Methicillin-resistant Staphylococcus aureus (MRSA) bone and joint infections have traditionally required prolonged intravenous (IV) antibiotics. While recent trials support the non-inferiority of oral therapy, most grouped all oral agents together, limiting data on specific options like doxycycline. We aimed to assess the real-world effectiveness and safety of oral doxycycline following IV therapy for MRSA bone and joint infections.Figure 1:Length of Stay - Oral Doxycycline Vs. Standard of CareComparison between our patient's mean LOS and relevant published MRSA studies.Table 1:Demographics We performed a retrospective analysis of adults treated at Tampa General Hospital between January 2014 and July 2018. Patients with MRSA bone and joint infections were initially treated with IV antibiotics and later transitioned to oral doxycycline. The primary outcome was treatment success, defined as absence of culture-proven MRSA reinfection at the same site within one year. Secondary outcomes included doxycycline-related adverse events and mortality within three months. We compared the cohort’s mean length of stay (LOS) to that reported in two published IV-only MRSA studies (mean LOS ∼33 days), using Welch’s t-test on summary statistics.Table 2:Distribution of cases by anatomical siteOnly culture proven infections were included.Table 3:Distribution of type of positive culturesIR= Interventional Radiology.Some patients had more than one positive culture and all were included.These were the only types of cultures that were accepted as positive culture for MRSA in the study. Twenty-eight patients were included. Treatment success was 96.4%, with one reinfection. No doxycycline-related adverse events or deaths occurred. Long-term suppressive doxycycline was prescribed in 10.7% of patients. Mean inpatient LOS was 18.1 days, significantly shorter than the 33-day average in IV-only cohorts (p = 0.013). Oral doxycycline was safe and effective in our cohort, achieving a 96.4% success rate without mortality or drug-related side effects. Compared to historical IV-only treatment, oral step-down therapy was associated with a significantly shorter LOS, potentially reducing complications and healthcare costs. An expanded cohort through 2024 is in progress to strengthen these findings and inform future treatment guidelines. All Authors: No reported disclosures

BACKGROUND:Steroids remain the primary treatment for severe alcohol-associated hepatitis (AAH), though there is little available tools to predict patient response to steroids. It was hypothesized that phosphatidylethanol (PEth) value will inversely correlate with response to steroid therapy based on Lille score in AAH. AIM:To assess the relationship of patient factors, focusing on pre-steroid therapy PEth value, to steroid therapy response in AAH. METHODS:A retrospective case control study was performed on patients who received ≥ 4 days of steroid therapy for AAH at our hospital between July 1, 2019 and June 30, 2022. A total of 2087 patients were screened for AAH and those treated with steroids were included for statistical analysis utilizing independent sample t-test and for categorical variables using the χ 2 test. RESULTS:No correlation was found between PEth value, pre-steroids abstinence length, or number of drinks per week pre-steroids and response to steroids. Non-responder status significantly correlated with older age (P = 0.024), lower albumin (P = 0.003), and higher bilirubin (P = 0.010) pre-steroids. Our study suggests that age, pre-steroid albumin, and pre-steroid bilirubin levels may predict nonresponse to steroid therapy. Non-responders have increased incidence of death and higher medical costs. CONCLUSION:Identifying non-responders through these identified factors should prompt early referral for liver transplantation. Future prospective studies with larger population size are needed to assess the efficacy of combined pre-steroid age, albumin, bilirubin and other biochemical markers as predictors of steroid response.

BackgroundNon-aeruginosa Pseudomonas (NAP) species, historically considered environmental contaminants, are increasingly recognized as clinically significant pathogens, particularly in immunocompromised patients. While Pseudomonas aeruginosa is well-studied, less is known about the epidemiology and resistance patterns of NAP species.MethodsWe conducted a retrospective review of culture-confirmed NAP infections in adult inpatients at a cancer center from 2012 to 2022. Data on demographics, infection sites, malignancy types, and antimicrobial susceptibilities were extracted from electronic medical records.ResultsAmong 104 infections, the most common species were Pseudomonas putida (63.5%), P. fluorescens (25%), P. stutzeri (7%), and P. mendocina (4%). Urinary and respiratory infections predominated, frequently linked to indwelling devices. P. fluorescens infections had the highest 30-day mortality (19%) versus P. putida (7%). Polymicrobial infections were common. Fluoroquinolone susceptibility was high across all species (85%-100%).DiscussionNAP species are emerging as relevant pathogens in oncology patients, especially those with hematologic malignancies. Species-level differences in clinical impact and resistance underscore the need for targeted diagnostics and stewardship strategies.

