bluuebunny/crossref_metadata_2025 huggingface dataset:
1771. A Novel Approach to Distributing COVID-19 Oral Antivirals During a Public Health Emergency Using a Pharmacy Home Delivery Model in New York City, 2022
Authors: Foote Mary M K , Navarro Elizabeth Diago , Silverstein Matthew , Shanmugarajah Niroshan , Eddy Meredith , Lall Ramona , Amiel Pierre J , Cheng Iris , Kennedy Joseph , Chan Hiu Tai
Published: November 2023

Background

In December 2021, the oral antivirals (OAVs) nirmatrelvir/ritonavir and molnupiravir were authorized for the treatment of COVID-19 in high-risk patients. Initial supplies were limited and states designated pharmacies to receive OAVs from a weekly federal allocation. New York City (NYC) has nearly 3,000 pharmacies serving a diverse population across a large urban area. To ensure fair access to OAVs, the NYC Health Department partnered with an online pharmacy to provide rapid delivery to any NYC address. Here we describe characteristics of patients served and metrics used to evaluate the program as the pandemic and OAV access evolved in 2022.

Methods

The NYC partner pharmacy provided data on OAV prescriptions including patient age, sex, delivery zip code, and dates of prescription and delivery. These data were matched with the NYC Health Department’s COVID-19 surveillance data including positive lab reported cases, Citywide Immunization Registry, deaths, all-cause emergency department (ED) visits and hospital admissions. Descriptive statistics were calculated using R Statistical Software.

Results

A total of 48,947 OAV prescriptions were delivered in 2022, reaching 99.5% of residential zip codes, accounting for 17.5% of the OAVs dispensed in NYC. The median time from prescription receipt to delivery was 17 hours (IQR 6-24) with half (49%) of deliveries going to high social vulnerability zip codes. Of OAV recipients, most (58%) were female, with a median age of 56 years (IQR 39, 68) with 32% aged 65 years or older; 78% had received at least a primary vaccination series; 36% matched with a lab reported COVID-19 case; 5.5% had an ED visit and 0.8% were hospitalized in NYC for any cause within 30 days of prescription date.

Conclusion

The NYC antiviral delivery program provided broad and timely access to COVID OAVs, serving a significant proportion of patients in high social vulnerability neighborhoods and older adults at higher risk for severe outcomes. Of note, an increasing proportion of people receiving OAVs were not reported as cases to public health, which likely reflects the increasing use of home tests in 2022. Limitations include the lack of data on race/ethnicity, underlying medical conditions and for patients receiving OAVs through other pharmacies.

Disclosures

All Authors: No reported disclosures
1782. Spatiotemporal Trends in Group A Streptococcal Pharyngitis in the United States
Authors: Kline Madeleine , Kissler Stephen M , Grad Yonatan H
Published: November 2023

Background

Pharyngitis caused by group A Streptococcus (GAS) drives many outpatient pharyngitis visits and antibiotic prescriptions in the US and can have serious post-infection immunological sequelae. Like many other upper respiratory infections, GAS pharyngitis burden is usually highest in the winter. However, compared to other common illnesses such as RSV or influenza, relatively little is known about the spatiotemporal distribution of GAS pharyngitis in the US. We analyzed outpatient claims data to better characterize regional differences in the burden and seasonal timing of GAS pharyngitis across US census regions.

Methods

US outpatient insurance claims from private insurers for GAS pharyngitis were extracted from the IBM MarketScan database from 2010-2018. Data were weighted to be representative of the overall population, and visits per month were averaged across the US census regions. Seasonal trends were assessed by fitting sinusoids to monthly state-, and region- level data using nonlinear-least squares regression.

Results

The South had consistently more GAS pharyngitis visits per 1000 people compared to the other regions, and the West had fewer visits per 1000 people (South January Average: 3.78, 95% CI 3.36-4.21, West January Average: 1.76, 95% CI 1.62-1.90) (Fig. 1). The wintertime peak in visits began its rise earlier in the South than other regions, and the regional differences in visits were most pronounced from July through December. Annual GAS pharyngitis visits peaked earliest in the South, particularly the West and East South Central subregions, in February (West South Central peak month: 1.49, 95% CI 1.20-1.77; East South Central peak month: 1.50, 95% CI 1.22-1.79), then radiated outwards peaking last in March on the coasts (Pacific West peak month: 2.35, 95% CI 2.10-2.61; New England peak month 2.62, 95% CI 2.44-2.81) (Fig. 2).

Figure 1

Figure 2

Conclusion

GAS pharyngitis visits showed distinct regional trends in burden and seasonality. These regional differences could indicate where and when to expect the most severe disease, complications, and sequelae. Further investigation is needed to uncover the mechanism of these differences –including socio-behavioral, environmental, or circulating strain– and to target interventions to reduce burden of disease.

Disclosures

Stephen M. Kissler, PhD, ModernaTx: Advisor/Consultant Yonatan H. Grad, MD, PhD, Day Zero Diagnostics: Board Member|GSK: Advisor/Consultant
1788. High Ferritin Levels in Hospitalized Patients with Acute Babesiosis in a Tertiary Medical Center in Long Island, NY (2014-2022)
Authors: Marcos Luis A , Gary Evan , Lamba Pooja , Saldivar Miguel A , Kalogeropoulos Andreas , Spitzer Eric
Published: November 2023

Background

Babesiosis, an intra-erythrocytic protozoan disease caused by Babesia spp, is an emerging zoonotic parasitic disease worldwide. Our group have recently described the utility of biomarkers such as lipid profile and procalcitonin levels in acute babesiosis caused by B. microti. Ferritin is a nonspecific marker, but serum levels can be seen with severe infections including bacterial and viral processes. Anecdotal reports suggest that elevated ferritin levels were elevated in a series of cases of acute babesiosis. Our aim is to investigate any association between ferritin levels and severity of infection and other biomarkers in patients diagnosed with acute babesiosis in Long Island, New York.

