bluuebunny/crossref_metadata_2025 huggingface dataset:
1374. Utilizing Genomic Epidemiology to Explore SARS CoV-2 Transmission Patterns and Support Outbreak Investigations in Long Term Care Facilities, Washington State, April-October 2021
Authors: Douglas Peggy , Burns Veronica , Prather Cassie , Lunn Stephanie , Frisbie Lauren , Pratt Drew , MacAllister Trent , Templeton Allison A , Brezak Audrey , Smith Nailah , Kibiger Lynae
Published: December 2022

Background

In Washington State, COVID-19 cases in long-term care facilities (LTCF) have accounted for less than 3% of all cases, yet 30% of all COVID-19 deaths. Understanding transmission patterns and outbreak epidemiology informs outbreak management. From April to October 2021, two large LTCFs experienced COVID-19 outbreaks. Whole genome sequencing and phylogenetic analysis were leveraged to explore transmission patterns and complement outbreak epidemiology.

Methods

Epidemiologic data was exported from the Washington Disease Reporting System. Sequences, retrieved from GISAID, were aligned to the Wuhan-1 reference genome using Nextalign version 1.11.0. Pairwise single nucleotide polymorphism (SNP) distance matrices were calculated using SNP-Dists version 0.8.2. Phylogenetic trees for each outbreak were generated using IQ-Tree multicore version 2.2.0-beta COVID-edition using the GTR+F+G4 nucleotide substitution model with 1000 bootstrap replicates. MicrobeTrace was used to visualize the phylogeny, SNP heatmap, and identify clusters among sequences.

Results

Weekly, LTCF A tested 162 residents and 800 staff, and LTCF B tested 60 residents and 144 staff. Of all cases in LTCF A (n= 119), 23% (n =27) were residents and 77% (n = 92) were staff, compared to 78% (n =28) residents and 22% (n =7) staff among total LTCF B cases (n=36). In LTCF A, 34% (n=40) of the cases had high-quality sequences available. Seven clusters of two or more genetically related sequences and thirteen genetically unrelated sequences were identified. Five of the clusters involved resident and staff cases, linked by unit. Two clusters and remaining unrelated sequences were among staff. In LTCF B, 40% (n=14) of the cases had high-quality sequences available. One cluster of genetically related sequences was identified, all from residents of two floors. The SNP differences between sequences from LTCF A ranged from 0 to 70, whereas SNP differences between LTCF B sequences ranged from 0 to 6.

Conclusion

Phylogenetic analysis of the two outbreaks confirms differences in disease transmission patterns. Multiple independent introductions of SARS-CoV-2 were identified in LTCF A, compared to a single introduction in LTCF B. Genomic epidemiology is a valuable resource for outbreak investigation and management.

Disclosures

All Authors: No reported disclosures.
1389. A Comparison of a Telephone versus In-Person HIV Linkage to Care Intervention in a Large Health Care System
Authors: Leonard Michael , Polk Christopher , Zhao Jing , Zhao Jing , Zhao Jing , Hetherington Timothy , Gohs Frank , McCurdy Lewis
Published: December 2022

Background

Evidence suggests linkage to care (LTC) should occur immediately after HIV diagnosis improves retention in care and viral suppression. Established protocol for newly diagnosed or out of care people living with HIV (PLwH) with hospital admission in our healthcare system is for an in person LTC encounter for outpatient care including clinic follow up. We compared whether an in-person versus phone encounter intervention, were equally effective LTC methods.

Methods

PLwH admitted to any of three hospitals in our vertically integrated healthcare system were identified through the electronic health record (EHR) daily by the LTC coordinator for further screening. Inclusion criteria included: inpatient status with ICD9/10 code in EHR for HIV, no self-reported combination anti-retroviral therapy (cART) in the 30 days prior to admission, and not engaged in HIV care in greater than 12 months. Patients were randomized to either an in-person visit or a phone-call LTC encounter. Primary outcomes included follow up with an HIV provider within 30 days of discharge, and cART prescription 90 days of being discharged. Viral load suppression, CD4 count and readmission rates were secondary outcomes. Results were analyzed using an intent to treat model. All tests were two-sided at the significance level of 0.05

Results

2750 patients were screened for eligibility, 260 randomized during an 18-month period to an in-person visit (n=131) or telephone visit (n=129). The median age was 45 years, 67% were male, and 78% Black/African American. 15% of patients were newly diagnosed during admission. (Table 1) No differences were observed between the two LTC groups in follow up within 30 days (41% total), cART prescription within 90 days (76%), viral load suppression at 6 months (45%), CD4 count (57%), and readmission within 30 days of discharge (34%). (Table 2).

Conclusion

Telephone and in-person encounters for LTC had similar outcomes regarding HIV follow up, ART prescribing, viral suppression, and hospital readmission at our institution. Improvements in the linkage process do need to be made in all outcome categories to further improve care with and ultimately viral suppression. Telephone visits provide opportunity to make LTC more efficient and with less human resource needs.

Disclosures

Christopher Polk, MD, Gilead: Advisor/Consultant.
1391. Association between Substance Abuse and Mental Illness Symptoms Screener (SAMISS) scores and HIV care cascade outcomes in newly diagnosed people with HIV (PWH) in the US South
Authors: Ahmed Manal , Nijhawan Ank E , Chow Jeremy Y , Gao Ang , Ahn Chul
Published: December 2022

Background

Mental illness (MI) and substance use (SU) among people with HIV (PWH) impact multiple stages of the care cascade. Little is known about baseline mental illness and substance use as defined by the Substance Abuse and Mental Illness Symptoms Screener (SAMISS), a common tool used at entry into care, and subsequent care cascade outcomes.