Ecthyma gangrenosum is a cutaneous infection characterized by gangrenous ulcers with erythematous borders. Bacterial invasion of arterial media, adventitia, and veins promotes ischemic necrosis. Pseudomonas aeruginosa is the most frequently identified organism, although other bacterial and fungal pathogens have been implicated. The risk of ecthyma gangrenosum development and infection prolongation is increased among immunocompromised and neutropenic patients. While eradication requires source control and wound closure, neutropenic patients are poor surgical candidates due to low leukocytes and poor graft uptake. Furthermore, a prolonged neutropenic state provides ample access of enteric flora to the broad-spectrum-treated wound, promoting multidrug-resistant strains. Here, we present a fatal case of multidrug-resistant ecthyma gangrenosum in a neutropenic patient with acute myeloid leukemia. We emphasize the importance of leukopenia resolution for recovery, which is often not achieved in prolonged neutropenic patients.

Abstract Background Despite advancements in HIV treatment, there remains a significant gap in understanding mortality rates among reproductive-aged women with HIV in the United States. To enhance evidence-based interventions, this study aims to delineate mortality trends from 1999-2020, focusing on demographic characteristics such as age, race, and geographic regions. HIV-related AAMRs per 100,000 individuals stratified by race in women aged 15-44 in the United States, 1999 to 2020. Methods This study involved a retrospective analysis using the CDC WONDER database, extracting data via ICD-10 codes B20-B24 to identify HIV-related deaths among women aged 15-44 from 1999 to 2020. We analyzed demographic disparities in HIV mortality rates over time based on age, ethnicity, and geographic regions using systematic database analysis. Results are presented as age-adjusted mortality rate (AAMR) and 95% confidence interval (CI). These were calculated by standardizing HIV-related deaths in the United States in 2000. HIV-related AAMRs per 100,000 individuals stratified by state in in the United States among women aged 15-44 from 1999 to 2020. Results Between 1999 and 2020, a total of 29,358 women aged 15-44 died from HIV in the US (AAMR = 2.2 per 100,000; 95%CI: 2.2-2.2). The crude mortality rate declined from 4.2 in 1999 to 2.1 in 2020. The overall decline in mortality rates masked disparities: Non-Hispanic Black women experienced the highest AAMR (11.3), while Hispanics, though initially higher, saw the most substantial decrease in mortality rates (1.4). Geographical analysis revealed the South as the most affected region (3.5), accounting for 58.3% of deaths, with urban areas presenting higher mortality rates than rural ones (2.4 and 1.4). Notably, older age groups (35-44) accounted for the majority of deaths (67.1%) HIV-related AAMRs per 100,000 individuals among women aged 15-44 from 1999 to 2020 in the United States census regions. *=significant at p < 0.05; confidence interval does not include zero Conclusion HIV-related mortality among reproductive-aged women decreased nationally from 1999 to 2020, yet disparities persist. Our analysis emphasizes the disproportionate impact of HIV-related deaths on non-Hispanic Black women and those residing in the Southern United States, suggesting the need for region and population-specific public health interventions. This highlights the need to improve access to care, particularly in urban areas, and target age-specific prevention programs to further reduce mortality rates. Improving timely diagnosis and addressing the stigma surrounding HIV among women is vital to reduce mortality in this demographic. HIV-related crude mortality percentage stratified by different variables in women aged 15-44 in the United States, 1999 to 2020 Disclosures All Authors: No reported disclosures

