bluuebunny/crossref_metadata_2025 huggingface dataset:
1847. A mixed methods approach to understanding the perceived risk of COVID-19 and vaccination perceptions among people living with HIV in Nebraska
Authors: Labisi Titilola , Fadul Nada , New-Aaron Moses , Coleman Jason , Podany Anthony , King Keyonna
Published: November 2023

Background

Despite COVID-19 vaccine benefits, some people with HIV (PWH) might be unvaccinated. Also, whether PWH may have increased risk of severe COVID-19 outcomes due to immunosuppression remain inconclusive. Thus, understanding the perceived risk (PR) of COVID-19 and vaccine perceptions is critical for reduced COVID-19 complication risk and vaccine uptake. We applied a mixed methods approach to understand the PR of COVID-19 and perception of vaccines among PWH.

Methods

We recruited participants from University of Nebraska Medical Center HIV clinic. Eligible criteria included 1) ≥19 years; 2) Nebraska resident; 3) English Language proficiency; 4) HIV diagnosis. Participants (N=100) completed an electronic survey. We operationalized PR using the fear of COVID-19 scale scores. Quantitative data analyses included descriptive statistics, logistic regression and negative binomial. Participants (N=19) were purposefully selected for qualitative phase and completed a semi-structured one-on-one interview. Qualitative data were analyzed using open-ended coding and thematic analysis.

Results

Overall, perceived risk of COVID-19 was moderate (mean 15.3, SD: 7.0) out of 35. Eighty-five percent reported receiving ≥1 vaccine dose and 31% reported a history of COVID-19. Participants aged 19-30 years compared to 31-50 years were less likely to have high perceived COVID-19 risk scores (p= 0.02, RR: 0.70, CI: 0.53-0.93). Similarly, age group 19-30 years was more likely to report COVID-19 infection history (p= 0.03, OR: 1.83, CI: 0.04 – 0.68). The qualitative data reveal that participants’ PR waned over time. However, those with high PR expressed fear of severe COVID-19 complications. Vaccine perceptions were mixed, with lack of trust in the vaccines as main reason for hesitancy. Though not medically confirmed, 4 out of 19 participants interviewed believed they had adverse effects post-COVID-19 vaccination, including stroke, blood clots, and hives.

Conclusion

Our data suggest below national vaccination status among PWH and lack of vaccine trust might be a reason for low vaccination status. Also, younger PWH may have lower PR and higher COVID-19 risk than older PWH. We recommend further research on vaccination uptake, HIV-COVID-19 vaccine interactions, and long-term effects of COVID-19 among PWH.

Disclosures

All Authors: No reported disclosures
1848. Barriers and Facilitators to HIV Care in the Transgender Population
Authors: Martinez Dora , Hines Dana D , Inurritegui-Lint Arianna , Pillinger Kelly E , Simone Laura , Molloy Leah
Published: November 2023

Background

Transgender-inclusive healthcare focused on HIV prevention and treatment is a critical component to ending the HIV epidemic. Understanding the needs of this population is essential.

Methods

Between March – May 2022, surveys were distributed by Arianna’s Center to the transgender community to assess barriers and facilitators related to HIV care services. These results informed a national webinar for healthcare providers (HCPs), who were surveyed before and after the webinar.

Results

There were 254 individuals who completed the survey (50% transgender female; 20% transgender male; 58% LatinX; 30% African American; 31% living with HIV). The biggest barriers to accessing or staying engaged in HIV prevention/care services were socioeconomic (24%), discrimination/racism/transphobia (15%), and mental health challenges (13%).

Over half (52%) felt there were barriers to initiating conversations about sexual health and HIV and 27% reported being denied healthcare services because of their gender and/or sexual orientation.

For those taking medication for HIV prevention or treatment (59%, n = 150/254), the biggest adherence facilitator was having a supportive provider knowledgeable about transgender health (56%, n = 84/150). However, there was a disconnect between those who felt highly involved in decisions regarding their sexual/HIV health and those who wanted to be highly involved (Fig. 1). Among those who felt uninvolved in these care decisions (54%, n = 137/254), 39% (n = 53/137) felt too overwhelmed with other things in their lives and 24% (n = 33/137) felt they tried to be involved but their care team did not listen.

Most HCPs (55%, N = 98/178) attending the webinar had little to no experience caring for transgender individuals. Only 12% (n = 21/178) of HCPs felt they included their transgender clients extremely well in their HIV care (Fig. 1). Notably, there was improvement in HCPs’ knowledge (p < .001) and confidence in counseling (p < .001) about drug interactions between antiretrovirals and gender-affirming hormone therapy.

Conclusion

Insights from the transgender community indicate potential areas for improvement in HIV care, and can be leveraged to support HCP education to improve engagement with transgender individuals and promote shared decision-making.

Disclosures

Dora Martinez, MD, FAAFP, AAHIVS, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Honoraria|Janssen: Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Honoraria|ViiV Healthcare: As of May 16th will be employed by ViiV, however was not a ViiV employee at time of project Arianna Inurritegui-Lint, -, Gilead Sciences, Inc.: Advisor/Consultant|Human Rights Campaign Foundation: Advisor/Consultant|National Minority AIDS Council: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant
1858. Examining the Racial Differences in Polymicrobial Bacteremia Infections in an Area of Varying Social Vulnerability
Authors: Tan Karen K , Abdul-Mutakabbir Jacinda C
Published: November 2023

Background

Polymicrobial bacteremia (PMB) is associated with heightened disease severity and an increased burden of comorbidities has been identified as a key risk factor. Of interest, racially and ethnically minoritized (REM) individuals that reside in areas of high vulnerability have been shown to be more likely than their non-racially and ethnically minoritized (n-REM) counterparts to be diagnosed with chronic comorbidities. Nonetheless, there is a cessation of data that examines the confluence of these factors on PMB infection outcomes. This study aims to describe the racial differences in the outcomes of patients diagnosed with PMB in an area of varying social vulnerability.