Methods

A retrospective chart review was conducted of individuals newly diagnosed with HIV between 2016-2019 in an urban HIV clinic in Dallas, Texas. Baseline demographic, HIV labs, socio-economic variables and availability of rapid ART (implemented 10/2018) were collected. Patients were screened for MI and SU using the SAMISS. Outcomes included retention in care (2 encounters within 12 months, 90 days apart), probability of achieving virologic suppression (VS = viral load (VL) ≤200 copies/mL), and sustained VS at 12 months. Data analyses included stepwise Cox and logistic multivariate regression modeling conducted in SAS, version 9.4. Covariates with p< 0.2 in univariate analyses were entered as candidate variables for stepwise selections.

Results

Among the 530 newly diagnosed PWH, mean age was 35, 79% were male, 46% non-Hispanic Black, 37% Hispanic. Overall, 34% screened positive for SU and 41% for MI; 46% received rapid ART. In univariate analyses, those screening MI-positive were less likely to be retained in care (OR 0.68, p=0.035), or to have continuous VS (OR 0.61, p=0.005), though neither remained significant once controlling for rapid ART initiation and other covariates. In univariate analysis, those screening SU-positive were less likely to achieve VS (HR 0.80, p=0.030), and in multivariate analyses, they were less likely to be retained in care (OR 0.60, p=0.015) or to have continuous VS (OR 0.61, p=0.015) after adjusting for rapid ART initiation and covariates.

Conclusion

In a safety-net southern US clinic, baseline SAMISS MI and SU scores were associated with worse 12-month retention in care and virologic suppression. Given widespread adoption of rapid ART initiation soon after HIV diagnosis, further studies should explore how initial assessment scores like SAMISS could be used to both identify and direct interventions to at-risk, newly diagnosed PWH to impact long-term retention and VS.

Disclosures

Ank E. Nijhawan, MD, MPH, MSCS, Gilead Sciences: Grant/Research Support Jeremy Y. Chow, M.D., M.S., Gilead Sciences: Grant/Research Support.
1392. Associations between Stigma and Physical and Mental Health in the U.S. Military HIV Natural History Study
Authors: Schvey Natasha , Hsieh Hsing-Chuan , Illinik Luca , Chu Xiuping , Ganesan Anuradha , Schofield Christina , Colombo Rhonda E , Berjohn Catherine M , Okulicz Jason , Agan Brian
Published: December 2022

Background

Despite increasing attention to HIV-related stigma within the DoD, to date, the majority of research has focused on civilians, up to half of whom report perceived or experienced stigma. However, military service members and retirees with HIV may be particularly vulnerable to stigma and its adverse correlates.

Methods

The current study utilized cross-sectional data collected within the U.S. Military HIV Natural History Study. Participants completed questionnaires, including the Center for Epidemiologic Studies Depression scale, the Short Form Health Survey, the Internalization Subscale of the HIV Stigma Scale, and a measure of stigma experienced in the past year. Experiences of stigma were dichotomized to indicate presence or absence. Linear and logistic regressions were used to examine associations between internalized stigma and psychosocial functioning. All analyses were adjusted for age, race, sex, marital status, military rank, and duty status (i.e., active duty or retired).

Results

The sample comprised 399 participants (93.5% male; 46.0% Black/African American; Mage: 50.8 ± 13.2 years; Mage at HIV diagnosis: 31.9 ± 8.2 years; 32.4% on active duty). The majority (94.4%) had an undetectable viral load at the time of the visit. Fourteen percent reported being teased, treated unfairly, or discriminated against in the past year due to their HIV status, and 8% reported discrimination specifically within healthcare. Adjusting for covariates, internalized stigma was associated with poor physical (p < .001) and overall mental (p < .001) health. Internalized stigma was also associated with greater odds of reporting elevated depression (p < .001).

Conclusion

In this sample of service members and retirees with HIV, a small but significant minority of participants reported experiencing stigma. Rates of stigma were lower than those observed in some civilian samples, though heterogeneity in sampling and methodology preclude direct comparisons. Internalized stigma was associated with poor physical and mental health, signaling a need for continued efforts to assess both experienced and internalized stigma. Future research should explore associations between stigma, ART adherence, and other metrics of health, such as CD4 count, substance use, and cardiometabolic risk.

Disclosures

All Authors: No reported disclosures.
1394. Clinical and Sociodemographic Characteristics Associated with Poor Self-rated Health across Multiple Domains among Older North American Adults Living with HIV
Authors: Dominguez Megan , Okoli Chinyere , de los Rios Patricia , Prakash Manyu , Clark Andrew
Published: December 2022

Background

Older adults living with HIV (OALHIV) are a growing demographic in North America. We summarized baseline characteristics and associated self-rated suboptimal health in North American OALHIV.

Methods

OALHIV aged ≥ 50 years from the United States, Canada, and Mexico who participated in the 25-country 2019 Positive Perspectives survey were included. Self-rated health was assessed across 4 domains (physical, mental, sexual, overall); each was dichotomized as optimal (Good/Very good) or suboptimal (Neither good nor poor/Poor/Very poor). Multinomial logistic regression was measured for associations between domains and relevant sociodemographic and clinical characteristics.