Abstract Background Bacterial pneumonia is one of the leading causes of mortality in the US, particularly among those aged 65 and older. No study has been done on this population to understand mortality patterns based on demographic characteristics such as age, gender, race, and geographic regions, which helps to enhance evidence-based interventions for this vulnerable age group. Trends in Bacterial Pneumonia-related AAMRs and APC stratified by race in older adults. Methods This study involves a two-decade CDC WONDER data on bacterial pneumonia-related deaths via ICD-10 codes A48.1 and J13-J16.0 in ≥ 65-year-olds from 1999-2019. Demographic disparities are analyzed based on age, gender, race, census region, and urban-rural classification using systematic database analysis. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent change (APC) with a 95% Confidence Interval (CI) are calculated through joinpoint regression analysis. Trends in Bacterial Pneumonia-related AAMRs in Black and White men and women. Results 155,819 individuals aged ≥65 died from bacterial pneumonia in the US from 1999 to 2019. Initially, AAMR declined (1999-2005: APC -0.47; 95% CI -1.53 to 1.08), followed by a steep decline (2005-2010: APC -6.25; 95% CI -9.72 to -4.51), and concluded with a significant increase (2010-2019: APC 1.97; 95% CI 1.09 to 3.12). Males had higher AAMR (23.6) than females (14.2). Hispanics (19.6) were more affected than non-Hispanics (17.8) and Blacks more than Whites, except for White men (23), surpassing Black women (15.3). Pneumonia mortality varied by region, highest in Arizona and California (44.5 and 30.4) and lowest in New Jersey and Wisconsin (8 and 9.4). Nationwide, Black/White mortality is comparable except for the Northeast, where Black mortality doubles that of Whites. Trends in Bacterial pneumonia-related AAMRs stratified by census regions. *=significant at p < 0.05; confidence interval does not include zero. Conclusion While initial reductions in bacterial pneumonia-related mortality among older U.S. adults were observed, an upward trend from 2010 to 2019 negated this progress, resulting in a concerning resurgence. This upsurge disproportionately impacts specific demographics, including those aged 85 and older, males, non-Hispanic Blacks, those in the Western U.S., and urban populations. To further reduce mortality rates, this highlights the urgent need for effective interventions, improved access to care, and age-specific preventive programs. Further research is required to understand contributing factors. Bacterial Pneumonia-related crude mortality percentage stratified by different variables between men and women. Disclosures All Authors: No reported disclosures

Abstract Background Skin and soft tissue infections (SSTI) are divided into purulent vs non-purulent with the former necessitating the need for methicillin resistant staph aureus MRSA antimicrobial coverage per IDSA guidelines for management of SSTI. MRSA nares PCR screening for MRSA pneumonia has demonstrated high negative predictive value (NPV) (98.1%) for MRSA associated community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). Studies evaluating MRSA nares PCR to predict MRSA infection involving other anatomical sites including skin/soft tissue have shown mixed results. This retrospective cohort study seeks to further evaluate the utility of MRSA nares PCR in predicting MRSA associated purulent SSTI including in relation to anatomical site of the skin infection (above the waist line vs below the waist line). Methods We performed a retrospective medical record review of patients admitted to the hospital or evaluated in the emergency department with SSTI between 1/1/2015-11/30/2022. Patients 18 years or older with a diagnosis of purulent cellulitis were included if they had a MRSA nares PCR result and a positive culture for staph aureus from either a purulent wound culture swab or an abscess incision/drainage culture. Medical records were reviewed to confirm a diagnosis of purulent cellulitis including physician documentation and pictures of associated skin infections when available. The anatomic site of the SSTI were recorded. Results 85 patients were included in the final analysis. MRSA nares PCR for MRSA SSTI had a negative predictive value (NPV) of 66.7% and positive predictive value (PPV) of 96.8%. The sensitivity and specificity of MRSA nares PCR for MRSA SSTI was 62.5% and 97.3% respectively. The NPV of MRSA nares PCR for MRSA SSTI above the waist was 71% vs 63% below the waist. Conclusion Our results are consistent with other studies showing high specificity and low sensitivity for MRSA nares PCR in predicting MRSA SSTI. However, the NPV was much lower in this cohort compared to other studies. These results do not support the use of MRSA nares PCR to rule out MRSA SSTI. Clinicians should continue to use clinical exam (purulent vs non-purulent) and microbiologic data when available to guide antimicrobial coverage of MRSA when treating patients with SSTI. Disclosures All Authors: No reported disclosures

