bluuebunny/crossref_metadata_2025 huggingface dataset:
1519. Reduction of healthcare-associated viral infections during COVID-19 pandemic
Authors: Handy Lori , Ehritz Carly , Hei Hillary , Brennan Lauren K , Wilson Kimberly , O’Callaghan Kevin P , Coffin Susan E , Coffin Susan E , Sammons Julia S
Published: January 2021

Background

Healthcare-associated viral infections (HAVI) are a common cause of preventable harm, particularly in pediatric patients. We utilized routine hospital-wide surveillance data for HAVIs at a quaternary care pediatric hospital in order to assess the impact of enhanced public health measures on rates of HAVI at our institution during the COVID-19 pandemic.

Methods

Patient cases of HAVI were detected through routine house-wide microbiologic surveillance. Compliance with our institutional prevention bundle, which includes hand hygiene, appropriate use of isolation precautions and personal protective equipment (PPE), maintaining a clean and clutter free environment, employee illness policy, and restrictions on sick visitors, was measured through use of Kamishibai-card rounding.

Results

During the most acute period of the COVID-19 pandemic, intensification of the majority of elements of the HAVI bundle occurred by nature of our institutional response, including use of PPE monitors in certain locations, increased used of eye protection, universal masking for staff and caregivers, re-education for employees on not coming to work sick, and further restrictions to visitation. The monthly HAVI rate in the acute phase of the COVID-19 pandemic was lower in March (0.76), April (0.27) and May (0.0) 2020 compared to the same time period last year (0.8, 0.8, 0.56). Bundle compliance during those months in 2020 was 83%, 89%, and 100%, respectively. In May, zero HAVIs were identified. (Figure 1)

Healthcare-associated viral infections rate and bundle compliance after COVID-19 prevention measures

Conclusion

The intensification of routine infection prevention practices aimed at minimizing the transmission of COVID-19 may also reduce rates of HAVI. During our COVID response, we identified a decrease in our institutional HAVI rate compared to the same time last year, reaching lower special cause in May with a rate of 0. We will have ongoing measurement of the HAVI rate throughout the pandemic to determine if this reduction can be sustained and understand which intensified bundle elements need to be maintained in non-pandemic hospital operations.

Disclosures

All Authors: No reported disclosures
1520. Respiratory Syncytial Virus Hospitalizations (RSVH) and All-Cause Bronchiolitis Hospitalizations (BH) Among Children Aged ≤ 24 Months at the Start of RSV Season With Bronchopulmonary Dysplasia/Chronic Lung Disease of Prematurity (BPD/CLDP) Before and After the 2014 American Academy of Pediatrics (AAP) Policy
Authors: Fergie Jaime , Gonzales Tara , Suh Mina , Jiang Xiaohui , Fryzek Jon , Howard Ashley , Bloomfield Adam
Published: January 2021

Background

The AAP, in 2014, stopped endorsing palivizumab for use in children with BPD/CLDP born at < 32 weeks’ gestational age (wGA) between the ages of 12 to 24 months not requiring medical support during the 6 months before the start of RSV season and all children with BPD/CLDP born at > 32 wGA. We sought to understand the impact of the guidance change on RSVH and BH in children no longer advised for RSV immunoprophylaxis with palivizumab.

Methods

Children with BPD/CLDP aged ≤ 24 months at the RSV season start and hospitalized for RSV or bronchiolitis during the 2010-2017 RSV seasons (November-March) were studied. RSVH, BH, and BPD/CLDP were defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM codes. ICD-9 codes for wGA combine 31 and 32 wGA into one code. Therefore, for BPD/CLDP, we classified group 1 as children aged 12 to 24 months who were born at < 31 wGA and group 2 as those born at ≥ 31 wGA. The Children’s Hospital Association’s Pediatric Health Information System® (PHIS) data set was used to describe frequency and characteristics of RSVH and BH and disease severity (including intensive care unit [ICU] admission and mechanical ventilation [MV]) before and after the 2014 AAP policy. Statistical analyses were done using z-tests; SAS version 9.4.

Results

Among children with BPD/CLDP, RSVH rates were 1.7% (1035/59,217) before 2014 and 2.1% (973/45,470) after 2014 (P< 0.0001). RSVH rose after the policy change vs before among children with BPD/CLDP in both group 1 (0.40% vs 0.26%; P< 0.0001) and group 2 (0.22% vs 0.14%; P=0.002). Similarly, BH also increased for both group 1 (P< 0.0001) and group 2 (P=0.002) after the guidance change vs before. Although ICU admissions increased significantly for children with BPD/CLDP in both group 1 (P< 0.0001) and group 2 (P=0.0004), use of MV (P=0.002) increased after 2014 for children with BPD/CLDP in group 1 only. Similar results were observed for BH.

Conclusion

This analysis highlights the increase in RSVH, BH, and associated severity among BPD/CLDP subgroups within the PHIS health system after 2014. Further study of long-term complications associated with RSVH in these children is warranted.

Disclosures

Jaime Fergie, MD, AstraZeneca (Speaker’s Bureau)Sobi, Inc. (Speaker’s Bureau) Tara Gonzales, MD, Sobi, Inc. (Employee) Mina Suh, MPH, International Health, EpidStrategies (Employee) Xiaohui Jiang, MS, EpidStrategies (Employee) Jon Fryzek, PhD, MPH, EpidStrategies (Employee) Adam Bloomfield, MD, FAAP, Sobi, Inc. (Employee)
1526. The economic impact of respiratory syncytial virus (RSV) in infants in the United States: systematic literature review
Authors: Bowser Diana , Gervasio Reissa , Glaser Elizabeth , Harihan Dhwani , Rowlands Katie , Buckley Lauren , Rizzo Christopher , Nelson Christopher
Published: January 2021

Background

Respiratory syncytial virus (RSV) is a human orthopneumovirus spread by direct contact with symptomatic, infected individuals. An estimated 587,000 RSV LRTIs result in inpatient or outpatient encounters annually among US infants (Rainisch et al 2019). The health care costs associated with RSV include medical costs to insurers, governments, and households, travel, and loss of wages.

