bluuebunny/crossref_metadata_2025 huggingface dataset:
1536. Hepatitis C Care Cascade Before and After Lifted Insurance Restrictions In Birth Cohort and Non-Birth Cohort Patients
Authors: Aleger Nathan , Aleger Nathan , Aleger Nathan , Jenkins Melissa O , Jenkins Meliisa , Gielach Michael , Battle Brittany , Avery Ann A
Published: December 2022

Background

In 2016, the MetroHealth System implemented a system-wide hepatitis C (HCV) screening initiative in novel settings. We previously showed that those born 1945–1965 (birth cohort, BC) had higher rates of linkage to care (LTC) and sustained virologic response (SVR) rates compared to non-BC (not born 1945–1965). Since 2019, restrictions on fibrosis, sobriety and prescriber have been loosened. We hypothesized that gaps in care cascade between BC and non-BC patients (including LTC rates) would lessen in those diagnosed after 2019.

Methods

We compared the HCV LTC rates and care cascade in patients diagnosed from Jan 1, 2016 to June 30 2017 (early group) to those diagnosed July 1, 2019 to Dec 31, 2020 (late group) as well between BC and non-BC patients. We performed logistic regression to evaluate the impact of race, gender, known prior HCV positivity, site of HCV diagnosis, HIV, insurance, active injection drug use (IDU), remote IDU, psychiatric disorder, BC status and early/late diagnosis on LTC.

Results

The study population comprised 2103 HCV+ patients (1349 non-BC, 754 BC). There were 1026 patients in the early group and 1077 patients in the late group. 1353 patients were HCV RNA+. Of those, 914 (67.6%) were white, 306 (22.6%) African American; 872 (64.4%) male; 990 (74.5%) Medicaid; 822 (60.7%) outpatient diagnosis. On multivariable analysis, factors affecting.

LTC were: BC (aOR 1.71, 95%CI 1.19–2.45, p=0.003); diagnosed inpatient (aOR 0.45 (0.32–0.66), p< 0.0001), emergency department (aOR 0.55, (0.35–0.89), p=0.0142) or jail (aOR 0.23, (0.13–0.4), p=0.23); active IDU (aOR 0.22, (0.14–0.35),p< 0.0001); remote IDU (aOR 0.60, (0.4–0.89)p=0.01); and diagnosis in the late group (aOR 0.67, (0.51–0.8), p=0.005). The care cascade improved in the late group, but gaps remained in non-BC vs BC (Table).

Conclusion

The non-BC continued to have lower rates of LTC compared to BC in the late group.Overall LTC was decreased in the late group for both non-BC and BC likely due to COVID-19. However, improvement in medication approval was shown in the late group, and most patients who were prescribed treatment completed it. Active IDU remained a barrier to non-LTC, but did not fully explain the differences between BC and non-BC patients.

Disclosures

Melissa O. Jenkins, Meliisa Jenkins, Gilead Sciences: Grant/Research Support.
1165. Ascertainment of anthropometric thresholds to identify glucose intolerance in HIV-endemic African populations: results from a population-based survey in rural KwaZulu-Natal, South Africa
Authors: Castle Alison , Siedner Mark
Published: December 2022

Background

Improved screening and diagnostic algorithms are needed to achieve 2030 targets proposed by the Global Diabetes Compact. We sought to explore anthropometric thresholds to optimally screen and refer individuals for glucose intolerance testing in an HIV-endemic rural South African population.

Methods

We analyzed data from the cross-sectional Vukuzazi study that enrolled adults living in rural KwaZulu-Natal, South Africa. We assessed screening thresholds for waist circumference (WC), body mass index (BMI), and waist hip ratio (WHR) to detect glucose intolerance (hemoglobin A1c >6.5%) using weighted, non-parametric ROC regression analyses. We then assessed the diagnostic validity of traditional obesity thresholds, explored optimal thresholds for the South African population, and fit models stratified by sex, age, and HIV.

Results

In the total cohort (n=17,868), the prevalence of glucose intolerance was 7.8% (95% CI 7.4–8.2) and HIV prevalence was 33.8% (95% CI 33.1-34.5). WC outperformed BMI and WHR in detecting glucose intolerance (males p< 0.001; females p< 0.001). Whereas guideline WC thresholds for females performed well for glucose intolerance (Sensitivity 91% [95% CI 89.5-92.5], positive predictive value [PPV] 14.9%), substantially lower thresholds were needed to achieve acceptable sensitivity and positive predictive values among men. We found significant sub-groups effects by sex and age, but HIV status did not affect WC thresholds for identifying glucose intolerance.

Conclusion

Waist circumference improves anthropometric screening for glucose intolerance in South Africa. Guideline-based WC thresholds are appropriate for females, but male-derived WC cutoffs were optimized at lower thresholds. HIV did not affect the performance of WC thresholds in either sex. In rural African populations, thresholds that maximize specificity and PPV for efficient resource allocation may be preferred.

Disclosures

All Authors: No reported disclosures.
1183. Serotype Prevalence and Antimicrobial Resistance Patterns of Streptococcus pneumoniae in Ecuador
Authors: Salazar Grace Johanna , Galarza Margarita , Soria Carmen , Zurita Jeannete , Salgado Johana
Published: December 2022

Background

Streptococcus pneumoniae is a leading cause of pneumonia and meningitis in the world, and it is under-researched in Ecuador. Reported mortality in this country was 280 cases per year. The national policy of the country established the obligatory application of the pneumococcal vaccine to infants in 2010, but there is no such law for adults. The serotypes' distribution and resistance patterns are unknown. This study aims to describe the serotypes and resistance patterns of Strepcococcus pneumoniae isolations in Ecuador.