Abstract Background There have been documented cases, although rare, of clinically significant infections caused by Hafnia alvei leading to infections such as bacteremia, pneumonia, UTI, meningitis, and empyema. H. alvei infections can be community-acquired or nosocomial. The published data for H. alvei in cancer patients is limited. The aim of this study was to characterize H. alvei infections including patient characteristics, antimicrobial susceptibility patterns, location of isolation, and microbial characteristics of isolates in cancer patients. Methods A retrospective cohort study was performed to review records of all consecutive patients with a positive H. alvei culture during the past 7 years. Variables included patient’s age, sex, underlying malignancy, neutrophil count, location and duration of infection, antimicrobial susceptibility patterns, hospital stay, co-isolates, and outcomes. Results A total of 15 patients with positive H. alvei cultures were identified at the Moffitt Cancer Center. There were 8 (53%) female and 7 (47%) male patients. The mean patient age was 65.7 ±15.8 yrs. All patients had underlying malignancies, most common type was solid organ malignancy in 11 patients (73%), and hematologic malignancies in 4 patients (27%). Two patients (13%) were neutropenic at the time of positive culture. H. alvei isolates were first identified in patients at a median of 8 days and an average of 11 days after admission to the hospital. Of the 15 isolates, 8 (53%) were monomicrobial and 7 (47%) were polymicrobial cultures (Table 1). Co-isolates and susceptibilities are shown in the Table 2 and 3. Table 1 Demographic data for all identified patients Table 2 Characteristics of H. alvei isolations Table 3 H. alvei antibiotic susceptibility report Conclusion This study demonstrated that H. alvei is a truly rare pathogenic organism with only 15 documented cases of isolation over an 80-month time period at an academic cancer center. In patients with underlying malignancies, the organism tends to have a predilection for both the urinary tract and abdominal wounds, and can be isolated from pure cultures in the urine and with co-isolates in all other locations. Our study showed that resistance with H. alvei is usually with ampicillin and most of our isolates were resistant to cefazolin and cefoxitin. When infection does occur, isolates tend to be susceptible to standard antibiotics such as aminoglycosides and ciprofloxacin. Disclosures All Authors: No reported disclosures

Abstract Background Decubitus ulcers are a costly and challenging problem in the healthcare system, with an estimated 2.5 million pressure ulcers treated annually in the United States at a cost of $11 billion. Patients with decubitus ulcers may present with evidence of infection or sepsis, but the source is rarely the ulcer itself. Recent guidelines recommend evaluating patients for curative management before pursuing further testing or empiric antimicrobial treatment. This study aimed to assess the appropriateness of antibiotic usage in patients admitted to the hospital with decubitus ulcers, and to determine the rate of appropriate antibiotic use. Methods This study involved a retrospective review of 1678 patients records with decubitus ulcers to assess the appropriate use of antibiotics during their inpatient stay. Appropriateness was determined by one of three criteria. The 1st criteria included patients who met systemic inflammatory response syndrome with suspected infection from osteomyelitis; 2nd criteria included patients who received antibiotics due to another infection (pneumonia, urinary tract infection or bacteremia) and 3rd criteria included use of antibiotics as a bridge therapy to surgical intervention (flap closure or Incision and Drainage). The rate of consultation for infectious disease and plastic surgery was also investigated. Results Of the total 1678 patients, the median age was 70 yrs (IQR=21), of that 51 % were males. Based on the criteria for appropriateness, there were a significant difference in gender (p= 0.000) females were more likely to receive inappropriate antibiotics (Table 2). Similarly, the rate of inappropriate use of antibiotics was 15.9% with ID consults as compared with 84.1% who didn’t receive ID consult (p=0.000) as seen in table 1. What is the payment method you want? What is the payment method you want? What is the payment method you want? What is the payment method you want? Conclusion This study contributes to a better understanding of appropriate antibiotic usage in patients with decubitus ulcers. The findings favor the importance of ID consults in the appropriate use of antibiotics. Additionally, there may be some underlying bias with prescribing antibiotics to females compared to males. Thus, the study provides clinicians with tools in order to make evidence-based decisions on the management of these patients, and for healthcare systems to optimize resource allocation Disclosures All Authors: No reported disclosures

Abstract Background Pseudomonas aeruginosa a gram-negative bacteria that is known to cause severe nosocomial infections. Other species of Pseudomonas are considered to be part of the human indigenous microbiota, commonly found in sites such as the gastrointestinal tract and skin. Although believed to be non-pathogenic for many years, these species can cause diseases in immunocompromised patients, albeit less virulent than P. aeruginosa. In this report, we will discuss the characteristics of non-aeruginosa Pseudomonas infections in cancer patients. Methods We conducted a retrospective study investigating culture results of adult inpatients with Pseudomonas spp. infections, excluding P. aeruginosa, at a Florida cancer center from 2012-2022. Data collected included infection source, antibiotics used, resistance against fluoroquinolones, surgical procedures or chemotherapy in the past month, polymicrobial infection, and 30-day mortality. Results Of 104 cases, P. putida was the most common species, followed by P. fluorescens, P. stutzeri, and P. mendocina. P. putida infections were often associated with urine (44%), respiratory and skin wounds (16% each). Respiratory tract was the most common source for P. fluorescens infections (38%). Solid tumors accounted for 71% of malignancies in the P. putida group, while hematologic malignancies accounted for 29%. For P. fluorescens, solid tumors and hematologic malignancies accounted for 62% and 38%, respectively. P. stutzeri and P. mendocina were mostly associated with solid malignancies. All groups were susceptible to quinolones (86-100%), and polymicrobial infections were frequently observed (68%, 73%, 63%, and 50%, respectively). P. putida and P. fluorescens had 7% and 19% 30-day mortality rates, respectively. P. stutzeri and P. mendocina had no observed mortality. Conclusion Our study highlights non-aeruginosa Pseudomonas infections are rare but notable in cancer patients. In the majority of cases, the disease course is less severe, and treatment with appropriate antibiotics, such as fluoroquinolones, leads to complete recovery. Disclosures All Authors: No reported disclosures