Initial summary of Inpatient and Ambulatory Medical Costs p Infant w RSV.JPG Jun 17th, 2020 @ 2:44 PM 852 x 572 122.3 Kb

Methods

A systematic literature review of the costs associated with children who have RSV was conducted. Following PRISMA methodology, key search terms were searched within article titles and abstracts through PubMed, EconLit, and Scopus. A total of 1,942 unique abstracts were screened independently by two authors and reduced to 180 articles after applying inclusion and exclusion criteria. The number of included articles after reviewing the full text was 66. Costing results were adjusted to USD2020 based on the Medical Care Consumer Price Index.

Results

Costing results were reported mainly for medical costs in inpatient settings. Initial results show that annual mean inpatient costs per RSV patient range among individual studies from $9,825 (SD=$25,227) for full term infants to $26,120 (SD unspecified) for late preterm infants (Table 1). Costing results vary by gestational age, with late preterm infants having an annual mean inpatient cost almost 1.6 times that of a full term infant. Inpatient costs for RSV infants are higher for commercial pay versus Medicaid, for both full term infants (commercial mean=$16,489 SD=$31,068, Medicaid mean=$10,291 SD=$64,625) and late preterm infants (commercial mean=$23,836; SD=$43,709, Medicaid mean=$18,864 SD=$28,716). Annual RSV ambulatory costs per infant vary between $4,371 (SD=$13,411) and $19,963 (SD=$27,269), depending on gestational age. Other relevant RSV costs include preventative drug costs, such as palivizumab (average $11,954 per infant).

Conclusion

The literature describes the economic impact of RSV primarily for hospitalization of children with underlying comorbidities. There is a need to better understand costing results for RSV, including the burden in ambulatory settings and indirect costs to families affected.

Disclosures

All Authors: No reported disclosures
1529. Sexually-Transmitted Infection Testing and Positivity among Adults Receiving HIV Pre-Exposure Prophylaxis within an Integrated Health Care Delivery System in the United States
Authors: Schmidt Mark A , Dickerson John F , Schmidt Suzanne B , O’Keeffe-Rosetti Maureen , Donald Judy L , Stenzel Molly S
Published: January 2021

Background

The goal of this project was to assess the frequency of sexually-transmitted infection (STI) testing and positivity among adult individuals initiating HIV Pre-Exposure Prophylaxis (PrEP) within Kaiser Permanente Northwest (KPNW).

Methods

We identified KPNW members, 18 years of age and older, who initiated PrEP (tenofovir+emtricitabine) between January 1, 2015 – December 31, 2018. Using data elements abstracted from the electronic health record system, we assessed demographic characteristics of those initiating PrEP and the rate of testing and positivity for HIV, chlamydia (CT) and gonorrhea (GC) and syphilis within a window around 120 days after PrEP initiation.

Results

Overall, 685 members initiated PrEP during our study period, 661 (96.5%) of whom were male. Mean and median ages were 38 and 36 years, respectively, with those 25-34 years of age comprising the highest proportion (241; 35.2%). The 460 PrEP initiators (67.2% of total) who continued use beyond 120 days were significantly older than those who discontinued use (39 vs. 36 years, p=0.0008). Among continuous users, 78.3% were tested for CT+GC and 83.9% were tested for syphilis roughly 120 days post-initiation, with positivity proportions of 6.9%, 6.7%, and 2.3%, respectively. Among those discontinuing, 39.6% were tested for CT+GC and 37.3% were tested for syphilis, with positivity proportions of 10.1%, 9.0%, and 2.4%, respectively. HIV testing was completed for 87.4% of continuous PrEP users and 40.9% of those who discontinued use; and we identified a total of three individuals who tested positive for HIV, all among the latter group. Manual chart review of these individuals confirmed that HIV exposure and infection occurred after PrEP discontinuation.

Conclusion

We found high rates of STI testing among individuals receiving PrEP, in accordance with recommendations. Our findings of a lower STI prevalence among PrEP users is encouraging, although further work is required to assess the impact of differential testing rates and age between those who continue and discontinue PrEP use as well as reasons for PrEP discontinuation. Regular testing remains an important part of comprehensive PrEP care management and should continue to be encouraged to identify and treat STI among those at high risk for disease.

Disclosures

All Authors: No reported disclosures
1530. A Cluster of Disseminated Gonococcal Infections in a Non-Immunocompromised Veteran Population
Authors: Vissichelli Nicole C , Hill Emily , Anderson Linda E , Eckert Angela , Fagan Cynthia M , Tassone Daniel , Vaughan Leroy , Cecil Jane A , Markley John D , Hitchcock Matthew M
Published: January 2021

Background

Disseminated gonococcal infection (DGI) is an uncommon manifestation of N. gonorrhoeae that is estimated to occur in 0.5-3% of cases, with a decreasing incidence that has been attributed to changes in circulating serotypes. At a Veterans Affairs Medical Center (VAMC), 3 cases were identified within 4 months in 2019.

Methods

A case series of patients with DGI between March and July 2019 was conducted at a 399-bed tertiary care VAMC that serves central Virginia. Clinical case data was abstracted from the medical record, and data regarding prior gonorrhea cases at the facility was obtained from the laboratory information system.

