bluuebunny/crossref_metadata_2025 huggingface dataset:
2886. The Clinical Implications of High Echinocandin Persistence of a Major Fungal Pathogen and Development of a Rapid and Convenient Approach to Determine Echinocandin Persistence
Authors: Arastehfar Amir , Daneshnia Farnaz , Floyd Daniel , Mansour Michael
Published: November 2023

Background

Candida glabrata is a major human fungal pathogen known for its rapid acquisition of antifungal resistance and its ability to replicate inside the macrophages. Echinocandins are the first-line antifungal drugs and the number of echinocandin resistant (ECR) C. glabrata isolates are on the rise. Echinocandin persistent (ECP) C. glabrata cells are one of the major drivers of ECR. Although bacterial isolates with high antibiotic persistence are associated with a higher rate of resistance and burden, it is not clear if ECP level in C. glabrata bears a clinical significance. Additionally, ECP level determination traditionally relies on labor-intensive and time-consuming approaches.

Methods

Six C. glabrata isolates with similar minimum inhibitory concentrations of micafungin were included and their ECP was determined using traditional colony forming counting. An ex vivo primary macrophage model was used to assess the intracellular replication, the dynamic of killing, and the ECR colony rates of all isolates in the absence and presence of micafungin treatment. Two isolates, including a high and a low ECP C. glabrata isolates, were used to induce systemic infection and to evaluate the fungal burden and the rate of ECR colonies in spleen, liver, and kidney in the absence and presence of humanized dosage of micafungin (5mg/kg). A SYTOX-based assay was used as a proxy to determine the ECP levels of various C. glabrata.

Results

We show that high ECP-Cg isolates better replicate inside the macrophages and establish systemic infection than low ECP isolate. Additionally, under echinocandin treatment high ECP-Cg isolates have a higher burden and exclusively develop ECR colonies in our ex vivo and systemic infection models. Finally, we report a convenient SYTOX-based assay that reliably and rapidly measures the ECP level.

Conclusion

C. glabrata isolates with a higher ECP level are less effectively cleared by echinocandins and more likely to develop ECR and as such are clinically relevant. Our rapid and convenient SYTOX-based protocol reliably determines the ECP level and therefore has the potential to be used in clinical settings, high throughput screening studies, and has the potential to be extended to measure persistence level of various fungal pathogens.

Disclosures

Michael Mansour, MD, PhD, Thermofisher: Grant/Research Support
1803. Analysis of National Policies and Antimicrobial Resistance Burden: An Ecological Study of 114 Countries
Authors: Vargas Moises R , Ikuta Kevin
Published: November 2023

Background

The rise of antimicrobial resistance (AMR) is a top public health concern. The drivers of AMR are complex, with antimicrobial misuse, lack of coordinated policies and inter-country data cooperation playing key roles. The growing burden of AMR is not shared proportionally across countries and there’s marked heterogeneity of national-level policies to tackle AMR. Our aim was to evaluate whether stronger national policies correlate with reduced burden 3rd generation cephalosporin (3GC) resistant Escherichia coli utilizing two recently published estimates.

Methods

We used 2019 estimates of deaths and Disability Adjusted Life Years (DALYs) due to 3GC resistant E. coli published by Murray et al. We matched these estimates to the governance score produced by Patel et al, which analyzed National Action Plans (NAP) through a governance framework, assigning a “governance score” to countries based on 54 indicators across 3 domains (Table 1). We describe the relationship between the burden of 3GC resistant E. coli and governance score across six WHO regions: Africa, Americas, Eastern Mediterranean, Europe, South-East Asia, and Western Pacific.

Results

A total of 114 countries with both governance score and 3GC resistant E. coli data available were included. A multivariate log-linear regression model adjusted for region showed a relative risk reduction in the mortality of 3GC resistant E. coli of 2.8% (CI 1% –4.6%; p-value 0.002) for every increase in point of governance score (Figure 1).

When looking at DALYs as a measure of AMR burden, using a multivariate log-linear regression model adjusted for regions, we find a relative risk reduction of 4.7% (CI 1.8% - 6.2%; P value < 0.001) for every increase in point of governance score (Figure 2).

Conclusion

We show that countries with high governance scores had overall lower burden of 3GC resistant E. coli. Additional time series analysis as well as evaluating specific aspects of NAPs against AMR burden would be an important next step.

Disclosures

All Authors: No reported disclosures
1804. A Hospital System Utilization of EMR towards New Jersey’s Goal of Viral Hepatitis and HIV Elimination
Authors: Xu Binghong , Brogden Ruth P , Velez Aryana , Pillay Meenakumarie , Yango Jaymie , Patel Ammie J , Handler Eric , Crean Christopher , Ramnarine Mityanand , Trattner Lauren , O’Mahony Stephen , Wang Su H
Published: November 2023

Background

New Jersey plans to reduce 75% of new HIV infections and promote access to testing and linkage-to-care (LTC) to end the HIV epidemic by 2025. In the US, CDC 2020 hepatitis surveillance report indicated cases of hepatitis C in 2020 corresponded to a 124% increase from 2013. Globally, if the HBV effort remains unchanged, the annual deaths from HBV are projected to increase by 39% from 2015 to 2030. We implemented an electronic medical record (EMR) based screening algorithm to scale up HBV, HCV, and HIV screening and provide LTC.