Results

Of 583 participants from North America, 161 were aged ≥ 50 years and included in this analysis. Most were male (73%), 14% were aged ≥ 65 years, 66% were diagnosed with HIV ≥ 10 years ago, median disease duration was 20 years, and 55% took ≥ 5 non-HIV pills daily. Most OALHIV (n=128; 80%) had switched antiretroviral therapy (ART) at least once, 14% (18/128) because of potential drug-drug interactions and 22% (28/128) because it was no longer effective or for resistance, and 6% were very treatment experienced (changed ART ≥ 4 times, with ≥ 1 switch in the past year for resistance or poor tolerability). Among OALHIV, 86% reported ≥ 1 comorbidity; the most common were hypertension (42%), hypercholesterolemia (39%), mental illness (32%), and insomnia (29%). Overall, 48% (77/161) of OALHIV reported suboptimal physical health, 35% (56/161) suboptimal mental health, 60% (97/161) suboptimal sexual health, and 47% (75/161) suboptimal overall health. On all domains, 19% (31/161) reported suboptimal health; 24% (38/161) reported optimal health on all domains, 23% (37/161) on 3 domains only, 13% (21/161) on 2 domains only, and 21% (34/161) on 1 domain only. Comorbidities with a > 15% difference between OALHIV reporting suboptimal health in all domains vs those reporting optimal health in at least 1 domain, respectively, were mental health (48% vs 28%), substance abuse (26% vs 5%, as self-reported in the survey), bone disease (26% vs 8%), and insomnia (42% vs 25%).

Conclusion

Most OALHIV in North America reported comorbidities and polypharmacy, with approximately one-quarter reporting suboptimal health on all domains.

Disclosures

Megan Dominguez, PharmD, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employee|ViiV Healthcare: Stocks/Bonds Chinyere Okoli, MSc, DIP, ViiV Healthcare: I am an employee of ViiV healthcare|ViiV Healthcare: Stocks/Bonds Patricia de los Rios, MSc, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employment Manyu Prakash, PhD, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employee Andrew Clark, MD, ViiV Healthcare: Employee|ViiV Healthcare: Stocks/Bonds.
1399. Dramatic Increase in Invasive Group A Streptococcal Infection in Persons Who Inject Drugs in an Urban Philadelphia Hospital
Authors: Altneu Eric , Metlay Jessica , Davis Hugh A , Spivack Stephanie , Sullivan Kaede Ota , Schultz Sara K
Published: December 2022

Background

Invasive infection from Group A streptococcus (iGAS) is rising nationally, and we report a significant increase in incidence at an urban, quaternary care health center, which serves the Kensington neighborhood, the epicenter of the opioid crisis in Philadelphia, PA. We examined iGAS infection in the Temple University Health System catchment area

Methods

iGAS was defined as an of streptococcus pyogenes cultured from a previously sterile site. Injection drug use (IDU) is a known risk factor for bacterial infection, including iGAS infection. All blood, sterile fluid, and/or tissue cultures that yielded S. pyogenes were identified using the laboratory information system at Temple University Hospital – Main Campus. Two cohorts were compared: January 1, 2021, to December 31, 2021, and January 1, 2019, to December 31, 2019. Electronic health records were reviewed and data pertaining to age, gender, and injection drug use were abstracted. Descriptive statistics were used to summarize findings.

Results

155 cases of iGAS were identified in 2021 (105 of which involved bacteremia) compared to 69 in 2019 (42 of which involved bacteremia), representing a 224% increase overall. Of the cases in 2021, 130 (84%) were Persons Who Inject Drugs (PWID) compared to only 39 (57%) in 2019. PWID with iGAS were younger (median age 35 vs 54 in 2019, 39 vs 53 in 2021) and more likely to be male (57% vs 43% in 2019, 68% vs 32% in 2021). Male patients also had a higher incidence of PWID than female patients (56% vs 44% in 2019 and 64% vs 36% in 2021).

Conclusion

During this same time period, the COVID-19 pandemic added to the ongoing opioid crisis in Philadelphia. The city of Philadelphia publicly reports opioid data, which shows that hospitalizations related to non-fatal opioid overdose have exponentially risen in the past two decades. This also coincides with an increase in the presence of xylazine, an adulterant in the Philadelphia fentanyl supply. Xylazine has been implicated in worsening wounds. Our data supports a concerning association between iGAS and PWID.

Disclosures

All Authors: No reported disclosures.
1400. Emergency Department (ED) Use among Persons With HIV (PWH) before and during the COVID-19 Pandemic
Authors: Agil Deana , Browne Lindsay , Davy-Mendez Thibaut , Durr Amy , Henderson Heather , Li Kuo-Ping , Farel Claire E , Eron Joseph J , Napravnik Sonia
Published: December 2022

Background

Substantial changes in access and delivery of primary HIV care occurred during the COVID-19 pandemic. To assess how care access changed during the COVID-19 pandemic, we estimated ED use among PWH in care 2017-2021 in the southeastern US.

Methods

For each calendar year, among PWH in care in the UNC CFAR HIV Clinical Cohort (defined as having a clinic visit in the current or prior year), we estimated the percent of patients with ≥ 1 ED visit in a given year, overall and by age, gender, race/ethnicity, HIV viral load (VL), and CD4 count. We estimated risk ratios (RRs) comparing patient characteristics and years 2020-2021 vs. 2017-2019, using Poisson regression with generalized estimating equations to account for repeated measures.