Correlation between Ferritin and LDH levels in hospitalized patients with acute babesiosis (r=0.565, P=0.0004).

Methods

We conducted a retrospective chart review of adult patients who had a positive peripheral blood thin smear for intra-erythrocyte B. microti parasites at Stony Brook University and Southampton Hospitals (Stony Brook Medicine) between 2014 and 2022. All cases were confirmed by PCR analysis which was performed by the NY State Department of Health. Only patients who had a ferritin level drawn during acute presentation were included in the analysis.

Results

A total of 36 patients (n=6, 16.6% female) met criteria for acute Babesia infection and had ferritin level drawn on admission during 2014-2022. Average age was 64 years-old (range: 42–90). Four patients (11.1%) were asplenic and 10 (27.7%) required ICU level of care. Parasitemia median was 1.6% (range: 0.1%-19.5%), eight cases (22.2%) required RBC exchange transfusion. Ferritin level median was 2297 ng/mL (range: 275-17,684). All cases had ferritin levels above 600ng/mL except one. Ferritin levels were higher on the group of patients who were not admitted to ICU (median: 2301ng/mL) than those admitted to ICU (median: 1894ng/mL) (p=0.25). In linear regression analysis, there was a correlation between ferritin and lactate dehydrogenase (LDH) levels (r=0.565, P=0.0004; Fig 1).

Conclusion

Ferritin was found strongly correlated with LDH levels. However, clinical severity of babesiosis is difficult to predict from inflammatory markers since low levels of ferritin and LDH were seen in ICU patients (Fig. 1). High ferritin levels were seen in almost all patients on this study.

Disclosures

All Authors: No reported disclosures
1793. Pipes as a Harm Reduction Tool: Insights from People Who Use Methamphetamine in Rural Illinois
Authors: Rains Alex , Augustine Erin , Bresett John , Fletcher Scott , Miller Kyle , Bolinski Rebecca , Jenkins Wiley D , Pho Mai T , Ezell Jerel
Published: November 2023

Background

Methamphetamine (meth) use is disproportionately high in rural settings and increased during COVID-19. While sterile syringes services are an evidence-based measure to reduce infectious disease transmission, little research exists around the value of smoking equipment, specifically pipes, in minimizing harms associated with rural drug use in the US.

Methods

Between March and June 2022, we conducted structured interviews with people who use methamphetamine (PWUM) living in rural Illinois who were at least 15 years old and used meth by any route in the past 30 days. Interview guides explored attitudes and behaviors regarding meth use routes, meth pipe use practice, and pipe access, and were refined by a peer-led Community Advisory Board. Interviews were audio recorded, transcribed, and coded in MAXQDA. The data were then analyzed for emergent themes using modified grounded theory.

Results

Nineteen participants, average age 37.1 (SD+8.7), were interviewed. Of these, 53% were women, and 89% were white. All reported smoking meth, and 84% injected meth. Participants reported that they often chose to smoke rather than inject to mitigate health concerns like wounds, pain, and infections. Smoking enabled them to use around others as opposed to using alone (as was typical when they injected). Participants expressed interest in pipe distribution through a harm reduction agency, e.g. according to one participant (a 31-year-old white male), “I’ve asked specifically if they had a pipe because I was trying to lay off the syringes.” They related that access to a harm reduction agency distributing pipes would connect people to other services such as HIV testing, naloxone, and safer sex supplies.

Conclusion

Distribution of meth pipes through harm reduction agencies represents a means for decreasing harm through circumvention of injection, decreased solitary drug use, and linkage to additional services related to overdose and disease prevention. Given increased rates of meth use in rural regions, this intervention could specifically address drug-related harms that impact rural PWUM. Future work should quantitatively explore the health impacts of pipe use as a harm reduction intervention.

Disclosures

All Authors: No reported disclosures
1794. Analysis of Antimicrobial Resistance Patterns in a Large Sample of US Hospitals Before and After COVID-19
Authors: Ranade Tarjani M , Griffin Meggie , Schwei Rebecca , Pulia Michael
Published: November 2023

Background

Significant concerns have been raised about a potential acceleration of trends in antimicrobial resistance (AMR) due to the COVID-19 pandemic. The pandemic disrupted infection control and antimicrobial stewardship processes and introduced a novel respiratory infection that mimics bacterial pneumonia, resulting in increases in hospital acquired infections and overall antibiotic prescribing. The objective of this study is to compare AMR of key bacterial pathogens before and during the pandemic to identify any concerning trends.

Methods

We used bacterial culture data (blood, respiratory, urine, and wound) from 313 U.S. hospitals in the Premier Healthcare Database to compare AMR patterns pre-COVID and during-COVID, defined as Jan. 2019 to Feb. 2020 and Mar. 2020 to Mar. 2022, respectively. We characterized % resistant cultures for three organisms identified as major threats to public health: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) and extended-spectrum beta-lactamase (ESBL). In addition to descriptive results, we assessed for statistically significant changes between pre and during-COVID using chi-square tests.