Methods

This is an IRB-approved, retrospective cohort study of adult patients hospitalized at Loma Linda University Medical Center between January 2018 and April 2021. Positive polymicrobial blood culture samples were identified with the use of Microscan Bacterial Identification Panel. Demographics (including race/ethnicity), comorbid conditions, sepsis incidence, and infection source were collected through chart review. The Centers for Disease Control and Prevention (CDC) SVI scoring tool was used to determine the social vulnerability index (SVI). A P value of ≤ 0.05 was defined as statistically significant.

Results

A total of 70 patients REM (60%, 42/70) and non-REM (40%, 28/70) among PMB gram-negative (GN) and gram-positive (GP) cultures collected from hospitalized adult patients were included. Hispanic/Latino was the most prominent REM group (59.5%) and overall, REM patients were more likely to be classified as “highly vulnerable” when compared to non-REM patients (47.6% vs 42.9%). Also, REM patients were younger (61.5 years vs. 65.1 years) and were more likely to have underlying comorbidities (diabetes mellitus (47.6% vs 21.4%; p=0.026 and moderate to severe chronic kidney disease (28.8% vs 14.3%; p= 0.329). Additionally, REM patients were more likely to develop sepsis and severe sepsis (45.2% vs. 25.0%; p= 0.13 and 40.6% vs 35.7%, p=0.804), respectively, though there was no difference in mortality.

Conclusion

Ultimately, further research is needed to understand the confluence of race/ethnicity and social vulnerability factors on PMB clinical outcomes.

Disclosures

Jacinda C. Abdul-Mutakabbir, PharmD, MPH, Entasis: Advisor/Consultant|Entasis: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria
1860. Long COVID Incidence by Sociodemographic Factors in a Large National Payor Database
Authors: Craig K J , Zaleski Amanda , Wiggins Michael , Altieri-Alger Leah , Verbrugge Dorothea , Watkins Richard R
Published: November 2023

Background

Race/ethnicity (R/E) may be an independent risk factor for developing long COVID or post-acute sequelae SARS-CoV-2 infection (PASC). Evaluation of real-world data will likely reveal PASC-related sociodemographic (e.g., R/E and insurance type) disparities.

Methods

A retrospective claims cohort analysis of Medicare, Medicaid, and Commercial fully-insured members (N=8,447,882) between October 2021 to December 2022 was conducted to identify members with PASC (ICD-10, U09.9). Overall differences in PASC estimated incidence and symptomatology and its duration were explored with post-hoc analyses to examine the influence of R/E and insurance type.

Results

Overall PASC estimated incidence (n = 51,649) was 0.61% and was highest among American Indian/Alaskan Native (AI/AN, 0.91%) members, followed by White (0.78%), Black or Hispanic (0.49%), Pacific Islander (PI, 0.41%), and Asian or Unknown (0.34%) R/E groups. Compared to White members, all other R/E groups except AI/AN (P = 1.0) had lower incidence (all P < .01). Post-hoc analyses by R/E and insurance type indicated this trend persisted for Asian or Unknown members across all insurance types (all P < .001). Furthermore, compared to White members, lower PASC incidence (P < .001) was observed for a) Black Medicaid and Medicare; b) Hispanic Medicaid; and c) AI/AN Medicare members. The most frequent PASC symptoms identified by claims were pulmonary (36%), neurologic (17%), and cardiac (15%). Compared to White members (all P < .001), Black members had more cardiac symptoms in Medicaid and Medicare groups and more pulmonary symptoms in Commercially insured; and Hispanic or Unknown members had fewer pulmonary, neurologic, and cardiac symptoms among all insured. There were no differences in PASC symptom duration by R/E within insurance type (all P > .053).

Conclusion

Hispanic and Unknown members had fewer claims for PASC than White members, which may indicate a lower disease burden or disparities in care access. Despite having overall less PASC estimated incidence than White members, Black members had more cardiac and pulmonary symptoms. Pulmonary symptoms were most frequently identified in all R/E groups. There was no association of PASC symptom duration between R/E within insurance type.

Disclosures

KJ Craig, PhD, cvs Health Inc: employment|cvs Health Inc: Stocks/Bonds Amanda Zaleski, PhD, CVS: Employee|CVS: Stocks/Bonds Michael Wiggins, MPH, CVS: Employee|CVS: Stocks/Bonds Leah Altieri-Alger, MPH, CVS: Employee|CVS: Stocks/Bonds Dorothea Verbrugge, MD, CVS: Employee|CVS: Stocks/Bonds Richard R. Watkins, MD, MS, FACP, FIDSA, FISAC, bioMerieux: Advisor/Consultant|CVS: Employee|CVS: Stocks/Bonds
2898. PrEP Inequity Across Geographic, Racial and Sex Groups in a Nationwide US Veteran Cohort
Authors: Musoke Lewis S , Shumaker Amy , Wilson Brigid , Van Epps Puja
Published: November 2023

Background

Despite increasing uptake of Pre-exposure prophylaxis (PrEP) for HIV prevention, gains have been disparate across groups in non-Veteran populations. PrEP to need ratio (PnR), a measure of PrEP use relative to HIV incidence in a population, has been shown to be a useful indicator of PrEP equity. Veterans Health Administration (VHA) is the largest integrated health care system in the US and offers an opportunity to aim for PrEP equity in the Veteran population.