Results

Among 2129 PWH in care 2017-2021 (N≈1700-1800 in each year), 57% identified as Black, 31% White, 8% Hispanic, 26% women, with median age of 47 years (IQR 35-55). During the study period, there were 3645 ED visits over 8813 person-years, a rate of 41.4 ED visits-per 100 person-years(95% CI 36.8-46.5) per 100 person-years. The 845 PWH with at least one ED visit during the study period contributed a median of 2 visits each (IQR 1-5). The unadjusted probability of having ≥1 ED visit in a given year was higher among women vs. men (RR=1.14, 95% CI 0.99-1.32), Black vs. White PWH (1.31, 1.13-1.52), with VL ≥ 40 copies/mL (1.40, 1.20-1.64), and with CD4 < 200 (1.66, 1.32-2.09) or 200-349 (1.50, 1.25-1.79) vs. ≥ 500 cells/μL; age was not associated with ED use. Compared with 2017-2019, the annual probability of having ≥ 1 ED visit was lower in 2020-2021, with RRs of 0.83 (95% CI 0.76-0.90) in unadjusted analyses and 0.80 (95% CI 0.71-0.90) after adjusting for demographics, VL, and CD4. There was also a significant unadjusted decrease for 2020-2021 vs. 2017-2019 among women, men, PWH who were Black, White, < 40 or 50-59 years old, and with CD4 >500 (Fig. B-F, all P< 0.05).

Conclusion

Among PWH in HIV care, ED use was higher among women, Black PWH, and PWH with poorly controlled HIV. ED use decreased 2020-2021 in most groups, indicating that PWH during the COVID-19 pandemic may be delaying seeking care for acute conditions, or accessing care in other ways. Work is ongoing to characterize reasons for ED visits across calendar years and examine the impact of reduced ED utilization among PWH.

Disclosures

Joseph J. Eron, MD, Adagio Therapeutics: data safety monitoring committee|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Glaxo Smith Kline: Advisor/Consultant|Merck: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support.
1402. Expand accessibility of monoclonal antibody in COVID-19 among different ethnicities and races.
Authors: Farooq Hina , Shankaran Shivanjali
Published: December 2022

Background

Anti-SARS-CoV-2 monoclonal antibodies are administered to patients with mild-moderate COVID-19 who are at high risk of progression to severe disease. It has been shown that in addition to medical comorbidities, race or ethnicity may also place patients at high risk for progression to severe COVID-19 infection due to social disparities including limited access to care. The purpose of this study is to increase the accessibility of monoclonal antibody infusion to patients at high risk for severe outcomes of COVID-19, irrespective of race and ethnicity, by expanding outreach resources when availability of oral antiviral therapies was limited.

Methods

We performed a single-center retrospective analysis of patients with mild-moderate COVID-19 infection receiving sotrovimab, a monoclonal antibody, between December 2021 and January 2022. A total of 93 SARS-CoV-2-positive patients meeting EUA criteria for eligibility were infused with sotrovimab in different settings such as emergency department, outpatient setting including infusion clinics and cancer centers, home health as well as patients hospitalized due to reasons other than COVID-19 at RUSH medical center, Chicago. For context, during omicron surge, initially home health was set up followed by introduction to infusion clinics. Primary care provider could refer patients to the infusions clinics or home health.

Results

Out of 93 patients, 8 patients received mAb infusion in emergency department, 25 patients each in cancer center and infusion clinic, 17 patients in home health setting and 18 patients who were hospitalized due to reasons other than COVID-19. The median age of participants was 57 years and 61.2% were females. Overall, Hispanic patients received mAb less often than did non-Hispanic patients (33% vs 62%). Black, Asian and other racial groups received mAb 18.2%, 3.23%, 3.23% less often, respectively, than did White patients. Interestingly, in home health setting, Hispanic patients received infusion more often than non-Hispanic patients (12.9% vs 5.3%).

Conclusion

Implementation of programs centered around needs of community such as increase accessibility to COVID-19 medications through home health or infusion clinics may help mitigate the racial and ethnic disparities in COVID-19 and thus, promote health equity.

Disclosures

All Authors: No reported disclosures.
1408. Increasing Access to Medications for Opioid Use Disorder in Patients Hospitalized with Severe Injection Related Infections: A Single Center Experience
Authors: Keegan Jack , Bauer Rebecca , Peppard William
Published: December 2022

Background

Hospitalizations for severe injection related infections (SIRI) amongst persons who inject drugs (PWID) are often complicated by patient directed discharge (PDD), incomplete antibiotic treatment and 90-day readmission. Despite a strong association with improved clinical outcomes, medications for opioid use disorder (MOUD) remain significantly underutilized in this patient population. Beginning in January of 2022, our institution revised several key policies that had limited inpatient use of MOUD while also implementing a new order set to facilitate MOUD inductions. This study seeks to quantify the clinical impact of these interventions in PWID admitted with SIRI.

Methods

We first performed a retrospective analysis of all PWID hospitalized with SIRI between January 2018 and December 2020 to establish baseline rates of PDD, antibiotic completion and 90-day readmission in patients who received MOUD compared to those who did not. Subsequent analyses will utilize a quasi-experimental design to compare the same clinical outcomes in patients admitted before and after institutional guideline revision and MOUD order set implementation.

Results

A total of 97 patients were included in our baseline assessment, of which 21 (21.6%) received MOUD while hospitalized. Of patients receiving MOUD, 11 (52.4%) were new inductions. Use of MOUD was associated with significantly lower rates of PDD (5 [23.8%] MOUD patients vs 40 [53.3%] no MOUD patients; OR, 0.273 [95% CI, 0.091-0.823]) and significantly higher rates of antibiotic completion (17 [81.0%] MOUD patients vs 36 [48.0%] no MOUD patients; OR, 4.6 [95% CI, 1.41-14.98]).

Conclusion

Our baseline data agrees with existing literature in finding MOUD to be an effective way of reducing PDD and increasing antibiotic completion in PWID admitted with SIRI. However, overall MOUD utilization was low, particularly after accounting for the effect of individuals prescribed MOUD prior to admission. Forthcoming data will assess the impact of institutional guideline revision and MOUD order set implementation on PDD, antibiotic completion and hospital readmission in PWID admitted with SIRI.