Methods

A retrospective study of all positive cultures for Streptococcus pneumoniae (blood, other sterile liquids, respiratory, ocular, and ear samples) was conducted in three hospitals and one reference laboratory in Ecuador. Serotype data, E-test results for penicillin and ceftriaxone, resistance patterns and susceptibility to other antibiotics by the Kirby-Bauer test were collected.

Results

A total of 214 samples were evaluated: 18.8% (39) were tracheal secretions, 36.7% (76) sputum, 5.7% (11) cerebrospinal fluid, 17.4% (36) blood, 2.9% (6) pleural fluid, and 27.9% (37) others: ocular, abdominal, and ear secretions.

A wide distribution of serotypes was observed. The most prevalent were 19A, 14 and 3.

Figure 1 shows penicillin resistance increased per year. However, 93,3% (166) of the strains were ceftriaxone susceptible and 100% of the isolates tested showed susceptibility to vancomycin. Susceptibility to levofloxacin was 99.2%; only one isolate was resistant. No microorganism tested for linezolide was resistant. For other antibiotics, a high level of resistance was identified; 69.3% (54) for trimethoprim sulfamethoxazole, 47.5% (107) for erythromycin and 37.6% (104) for clindamycin. Figure 1.S. pneumoniae penicillin susceptibility percet by year in Ecuador

Conclusion

It is important to know the resistance patterns and serotypes of S. pneumoniae for therapeutic and epidemiologic decisions. In countries with more than 12% ceftriaxone resistance to Streptococcus pneumoniae, it is suggested for use as an empiric vancomicyn. Nowadays, in Ecuador, the resistance patterns don’t apply to extended vancomycin use. We do not recommend the empirical use of trimethoprim sulfamethoxazole, macrolides and clindamycin for S. pneumoniae infections.

Disclosures

All Authors: No reported disclosures.
1184. Structural Characteristics of Alcohol Venues are Associated with Positive HIV Test Results in Rural KwaZulu-Natal, South Africa
Authors: Norton Sarah , Morojele Neo , Friedland Gerald , Moll Tony , Shenoi Sheela
Published: December 2022

Background

The HIV epidemic in South Africa is among the largest in the world with a prevalence of 20% among adults. The South African National Strategic Plan recognizes the need to address social and structural barriers to HIV prevention, as well as sociocultural and behavioral drivers, including alcohol abuse. Alcohol venues (AVs) are important social venues, yet few studies have explored structural factors contributing to HIV risk. We sought to evaluate the relationship between structural characteristics of AVs and HIV status of patrons.

Methods

The study was conducted in rural Msinga, South Africa where, as part of a community-based approach, education, counseling and HIV testing was offered at a convenience sample of AVs. Nested within this study, staff completed a structural characteristic checklist of the AVs where testing occurred. Categorical analyses evaluated the association between structural characteristics and positive HIV results.

Results

Of the 488 individuals tested at 46 AVs, 43 (8.8%) were seropositive. The majority of AVs were rural (71.7%), along a gravel road (43.5%), un-registered (56.5%), informal (73.9%), lacked a liquor license (58.7%), were well-maintained (78.3%), single rooms (84.1%) with lighting (97.8%), make-shift seating (62.2%), and adjacent to outdoor space (65.8%). Sound systems (41%) and bathrooms (37%) were less common. Preventative health signage for under-age drinking (26%), smoking cessation (8.7%) and HIV prevention (2.2%) were rare. Several AVs employed women to work behind the bar; security guards and DJs were less common. Higher HIV prevalence was significantly associated with AVs that were well-maintained (p=0.008), in town (p=0.006) compared to remote, had an indoor toilet (p=0.004), discrete gender bathrooms compared to a single bathroom (p=0.003), and a security guard present (p=0.047).

Conclusion

Higher HIV prevalence was associated with certain structural characteristics of AVs. Further research is needed to understand social dynamics within AVs and how these structural characteristics facilitate risk behaviors to inform community-based interventions that can address HIV risk.

Disclosures

Sheela Shenoi, MD MPH, Merck: My spouse worked for Merck 1997-2007 and retains stock in his retirement account. There is no conflict with the work presented in the abstract.
1194. Efficacy of shortened high-level disinfection (HLD) protocols for GI duodenoscopes with disposable tips used for endoscopic retrograde cholangiopancreatography (ERCP)
Authors: Warren Bobby G , Muralidharan Sriya , Brown HannahSofia , Barrett Aaron , Graves Amanda M , King Carly , Mohammed Fahad S , Triplin Carlos , Anderson Deverick J , Seidelman Jessica , Smith Becky A , Dufault Darin
Published: December 2022

Background

The most efficient combination of manual washes (MW) and high-level disinfection (HLD) cycles for the reprocessing of duodenoscopes used for ERCP is unknown. The FDA recently announced the national recommendation for transition to duodenoscopes with disposable components.

Methods

We studied contamination of Pentax Medical duodenoscopes with disposable tips used for ERCP. Duodenoscopes were cleaned and disinfected following removal of the disposable tip. First, one manual wash was performed with detergent and brushes that fit into the suction channel, air/water valves, cylinder, and elevator chamber. Afterward, the duodenoscope underwent HLD with an automated endoscope re-processor. Our study evaluated the success of an abbreviated cycle of one MW followed by one HLD (MW-HLD) cycle compared to a pair of MW-HLD cycles.

