bluuebunny/crossref_metadata_2025 huggingface dataset:
1253. Acceptability and feasibility of long-acting injectable antiretroviral therapy for persons who inject drugs in Vietnam: using the Consolidated Framework on Implementation Research to identify determinants and inform implementation strategies
Authors: Rutstein Sarah E , Sibley Adams L , Nguyen Trang Thu Do , Tran Ha Viet , Giang Le Minh , Sripaipan Teerada , Nguyen Minh , Huffstetler Hanna E , Miller William C , Eron Joseph J , Gay Cynthia L , Go Vivian F
Published: December 2022

Background

Long-acting injectable antiretroviral therapy (LAI) is an exciting alternative to daily oral ART. Less frequent dosing afforded by LAI may be especially pertinent for persons who inject drugs (PWID), who experience more HIV-related mortality largely driven by inadequate ART adherence. We used the Consolidated Framework on Implementation Research (CFIR) to characterize determinants of LAI implementation, focusing on use among PWID, in Hanoi, Vietnam.

Methods

We conducted in-depth interviews with HIV-infected PWID, ART providers, and policymakers using purposive sampling, recruiting respondents with diverse ART experience from public HIV/ART clinics and national regulatory agencies. Participants were briefed regarding LAI ART, including administration, effectiveness, side effects, and dosing frequency. Data were coded and analyzed using thematic analysis.

Results

We interviewed 19 PWID, 14 providers, and five policymakers (February-November, 2021). We identified recurrent themes in CFIR domains. Intervention: All informants were excited about LAI, citing convenience and discrete dosing as major facilitators. Surprisingly, provider concerns, including more frequent clinic visits and injection reactions, were rarely voiced by PWID who described monthly injections as similar to current visit frequency and cited “high pain tolerance.” Outer: Providers and policymakers were eager to offer patients ART choice but were divided as to if LAI distribution should proceed with sub-population prioritization. Inner: Providers described personnel and clinic logistic concerns but were confident these could be addressed. Individual: Providers were motivated and confident in their ability to deliver LAI. Process: Transitions to new ART and provision of COVID-19 vaccines were frequently invoked by providers and policymakers as interventions informing LAI implementation. FigureDeterminants of LAI ART implementation in Vietnam using the domains of the Consolidated Framework on Implementation Research

Conclusion

Using CFIR, we identified multiple determinants of LAI implementation in Vietnam. Stakeholders agreed that LAI was feasible and acceptable. Medication tolerance and efficacy concerns highlight the importance of patient and provider education. Areas where stakeholders diverge should be considered in designing LAI implementation strategies.

Disclosures

Joseph J. Eron, MD, Adagio Therapeutics: data safety monitoring committee|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Glaxo Smith Kline: Advisor/Consultant|Merck: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support.
1271. HIV-1 Drug Resistance in Patients Failing Integrase Strand Transfer Inhibitor-Based Regimens in Rhode Island, USA
Authors: Nagel Katherine E , Novitsky Vladimir , Aung Su , Solomon Matthew , Won Cindy , Brotherton Amy , Howison Mark , Gillani Fizza S , Kantor Rami
Published: December 2022

Background

Integrase Strand Transfer Inhibitors (INSTIs) are the most common antiretroviral therapy (ART) anchor drugs. Despite reassuring clinical trial data, real-life extent and characteristics of resistance at failure of INSTI-based regimens are unclear and can inform care.

Methods

We investigated drug resistance upon failure of INSTI-based regimens at the largest HIV program in Rhode Island (RI), caring for > 80% of the state’s people with HIV. Eligible patients had full ART history, were on INSTI-based regimens, and had available protease-reverse transcriptase-integrase sequences from clinical care. Resistance interpretation was done with Stanford Database tools.

