On-going impact of the SARS-CoV-2 pandemic on the evolution of carbapenemase-producing Enterobacterales in Ontario, Canada

Background. The spread of carbapenemase-producing Enterobacterales (CPE) is global threat. Numerous outbreaks of CPE have been reported during the COVID-19 pandemic. We describe the impact of of the SARS-CoV-2 pandemic on the emergence of CPE in south-central Ontario, Canada. Incidence of clinical isolates of CPE and isolates with different CPE genes in Toronto/Peel region, 2017-2021. The upper panel shows the incidence of patients with clinical isolates of CPE by year and quarter from q4 2007 to q1 2022. The lower panel shows the incidence of patients with clinical isolates with different carbapenemase genes by fiscal year during the same period. Methods. TIBDN has performed population-based surveillance for CPE in Toronto/Peel region (pop 4.5M) from first identified isolate in 2007. All laboratories test/refer all carbapenem non-susceptible Enterobacterial isolates for identification of CPE. Hospital charts are reviewed and patients/physicians interviewed. Population data are obtained from Statistics Canada. Results. From 10/2007 to 3/31/2022, 1367 persons colonized or infected with CPE were identified. Theirmedian age was 68.7yrs (IQR 54-78yrs);761 (56%) weremale. 772 (56%) were colonized when first identified;115 (8.4%) were bacteremic at identification or subsequently developed bacteremia. The most common organisms were E. coli (651, 48%), K. pneumoniae (436, 32%), Enterobacter spp. (146, 11%), Citrobacter spp (62, 5%);the most common genes were NDM+/-OXA-48 (722, 53%), OXA-48-like (341, 25%), KPC (225, 16%), VIM(44, 3%). The incidence of CPE infections increased steadily until 3/2020 then declined by 61%and remained stable until 3/2022 (Figure, upper panel). The declinewas greater for E. coli (56%decrease), K. pneumoniae (62%) than for Enterobacter spp. (30%) and other species (19%). It occurred in all genes in 2020;however, KPC containing organisms increased again in 2021 (Figure, lower panel). Conclusion. The advent of the COVID-19 pandemic was associated with an immediate, substantial decline in the incidence of patients with CPE in our population area. This decline occurred in both isolates with genes usually occurring in cases imported from other countries, and in those usually occurring in cases associated with transmission within Canadian hospitals. Decreased travel and enhanced infection prevention and control in hospitals may both have contributed to reductions in CPE during the pandemic. (Figure Presented).

Investigating Students' Experiences with Collaboration Analytics for Remote Group Meetings

Remote meetings have become the norm for most students learning synchronously at a distance during the ongoing coronavirus pandemic. This has motivated the use of artificial intelligence in education (AIED) solutions to support the teaching and learning practice in these settings. However, the use of such solutions requires new research particularly with regards to the human factors that ultimately shape the future design and implementations. In this paper, we build on the emerging literature on human-centredAIED and explore students' experiences after interacting with a tool that monitors their collaboration in remote meetings (i.e., using Zoom) during 10 weeks. Using the social translucence framework, we probed into the feedback provided by twenty students regarding the design and implementation requirements of the system after their exposure to the tool in their course. The results revealed valuable insights in terms of visibility (what should be made visible to students via the system), awareness (how can this information increase students' understanding of collaboration performance), and accountability (to what extent students take responsibility of changing their behaviours based on the system's feedback);as well as the ethical and privacy aspects related to the use of collaboration analytics tools in remote meetings. This study provides key suggestions for the future design and implementations of AIED systems for remote meetings in educational settings.

HIV PARTNER NOTIFICATION IN NEWLY DIAGNOSED PATIENTS IN THE CLINIC AGAINST BRITISH ASSOCIATION OF SEXUAL HEALTH AND HIV (BASHH) PARTNER NOTIFICATION (PN) STANDARDS