Each duodenoscope was sampled in 4 locations after the first MW-HLD cycle and the second: 1) The elevator tab, 2) elevator channel distal opening, 3) composite duodenoscope tip, and 4) the elevator channel (Figure 1). Samples 1-3 were collected with flocked swabs. Swabs were plated on routine medias for relevant enteric pathogens. The 4th was collected by flushing 25 mL of neutralizing buffer through the elevator channel, then scrubbing the channel with a brush, followed by another 25 mL flush. The 50 mL eluent was vacuum filtered through a 0.22-micron filter and plated on TSA. Antibiotic resistance was assessed via PCR. CFU and proportion of contaminated scopes were compared between MW-HLD cycles.

Results

46 duodenoscopes were sampled from September 2021 through March 2022 resulting in 92 sample events and 368 total samples. After one MW-HLD cycle, 19 of 46 (41%) duodenoscopes remained contaminated, including 5 (11%) with VRE (Table 1). After two MW-HLD cycles, 11 (24%) remained contaminated and 0 (0%) with VRE (p=0.08, 0.02, respectively). Results were similar at the sample location level (p=0.03, 0.01, respectively).

Proportion of duodenoscopes contaminated with any flora and Vancomycin-resistant Enterococcus spp.

Conclusion

Our data demonstrate that 1 MW-HLD cycle is insufficient at decontaminating duodenoscopes with disposable tips but do support the use of two MW-HLD cycles. VRE was identified after one MW- HLD cycle, but not after two MW-HLD cycles. Further studies are needed to determine the optimal combination of MWs and HLDs while minimizing HLD staff time.

Disclosures

All Authors: No reported disclosures.
1575. Screening Plus Outreach Versus Referrals to Identify Patients for Outpatient COVID Medications
Authors: Parzen-Johnson Simon L , Sun Shan , Patel Sameer
Published: December 2022

Background

Scarcity of therapeutics to treat Coronavirus Disease 2019 (COVID-19) during the surge in cases caused by the Omicron variant raised concerns that structural inequities would decrease access to these medications for racial minorities and patients with lower socioeconomic status. We hypothesized that screening plus outreach would increase identification of eligible patients in these vulnerable patient populations when compared to referrals alone.

Methods

A retrospective cohort study of COVID medication allocation was performed at a quaternary pediatric medical care facility between 1/1/22–2/15/22. The two cohorts were patients referred for COVID therapy and patients identified via screening followed by outreach. Screening plus outreach included daily review of laboratory reports for new positive cases of SARS-CoV-2, followed by chart review for high-risk conditions, and communication with providers or directly with eligible patients to offer therapy. Demographic characteristics, chronic medical conditions, socioeconomic parameters, and medication receipt were compared between the two groups.

Results

Overall, 51 and 94 patients were identified via referral and screening plus outreach, respectively. Thirty-two patients received medication of which eight (25%) were identified by screening plus outreach alone. Compared to referred patients, patients in the screen plus outreach group were more likely to have moderate, low, or very low childhood opportunity index (COI) scores (74.5% vs 52.9%%, p = 0.009); public health insurance (69.1% vs 37.5%, p < 0.001); asthma/obesity (63.8% vs 21.6%, p < 0.001), and race/ethnicity other than White, Non-Hispanic (79.8% vs 54.9%, p = 0.002). Patients in the referral group were more likely to receive medication (47.1% vs. 8.5%, p < 0.001).

Conclusion

Compared to referral, screening plus outreach for COVID medications can increase identification of patients who are racial minorities, have asthma/obesity, and have lower socioeconomic status. Future studies should investigate communication strategies to improve uptake of these medications after outreach.

Disclosures

All Authors: No reported disclosures.
1207. Epidemiology and Timing of Infectious Complications from Battlefield-Related Burn Injuries
Authors: Geringer Matthew , Stewart Laveta , Shaikh Faraz , Carson Leigh , Lu Dan , Cancio Leopoldo C , Gurney Jennifer M , Tribble David R , Kiley John L
Published: December 2022

Background

Thermal injury alters the host response, making burn patients more susceptible to infections. In fact, infections represent the most frequent complication and cause of mortality in burn patients. We describe the epidemiology, clinical characteristics, timing, and outcomes of infections among wounded military personnel with burns.

Methods

Data were collected through the Trauma Infectious Disease Outcomes Study, an observational study of US service members injured in Iraq and Afghanistan (6/09-12/14). Patients who sustained ≥1 burn injury and were admitted to the Burn Center at Brooke Army Medical Center were included in the analysis. Infections were defined using standardized criteria. For patients with multiple infections, only the initial infection was assessed.

Results

Among 144 burn patients, 99% were males and 62% had combat-related burns with a median total body surface area (TBSA) of 6% (IQR 3-14%) thermally injured. Infections were diagnosed in 26 (18%) patients with pneumonia being the predominant initial syndrome (N=16, 62%), followed by skin and soft-tissue infections (N=6, 23%), bloodstream infections (N=3, 12%), and intra-abdominal infections (N=1, 4%). Median number of days to each of these initial infecting syndromes were 4 (IQR 3-5), 7 (IQR 4-12), 7 (IQR 6-7), and 17 (IQR 17-17) days, respectively. Patients with infections were more severely injured with greater TBSA (median 31 vs 5) and Baux scores (median 59 vs 29), and were more likely to have combat trauma, inhalation injury, require mechanical ventilation, and have longer time to definitive grafting (Table 1). Microbiology of initial infections varied with 35% of patients having polymicrobial infections (Table 2). Gram-negative organisms were recovered from 20 (77%) patients, of whom 20% had a multidrug-resistant Gram-negative. Gram-positive organisms and fungi were identified in 42% and 8% of patients, respectively.