Disclosures

All Authors: No reported disclosures.
1411. Missed HIV Clinic Visits among Youth Living with HIV in Alabama
Authors: Hao Jiaying
Published: December 2022

Background

Adolescents and young adults with HIV consistently account for about one-fifth of new infections in the United States. YLWH have lower rates of testing, diagnosis, treatment engagement, and viral suppression than adults with HIV. YLWH are particularly challenged with missing medical appointments. Few studies have been published on youth living with HIV (YLWH)’s missed clinic visits and risk factors. Therefore, this study was designed to explore:

1). if the missed visits have significant associations with HIV treatment outcomes (more than 50 counts of CD4 counts drop, viral load increment, and viral suppression) in YLWH; 2). What factors are associated with missed visits for YLWH? 3) Are these factors different from the risk factors of all PLWH?

Methods

A retrospective study using data records from UAB Family Clinic was designed. The study used the records from March 1st 2020 to August 31st, 2021. Patients aged 16-24 were considered as YLWH. The primary outcomes are missed visits and treatment outcomes. CD4 change, Viral suppression and VL change during the study period were investigated for identifying the association between missed visit and treatment outcome. Age, gender, race, HIV transmission mode, insurance type and the viral suppression in index record were used as factors to predict missed visits. Chi-square test and logistic regression have been conducted in SAS 9.4.

Results

YLWH with missed visits had more viral load rebound compared to those without missed visits (p=0.04).

For YLWH, gender and viral suppression in the index record have significant associations with missed visits (Gender: p=0.03, Viral suppression in index record: p=0.04).

In tests among all PLWH, Race (p=0.03), Insurance type (p=0.01) and viral suppression in index record (p=0.001) are associated with missed visits. Table 1.Viral load change by missed visits.Table 2.Risk factors associated with missed visits among YLWH (n=101).Table 3.Risk factors associated with missed visits among PLWY (n=296).

Conclusion

Missed visits are significantly associated with viral load maintenance, and missed visits have adverse effects on treatment outcomes. Also, the risk factors for YLWH of missed visits are not identical with the risk factors for PLWH from the same cohort.

Disclosures

All Authors: No reported disclosures.
1416. The Economic Burden of Adverse Events Requiring Acute Care Services from Outpatient Parenteral Antibiotic Therapy (OPAT) Treatment
Authors: Rodriguez Mauricio , Buscaglia Georgia , Tolle Steven , Michael Darren
Published: December 2022

Background

Antimicrobial resistance (AMR) is a growing threat. ESBL-producing Enterobacterales infections are rising, especially within the community setting. Patients requiring OPAT services will increase based on AMR to oral antibiotic (ABX) options. OPAT adverse events (AEs) are linked to the use of IV catheters, followed by adverse drug events. Complications that arise from OPAT, often necessitate acute care services. We sought to quantify costs associated with OPAT AEs.

Methods

A multicenter retrospective claims analysis from the state of Utah’s (UT) Public IBIS database was performed for 2020. OPAT AEs as described in the literature were used to query charges. All UT hospitals and common OPAT AE principal diagnosis (PDx) codes were included in the analysis. Estimated inpatient (IP) costs associated with common OPAT AEs were calculated from a charge-to-cost ratio (22.5%) using publicly available data from the Centers for Medicare & Medicaid Services. Event counts reported for UT were scaled proportionally to estimate total events for the U.S. population. Emergency department (ED) incidence rates for OPAT AEs from 2016 to 2020 were also examined.

Results

During the study period, 248,843 patients met study inclusion for an OPAT AE PDx. Among IV-related complications, catheter phlebitis accounted for highest median cost per IP event at $14,051. Other PDx, included catheter blockage and central line-associated bloodstream infections at $11,237 and $10,103, respectively, followed by $9,371 for complications post injection. Thrombotic events equated to total of $11,915 for the combined costs of deep venous thrombosis and pulmonary embolism. Lastly, C. difficile infections accounted for a median cost of $5,284 (Figure 1). Age-adjusted rates of ED activity related to AEs rose to 17.6 per 10,000 in 2020; this marked an 18% increase from 2016 (Figure 2). Figure 1.Figure 2.

Conclusion

Give that viable oral ABX treatment options in the community setting are limited, patients will require additional OPAT services as AMR rates continue to escalate. OPAT services are not without added risks of complications, as the average median cost for an OPAT AE was $8,852. These costs may be minimized by the addition of new oral ABXs that overcome AMR, thus improving patient outcomes.

Disclosures

Mauricio Rodriguez, PharmD, MS-HEOR, BCPS, BCCCP, BCIDP, Spero Therapeutics: Employee Georgia Buscaglia, PhD, Spero Therapeutics: Advisor/Consultant Steven Tolle, BFA, Spero Therapeutics: Advisor/Consultant Darren Michael, PhD, CC, SC, Spero Therapeutics: Advisor/Consultant|Spero Therapeutics: Grant/Research Support.
1417. The Impact of Psychosocial Factors on ART Adherence is Mediated by Poverty in Older Adults Living With HIV
Authors: Mazonson Peter J , Karris Maile Y , Huang Emily , Berko Jeff , Spinelli Frank , Zolopa Andrew
Published: December 2022

Background

Despite decades of work evaluating multiple interventions to improve ART adherence, viral load suppression in the U.S. remains far below Ending the HIV Epidemic goals. Previous research demonstrates that income and other factors, including social well-being (SWB), resilience, and exercise, are correlated with ART adherence. However, it is unclear how these factors interact with income to impact adherence in older adults living with HIV (OALWH).