Results

There were 141,027 cultures analyzed for MRSA, 104,770 for VRE and 655,240 for ESBL. Wound was the most common culture type for MRSA (51.20%), while urine was most common for VRE and ESBL (75.84% and 86.21%, respectively). Between pre and during-COVID, the percent of MRSA isolates decreased (48.74% to 46.66% , p < 0.001), VRE isolates increased (11.45% to 12.06%, p = 0.004), and ESBL infections decreased (8.22% to 8.04%, p = 0.009) (Table 1). There were differences in AMR across all pathogens by race (p < 0.001) and ethnicity (p < 0.001) both pre and during-COVID. Risk of AMR infections increased among Black and Hispanic patients during COVID (Table 2).

Conclusion

Unexpectedly, we observed a statistically significant decrease in AMR for MRSA and ESBL during-COVID. AMR risk among racial and ethnic minority groups further increased during-COVID, raising concern about this as an additional area of disparity. The clinical significance of these results remains unclear and further research is needed to characterize the short and long term impact of COVID on AMR.

Disclosures

All Authors: No reported disclosures
1806. Community Spread of Highly Resistant Enterobacterales
Authors: Xiao Jamie , Brown Dylan , Chen Liang , Holowka Thomas , Ruegsegger Laura , Liccione Mera F , Bonomo Robert A , Marshall Steven , Rudin Susan D , Bartelt Luther A , van Duin David
Published: November 2023

Background

Highly Resistant (including ceftriaxone-resistant and carbapenem-resistant) Enterobacterales (HRE) are a major and growing public health threat. Community spread of HRE is poorly understood.

Methods

Monthly stool samples were obtained from patients who were discharged home after a hospitalization at one of 6 participating US medical centers with a clinical culture positive for HRE based on local laboratory antimicrobial susceptibility testing. Stool samples were also collected from community and household contacts they referred, and any contacts referred by those contacts. Samples were screened by culture on selective media for HRE, and with PCR for presence of extended-spectrum β-lactamase (ESBL), AmpC, and carbapenemase genes. Whole genome sequencing was performed on selected isolates.

Results

Of 1,923 patients with positive HRE cultures from healthcare settings, 943/1,923 (49%) were discharged home. 65/943 (7%) were consented into the study, and 31/65 (48%) returned at least one sample (median of 6 samples; IQR 5-10). The index HRE species was isolated from stool samples from 19/31 (61%) participants; the median duration of detected carriage was 391 days (range 84-662 days). Screening for resistance genes was performed on 477 sample-derived isolates (Table 1); ESBL/AmpC and carbapenemase genes were present in 221/447 (49%) and 17/447 (4%), respectively. Stool samples (median of 7 samples; IQR 5-11) were collected from 11 contacts of 9 participants, and 1 contact of a contact. Index HRE were isolated from samples from 10/12 contacts (83%); the median duration from date of positive index culture to last positive sample in a contact was 400 days (range 146-588). Whole genome analysis confirmed genetic similarity (< 21 single nucleotide polymorphism difference) between ceftriaxone-resistant blaSHV and blaCTX-M-15 carrying K. pneumoniae isolates in a cluster of 4 participants, which included secondary transmission between a contact of the index patient and one of their contacts over a period of 555 days.Table.Resistance genes

Conclusion

Patients with a clinical culture positive for HRE are at risk for prolonged intestinal HRE carriage after hospitalization. Upon returning home, community spread of HRE was very common in this cohort.

Disclosures

Robert A. Bonomo, MD, Entasis: Grant/Research Support|Merck: Grant/Research Support|venatorax: Grant/Research Support|Wockhardt: Grant/Research Support David van Duin, MD, PhD, Entasis: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Qpex: Advisor/Consultant|Roche: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Union: Advisor/Consultant|Utility: Advisor/Consultant
2887. Implication of genotypes for prognosis of Candida glabrata bloodstream infections
Authors: Chen Pao-Yu , Huang Yu-Shan , Chuang Yu-Chung , Wang Jann-Tay , Sheng Wang-Huei , Chen Yee-Chun , Chang Shan-Chwen
Published: November 2023

Background

Genotyping a specific pathogen may demonstrate unique patterns of antimicrobial resistance and/or interaction between pathogen and host, which subsequently lead to miserable consequence. Herein, we conducted a retrospective single-center study to analyze the association between genotypes and clinical outcomes among Candida glabrata bloodstream infections (BSIs).

Methods

A standard case report form was used to collect the clinical data of hospitalized adults with C. glabrata BSIs in 2017. Antifungal susceptibility testing was performed by using the Sensititre YeastOne SYO-10 panel, and minimum inhibitory concentrations (MICs) were interpretated according to the Clinical and Laboratory Standard Institute. Genotyping was performed by using a multilocus sequence typing scheme, and further analyzed by the unweighted pair group method with arithmetic averages (UPGMA) method.

Results

Among 48 patients, clonal complex 7 (CC7, defined by UPGMA similarities >80%) was the most common CC (n=14, 29.2%). The rates of fluconazole and candin resistance were low (6.6% and 0%, respectively) without specific distributions among genotypes Charlson comorbidity index (adjusted odd ratio [aOR], 1.49; 95% CI, 1.05-3.11) was the only risk factor for CC7 C. glabrata BSIs. CC7 was independently associated with 28-day mortality (aOR, 5.88; 98% CI, 1.06-32.47) in addition to a APACHE II score of >18 (aOR, 5.84; 98% CI, 1.16-29.46). The Kaplan–Meier survival analysis also showed greater mortality in CC7 (Figure). Fluconazole resistance or candin therapy had no significant impact on mortality.Figure.Comparison of Kaplan–Meier survival curves between cloncal complex 7 (CC7) and non-cloncal complex 7 (non-CC7) at 28 days in patients with Candida glabrata bloodstream infections

Conclusion

Our data shed light on the impact of genotypes on clinical outcomes in C. glabrata BSIs. Further virulence characterization of CC7 is warranted.