Conclusion

Improved understanding of risk factors and the timing of infections in this unique population is critical for effective management. Patients with infections were more severely injured, had higher rates of inhalational injury, and longer days to definitive grafting. Initial infections were more commonly pneumonia.

Disclosures

David R. Tribble, DrPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.
1210. A Lean Six Sigma Approach to Improving Accuracy of Manual Hand Hygiene Observations
Authors: Drees Marci , Bonis Kathleen , Coles Krystal , Emberger John , Littleton Lauri , Mirage Mark , Mount-Campbell Austin , Briody Carol
Published: December 2022

Background

Hand hygiene (HH) is widely regarded as the most important factor in preventing transmission of infections. Since 2012 our health system has utilized unit-based direct observation to measure HH compliance. Although direct observation is widely used and considered gold standard, the discrepancy between unit-based HH compliance (UB-HH) and Infection Prevention validation HH audits (IP-HH) was increasing over time. To understand the drift in HH compliance, we began a Lean Six Sigma (LSS) Green Belt project to improve UB-HH observation accuracy.

Methods

The IP LSS Green Belt team included nursing, respiratory care, and human factors, and analyzed factors leading to inaccurate UB-HH using LSS tools including the Voice of the Customer, process mapping, fishbone diagrams, and failure modes and effects analysis. We updated HH observer web-based education; implemented a new process to ensure observer training; and eliminated unit report card penalties for poor UB-HH. We implemented a new, more accessible observation tool, which provides a dashboard for real-time access to HH results by all staff. IPs began weekly validation HH audits.

Results

Baseline data revealed a 34% discrepancy between UB-HH and IP-HH compliance (95% vs 61%) over 4 different monthly validation events; only 27% of observers had completed web-based training. Goal conflicts were discovered: units were penalized for poor HH, yet the observations were unit level self-report. These results prompted design changes to the online tool and the process flow of UB-HH observation; units implemented the new program sequentially between 9/20 and 12/20. These changes resulted in 99% of observers being web-trained; however, between 10/21-3/22, UB-HH compliance averaged 98% (n=19,940), while IP-HH compliance averaged 53% (n=579) (difference, 45%).

Conclusion

Using multidisciplinary process improvement, we enhanced our manual HH observation processes; however, no improvement in HH accuracy was observed. Unit-based staff, who lack dedicated time for HH observation, are biased to document HH compliance over non-compliance, even with recent re-training in non-biased HH observation processes and elimination of penalties. To improve HH accuracy, we recommend either dedicated neutral HH observers or automated systems.

Disclosures

All Authors: No reported disclosures.
1214. The Effects of Modified Personal Protective Equipment (PPE) Protocols on Healthcare Personnel Providing Patient Care During the COVID-19 Pandemic: A Qualitative Assessment
Authors: Chasco Emily E , da Silva Jaqueline Pereira , Jones DeShauna , Dukes Kimberly , Ward Melissa , Herwaldt Loreen
Published: December 2022

Background

Healthcare personnel (HCP) faced personal protective equipment (PPE)-related challenges during the COVID-19 pandemic including supply shortages, additional PPE items, different designs, and modified protocols (PR)/guidelines. We used a human factors engineering- and ethnography-informed approach to qualitatively assess the effects of these challenges on HCP and their PPE use during the pandemic.

Methods

We observed PPE use (e.g., donning/doffing) by HCP caring for patients with COVID-19, those under investigation (PUI), and those with other conditions in 1 acute, 1 intermediate, and 1 intensive care unit at a large Midwestern academic hospital. We conducted mini-interviews with a subset of HCP to clarify observed behavior and identify PPE-related concerns. We captured observation, interview, and additional data (e.g., unit layouts, signage) in structured and unstructured notes. We transcribed and imported notes into MAXQDA and applied a deductive-inductive analytical approach.

Results

From April-July 2021, we observed 188 patient care episodes and conducted 47 mini-interviews. Observations included COVID-19 (n=102), PUI (n=4), and non-COVID-19 (n=82) rooms on varying isolation precautions. PRs related to masks and eye protection changed during the study period and particularly affected donning practices. Other barriers included time-intensive PRs, unclear PR communication, unfamiliar designs, lack of surfaces on which to set supplies while donning/doffing, and inconvenient PPE storage/cleaning locations. We observed recommendation/PR deviations related to PPE use (e.g., exposed wrists, unapproved/no eye protection), cleaning, and signage/storage (e.g., designated “clean” surfaces). HCP reported PPE extended use/reuse, provision of design options, and their own adaptations (e.g., “batching” tasks, modifying PPE) facilitated donning/doffing. New PPE requirements highlighted tensions between HCP comfort and safety; despite this, some wanted to include modified PRs in their routine infection prevention practices permanently.

Conclusion

PPE use barriers and facilitators related to modified COVID-19 PRs have implications for the ongoing pandemic and future respiratory pathogen outbreaks.

Disclosures

Loreen Herwaldt, MD, 3M: • 3M is providing products for one of Dr. Herwaldt’s research studies unrelated to the work reported here.|PDI Healthcare: PDI Healthcare has provided research funding to Dr. Herwaldt unrelated to the work reported in this abstract.
1220. Public Health Investigations of Water-Related Organisms in Neonatal Intensive Care Units—United States, 2014–2022
Authors: Keaton Amelia , Li Ruoran , Glowicz Janet , Stuckey Matthew J , Perz Joseph , Perkins Kiran M
Published: December 2022

Background

Preterm and critically ill infants cared for in neonatal intensive care units (NICUs) are vulnerable to a wide variety of infections. Water use in healthcare settings is a known risk factor for opportunistic pathogen transmission due to the ability of such pathogens to persist in premise plumbing, though facility water risk assessments may also not account for practices within NICUs. We describe Centers for Disease Control and Prevention (CDC) consultations involving NICU patients and water-related organisms to help inform infection prevention and control response.

