Challenges of diagnosing acute HIV-1 subtype C infection in African women: performance of a clinical algorithm and the need for point-of-care nucleic-acid based testing.

Background. Prompt diagnosis of acute HIV infection (AHI) benefits the individual and provides opportunities for public health intervention. The aim of this study was to describe most common signs and symptoms of AHI, correlate these with early disease progression and develop a clinical algorithm to identify acute HIV cases in resource limited setting. Methods. 245 South African women at high-risk of HIV-1 were assessed for AHI and received monthly HIV-1 antibody and RNA testing. Signs and symptoms at first HIV-positive visit were compared to HIV-negative visits. Logistic regression identified clinical predictors of AHI. A model-based score was assigned to each predictor to create a risk score for every woman. Results. Twenty-eight women seroconverted after a total of 390 person-years of follow-up with an HIV incidence of 7.2/100 person-years (95%CI 4.5–9.8). Fifty-seven percent reported ≥1 sign or symptom at the AHI visit. Factors predictive of AHI included age <25 years (OR = 3.2; 1.4–7.1), rash (OR = 6.1; 2.4–15.4), sore throat (OR = 2.7; 1.0–7.6), weight loss (OR = 4.4; 1.5–13.4), genital ulcers (OR = 8.0; 1.6–39.5) and vaginal discharge (OR = 5.4; 1.6–18.4). A risk score of 2 correctly predicted AHI in 50.0% of cases. The number of signs and symptoms correlated with higher HIV-1 RNA at diagnosis (r = 0.63; p<0.001). Conclusions. Accurate recognition of signs and symptoms of AHI is critical for early diagnosis of HIV infection. Our algorithm may assist in risk-stratifying individuals for AHI, especially in resource-limited settings where there is no routine testing for AHI. Independent validation of the algorithm on another cohort is needed to assess its utility further. Point-of-care antigen or viral load technology is required, however, to detect asymptomatic, antibody negative cases enabling early interventions and prevention of transmission

265. Blood culture results pre- and post- antimicrobial administration in the Medicine Intensive Care Unit: a retrospective study in South Bronx

Abstract Background It is intuitive that obtaining blood cultures prior to administering antibiotics can increase the likelihood of a positive blood culture result. Surviving Sepsis Campaign Hour-1 bundle stipulates that obtaining a blood culture and administering antibiotics within 1 hour is a critical determinant of survival. However, the diagnostic sensitivity shortly after antibiotic administration remains unknown. In clinical practice, some health care providers delay antibiotic administration in order to first obtain a blood culture. Methods Adult patients (&amp;gt; 18 years of age) admitted to the Medicine Intensive Care Unit in Lincoln Medical Center, located in South Bronx, New York City, from 09/2019 to 12/2019. Patients needed to have at least one blood culture obtained within 12 hours of admission and have received intravenous antibiotics during the admission to the Medicine Intensive Care Unit. Results Of 327 patients screened, 196 met enrolment criteria and 253 sets of blood cultures underwent analysis. Blood cultures grew bacteria in 21.8% of pre-antimicrobial group whereas 26.9% in post-antimicrobial group (p=0.37). 25.9% of patients received antibiotics within 1 hour before blood culture sampling, while 34.0% of patients received antibiotics &amp;gt;1 hour prior to obtaining blood culture. Blood culture results positive for coagulase-negative staphylococci were more prevalent in the pre-antimicrobial group. Table 1. Patient Characteristics Table 2. Number of blood cultures obtained and blood culture result Table 3. Initial antimicrobial agent and 30-day mortality Conclusion In the sequence of blood culture and antibiotic administration, there is no 30-day survival difference in pre-antimicrobial group and post-antimicrobial group (p=0.15), as long as both received antibiotics within 12 hours of coming to the hospital. Coagulase-negative staphylococci were higher in the pre-antimicrobial group which may indicate that the health care provider hastily obtained the blood culture in a non-sterile manner. Antibiotic administration should not be delayed because of pending blood culture collection. In addition, given that more than 70% of patients were ultimately found to have negative blood cultures, it would be useful to develop practical tools to identify low-risk patients that can be treated without obtaining blood culture, as the blood culture would not be likely to provide diagnostic information. Figure 1: Hours Before and After IV Antibiotic Started Figure 2: Distribution of Blood Culture Before and After IV Antibiotics Disclosures All Authors: No reported disclosures </jats:sec

205. Comparing Cefazolin and Nafcillin in Treatment of Methicillin-Susceptible Staphylococcus Aureus Bacteremia: A Retrospective Study in a Single Center in the South Bronx

