bluuebunny/crossref_metadata_2025 huggingface dataset:
1173. Risk of Pneumococcal Disease and Rate of Pneumococcal Vaccination Among Medicare Beneficiaries Aged 65 Years and Older Residing in Long-Term Care Facilities — United States, September 1, 2014 – December 31, 2019
Authors: Kobyashi Miwako , Andrejko Kristin , Zielinski Lindsay , Lindaas Arnstein , Cha Hyejeong , Lufkin Bradley , Chillarige Yoganand
Published: November 2023

Background

Adults living in long-term care (LTC) facilities are at increased risk of respiratory infectious diseases, including pneumococcal disease. On August 13, 2014, the Advisory Committee on Immunization Practices recommended 13-valent pneumococcal conjugate vaccine (PCV13) in addition to 23-valent pneumococcal polysaccharide vaccine (PPSV23) for adults aged ≥65 years based on data that showed PCV13 vaccination confers protection against all-cause community-acquired pneumonia (CAP) and invasive pneumococcal disease (IPD). We assessed PCV13 vaccination coverage and incidence of CAP and IPD among Medicare beneficiaries with ≥1 LTC stay.

Methods

We identified Medicare Fee-for-Service beneficiaries aged ≥65 years with no prior PCV13 receipt and ≥1 LTC facility stay during September 1, 2014 through December 31, 2019 through Minimum Data Set assessments and skilled nursing facility claims. PCV13 and PPSV23 vaccination history was determined through Medicare claims using Healthcare Common Procedure Coding System and Current Procedural Terminology codes. Incident IPD and CAP outcomes were identified through inpatient Medicare claims using International Classification of Diseases diagnosis codes (ICD-9-CM/ICD-10-CM). Outcome incidence was calculated based on time during and outside LTC stays. PCV13 coverage was assessed by LTC residency status on December 31, 2019.

Results

There were 3,643,248 beneficiaries with ≥1 LTC facility stay during the observation period. Beneficiaries were majority white (89.9%), female (62.1%), aged ≥75 years (67.7%), and had ≥1 chronic medical condition (55.7%); 25.6% had received PPSV23 vaccination at the study start date. By December 31, 2019, PCV13 coverage was 55.3%; coverage among those residing in and outside a LTC facility was 47.5% and 57.3%, respectively. Incidence of CAP and IPD were higher during LTC compared with time outside LTC stay (incidence rate ratio 3.17 [95% CI: 3.15, 3.19] and 1.90 [95% CI: 1.80, 2.00] for CAP and IPD, respectively) (Table).

Conclusion

Incidence of IPD and CAP were higher during an LTC stay compared with time residing outside of a LTC facility. PCV13 coverage was lower among those in LTC. Improving pneumococcal vaccination coverage may help mitigate the risk of IPD and CAP in this population.

Disclosures

All Authors: No reported disclosures
1184. Investigating the Relationship Between Beta-Lactam Antibiotics and Thrombocytopenia: A Propensity Score-Matched Cohort Study
Authors: Chen Alyssa Y , Hanna John J , Basit Mujeeb , Monogue Marguerite
Published: November 2023

Background

Cases of beta-lactam (BL) induced thrombocytopenia (TCP) have been reported, but the evidence on whether BLs pose an increased risk for TCP remains inconclusive. This large-scale study examines the association of TCP with BLs when compared to alternative non-beta-lactams (nBL).

Methods

This retrospective study included adult inpatients who received at least one antibiotic administration at The University of Texas Southwestern Medical Center between 2008 and 2021. We excluded surgical patients, patients with baseline TCP, noncontinuous antibiotic therapy, no recorded platelet count value following antibiotic administration, and those who received more than one class of antibiotic therapy. Antibiotics were grouped into classes and subclasses (Table 1). BL as well as each BL subclass were compared to nBL. For each comparison group, propensity score matching was performed to control for age, sex, baseline PLT, days of antibiotic therapy, immunosuppression, exposure to other thrombocytopenic medications, hematologic cancer, and transplant status. The primary outcome was TCP defined as 1)< 150×109/L or 2) > 50% decrease from baseline in the 30 days following the first antibiotic administration. Secondary outcomes included TCP in 3 and 7 days, and clinically significant TCP(< 50×109/L).

Results

A total of 13,887 unique patients were included, with 6,127 received exclusively BL and 7,760 nBL (Figure 1). Covariate balance was achieved following matching for each comparison. After matching, 931/5047 patients in the BL group developed TCP compared to 875/ 5047 matched patients in the nBL group. There was no statistically significant difference in the odds of TCP between both groups (OR, 1.08; 95 CI%, 0.97-1.19). Of the BL subclasses, only 1st generation cephalosporins and extended combination penicillins were found to carry statistically significant greater odds of TCP compared to nBL (Table 2). However, these differences disappeared for clinically significant TCP levels. There was no statistically significant difference in time to TCP for BL compared to nBL (Figure 2).Figure 1.Cohort flow diagramFigure 2.Kaplan Meier curve for thrombocytopenia by antibiotic class

Conclusion

The study found no statistically significant increase in TCP risk for BL when compared to nBL. Therefore, the risks and benefits should be considered before switching off preferred BL therapy.