Methods

In March 2018, the EMR was modified at Cooperman Barnabas Medical Center in the Emergency Department (ED) to start automated screening, we expanded the screening criteria to boost identifying the undiagnosed. Subsequently, the program expanded to Somerset Medical Center and Rahway Hospital. Patient Navigators receive a real-time alert of positive results to contact patients and arrange LTC, the multidisciplinary team offers evaluation and treatment.Figure 1.Expanding Automated Screening Program

Results

We found HIV prevalence in CBMC is 1.5%, close to 5 times the NJ statewide 397.2 per 100,000 population. HBV infection rates varied in three hospitals, representative of the diverse population in their service areas. The HBV patients we confirmed came from more than 170 countries with different insurance statuses, the majority are immigrants from endemic countries or with high-risk behaviors identified. From Aug 2022, new HbsAg + cases reflex to HDVAb test, where 5% resulted HDVAb+ and no HDVRNA+. HCV prevalence rates are more consistent among the three sites, however, the percentages of the birth cohort (1945-1965) are varied. LTC rates are higher in HBV patients than HCV, thus far, 41 patients were cured of HCV from our team.Figure 2.Total Numbers of HBV, HCV & HIV Tested, Prevalence & LTC

Conclusion

EMR automated screening significantly scales up the diagnosis of HBV, HCV and HIV, as well as identifying HIV at-risk patients to receive comprehensive preventative services. HBV, HCV and HIV share similar risks, LTC is crucial to treat current infections and is beneficial to prevent transmission and potential exposure. In summary, automated screening and LTC work robustly toward elimination.

Disclosures

All Authors: No reported disclosures
1807. Implications of Sewer Connectivity in the U.S. for Equity in Wastewater-Based Epidemiology
Authors: Yu QinQin , Olesen Scott , Duvallet Claire , Grad Yonatan H
Published: November 2023

Background

Wastewater-based epidemiology is a promising public health tool that can yield a more representative view of the population than case reporting. However, only about 80% of the U.S. population is connected to public sewers, and the characteristics of populations missed by wastewater-based epidemiology are unclear.

Methods

We used publicly available datasets to assess sewer connectivity in the U.S. by location, demographic groups, and economic groups. We used mathematical modeling to assess the impact of wastewater sampling inequities on inferences about epidemic trajectories at a local scale.

Results

Data from the U.S. Census’ American Housing Survey (AHS) revealed that sewer connectivity was lower than average for American Indian and Alaskan Native, White, non-Hispanic, older, non-poverty, and larger households. Data from the U.S. Census’ American Community Survey and Environmental Protection Agency (EPA) revealed geographical areas with low sewer connectivity, such as Alaska, the Navajo Nation, Minnesota, Michigan, Florida. In contrast to the AHS data, data from the EPA showed that sewer connectivity was correlated with income in Minnesota, Florida, and California. However, with the exception of the U.S. Census data, there were inconsistencies across datasets.

Using mathematical modeling, we found that even weak connections between communities may allow wastewater monitoring in one community to serve as a reliable proxy for an interacting community of similar population size with no wastewater monitoring when cases are widespread.

Conclusion

A systematic, rigorous assessment of variation in sewer connectivity will be important for ensuring an equitable and informed implementation of wastewater-based epidemiology as a public health monitoring system.

Disclosures

Scott Olesen, PhD, Biobot Analytics: Former employee Claire Duvallet, PhD, Biobot Analytics: Former employee|Biobot Analytics: Stocks/Bonds Yonatan H. Grad, MD, PhD, Day Zero Diagnostics: Board Member|GSK: Advisor/Consultant
1817. Skin and Soft Tissue Infection Incidence Before and During the COVID-19 Pandemic at A Large Safety Net Healthcare System
Authors: Merino Prudencio , Kupferwasser Deborah , Flores Evelyn A , Tran Donna Phan , Ortega Abisay , Miller Loren G
Published: November 2023

Background

Skin and Soft Tissue Infections (SSTIs) are one of the most common bacterial infections that drive persons to seek medical care. We hypothesized that during the COVID-19 pandemic, SSTI rates would significantly decrease due to Public Health directives to avoid unneeded care and due to attenuated risk behaviors, such as skin injury and person to person contact, that drive SSTIs.

Methods

We performed a health system wide retrospective study using databases from the Los Angeles Department of Health Services, the second largest U.S. safety net healthcare system which is composed of 4 major medical centers and 20 clinics and ambulatory care centers. We examined all patients who had ≥1 medical encounter (inpatient, Emergency Department [ED], outpatient, or observation) for an SSTI. SSTIs were identified using ICD-10 diagnosis code between March 16, 2017 and March 15, 2022. Pre-pandemic and intra-pandemic SSTI rates were compared using a student’s t-test.

Results

During the study period there was a mean of 426,995 empaneled of patients per month. In total there were 72,218 SSTIs, 36,167 in the outpatient setting, 21,035 in the ED, 1143 in the observation unit, and 13,433 in the inpatient setting. Intra-pandemic SSTI rate was significantly lower than pre-pandemic (2.3 cases/1000 empaneled patient-months versus 3.3 cases/1000 empaneled patient-months, p< 0.0001). SSTI subgroups stratified by site of care all had significant SSTI decreases between the intra-pandemic and pre-pandemic time periods (inpatient (0.5 vs 0.6 empaneled patient-months), observation unit (0.05 vs 0.07), ED (0.6 vs 1.0), and outpatient clinics (1.2 vs 1.6), p< 0.0001 for all comparisons, see Figure).