Methods

VHA’s nationwide databases were queried to identify PrEP users and new HIV diagnoses at each facility from 2019-2022. Unique PrEP users were defined as persons with ≥1 fill of PrEP during the calendar year (CY), excluding those with a diagnosis for HIV or chronic hepatitis B prior to the first fill in CY. A new HIV diagnosis was defined as a first ever positive HIV confirmatory test or detectable HIV viral load prior to first ever antiretroviral fill in a CY. For each region and CY, data was stratified by birth sex, self-reported race and ethnicity and the PnR was calculated as the ratio of PrEP users in a group divided by the number of new diagnoses in that group.

Results

In the VHA, overall PnR increased from 2019 to 2022 (6.8 to 20.2), with the highest in the West at 18.9 and lowest in the South at 8.9 in 2022 (Figures 1 & 2). While gains were made across both Black and White racial groups, with West (W) and Northeast (NE) erasing racial disparities, PrEP use remained inequitable among Black Veterans compared to White Veterans in the Midwest (MW) and South, with the most pronounced disparities observed in the South (Black 5.7 vs. White 12.0). Non-white Hispanics had comparable PnR to White Veterans across most regions. Nationwide, PnR in males (birth sex) was double that observed in females (birth sex), but this differed by region with MW and W erasing disparities by 2022 while gaps worsened in the South and (8.9 vs. 5.3) and NE by 2022 (16.4 vs. 4.4).

Conclusion

Despite gains over the last four years, racial and sex-based disparities exist in PrEP use along geographic lines. VHA should continue to expand PrEP access across all groups, with a special focus on the South, particularly among Blacks and birth sex females. PnR can serve as a helpful metric for PrEP programs to identify areas of greatest need.

Disclosures

All Authors: No reported disclosures
1870. Changes of Tuberculosis Incidence and Mortality after COVID-19 Pandemic: A Interrupted Time-series Analysis
Authors: Lee Jungju , Chun Byung Chul
Published: November 2023

Background

The objective of this study is to investigate how the incidence and mortality levels and trends of tuberculosis changed before and after the COVID-19 pandemic in Korea.

Methods

To estimate the incidence rate of tuberculosis in Korea, we calculated the number of reported cases per year from 2015 to 2021 and divided it by the corresponding mid-year population. Data on reported cases were obtained from the Korea Centers for Disease Control and Prevention, which mandates the reporting of tuberculosis. Descriptive epidemiology was used to analyze monthly incidence and mortality rates, and the Durbin-Watson test was employed to assess seasonality and time-series autocorrelation. Interrupted time series analysis (ITS) using ARIMA models was performed on both the incidence and mortality rates, with the starting point of the COVID-19 pandemic set at February 2020, when the first cases emerged in the community. The tuberculosis mortality was analyzed separately for two age groups: those aged 65 and above, and those under 65.

Results

During the study period, a total of 204,190 tuberculosis cases were reported, with 12,407 deaths identified. The ITS results showed that the incidence had a significant decreasing trend before the COVID-19 pandemic (b=-0.024, p< 0.01) and a significant decrease in the level of incidence after the pandemic (b=-0.72, p< 0.01). The decreasing trend of incidence was not statistically significant after the pandemic. The mortality had a continuous decreasing trend before the pandemic (b=-0.002, p< 0.01), and the level of mortality significantly decreased after the pandemic (b=-0.029, p< 0.01). However, the trend of mortality increased significantly after the pandemic (b=0.003, p< 0.01). When analyzed by age group, the increase in mortality rate was significantly evident in those aged 65 and above (b=0.016, p< 0.01), while it was not significant in those under 65 (b=0.002, p=7.08).

Conclusion

After the COVID-19 pandemic, there was a decrease in the incidence of tuberculosis, which resulted in a decrease in the tuberculosis mortality rate. However, in contrast to the pre-pandemic period, the tuberculosis mortality rate has shown a significant increasing trend since the pandemic, indicating collateral damage to tuberculosis patients due to the COVID-19 pandemic.

Disclosures

All Authors: No reported disclosures
2899. Integrating HIV Partner Services and Molecular Epidemiology Data to Enhance HIV Transmission Disruption in Rhode Island: Findings from a Public Health-Academic Partnership
Authors: Khanna Aditya , Novitsky Vladimir , Guang August , Howison Mark , Gillani Fizza S , Steingrimsson Jon , Dunn Casey , Fulton John , Bertrand Thomas , Howe Katharine , Bhattarai Lila , Ronquillo Guillermo , MacAskill Meghan , Bandy Utpala , Kantor Rami
Published: November 2023

Background

HIV remains a significant public health concern. Both contact tracing (identifying and notifying partners of people diagnosed with HIV) and molecular epidemiology (phylogenetic inference and cluster detection), are used to disrupt transmission. Integration of both modalities may be synergistic, though it is not evaluated or implemented routinely.