Abstract Background Methicillin-Susceptible Staphylococcus Aureus (MSSA) bacteremia treatment includes B-lactams as first-line therapy; however, comparative effectiveness within B-lactams has not been well studied in literature. Herein, we look at definitive treatment with nafcillin or cefazolin in patients with MSSA bacteremia. Methods This retrospective study included patients admitted at Lincoln Medical Center from January 2000 to March 2019 who had a positive blood culture for MSSA and was treated with either nafcillin or cefazolin. We excluded patients who received both nafcillin and cefazolin. In addition to this, included patients had to have (1) bacteremia alone with 14 days treatment after first negative blood culture or (2) endocarditis or osteoarthritis with 6 weeks treatment after first negative blood culture. Results Of the 186 patients identified to have at least one positive culture for MSSA during the study period, only Eighty-two patients met our set criteria. Seventy of our patients were treated with nafcillin while 12 patients were treated with cefazolin. Outcome measures included duration of bacteremia (P = 0.151), ICU admissions (P = 0.542) and development of Clostridium difficile (P = 0.475). All-cause 30 day mortality and recurrent MSSA bacteremia were not different between the two treatment groups with an incidence of 17% for cefazolin vs. 21% for nafcillin (P =1) and 1% for cefazolin vs. 0% for nafcillin (P =1), respectively. Conclusion The average price of nafcillin is approximately 174 USD/day, while cefazolin is 33 USD/day. In addition to being economically practical, especially in a city hospital such as Lincoln Medical Center, cefazolin also has the benefit of only being administered every 8 hours rather than every 4 hours that nafcillin requires. This decreases the need for staff and supplies, allowing for the cefazolin regimen to be administered more easily. In this single-center study, patients who received cefazolin and nafcillin had no statistically significant difference in incidence of recurrence of bacteremia or mortality rate therefore, physicians may consider prioritizing cefazolin for treatment of MSSA bacteremia. Disclosures All authors: No reported disclosures. </jats:sec

178. Comparing the Incidence of Multidrug Resistant Bacteremia, Fungemia and Hospital-acquired <i>Clostridioides difficile</i> Infection in COVID-19 Versus Non-COVID-19 Patients: a Single Hospital, One-year Observational Study in New York City

Abstract This abstract has been withdrawn.</jats:p

1710. Comparison of herpes simplex prevalence in serum and semen-cervical sample of infertility patients: A systematic review and meta-analysis

Abstract Background Herpes simplex virus (HSV) is a common pathogen of sexually transmitted infections, however the role it plays in the development of infertility is unknown. In animal studies, inoculating murine rete testis with HSV-1 revealed irreversible atrophy of the germinal epithelium. Another study found that human herpesvirus 1 thymidine kinase (HHV-1 TK) protein disrupts spermatogenesis by creating immature sperm and accelerating apoptotic cell death in rodent. Although it is well established that herpes virus affects fertility in male animal models, the question remains as to the effect of HSV in human infertility. Routine testing of serum HSV IgG/IgM/DNA or HSV PCR in semen-cervical sample is not commonly done in clinical practice, and there are no set guidelines as when to screen. We aim to review the available literature and compare the prevalence of HSV in serum versus semen-cervical samples, focusing on the infertile patient population. Methods We searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov from inception to December 2019. Our search terminology included: “Herpes, Human herpesvirus, infertility.” Inclusion criteria required testing to be done on either serum, sperm, menstrual fluid, or endocervical sample in infertile patients. PRISMA Flow Diagram for study selection. Results 17 retrospective studies were included in this review. In the male-infertility cohort, a total of 11 studies were compared. The random-effects pooled prevalence was 12.7% in semen sample, and 16.8% in serum sample. In the female-infertility cohort, a total of 6 studies were compared. The random-effects pooled prevalence was 12.1% in menstrual fluid /endocervical sample, and 17.8% in serum sample. Figure 1. Studies enroll in this meta-analysis, Male Figure 2. Studies enroll in this meta-analysis, Female Conclusion The prevalence of HSV in semen-cervical sample was about 12%, compared to HSV in serum sample is about 17%. Therefore, HSV contribution to infertility will be overestimated when we use serum sample for diagnosis. It is noteworthy to mention that the seroprevalence of HSV IgG is much higher in general population, previously reported at 35% to 50%. In addition, given that current antiviral treatment for HSV has side effects that could cause infertility on its own, as seen in animal studies. More studies are needed to evaluate the role HSV plays in causation of infertility. Disclosures All Authors: No reported disclosures </jats:sec

New-Onset Cervical Lymphadenopathy in a Patient Undergoing Treatment of Pulmonary <i>Mycobacterium avium</i> Complex Infection: Toxoplasmosis Lymphadenitis

Immunocompetent hosts with toxoplasmosis are usually asymptomatic. However, T. gondii can present as an acute systemic infection. Symptomatic patients usually have a benign, self-limited course that typically lasts from a few weeks to months. Herein, we present a 66-year-old immunocompetent female who developed dysphagia and new-onset cervical lymphadenopathy during pulmonary Mycobacterium avium complex treatment.</jats:p

New-Onset Cervical Lymphadenopathy in a Patient Undergoing Treatment of Pulmonary Mycobacterium avium Complex Infection: Toxoplasmosis Lymphadenitis

Immunocompetent hosts with toxoplasmosis are usually asymptomatic. However, T. gondii can present as an acute systemic infection. Symptomatic patients usually have a benign, self-limited course that typically lasts from a few weeks to months. Herein, we present a 66-year-old immunocompetent female who developed dysphagia and new-onset cervical lymphadenopathy during pulmonary Mycobacterium avium complex treatment