Disclosures

Alyssa Y. Chen, MD, MPH, Advanced Clinical: Medical Specialist
1214. Short versus long antibiotic treatment duration for febrile urinary tract infection and acute pyelonephritis: A systematic review and meta-analysis
Authors: Schneider-Smith Erika , Bacher Bailey , Morgan-Gillard Xavier , Yaeger Lauren , Durkin Michael J , Marschall Jonas
Published: November 2023

Background

The optimal treatment duration for febrile UTI and pyelonephritis is unknown; however, multiple randomized trials have compared shorter versus longer duration. The most recent systematic review and meta-analysis was published 10 years ago.

Methods

With the support of a medical librarian (LY), we conducted a systematic review of the pertinent literature up to December 14, 2021. We used key terms for febrile urinary tract infection and acute pyelonephritis, treatment duration, and possible antimicrobial agents in the search. Using the evaluation tool Covidence, the identified abstracts were reviewed by the research team and potentially eligible studies were subject to full-text review. We also reviewed the references of eligible articles and scrutinized meeting abstracts. For the meta-analysis, we used SPSS version 28. For quality assessment, we used the Cochrane risk-of-bias tool.

Results

We screened 6732 abstracts, reviewed 21 full-text articles, and included 12 articles in this systematic review. We conducted a meta-analysis of these 12 articles (Figure 1). The Odds Ratio (OR) for clinical failure between short versus long treatment duration was 0.81 (95% CI 0.55-1.19). We also conducted a subgroup analysis for the more recent trials (#9-12 in Fig 1), with an OR 1.09 (95% CI 0.64-1.87), and the older trials (#1-8 in Fig 1), with an OR 0.68 (95% CI 0.36-1.31). The OR of experiencing an adverse event was 0.88 (95% CI 0.63-1.22) between short and long duration groups (Fig 2).Figure 1:Odds ratio of treatment failure with short versus long antibiotic course for febrile UTI and acute pyelonephritis

This figure represents the odds ratio of treatment failure in short versus long duration treatment. Therefore, an odds ratio <1 favors short duration (i.e. lower odds of treatment failure), whereas an odds ratio >1 favors long duration.Figure 2:Odds ratio of adverse events with short versus long antibiotic course for febrile UTI and acute pyelonephritis

This figure represents the odds ratio of a patient experiencing at least one adverse event in the short versus long duration treatment groups. Therefore, an odds ratio <1 favors short duration (i.e. lower odds of adverse events), whereas an odds ratio >1 favors long duration.

Conclusion

In this systematic review and meta-analysis of the evidence comparing shorter versus longer treatment durations for febrile UTI and pyelonephritis, 7 days of treatment were non-inferior to 14 days. There was no difference in adverse events between the two groups. Our findings confirm those of an earlier meta-analysis and serve as a reminder that shorter treatment durations for febrile UTI and pyelonephritis are sufficient.

Disclosures

All Authors: No reported disclosures
1215. The Impact of MRSA Nasal PCR on Antibiotic De-escalation
Authors: Silverman Adam , Gautam-Goyal Pranisha , Saunders-Hao Patricia , Kline Myriam , Jain Sumeet
Published: November 2023

Background

Methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) of the nares is effective in the screening and detection of MRSA colonization. Prior studies have shown that MRSA PCR has an overall negative predictive value (NPV) of more than 90% for ruling out MRSA infection of various anatomic sites.

Methods

We conducted a retrospective, single-center cohort study to determine if concomitant collection of an MRSA PCR nares swab among patients receiving IV vancomycin in the emergency department (ED) for suspected or known infection alters vancomycin days of therapy (DOT). We educated ED providers to collect MRSA PCR on all patients receiving a dose of vancomycin, however ordering and collection was left at the discretion of the provider. Patients who received at least one dose of IV vancomycin in the ED were identified through a medication usage report and were retrospectively reviewed through their hospital admissions to compare vancomycin DOT in patients who did and did not have an MRSA PCR collected. PCR collection was required to be done by the ED.

Results

Before education, collection of MRSA PCR by ED providers was 0%. Afterwards, there was an observed sustained MRSA PCR collection rate of approximately 25-30%. Of the 236 patients included, 98 had MRSA PCR collected and 138 did not. Both groups showed similar outcomes. There was no statistically significant difference between median vancomycin DOT in the PCR group vs. non-PCR group (3 vs. 2 days, p=0.2638). There was also no statistically significant difference in vancomycin-associated nephrotoxicity (5.10% vs. 5.80%, p=0.9731), hospital length of stay (median 7 days for both groups, p=0.5638), and mortality (10.20% vs. 11.59%, p=0.7368).

Conclusion

Despite the use of MRSA PCR in admitted patients undergoing treatment for suspected infection, there was no significant difference seen in vancomycin DOT or associated secondary outcomes. The utility of MRSA PCR at our institution was likely undermined by shorter vancomycin DOT at baseline, leading to difficulty detecting its impact on vancomycin de-escalation. Given the test’s high NPV, it is likely being underutilized and should be studied further as a tool in the de-escalation of vancomycin.

Disclosures

All Authors: No reported disclosures
1250. Association Between Antimicrobial Stewardship Resources and Practices Reported by California Hospitals in the National Healthcare Safety Network Annual Survey and California Department of Public Health Antimicrobial Stewardship Program Honor Roll Designation
Authors: Brenes Lizette , Czerny Becca , Mitsunaga Tisha , Epson Erin , Kriengkauykiat Jane
Published: November 2023

Background

California hospitals report information on antimicrobial stewardship (AS) Core Elements, resources, and practices through the National Healthcare Safety Network Annual Survey. The California Department of Public Health has an AS Program (ASP) Honor Roll to recognize and promote hospital AS. We explored associations between AS-related responses in the Annual Survey with Honor Roll designation, which ranks increasingly comprehensive ASP as Bronze, Silver, or Gold.