Methods

To assess whether integrating HIV contact tracing and molecular epidemiology data are more informative for public health than using each separately, we evaluated concordance between a statewide public health contact tracing database (CTDB) collected in 2008-2021 and handled by the Rhode Island Department of Health, and a statewide individual-level HIV-1 pol sequence database (SDB) collected in 2004-2021 by Brown University investigators. Molecular clusters were identified using at least one of seven common phylogenetic methods. Concordance (overlap in persons appearing in both databases) was evaluated using the Jaccard Similarity Coefficient (JSC).

Results

The CTDB included disease intervention specialist interview data from 2469 unique persons (2468 newly diagnosed; 1458 named partners) and the SDB included sequences from 3266 persons. There were 920 persons who appeared in both databases, while 2346/3266 (72%) appeared in the SDB but not CTDB, and 1549/2469 (63%) appeared in the CTDB but not SDB. Of the 351 molecular clusters identified, 156 (44%) consisted of persons also in the CTDB. The JSC between the SDB and CTDB was 0.19. Of the 920 persons in both databases, 509 newly diagnosed persons provided partner data and 63% (320/509) of those clustered phylogenetically. Of the 156 named partners of these 509, 76% (118/156) clustered phylogenetically. Cluster sizes ranged from 2-31 (mean = 3.4), of which a mean of 0.20 partners were named in the CTDB.

Conclusion

Integration between molecular epidemiology and contact tracing data may be synergistic to disrupt HIV transmission given the only moderate concordance between them. The existing concordance between the databases allows better characterization of the local HIV epidemic, while the discordance suggests data incompleteness in both databases, informing public health towards investigations to disrupt transmission.

Disclosures

All Authors: No reported disclosures
1873. The role of electronic health record note templates to improve screening for tuberculosis risk factors in children
Authors: Fink Julia , Burrough William , Hsieh Charlotte , Tamerat Mariamawit , Noor Zarin , Chitnis Amit S , Lewis Gena , Jaganath Devan
Published: November 2023

Background

Children should be evaluated annually for tuberculosis (TB) risk factors to detect and treat latent TB infection (LTBI), but there are gaps in screening and documentation. Embedding TB questions in an electronic health record (EHR) note template may increase screening.

Methods

TB risk assessment questions were added to the well-child and -adolescent note templates at a Federally Qualified Health Center in Oakland, California in 2014. We extracted EHR data from all well patient visits from individuals 1-19 years old without a past medical history of latent or active TB over a 7-year period. We compared the proportion of visits that documented TB risk factor screening, before and after introduction of the note template and annually.

Results

We examined 18,681 visits from 2014-2020, of which 7,071 (38%) were for children 1-4 years old, and 3,556 (19%) preferred a language other than English. One year after embedding TB risk factor questions in the note template, TB risk assessment increased from 76% to 92% (p = 0.02). In the subsequent six years, TB risk factor screening remained high ( >90%) and sustained (Figure 1). This trend was also seen among visits for those whose primary language spoken was not English. Screening for adolescents ≥12 years old improved over time (63% to 86%) but had lower overall screening than children 1-4 years old (≥90%) (Figure 1, p < 0.01).

The lines represent the proportion of well-child or -adolescent visits that have documentation of a TB risk assessment, overall and for children who prefer a language other than English, as well as for children aged 1-4 years old and those older than 12. The red horizontal line indicates that assessments for TB risk factors were completed in 90% of visits during the given year.

Conclusion

A simple EHR-based intervention can significantly improve screening and documentation for TB risk factors in the primary care setting and suggests that additional EHR solutions may address other gaps in the LTBI care cascade.

Disclosures

All Authors: No reported disclosures
1876. Characterization of patients with active drug-sensitive tuberculosis on synchronous and asynchronous video monitoring treatment in Cali - Colombia during 2019-2022
Authors: García-Goez José Fernando , Montes-Tello Sofía Alexandra , Rios-Pineda David A , Uribe-Romero Esteban , Rojas-Ramirez Mayra A
Published: November 2023

Background

Tuberculosis (TB) is an infectious disease with a high burden of morbidity and mortality, potentially curable in up to 85% of cases with first-line treatment, when adherence is over 90%. Direct observed treatment (DOTS) guarantees treatment adherence. However, barriers such as the time and cost of travel to the supply site, social stigma have weakened its efficiency. As an alternative, video monitoring of tuberculosis treatment (VDOT), had been evaluated with favorable results compared to DOTS, making it a promising strategy.Table 1.Clinical and demographic characteristics and risk factors

Methods

A quasi-experimental study was conducted in Cali, Colombia. Patients aged ≥ 18 years with TB sensitive to first-line drugs were included. Patients were allocated in synchronous VDOT, where remote and real-time video calls were daily, while in asynchronous VDOT, patients sent video messages of the daily dose intake using the WhatsApp app mobile application. The characteristics of both groups were described, and the comparison was made according to the intervention (VDOT) using Cox regression.

Results

A total of 133 were included, 66 in synchronous VDOT and 67 in asynchronous VDOT . The mean age was similar in both groups and, the 60% of the patients were male. Patients in the asynchronous VDOT group had more comorbidities. Pulmonary tuberculosis was the most frequent presentation in both groups. Treatment was completed in 43.9% in synchronous VDOT, and 28.3% in asynchronous VDOT. Loss to follow-up was higher in the asynchronous VDOT. Four deaths occurred in synchronous VDOT and one in asynchronous VDOT. The mean follow-up time was 198 days. Also, Cox regression showed that the synchronous strategy has 88% risk of completing antituberculosis treatment in less time than the asynchronous monitoring group, HR: 1.88 IC95%: 1.26 - 2.81, p= 0.002.