Results

In 2019, the rate of DGI was 4.9%, with 3 cases out of 61 reported. All occurred in immunocompetent, African-American males with a mean age of 59 years, and all had female sexual partners (Table 1). All presented with joint symptoms, 2 had skin manifestations, and none had genital symptoms. Two patients had positive synovial fluid cultures and the third had a positive blood culture. All isolates were beta-lactamase negative. Orogenital testing by nucleic acid amplification was only positive in 1 patient. No other sexually transmitted infections were identified. One patient underwent surgical washout of the involved shoulder joint, but the others were managed non-operatively. All received a single dose of azithromycin and a 14-day course of ceftriaxone with full symptom resolution. These were the first positive N. gonorrhoeae isolates from invasive specimens at this VAMC since at least 2016.

Table 1. Clinical History and Laboratory Results at Presentation for Patients with Disseminated Gonococcal Infection

Conclusion

This cluster of DGI cases was unusual given the recent rarity at this VAMC, the age of the patients, and lack of overt risk factors. In Virginia, DGI is reported to the health department no differently than uncomplicated infections, so the actual rate of DGI regionally is unknown. One isolate was preserved and sent to the Centers for Disease Control and Prevention for deidentified whole genome sequencing. More refined reporting is necessary to improve understanding of local gonorrhea epidemiology, as well as coupling with additional methodologies such as serotyping or whole genome sequencing. Clinicians should be aware of the possibility of DGI, even in older patients without classic risk factors.

Disclosures

All Authors: No reported disclosures
1531. Antibiotic Selection for Neisseria gonorrhoeae among Penicillin Allergic Patients in the Emergency Department
Authors: McGuinness Matthew J , Mccoy Jonathan , Bhowmick Tanaya
Published: January 2021

Background

While penicillin (PCN) allergies are commonly reported, their cross-reactivity with beta-lactam antibiotics is minimal. First line treatment of gonorrheal infections includes a cephalosporin (CPH). In an emergency department (ED) environment, physicians must consider potential allergies when selecting antibiotics for a patient with symptoms concerning for sexually transmitted infection (STI).

Methods

A retrospective chart review on adult patients with symptoms concerning for STI presenting to an urban ED from January 2014 through June 2019 was performed. Chart discovery was performed using search terms of “STI”, “STD”, “urethritis”, “vaginitis”, and “gonorrhea”. Information abstracted included patient symptoms, type of care provider, and antibiotics prescribed or administered in the ED. The primary outcome was prevalence of allergy to PCN and CPH in patients evaluated for STI symptoms and secondary outcomes included prescribed antibiotic treatments. Chi-square and Fischer-exact tests were utilized to examine for statistical significance, with p values < 0.05 as statistically significant.

Results

A total of 603 patients met the inclusion criteria, of which 31 reported allergies to PCN, and another 3 reported allergies to CPH. Patients reporting PCN allergy were found to be less likely to receive a CPH antibiotic (p=0.0035). Patients reporting a non-anaphylactic allergy to PCN received a CPH at a rate of 92.3%. Attending physicians in particular were less likely to prescribe a CPH antibiotic to a patient reporting allergy compared with both resident physicians and PAs (p=0.00019). Patients reporting a PCN allergy were more likely to receive alternative antibiotics beyond CPH or azithromycin (p=0.046); the most frequently given antibiotics were metronidazole, doxycycline, and levofloxacin.

Demographic Data

Antibiotic Prescriptions by Type of Penicillin Allergy

Antibiotic Prescriptions for Penicillin Allergy vs. No Allergy

Conclusion

Patients with PCN allergies represent a recurring challenge for ED physicians when faced with antibiotic selection for STI symptoms concerning for gonorrheal infection. Those with PCN allergies are significantly less likely to receive a CPH antibiotic, though these remain the only universal treatment for gonorrheal infections. These findings highlight the significant need for further physician education on allergies and antibiotic selection.

Disclosures

All Authors: No reported disclosures
1536. Impact of Type of Provider on Appropriateness of Treatment for Gonorrhea and Chlamydia in Outpatient Clinics
Authors: Sittig Katherine , Espinoza Rossana Rosa
Published: January 2021

Background

Patients with sexually transmitted infections (STIs) receive care in a variety of outpatient settings with medical providers of different levels of training and expertise, especially regarding STIs. We aimed to determine the impact of type of provider on the appropriateness of treatment for chlamydia and gonorrhea in a large integrated health system.

Methods

We conducted a retrospective cohort study of adult patients diagnosed with chlamydia and/or gonorrhea at any outpatient clinic within an integrated health system in Des Moines, Iowa. Nucleic-acid amplification tests were used for diagnosis, and all samples were processed at the same laboratory. Adequate treatment was defined as prescription for appropriate antibiotic, dose and duration within 7 days of the positive test. Logistic regression models with robust standard errors and adjusting for clustering by clinic were built.

Results

We identified 481 unique patients and a total of 515 unique encounters. Considering unique patients only, the median patient age was 23 years (IQR 20-26), 466/481 (96.9%) were female (96.9%), 15/481 (3.1%) were male, and 79/481 (16.4%) were pregnant. Table 1 shows the patient demographic and provider characteristics by appropriateness of treatment for individual visits.

A total of 53 patients had inappropriate treatment, some with multiple errors which are described in Table 2.