Methods

We searched internal CDC records from January 1, 2014, through December 31, 2021, to identify consultations involving investigations of potential or confirmed transmission of water-related organisms in NICU settings. We used available information to determine number of consultations and patients affected, most common organisms implicated, and potential exposure pathways and transmission routes.

Results

Of 92 consultations involving NICUs in the United States during the study period, we identified 30 consultations (33%) of water-related organism infections or outbreaks; combined, water-related organisms were isolated from 178 patients during these investigations. Serratia marcescens was the organism reported in the greatest number of investigations (n=10, 33%), followed by Pseudomonas spp. and Burkholderia cepacia complex (each n=4, 13%). Definitive transmission routes were not determined for all consultations, though investigations frequently identified concerns with water use in infant activities of daily living, such as bathing or feeding (n=14, 47%). Examples of such exposures unique to the NICU setting included the use of tap water to remove disinfectant residue from humidified isolettes and storage of supplies rinsed in water in infant bath basins to dry.

Conclusion

Consultations involving water-related organisms are common in the NICU. While clear sources of transmission are not always found, investigations often identified water exposures that may pose infection risks. To protect critically ill infants, hospitals should account for the extensive and unique characteristics of water use in NICUs when developing water management programs.

Disclosures

All Authors: No reported disclosures.
1229. Evaluation of Colorectal and Hip/Knee Arthroplasty Surgical Site Infections at Ocean University Medical Center
Authors: Ismail Omar , Nissim Yosef , Kerr Nancy , Lake Thomas , Dwivedi Sukrut
Published: December 2022

Background

A surgical site infection (SSI) is defined as an infection that occurs up to 30 days after surgery without an implant (or within one year if an implant is placed). The infection also must appear to be related to surgery. In 2021, there were 19 SSIs reported at Ocean University Medical Center (OUMC). These SSIs were associated with colorectal and hip/knee arthroplasty cases. The primary objective of this study is to evaluate appropriate preoperative antibiotic administration based on the type of surgical procedure. Some secondary objectives include the number of preoperative antibiotics administered and the appropriate timing of preoperative antibiotic administration.

Methods

A retrospective observational evaluation was conducted on patients identified to have a SSIs from January 1, 2021, to December 31, 2021. Appropriate preoperative antibiotics were defined as the administration of guideline-recommended antibiotics for the given procedure. Appropriate timing of antibiotics was defined as antibiotics administered within guideline-recommended time frames prior to procedure start time. Descriptive statistics were used to analyze the results.

Results

Of the 19 infections, ten were associated with colorectal procedures, and nine were associated with hip/knee arthroplasty procedures. Patients received preoperative antibiotics in 89% of the surgeries (17 of 19). We found that 71% (12 of 17) of patients received appropriate antibiotics determined by the surgical procedure. Of the five inappropriate antibiotic selection instances, two lacked appropriate bacterial coverage, while the other three covered the suspected pathogens but were not guideline-recommended agents. The timing of preoperative antibiotics was found to be appropriate in 76% of all surgeries. When assessing the overall compliance with antibiotic selection and timing, 58% (11 of 19) of cases followed all guideline recommendations.

Conclusion

This study has identified areas of improvement regarding the antimicrobial selection and timing, documentation process of administration, and the use of order sets to combat inappropriate prescribing of surgical antimicrobial prophylaxis. Educational materials and in-services have been provided at OUMC.

Disclosures

All Authors: No reported disclosures.
1232. Mupirocin Susceptibility of Staphylococcus aureus (SA), 2022: Is It Time for Change in MRSA Decolonization?
Authors: Shah Sonia , Labrecque Sophie , Fergus Diedre , Parry Michael F
Published: December 2022

Background

Nasal decolonization with mupirocin has been a commonly used strategy for the prevention of surgical site infections (SSIs) due to SA. We recently noted an increase in SSIs due to SA despite the use of mupirocin, including a case of post-operative mupirocin-resistant MRSA infection despite intranasal mupirocin. We therefore evaluated the mupirocin susceptibility of SA at Stamford Hospital to determine the optimal regimen for decolonization.

Methods

SA isolates were recovered from clinical and screening samples received in the microbiology laboratory from 8/1/2020 to 2/28/2022. Mupirocin susceptibility was determined using e-tests and a standardized inoculum on Mueller-Hinton agar. Isolates were categorized as “susceptible” (MuS) with minimum inhibitory concentrations (MIC) ≤4 mcg/ml or resistant (MuR) with MIC values ≥8mcg/ml. Resistant strains were further divided into low-level resistance, with MIC values from 8 to 256 mcg/ml, and high-level resistance, with MIC values >256/ml. SA isolates were identified and tested for susceptibility by usual Clinical Laboratory Standards Institute (CLSI) criteria.

Results

223 unique SA isolates from 218 patients were tested. Patients ranged in age from newborn to 94 years. Twenty-four SA isolates (10.8%) were resistant to mupirocin (20 MRSA and 4 MSSA). Of the 24 MuR strains, 19 (79.2%) isolates demonstrated high-level resistance. MRSA strains were more likely to be resistant (22.5% were MuR) than MSSA strains (3.0% were MuR) (p< 0.001). MuR strains did not differ from MuS strains with respect to patient age, sex, race, site of isolation, infected versus colonized, community-acquired versus hospital-acquired or inpatient/out-patient location.