Conclusion

Asynchronous VDOT seems to have a higher risk of desertion than synchronous VDOT, as opposed to literature finds. A relationship between comorbidities or risk factors that have not been evidenced in our study is not ruled out. Further studies are needed to compare the effectiveness of synchronous vs asynchronous VDOT in challenging scenarios, such as low income, poor internet connectivity, poor technology, and limited logistical capacity of the TB group.

Disclosures

All Authors: No reported disclosures
1881. Costs of Treating Multidrug Resistant Tuberculosis in California, 2022
Authors: Katrak Shereen , Wang Rebecca , Barry Pennan
Published: November 2023

Background

New, shorter regimens containing bedaquiline, pretomanid, and linezolid (BPaL) are entering clinical use for treating multidrug-resistant tuberculosis (MDR TB). Using a micro-costing approach, we estimated the direct cost of individual episodes of care for MDR TB for four different regimens and compared the cost of BPaL regimens with previously recommended, longer regimens.

Methods

We estimated the cost of four regimens: an 18-month 5-drug regimen with an injectable agent but no bedaquiline (INJ18), a U.S. guideline-based 18-month 5-drug all oral regimen with bedaquiline (BDQ18), and two 6-month regimens: BPaL and BPaL plus moxifloxacin (BPaLM). We established a standardized set of services for each regimen, assumed no treatment side effects or treatment failure, and summed cost components in 2022 dollars. Cost components included inpatient care costs based on published literature, medication costs (340B and wholesale acquisition prices) paid by California public health TB programs, outpatient laboratory, imaging and physician fees based on California Medicaid reimbursement schedule, and case management (e.g., nurse case manager or outreach worker time, adherence incentives) based on published literature.

Results

Total direct cost for MDR TB care was $86,000-94,000 for BPaL, $86,000-96,000 for BPaLM, $117,000-187,000 for INJ18, and $127,000-203,000 for BDQ18. Hospitalization costs comprised the largest proportion of direct costs for BPaL/BPaM, regardless of type of drug pricing (47-53%) but were also a substantial component of other regimens (22-39% for BDQ18 and INJ18). Bedaquiline was the largest contributor to cost of medications for BPaL and BPaLM even with public health pricing.

Conclusion

MDR TB care is costly. Despite high cost of medications, shorter BPaL/BPaLM regimens may provide cost savings.

Disclosures

All Authors: No reported disclosures
2900. Clinical Utility of Repeat Magnetic Resonance Imaging Studies Among Children with Acute Hematogenous Osteomyelitis
Authors: Thorne Abby , Moss Angela , Sanders Julia S , Stein Jill , Searns Justin B
Published: November 2023

Background

Magnetic resonance imaging (MRI) is the diagnostic study of choice for children with acute hematogenous osteomyelitis (AHO). However, there is limited guidance for whether repeat MRIs are clinically impactful for children with AHO who fail to improve after initial treatment. This study aimed to determine whether repeat MRIs changed clinical management among children with AHO.

Methods

Children admitted to a quaternary care pediatric hospital with a discharge diagnosis of osteomyelitis were identified during a 9-year period. Patients with chronic symptoms, non-hematogenous infections, or significant contributing comorbidities were excluded. Medical records were retrospectively reviewed for all MRIs performed 3 weeks prior to admission to 24 months after discharge. An MRI was considered clinically impactful if it identified a new infectious process (e.g., abscess not seen on initial MRI) or if it resulted in surgical intervention within 24 hours. Categorical variables were compared using Fisher’s Exact or chi-square tests and continuous with Wilcoxon Rank-Sum tests.

Results

Among 239 included patients, 41 (17%) had more than 1 MRI performed during clinical care for their AHO. Twenty-nine repeat MRIs occurred during initial hospitalization and 27 during outpatient follow up. Children who underwent repeat inpatient MRIs had longer hospitalizations (9 vs 5 days, P< 0.01) and higher C-reactive protein levels (20 vs 7 mg/dL, P< 0.01), and were more likely to be critically ill (20% vs 6%, P=0.02) or to experience a therapeutic failure (20% vs 3%, P< 0.01). Among repeat inpatient MRIs, 19 (66%) were clinically impactful; 9 (31%) led to repeat surgical procedures and 13 (45%) identified new diagnoses. Repeat outpatient MRIs were more likely to be performed in children with vertebral AHO or multifocal infections (P=0.02). Among repeat outpatient MRIs, 7 (25%) were clinically impactful. Six (22%) led to repeat operative procedures and 3 (11%) identified new diagnoses.

Conclusion

When used judiciously among ill children with complicated AHO, repeat MRI can be clinically impactful in both the inpatient and outpatient setting. Prospective studies are needed to better define which children with AHO benefit from repeat MRI.

Disclosures

Julia S. Sanders, MD, OrthoPediatrics Corp: Advisor/Consultant
1890. Evaluating the effect of respiratory isolation for TB on patient- and public health-important outcomes- a systematic review
Authors: Pearl Abarna , Biewer Amanda M , Delrooz Naveed , Subramanian Advaith , Miller Sarah E , Mukasa Leonard , Young Laura R , Mase Sundari R , Munsiff Sonal , Nardell Edward , Nathavitharana Ruvandhi
Published: November 2023

Background

The duration of respiratory isolation for infectious tuberculosis (TB) is based on limited data and expert opinion. Yet the impact of isolation on persons with TB and public health programs is significant. This systematic review synthesized evidence on public health and patient-important outcomes of respiratory isolation for TB to inform revised National TB Controllers Association guidelines.