Provider type, age, type of infection, and pregnancy status were significantly associated with appropriateness of treatment. After adjusting for type of infection, pregnancy status and clustering by clinic, compared to physicians, certified nurse midwives (CNMs) had 33% lower odds of prescribing appropriate treatment (95% CI 0.49-0.91; p-value = 0.010), with no difference in appropriateness of prescribing by mid-level providers (OR 1.61, 95% CI 0.82-3.17; p-value = 0.167). Pregnancy was independently associated with lower odds of appropriate treatment (OR 0.35, 95% CI 0.24-0.52; p-value < 0.001), as was infection with gonorrhea (OR 0.29, 95% CI 0.12-0.68; p-value = 0.004).

Table 1. Demographic characteristics of adult patients diagnosed with chlamydia and/or gonorrhea in outpatient clinics by appropriateness of treatment. Des Moines, Iowa, January 1, 2019 to December 31, 2019

Table 2. Type of therapeutic errors encountered among patients diagnosed with chlamydia or gonorrhea

Conclusion

CNMs had lower odds of prescribing appropriate treatment for STIs. Efforts aimed at improving prescribing by healthcare providers should actively engage with this group.

Disclosures

All Authors: No reported disclosures
1538. Pilot Study of Self-collected Pharyngeal Testing for Chlamydia and Gonorrhea in the Setting of COVID19 Restrictions
Authors: Straub Diane M , Tetlow Angela
Published: January 2021

Background

Given that many youth and young adults utilize multiple orifices during sexual activity, testing for STIs from multiple anatomical sites can increase rates of diagnosis. However, during the COVID pandemic, obtaining oral swabs by clinical staff was deemed an unacceptable COVID transmission risk and was discontinued in our clinic. To circumvent this obstacle to diagnosis, clinic staff developed a workaround of obtaining patient collected pharyngeal swabs for STI testing. This abstract reviews the results of this pilot intervention.

Methods

Patients presenting to an urban youth family planning/STI clinic who desired STI testing and ever engaged in oral sex were offered pharyngeal testing for chlamydia (CT) and gonorrhea (GC). Patients were instructed on how to obtain an oral sample, and subsequently sent outside of the clinic to obtain their individual sample. Chart review was conducted by clinic staff of a two month period during which this protocol was in place, and the following variables were collected: gender, sexual orientation, race/ethnicity, and STD testing results by anatomic site. Simple descriptive statistical analysis were used.

Results

146 patients received a GC/CT test from > 1 anatomical site, with 34 patients having > 1 positive result. All pharyngeal samples were self-collected. Four patients were positive for GC/CT from throat samples only (12% of positive tests). All were biologically female, including one transgender FTM. Sexual orientation was split evenly between bisexual and heterosexual. Reported race/ethnicity included two African-American, one white, and one “Filipino”. For comparison, of the overall subsample of patients with positive GC/CT results, patients identified as 53% female, 44% male, and 3% FTM; 74% “straight”, 15% bisexual, 9% “gay”, and 3% did not disclose; 29% white, 50% African-American, 21% unknown as other; and 11% Hispanic. Twelve patients were positive for GC/CT from the throat and either rectum and/or urine/vagina/endocervix (35% of positive tests).

Conclusion

Our experience demonstrates that obstacles created by the COVID crisis can be circumvented with creative strategies. We were able to pick up 12% and 35% of total infections by self-collected pharyngeal swabs in throat only and throat plus other sites, respectively.

Disclosures

All Authors: No reported disclosures
127. A Retrospective Review of Antibiotic Appropriateness for Urinary Tract Infections in Ambulatory Patients
Authors: Donohoe Kendall , Boeser Kimberly D
Published: January 2021

Background

The Centers for Disease Control and Prevention and the Joint Commission recommend establishing antibiotic stewardship in outpatient settings. Previous studies estimate over half of all antibiotic prescriptions in the outpatient setting for any indication are inappropriate. Urinary tract infections present a key stewardship opportunity, as most fluoroquinolones prescribed for acute uncomplicated cystitis are potentially inappropriate and many safety concerns exist for this drug class. This study evaluates the outpatient antimicrobial prescribing practices for cystitis and other urinary tract infections at ambulatory clinics within a health system.

Methods

This retrospective cohort study includes adults treated for cystitis or urinary tract infection at 60 primary care and 21 specialty clinics within a large academic health system over a three-year period. Diagnosis codes and individual chart review were used to collect data. The primary outcome is the proportion of patients prescribed antibiotics for urinary tract infection who received a fluoroquinolone.

Results

Of 22,099 encounters which included one of the diagnosis codes indicative of cystitis, an antibiotic was prescribed in 19,101 (86%). Among the encounters in which an antibiotic was prescribed, 29.1% included a fluoroquinolone prescription. A subset of 100 patients from this population were reviewed and assessed for appropriateness based on symptoms, comorbidities, allergies, and previous urinary isolates. The prescribed drug class was determined appropriate in 40% of the fluoroquinolone cases and in 80% of the nitrofurantoin or sulfamethoxazole/trimethoprim cases.

Conclusion

Potential strategies that may reduce the inappropriate prescribing of fluoroquinolones in our large academic health system include an EHR alert, regular dissemination of prescriber reports, and additional provider education to facilitate shared decision-making. These results provide a baseline to inform future interventions to reduce inappropriate antibiotic prescribing and to ensure compliance with Joint Commission standards.