Disclosures

All Authors: No reported disclosures
1811. Impact of a one-time oritavancin infusion on hospital length of stay for uncomplicated skin and soft tissue infections
Authors: Bremmer Derek N , Alvarez Gabriela , Buchanan Carley , Carr Dustin R , Shively Nathan R , Moffa Matthew A , Trienski Tamara , Walsh Thomas L
Published: November 2023

Background

Oritavancin is a lipoglycopeptide antibiotic approved in the United States for the treatment of adults with skin and soft tissue infections (SSTIs). Given the extended half-life of this agent, a one-time intravenous (IV) infusion is adequate to treat SSTIs. This single IV dose provides a convenient outpatient alternative to a traditionally dosed inpatient vancomycin regimen, which may cause a prolonged hospital length of stay (LOS). Previous studies have demonstrated oritavancin to be non-inferior to vancomycin in clinical measures of SSTI resolution. Our antimicrobial stewardship program proactively identified oritavancin eligibility to potentially decrease hospital LOS for patients with SSTIs admitted to the hospital when the primary team preferred continued IV therapy.

Methods

This was a retrospective, cohort study of adult patients with uncomplicated SSTI admitted to the hospital. All patients who received oritavancin that met these criteria were included and a comparator standard of care arm (SOC) was matched based on age, Charlson score, SOFA score, location of cellulitis, and organism if available. The primary outcome was hospital LOS. Secondary outcomes included documented adverse drug events (ADEs) and 30-day emergency department (ED) visit, hospital readmission, and a composite re-evaluation in outpatient setting, ED, or hospital for continued or worsening infection.

Results

A total of 57 oritavancin patients were included with 35 able to be matched to a SOC comparator. The only difference in baseline demographics was patients in the oritavancin arm were more likely to have failed outpatient antibiotics (49% vs 26%; p = 0. 048). There was no difference in hospital LOS between the oritavancin arm and SOC (2.02 vs 2.56; p = 0.250). There were similar rates of ADEs (2.8% vs 0%; p = 1.00), 30-day ED visits (11.4% vs 14.3%; p = 1.00), hospital readmissions (11.4% vs 5.7%; p = 0.673), and composite re-evaluation for continued or worsening infection (8.6% vs 17.1%; p = 0.477) in the oritavancin arm compared to SOC, respectively.

Conclusion

This analysis found that patients given oritavancin for SSTIs had a numerically shorter hospital LOS, but was underpowered to detect significance. Oritavancin is a reasonable alternative when oral therapy is not an option.

Disclosures

Derek N. Bremmer, PharmD, BCIDP, Thermo Fisher Scientific: Advisor/Consultant Dustin R. Carr, PharmD, BCPS, BCIDP, Merck: Advisor/Consultant Thomas L. Walsh, MD, Accelerate Diagnostics: Advisor/Consultant
1815. Clinical Characteristics of Infections due to Staphylococcus Lugdunensis Compared to Other Staphylococcal Infections
Authors: Harb Souad Bou , Zougheib Youssef , Matar Ayah , Mansour Reem , Kanafani Zeina
Published: November 2023

Background

Staphylococcus lugdunensis (SL) belongs to the group of coagulase negative Staphylococci (CoNS). SL infections may have a more virulent course compared to other CoNS, bearing resemblance to infections caused by S. aureus (SA). This study aims to investigate the clinical characteristics of SL infections at a tertiary care center in Lebanon.

Methods

We enrolled all patients presenting from 2017 to 2021 with positive cultures for SL from four clinical sites (urine, respiratory, wound, and blood). We then selected controls with SA matched 1:1 by site of infection. Since CoNS is not a well-described respiratory pathogen, CoNS were only matched to urine, wound, and blood. Patients who were deemed to have colonization were excluded. We determined the risk factors and outcomes associated with SL infections compared to SA and CoNS infections. We then identified predictors of mortality in the SL cohort.

Results

We identified 101 patients with SL infection, who were matched to 103 patients with SA and 97 patients with CoNS. Most SL isolates were obtained from wound samples (72%), followed by urine (16%), blood (8%) and sputum (4%). Compared to SA, SL patients were less likely to be admitted to the hospital for more than 6 days within the past 30 days (8% vs. 31%; p< 0.01). On the other hand, compared to CoNS, patients in the SL cohort were more likely to have a history of endocarditis (6% vs. 0%; p=0.01). There were no other significant differences between baseline characteristics of SL, SA, and CoNS patients. As far as outcomes, compared to the SA group, patients with SL were more likely to develop renal insufficiency (odds ratio [OR] 4.9; 95% confidence interval [CI] 1.0-23.5) and less likely to have persistent bacteremia (OR 0.5; 95% CI 0.4-0.6). No difference in outcomes was observed between the SL and CoNS cohorts. The mortality rate among SL patients was 8%. The predictors of mortality in this cohort are found in the table.

Bivariable and multivariable analysis of predictors of mortality among patients with SL infections

Conclusion

SL appears to be more associated with patients in the community rather than the hospital setting and may be more likely to occur in patients with damaged heart valves. Chronic pulmonary disease and a blood source of infection are associated with a fatal outcome in SL patients.