Skin and Soft Tissue Infection Rates Pre- and Intra- COVID-19 Pandemic

Conclusion

Compared to the pre-COVID-19 pandemic period, SSTI rates in our large U.S. safety net healthcare system significantly decreased by over 30% during the COVID-19 pandemic. Decreases occurred at all levels of care delivery. Whether the results of this study reflect a true reduction in SSTI incidence rates or a reduction in health system utilization for SSTIs requires further examination. Our data provide some insights as to expected changes in common bacterial infections during subsequent pandemics.

Disclosures

Loren G. Miller, MD MPH, ContraFect: Grant/Research Support|GSK: Grant/Research Support|Medline: Grant/Research Support|Merck: Grant/Research Support|Paratek: Grant/Research Support
2894. PEP-in-Pocket (PIP): Long-Term Follow-Up of On Demand HIV Post-Exposure Prophylaxis
Authors: Billick Maxime J , Fisher Karla , Myers Samantha , Tan Darrell , Bogoch Isaac
Published: November 2023

Background

Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are well established methods of HIV prevention through the use of antiretroviral medications. However, the suitability of these tools for individuals with infrequent, higher-risk HIV exposures might be limited due to cost, high pill burden and/or barriers to care. PEP-in-pocket (PIP) involves prospectively identifying such individuals, proactively prescribing them 28 days of PEP medication, and providing instructions on when to self-initiate medications and how to follow up with care. We present long-term follow-up of a cohort of patients provided with PIP for HIV prevention.

Methods

We evaluated the clinical characteristics and outcomes of patients using PIP for HIV prevention. Patients referred for PrEP or PEP care were offered PIP if they reported a low frequency (0-4 per year) of higher-risk HIV exposures of any type. The HIV prevention method was chosen through shared decision-making between patients and clinicians and was outside the realm of this study. Patients were followed at regular 4-6 months intervals.

Results

We followed 112 patients prescribed PIP between the ages of 20-69 for a total of 183.8 patient-years. 108 (96%) patients were assigned male at birth. Thirty-five (31%) patients self-initiated a total of 69 courses of PIP during the observation period. Patients fluidly transitioned between HIV prevention modalities as circumstances warranted: 34 (31%) changed from PIP to PrEP, and 33 (30%) changed from PrEP to PIP. There were 18 episodes of bacterial sexually transmitted infections in 13 individuals (12%) using PIP. No HIV seroconversions were detected.

Conclusion

PIP is an innovative HIV prevention strategy for individuals with a lower frequency of higher-risk HIV exposures, and provides patients with autonomy and agency over their care. Patients may transition between PIP and PrEP based on evolving risk. PIP should be included with PEP and PrEP as a biomedical HIV prevention option for individuals at risk for infection.

Disclosures

Darrell Tan, MD PhD, Abbvie: Grant/Research Support|Gilead: Grant/Research Support|Glaxo Smith Kline: Grant/Research Support Isaac Bogoch, MD, MSc, BlueDot: Advisor/Consultant|NHL Players' Association: Advisor/Consultant
1823. Disproportionate Rates of COVID-19 Among Black Canadian Communities: Lessons from the First Year of the Pandemic
Authors: Allen Upton D , Barton Michelle , Upton Julia , Bailey Annette , Campigotto Aaron , Abdulnoor Mariana , Julien Jean-Philippe , Gubbay Jonathan , Kissoon Niranjan , Litosh Alice , Wong Peter , Allen Andrew , Bailey Renee , Byrne Walter , Hwang Matthew , Phillips Chantal , Polack Alicia , Prescod Cheryl , Thompson Kimberly , Thompson Sylvanus , Wisener Nicole , James Carl
Published: November 2023

Background

Black North American communities have been disproportionately affected by COVID-19. These data have been largely based on case counts, hospitalizations and mortality data. Serologic testing enables a more complete determination of infection burden by documenting infection in persons with symptomatic as well as asymptomatic infection. We used serologic testing to determine the extent to which SARS-CoV-2 had penetrated into the Black community. We examined risk factors associated with seropositivity, including the presence of medical comorbidities and the social determinants of health.

Methods

We conducted a cross-sectional survey in a COVID-19 high-prevalence zone in Ontario along with 2 areas that have lower rates of COVID-19 cases. SARS-CoV-2 IgG antibodies were determined using the EUROIMMUN assay. The study samples were collected between August 15, 2020, and December 15, 2020 prior to the deployment of COVID-19 vaccines. Proportions were compared using Fishers Exact test or chi-square; potential risk factors were examined using a multiple logistic regression approach.

Results

Among 387 evaluable subjects, the majority, 274 (70.8%) were enrolled from northwest Greater Toronto Area (GTA) and adjoining suburban areas of Peel, Ontario with a high proportion of Black residents. The seropositivity rates for the lower prevalence areas (Oakville and London, Ontario) were comparable (3.3% (2/60; 95% CI 0.4-11.5) and 3.9% (2/51; 95% CI 0.5-13.5), respectively). The seropositivity rate for the northwest GTA was 12.6% (26/206); RR 3.5, 95% CI 1.3-9.8). Persons under the age of 19 years had the highest seropositivity rate (10/50; 20.0%, 95% CI 10.3-33.7%). Front-line workers were greater than 3 times more likely to be seropositive compared with non-frontline workers (13.0 vs 3.2%; p=.01; RR 3.3 (95% CI 1.3 – 8.3). There was an interaction effect between race and location of residence as this relates to the relative risk of seropositivity.