Methods

We linked 2020–2021 Annual Survey data to Honor Roll designations for acute care and critical access hospitals by year. We included 59 AS-related survey questions based on completeness and consistency between survey years. We compared survey responses by designations with chi-square and Fisher’s exact tests. We used a multivariable proportional odds regression model to evaluate the association of survey responses with the likelihood of ordinal designations. We used a stepwise approach and compared goodness-of-fit statistics at each iteration of model variable selection.

Results

Of 179 Honor Roll hospital designations with linked survey data, 21% were Gold, 41% Silver, and 38% Bronze in 2020, and 21% were Gold, 53% Silver, and 26% Bronze in 2021. The final ordinal model included 29 survey covariates related to leadership oversight, ASP lead, AS practices, and education. Hospitals significantly associated with higher designation included those that: performed prospective audit and feedback (PAF) of vancomycin (OR:4.09, 95%CI 1.27-13.83) and azoles (OR:3.37, 95%CI 1.07-11.31); and required prior authorization of newer beta-lactam/-lactamase inhibitors (OR:3.31, 95%CI 1.18-9.49) and echinocandins (OR:2.78, 95%CI 1.02-7.77), holding constant all other variables. Odds for higher designations were reduced if facilities performed PAF of echinocandins (OR:0.17, 95%CI 0.05-0.53).

Conclusion

Higher Honor Roll designation is a marker for a more effective ASP; thus, AS practices, especially prospective audit and feedback, in conjunction with resources related to ASP lead(s) and leadership oversight, should be prioritized by ASPs. Further exploration of practices, such as prior authorization of select antimicrobials, would be warranted as there were varying associations with designations.

Disclosures

All Authors: No reported disclosures
1252. Penicillin Allergy Reassessment for Treatment Improvement (PARTI): A Dental Office Tool to Support Appropriate Penicillin Allergy Labeling
Authors: Coyne Ashlan J Kunz , Holger Dana , Kennedy Erinne , Connell Mackenzie , Binienda Juliann , Giuliano Christopher , Bailey Elaine
Published: November 2023

Background

Dentists routinely review patient allergy histories and prescribe penicillin. Dental visits offer an opportunity to identify patient candidates for PCN allergy reassessment. Aim: to collect and evaluate clinician and patient feedback on a PCN Allergy Reassessment for Treatment Improvement (PARTI) tool created for patient-clinician communication about PCN allergy labels, and ultimately, to delabel patient EHR records, as appropriate.

Methods

A mixed methods pilot study was conducted January-March 2023. We administered a semi-quantitative questionnaire to interdisciplinary clinicians and performed semi-structured focus groups of patients with a PCN allergy label for tool feedback. The questionnaire and focus group guide were developed to focus on the three tool components: (1) steps for PCN allergy reassessment, (2) general patient-centered PCN allergy information, and (3) a follow-up checklist for updating EHR allergy records. Deductive thematic analysis was used for the focus group data.

Results

In total, 50 clinicians completed the questionnaire and 15 patients participated in focus groups. Both groups included individuals from 5/5 U.S. regions. Survey respondents included mostly pharmacists (30%) and dentists (20%). PARTI steps 1, 2, and 3 were rated as “very important” or “important” for 81%, 67% and 93% of clinicians, respectively. Inclusion of the patient information section was supported by 100% of clinicians and 94% thought the PARTI tool was at an appropriate literacy level. Stated barriers to using the PARTI tool included patient follow-through and provider comfort with evaluating PCN allergies. Regarding the PARTI tool itself, focus group participants indicated that the tool was a conversation starter, easy to understand, included helpful patient-centered allergy information, and that the follow-up checklist for EHR record updates was useful. Stated patient barriers to the PARTI tool included patient follow-through and clinician hesitancy to update allergy records.

Conclusion

Patients and clinicians were receptive to using the PARTI tool for PCN allergy reassessment. Data herein will be used to address clinician and patient feedback to further develop the PARTI tool in preparation for its use in a national, multidisciplinary pilot study.

Disclosures

All Authors: No reported disclosures
1257. The Impact of Communication Type on Acceptance Rates of Antimicrobial Stewardship Interventions
Authors: Morado Faiza , Nanda Neha
Published: November 2023

Background

While face-to-face communication (ie. “handshake stewardship” (HS)) has been shown to improve antimicrobial stewardship program (ASP) intervention acceptance rates, this strategy is resource intensive. Therefore, systems unable to conduct HS must identify the optimal mode of communication for ASP recommendations. This study evaluated the effects of communication type on ASP intervention acceptance.

Methods

An infectious disease physician and ASP pharmacist met Monday through Friday to assess appropriateness of select antimicrobials. ASP recommendations were delivered through direct communication via telephone conversations or passive communication via text-page. A text page consisted of a message limited to 240 characters sent directly to the primary team. We performed a retrospective review of all interventions and associated acceptance rates, antimicrobials and antimicrobial indications between January 1st, 2023 to March 31st, 2023. The primary outcome evaluated was ASP intervention acceptance rate.