Disclosures

All Authors: No reported disclosures
1819. The Impact of Vascularized Lymph Node Transplant in Reducing the Rate of Cellulitis in Patients with Breast Cancer–Related Lymphedema
Authors: Perez Alejandro , Schaverien Mark , George-Palop Monica , Barcenas Carlos , Viola George M
Published: November 2023

Background

Lymphedema following breast cancer surgery is a chronic and disabling complication that may lead to recurrent cellulitis. Innovative advances in treatment of breast cancer–related lymphedema have evolved beyond conservative management to include vascularized lymph node transplant (VLNT). Herein, we analyzed the impact of VLNT in reducing the rate of upper extremity cellulitis in breast cancer survivors.

Methods

The charts of all patients who had breast cancer and mastectomy, whose course was complicated by upper extremity lymphedema, and who ultimately underwent VLNT at our comprehensive cancer center from 2017 to 2021 were reviewed. Patients who had at least one episode of cellulitis within the year prior to VLNT and were followed for 24 months were included. Thereafter, we reviewed patients’ demographics, cancer management, breast reconstructive procedures, VLNT surgeries, and infectious complications.

Results

We included 66 patients in our study. Their median age was 57 years (IQR, 23-76 years) (Table 1). The majority were White (88%), with a mean (± SD) body mass index of 29.4 ± 6.7 kg/m2. Most patients had invasive ductal carcinoma (82%) and received chemotherapy (94%), including taxane-based regimens (85%), which increases the risk for lymphedema. Also, most patients received radiation therapy (86%), including to the axillary nodal basin (92%). Furthermore, most underwent unilateral mastectomy (74%) with axillary lymph node dissection (95%) followed by autologous or implant-based reconstruction (both 42%) (Table 2). VLNT was performed at a median of 92 months (IQR, 32-156 months) after mastectomy and were mainly harvested from the inguinal and gastroepiploic regions (both 32%). After VLNT, 58 (88%) patients remained infection-free throughout the 24-month follow-up period. The only factor associated with recurrent cellulitis was the need for a second lymph node transfer or lymphovenous bypass surgery, likely owing to a significant lack of lymphedema reduction (p=0.006).

Conclusion

The novel approach of VLNT in the management of breast cancer–related lymphedema is associated with significantly decreased recurrent cellulitis rates and should be considered as part of the infectious diseases treatment armamentarium.

Disclosures

All Authors: No reported disclosures
1820. Source Control and Odontogenic Infections in an Urban Safety Net Hospital: What, When and How?
Authors: Pollock Erin , Elbathani Mohamed , Damughatla Anirudh , Monday Lea M
Published: November 2023

Background

Odontogenic infections cause 2.2 million emergency department (ED) visits annually. Infectious diseases (ID) physicians are frequently consulted and recommend source control procedures by oral and maxillofacial surgery (OMFS). However, patients are often instructed to follow-up outpatient which may be difficult due to social determinants of health. Despite this common occurrence, almost no studies exist in the ID literature on follow-up rates or outcomes of these management strategies. We aim to identify and characterize patients with odontogenic infections, and determine whether definitive source control (SC) impacts outcomes.

Methods

An observational cohort study analyzing patients seen by OMFS for odontogenic infection over 14 months (1/2022-2/2023) at a safety net hospital system in Detroit, MI. Odontogenic infection was defined as that of the jaw, neck, or face originating from a tooth or its supporting structures. Non-infectious consults were excluded (Fig 1). Characteristics and outcomes were compared between patients with and without SC. Primary outcome was incidence of 30-day readmission. Mortality and microbiologic data were also collected.

Results

78 patients were evaluated by OMFS; 44 (56%) were admitted and 34 (44%) were discharged from the ED. SC occurred in 60 patients, 50 of which had SC on the index admission or ED visit (29 of 44 admitted and 21 of 34 ED patients, respectively) (Fig 1). SC was deferred in 28 patients, 10 of whom did later receive it. Follow up rates for ED patients who SC deferred were high (8 of 13 patients). Only 2 of 15 deferred inpatients were seen (Fig 1). No documented SC occurred in 18 patients. Groups did not differ significantly in clinical characteristics, antibiotics, or rates of ID consultation (Table 1). There was a trend for SC patients to be male (p=0.057) and require intensive care unit support (p=0.081) (Table 1). Readmission rates were higher in those without source control (28% versus 3%, p=0.001). Common pathogens isolated included oral Streptococci and gram-positive rods (Fig 2).

Conclusion

Odontogenic infection patients without source control had high rates of readmission despite being less critically ill. The ID community should take a more active role in studying the optimal management strategy for this common occurrence.

Disclosures

All Authors: No reported disclosures
1821. Time Until Definitive Grafting of Battlefield-Related Burn Injuries Is Associated with Burn Wound Infection
Authors: Wakefield Connor , Geringer Matthew , Stewart Laveta , Shaikh Faraz , Carson M Leigh , Lu Dan , Cancio Leopoldo , Gurney Jennifer , Tribble David R , Tribble David R , Kiley John
Published: November 2023

Background

With thermal injuries, infection is the leading cause of mortality after initial injury. We examined factors associated with development of skin and soft-tissue infections (SSTIs) in military personnel who sustained burns.