Conclusion

During the pre-vaccine phase of the COVID-19 pandemic, the seropositivity rate for SARS-CoV-2 within a COVID-19 high-prevalence area was 3-fold greater than lower prevalence areas of Ontario, Canada. The data help to define the burden of COVID-19 within a community with a high proportion of Black residents compared with other communities.

Disclosures

All Authors: No reported disclosures
1825. Project ECHO HIV: Engaging Clinicians to Address Substance Abuse, Interpersonal Violence, and Depression in Patients with HIV
Authors: Beals Dean K , Pogroszewski Stan , Anderson Jean , Livingston Alison
Published: November 2023

Background

Finding the Invisible Patient (FIP): Substance abuse (SA), interpersonal violence (IPV), depression and HIV are part of overlapping epidemics adversely affect HIV and the burden of each (SAVA). The Johns Hopkins HIV Women's Clinic (JHWC) initiated screening for SAVA to better identify these problems, link to needed services and evaluate the impact. Challenges included time and impact on clinic flow; need for clinic wide training and sensitization and a systems approach. SAVA Project ECHO- FIP took the learnings from FIP and expanded it to ten small groups across the US in order to enhance the reach and share the learnings

Methods

FIP: Education and a series of clinic-wide changes were implemented at JHWC. Patients were now routinely screened for SAVA. and if positive sent for care. Resources were developed for patients including linkage to local assistance programs, temporary housing, posters on bathroom doors and emergency contacts. SAVA Project ECHO- FIP featured expert specialists to provide ongoing telementoring to clinicians through regularly scheduled educational sessions over five weeks. There were ten separate workshops, each covering a 5-part curriculum.

Results

FIP: Of 116 women 60% were + for SAVA. Six months post-intervention, 56% were engaged in care; 39% were given a referral for psych/SUD/IPA therapy; 50% entered psychologic therapy; 28% entered substance abuse treatment; 39% for mental health issues. SAVA Project ECHO- FIP trained 208 clinicians to become experts in screening, identifying and treating SAVA. There was a 105% increase in confidence on identifying and treating SAVA and a 177% improvement in competence. Clinicians shared insights around building relationships with their patients and utilizing local community-based programs to help patients overcome SAVA.

Conclusion

SAVA is common among many women in HIV care and is likely underestimated. There was a significant correlation with + screens and higher no show rates, reflecting increased resources needed to optimize VLS screening for components of SAVA. Screening for SAVA should be routine in HIV care settings. Resources for appropriate referral are critical. SAVA Project ECHO- FIP demonstrated knowledge transfer and practice improvement through its curriculum and small-group engagement.

Disclosures

Jean Anderson, MD, Merck & Co: Stocks/Bonds
1832. Rise in Deaths from Firearm Injury and Drug Overdose During COVID-19 Pandemic and its Impact on Organ Donation in the United States
Authors: Dhand Roshan , Dhand Abhay , Nishida Seigo , Okumura Kenji
Published: November 2023

Background

COVID-19 pandemic had profound societal impact in United States (US) with decrease in overall life expectancy and associated increase in polysubstance abuse.

Methods

Crude rates of population-based deaths among adults (18-75 years) from firearm injury and drug overdose were obtained from centers of disease control (CDC) WONDER database from period of 2011- 2021. Crude rates of underlying causes of donor (18-75 years) deaths from 2011- 2021 were obtained from United Network for Organ Sharing (UNOS) database. Trends of cause of death and impact of COVID-19 period on deaths from drug overdose and firearm injury were analyzed using joint point regression analysis. Correlation between population and organ-donor deaths was analyzed using spearman's rank correlation coefficient.

Results

Average annual percentage change (AAPC) in deaths among the US population from drug overdose was 9.5 % and from firearm injury was 3.4%, with the highest ever rates from both causes in the US seen in 2021 (figure 1).

AAPC in cause of death among donors of organs for transplantation was 10.9% from drug overdose and 2.1% from firearm injury (figure 2).

There was a significant progressive increase in deaths from drug overdose (1.48 fold) and firearm injury (1.2 fold) from 2019 to 2021 (P < 0.01).

There was a significant correlation between population and organ-donor deaths from drug overdose and firearm injury during the COVID-19 period of 2020-2021 ( P < 0.01).

rates per 100,000 population

rates per 100,000 population

Conclusion

COVID-19 pandemic has further exacerbated the trends in US population of deaths from drug overdose and firearm injury (including suicide and homicide). There was a consequent increase in organ donation for transplantation from donors who died from these two causes. Identifying socio-economic, regional and racial discrepancies associated with this rise can help guide public health policies for the immediate and long-term future. Unique risk factors, including increased infectious risk, associated with use of organs from these donors and subsequent long-term graft outcomes in the recipients will need to be monitored.