Results

Recommendations were delivered through telephone conversations in 267/454 (58.8%) cases compared to 187/454 (41.2%) cases in which recommendations were provided via text-page. We found that direct communication delivered telephonically resulted in a significant increase in ASP intervention acceptance rate compared to passive communication via text page (82.8% vs 73.8%, respectively; p=0.02). This resulted in 884 and 552 days of antimicrobial therapy saved in the telephonic and text-page group, respectively (p=0.64). Significant differences in baseline characteristics included: antimicrobial indications of intraabdominal, respiratory, sepsis and febrile neutropenia; having a broad differential; and an intervention category of de-escalation.

Conclusion

Direct communication with clinicians (eg. telephonically) improves ASP intervention acceptance rates compared to passive communication styles (eg. text-page). Direct communication with the prescriber encourages shared decision making, increases visibility of ASP, and allows for education to modify prescribing behavior. The success of an ASP relies heavily on provider relationships, which direct communication can further promote.

Disclosures

All Authors: No reported disclosures
1270. Impact of a Multidisciplinary Antimicrobial Stewardship Program (ASP) on Antibiotic Utilization and Clinical Outcomes at Tertiary Hospital in Saudi Arabia: A Quasi-experimental Study
Authors: Sarkhi Khadijah , Thabit Abrar K , Eljaaly Khalid , Kaki Reham , Bahamdan Rahaf , Alghamdi Sultan A , Baharith Mohammed O
Published: November 2023

Background

The concept of antimicrobial stewardship has been introduced for over a decade in response to the rapid global emergence and spread of antimicrobial resistance. To measure the impact of ASP interventions, several ASP metrics were developed. Very limited studies from Saudi Arabia have evaluated the impact of ASP interventions on antibiotic use and clinical outcomes of non-ICU patients. Therefore, we aimed to assess the impact of this ASP intervention on various ASP metrics by comparing the data of the post-intervention phase to that of the pre-intervention phase.

Methods

A quasi-experimental study was performed on patients admitted to non-ICU wards for whom a restricted antibiotic was ordered. Prospective audit and feedback (PAF) were already in place; however, on September 1st, 2020, a bundle of changes was introduced to improve the intervention making it a multifaceted intervention. These included the involvement of an infectious diseases clinical pharmacist, review of orders by attending (consultant) infectious diseases physicians, utilization of electronic resources instead of paperwork, and improvement of documentation. The primary outcomes were antibiotic utilization measures as defined daily dose per 100-patient days (DDD/100PD) and days of therapy per 100-patient days (DOT/100PD). Secondary outcomes were clinical outcomes of patients.

Results

A total of 402 episodes were evaluated for 167 and 188 unique patients in the pre- and post-intervention phases, respectively. DDD/100PD and DOT/100PD in the pre phase vs the post phase were 1.75 vs. 2.54 and 16.13 vs. 44.93, respectively (P < 0.001 for both comparisons). Antibiotic de-escalation and clinical cure rates were significantly higher in the post phase than in the pre phase (62% vs. 40.6% and 83.5% vs. 65.8%; P < 0.001 for both comparisons). In-hospital mortality and 30-day readmission rates were lower in the post phase than in the pre phase (13% vs. 20.8%; P = 0.037 and 20.5% vs. 33.8%; P = 0.003, respectively). Length of stay in both hospital and ICU were shorter in the post phase (14 vs. 22 days and 3 vs. 9 days, respectively; P < 0.001 for both comparisons).

Conclusion

Our study demonstrates that the ASP intervention was associated with significant improvement in antibiotic utilization and patients’ clinical outcomes.

Disclosures

Khalid Eljaaly, PharmD, MS, BCPS, BCIDP, FCCP, Reckitt Benckiser Healthcare International Ltd, UK: Member of the Global Respiratory Infection Partnership, supported by unrestricted educational grant from Reckitt Benckiser Healthcare Ltd
1282. Evaluation of Opportunities for Implementing OVIVA Criteria on Patients with Bone and Joint Infections (BJIs) in Outpatient Parenteral Antimicrobial Therapy (OPAT)
Authors: Crawford Garrett , Wasan Michelle , Brenon Jessa , Soto Caitlin , Wright William F , Keller Sara C
Published: November 2023

Background

Historically, long term intravenous (IV) antimicrobial therapy has been considered superior to oral (PO) for the management of BJIs. In recent years, this concept has been challenged with studies showing similar efficacy and safety between PO and IV therapy. The purpose of this study is to evaluate areas for improvement within Johns Hopkins Medicine (JHM) in utilizing oral antibiotics for the treatment of BJIs as outlined in the OVIVA trial.

Methods

A multicenter, retrospective study was performed of adult patients with BJIs discharged from The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center followed by the JHM OPAT Service between February 1, 2021 and February 1, 2022. The following was collected on all patients: demographics, comorbidities, site of infection, OPAT-related adverse events (AEs), 30-day readmissions, emergency department (ED) visits, source control, microbiological data, antibiotic regimen, and treatment outcomes. The primary outcome is the proportion of patients treated for BJIs with OPAT who would have qualified for oral antibiotics according to OVIVA trial criteria. Secondary outcomes include the rate of OPAT-related AEs and treatment outcomes (30-day readmissions and ED visits, 6-month treatment failure, early IV to PO transitions, and durations of therapy). Descriptive statistics were used to summarize demographics and the primary and secondary outcomes.