IQR= interquartile range

Multivariate Analysis of Factors Associated with Development of Skin and Soft-Tissue Infections

Methods

Military personnel with burn injuries sustained during deployment (6/09-12/14) who required admission to the Burn Center at Brooke Army Medical Center were included in this analysis. Definitive grafting was defined as effective, successful wound closure noted in the surgical/wound care record. Infection outcomes were grouped by syndrome and comparative analysis using Fisher’s Exact test, Wilcoxon rank-sum test, and logistic regression were performed.

Results

A total of 144 burn patients were included, of whom 143 (99%) were male with a median age of 24 years (Table 1). Approximately 57% sustained blast trauma and the median injury severity score (ISS) was 9. Total body surface area of the burn was a median of 5.75% (interquartile range [IQR]: 3-95%). Twenty-six (18%) burn patients developed an infection with 57% having ≥1 infection: 8% had SSTIs, 15% had pneumonia, 8% had bloodstream infections, and 3% had urinary tract infections. For the 57 (40%) patients who required grafting, the median days to definitive grafting was 9 (IQR: 6-56 days) for those without infections vs 35 days (IQR: 15-127 days) for those with ≥1 infection. Median hospital length of stay (LOS) was 14.5 days and 3% of patients died. On univariate analysis, time to surgery (p=0.032), duration of time until definitive graft (p< 0.001), increasing ISS (p< 0.001), and hospital LOS (p< 0.001) were associated with SSTI development, while injury mechanism (blast vs non-blast) was not significantly associated (p >0.05). On multivariate logistic analysis, increasing duration of time until definitive graft was associated with SSTI development when adjusted for ISS (regression coefficient: 0.07, 95% confidence interval: 0.02-0.12, p=0.005, Table 2), indicating a weak correlation.

Conclusion

A longer time until definitive graft in wounded military personnel with burn injuries was associated with the development of SSTIs. Studies examining medical and surgical management strategies are needed to mitigate impact of infectious outcomes and reduce the time to definitive grafting in these patients.

Disclosures

All Authors: No reported disclosures
1831. Beyond the Viral Load: Infectious Disease Clinicians as Primary Providers for People Living with HIV
Authors: Daudelin Isaac , Salim Tanzila , Khurana Sahiba , Murthy Ashish , Keller Steven , Finkel Diana , Goshorn Eli S
Published: November 2023

Background

With advances in antiretroviral therapy, life-expectancy for people living with HIV (PLWH) has increased. Many HIV specialists function as primary care providers for PLWH and are often the front-line of defense when it comes to preventative healthcare. The Infectious Disease Practice (IDP) at University Hospital in Newark, NJ serves as a medical home and primary care site for many PLWH. The clinic incorporates preventative healthcare measures into providing whole patient care as well as focusing on HIV specific care. Here, we present data from multiple quality assessment projects at our clinic assessing preventative health measures in PLWH.

Methods

Following IRB NHS determination, data was collected from an EPIC database of PLWH seen at IDP. Guidelines for Primary Care by Infectious Disease Society of America, the Advisory Committee on Immunization Practices, JNC8, and the US Department of Health and Human Services were reviewed.

Results

Bone mineral density (BMD) screening was ordered for 59% and completed in 39% of PLWH who met guideline criteria compared to national average of 7.4%

Among PLWH with Diabetes mellitus (DM), 62% achieved A1C goals, 65% achieved blood pressure goals and 67% achieved LDL-c goals. National averages for achieving A1C, blood pressure, and LDL-C goals in people with DM were 51%, 70%, and 66% respectively in 2018.

Hypertension pharmacologic therapy was initiated, and blood pressure controlled to systolic blood pressure < 150 diastolic blood pressure < 90 in 72% of PLWH compared to national average of 65%

Among PLWH, 64% received at least one dose of PCV13, 60% received at least one dose of PPSV23, and 38% were fully up to date compared with national average 23% in PLWH in 2018 receiving at least one dose of either vaccine.

Conclusion

Clinicians practicing in HIV clinics should be up to date on age-appropriate screenings and vaccinations. The IDP has matched or outperformed national standards in several aspects of preventative healthcare for PLWH including DM, hypertension, vaccinations, and BMD screening. Infectious disease specialists who provide care for PLWH are in a unique, trusted position to deliver preventative healthcare and should have expertise in primary care to optimize patient centered care.

Disclosures

Eli S. Goshorn, MD, Genmark Diagnostics Inc: Advisor/Consultant
1833. Infectious Diseases in Patients Experiencing Homelessness in Detroit, MI Over a Three-Year Period (2020-2023)
Authors: Failla Andrew J , Zervos Marcus
Published: November 2023

Background

The homeless population has many health challenges. In Detroit there are estimated 8000 people experiencing homelessness, 62% with a disabling condition, and an estimated readmission rate 4x greater than non homeless (Homeless Action Network Detroit). Coordinating care presents unique challenges. It is imperative to examine infections over the long term to identify areas for care improvement, education, infection prevention and better access. We show an infection profile in patients experiencing homelessness from admissions over 3 years at a large hospital in Detroit. This will bring to light the needs of this population and foster delivery of equitable care to the classically underserved.

Methods

This is a retrospective cohort study done over a 3 year period from 2020-2023 in homeless patients hospitalized at a 850 bed urban hospital. In total we were able to identify 200 patients, and 31 patients had information collected from the EMR.