Strongyloides hyperinfection syndrome is a rare manifestation caused by the Strongyloides stercoralis parasite and has mortality rates close to 90% if left untreated. Corticosteroids are commonly implicated as a trigger for hyperinfection syndrome in patients with Strongyloides autoinfection, and it has been suggested that even a single dose of corticosteroids can trigger hyperinfection syndrome. Here, we report a case of hyperinfection syndrome eight days after administering a single 8 mg dose of dexamethasone for fetal lung development before a late preterm, emergency cesarean section (C-section) delivery secondary to placental abruption. Prior to the C-section, the patient had been exhibiting signs of autoinfection syndrome, cough, and abdominal pain, for several months. Following corticosteroid administration, she had sequelae of Strongyloides hyperinfection syndrome, including gram-negative bacteremia, undulating fevers, protein wasting enteropathy, and hypersensitivity pneumonitis. Sputum cultures were positive for Strongyloides, and after treatment with ivermectin and albendazole, the patient fully recovered. Strongyloides hyperinfection syndrome is a documented consequence of short courses of corticosteroids. Still, this case is unique because the patient only received a single dose of corticosteroids before developing hyperinfection syndrome. Clinicians must recognize patients at risk for Strongyloides hyperinfection syndrome and understand the risks of administering corticosteroids to patients harboring the parasite.

Abstract Background Pneumocystis Pneumonia (PCP) is a respiratory pathogen that has been known to cause severe illness in the immunocompromised patients. The pathogen became well known in the HIV epidemic where much of the current standard of practice was first researched. However since the invention of antiretroviral therapy, and advances in cancer therapy the population affected by PCP has shifted to patients with malignancy or a medication induced immunocompromised state. Here we wish to better define the epidemiology and pathogenicity of PCP in the immunocompromised malignancy patients. Methods We utilized a retrospective review of 28 consecutive patients from January 1st 2012 to January 1st 2023 that had visited Moffitt Cancer Center with a diagnosis of confirmed or suspected PCP. We collected data on age, underlying malignancy, type of treatment, comorbidities, presenting symptoms, method of diagnosis and computed tomography findings. Results Hematologic malignancies comprised 90% of all cases, half of all cases were in patients’ with a type of non-hodgkin’s lymphoma (NHL). The most common malignancy was diffuse large B cell lymphoma 25%, followed by acute myelocytic leukemia treated with stem cell transplant (SCT) 14%, followed by multiple myeloma 11% (Figure 1). The therapy mostly implicated was glucocorticoids in 57% cases, followed by alkylating agents in 32%, and SCT in 25% (Figure 2). The most frequently reported symptoms was dyspnea in 71% of patients, followed by fever 39%, and cough 32%. Diagnosis was made in 21% of patients with serum 1,3-β -D-glucan, 68% were diagnosed following a bronchoalveolar lavage, 11% utilized both (figure 3). of The most common finding on CT was ground glass opacities in 79% of cases. Lymphopenia was present in 79% cases. PCP contributed or was the cause death in 17% cases. Underlying Malignancy Underlying Malignancy of those who developed PCP pneumonia, n=28 Diffuse large B Cell Lymphoma DLBCL, Acute Myelocytic Leukemia AML, Chronic Lymphocytic Leukemia CLL, Cutaneous T Cell Lymphoma CTCL, Acute T cell Leukemia/Lymphoma ATLL, Immune Thrombocytopenic Purpura (ITP) Type of cancer treatment Cancer Treatment of those who developed PCP pneumonia, multiple different therapies were often used in treatment, n=28 Method of Diagnosis of PCP Conclusion Our data shows that patients’ with NHL comprise half of the patients who developed PCP. Consistent with other studies, steroids were the most frequently implicated therapy, however the second most frequent were alkylating agents. Lymphopenia was commonly associated as well. We wish to bring to light that NHL, Alkylating agents, and particularly lymphopenia as risk factors for development of PCP and should prompt early concern of PCP, particularly those with NHL. Disclosures All Authors: No reported disclosures