Results

Among the 350 patients with BJIs, 221 patients met inclusion criteria. For the primary outcome, 169 (76.4%) met oral eligibility criteria with sulfamethoxazole-trimethoprim, tetracyclines, and cephalosporins being the most common PO options. There were 35 total OPAT-related AEs (24 [14.2%] in the PO eligible group and 11 [21.2%] in the PO ineligible group). There were 15 readmissions (11 [6.5%] in the PO eligible group and 4 [7.7%] in the PO ineligible group) and 17 ED visits (13 [7.7%] in the PO eligible group and 4 [7.7%] in the PO ineligible group). For 6-month treatment failure, there were 29 total occurrences (23 [13.6%] in the PO eligible group and 6 [11.5%] in the PO ineligible group).

Conclusion

Based on OVIVA trial criteria, the majority of evaluated patients could have utilized oral antibiotics, which could have resulted in fewer OPAT-related AEs, readmissions, and ED visits.

Disclosures

Sara C. Keller, MD, MPH, MSPH, Pfizer: Advisor/Consultant
1289. Assessing the Safety and Efficacy with Prolonged Use of Tedizolid in Orthopedic Patients
Authors: Garza Daniel E , Maguire Christina , Binkley Amanda , Weinstein Erica J , Silibovsky Randi
Published: November 2023

Background

Bone and joint infections (BJI) often require 4 to 6 weeks of treatment with oral or intravenous antimicrobials. To aid in achieving clinical cure, oral agents should be highly bioavailable, have a wide therapeutic index, and ideally penetrate bone tissue well. Data is available for linezolid’s use in BJIs but uptake is limited given its propensity to cause thrombocytopenia with long term use. Tedizolid, however, is associated with less side effects but little remains known about its use for longer treatment durations in BJIs.

Methods

This study is a single center, retrospective cohort study. It evaluated individuals 18 years or older that received tedizolid for 14 days or more for treatment or suppression of BJIs with available follow up lab data monitoring between 2014 and 2022. The primary outcome was occurrence of grade 2 or higher hematological or hepatic National Institute of Health defined adverse drug events during the course of therapy. Secondary outcomes included treatment success defined by no recurrence of infection within 3 months of completing therapy or sustaining suppressive therapy identified by microbiological, clinical or histological evidence.

Results

Thirty-three patients were included in this study and two (6%) patients experienced a safety event, both due to worsened anemia during treatment. Tedizolid also showed efficacy with 26 (90%) of 29 patients completing treatment without recurrence of infection within 3 months. One (25%) of 4 patients failed suppression therapy but are now re-suppressed on tedizolid.

Conclusion

Tedizolid used for 14 days or greater for BJI treatment or suppression was well tolerated and associated with a favorable treatment outcome. Our findings align with other data available highlighting safety of long-term use of tedizolid for non-orthopedic indications.

Disclosures

Christina Maguire, PharmD, Viiv: Advisor/Consultant Amanda Binkley, PharmD, BCIDP, AAHIVP, Viiv: Advisor/Consultant
1293. Efficacy of Doxycycline in Staphylococcal Prosthetic Joint Infection Treated with Debridement, Antibiotics and Implant Retention (DAIR) or Revision with Destination Spacer Placement
Authors: Jang Timothy , Hewlett Angela , Cortes-Penfield Nicolas W
Published: November 2023

Background

Prosthetic joint infection (PJI) is common, limb-threatening, and often warrants extended antibiotic durations. Intravenous (IV) glycopeptide, lipopeptide, and beta-lactam antibiotics have been the de facto US standard of care for staphylococcal PJI for decades, while the preponderance of (mostly European) published clinical data for PJI involves fluoroquinolone and rifampin combinations. However, these antibiotic strategies carry substantial adverse effects. In contrast, tetracyclines are less-studied for treatment of staphylococcal PJIs, but offer ease of administration and a favorable side effect profile.

Methods

We retrospectively evaluated the characteristics and outcomes of patients with staphylococcal PJI treated with doxycycline from March 2019 to April 2021 who received some period of outpatient parenteral antibiotic therapy (OPAT) and were included in our medical center’s OPAT database. We included patients with hip, knee, or shoulder PJIs managed with either debridement, antibiotics and implant retention (DAIR) or revision to a permanent “destination” spacer who received doxycycline within the first 12 weeks of therapy. Diagnosis of staphylococcal PJI was based on the documentation of the treating ID team plus identification of staphylococci in surgical tissue or synovial fluid cultures. Our primary outcome of interest was treatment failure, defined as reoperation for infection in the affected joint within one year of initial surgery.

Results

Of 24 patients switched to doxycycline after a mean 42 days, 17 underwent DAIR and 7 had destination spacers placed. 15 of 17 patients (88.2%) who underwent DAIR and 7 of 7 patients (100%) who received destination spacers remained free of treatment failure at one year; two patients had recurrent infections and none died.

Conclusion

These findings suggest that doxycycline is a safe and efficacious option for treatment of PJI. A key limitation of this study is patient identification via the OPAT database, meaning patients with short IV lead-in therapy (i.e. switch to PO at discharge) were not included, and that the efficacy of doxycycline is likely exaggerated by immortal time.

Disclosures

Angela Hewlett, MD, MS, Forcast Orthopedics: Advisor/Consultant|Mapp Biopharmaceutical: Grant/Research Support
1302. Impact of Insurance Coverage on the Route of Antibiotic Treatment for Forefoot Osteomyelitis
Authors: Ritter Austin , Ovalle Anais , Hadeel Zainah
Published: November 2023

Background

Recent studies suggest oral antibiotics can be a non-inferior alternative to intravenous antibiotics for treating bone and joint infections. In this study, we aimed to investigate whether insurance type affects the choice of antibiotic treatment routes and whether the route of antibiotic treatment influences the delivery of home health services.