Introduction Effective HIV interventions have significantly reduced HIV transmission. However with each new case, effective HIV partner notification(HIV-PN) is pivotal in identifying new HIV transmission networks and is a crucial contribution towards ending new HIV infections in England by 2030. We aimed to review our local PN standards against the BASHH guidelines. Method Using GUMCAD coding and heath adviser/HIV team databases we collected data from all new HIV diagnoses in 2021. Results Overall, there were 24 individuals newly diagnosed with HIV in our clinic in 2021. There were 3(13%) who were experiencing sero-conversion at the time of diagnosis. 22 (92%) were cis-male, 17/24(71%) were MSM, the median age was 44 years (IQR=29-51) and 19(79%) described themselves as being of white ethnicity. We found that 1.88 (BASHH standard=0.88) contacts were reported by the index and 1.13 (BASHH standard=0.8) were tested per index case. The proportion of contactable partners tested according to the patient was 83%(BASHH=85%) and those verified by the clinician was 51%(BASHH=65%). 75%(BASHH=97%) of cases had a documented PN plan and 97%(BASHH=100) had a PEPSE assessment. From the notes review, the reasons why HIV PN was not achieved related to being diagnosed in other services and an absence of health adviser input. During Covid-19 inpatient diagnoses were unable to have HIV-PN initiated on 'red' wards. Discussion Overall we are meeting most of the BASHH standards for HIV PN. Further work is needed as an MDT to ensure this gap in PN follow up is addressed.

Exploring the Opportunities for Online Learning Platforms to Support the Emergency Home School Context

The COVID-19 pandemic and subsequent closure of schools forced families across the globe to transition to school at home. This unprecedented context is likely to have a lasting impact on the practice of schooling and the role of online, digital platforms within school contexts. In this paper we present a contextual inquiry of an 'emergency home school context', detailing how nine young families in Melbourne, Australia adapted to the unexpected introduction of school to the home following the government-directed closure of schools. Through an online interview and photo-journal study, we develop an emplaced understanding of the context detailing how the relations between people and places around the home evolved over time. We present fve design considerations for digital platforms to support the emergency home school context, placing focus on the fuid roles, relationships and evolving sense of place.

Prescribing intranasal steroids in HIV-positive patients: systematic review of the literature.

BACKGROUND: There are significant drug-drug interactions between human immunodeficiency virus antiretroviral therapy and intranasal steroids, leading to high serum concentrations of iatrogenic steroids and subsequently Cushing's syndrome. METHOD: All articles in the literature on cases of intranasal steroid and antiretroviral therapy interactions were reviewed. Full-length manuscripts were analysed and the relevant data were extracted. RESULTS: A literature search and further cross-referencing yielded a total of seven reports on drug-drug interactions of intranasal corticosteroids and human immunodeficiency virus protease inhibitors, published between 1999 and 2019. CONCLUSION: The use of potent steroids metabolised via CYP3A4, such as fluticasone and budesonide, are not recommended for patients taking ritonavir or cobicistat. Mometasone should be used cautiously with ritonavir because of pharmacokinetic similarities to fluticasone. There was a delayed onset of symptoms in many cases, most likely due to the relatively lower systemic bioavailability of intranasal fluticasone.

Incorporating Latino patient input in messaging for follow-up colonoscopy after abnormal fecal testing

Introductory sentences indicating the purposes of the study: We used boot camp translation (BCT), a validated community based participatory strategy, to elicit input from diverse stakeholders (i.e., patients and clinic staff) to develop messaging and patient education materials for follow-up colonoscopy after abnormal fecal testing. BCT is a process that engages participants in translating health information into ideas, messages, and materials that are understandable and relevant to patients. Brief description of pertinent experimental procedures: Colorectal cancer is the second-leading cause of cancer death in the United States, and screening rates are disproportionately low among Latinos. Mailed fecal immunochemical test (FIT) outreach programs have been shown to improve colorectal cancer screening rates in federally qualified health centers (FQHCs), with improvements ranging from 22% - 45%. Patients with an abnormal FIT result have an increased risk of having colorectal cancer, and the risk increases if the necessary follow-up colonoscopy is delayed. Unfortunately, rates of follow-up colonoscopy among adults with an abnormal FIT result are low in FQHCs. As part of the Participatory Research to Advance Colon Cancer Prevention (PROMPT) study, a partnership with a Los Angeles-based FQHC that provides medical services to over 300,000 patients annually (82% Latino), we used BCT to gather input from patients and staff to develop messaging and materials for patients in need of a follow-up colonoscopy after abnormal FIT. Due to the COVID-19 pandemic, we conducted BCT using a digital platform. Eligible patient participants were Latino, ages 50 to 75 years, Spanish-speaking, and willing to participate in three virtual sessions. Recruitment and BCT materials were developed in English and Spanish, but all three sessions were held in Spanish consistent with patient preferences. The sessions included presentations on colorectal cancer screening, effective messaging to improve Latino screening participation, and brainstorming sessions to obtain feedback on messaging and materials. Summary of the new unpublished data: A total of 10 adults (7 patients and 3 clinic staff) participated in the BCT sessions. Key themes learned were 1) increasing awareness about the colonoscopy procedure (why it is important, what the procedure is, how to prepare), 2) using simple and clear wording, including statistics, and using family as a motivator, and 3) providing different patient outreach modalities to broaden reach, such as patient-facing fact sheets, videos in clinic or sent by text. Statement of the conclusions: Using BCT, we successfully incorporated feedback from Spanish-speaking Latino patients to design culturally relevant materials to promote follow-up colonoscopy after abnormal FIT results. Targeted efforts are needed to improve rates of follow-up colonoscopy among patients with abnormal FIT results in FQHC settings. (Final materials, including patient-facing fact sheets and screenshots from short videos, will be showcased in the poster.).