Methods

Self-reported outcome measures from the Aging with Dignity, Health, Optimism, and Community (ADHOC) cohort were collected from November 2017 to June 2019. Adherence was measured using the Brief Adherence Self-Report Questionnaire, depression using the Patient Health Questionnaire-2, SWB using the Functional Assessment of HIV Infection, and resilience using the Connor-Davidson Resilience Scale. Face-valid questions provided data on household income, race, sexual orientation, # of ART pills daily, and exercise. Linear regressions assessed the associations between these variables and adherence. Mediation analysis using bootstrapping assessed the significance of the mediation effects of income on these variables.

Results

For 1,039 ADHOC participants, average age was 59 years, 86% were male, 69% were White, and mean adherence was 96.2% (SD=11.2). In bivariate analyses, depression, SWB, exercise, resilience, White race, # ART pills daily, and sexual orientation were each significantly correlated with both ART adherence and income. Interestingly, depression, SWB, resilience, and exercise became non-significant predictors of adherence after adjusting for the effects of income. Mediation analysis with bootstrapping demonstrated significant causal mediation effects of income on depression and adherence (B=-0.14, 95% CI (-0.25 – -0.04)), SWB and adherence (B=0.03, 95% CI (0.01 – 0.05)), resilience and adherence (B=0.15, 95% CI (0.04 – 0.27)), and exercise and adherence (B=0.002, 95% CI (0.0007-0.003)).

Conclusion

In OALWH, household income mediates the relationship between ART adherence and depression, SWB, resilience, and exercise. Therefore, interventions to improve adherence must address the causal role of income and focus on providing low-income patients with economic support to help lift them out of poverty.

Disclosures

Peter J. Mazonson, MD, MBA, ViiV Healthcare: Grant/Research Support Maile Y. Karris, MD, Gilead Sciences: Grant/Research Support|Gilead Sciences: I have received honorarium to speak at conferences|ViiV Healthcare: Grant/Research Support Emily Huang, MPH, ViiV Healthcare: Grant/Research Support Jeff Berko, MPH, ViiV Healthcare: Grant/Research Support Frank Spinelli, MD, Gilead Sciences: Employee|ViiV Healthcare: former employee Andrew Zolopa, MD, ViiV Healthcare: full time employee|ViiV Healthcare: Stocks/Bonds.
1419. Matters of the Heart: A Scoping Review Toward Better Management‌ ‌of‌ Nontuberculous‌ ‌Mycobacterial‌ ‌Infections of‌ Cardiac ‌Devices‌
Authors: Mahatanan Rattanaporn , Ovalle Anais , Lee Devin , Alkozah Maria , Talbot Elizabeth
Published: December 2022

Background

Medical device infections caused by nontuberculous mycobacteria (NTM) are increasingly reported in the literature. Management is complex and often guided by expert opinion, in the absence of evidence-based guidelines.

Methods

We searched available databases for reports of‌ implantable‌ cardiac device-related‌ (ICDR) infections with NTM. We collected patient-level characteristics, microbiological, and treatment data, and used univariate analysis to correlate with reported outcome, which we defined as death, treatment failure, relapse after treatment completion, cure, and treatment completion.

Results

Of 2573 potential eligible articles, 68 articles were included, representing 112 patients. The average patient age was 61 years, and 6% of patients were immunocompromised. Of 12 species reported, 65% were rapid growers, with M. fortuitum most common. Prosthetic heart valves and pacemaker/automatic implantable cardiac devices (AICD) were the most commonly reported infected devices (45% and 37%, respectively). Diagnosis was often delayed, and confirmed with culture (62%, 41% blood cultures) and 16s ribosomal RNA gene sequencing data (14%) of cases. Antimicrobial susceptibility was available in 55% of cases. 70% of patients received >2 antibiotics and, of these, 41% included a macrolide. Devices were removed for 65% of patients, more commonly if the infected deice was a pacemaker or AICD than another type of cardiac device (86% vs 56%, p=0.02). 67% of patients with prosthetic valves underwent valve replacement. Compared with those who did not have their device removed, patients who underwent device removal were less likely to die (23% vs 48%, p=0.02) and more likely to have favorable outcomes (68% vs 28%, p=0.002).

Conclusion

Reports of ICRD NTM infections were common, and suspicion should be high even for those without immunocompromising condition. Determining outcome was challenging and should be standardized to provide an evidence base for better management. In our analysis, patients who underwent device removal had improved survival, suggesting either that comorbidity precluded device removal and/or that removal may be an essential part of the management.

Disclosures

All Authors: No reported disclosures.
1420. 99mTc-Ethambutol scintigraphy with SPECT/CT in skeletal tuberculosis: A Prospective Study
Authors: Sikdar Sunit , Damle Nishikant , Ranjan Piyush , Tripathi Varsha , Tyagi Apoorva , Arora Geetanjali , Bal Chandrasekhar , Nischal Neeraj , Bala Kiran
Published: December 2022

Background

Tuberculosis (TB) is the most common infectious disease in poor and underdeveloped countries, with extra-pulmonary TB (EPTB) infections accounting for 10-15 percent of all cases in developing and underdeveloped countries. Apart from 18F-FDG PET/CT, which cannot discriminate between metastatic and infective lesions, Nuclear Medicine methods do not play a significant role in clinical practice. We have attempted to address this constraint by our study involving radiolabelled Ethambutol.

Methods

The study was conducted over a period of 20 months at the Department of Nuclear Medicine of our institution and included a prospective cohort of 16 adult patients diagnosed as skeletal TB (clinico-radiologically, histopathologically, or microbiologically) who were treatment naive or within 14 days of treatment initiation. 10-15 mCi of Tracer was administered to the patients. Dynamic phase imaging was performed for 10 minutes, followed by minimum 3 planar anterior and posterior views whole-body scans with over 4 hours. SPECT/CT was performed between 60-120mins after injection. Patients were followed up by a clinical assessment/telephonic review with a follow up period of 2 months to 21 months (mean follow up period of 10.2 months).