Methods

We conducted a retrospective chart review of non-bacteremic patients who underwent amputations for forefoot osteomyelitis with residual signs of infection on proximal bone cultures and were discharged home from the hospital. Of 461 patients scheduled for hospital follow-up visits for bone and joint infections in our community practice infectious diseases clinic from January 2019 to December 2022, 40 met the inclusion criteria. Results were analyzed with multivariable logistic regression, selecting models with the lowest Akaike Information Criterion.

Results

The placement of PICC lines decreased significantly over time (OR 0.34, 95% CI: 0.14 - 0.71, p = 0.01), mirroring national trends favoring increased oral antibiotic use. After controlling for the year of treatment, we observed a trend towards patients with Medicaid insurance more frequently receiving IV antibiotics (OR 4.8, 95% CI: 1.0 - 29, p = 0.06). We found no evidence that the antibiotic administration route led to differences in the delivery of home health services at the time of discharge (p = 0.99).

PICC Placement Percentage by Year and Insurance

Percentage of PICC line Placement by year in patients with and without Medicaid Insurance during hospital encounter

PICC Placement Frequency by Insurance and Home Nursing

Frequency of PICC placement in patients during hospital encounters based on (A) if a patient has Medicaid insurance and (B) if home nursing is ordered at discharge

Organisms Cultured by Year

Frequency of organisms cultured on proximal bone cultures by year of study

Conclusion

Our findings suggest a trend towards patients with Medicaid insurance more frequently receiving IV antibiotics, despite the higher direct and indirect costs. It remains unclear whether this trend is due to differences in the severity of infections or microbiological resistance patterns. Future studies should assess the interaction of psychosocial and microbiological factors in influencing shared decisions regarding the route of antibiotic treatment outside of clinical trial settings.

Organisms Cultured by Antibiotic Route, Insurance Type, and Home Nursing Orders

Frequency of PICC line placement (A), Insurance coverage (B), and ordered for home nursing at discharge (C) by organisms cultured from proximal bone margins

Disclosures

All Authors: No reported disclosures
1309. Fungal Prosthetic Joint Infection - Case Series and Review of the Literature
Authors: Starnes Victoria , Duggan Joan , Hollingshead Caitlyn M
Published: November 2023

Background

The most effective treatment for fungal prosthetic joint infections remains unclear. Most cases are treated with two-stage revisions combined with systemic antifungal medications. To date, the largest studies of total hip arthroplasty and total knee arthroplasty fungal infections have included 37 and 45 patients, respectively.

Methods

A retrospective record review of patients admitted in two health systems between January 1, 2007 and December 31, 2018 with prosthetic joints and a deep culture of the joint positive for fungal organisms was performed as well as a review of the literature. A Pubmed and Embase search of the English-language literature from Jan 1, 1980 to Jan 1, 2023 was performed with review of the pertinent references for cases meeting the following case definition: individual with prosthetic joint and positive deep tissue culture for fungus.

Results

159 patients fit criteria. 73 patients had knee replacements, 62 patients had hip replacements, and 5 had other joint involvement. 52% were female. 137 patients had yeast involvement, with Candida species being predominant, while 11 had mold and 11 with dimorphic infections. 55 patients were treated with two-stage revisions, 44 received one-stage revisions, 32 received debridement only or Girdlestone procedure, and 1 required amputation. 141 reported details on antifungal therapy. After performing multivariate analysis, polyene treatment was found to be associated with higher rate of recovery, p=0.042. However, there was a trend towards recurrence requiring surgical intervention in patients treated with polyenes, p=0.067. 22.6% had a poor outcome, including recurrence, amputation, or death.

Conclusion

Surprisingly, polyenes did not underperform when compared to other antifungal therapy. Prospective research assessing optimal surgical treatment modality and antifungal therapy is needed as this infection is associated with high morbidity and mortality.

Disclosures

All Authors: No reported disclosures
1988. Early Syphilis in Minnesota: Statewide and Regional Trends, 2018-2022
Authors: Dufort Elizabeth , Bo-Subait Khalid , Lehnertz Nicholas , Hadsall Candy , Dippmann Karmen , Lind Livingston Cindy , Lynfield Ruth
Published: November 2023

Background

Cases of syphilis have been increasing in the US for several years. We assessed the epidemiology of syphilis in MN.

Methods

Syphilis cases are reported to MN Dept of Health through electronic laboratory reporting and are interviewed by disease intervention specialists. We reviewed early syphilis case data (primary, secondary, or early non-primary/secondary) and evaluated demographics, geographic region, HIV infection and substance use.

Results

From 2018-2022 there was a 108% increase in early syphilis with a total of 4,306 cases; 76% males, 65% of whom identified as men who have sex with men (MSM). Median age was 33 (IQR 27-42) years. The average 5-year rates of early syphilis in those who identify as American Indian (AI) (162 per 100,000) and Black, Non-Hispanic (66.9 per 100,00) were 22.2-fold and 9.2-fold higher respectively, compared to White (7.3 per 100,000). 25% of early syphilis cases occurred in persons with HIV (PWH), a 68% increase from 2018-2022 (165 cases in 2018 to 276 in 2022). Substance use was reported in 23% of cases. Cases in females rose 267% (97 in 2018 to 344 in 2022) and in males 81% (478 in 2018 to 866 in 2022). Among early syphilis female cases, 30% were AI and 19% were Black. Congenital syphilis cases also increased from 10 cases in 2018 to 20 in 2022 (rate 15.1 to 31.7 per 100,000 live births).