Conclusion

Preventing surgical site infections is challenging. Decolonization with mupirocin nasal ointment has been a common component of preoperative optimization. However, the emergence of resistance would render mupirocin suboptimal and other regimens might be preferred. In our study, less than 80% of MRSA strains were MuS. These findings are concerning and have led us to reevaluate our current decolonization strategy. In patients colonized with MRSA at high risk for infection (e.g. total joint replacement), intranasal povidone iodine may be preferable to mupirocin.

Disclosures

All Authors: No reported disclosures.
1258. B/F/TAF in HIV-Infected Adults with Substance Use Disorders: BASE Week 48 Results
Authors: Havens Josh , Bares Sara H , Lyden Elizabeth , Lyden Elizabeth , Lyden Elizabeth , Podany Anthony , Scarsi Kimberly , Fadul Nada , Swindells Susan
Published: December 2022

Background

People with HIV (PWH) and substance use disorders (SUD) are at higher risk of non-adherence. Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) exhibits high rates of efficacy with a favorable adverse event profile. The BASE study (NCT03998176) is a Phase 4, single-arm study evaluating the effectiveness and safety of B/F/TAF among PWH and SUD.

Methods

Viremic (HIV RNA >1000 copies [c]/mL) treatment-naïve or -experienced PWH and ongoing SUD initiated B/F/TAF once daily for 48 weeks (W). The primary endpoint was HIV RNA < 50 c/mL (FDA Snapshot Algorithm) at W48. Secondary endpoints were safety, adherence (dried blood spot [DBS] levels of emtricitabine-triphosphate [FTC-TP] and tenofovir-diphosphate [TVF-DP]), substance use (NIDA ASSIST) and quality of life (SF-12).

Results

Forty-three participants enrolled; 95% reported methamphetamine use. Median age was 38 years (range: 21-62); 19% female, 81% White, 14% Black, 16% Latinx. At W48, 21 participants (49%) had HIV RNA < 50 c/mL (ITT, Figure 1). Four participants (9%) experienced confirmed virologic failure; none developed treatment-emergent resistance. Seventeen participants (40%) experienced grade ≥3 adverse events; none attributed to B/F/TAF. Five participants reported suicidal ideation; none resulted in discontinuation. Observed mean FTC-TP and TVF-DP concentrations in DBS corresponded to 5-6 doses/week (FTC-TP: >3.6 pmol/7mm punches; TVF-DP: >1733 fmol/7 mm punches; Figure 2). NIDA ASSIST scores declined from baseline, with methamphetamine use decreasing most (-7.9 points; -29%). SF-12 physical/mental scores increased 1.2 and 7.6 points, respectively, but remained below mean US scores.

Longitudinal virologic outcomes, intent-to-treat analysis

Mean observed intracellular emtricitabine triphosphate (FTC-TP) and tenofovir diphosphate (TFV-DP) in dried blood spots at weeks 6, 24, and 48

Thresholds for 2-3 doses/week (Solid Line) and 4-5 doses/week (Dashed Line) are noted for both FTC-TP and TFV-DP based on TAF-DBS data [Yager J, et al. JAIDS, 2020].

Notes: Y-axis represents femtomoles/punches

Conclusion

B/F/TAF among a high-risk population of PWH and ongoing SUD resulted in a 49% viral suppression rate at W48. No emergent resistance was noted supporting the high barrier to resistance provided by B/F/TAF.

Disclosures

Sara H. Bares, MD, Gilead Sciences: Expert Testimony|GSK ViiV Healthcare: Grant/Research Support|Janssen: Grant/Research Support Kimberly Scarsi, PharmD, Organon: Grant/Research Support.
1260. Comparing the impact of six-month antiretroviral therapy dispensing to three- to five-month dispensing on viral load suppression in Kenya and Nigeria.
Authors: Cavanaugh Joseph S , Dear Nicole , Shah Neha , Iroezindu Michael , Bahemana Emmanuel , Kibuuka Hannah , Owuoth John , Maswaii Jonah , Sing’oei Valentine , Hern Jaclyn , Esber Allahna , Crowell Trevor A , Polyak Christina , Ake Julie A
Published: December 2022

Background

Multi-month dispensing (MMD) of antiretroviral therapy (ART) decreases logistical burdens on HIV clinics and patients, which is especially important during the COVID-19 pandemic. HIV programs are scaling-up 6-month dispensing (6MD), but the impact on viral suppression (VS) has not been well-documented in programmatic settings.

Methods

The African Cohort Study (AFRICOS) is an international observational study of people living with HIV (PLWH) receiving HIV care. In Nigeria and Kenya, this includes 6MD. Participants undergo semiannual viral load quantification and were included in analysis if they had complete data, documentation of MMD (self-reported) and at least two follow-up visits after initiating MMD. In stratified analyses for each country, we used multivariable logistic regression with generalized estimating equations to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) comparing VS < 50 copies/mL among those who received 6MD to those given 3-5 months dispensing (3-5MD) of ART. Analyses were adjusted for age, education, employment, distance to clinic, duration on ART, ART regimen (TLD vs other) and self-reported ART adherence (≥ 1 missed dose in past 30 days).