Disclosures

All Authors: No reported disclosures
1838. Determinants of Antimicrobial Resistance among ≤5-Year Children in Low-Income Urban Bangladesh
Authors: Harun Md Golam Dostogir , Sumon Shariful Amin , Abdullah Syed Abul Hassan Md , Islam Md Saiful , Anwar Mahabub Ul
Published: November 2023

Background

Antimicrobial resistance (AMR) is a growing global concern, with the most significant health and financial implications for low- and middle-income countries. Due to irrational and inappropriate use, AMR is rapidly increasing in Bangladesh, especially among low-income urban populations. This study explored the factors for antimicrobial resistance among ≤ 5 years children in low-income urban Bangladesh.

Methods

From February 2018 to April 2019, we did quantitative and qualitative assessments of antibiotic use among urban ≤5-year children. We conducted a cross-sectional survey among 626 low-income urban ≤5-year children's parents in four cities in Bangladesh. We used a semi-structured questionnaire to collect data related to antibiotic use through face-to-face interviews. We also conducted eight focus group discussions among the parents to gather in-depth information on antibiotic use to treat their children. Bivariate and multivariate analysis was done to see the causes and associated factors.

Results

The study identified that 62.9 % (394/626) of parents used antibiotics last year to treat their children. More than half (52.7%) of the parents bought antibiotics from local drug stores without a prescription. 46.5% (291/626) of the parents stopped antibiotics soon after the symptom disappeared, and 62.6% used leftover antibiotics for similar symptoms. However, 82.9% of parents opined that qualified physicians' advice is important to treat children with antibiotics. Inappropriate antibiotic use was significantly associated with participants' education (p=0.02), family income (p=0.01), and profession (p=0.04). Qualitative investigation revealed the convenience of getting treatment and medicine from the drug store, the financial burden to buy the full course, the distance and waiting time at qualified physicians, and parents' inadequate knowledge were identified as the key causes of irrational antibiotic use.

Pattern of Antibiotic Consumption among ≤5-Year Children in Low-Income Urban Bangladesh

Conclusion

Intervention packages are required to improve parents’ knowledge and awareness on the rational use of antibiotic. Strengthening the health system could enhance the optimum use of antibiotics and combat antibiotic resistance. Antibiotic dispensing, prescription, purchase, and selling policy required with enforcement of the policy to reduce AMR.

Disclosures

All Authors: No reported disclosures
1845. Integrating Infectious Diseases and Primary Care Providers in a Syringe Service Program in Chicago to Improve Access to Care for People with Substance Use Disorder
Authors: Knodle Ryan D , Chaisson Lelia H , Cotler Karen F , Huyck Michael , Messmer Sarah , Mayer Stockton
Published: November 2023

Background

People with substance use disorders (SUD) are at elevated risk of infectious diseases (ID) but have low uptake of preventive and primary care (PC) due to structural, social, and behavioral barriers to care. Syringe service programs (SSP) are established, trusted sources of care; expanding health care provided through these programs may result in improved health for this population. We aimed to assess uptake of services from a pilot program in Chicago that offered PC, ID consultation, and harm reduction services.

Methods

PC and ID providers were embedded in the SSP to provide routine PC and preventive health services to patients seeking harm reduction services referred by outreach workers with lived SUD experiences. For this analysis, we reviewed all clinical encounters occurring from 10/19/2018-12/31/2021. We assessed patient demographics and visit types and determined the number of encounters for those with and without SUD. We compared characteristics of encounters for individuals with and without SUD using Chi-squared tests and Wilcoxon rank sum tests.

Results

During the study period, a total of 552 patients had 1720 clinical encounters (median 1 per patient, range 1-44). Overall, 390 (70.7%) patients were male, median age was 43 years (IQR 19-71), and 415 (75.2%) had public insurance (Table 1). A higher proportion of those who had a visit for SUD had public insurance compared to those without SUD (79.6% vs 67.2%, p=0.003).

Of the 1720 encounters, 1227 (71.3%) included care for active SUD, of which 402 (23.4%) addressed infections often associated with SUD (Table 2). Encounters for HIV and hepatitis C virus made up 20% of all encounters. PC services were rendered at 910 (52.9%) encounters and 625 (36.3%) encounters included services for both SUD and PC. Those without active SUD were more likely to have encounters for PC (61.7% vs 49.4%, p< 0.001) and infections (50.7% vs 27.1%, p< 0.001) than those with active SUD.

Conclusion

Incorporating ID and PC services in an established SSP was effective for engaging vulnerable populations in Chicago, including people with SUD, with nearly half of all encounters among people with SUD including PC services. Integration of ID and PC within SSPs should be scaled-up to improve access to care, especially given the burden of infections in this population.

Disclosures

All Authors: No reported disclosures
1857. Why do antibiotic become resistant in hospitalized patients? Evidence from tertiary healthcare facilities in Bangladesh
Authors: Sumon Shariful Amin , Chowdhury A B M Alauddin , Sharmin Sabrina , Harun Md Golam Dostogir
Published: November 2023

Background

Antibiotic resistance among hospitalized patients is a growing concern due to irrational antibiotic consumption. Exploring the dynamics of antibiotic consumption including healthcare-seeking behavior is indispensable to minimizing the antibiotic resistance burden. This study explored the pattern of antibiotic consumption and healthcare-seeking behavior of patients before being admitted to tertiary hospitals in Bangladesh.

Methods

Between August and September 2022, we conducted this cross-sectional study in four tertiary care ( 2 public and 2 private) hospitals. A total of 943 admitted patients were randomly enrolled and face-to-face interviews were conducted to obtain data on antibiotic usage history, healthcare-seeking patterns, and duration of medical consultation. Descriptive statistics were used for the analysis and interpretation.