Results

SPECT-CT and 99mTc-Ethambutol scintigraphy were performed on 16 patients at the time of diagnosis or treatment initiation. The average age of individuals with positive scans was 33.75, whereas those with negative scans was 36.25 +/- 19.80. The most common symptom was bone pain (93.75%), followed by fever (81.25%) and weight loss (13 of 16 cases) (81.25 percent ). 3/12 (25%) of the 12 positive patients had multiple site involvement, whereas 8/12 (75%) had single site involvement. We found considerable tracer uptake in 75% of the patients in the trial. When ATT was given to 11/12 (92%) of the people who had a positive scan, the clinical result was decreased discomfort and greater mobility in the affected joints.

Conclusion

99mTc-ethambutol scintigraphy with SPECT/CT was accurately able to show bony lesions in 75% of the patients. Also 92% of those with positive scan eventually responded to Anti-Tubercular Treatment thus showing that this rarely used technique may have a role in prognosticating skeletal tuberculosis.

Disclosures

All Authors: No reported disclosures.
1429. Epidemiology, Clinical Characteristics, and Outcomes of Extra-Pulmonary Non-Tuberculous Mycobacterial Infections from a Single Center over a 10-Year Period
Authors: Ford Mary B , Okulicz Jason , Salinas Jesse , Kiley John L
Published: December 2022

Background

Non-tuberculous mycobacteria (NTM) cause a wide variety of clinical syndromes, including extra-pulmonary infections. Skin and soft tissue infections (SSTI) and bone infections caused by NTM are often associated with traumatic inoculation and data to guide diagnosis and treatment is limited. We sought to better understand skin and soft tissue infections (SSTI) and bone infections caused by NTM.

Methods

All NTM clinical isolates recovered at Brooke Army Medical Center from 2012-2022 were initially screened and SSTI and bone isolates were included. Corresponding electronic health records were reviewed for epidemiologic, microbiologic, and clinical data. Infections were defined as recovery of ≥ 1 NTM isolate from skin, soft tissue, or bone cultures with a corresponding clinical syndrome.

Results

Forty isolates from 27 corresponding patients were analyzed with a median of 1 isolate [IQR 1-1] per patient. Two-thirds (18, N = 27) were female with a median age of 51 years (IQR 33-66, Table 1). A total of 21 (78%) patients had infecting isolates, most commonly secondary to surgery (28.6%) or trauma (33%). Six of 21 (29%) had bone infections, 5 (83%, N = 6) were secondary to trauma, and 2 (33%, N=6) had both bone and SSTI isolates recovered. The majority were rapid growers (81%), most frequently M. abscessus. In infected patients, 8 (38%) had combined medical/surgical therapy, 8 (38%) had surgery alone, 4 (19%) had medical therapy alone, and 1 (5%) patient received no treatment. No infectious disease consultation was sought for 7 (87.5%) patients who received only surgery nor for the patient who received no treatment. Time from symptom onset to isolate recovery was a median of 64 days (IQR 48-108), with a median of 33 days (IQR 6-60) from isolate recovery to directed medical therapy. At the end of the study period 2 of 21 patients had died.

Conclusion

Data supporting diagnosis and treatment decisions in SSTI and bone NTM infections is sparse. In this study the majority of NTM isolated were determined to be the cause of true infections. We confirm that surgery and trauma are the most common mechanisms of exposure. The delay between symptom onset and directed therapy demonstrates a need for additional studies delineating specific criteria for diagnosis and treatment.

Disclosures

All Authors: No reported disclosures.
1437. Investigation of Increased Latent Tuberculosis Infection Rates During the COVID-19 Pandemic Among International Students at a U.S. University Campus
Authors: Askar Wajih , Nandyal Lauri E , Hardig RaeJean , Coberley Tina , Doner Amanda , Haglund Lisa , Forrester Jennifer W , Wang Shu-Hua , Holliday Michael B , Huaman Moises A
Published: December 2022

Background

The COVID-19 pandemic has caused dramatic changes in the epidemiology of many diseases globally due to various changes in exposure to different pathogens, social restrictions, and demographic shifts. A university student health center located in the U.S. Midwest detected an increase in latent tuberculosis infection (LTBI) rate among its incoming international students (INTS) from 5.7% to 8.1% in the fall semesters of 2019 and 2021, respectively. We describe our approach to investigating the increase in LTBI rate at a university campus in a low-endemicity area.

Methods

Factors that may affect LTBI rates were evaluated. LTBI testing policy and methods were reviewed. Medical and lab staff were interviewed regarding the consistency of specimen collection, transport, and processing. LTBI risks in the general population such as older age, male gender, and country of origin (COO) were also considered. Factors that were expected to be uncommon in the INTS (homelessness, incarceration, and illicit drug abuse) were not evaluated.

Results

No changes in the INTS screening policy were noted. All incoming INTS were screened for LTBI during initial health screening, regardless of COO. The same manufacturer's QuantiFERON®-TB Plus test was utilized. Compared to previous years, no inconsistencies in the testing logistics were reported. A total of 1,016 INTS were screened in 2019 and 1,179 in 2021. There were no significant differences in average age in years (23.1 vs. 23.3) or male gender (59.6% vs. 56.8%) between 2019 and 2021, respectively. Most INTS came from two countries (A and B). Country A was COO of 21.6% of INTS in 2019, which dropped to 8.4% in 2021. Country B was COO of 44.8% of INTS in 2019, which increased to 57.6% in 2021 (p< 0.001; Figure 1). Although LTBI rates within each country (A and B) remained similar before and during the COVID-19 pandemic (Figure 2), country B had consistently higher rates than country A (p< 0.001), which contributed to the overall increased rate of LTBI in 2021. Figure 1.Numbers and percentages of international students from countries A and B.Figure 2.LTBI positivity rates for countries A and B before and during COVID-19 pandemic.