Results

Between January 30, 2020, when MMD data was first collected, and September 1, 2021, 1176 PLWH in Kenya and 272 in Nigeria had at least one visit; 285 participants from Kenya, totaling 442 visits, and 177 participants from Nigeria, totaling 382 visits, met criteria and were included in analysis. At most recent visit, VS < 50 copies/mL was documented in 266 (93.3%) participants from Kenya and 125 (70.6%) participants from Nigeria. Among the 35 participants given 6MD in Kenya, compared to 250 participants given 3-5MD, the aOR for VS was 0.42 (95%CI: 0.13-1.37); among the 91 participants given 6MD in Nigeria, compared to the 86 participants given 3-5MD, the aOR was 3.01 (95%CI: 1.70-5.31).

Conclusion

The positive association between 6MD and VLS in Nigeria, as compared to 3-5MD, should prompt more aggressive scale-up of 6MD. The lack of an association in Kenya merits further investigation, but likely relates to high overall VS and few participants on 6MD. Updated data from specific geographic and demographic sub-populations is needed to inform programming as 6MD is scaled.

Disclosures

All Authors: No reported disclosures.
1261. Do All Patients Prefer Telehealth Care?
Authors: Gudipati Smitha , Lee Monica , Huitsing Joanne , Markowitz Norman , Brar Indira
Published: December 2022

Background

COVID-19 has threatened health care for many individuals. Restriction of resources, redeployment of staff, and patient reluctance to make clinic appointments disrupts continuity of care of existing patients and limits access to care of new ones. To overcome this, our HIV clinic aggressively promoted a telehealth, MyChart (MC) application, and provided smart phone technology to those in need. Despite these efforts, we found that utilization of telehealth accounted for 4.7% of HIV clinic visits, compared to 25% in internal medicine clinics. In this report, we sought to obtain reasons why our patients were reluctant to use telehealth even in the midst of a pandemic.

Methods

All Ryan White (RW) people living with HIV (PLWH) at Henry Ford Hospital that were initiated in our telehealth pilot program were surveyed on the underutilization of MC. Utilization was determined by if PLWH responded to a MC notification sent by the telehealth navigator. Activity level was established on MC (Figure 1), and if PLWH did not respond, they were called as a follow up for survey answers.

Results

From 10/2020 – 01/2022, 206 PLWH were enrolled into our pilot program and given telehealth education. Of those successfully enrolled: 83.7% were black, 73% male, 57% were older than 45 years, 88% lived in Wayne County, and 27 needed and received pre-loaded smart phones. When contacted, 90 (44%) interacted on MC, 61 (29%) were unable to be reached and 55 (27%) successfully completed the survey (Figure 2). When asked why telehealth was not utilized, 27 (49%) stated they preferred in-person visits (Figure 3).

Conclusion

Telehealth programs can help overcome barriers to HIV care and maintain patient engagement when crises interrupt traditional care models. However, our study suggests that our PLWH preferred and felt safe engaging with in-person visits despite telehealth education and smartphone supplementation even in a pandemic. As the future of medicine moves towards telehealth management, we must not forget our vulnerable populations and find opportunities to safely engage with in-person visits.

Disclosures

Indira Brar, MD, Gilead: Grant/Research Support|Gilead: speakers bureau|Janssen: Grant/Research Support|Janssen: speakers bureau.
1263. Dolutegravir/Rilpivirine Switch Study in Persons with HIV and Chronic Kidney Disease: 24-week Assessment of Viral Suppression, Adherence, Treatment Satisfaction and Quality of Life
Authors: Kwakwa Helena , Gaye Oumar , Ruff Julia
Published: December 2022

Background

Single tablet regimens (STRs) improve convenience of administering antiretroviral therapy. However, for people with HIV and chronic kidney disease (CKD), STR options have been limited due to pharmacokinetic considerations. We evaluate the impact on viral suppression, adherence, treatment satisfaction and quality of life (QOL) of switching to dolutegravir/rilpivirine (DTG/RPV) for a cohort with HIV-1 and CKD.

Methods

In this 48-week single arm open label switch study, adults with HIV and a GFR< 60 mL/min/1.73m2, an HIV RNA < 50 copies/mL, and no known prior resistance to DTG or RPV were switched to DTG/RPV STR. HIV RNA and CD4 cell count were monitored quarterly. Standardized adherence, treatment satisfaction and QOL tools were administered at baseline, 24 weeks and 48 weeks. We present 24 week data.

Results

Between August 2019 and December 2021, 35 participants were enrolled. One participant terminated at 19 weeks when his transplant team stopped DTG/RPV due to concerns about potential drug-drug interactions following a kidney transplant. 94% of participants were Black, 57% were female, 94% were > 50 years and 43% were 65 years or older. At baseline, 23% had GFR < 30mL/min/1.73m2 and 55% had a GFR between 30 and 50mL/min/1.73m2. Of the 30 participants who have completed 24 weeks, 97% had an HIV RNA < 50 copies/mL, 67% reported an improvement in medication adherence, 70% noted an improvement in QOL and 77% in treatment satisfaction. There were no serious adverse events.

Conclusion

For this diverse aging cohort with HIV and CKD, DTG/RPV was efficacious, well-tolerated, and associated with improvements in adherence, treatment satisfaction and QOL.