Results

Patients were mostly Black (83%) males (77%). 48% had primary care providers. 87% had history of substance abuse (35% endorsing IV). Of the 31 patients, all had an infection during the study period. 16% with diagnosis of HIV, and 42% had Hep C. Most common infections were as follows: soft tissue (51.6%), pneumonia (29%), urinary tract (16%). Most common organism in culture was Staph aureus (42%; 46% MRSA), Strep (13%) and E coli (13%). Of gram negatives, 20% were ESBL and 20% AmpC. 35% had a surgical procedure while inpatient. The most common antibiotics were vancomycin (35%) and cephalosporins (32%). Treatment duration was usually 7-10 days (29%). 61.3% completed treatment, 16% had recurrent infection, and 9.6% lost to follow up. 55% received ID consult, but only 9.6% followed up in clinic. 19.3% saw a street medicine organization. Readmission was low (9.6%), although 19.3% had an ER visit post discharge.

Conclusion

This preliminary study establishes a profile of infections in those experiencing homelessness in Detroit. This data will help educate providers, allow equitable and targeted care to be delivered, and lead to intervention options that improve access to care. In the future we plan to create useful tools such as an antibiogram specific to this population that can help community health organizations impact care delivered at initial contact.

Disclosures

Marcus Zervos, MD, Contrafect: Advisor/Consultant|GSK: Grant/Research Support|Johnson and Johnson: Grant/Research Support|Pfizer: Grant/Research Support
1834. Impact of COVID-19 and Socioeconomic Status on Food Insecurity in the US Adult Population: Analysis of the 2021 National Health Interview Survey
Authors: Freeman Jincong Q , Li Xinyi , Lee Yong Gun , Scott Adam W , Xiang Yijin
Published: November 2023

Background

Food insecurity (FI) is a public health concern and negatively affects the health and well-being of many adults in the US, which may have been exacerbated since the COVID-19 pandemic. However, the relationship between COVID-19 and FI among US adults has not been elucidated.

Methods

Data were from the 2021 National Health Interview Survey that used stratified clustering sampling to interview US adults aged ≥ 18 years. COVID-19 infection (yes/no) was per self-report. FI, determined by a 10-item questionnaire assessing household food situations in the past 30 days, was dichotomized (yes/no). Unweighted frequencies and weighted percentages were calculated and compared using Rao-Scott chi-square tests. Multivariable logistic regression was used to examine differences in FI prevalence by COVID-19. All analyses accounted for complex survey design and weights.

Results

The unweighted sample size was 28,274 (mean age 48.3 years). Overall, 13.5% (95% CI: 13.0%-14.1%) had COVID-19, and 5.9% (95% CI: 5.5%-6.3%) experienced FI. Adults with COVID-19 reported a significantly higher percentage of FI than those without (7.3% [95% CI: 6.1%-8.6%] vs. 5.6% [95% CI: 5.2%-6.0%], p=0.003). Most (63.2%) were White, followed by 16.7% Hispanic, 11.5% Black, 5.9% Asian, and 2.6% other races; 22.6% were on Medicaid/Medicare and 9.8% were uninsured; 12.9% received food stamps in the past 12 months. In the adjusted model, adults with COVID-19 were more likely to have experienced FI than those without (adjusted odds ratio [aOR]=1.29, 95% CI: 1.07-1.56). Black (aOR=2.08, 95% CI: 1.72-2.50) or Hispanic (aOR=1.26, 95% CI: 1.03-1.53) adults were more likely than their White counterparts to have experienced FI. Uninsured adults (aOR=2.67, 95% CI: 2.15-3.31) or those on Medicaid/Medicare (aOR=1.94, 95% CI: 1.60-2.35) had greater odds of having experienced FI than those privately insured. Adults receiving food stamps were more likely to have experienced FI than those not receiving (aOR=2.87, 95% CI: 2.36-3.50).

Conclusion

In this study of a nationally representative sample, our findings highlight a higher prevalence of FI among adults with COVID-19, with lower socioeconomic status, or in racial/ethnic minority communities and suggest the need for intervention strategies addressing FI in these adult populations.

Disclosures

All Authors: No reported disclosures
1836. Disparities in COVID-19 Vaccination Coverage Among a Large Patient Population in a Network of Community-Based Healthcare Organizations
Authors: Groom Holly C , Biel Frances , Crane Bradley , Sun Evelyn , Georgescu Joanna , Weintraub Eric , McNeil Michael , Jazwa Amelia , Owens Constance , Naleway Allison L , Schmidt Teresa
Published: November 2023

Background

There are known disparities in U.S. COVID-19 vaccination by race, ethnicity, and rurality, but there is limited information on national trends in vaccine uptake in a large, racially diverse population spanning all ages. Here we describe COVID-19 vaccination coverage in a large US population accessing care in a national network of community-based healthcare organizations (OCHIN).

Methods

Within the OCHIN network, we identified all individuals aged 6 months and older who had at least one completed encounter in an OCHIN facility across 26 U.S. states since becoming age-eligible for the COVID-19 vaccine, through 2022. Patients’ COVID-19 vaccination status was assessed from the OCHIN Electronic Health Record which includes data from state immunization information systems. Individuals were categorized as vaccinated with the primary series if ≥2 appropriately spaced doses of either mRNA monovalent product, or a single dose of Johnson & Johnson® vaccine, were documented. Coverage was assessed by age groups based on the roll-out of COVID-19 vaccine recommendations (6 months-4 years; 5-11 years, 12-15 years, 16+ years).

Results

The cohort of over 3.3 million identified as Hispanics (37%), non-Hispanic (NH) Whites (31%), NH Blacks (15%), and NH Asians (7%); 44% of whom were Medicaid-enrolled, 19% without health insurance, and 53% with a household income below 100% of the federal poverty level.