Conclusion

Evaluating changes in COO of INTS is essential in investigating trends in LTBI rates at otherwise low-endemicity universities. In our investigation, demographic changes in university admissions over two years relative to COVID-19 pandemic restrictions contributed to an increase in the overall LTBI rate.

Disclosures

Moises A. Huaman, MD, MSc, Gilead: Grant/Research Support|Insmed: Grant/Research Support.
1438. Latent tuberculosis infection (LTBI) in hematopoietic stem cell transplantation (HSCT) recipients: a retrospective Italian cohort study in Tor Vergata University Hospital, Rome.
Authors: Compagno Mirko , Navarra Assunta , Campogiani Laura , Coppola Luigi , Benedetta Rossi , Marco Iannetta , Goletti Delia , Sarmati Loredana
Published: December 2022

Background

Patients undergoing haematopoietic stem cell transplantation (HSCT) have severe and prolonged immunodeficiency and the incidence of tuberculosis (TB) disease in those patients is 10 to 40 times higher than the general population

Methods

This retrospective study performed at Tor Vergata University Hospital in Rome (Italy) included all adult patients who underwent a HSCT in the Hematologic Transplant Unit from January 2015 to December 2019. Data on TB screening, performed through interferon-γ release assay (IGRA), were collected; patients were observed for TB reactivation in a follow up period of at least 3 years

Results

323 HSCT recipients were enrolled in this study. Patients’ characteristics are summarized in table 1. 63 patients (19.5%) were not screened for TB, of which 6.3% were born overseas. 260 HSCT recipients (80.5%) were screened: 228 patients (87.7%) had a negative IGRA result, 21 (8.1%) tested positive, and 11 (4.2%) had an indeterminate result. 98.5% were screened before the HSCT. Of the 21 patients with a positive pre-HSCT IGRA test, 14 (66.7%) were males and significantly (p< 0.001) older (median age 60 [IQR] 58-65 years) than those with negative or indeterminate results. Almost all patients (95.2%) were Italian. Patients with a positive IGRA showed a higher monocyte count compared to the other groups (p=0.044), while those with indeterminate IGRA showed a tendence to lower lymphocyte absolute counts, compared to the other groups (p=0.060) (Table 2).

All the 21 patients with a pre-HSCT positive IGRA test were radiologically and clinically screened for active TB and, once it was ruled out, treated for latent TB (LTBI) with isoniazid (INH) for 6 months. No events of toxicity or treatment interruption were reported. None of the patients was treated with rifampin. None of the 21 patients with pre-HSCT positive IGRA test developed active TB during the follow up period. Table 1.Characteristics of the study population, overall and divided according to IGRA testingTable 2.Characteristics of the IGRA tested patients, overall and divided by IGRA test results

Conclusion

To our knowledge, this is the first Italian study on the prevalence of LTBI in patients undergoing HSCT. 8.1% of the 260 patients screened with an IGRA tested positive. The great majority (95.2%) of LTBI patients were Italian and significantly older than IGRA-negative patients. All LTBI HSCT patients received INH treatment and no drug toxicity, nor TB reactivation was observed during the follow-up period

Disclosures

All Authors: No reported disclosures.
1661. Evaluation of Cefazolin < 3 g vs. 3 g Treatment Doses for Cellulitis in Patients Who Weigh ≥ 120 kg within a Large, Community Health System
Authors: Gens Krista , Wankum Michael , Hirsch Elizabeth B , Gagnon Brandon
Published: December 2022

Background

Cefazolin 3 g is recommended for obese patients weighing > 120 kg preoperatively; however, there is no available evidence to suggest 3 g for treatment dosing of cefazolin in this population. This study aims to provide the first clinical data of its kind on the efficacy and safety of high-dose cefazolin in the treatment of cellulitis in obese patients using a modified Desirability of Outcomes Ranking (DOOR) methodology.

Methods

This is a multi-center, retrospective cohort study including adults weighing > 120 kg at the time of admission who received ≥ 48 hours of cefazolin monotherapy for cellulitis. Patients were gathered in a 3:1 ratio between the < 3 g dosing (standard-dose; SD) and 3 g dosing (high-dose; HD) groups. Patients were excluded if they had co-infections, bacteremia, bilateral lower extremity cellulitis, or if they received > 48 hours of concomitant antibiotics. The primary endpoint of efficacy and safety as determined by modified DOOR criteria was compared between obese patients who received HD and those who received SD between 1/1/2021 and 12/31/2021. The DOOR is a patient-centered methodology that uses combined efficacy and safety endpoints to help inform better clinical decision-making.

Results

A total of 68 patients were included; 51 received SD and 17 received HD cefazolin. There were no differences in mean age nor baseline kidney function or severity of illness between groups. The median patient weights were 140.6 kg and 160 kg for the SD and HD groups, respectively (p = 0.07). Patients achieving clinical success (resolution of cellulitis within 10 days or clinical improvement upon discharge) was higher in the HD vs SD group (70.6% vs 41%; p=0.036) (Figure 1).

Conclusion

Cefazolin 3 g was associated with higher clinical success in patients > 120 kg with cellulitis. Further study is necessary to confirm these results.

Disclosures

Elizabeth B. Hirsch, PharmD, FCCP, FIDSA, Melinta: Advisor/Consultant|MeMed: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support.