Methods

We searched PubMed, EMBASE, CINAHL, Web of Science, Cochrane Central and WHO-Global Index Medicus using terms for TB and respiratory isolation (Figure). Eight reviewers screened abstracts, full-texts, and extracted data in pairs. Inclusion criteria were data on effects of respiratory isolation compared to no isolation or masking. Studies were stratified by outcomes: TB infection or TB disease in contacts, mortality, hospitalization duration, patient and health system costs, and impact on mental health or stigma. A convergent mixed methods approach was used to integrate quantitative and qualitative findings and assess limitations.

Results

After screening 3640 publications, 17 studies: randomized controlled trial (1), quasi-experimental (1), cohort (1), modelling (3), mixed-methods studies (3), and qualitative (8), were included. The trial (conducted in the 1950s) suggested treatment in isolation in a sanatorium versus at home did not affect TB infection (22% versus 23%) or disease incidence (11% versus 10.5%) in contacts (Table 1). Modelling studies suggest isolation may reduce transmission, including drug-resistant TB, but highlighted isolation is rarely implemented without other interventions, including treatment or masking. Many studies described adverse impacts of isolation on employment, education, food/housing security, and mental health due to transmission fears, stigma and social isolation (Tables 2 & 3). Impacts were compounded in marginalized groups such as indigenous and incarcerated persons.

Conclusion

Data to support current isolation practices, particularly once effective treatment is started, to reduce TB transmission in communities are limited. Public health guidance should consider the negative impacts on persons with TB against the potential for transmission reduction to facilitate evidence-based decisions about respiratory isolation.

Disclosures

All Authors: No reported disclosures
1891. Descriptive Epidemiology of African-American Patients with Tuberculosis in in Detroit
Authors: Sandhu Avnish , Pollock Erin , Smith Shona , Sunstrum James , Kissner Dana
Published: November 2023

Background

Knowing local risk factors for tuberculosis (TB) facilitates identification of individuals with latent or active TB. The purpose of this study is to describe the epidemiology of TB among patients seen in the Detroit Health Department. We will refer to our study population as Detroit TB cases.

Methods

A retrospective descriptive study was conducted in collaboration with the Michigan Department of Health and Human Services. TB data submitted to MDHHS from Detroit between January 2017 and December 2022 was evaluated. Information on demographics, genotype clusters, and clinical / lifestyle risk factors was collected

Results

One-hundred forty-one TB cases were verified in Detroit during the study period and will be referred to as the study population. See Table 1 for baseline demographics. Sixty percent (85) of cases were males. Fifty-eight % (81) were Black / African American (B/AA). Sixty-two % (87) of cases were born in the U.S. Of persons with positive cultures for TB, 45% (37) were in a genotype cluster. Please see figure 1 for example of genotype cluster. The major clinical risk factors were diabetes mellitus in 31% (43) of cases, followed by incomplete treatment of latent TB infection (LTBI) in 11% (16). Major life-style risk factors included any substance use in 24% (34), non-injecting drug use in 18% (26), and excess alcohol use in 13% (18) of cases.

Conclusion

This study highlights epidemiologic differences between individuals with TB in Detroit and the US. Almost 60% of the 141 Detroit TB cases were B/AA. Nationally, 10% of non-US-born individuals and 30% of US-born ones were B/AA in 2022. More than 60% of the Detroit cases were US-born. This is in stark contrast to the U.S., where 37% of cases in 2022 were US-born. A significant number of Detroiters belonged to a genotype cluster, indicating continued transmission of TB. Alcohol and drug use were major lifestyle risk factors, suggesting increased contact in shared venues contributing to transmission of TB. Knowing these local risk factors for TB should lead to earlier detection and treatment of TB and LTBI and eliminate opportunities for transmission.

Disclosures

All Authors: No reported disclosures
2901. Associations between climate and diabetic foot infection microbiology: a systematic review and meta-analysis
Authors: Rabin Benjamin , Lockwood Sophie M , Martinson Ellen , Urquhart-Foster Kyra , Bhanushali Priyanka , Raymond Julia , McAloon Meg , Dunbar Jillian , Otchere Baffour , White Mia S , Schechter Marcos
Published: November 2023

Background

Diabetic foot infections (DFIs) are the leading cause of preventable limb loss globally. The International Working Group on Diabetic Foot Infection guidelines advise an empiric antibiotic regimen choice for DFI partly based on climate: gram-negative and P. aeruginosa active antibiotics are recommended for people residing in subtropical and tropical climates with moderate and severe DFIs. However, there is limited data supporting this recommendation. Our systematic review and meta-analysis aimed to understand the prevalence of gram-negative and P. aeruginosa DFIs across solar climate zones (temperate, subtropical, and tropical).

Methods

We searched PubMed, Embase, AIM, IMSEAR, IMEMR, LILACS, and WPRIM for studies published in any language between 2010-2020 reporting ≥5 unique patients with a DFI (Figure 1). Two reviewers independently assessed studies for eligibility, and we used double data entry. The senior author resolved disagreements. We assigned climate zone based on study center location and built Forest plots to depict the proportion of patients with (1) ≥1 gram-negative bacteria and (2) with P. aeruginosa­ in foot soft tissue and/or bone cultures. We reported common and random effects models.