HIV-1 transmitted drug resistance and non-B subtype prevalence from a clinic-based population in Brighton, UK

Background: Using the WHO TDR list, we aimed to determine from our clinic database;the prevalence of TDR, non-B subtype and associated features in our large tertiary HIV department (∼2500 patients) from 2014-2020. Method: Using the WHO TDR list, we aimed to determine from our clinic database;the prevalence of TDR, non-B subtype and associated features in our large tertiary HIV department (∼2500 patients) from 2014-2020. Results: Of the 218 new diagnoses, 217 had a resistance test attempted (1 stored due to COVID-19). 212/217 had an available genotype (5 failed to amplify). 191/212(90%) were MSM, 12/212(6%) cis-female, 80/212(38%) non-UK born and the median age was 36 years (IQR = 29-46). The overall prevalence of TDR was 17/212(8%;95%CI = 5.0-12.4), seven (3%) had a NRTI mutation, six (3%) had at least one nNRTI mutation and 4(2%) had a PI mutation. There were no dual/triple class/INI mutations. There was no significant change in the prevalence of TDR over the study period. The overall prevalence of non-B subtype was 53/212(25%;95%CI = 19.6-31.2), and was not more frequently seen in non-UK born individuals (OR = 1.24;CI = 0.66-2.33, P = 0.51). Patients with TDR were older [45.v.36 years, P = 0.006] and have non-B subtype (OR = 2.96;CI = 1.08-8.13, P = 0.03). Although overall rates of bacterial STIs was high (34%), having a bacterial STI was not associated with TDR(OR = 1.77;95%CI = 0.66-4.82, P = 0.26). Conclusion: TDR is associated with age and non-B subtype in our population. HIV TDR is not decreasing locally and remains a small but significant concern despite effective HIV prevention strategies, which may not reach hidden populations affected by HIV. Continued efforts to reduce HIV transmission must target hidden populations and we must maintain adequate surveillance of TDR.

HIV-1 transmitted drug resistance between 2014-2020 in a HIV large population in Brighton, UK

Background HIV-1 transmitted drug resistance (TDR) is associated with sexually transmitted infections (STIs) and sexual clusters including MSM and non-MSM. TDR can lead to antiretroviral failure, and therefore UK guidelines recommend TDR testing in all new HIV patients. Subtype B is most common in urbanised western populations however is decreasing in proportion. Within the UK TDR is estimated to be 7.5% and non-B subtype 51%. Methods Using the WHO TDR list, we aimed to determine from our clinic database;the prevalence of TDR, non-B subtype and associated features in our large tertiary HIV department (∼2500 patients) from 2014-2020. Results Of the 218 new diagnoses, 217 had a resistance test attempted (1 stored due to COVID-19). 212/217 had an available genotype (5 failed to amplify).. 191/212(90%) were MSM, 12/212(6%) cis-female, 80/212(38%) non-UK born and the median age was 36 years (IQR=29-46). The overall prevalence of TDR was 17/212(8%;95%CI=5.0-12.4), seven (3%) had a NRTI mutation, six (3%) had at least one nNRTI mutation and 4(2%) had a PI mutation. There were no dual/triple class/INI mutations. There was no significant change in the prevalence of TDR over the study period. The overall prevalence of non-B subtype was 53/212(25%;95% CI=19.6-31.2), and was not more frequently seen in non- UK born individuals (OR=1.24;CI=0.66-2.33,p=0.51). Patients with TDR were older [45.v.36 years, p=0.006] and have non-B subtype (OR=2.96;CI=1.08-8.13,p=0.03). Although overall rates of bacterial STIs was high (34%), having a bacterial STI was not associated with TDR (OR=1.77;95%CI=0.66-4.82,p=0.26). Conclusion TDR is associated with age and non-B subtype in our population. HIV TDR is not decreasing locally and remains a small but significant concern despite effective HIV prevention strategies, which may not reach hidden populations affected by HIV. Continued efforts to reduce HIV transmission must target hidden populations and we must maintain adequate surveillance of TDR.