Disclosures

All Authors: No reported disclosures
1540. Prevalence and Risk Factors associated with HIV and Syphilis Co-infection in the African Cohort Study
Authors: Gilbert Laura , Dear Nicole , Esber Allahna L , Iroezindu Michael , Bahemana Emmanuel , Kibuuka Hannah , Owuoth John , Maswai Jonah , Crowell Trevor A , Polyak Christina , Ake Julie A
Published: January 2021

Background

Each year, 6 million new syphilis cases are diagnosed globally. Seroprevalence studies in low-income countries (LIC) are limited but is estimated at 3.5-4.6%. Few studies have researched prevalence of sexually transmitted infections (STIs) in people living with human immunodeficiency virus (HIV; PLWH). Current guidelines for PLWH in LIC recommend STI testing for symptomatic persons and those with a new HIV diagnosis, which may lead to high rates of undiagnosed STIs. Here we provide updated STI prevalence rates and risk factors for syphilis co-infection in PLWH in the African Cohort Study (AFRICOS).

Methods

AFRICOS is an ongoing longitudinal study enrolling PLWH in four African countries where participants undergo routine medical exams, sociobehavioral questionnaires, and laboratory extraction for study purposes every 6 months. Enrollment syphilis data was extracted to determine screen-positive and serologically-confirmed syphilis prevalence rates for this study. Bivariate and multivariate analysis were performed to determine risk factors for HIV and syphilis co-infection and reported as adjusted prevalence ratios (APR) with 95% confidence intervals (CI).

Results

Between January 2013 and March 1, 2020, 2883 PLWH enrolled. Prevalence of screen-positive and confirmed syphilis was 5.2% and 3%, respectively. Among PLWH with confirmed syphilis, 58.6% were women, mean age was 37.8 years old (IQR 31.658, 45.011, p = 0.068), and genital ulcers were documented in 1.61% participants. In the multivariate model, participants with confirmed syphilis co-infection were more likely to have none or some primary education [2.65 (1.34, 5.230)], demonstrate impaired cognition [2.1 (1.25, 3.590], and consume alcohol [1.88 (1.19, 2.970] compared to those without syphilis.

Conclusion

In conclusion, our findings suggest that syphilis rates remain elevated at endemic levels in LIC where diagnosis remains challenging. Based on our analysis, current STI guidelines for PLWH in Africa are likely leading to a large proportion of undiagnosed STIs and potentially contributing to community spread. While this study observed that lower education level, alcoholism, and impaired cognition were associated with syphilis co-infection, further studies are needed to investigate these associations.

Disclosures

All Authors: No reported disclosures
1541. Prevalence of Asymptomatic Sexually Transmitted Infections (STIs) in a Philadelphia Ryan White HIV population
Authors: Stuccio Sarah , Akram Rakhshanda , Spacek Lisa A
Published: January 2021

Background

In 2018, Philadelphia County ranked 7th, 8th and 16th for chlamydia (CT), gonorrhea (GC), and syphilis cases, respectively, in the Centers for Disease Control (CDC) STI Surveillance Report. Asymptomatic presentations and lack of routine screening, especially at extragenital (i.e., pharyngeal and rectal) sites, increase the challenge of timely diagnosis and treatment. We determined extent of screening, reported symptoms, and asymptomatic infections.

Methods

We analyzed records of 372 patients receiving care at an urban, university-based Ryan White HIV clinic from 2016-2018. Outcomes included: positive GC/CT nucleic acid amplification tests from genital, pharyngeal, and rectal sites as well as new diagnoses of syphilis. We collected demographic data, risk factors for HIV transmission, time from HIV diagnosis, number of clinic visits, multiple sex partners, partner with STI, and injection drug use. We used logistic regression to model factors associated with STIs and determined prevalence of asymptomatic STIs.

Results

Of 372 participants, 234 (63%) were men, 262 (70%) were Black, 245 (66%) were over 40 years old, 148 (40%) identified as MSM, 140 (38%) reported inconsistent condom use, 89 (24%) reported multiple sex partners, 35 (9%) reported injection drug use, 141 (38%) had past STI, and 26 (7%) had partner with past STI. Mean time from HIV diagnosis was 12.3 years (SD, 8.8) and mean number of clinic visits was 2/year. Testing included 720 GC/CT urine, 176 GC/CT pharyngeal, 143 GC/CT rectal swabs and 887 syphilis blood tests. Asymptomatic GC/CT infections were seen in urine 6/22 (27%), pharyngeal 12/14 (86%) and rectal 28/31 (90%) swabs. And, of 39 new diagnoses of syphilis, 23 (59%) were asymptomatic. In multivariate analysis, men (aOR, 12.2, 95%CI, 2.7-55.3), < 40 years (3.2, 1.7-6.1), with clinic visit in 2018 (1.4, 1.2-1.8), and partner with STI (1.7, 0.9-2.8) were more likely to have a positive GC/CT test. Patients with positive syphilis test were more likely men (4.6, 1.1-20.2), with multiple sex partners (3.7, 1.7-8.0), and more recent HIV diagnosis (1.1, 1.0-1.1).

Prevalence of Asymptomatic STIs

Conclusion

Results indicate the importance of routine, site-specific STI screening among patients living with HIV. Our findings can inform screening strategies among urban HIV populations.

Disclosures

All Authors: No reported disclosures
1546. Update in Syphilis Proctitis: Insights from a Case Series and Literature Review
Authors: Ferzacca Elizabeth S , Dunne Dana , Barbieri Andrea , Aoun-Barakat Lydia
Published: January 2021

Background

In the US, syphilis infections have increased 71% since 2014. Proctitis is a rare manifestation of early syphilis transmitted through anal intercourse. We suspect that its misdiagnosis results from physician under-awareness and thus we present the largest case analysis to date of syphilis proctitis.

Methods

We searched PubMed and Scopus for articles describing cases of proctitis in which Treponema pallidum was a likely causative pathogen based on serologies, and/or organism-specific staining of anorectal biopsy specimens. Furthermore, we conducted chart review to identify cases of syphilis proctitis diagnosed within our health center from 2011-2019. Pertinent data were extracted from the articles and medical records and analyzed to provide a summative account.