Across 3 impacted MN regions over the 2018-2022 timeframe, case characteristics varied. In the Twin Cities Region (TCR: n=3154, 73% cases) 81% were male, of whom 73% identified as MSM. In the Duluth Region (DR: n=157, 4% cases), 71% were male of whom 54% identified as MSM. In TCR, 31% cases were PWH and in DR, 13% of cases were PWH. In the Northwest Region (NWR: n=352, 8% cases), 45% were male, of whom 6% identified as MSM. In NWR, 51% cases reported substance use, compared with 20% in TCR and 11% in DR.

Conclusion

Similar to other US areas, syphilis is increasing in MN and is disproportionately impacting AI and Black populations. These trends and the rise in female and congenital cases warrant accelerated public health action. Rather than one statewide syphilis approach, regional differences in epidemiology highlight the need for understanding root challenges, engaging effectively with communities to develop locally specific interventions, access to testing and prenatal screening, and access to care.

Disclosures

All Authors: No reported disclosures
1317. Porphyromonas gingivalis and Treponema denticola Induce Alzheimer's Disease Biomarkers in Mice
Authors: Butler Catherine A , Mohammed Ali , Paolini Rita , Gomez Stephanie , Toulson Su , Reynolds Eric C , Dashper Stuart G
Published: November 2023

Background

Periodontitis, a chronic disease that progresses over years, is a modifiable risk factor for Alzheimer’s disease (AD). Periodontitis is caused by endogenous oral pathobionts, including Porphyromonas gingivalis (Pg) and Treponema denticola (Td), that have a synergistic relationship resulting in increased virulence. Pg and Td proteins and DNA have been detected in post-mortem brains of AD patients. However it is unclear if these bacteria infect the brain or if the detected bacterial products are on membrane vesicles (MVs); spherical nanostructures released from bacteria. The aims of this work were to determine whether intact bacterial cells were in brains of mice after chronic oral inoculation with these organisms; whether Td enhanced the ability of Pg products to penetrate the brain and whether Td alone induced AD biomarkers

Methods

C57BL/6 mice were orally inoculated 3 times/week for 12 weeks with either Pg, Td, or Pg + Td cells in a 2:1 ratio, or sham inoculated as a negative control. Mice were culled and their brains dissected, with one hemisphere prepared for immunohistochemistry (IHC) as FFPE tissue and probed with antibodies to amyloid beta (Aβ), phospho-Tau (p-Tau) and the Pg surface protein RgpA. The other hemisphere had the hippocampus removed for transmission electron microscopy (TEM) analysis.

Results

Pg alone and Pg + Td inoculated mice showed significant increases in alveolar bone loss compared with the uninoculated control. No whole bacterial cells were detected in any of the brains of inoculated mice including those that were IHC positive for RgpA. RgpA immunoactivity was not significantly different in brains of mice that received Pg alone or the Pg+Td combination. Aβ and p-Tau were detected in all mice with an increasing magnitude in uninoculated < Td inoculated ≤ Pg inoculated ≤ Pg+Td inoculated.

Conclusion

Conclusions: Repeated oral inoculation of mice with Pg alone and Pg + Td resulted in periodontitis, as determined by alveolar bone loss. The lack of whole bacterial cells in the brain argues against a direct infection mechanism of AD initiation by the oral bacteria Pg and Td. Our data are consistent with the observed AD-like pathology in the brain resulting from a focal infection of Pg and/or Td in the mouth mediated by MV penetration of the brain.

Disclosures

All Authors: No reported disclosures
1322. Outcomes Associated with Primary Antibiotic Therapy in Spinal Epidural Abscess due to Staphylococcus aureus: Comparison of First-line vs Alternative Agents
Authors: Fowler Madeline , Phan Jessica , Jaffa Rupal K , Carlson Travis J , Medaris Leigh Ann , Williamson Julie E
Published: November 2023

Background

Spinal epidural abscess (SEA) is an uncommon but serious infection with potentially devastating sequelae. For SEA due to methicillin- susceptible S. aureus (MSSA), anti-Staphylococcal penicillins have been considered first line, however retrospective data have failed to show a difference in outcomes compared to cefazolin. Comparative data in methicillin-resistant S. aureus (MRSA) SEA are sparse.

Methods

This was a multisite, retrospective cohort of adults admitted to an acute care or acute rehabilitation hospital from 1/1/2017 – 9/10/2021 with confirmed S. aureus SEA by radiology and microbiology (blood and/or surgical cultures). Recurrent or polymicrobial SEA, endocarditis, meningitis, or prosthetic joint infection cases were excluded. Therapy was grouped as lower (LCNS) or higher (HCNS) CNS penetration (Fig. 1) and was assessed as overall principal therapy (OPT) (definitive therapy for > 50% of the total course) and early principal therapy (EPT) (definitive therapy for > 50% of the first 2 weeks). Patients were also analyzed by MSSA vs MRSA. The primary outcome was composite 90-day clinical failure, (≥ 1 of the following: extension of original antibiotic course, unplanned surgical intervention related to SEA, recurrence of S. aureus bacteremia, and all-cause mortality) by OPT. Secondary outcomes included components of the primary outcome and composite 90-day clinical failure by methicillin susceptibility and EPT.Figure 1.Lower (LCNS) vs Higher (HCNS) CNS Penetration Agents for Definitive Therapy