Results

293 studies out of 4101 studies met our inclusion criteria. Of these, 53 studies representing 4,970 patients reported the proportion of patients with gram negative infections, and 270 studies representing 36,026 patients reported the proportion with P. aeruginosa. A random effects model found the proportion of patients with gram negative infection varied by climate zone: 40% (95% confidence interval 33% – 54%) in temperate regions; 58% (95% CI 51% – 65%) in sub-tropical regions; and 67% (95% CI 49% – 61%) in tropical regions (Figure 2). The proportion of DFI with P. aeruginosa was 14% (95% CI 12% - 17%) in temperate areas; 15% (95% CI 13% - 17%) in subtropical regions; and 16% (95% CI 14 – 17%) in tropical regions (Figure 3).Figure 2:Meta analysis of the proportion of gram negative DFI infection by solar climateFigure 3:Meta analysis of the proportion of Pseudomonas aeruginosa DFI infection by solar climate

Conclusion

Our meta-analysis suggests that gram-negative infections occur at higher proportions in tropical and sub-tropical areas compared to temperate regions. Future studies should aim to elucidate the interactions between other risk factors for gram-negative and/or P. aeruginosa DFIs (e.g., antibiotic exposure, infection severity) and climate.

Disclosures

All Authors: No reported disclosures
1893. Mathematical modeling the impact of the age-dependent latent tuberculosis treatment on active tuberculosis in South Korea
Authors: Seong Hye , Lee Yunjeong , Seo Jiyeon , Hyun Hakjun , Yoon Jin Gu , Nham Eliel , Noh Ji Yun , Cheong Hee Jin , Kim Woo Joo , Lee Jeehyun , Song Joon Young
Published: November 2023

Background

As most of the tuberculosis (TB) cases occur from latent TB (LTBI) reactivation, effective therapeutic interventions for LTBI are crucial to national TB control. Age is one of the important factors affecting LTBI treatment and management. This study assessed the impact of the age-dependent intervention on the treatment rate, the probability of treatment success for LTBI, and the overall incidence of active TB cases in South Korea.

Methods

We developed an age-structured dynamic compartmental model to describe the person-to-person transmission of TB focused on latent TB in South Korea. We calibrated the model to an annual number of active TB cases from 2011 to 2018 reported by Korea Disease Control and Prevention Agency. The model estimated averted active TB cases for 30 years, and sensitivity analysis was performed by changing the treatment coverage and success rates for LTBI, stratified by age groups.

The mathematical model for tuberculosis transmission in South Korea

Results

In the model simulation, the number of new active TB cases gradually decreased in 19-34 and 35-64 age groups but gradually increased in the elderly. Among three age groups, the intervention of LTBI in 35-64 age group markedly reduced total active TB cases by reducing both acute infection and reactivation from LTBI cases. When the LTBI treatment rate increased by 4-times in 35-64 age group, the 32,785 active TB cases were averted, while in 19-34 and ≥65 age groups, 11,597 and 5,678 cases were averted, respectively. When changing the probability of treatment success, similar results were shown also. The 19-35 age group was most affected by the change in the LTBI treatment success rate compared to other age groups. Assuming the probability of treatment success approached 100%, 1,290, 3,208 and 822 active TB cases were averted in 19-34, 35-64 and ≥65 age groups, respectively.

The incidence rates are plotted for all ages (top left), 19-34 (top right), 35-64 (bottom left), and 65+ (bottom right) age groups.

The incidence rates are plotted for all ages (top left), 19-34 (top right), 35-64 (bottom left), and 65+ (bottom right) age groups.

Active TB cases in 2048 year according to changes of LTBI treatment rate for each age group

Conclusion

The model simulation suggested that changes in the treatment coverage and success rates of LTBI may have different effects by the age group. LTBI control measures affected the 35-64 year age group more significantly than the other age groups.

Disclosures

Hee Jin Cheong, M.D.,Ph.D., Sequiris: Advisor/Consultant
1895. Omadacycline for the Treatment of Non-Pulmonary Mycobacterial Infections: a Single-Center Retrospective Review
Authors: Shen Edmund , Albin John , Hysell Kristen , Hurtado Rocio M
Published: November 2023

Background

Infections due to rapidly growing mycobacteria (RGM) such as M. abscessus, M. chelonae and M. fortuitum typically require long and toxic regimens, with complex resistance patterns and limited oral options further producing suboptimal efficacy. Since its approval in 2018, however, the tetracycline derivative omadacycline has established new options in antibiotic management. We report here clinical experience with the use of omadacycline for non-pulmonary RGM infections within the Mass General Brigham (MGB) system.

Methods

The study was approved by the MGB Institutional Review Board (2022P001578). Electronic ambulatory notes in the MGB Research Patient Data Registry (RPDR) from 2012-present were filtered by the term “omadacycline,” and manual chart review was conducted for individuals treated for non-pulmonary RGM infections.