P315 Increased clinician confidence and uptake of event-based PrEP by men who have sex with men during the COVID-19 pandemic

BackgroundHIV pre-exposure prophylaxis (PrEP) is an effective, safe strategy to prevent HIV. PrEP can be used either daily or as an event based dosing (EBD) regimen by men who have sex with men (MSM) having condom-less anal sex, however clinicians with expertise delivering daily PrEP often lack confidence delivering EBD-PrEP. During the COVID-19 pandemic, MSM appear to have tailored their sexual behaviour in-line with local social restrictions including the way they use PrEP.MethodWe aimed to investigate the proportion of MSM using EBD-PrEP between October-December 2020 and to survey clinician confidence in delivering EBD-PrEP through an online questionnaire.Results551 MSM were seen who were eligible for PrEP in the study period, of which 448 were prescribed PrEP (64-declined, 2-stopped, 8-new patients and 29-repeat attenders accessed PrEP from another source). The median age of PrEP users was 37 years (IQR=29–48). Overall, 94/448 (21%,95%CI=17–25) of MSM were using EBD-PrEP. New starters were significantly more likely to use EBD-PrEP compared to existing PrEP users (34%.v.13%, χ2=27.6, p<0.00001). There was no significant difference in age between daily and EBD-PrEP users (37years. v.41years,p=0.2). There were 33/38 clinicians who responded to the online survey. Clinicians felt equally confident at delivering daily PrEP as EBD-PrEP (Likert scores=4.4/5 v 4.2/5, p=0.2). However, potential barriers identified to providing EBD-PrEP by clinicians were;assessing which MSM would be suitable for using EBD-PrEP, having access to appropriate information for patients to support their understanding of using EBD PrEP;and clinician knowledge and belief in the efficacy of EBD-PrEP.ConclusionThe uptake by MSM and clinician confidence in discussing EBD-PrEP appears to have increased since the start of the COVID-19 pandemic. Giving MSM greater choice in how PrEP is used will optimise its effect on reducing HIV transmission. More research is needed to support both MSM and clinicians to deliver EBD-PrEP.

Clinical characteristics and outcome of critically ill COVID-19 patients with acute kidney injury: a single centre cohort study.

BACKGROUND: Acute kidney injury (AKI) is a common manifestation among patients critically ill with SARS-CoV-2 infection (Coronavirus 2019) and is associated with significant morbidity and mortality. The pathophysiology of renal failure in this context is not fully understood, but likely to be multifactorial. The intensive care unit outcomes of patients following COVID-19 acute critical illness with associated AKI have not been fully explored. We conducted a cohort study to investigate the risk factors for acute kidney injury in patients admitted to and intensive care unit with COVID-19, its incidence and associated outcomes. METHODS: We reviewed the medical records of all patients admitted to our adult intensive care unit suffering from SARS-CoV-2 infection from 14th March 2020 until 12th May 2020. Acute kidney injury was defined using the Kidney Disease Improving Global Outcome (KDIGO) criteria. The outcome analysis was assessed up to date as 3rd of September 2020. RESULTS: A total of 81 patients admitted during this period. All patients had acute hypoxic respiratory failure and needed either noninvasive or invasive mechanical ventilatory support. Thirty-six patients (44%) had evidence of AKI (Stage I-33%, Stage II-22%, Renal Replacement Therapy (RRT)-44%). All patients with AKI stage III had RRT. Age, diabetes mellitus, immunosuppression, lymphopenia, high D-Dimer levels, increased APACHE II and SOFA scores, invasive mechanical ventilation and use of inotropic or vasopressor support were significantly associated with AKI. The peak AKI was at day 4 and mean duration of RRT was 12.5 days. The mortality was 25% for the AKI group compared to 6.7% in those without AKI. Among those received RRT and survived their illness, the renal function recovery is complete and back to baseline in all patients. CONCLUSION: Acute kidney injury and renal replacement therapy is common in critically ill patients presenting with COVID-19. It is associated with increased severity of illness on admission to ICU, increased mortality and prolonged ICU and hospital length of stay. Recovery of renal function was complete in all survived patients.