Results

174 patients met inclusion: 94 (54%) in the LCNS group and 80 (46%) in the HCNS group. There was no significant difference in 90-day clinical failure of OPT between groups (Fig. 2). The composite 90-day clinical failure of OPT also did not differ between LCNS and HCNS based on methicillin susceptibility (MSSA 25.9% vs. 19.2%, p = 0.49; MRSA 30.8% vs. 31.5%, p = 0.96). Similarly, there was no difference in 90-day clinical failure based on EPT (31% vs. 24%, p = 0.28), regardless of methicillin susceptibility, (MSSA 29% vs. 17.8%, p = 0.18; MRSA 50% vs. 28.8%, p = 0.23) between the LCNS and HCNS groups, respectively (Fig. 3).Table 1.Selected Baseline Characteristics

Figure 2

Figure 3

Conclusion

There was no significant difference in the rate of 90-day composite clinical failure between OPT with LCNS and HCNS. Given the limited sample size, further study, particularly in an MSSA SEA cohort, is warranted.

Disclosures

All Authors: No reported disclosures
1340. Towards better understanding of the epidemiology of SARS-CoV-2 PCR conversion in hospitalized patients: a case-control study
Authors: Manian Farrin A , Karlapalem Chaitanya A
Published: November 2023

Background

The epidemiology of hospitalized patients who "convert" from a negative nasopharyngeal SARS-CoV-2 by PCR to a positive test during the same hospitalization has not been adequately studied.

Methods

This was a retrospective case-control study at 2 large suburban community hospitals. Eligible adult inpatients 18 years or older who underwent 2 or more nasopharyngeal SARS-CoV-2 PCR testing during the same hospital stay from January 1, 2020-March 31, 2021 were included. Controls were randomly selected from a data base of patients with negative repeat test(s) during the same hospitalization at respective hospitals (case-control ratio 1:1)

Results

Of 40 SARS-CoV-2 PCR converters (18 cases from hospital A, 22 cases from hospital B), 23 (57.5%) were 65 years or older, 21 (52%) were female, and 36 (90%) were Caucasian; mean BMI was 28.4. Thirteen (32.5%) patients had 1 or more common Covid-19 symptoms (eg, cough, fever, shortness of breath, weakness, GI symptoms, loss of appetite, confusion) on initial testing (98% within 24 hours of admission). Mean interval between paired tests was 8.4 days; 52.5% were repeated on hospital day 7 or later. Compared to non-converters, converters were less likely to be 65 y or older (58% vs 80%), more likely to be retested due to new Covid-19 symptoms (35% vs 7.5%), had longer hospital stay (17.8 days vs 9.6 days) and had higher in-hospital mortality (32.5% vs zero) (P< 0.001 for all). There was no significant difference between converter and non-converters in the prevalence of Covid-19 symptoms on initial testing, sex, race, BMI, time spent in the ED or other hospital wards, prevalence of selected high-risk Covid-19 comorbidities (eg, hypertension, diabetes, immunocompromised state, COPD, chronic kidney disease or cancer) or interval between paired tests.

Conclusion

Hospitalized patients who convert from a negative to a positive nasopharyngeal SARS-CoV-2 PCR test during the same hospitalization are more likely to be less than 65 y old, be retested because of new-onset Covid-19 symptoms often a week or more days into hospitalization and have significantly longer hospital stay and higher inpatient mortality compared to those of non-converters. More studies are needed to determine factors associated with SARS-Cov-2 PCR conversion in this vulnerable patient population.

Disclosures

All Authors: No reported disclosures
1344. Stakeholders’ Perspectives of the Establishment of SARS-CoV-2 Monoclonal Antibody Infusion Centers in Rural Southwestern Virginia: A Qualitative Analysis with Realist Interview Approach
Authors: Kim Hyun Sue , Baffoe-Bonnie Anthony
Published: November 2023

Background

The COVID-19 pandemic prompted healthcare organizations around the country to rapidly set up infusion centers that were solely dedicated to delivering outpatient COVID-19 monoclonal (mAb) and antiviral infusions. We capture the process of setting up these mAb infusion centers from the perspectives of key stakeholders. These lessons learnt may inform or refine actions in future pandemics.

Methods

A realist interview approach was undertaken to evaluate the effectiveness of the program development with ten key stakeholders and healthcare workers who were involved. In contrast to traditional interviewing methods where a straight question leads to a straight answer, realist interviewing involves capturing the interviewees’ experiences through conversations of teaching and learning. We interviewed ten key stakeholders and healthcare workers who were involved with developing the mAb infusion process from Dec 13th, 2021, to Jan 19th, 2022, over online videoconferencing.

Results

A causal mechanism diagram using a context-mechanism outcome configuration was identified. There was a rapid development of multiple infusion sites over a short time frame with dynamic staffing and patient appointment models leading to rapid increases in mAb infusion capacity in southwestern Virginia.

Figure 1.

Causal mechanism diagram using a CMO configuration for the successful attributes leading to eligible patients treated with monoclonal antibodies.

Conclusion

Strong clinical leadership, a robust communication and feedback framework and shared goals were identified by stakeholders as pivotal in the success of a COVID-19 monoclonal antibody infusion program for a health care system. Pandemic preparedness strategies should hardwire and leverage these features for resiliency.

Disclosures

All Authors: No reported disclosures