Abstract Background COVID-19 disease became a global health care crisis and was declared pandemic by WHO in March 2020. Some studies have indicated that Solid Organ Transplant (SOT) patients may have increased morbidity and mortality while others showed no difference. Our study aims to investigate patients’ characteristics, disease course, management of COVID-19 and outcomes in our SOT patient population. Methods We conducted a retrospective cohort study of all consecutive SOT recipients who were admitted to our transplant center from March 2020 to April 2021 with COVID-19 infection. Data was collected from the electronic medical records after receiving Institutional Review Board approval. Table 1Study Population Demographics Figure 1 Age and Gender distribution of the study population Results A total of 135 patients met inclusion criteria. Average age at the time of COVID-19 diagnosis was 56.38±12.93 years. Majority of the patients (54%) were kidney transplant recipients. Out of the total, 28% of the patients required supplemental oxygen and 14% required intensive care unit (ICU) care. A total of 12 patients (9%) required intubation and mechanical ventilation. 21% of the patients were treated with Remdesivir and 30% met criteria for the use of corticosteroids. Unfortunately, 11 patients (8%) of the patients died from COVID-19 infection and its complications. Of those 11 patients 5 were treated with Remdesivir and 10 were treated Corticosteroids. None of the patients met the criteria for ECMO (Extra Corporeal Membrane Oxygenation). Figure 2Study Population Distribution of the Types of Transplants at time of COVID-19 infection Figure 3 Outcomes - Admission to ICU and Mortality Figure 4 COVID-19 Therapies and Outcomes in the SOT Recipients Conclusion Our study showed a higher mortality rate in SOT patients compared to general population. Treatment with Remdesivir and Corticosteroids improved the overall mortality rate but had no benefit in patients with critical illness requiring ICU level care. COVID vaccination significantly improved the outcome, and the major limitation of the study was COVID vaccination information was not included since the study was initiated prior to introduction of vaccines. More studies with larger sample size and vaccine data need to be conducted to accurately determine the outcome of COVID-19 infection in this patient population. Disclosures All Authors: No reported disclosures.

Abstract Background COVID-19 disease became a global health care crisis and was declared pandemic by WHO in March 2020. Little is known how the immunosuppressive medications impact the mortality rate in Solid Organ Transplant (SOT) recipients. There is also minimal data regarding the incidence of transplanted graft failure or rejection that could be attributed to the COVID-19 infection itself or its complications and management. Our study aims to investigate the management of COVID-19 infection, outcome of the infection, transplant failure and rejection rates in SOT recipients. Methods We conducted a retrospective cohort study of all consecutive SOT recipients who were admitted to our transplant center from March 2020 to April 2021 with COVID-19 infection. Data was collected from the electronic medical records after receiving Institutional Review Board approval. Table 1Characteristics of the Population in the two groups Table 2 Type of Transplants in the two groups Results A total of 135 patients met the inclusion criteria. After the diagnosis of COVID -19 infection, 31% recipients had decrease in the dose of immunosuppressive medications (change group) and 69% had no changes in the dose (no change group). Out of the 73 Kidney Transplant recipients 33% were in the change group compared to 14% of liver, 25% of heart and 27% of lung transplant recipients. Of the total 42 recipients in the change group, 28.6% required Intensive Care Unit (ICU) level care significantly higher compared to 7.5% in the no change group (p-value < 0.005). Mechanical ventilation was required in 14.3% of the patients in the change group and 6.5% in the no change group (p-value < 0.5). Out of the total, 85.7% patients in the change group survived compared to 94.6% in the no change group (p-value < 0.1). Overall, the transplant rejection rate was higher in the change group compared to the no change group (p-value < 0.5). Table 3Comparison of the Outcomes in the two groups Figure 1 Kaplan – Meier Curve for survival Figure 2 Kaplan – Meier Curve with Cox Regression for survival Conclusion Our study showed a significantly higher ICU admission rate and mortality in SOT recipients who had their immune suppression reduced at the time of COVID-19 diagnosis. The same group also had a higher risk of rejection of transplanted graft. More studies with larger sample size needs to be done to further understand the management of immunosuppressive drugs in the SOT recipients with COIVD-19 infection. Disclosures All Authors: No reported disclosures.