Results

Prior to hospitalization, 32.8% (95%CI: 30.5, 35.1) of patients had antibiotic consumption history within the previous two months without lab confirmation. About one-quarter (25.6%) of the participants sought antibiotic treatment from unregistered physicians. Patients admitted to private hospitals were found to be higher to seek treatment from unregistered sources compared to public hospitals (37.8% vs. 13.4%, p-value: 0.001). Less than two-thirds (63.8%) of patients completed their entire course of antibiotics before admission to the hospitals. The average duration between symptom onset and medical consultation was 5.6 (SD 1.3) days before hospitalization. In terms of place for healthcare seeking, the majority of participants (52.0%) visited government hospitals, followed by private hospitals (22.6%), and pharmacies (20.1%). Self-medication was found in 5.3% of participants before being admitted to the hospital. However, 72.2% of patients were prescribed antibiotics after admission and only 5.3% had a laboratory diagnosis before receiving antibiotics.

Conclusion

Hospitalized patients were found to consume antibiotics more frequently before and after admission. Furthermore, healthcare seeking from unregistered sources, including delayed and incomplete treatment could hindrance to combating against antibiotic resistance among admitted patients.

Disclosures

All Authors: No reported disclosures
1859. Median Income by Location of Residence and Clinical Outcomes of Hospitalized Persons with COVID-19 in an Urban Veterans Affairs Medical Center
Authors: Tuck Matthew , Rivasplata Heather , Towers Steven , Liappis Angelike P , Arundel Cherinne , Dinescu Anca , Hamidi Zachariah , Alaithan Haitham , Uppal Surabhi , Patel Pratish C , Khosla Shikha , Simmens Samuel , Benator Debra A
Published: November 2023

Background

The COVID-19 pandemic has disproportionately affected racial and ethnic minorities and those of low socioeconomic status, including higher rates of illness severity and death. This has been attributed in part to decreased healthcare access. We sought to determine whether place of residence as a marker of socioeconomic status, healthcare access, and median income were predictive of disease severity in a large integrated healthcare system.

Methods

We conducted a prospective observational cohort study of ­348 patients admitted to the hospital with a diagnosis of COVID-19 between March 1, 2020 through June 30, 2021. Using univariate and multivariable logistic regression, we evaluated associations of disease severity outcomes with demographic characteristics of veterans, age-adjusted Charlson Comorbidity Index (CCI), and median income by place of residence.

Results

< The mean age of our cohort was 68 and 90% were male. The racial and ethnic makeup was 83% black, 14% white, 5% Hispanic or Latino, and 3% other. In unadjusted models, only median income and the CCI predicted need for high-flow oxygen (p = 0.009 and p < 0.0001, respectfully) and death (p = 0.04 and p = 0.0005, respectively), while the CCI also predicted the need for intubation (p = 0.02). In multivariable models, CCI was strongly associated with the need for high-flow oxygen, intubation, and death (p = 0.0001, 0.01, and 0.02, respectively); age alone remained the most powerful predictor of death. Race and ethnicity were not associated with the need for high-flow oxygen, intubation, or death. Place of residence was not associated with worse outcomes.

Conclusion

This cohort study of hospitalized patients in an urban Veterans Affairs Medical Center found that race, ethnicity, and location of residence were not associated with COVID-19 disease severity and death, but median income and higher scores on the CCI predicted worse outcomes.

Disclosures

Pratish C. Patel, PharmD, BCIDP, AAHIVP, VBI Vaccines: Stocks/Bonds
1867. Clinical Presentation and Outcome of Tuberculosis in Patients with Chronic Kidney Disease Stage 4 and 5: A Retrospective Cohort Study from a TB Endemic Country
Authors: Babar Zaheer Udin , Dodani Sunil Kumar , Nasim Asma , Badlani Sanjay Kumar
Published: November 2023

Background

Patients with chronic kidney disease (CKD) have high risk of developing TB and numerous studies have been done on presentation and outcome of both conditions. However there is a lack of data on regional burden of TB in this group of population. We set out to study on clinical presentation and treatment outcome of TB in patients with moderate to severe renal impairment from a large renal and dialysis center.

Demographics and microbiological characteristics of Tuberculosis in patients with CKD

Risk factors of mortality in patients with TB and CKD

Methods

This is a retrospective cohort study included all patients with CKD stage 4 and 5 and diagnosed active TB from May 2016 till June 2020. Transplant recipients were excluded. TB diagnosis was made as pulmonary tuberculosis (PTB), extra pulmonary TB (EPTB) and disseminated TB (DTB). Primary outcome was measured as treatment successfully completed, lost to follow up, all-cause mortality. Our secondary outcome was to evaluate microbiological characteristics and drug resistant pattern in PTB and EPTB.

Microbiology of mycobacterium TB in CKD patients

Characteristics of EPTB

Results

A total of 259 patients with stage 4-5 CKD of all age groups were identified. Mean age of study population was 34.68 +16.7 and a higher proportion of EPTB than PTBTB (61% and 37.1% respectively). Diagnosis of TB in majority of patients 118 (45.51%) were microbiological based and 46 (17.8%) isolates found to have culture positive among those, 16 (34.78%) were resistant to either single (26.08%) or multiple TB drugs (8.69%). Out of 259, 38 (14.7%) patients died during treatment and 12 (4.6%) patients lost to follow up. Our treatment success rate (treatment completed and cured) was 80.7%.