Results

53 cases of syphilis proctitis were identified in 38 articles. 7 additional cases were diagnosed at our institution, totaling 60 cases. All cases of syphilis proctitis were described in individuals of male sex assignment at birth. The age at diagnosis ranged from 15 to 73 years (average 39 years). In 48 cases (92%) men endorsed sex with men. In 27 cases (56%) individuals were HIV co-infected. Syphilis proctitis presented most commonly with hematochezia (68%) and anal pain (48%). The most common physical exam findings were rectal mass (38%), lymphadenopathy (33%), and rash (31%). Non-treponemal titers averaged 1:60 (range 1:2-1:1024). Endoscopy was performed in 52 cases and most commonly showed anorectal mass (42%) and anorectal ulcer (35%). In 38 cases (68%), histopathology revealed a chronic lymphoplasmacytic inflammatory infiltrate, and in 14 of these cases (37%), prominent plasma cells were described. In 24 cases (77%), treponema immunohistochemical stain revealed spirochetes.

Conclusion

Syphilitic proctitis should be suspected in boys and men presenting with lower gastrointestinal symptoms. Histopathology, while suggestive, is not pathognomonic, and serology and specific tissue staining are required to make the diagnosis. Given overlapping symptoms and histology with inflammatory bowel disease, the diagnosis may be delayed resulting in personal and public health consequences. A sexual history should be routinely elicited and further testing for syphilis pursued if exposure is suspected.

Disclosures

All Authors: No reported disclosures
128. Antibiotic Prophylaxis Prior to Dental Visits in the Veterans Health Administration (VHA), 2015–2018
Authors: Suda Katie J , Fitzpatrick Margaret A , Poggensee Linda , Echevarria Kelly , Hubbard Colin , McGregor Jessina C , Evans Charlesnika T
Published: January 2021

Background

Antibiotic prophylaxis (AP) is recommended prior to invasive dental visits in patients with certain cardiac conditions but is not recommended in patients with prosthetic joints. Meta-analyses indicate benefit of AP prior to dental implants and tooth extractions. Within dentistry, it is also common to prescribe AP in patients with immunocompromising conditions. Our objective was to determine appropriateness of AP by VHA dentists.

Methods

A national cross-sectional study of dental visits was conducted in VHA, 2015–2018. Antibiotics prescribed 7 days before a visit were included. Antibiotics prescribed for an oral infection were excluded (15%). Appropriate AP was defined as visits with gingival manipulation and was further delineated into narrow and broad definitions by medical comorbidities. The narrow definition (primary analysis) only included cardiac conditions at risk of infective endocarditis. The broad definition included these cardiac conditions, tooth extractions/implants or immunocompromising conditions. The association of covariates with unnecessary AP was modeled using GEE for logistic regression.

Results

Out of 367,872 patient-visit dates associated with an antibiotic, 85% were prescribed for AP (N=313,886 prescriptions; median=7 days). AP (74% amoxicillin, 18% clindamycin) was prescribed to 198,314 patients (91% male; mean age=62 years). 87% of dental visits were categorized as gingival manipulation. With the narrow definition (cardiac only), 15% of AP were guideline concordant, increasing to 73% with the broader definition (cardiac or implant/extractions or immunocompromised). For the narrow definition, Black or other non-white race, current smoking, penicillin allergy and visits located in the West or South were associated with unnecessary AP. Protective factors were older age, prosthetic joints, immunocompromised, dental implants, extractions and visits in the Midwest. Unnecessary AP increased over time.

Conclusion

Few antibiotics prescribed before dental visits were for oral infections. Focusing on improving AP duration and appropriateness may have large implications for stewardship. Guidelines should inform if AP is indicated for extractions, implants, and immunocompromised patients.

Disclosures

All Authors: No reported disclosures
1553. Efficacy and Safety of Dalbavancin and Oritavancin in the Treatment of Gram-Positive Infections
Authors: Brown Vanessa , Linneman Travis W , Moenster Ryan P
Published: January 2021

Background

Lipoglycopeptides are approved for acute bacterial skin and skin structure infections (ABSSSI), but are often used in other infections, including osteomyelitis (OM) and bloodstream infections (BSI).

Methods

This retrospective cohort study included VA St. Louis Health Care System patients aged ≥18 through ≤89 years treated for ABSSSI, BSI, or OM with lipoglycopeptides. Patients were excluded if they received ≥72 hours (ABSSSI, BSI) or ≥7 days (OM) of antibiotics prior to lipoglycopeptide administration or other intravenous antibiotics were administered for ≥48 hours after lipoglycopeptide. The primary efficacy outcome was clinical success in the lipoglycopeptide cohort, defined per infection. Secondary outcomes were a comparison of clinical success in the lipoglycopeptide cohort to historical controls of patients treated at the VA St. Louis for ABSSSI, BSI, or OM. A multivariate regression was also conducted to find factors in the lipoglycopeptide group independently associated with clinical success. Safety outcomes compared adverse drug reactions between single- and 2-dose regimens of lipoglycopeptides.

Results

A total of 36 patients were included in the analysis; no patients met inclusion for bloodstream infection. Twenty-nine patients were treated for ABSSSI and 7 patients met inclusion for OM treatment. Dalbavancin was the agent used most often for both OM (4/7) and ABSSSI (22/29). The primary outcome of clinical success occurred in 77.7% (28/36) of the lipoglycopeptide cohort. There was no difference in clinical success between the lipoglycopeptide cohort and historical controls for ABSSSI (86% [5/29] vs 84% [159/189], p >0.05) or OM (43% [3/7] vs 58% [83/143], p >0.05). No difference in adverse outcomes between single- and 2-dose regimens of lipoglycopeptide were observed.