Common variable immunodeficiency (CVID) is a primary immunodeficiency disorder that causes decreased immunity and increased susceptibility to infections. It affects B lymphocyte differentiation, resulting in predominantly bacterial and less frequently viral, fungal, and protozoal infections. The respiratory and gastrointestinal tracts where antibody defences are essential are usually affected. Individuals with CVID are also predisposed to developing lymphoid and gastrointestinal malignancies. We present two cases with rare infectious and oncological complications of CVID, including a patient with Mycobacterium avium complex-intracellular infection and ovarian cancer, and another patient with group B Streptococcus empyema of the lung with acute myeloid leukaemia. The main objective of this study is to highlight how CVID-induced hypogammaglobulinaemia can lead to rare infections and malignancies. The management of these complications can vary according to severity, but an awareness of their existence is crucial to diagnose them promptly in an already immunocompromised CVID patient.

Background The incidence of alcoholic liver disease (ALD) has increased, causing it to become a primary indication for liver transplantation in the United States. We hypothesized an association between alcohol taxation and prevalence of ALD. Methods We conducted a retrospective study of united network for organ sharing (UNOS) waitlist additions for liver transplantation between January 2007 and December 2016. We also analyzed the average excise tax (2007-2016) for beer, wine, and spirits in listing states of liver transplant waitlist additions (LTWA). Results There were 104 805 adult UNOS LTWA with assigned diagnoses, an annual increase from 22% to 28%. There were 24 316 LTWA with ALD diagnosis. The mean value for beer tax was significantly lower for ALD patients than for non-ALD patients across all age groups ( P < .001). The analysis demonstrated significantly more ALD in waitlisted patients 35-54 years of age (30%), compared with 18-34 years (10%) and ≥55 years (20%), P < .001. The data confirmed significantly more ALD Medicaid patients in the 35-54 year age group (28%) compared with other age groups, P < .001. Discussion Our research demonstrated an association between lower beer tax and higher ALD prevalence across all age groups. We found a larger percentage of middle-aged (35-54 years) Medicaid patients listed with ALD. These findings raise the need for further investigation of a potential public health concern for an association between ALD and beer tax, especially for middle-aged patients of lower socioeconomic status.

Rationale: In the United States, non-tuberculous mycobacterium (NTM) infections are considered an important cause of morbidity and mortality, especially in people with progressive lung disease. The state of Florida has an extremely high incidence and prevalence of NTM disease which is likely a rapidly emerging infection in the state due to environmental and demographic factors. Objectives: Adjemian et al. [1] To determine the burden of NTM disease of patients admitted to a large Central Florida academic center, Falkinham [2] to identify the most common risk factors associated with developing NTM disease in this area, and Sfeir et al. [4] to categorize antimicrobial susceptibilities and genetic resistance markers. Methods: We conducted a retrospective case review from January 1, 2011 to December 31, 2017 in a large university-associated metropolitan hospital in west-central Florida. NTM infections were identified using Thera-Doc (R) during the study period with the inclusion criteria of any inpatient admission, culture confirmed NTM at any site, and age >= 12 years. Demographic variables (including residential zip code) and comorbidity data (including solid organ transplant status, HIV status and subsequent testing results, intrinsic pulmonary disease, and cancer diagnosis of any site) were collected for each patient. Microbiologic data collected included NTM species/subspecies, anatomic location of specimen collection, antimicrobial susceptibility including minimum inhibitory concentration (MIC). All collected data were analyzed within Stata/IC14.2. Geospatial relationships between zip codes, diagnosis type, and co-morbidities were computed using Arc GIS Pro. Results: Our results demonstrated that a substantial number of our inpatient cases with NTM were of the M. abscessus group, and with M. avium complex and M. fortuitum also representing the pathogen in numerous cases. Novel findings included compilation of the first hospital wide comprehensive NTM resistance plot to our knowledge. Our results did show a concordance with previous data with expected predominance of NTM inpatient cases in Caucasian males with pre-existing pulmonary disease, though additional work could be done with isolates within the transplant and immunosuppressed populations. Conclusions: Our data set demonstrates the most common species/subspecies of NTM infections and their associated conditions seen at our central Florida hospital, and includes an antimicrobial sensitivity analysis in toto. This could be insight into the possible prevalence of NTM in the area, and provides the foundation for future studies on both the acquisition and prevention for NTM infections in central Florida.

