1386. Seroprevalence of Strongyloidiasis in Liver Transplant Candidates at a Tertiary-Level Hospital in Newark, NJ

Abstract Background The liver transplant center at University Hospital (Newark, NJ) is one of the busiest in northern NJ. Current guidelines for Strongyloides stercoralis (Ss) screening in solid transplant recipients recommend targeted testing. We propose a high seroprevalence of this infection in our facility given its significant percentage of foreign-born patients from Ss endemic areas such as Latin America, the Caribbean, and Africa. Methods Descriptive study from secondary data. We obtained the total number of Strongyloides antibody tests performed at University Hospital in the last two years (08/2018-10/2020). Subsequently, medical charts were reviewed to obtain epidemiological and clinical data. Results A total of 388 patients underwent screening for Strongyloides antibody, of whom 71 (18%) were positive. The test was mainly performed in male (58%) and foreign-born (55%) patients. More than half (55%) of the US-born individuals had history of travel overseas. The main reasons for testing were transplant evaluation (65%), immunosuppression (14%) and eosinophilia (9%). There was no association between transplant evaluation and seropositivity (81% vs 81%, p = 0.994). Being foreign-born was not associated with a positive test (19% vs 20%, p = 0.834), but for US-born patients, having a history of travel was associated with a positive test (33% vs 14%, p = 0.039). For the Ss positive patients, 34% had a HTLV-I/II test, 48% had at least one stool test, and 76% were given treatment. Conclusion There is a significant seroprevalence of Ss in our transplant candidate population, both non-foreign and foreign-born, prompting the indication for universal screening at our facility. Disclosures All Authors: No reported disclosures

Differences in ID evaluation practices by type of cellular therapy candidate. Table 2 Characteristics of survey respondents.

Conclusion.
Practices around pre-HCT infectious disease evaluation and management are heterogenous among the centers surveyed. The adoption of standardized screening for and management of infectious diseases in this patient population would likely be beneficial.
Disclosures. Background. With the ongoing opioid epidemic in the US, there has been an increase in the proportion of deceased organ donors with a history of injection drug use (IDU), raising concern for additional infectious risks to transplantation.We sought to determine how recent IDU among deceased organ donors impacted donor culture results.
Methods. A retrospective cohort study was conducted at four transplant centers in Philadelphia between 1/1/2015 and 6/30/2016. All deceased organ donors who donated ≥ 1 organ to one of the centers were included. Exposed donors were those with a recent history of IDU (defined by use in the prior 12 months based on donor chart review). Unexposed donors were those with no recent history of IDU. The primary outcome was any positive donor culture (taken during the terminal hospitalization or at the time of organ procurement) for bacteria or Candida. Multivariable logistic regression was used to determine the association between recent IDU and donor culture positivity. Secondarily, the association between donor IDU and isolation of (1) a multidrug-resistant organism (MDRO) on culture, (2) Staphylococcus aureus on culture, (3) Candida on non-respiratory culture, and (4) bacteria or Candida on blood culture were determined.
Conclusion. Donors with a recent history of IDU are more likely to have bacteria or Candida identified on cultures taken during their terminal hospitalization or at organ procurement. This increase does not appear to be driven by MDROs, S. aureus, or bloodstream infections but rather by Candida isolated from non-respiratory sites, potentially alleviating some fears surrounding the acceptance of solid organs from donors with a history of recent IDU.
Disclosures Background. The liver transplant center at University Hospital (Newark, NJ) is one of the busiest in northern NJ. Current guidelines for Strongyloides stercoralis (Ss) screening in solid transplant recipients recommend targeted testing. We propose a high seroprevalence of this infection in our facility given its significant percentage of foreign-born patients from Ss endemic areas such as Latin America, the Caribbean, and Africa.
Methods. Descriptive study from secondary data. We obtained the total number of Strongyloides antibody tests performed at University Hospital in the last two years (08/2018-10/2020). Subsequently, medical charts were reviewed to obtain epidemiological and clinical data.
Results. A total of 388 patients underwent screening for Strongyloides antibody, of whom 71 (18%) were positive. The test was mainly performed in male (58%) and foreign-born (55%) patients. More than half (55%) of the US-born individuals had history of travel overseas. The main reasons for testing were transplant evaluation (65%), immunosuppression (14%) and eosinophilia (9%). There was no association between transplant evaluation and seropositivity (81% vs 81%, p = 0.994). Being foreign-born Background. Gaps in evidence concerning the epidemiology of nontuberculous mycobacterial (NTM) organisms and their associated treatment outcomes are evident in the literature. The aim of this study was to describe NTM species distribution and susceptibility profile and associated treatment outcomes among adult patients at a tertiary referral hospital in the Southeastern United States.
Methods. A retrospective cohort study of adult patients with NTM infections from January 1, 2010 to June 30, 2020 was performed. Included patients had a positive culture for NTM species and clinical suspicion of infection. Patients were excluded if they had concurrent positive culture for M. tuberculosis (MTB) or monomicrobial culture for M. gordonae. Study endpoints included predictors for favorable treatment outcome, species distribution, and susceptibility at baseline. Favorable treatment outcome was defined as physician-guided cessation of therapy due to clinical improvement. Univariate followed by multivariate regression analysis was used to analyze favorable predictors.
Results. A total of 250 and 78 patients were included in microbiologic and outcomes cohorts, respectively. Among treated patients, 47 (60%) had a favorable treatment outcome. The outcomes cohort consisted primarily of non-Hispanic Caucasians (71%) with pulmonary infection (67%). The most common isolates observed were Mycobacterium avium complex (MAC) (67%) and M. abscessus (18%). Being self-pay, underweight, history of MTB treatment, and concurrent asthma were more common in those with unfavorable treatment outcomes. The significant favorable predictors included antibiotic change not due to escalation or de-escalation of therapy and private insurance. Among MAC isolates, clarithromycin and amikacin were highly susceptible; however, M. abscessus has reduced susceptibility to first-line agents such as amikacin, clarithromycin, and cefoxitin (Table 1).

Conclusion.
Considering the long incubation time, knowledge of prevalence, antimicrobial susceptibility patterns, and outcomes could guide empirical antimicrobial selection for NTM infections. This is particularly useful for M. abscessus infections where most isolates carry significant resistance to one or more first-line agents. Disclosures