The proportion fully vaccinated increased incrementally with age and ranges from a low of 7.2% (6 months through 4 years) to a high of 63.4% (75 years and older); consistently lower than national coverage estimates across age groups (Figure 1). Patterns are consistent across age groups, where coverage is highest among NH Asians (range: 13%-64%) and lowest for NH Blacks (3%-40%) (Figure 2); and lowest among the people without insurance (7%-41%). Those with ≥ 1 prior influenza vaccine since 2019 had higher coverage than those without, most notably among those aged 16+ years (71% vs. 16% fully vaccinated, respectively). (Figure 3)Figure 1.COVID-19 Vaccine Primary Series Coverage, OCHIN vs. CDC National Estimates*, OCHIN, December 2022

Conclusion

We identified disparities in primary series COVID-19 vaccine coverage by age, race and ethnicity, household income, insurance status, and by prior influenza vaccination within this large, diverse population accessing care in community-based healthcare organizations.

Disclosures

All Authors: No reported disclosures
1841. Younger age and female gender are associated with delayed antibiotics in pediatric sepsis
Authors: Kandil Sarah B , Lee Seohyuk , Feinn Richard , Murray Thomas S
Published: November 2023

Background

Sepsis is a leading cause of pediatric mortality, with nearly 5,000 children dying annually.(Weiss, Fitzgerald et al. 2015) Clinical advances in care bundles to improve sepsis recognition and timely treatment have demonstrated improved outcomes.(Lane, Funai et al. 2016) Recently, literature suggests an association between pediatric sepsis mortality and various social determinants of health, including race and socioeconomic status.(Reddy, Badolato et al. 2022, Li, Ng et al. 2023) It is unclear what may contribute to these disparities; therefore, we chose to evaluate if race, ethnicity or other factors resulted in delayed antibiotic administration.

Methods

This retrospective cohort review of a single center quality improvement pediatric sepsis dataset included admitted patients with a blood culture and intravenous antibiotics within 4 hours and a hospital diagnosis of sepsis. Patients admitted to the neonatal intensive care unit were excluded. The primary outcome was antibiotic administration > 60 minutes. Exposures of interest included age, gender, race, ethnicity, language, sepsis severity level, ICU admission and mortality. Analysis included descriptive statistics and Chi-Square testing.

Results

From 2016 – 2023 there were 322 patients [43% White, 19% Black, 38% Other (Asian, multiple racial, or unavailable)], with 61% identified as non-Hispanic and 39% Hispanic. English was the primary language (83%) and there were 52% females, and 48% males. Overall, 58% of patients required intensive level care and 6.8% died. The mean time to antibiotics was 75 minutes. There was no statistical significance when evaluating if race, ethnicity, language, or sepsis severity contributed to antibiotic delays of > 60 minutes. Factor associated with a statistically significant delay in antibiotic administration were: mortality (68.2 died % vs 31.8% survived; p < 0.003) and female gender (46% female vs 29% male ; p < 0.002); regardless of sepsis severity and infants < 1 year (59% < 1 year, 32%, 1-17 years, and 31 % >18 years; p< 0.001).

Conclusion

Inequities exist in the timely delivery of antibiotics for younger infants and female patients with an admitting diagnosis of sepsis. Further investigation is warranted to identify drivers for these inequities.

Disclosures

All Authors: No reported disclosures
1842. Low Birthweight and Retention in HIV Care among Postpartum Women Living with HIV in Ghana
Authors: Kazanji Noora , Sakyi Kwame , Edler Bianca
Published: November 2023

Background

In Ghana, caring for small babies is associated with low social support, delayed care seeking, and experience of perceived stigma. These psychosocial factors can affect retention in HIV care for mothers living with HIV (MHIV). This has implications for maternal health and continuous access to lifesaving antiretroviral therapy (ART). Consequently, these women have higher risks of mortality, disease progression, and elevated viral load which can place the infant at risk of HIV acquisition through breastfeeding. The goal of this study was to examine the effect of infant birthweight on retention in HIV care among postpartum MHIV in Ghana.

Methods

A secondary analysis was conducted on a longitudinal study which examined how caring for low birthweight infants influenced maternal ART adherence. Study participants included 126 postpartum MHIV who delivered at hospitals in Accra, Ghana. Participants were enrolled at time of birth and followed for six months. Modified Poisson and Poisson Bivariate and Multivariate regression models were performed to examine two primary outcomes: missing one or more of the three expected visits for HIV care within six months after birth and total number of HIV clinic days missed within six months after birth. Primary exposure variables included hospital recorded birthweight and the size of the infant as perceived by the mother.

Results

In multivariate analysis, controlling for ART adherence, time on ART, education, income, baby health, age, hospital site, and internalized HIV stigma, for every 1 unit increase in birthweight, MHIV missed significantly less days of HIV care [IRR = 0.71, CI: 0.66 - 0.8, p< 0.001]. MHIV who perceived their infant size to be less than average missed significantly more visits when compared to MHIV who perceived their infant size to be average, while controlling for the same covariates [IRR = 1.41, CI: 1.27- 1.56, p< 0.001].

Conclusion

For MHIV, the size of the baby affects retention in HIV care from both hospital-recorded birthweight and perceived infant size by the mother. Further interventions are needed at the individual and health system levels, especially towards reducing internalized stigma, to help mothers remain engaged in HIV care.

Disclosures

All Authors: No reported disclosures