Conclusion

Clinical success for patients treated with lipoglycopeptides for ABSSSI and OM in this small cohort were comparable to historical controls. No difference was identified in the safety between single- and 2-dose regimens of lipoglycopeptides.

Disclosures

All Authors: No reported disclosures
1554. Epidemiology of Adult Bacterial Hand Infections at Two Urban Hospitals
Authors: Yassin Arsheena , Stavropoulos Christine , Woods Krystina L , Xu Jiashan , Carale Justin , Khachaturyan Elena , Taduran Chris , Sy Hendrik , Farkas Andras
Published: January 2021

Background

Hand infections represent a major source of morbidity, which can result in hand stiffness and amputation. Early appropriate empiric antibiotic regimen may reduce the associated morbidity, hence the importance to examine local epidemiology. The aim of this study was to define the current epidemiology of adult hand infections at two urban hospitals in New York City.

Methods

We performed a double center, retrospective study of adult patients hospitalized from March 2018 to May 2020. Patients with positive cultures associated with the hand infections were included. Retrospectively, 100 patients were reviewed. Data on baseline demographic, clinical, surgical, microbiology, and treatment parameters were collected.

Results

Of the 100 patients, 76% were male, with median age of 47.5 years (35, 58.25) and average C-reactive protein (CRP) of 50.66 mg/L (± 64.64) on admission (see Table 1). Previous hospitalization within 1 year (38%), previous surgical procedures (39%) and recent IV medication use (26%) were common. 130 bacterial isolates were identified (see Table 2). The most frequent organisms were Gram-positive, with Methicillin susceptible Staphylococcus aureus (MSSA, 25.38%), Streptococcus species (20.08%), and Methicillin resistant Staphylococcus aureus (MRSA, 15.38%) being the most common. Gram-negative organisms were infrequent, with Haemophilus parainfluenzae (3.85%), Enterobacter cloacae (3.85) and Pseudomonas aeruginosa (3.08%) being the most prevalent. Of the 100 patients, 27% had polymicrobial infections, associated with trauma (6%), illicit IV use (6%) and unknown (7%) etiologies.

Table 1: Baseline demographics and co-morbid conditions

Table 2: Types and numbers of organisms in relation to etiologies

Conclusion

Within our population, the most common organisms associated with hand infections were Gram-positive, with Staphylococcus aureus and Streptococcus species being the most prevalent. Gram-negative pathogens were infrequently isolated. The results within this study can provide guidance to clinicians on assessing the appropriate empiric antibiotic regimen in patients with hand infections, and can serve as a basis for further studies identifying risk factors associated with isolation of organisms associated with hand infections.

Disclosures

All Authors: No reported disclosures
1555. Evaluation of Local Pathogens and Management of Diabetic Foot Infections
Authors: Seadler Jessica L , Tucker Natalie , Cady Beth , Mullangi Praveen
Published: January 2021

Background

Diabetic foot infections (DFI) are a potentially devastating complication for patients with diabetes. When treating these patients, there is a need for selection of highly effective antibiotics coupled with a need to avoid excessive use of broad-spectrum antimicrobial agents that could lead to adverse patient outcomes. At this institution, it has been observed that there is a lack of compliance with consensus guideline recommendations for the choice of empiric antibiotic therapy for DFI, leading to overuse of broad-spectrum antibiotics.

Methods

A retrospective chart review was performed for hospitalized patients over 18 years of age that received antibiotics for DFI during the period of August 1, 2018 to July 31, 2019. Patients were excluded if they were continuing outpatient antibiotics for an existing DFI, were being treated with antibiotics for a concurrent infection, or were pregnant. The primary objective was the rate of guideline-compliant empiric antibiotic regimens as broken down by infection severity. Secondary objectives included the duration of antibiotic therapy per patient, and rates of empiric methicillin-resistant Staphylococcus aureus (MRSA) and P. aeruginosa coverage.

Results

A total of 114 patients were included in the analysis. A majority of patients had an infection of moderate severity (65.8%), followed by 19.3% with severe infections, and 14.9% with mild infections. In the total population, only 26.3% of patients received empiric antibiotic regimens that were guideline-compliant. A large percentage of patients received empiric anti-MRSA antibiotics (95.6%) and empiric anti-pseudomonal agents (89.5%). Use of these broad-spectrum agents did not differ by infection severity. Ninety-nine (86.8%) patients had a site culture collected. S. aureus was the most commonly isolated organism and there was a low rate of P. aeruginosa (10.1%).

Conclusion

There is room for improvement in the management of DFI at this institution. A specific area that has been identified is the overuse of empiric anti-pseudomonal agents in patients without risk factors for P. aeruginosa. The results of this study will be evaluated alongside consensus guidelines and used to create institution-specific treatment guidance that providers can employ to optimize the management of DFI.

Disclosures

All Authors: No reported disclosures
1556. Financial Analysis of Dalbavancin for Acute Bacterial Skin and Skin Structure Infections in a self-pay population
Authors: Murray E Yancey , Pizzuti Adam G , Bland Christopher M , Wagner Jamie L , Gaul Derek , Jones Bruce M
Published: January 2021

Background

Acute bacterial skin and skin structure infections (ABSSSI) are an increasing cause of admission in the self-pay population and can be difficult to treat due to socioeconomic status. We have previously described ABSSSI patients discharged to receive dalbavancin, a novel lipoglycopeptide, and shown a decreased length of stay (LOS) and total direct costs without increasing 30-day readmission rate. For patients who are financially eligible, a dalbavancin vial replacement program can offset costs in this population. The objective of this study was to determine cost differences in treating ABSSSI in self-pay inpatients discharged to receive dalbavancin compared to standard of care (SOC).