Conclusion

We have made few important observations such as diagnosis EPTB as predominant from in CKD. We have made microbiological based diagnosis in around half of our patients. Drug resistance and mortality was found to be high.

Disclosures

All Authors: No reported disclosures
1872. Risk factors associated with gaps in screening and testing for latent TB infection 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 treated for latent TB infection (LTBI) to prevent progression to TB disease, but there are gaps in screening and testing for LTBI. We evaluated demographic and clinical factors associated with LTBI screening and testing at a Federally Qualified Health Center in Oakland, California.

Methods

We extracted demographic, clinical and note data from the electronic health records of all well-patient visits of children and adolescents 1-19 years old without a history of LTBI or TB disease from 2014 – 2020. Screening was defined as documenting the presence/absence of new TB risk factors, and testing was defined as ordering/completing a tuberculin skin test (TST) or QuantiFERON-TB Gold blood test (Quantiferon Gold). We performed multivariable logistic regression to determine the factors associated with conducting a TB risk assessment, ordering LTBI testing, and completing LTBI testing.

Results

We evaluated 18,681 visits, of which 38% were age 1 – 4, 50% were female, and 19% preferred a language other than English. Overall, 90% of visits documented a TB risk assessment, of which 8% had a risk factor for TB infection. Only 26% visits with a documented TB risk had a TB test subsequently ordered. 82% of ordered tests were completed. We found that children 1 – 4 years old were more likely to be screened for TB risk factors than adolescents ≥12 years (aOR 7.87, 95% CI 6.77 – 9.13, p < 0.01), but adolescents were more likely to be tested (aOR 1.74, 95% CI 1.12-2.66, p < 0.05). Non-English-speaking patients were more likely to be assessed for TB risk factors and were more likely to have an LTBI test ordered (Table 1). LTBI testing was more likely to be completed in females (aOR 5.08, 95% CI 1.75 – 14.70, p < 0.01) as well as when TST was ordered compared to Quantiferon Gold (aOR 24.15, 95% CI 8.17 – 71.42, p < 0.01).

Conclusion

Gaps in the LTBI care cascade for children were associated with age, sex and language preference, and interventions are needed to improve LTBI care in these groups. Further efforts are needed to address barriers to Quantiferon Gold completion in children.

Disclosures

All Authors: No reported disclosures
1875. Factors associated with unfavorable tuberculosis treatment outcomes, Almaty, Kazakhstan, 2018-2021
Authors: Gabdullina Malika , Gazezova Saya , Ayapova Gulzhan , Smagul Manar , Horth Roberta , Nabirova Dilyara
Published: November 2023

Background

The COVID-19 pandemic negatively influenced the availability of TB related services around the world, including detection, diagnosis and treatment. The purpose of this research is to assess the impact of the COVID-19 pandemic on TB treatment outcomes in Almaty, and to determine risk factors associated with said outcomes by examining data from before (2018-2019) and during the pandemic (2020-2021).

Methods

We conducted a retrospective cohort study among all people newly diagnosed with drug-sensitive tuberculosis over 18 years old who initiated treatment from 2018-2021 in Almaty. We abstracted data from the national tuberculosis electronic database. Unfavorable treatment outcomes were sorted as follows: ineffective treatment, death, loss for follow-up, results not evaluated, and transferred for treatment with second-line anti-TB drugs. We used multivariate Poisson regression to calculate adjusted relative risk [aRR] and 95% confidence intervals [95%CI].

Risk factors associated with TB treatment outcomes among people newly diagnosed with drug-susceptible TB, Almaty, Kazakhstan, 2018-2022

Results

Among 1548 people newly diagnosed with TB during the study period, average age of was 43 years (range 18-93) and 52% were male. A higher proportion of people had unfavorable outcomes during the pandemic (2020-21) than before the pandemic (2018-19) (20% vs 11%, respectively, and aRR=1.8; CI: 1.4-2.2). Among those with unsuccessful outcomes, 1% were lost to follow-up, 3% had treatment failures, and 9% died. Risk factors for unfavorable TB treatment outcomes were: being male (aRR=1.4, 95%CI=1.1-1.8), having HIV (aRR=2.4, 95%CI=1.8-3.3), having drinking disorder (aRR=2.3, 95%CI=1.6-3.3) and experiencing homelessness (aRR=2.6, 95%CI=1.5-4.3) (Table 1). Protective factors for unfavorable TB treatment outcomes were: being 18-39 years old (aRR=0.4, 95%CI=0.3-0.6), 40-59 years old (aRR=0.6, 95%CI=0.4-0.8), and being student (aRR=0.1, 95%CI=0.02-0.9).

Conclusion

COVID-19 pandemic was associated with unfavorable treatment outcomes for people newly diagnosed with drug-sensitive tuberculosis in Almaty, Kazakhstan. People with lower social stability were at increased risk. Results point to the need for improved continuity of care for TB treatment for people at increased risk of unfavorable outcomes, especially during disease outbreaks and pandemics.

