , Baek Jee Yeon , Lee Ji Young 
Published: December 2022

Abstract

Background
Despite its clinical usefulness, the use of tetracycline antibiotics (TCs) in children has historically been limited because of the risk of permanent tooth discoloration and enamel deformity, although age restrictions have varied across countries (e.g., contraindicated under 8 years of age in Taiwan, USA, and Canada, and under 12 years of age in Korea and UK). We explored whether the incidence of dental abnormalities in Korean children with a history of TCs use differed by age. Furthermore, the relative risk compared to the TCs non-exposed group was calculated.

Methods
From 2002 to 2015, 1 million standard sample subjects data was provided from National Health Insurance Service in Korea. Children younger than 18 years were included and divided into groups A (0-7 years), B (8-12 years), and C (13-17 years). Subjects in 2002 were excluded for wash-out, as were those diagnosed with dental abnormalities within 6 months after TCs prescription. For comparison, 1:4 matching between the TCs exposure and non-exposure groups was performed according to age and gender.

Results
Among 14,831 individuals included as study subjects (487 (3%) in group A; 1,695 (11%) in group B; and 12,649 (85%) in group C), 201 (1.4%) were diagnosed with dental abnormalities. The 5-year cumulative incidence of dental abnormalities after exposure to TCs in the group A was 4.7%, which was significantly higher than that of the control group C (0.9%; p&lt; 0.0001), but that of group B was 1.3% and not significantly different from that of group C. In the risk analysis of dental abnormalities according to exposure of TCs, there was no significant difference (adjusted RR=1.03, 95%CI=0.71 to 1.50 in group A; adjusted RR=1.13, 95%CI=0.76 to 1.69 in group B; adjusted RR=1.18, 95%CI=0.97 to 1.43 in group C). Fig 1.Cumulative incidence rate and relative risk analysis.A. Cumulative incidence rate of dental abnormalities after TCs exposure by age group (p = &lt;.00001). B. Relative risk analysis by TCs exposure and age group.Abbreviation; TCs: tetracycline and its derivatives.

Conclusion
Korean children aged 0-7 years who were exposed to TCs had a higher cumulative incidence and relative risk of dental deformities compared to the 13-17-year-old group but not the 8-12-year-old group. No significant increase in dental abnormalities was observed with TCs exposure among pediatric age groups.

Disclosures
All Authors: No reported disclosures.
2171. Clinical Characteristics and Outcomes of Immunocompromised Patients with Enterococcal Pneumonia
Authors: Ajaka Leama , Day Shandra R , Hebert Courtney , Colburn Nora , Liscynesky Christina 
Published: December 2022

Abstract

Background
Although Enterococcus species can colonize and cause infection in multiple body sites, it is considered a rare cause of pneumonia (PNA). The study objective was to describe clinical outcomes in immunocompromised patients with PNA and Enterococcus in respiratory cultures to better elucidate the pathogenic role played by Enterococci.

Methods
A retrospective, descriptive observational study was conducted on immunocompromised patients with Enterococcus spp on lower respiratory culture from January 1, 2015 to September 22, 2021 with clinical PNA. Data was collected on patient demographics, microbiologic details including bacteremia, other potential infectious causes of PNA and clinical outcomes.

Results
116 cases of immunocompromised patients with PNA and Enterococcus spp on respiratory culture were identified. Two patients also grew Enterococcus spp on pleural fluid and 1 on lung tissue. Vancomycin-resistant Enterococcus grew in 41/116 (35%) cases. Six (5%) patients had a bloodstream infection due to Enterococcus spp and a central line was present in all cases. In 52/116 (45%) cases there was growth of another organism, and 61/116 (53%) cases had an alternative infectious cause for PNA, whether it was a typical respiratory bacterial pathogen, viral illness, or invasive fungal infection. In 55 (47%) cases, there was no alternative infectious cause of PNA identified; 44 (80%) of these patients received an antibiotic active against Enterococcus spp and of these, 30 (68%) were clinically improved after 14 days. Overall mortality was high with 52/116 total cases (45%) in which the patient was alive after 90 days. In 25 cases patients did not receive antibiotic therapy active against Enterococcus and 28% were alive at 90 days.

Conclusion
Enterococcus spp should be considered a significant pulmonary pathogen in immunocompromised hosts in the appropriate clinical context. At our institution, the majority of immunocompromised patients with a monomicrobial pulmonary infection with Enterococcus were treated with targeted antibiotics. Further studies should evaluate outcomes of and indications for targeted treatment of pleuropulmonary Enterococcus.

Disclosures
All Authors: No reported disclosures.
2176. In Vitro Evaluation of Delafloxacin Activity Against Contemporary US Isolates from Cystic Fibrosis Patients Hospitalized with Pneumonia: Results from the SENTRY Antimicrobial Surveillance Program (2019-2021)
Authors: Shortridge Dee , Streit Jennifer M , Huband Michael D , Castanheira Mariana 
Published: December 2022

Abstract

Background
Delafloxacin (DLX) is a broad-spectrum fluoroquinolone antibacterial approved in the US for the treatment of community-acquired bacterial pneumonia (CABP) and acute bacterial skin and skin structure infections. DLX is indicated to treat CABP caused by multiple pathogens, including methicillin-susceptible Staphylococcus aureus (MSSA) and Pseudomonas aeruginosa (PSA). S. aureus (SA) and PSA are common pathogens causing pneumonia in cystic fibrosis (CF) patients. In this study, the in vitro susceptibilities of DLX and comparator quinolones were determined for clinical isolates from US CF patients collected during 2019-2021.

Methods
Isolates from CF patients hospitalized with pneumonia were consecutively collected at 17 US medical centers participating in the SENTRY Surveillance Program. Sites submitted 1 isolate per patient per infection episode. Isolate identification was determined at each site and confirmed using MALDI-TOF at JMI Laboratories. Susceptibility testing was performed according to CLSI broth microdilution methodology. FDA interpretive criteria were used for DLX, and CLSI (2022) criteria were applied to comparators.

Results
A total of 115 SA, including 72 MSSA and 67 PSA, were submitted. Susceptibilities (%S) to DLX, levofloxacin (LEV), and moxifloxacin (MOX) for MSSA are shown in the table. As MOX does not have breakpoints for PSA, ciprofloxacin (CIP) was tested. Against all SA, %S was 73.9%, 67.0%, and 67.0% for DLX, LEV, and MOX, respectively. DLX had the highest %S against MSSA (94.4%). The %S to LEV and MOX was 87.5% and 87.5%. DLX was also more active than comparators against PSA, with DLX 68.7%S, while LEV was 43.3%S and CIP was 50.7%S.

Conclusion
DLX had good activity against recent CF isolates from US hospitals, and had the highest percent susceptibility of the quinolones tested against MSSA and PSA. These in vitro data suggest that DLX could be a useful therapy when coverage of both MSSA and PSA is needed.

Disclosures
Dee Shortridge, PhD, AbbVie: Grant/Research Support|JMI Laboratory: Employee|Melinta: Grant/Research Support|Menarini: Grant/Research Support|Shionogi: Grant/Research Support Jennifer M. Streit, BS, MT(ASCP), Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Shionogi: Grant/Research Support Michael D. Huband, BS, AbbVie: Grant/Research Support|Melinta: Grant/Research Support Mariana Castanheira, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support.