Flow diagram of chart review procedure for identification of non-pulmonary RGM patients

Results

Chart review revealed 25 patients with omadacycline-treated non-pulmonary RGM infections. The median age was 50, 52% female and 48% male. In total, 16 were infected with M. abscessus (64%), 8 with M. chelonae (32%), and 1 with M. immunogenum. 18 cases were skin and soft tissue infections (72%), 4 cases were bone and joint infections (16%), and 3 cases were disseminated infections (12%). Most patients (88%) received omadacycline as part of a step-down or a salvage regimen; 3 (12%) received omadacycline in initial treatment. 17 patients (68%) had completed regimens as of April 2023. Among these cases, the median duration of omadacycline use was 5 months (range=0.25-16). Patients within this cohort generally experienced clinical improvement. Adverse effects–most commonly nausea–were noted in 6 (24%) cases. No patients were discontinued due to the severity of these effects, though one regimen was temporarily paused due to hyperlipasemia.

Non-pulmonary RGM patient cohort demographics, Mycobacterial species, and site of infection.

Conclusion

Omadacycline is an increasingly common component of the treatment of RGM infections, with use in multidrug regimens appearing generally effective and well-tolerated. Limitations of this study include its retrospective nature and evaluation within a single health system. To our knowledge, however, this is the largest series on omadacycline in RGM infections reported to-date. This analysis provides support for the further evaluation of omadacycline outcomes among patients with RGM infections.

Disclosures

All Authors: No reported disclosures
2107. Anti-Biofilm Potential of Virulence Factor EsxB of Staphylococcus aureus against its own Sensitive Strain: Molecular Evidences
Authors: Ashraf Faryal , Maharjan Rukesh , tul-Wahab Atia , Choudhary Iqbal
Published: November 2023

Background

Staphylococcus aureus express different proteins that modulate intracellular bacterial survival and increase antimicrobial resistance with higher mortality rate. The EsxA and EsxB, substrates of the ESAT-6 like secretion system (Ess) are important during intracellular S.aureus infection. The genes EsxA and EsxB are present in close proximity with 6 other genes, including EsaA, EssA, EsaB, EssB, EssC, and EsaC.

Methods

EsxB virulence gene from vancomycin resistant S. aureus was cloned and transformed into expression cell line E.coli BL21(DE3) cells under IPTG induction. The expressed proteins were purified using affinity and size exclusion chromatography. Purity and protein structures were checked by using NMR spectroscopy and circular dichroism. Further, purified proteins were evaluated for it's hemolytic and antibiofilm property against S. Aureus (ATCC 6538).

Results

he purified EsaB protein showed well spread spectra of 1H- NMR spectrum, however, the 15N, 1H-HSQC spectrum showed overlapped peaks or contours in the region of 6.5-10 ppm indicating the absence of well folded 3D conformation in solution state. Circular dichroism showed the presence of beta sheets in structure of EsxB virulence factor. EsxB protein showed antibiofilm activity against S.aureus (ATCC 6538) when treated exogenously. It also showed non hemolytic activity indicating it's non-cytotoxic nature.

Conclusion

This study explains the evidence that bacterial virulent protein EsxB possess antibiofilm activity against its own sensitive strain.

Disclosures

All Authors: No reported disclosures
2903. Early Experience With Omadacycline For The Treatment Of Diabetic Foot Infections
Authors: Crotty Matthew P , Akins Ronda L , Dominguez Edward A , Alexander Julie , Alexander Nebu
Published: November 2023

Background

Diabetic foot infections (DFI) are often polymicrobial and increasingly caused by resistant pathogens. Progression of resistance requires utilization of broad-spectrum agents, further exacerbating the problem and resulting in collateral damage. Frequently used regimens are often complicated by adverse effects of acute kidney injury (AKI) and Clostridioides difficile infection (CDI). The unique spectrum of activity of omadacycline (OMC), availability both intravenously (IV) and orally, along with its safety profile may provide an optimal treatment for DFIs.

Methods

This is a prospective, open-label, two-center study (NCT04714411) to assess the safety of OMC use in the treatment of hospitalized subjects with moderate to severe DFI with or without acute osteomyelitis (AOM, defined as initial diagnosis) who are at high risk for development of CDI, AKI, and/or resistant pathogens. Adults (≥18 years) hospitalized with DFI were eligible. All subjects received OMC 200 mg IV once on day 1 followed by either 100 mg IV or 300 mg by mouth once daily for 14-21 days without AOM or 42 days with AOM. Clinical success was defined as infection resolution or sufficient clinical improvement requiring no other antibiotics.

Results

11 patients were enrolled and received OMC for DFI treatment (Table 1). Most patients had AOM (8/11, 72.7%) and systemic inflammatory response syndrome criteria were met in 5 of 11 (45.5%). All patients were converted to oral therapy with median time of 4 days (IQR, 2-5 days). Median hospital stay was 11 days (IQR, 9-15). 8 patients completed treatment with all achieving clinical success at end of therapy (EOT; Figure 1). At test-of-cure (TOC; EOT + 30 days), 6/8 (75%) patients had clinical success. Among two patients not achieving clinical success, one received additional antibiotic therapy during a subsequent hospitalization and the other had growth of Proteus mirabilis from local culture. At long-term follow-up (LFU; EOT + 60 days), 6/8 (75%) achieved clinical success. No instances of AKI or CDI were observed. Adverse effects were reported by two patients (nausea and burning sensation at injection site).

Conclusion

Early experience with OMC suggests it may be a potential treatment for some patient with DFI including AOM. Continued investigation for this indication is warranted.

Disclosures

Matthew P. Crotty, PharmD, BCIDP, Paratek Pharmaceuticals Inc.: Grant/Research Support Ronda L. Akins, PharmD, Paratek Pharmaceuticals, Inc.: Grant/Research Support