Disclosures

All Authors: No reported disclosures
1885. Resultados clínicos del tratamiento antituberculoso en pacientes oncológicos entre 2011-2022 en Cali Colombia
Authors: Montes-Tello Sofía Alexandra , García-Goez José Fernando
Published: November 2023

Background

Tuberculosis infection represents a clinical challenge despite the fact that treatment can cure 85% of cases because successful outcomes can vary due to other comorbidities such as cancer, during which pharmacological interactions, adverse effects and decreased adherence to treatments are common. This study aims to describe the characteristics and outcomes of patients with active tuberculosis and cancer from a referral hospital.

Methods

A retrospective observational study was conducted, which included patients who were diagnosed with cancer requiring oncological treatment during tuberculosis treatment management, as well as patients who were undergoing oncological management and were diagnosed with active tuberculosis during this process at a referral hospital in southwestern Colombia between 2011-2021.

Results

Fifty-eight patients with tuberculosis and cancer were included. The median age of the patients was 60 years (IQR: 42 – 67), 31% were women and 75% of the cases were pulmonary tuberculosis. Hematological neoplasms accounted for 62% of cases and the intention of oncological therapy was curative in 89% of cases. The most common clinical decision was to administer antituberculous and oncological therapy simultaneously in 46% of cases and the antituberculous regimen was modified in 34% of cases. The success rate of antituberculous treatment was 60% and 28% of cases died.

Conclusion

It is necessary to consider screening for active and latent tuberculosis as a priority in patients with neoplasia diagnoses and ensure prophylactic management.

Disclosures

All Authors: No reported disclosures
1886. Prevalence Of Latent TB Infection Among Critically Ill COVID-19 Population In a Tertiary Teaching Hospital In Mexico
Authors: Montiel Santiago , Valente-Acosta Benjamin
Published: November 2023

Background

Tuberculosis (TB) is the leading cause of death from a single infectious agent. Latent tuberculosis infection (LTBI) is defined as TB infection without clinical symptoms or microbiological evidence. LTBI is a risk factor to later development of active TB. COVID-19 pandemic represents an emerging infectious disease. Immunosuppressants as corticoids and tocilizumab are the standard of care of critically ill COVID-19 patients. Those drugs have previously been shown to increase the risk of developing active TB, especially in patients with latent TB.

Methods

We conduct a cross-sectional study to determine the prevalence of latent tuberculosis infection, through QuantiFERON, in patients who have been hospitalized with severe or critical COVID-19 at the ABC Medical Center in Mexico City-Mexico, from March 2020 to March 2021.

Results

From 1174 records reviewed, a total of 503 patients who have a QuantiFERON® test were included. The prevalence of LTBI in hospitalized patients with severe or critical COVID-19 in our hospital was 10.1% (n=51). Of the total of patients with a diagnosis of LTBI, 82.3% had severe disease and 17.6% had critical illness requiring invasive mechanical ventilation (IMV) and 42 (82%) received corticosteroids and 29 (57%) received tocilizumab.

Conclusion

To the best of our knowledge this is the first report that depict the LTBI prevalence in a cohort of severe and critical COVID-19 patients in a Lower-Middle Income Country. Our prevalence was lower than previously reported global prevalence of LTBI.

Disclosures

All Authors: No reported disclosures
1897. Therapeutic Drug Monitoring in CSF and Plasma in Tuberculous Meningitis:Correlation with Disease Outcome
Authors: Singh Urvashi , Aayilliath Adarsh
Published: November 2023

Background

Tuberculous meningitis (TBM) is a serious form of extra-pulmonary tuberculosis with significant morbidity and mortality. TBM patients are treated with pulmonary tuberculosis regimen, often requiring extension for 1 year or longer. Current study was designed to find any association of CSF and blood levels of anti-tubercular drugs with treatment response in patients with tuberculous meningitis using therapeutic drug monitoring.

Pharmacokinetic Parameters of Rifampicin and Isoniazid in CSF and Plasma

Methods

A prospective observational study was conducted in a tertiary care institute in North India among clinic-radiologically and/or microbiologically diagnosed TBM patients. Plasma and CSF levels of anti TB drugs (rifampicin, isoniazid, pyrazinamide and ethambutol) were determined using Liquid Chromatography Mass Spectrometry technology at 1 week and 1 month (follow up) after initiating treatment. The primary outcome assessed was association of drug levels with treatment response. The secondary outcomes assessed were association of drug levels with treatment duration/alteration, patient demographic profile, comorbidities and adverse effects. Patients were followed-up till treatment completion.

Results

A total of 40 patients with TBM were recruited. All received daily weight-based doses of anti TB drugs. Low Cmax of INH and rifampicin in plasma were observed in 60.5% & 42.1% of observations respectively. In CSF, low Cmax of INH and rifampicin were observed in 77.6% & 82.9% of observations respectively. The concentrations of INH (4 hours after drug intake) during follow up were significantly lower among patients with poor response, at 1 month (p=0.008) & 6 months (p=0.009). Similarly, low Cmax & CSF levels of INH at follow up sampling were significantly associated with poor response at 6 months of therapy (p= 0.022 & 0.042 respectively).

Conclusion

Low plasma and CSF concentrations of isoniazid were associated with a poor response to treatment in patients with TBM. Therapeutic drug monitoring can guide dose modification of ATT to achieve target concentrations in patients with TBM and facilitate optimal treatment outcomes. Higher dose INH can be considered in TBM treatment regimen for better outcome.

Disclosures

All Authors: No reported disclosures