Methods

This retrospective cohort within a community health system compared self-pay adult inpatients with ABSSSI from 2/3/16 - 8/5/19 discharged to receive dalbavancin at an outpatient infusion center with SOC intravenous antibiotics. Patients were included with a diagnosis of cellulitis, abscess, or postoperative wound infections based on International Classification of Disease 10 (ICD-10) codes. Excluded populations were those without dalbavancin vial replacement performed, pregnant patients, infections caused exclusively by gram-negative bacteria or fungi, or ICD-10 codes not consistent with ABSSSI. The primary outcome was direct cost of hospital stay. Secondary outcomes included LOS, 30-day readmission rates, adverse events (AE), and indirect hospital costs. Based on previous studies, a one-sided Student’s t-test with an alpha of 0.025 deeming statistical significance was performed on the financial data.

Results

Twelve dalbavancin and 263 SOC patients met criteria for study entry. Direct cost ($2,758 vs $4,010, p=0.105) and indirect hospital cost ($2,913 vs $3,645, p=0.162) per patient was less in the dalbavancin group. There was no significant difference between median LOS (4 vs 4, p=0.888), AE (0% vs 14.8%), and 30-day readmission rates for dalbavancin vs SOC group (8.3% vs 7.2%, p=0.604).

Conclusion

Self-pay ABSSSI patients discharged to receive dalbavancin with vial replacement resulted in decreased direct and indirect cost per patient with similar 30-day readmission rates, AE, and LOS. More studies targeted toward this population are warranted to determine ultimate benefit.

Disclosures

Christopher M. Bland, PharMD, FCCP, FIDSA, BCPS, ALK Abello, Inc. (Grant/Research Support)Biomerieux (Consultant)Merck (Consultant, Grant/Research Support, Advisor or Review Panel member, Speaker’s Bureau)Tetraphase (Speaker’s Bureau) Bruce M. Jones, PharmD, BCPS, ALK-Abello (Research Grant or Support)Allergan/Abbvie (Speaker’s Bureau)
1557. First Report of Nocardia veterana Soft Tissue Abscess
Authors: Radcliffe Christopher , Grant Matthew
Published: January 2021

Background

Members of the genus Nocardia are filamentous, gram-positive, aerobic bacteria and exist ubiquitously in most environments. In 2001, the species Nocardia veterana was first isolated, and it predominantly causes pulmonary infections in immunocompromised hosts.

Methods

We present the first report of a soft tissue abscess caused by N. veterana in a 59-year-old woman being treated for chronic cutaneous graft-versus-host disease.

Results

After failing to improve with empiric treatment, two incision and drainage procedures were required. She subsequently completed a one-year course of oral antibiotic therapy consisting of trimethoprim-sulfamethoxazole then azithromycin. No relapse occurred. To better characterize N. veterana infections, we performed a systematic literature review and summarized all previously reported cases.

Nocardia veterana abscess

Conclusion

The rising prevalence of immunocompromising conditions warrants increased vigilance for N. veterana infections and other atypical or opportunistic pathogens.

Disclosures

All Authors: No reported disclosures
1558. Injection Drug Use-Related Skin and Soft Tissue Infections Serve as Sentinel Events for Healthcare Utilization in a Vulnerable Population
Authors: Knodle Ryan D , Bielick Catherine , Burrowes Shana , Barlam Tamar F
Published: January 2021

Background

Persons with injection drug use (IDU) can have frequent skin and soft tissue infections (SSTIs) and high healthcare utilization. We sought to examine whether IDU-related SSTIs are associated with an acceleration in disease course and increased healthcare utilization (a ‘sentinel event’) and may present an important opportunity for intervention.

Methods

We performed a retrospective chart review of patients with an emergency department (ED) visit or hospital admission due to an IDU-related SSTI between 10/1/2015 and 6/1/2019 to obtain information on demographics, microbiologic data, addiction service consultation, and treatment with medications for opioid use disorder (MOUD). We compared the number of healthcare encounters in the 12 months before and after the SSTI using the Wilcoxon signed rank test for data with non-normal distribution. We examined differences in the distribution of variables between patients who were admitted and those discharged from the ED using Chi Square and Fisher exact tests for categorical variables and t-tests and Wilcoxon tests for continuous variables.

Results

In all, 305 patients met inclusion criteria for an IDU-related SSTI. The patients were 66.5% male, had a median age of 41 years (range 23-70), 84% were experiencing homelessness and 87% had Medicaid. Most patients (55.7%) were admitted to the hospital and the remainder were discharged from the ED. There was a statistically significant change in healthcare utilization in the year prior to the SSTI compared to the year after (median change +16.7%, p < 0.0001). Compared to those who were admitted, it was rare for patients discharged from the ED to have microbiologic data sent (13% vs 87%, p < 0.0001), an addiction consult completed (4% vs 96%, p < 0.0001), or to be discharged on MOUD (8.0% vs 92%, p < 0.0001). Despite these differences, there were no significant predictors of high vs low utilization among all-comers based on demographic and clinical data.

Conclusion

IDU-related SSTIs serve as sentinel events with increased healthcare utilization after the episode. Addiction consultation and initiation of MOUD had no impact on the trajectory of healthcare utilization. Further work must be done to identify how best to improve outcomes for this vulnerable population.

Disclosures

All Authors: No reported disclosures