Disclosures

Helena Kwakwa, MD, MPH, ViiV Healthcare: Grant/Research Support.
1587. Clinical Utility of a Cytomegalovirus (CMV)-specific T Cell Assay in Assessing the Risk of Post-Prophylaxis CMV Infection and Post-Treatment Relapse
Authors: Bhaimia Eric , Yetmar Zachary A , Dioverti Veronica , Melendez Dante P , Theel Elitza , Razonable Raymund R
Published: December 2022

Background

Cytomegalovirus (CMV) causes significant morbidity in solid organ transplant recipients (SOTR). As a lack of immunity predisposes to infection, a laboratory test that measures CMV-specific cell-mediated immunity (CMV CMI) may help guide antiviral prophylaxis, predict relapses and correlate with outcomes. We assessed CMV CMI in CMV D+/R- patients during valganciclovir primary prophylaxis and in CMV viremic SOTRs during antiviral treatment, and correlated the results with post-prophylaxis CMV infection and post-treatment relapse, respectively.

Methods

CMV CMI was assessed in two groups of SOTRs using the QuantiFERON© CMV interferon-gamma release assay (IGRA), with level >0.2 IU/mL suggestive of immunity. The first group included CMV D+/R- SOTRs who underwent monthly CMV CMI testing during 6 months of valganciclovir prophylaxis. These patients were prospectively followed for CMV episodes for 1 year post transplant.

The second group included SOTRs with CMV viremia or disease, who underwent CMV CMI testing at time of CMV diagnosis and at various time points during antiviral treatment. These patients were prospectively followed for CMV relapse for 1 year post-primary CMV episode. Standard definitions were used to define CMV infection and disease.

Results

In the primary prophylaxis cohort, 24 CMV mismatched (D+/R-) SOTRs were enrolled. Only 1 patient (4.2%) demonstrated a CMV CMI >0.2 IU/mL by the end of prophylaxis; this patient did not develop CMV disease. Four (16.6%) patients developed post-prophylaxis CMV infection, none of which had CMV CMI >0.2 IU/ml. In the post-treatment cohort, 20 CMV viremic SOTRs were enrolled, including 12 D+/R- (60%). Eighteen (90%) had CMV CMI levels >0.2 IU/mL by end of treatment and none developed CMV relapse. In contrast, the single patient who relapsed after treatment had a CMV CMI response < 0.2 IU/ml (p=0.05).

Conclusion

CMV D+/R- SOTRs are unlikely to develop CMV CMI during valganciclovir prophylaxis. Thus, the utility of CMV CMI for risk stratification of post-prophylaxis CMV infection in CMV D+/R- SOTRs is questionable. Conversely, CMV CMI testing may potentially be a useful marker of CMV relapse risk after treatment and guide the role of secondary antiviral prophylaxis.

Disclosures

Elitza Theel, PhD, D(ABMM), Euroimmun US: Advisor/Consultant|Oxford Immunotech: Advisor/Consultant|Roche Diagnostics: Advisor/Consultant|Serimmune Inc: Advisor/Consultant Raymund R. Razonable, MD, American Society of Transplantation: Board Member|gilead: Grant/Research Support|novartis: DSMB|regeneron: Grant/Research Support|Roche: Grant/Research Support.
1277. Provider Perspectives on Long-Acting Injectable Antiretroviral Therapy: A “Golden Ticket”?
Authors: Uhrig Castonguay Breana J , Carda-Auten Jessica , Rodriguez Humberto Gonzalez , Mayer Kenneth H , Wohl David A , Kerrigan Deanna , Barrington Clare , Fernandez Ricardo F
Published: December 2022

Background

Long-acting injectable antiretroviral therapy (LAI-ART) has been approved as an alternative to daily oral ART for people living with HIV (PLWH). Amidst the promise and potential challenges of LAI-ART, acceptability of this new therapeutic option remains largely unexplored beyond clinical trials. The aim of this study is to characterize perceptions and preferences related to LAI-ART among HIV care providers (HCPs).

Methods

We conducted qualitative in-depth interviews with 32 HCPs from three distinct geographic areas (Boston, MA; Chapel Hill, NC; Washington, DC) between November 2019 to March 2021. HCPs included: physicians, nurse practitioners, physician assistants, registered nurses, clinical pharmacists, social workers, medical assistants, and HIV navigators. We developed narrative summaries to understand individual perspectives and then systematically coded transcripts using Dedoose to identify recurring themes across participants.

Results

HCPs felt LAI-ART could be the “golden ticket” for patients who struggle with adherence or worry about HIV status disclosure. However, they perceived patient interest in LAI-ART would vary based on several factors. HCPs expected older patients who have lived with HIV longer and are reluctant to changing regimens, those who live far from clinic, or have a fear of needles to be less interested in LAI-ART. A recurring concern among HCPs was that LAI-ART will require frequent clinic visits, making it more burdensome to both patients and clinics. HCPs overwhelmingly preferred an 8-week over a 4-week dose schedule. To support introduction of LAI-ART, HCPs wanted: 1) clinic-wide trainings; 2) recommendations for optimal viral suppression status at LAI-ART initiation; 3) protocols for managing missed/late doses; and 4) implementation guidance to manage staff time tracking patients on LAI-ART.

Conclusion

Findings highlight the importance of understanding HCP perceptions, expectations, and concerns as these are likely to influence treatment discussions with PLWH and integration of LAI-ART. HCPs’ concerns and uncertainty regarding implementation, highlight the need for provider resources to support decision-making around LAI-ART. Additionally, clinic level guidance for the logistics of roll-out are urgently needed.

Disclosures

Kenneth H. Mayer, MD, Gilead: Advisor/Consultant|Merck: Advisor/Consultant|ViiV: Advisor/Consultant David A. Wohl, M.D., Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Janssen: Advisor/Consultant|Lilly: Grant/Research Support|Merck: Grant/Research Support|ViiV: Advisor/Consultant|ViiV: Grant/Research Support.