The pulmonary effects of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus that causes coronavirus disease (COVID-19), are well documented; however, more evidence is needed to understand its effect on multiple organ systems. We present the case of a 69-year-old male with dyspnea for two weeks and bilateral conjunctivitis who tested positive for SARS-CoV-2. He was found to be hypoxic, requiring supplemental oxygen. On hospital day two, he complained of worsening left eye pain with the development of a left lower eyelid ulcer. He underwent a CT of facial bones, which showed findings consistent with pre-septal cellulitis and abscess. Samples from bilateral conjunctival secretions and left lower eyelid ulcer tested positive for herpes simplex virus-1 (HSV-1), and negative for SARS-CoV-2. He received supportive care, antibiotics, and famciclovir with almost complete resolution of his ocular complaints. This case illustrates an atypical COVID-19 presentation and raises concern as to how this virus modulates the immune system, allowing for concurrent viral infections.

BACKGROUND:Prolonged cold ischemic time (CIT) in deceased donor kidney transplantation (DDKT) has been associated with adverse graft outcomes. Virtual crossmatch (VXM) facilitates reliable prediction of crossmatch results based on the profile of human leukocyte antigen antibodies of the recipient and the donor in reduced time compared with a physical crossmatch (PXM). We hypothesized a shorter CIT since the implementation of the VXM in recipients of DDKT.METHODS:We conducted a retrospective cohort study of consecutive adult recipients of DDKT. The data were analyzed for differences in CIT before and after the implementation of VXM.RESULTS:After the exclusion of 59 recipients (age less than 18 years and/or CIT ≥ 20 hours), our study compared outcomes of 81 PXMs from February to June 2018 against 68 VXMs from February to June 2019. There were no statistical differences between groups based on donor age (P = .09), donor type (P = .38), kidney donor profile index (P = .43), or delayed graft function (P = .20). Recipients with VXM were older (58 vs 51 years, P = .002) and had a higher estimated post-transplant survival score (59% vs 46%, P = .01). The CIT was significantly lower for the VXM group (P = .04).CONCLUSION:Our study demonstrated a significantly shorter CIT with VXM in DDKT recipients. Our study was limited with small sample size, but the trend of increased graft survival with higher estimated post-transplant scores and older recipients is encouraging as the donor pool expands with marginal kidneys and national sharing.

Abstract Background Common Variable Immunodeficiency (CVID) is a primary immunodeficiency disorder which affects B lymphocyte function and differentiation causing decreased levels of Immunoglobulin G (IgG), Immunoglobulin A (IgA) and Immunoglobulin M (IgM).1 The objective of this study is to highlight how hypogammaglobulinemia can lead to respiratory infections with microbes that are lesser known in the background of CVID with the help of a two-case series. Methods Medical records of two patients with CVID were reviewed who were found to have mycobacterium avium-complex intracellulare and streptococcus agalactiae lung infections respectively. Results Decreased IgG in CVID means reduced antibody production, low IgA leads to mucosal inflammation and increased susceptibility to respiratory infections2 and lower IgM memory B-cells causes infections with encapsulated microorganisms.3 Table 1 highlights the various respiratory infections and their etiologies that have been reported with CVID, the most common being encapsulated organisms like Haemophilus influenza, Streptococcus pneumonia, Neisseria meningitidis along with enterovirus. Table 2 demonstrates our findings. In the first case we have reported a patient with mycobacterium avium-complex intracellulare (MAC-I). This could be because of hypogammaglobulinemia, decreased B and T-cell interaction and reduced T-cell signaling caused by CVID.4 Although, mycobacterium tuberculosis, simiae and hominis lung infections and mycobacterium bovis systemic infections have been reported before, MAC-I is relatively rare in CVID.5 In our second case, the patient developed streptococcus agalactiae or Group-B streptococcus (GBS) empyema. Most cases of GBS have been reported in pregnant women and infants. Infections with other encapsulated organisms have been reported in CVID but GBS empyema is less frequent and can happen due to decreased bacteria-specific CD4 cells, microbial translocation and hypogammaglobulinemia.6 . Table 1. Respiratory Infections reported in CVID along with their etiologies. Figure 1. CT image of MAC-I infection. Conclusion We encountered two unique cases of CVID with rare infectious etiologies. The cases are intended to create an awareness and vigilance regarding CVID induced hypogammaglobulinemia which can cause respiratory infections with lesser known pathogens where antibodies may be important. Disclosures All Authors: No reported disclosures