Results

Of 1,169 eligible patients (55% of clinic population), 102 (9%) were failing INSTI-based regimens; mean age at genotyping 39 years, CD4 377 cells/µL, and 11 years on ART; 67% male; 53% white, 44% Black, 63% non-Hispanic; 58% US born; with prior exposure to 8 drugs and 4 regimens. Of these 102, 55% were on 1st-generation INSTI (41% elvitegravir (EVG); 14% raltegravir (RAL)), and 45% on 2nd-generation INSTI (23% bictegravir (BIC); 22% dolutegravir (DTG)); most (73%) with only 2 NRTIs. Overall, 57% had any intermediate-high level predicted resistance (55% on 1st-, 45% on 2nd-generation INSTI); NRTI 37%; NNRTI 40%; PI 3%; INSTI 22% (EVG 22%, RAL 21%, DTG/BIC/cabotegravir 8% each). Common INSTI mutations were N155H (n=7); E92Q, Q148H/R, S147G (5 each); T66I/K, E138A/K/T (4 each); G140A/S (3), R263K (2), Y143R (1). Multi (≥ 3) class resistance occurred in 12%, a third of whom had intermediate-high resistance to all five INSTIs (50% on 1st-, 50% on 2nd-generation). Resistance trends were stable over 2014-2021, and 2nd-generation INSTI resistance was only seen in those with prior exposure to 1st-generation INSTI.

Conclusion

At the largest RI HIV clinic, 9% of eligible patients were failing INSTI-based regimens, most with clinically relevant resistance that was stable over time, and 1% had multi-class resistance including some to all available INSTIs. Though low resistance levels to 2nd-generation INSTIs are encouraging, they exist; and continued ADR monitoring is important, particularly with increasing incorporation of INSTIs in HIV treatment and prevention and use of 2-drug regimens.

Disclosures

All Authors: No reported disclosures.
1274. Implementation of Pharmacist-led Medication Reconciliation in Older PLHIV
Authors: Karris Maile Y , Mazonson Peter J , Hill Lucas , Yin Jeffrey , Abulhosn Kari , Huang Emily , Berko Jeff
Published: December 2022

Background

Older (age ≥ 50) people living with HIV (PLHIV) have a higher prevalence of non-AIDS associated comorbidities and polypharmacy. Optimal care requires accurate knowledge of the number and types of medications older PLHIV take. Most providers use the electronic health record (EHR) to obtain this information, despite reported inaccuracy in other cohorts. Recent efforts have focused on engaging pharmacists to assist with EHR medication reconciliation. This abstract describes the results of a pilot study of phone-based, pharmacist-driven EHR medication reconciliation.

Methods

Older PLHIV reported via an online questionnaire the number of prescription medications they took, with response options ranging from “0” to “11 or more.” Then, a clinic-based pharmacist called each participant to review the daily and prn prescription medications they were taking. Finally, a physician reviewed EHR pharmacy data to count the number of daily and prn prescription medications listed. Wilcoxon rank sum tests compared the medians between the phone review, the self-reported questionnaire, and the EHR review.

Results

Forty participants were offered the intervention, and 26 (65%) were reachable by phone and agreed. Of those, the mean age was 61 years (range 51-73), 89% were male, 67% were White, and the mean number of self-reported comorbid conditions was 11.7 (SD=7.7). In 25/26 (96%) cases, both the number and type of HIV medications in the EHR matched what the pharmacist verified on the phone call. Median number of non-HIV medications are reported in Table 1. Assuming that pharmacist phone calls provided the most accurate data, the EHR overestimated the number of non-HIV medications by 5 medications (P = 0.01), whereas patients’ self-report underestimated by 1.5 medications (P < 0.01).

Conclusion

Among older PLHIV, EHR pharmacy data significantly overestimated, and patient self-report significantly underestimated, the number of non-HIV prescription medications. Phone-based, pharmacy-driven medication reconciliation improved upon both EHR-based and self-reported medication accuracy. Based on these findings, future interventions designed to decrease polypharmacy in older PLWHIV can rely upon pharmacist-led, phone-based outreach to ensure that baseline medication information is accurate.

Disclosures

Maile Y. Karris, MD, Gilead Sciences: Grant/Research Support|Gilead Sciences: I have received honorarium to speak at conferences|ViiV Healthcare: Grant/Research Support Peter J. Mazonson, MD, MBA, ViiV Healthcare: Grant/Research Support Lucas Hill, PharmD, AAHIVP, Gilead Sciences: Speakers Bureau Emily Huang, MPH, ViiV Healthcare: Grant/Research Support Jeff Berko, MPH, ViiV Healthcare: Grant/Research Support.
1588. Epidemiology of Chronic High Level (CHL) Epstein-Barr virus (EBV) DNAemia in Pediatric Solid Organ Transplant Recipients (SOTR) at Texas Children’s Hospital (TCH)
Authors: Valencia Deray Kristen G , Hosek Kathleen , Ruderfer Daniel , Buffaloe Leanne M , Munoz Flor M , Moulton Elizabeth A , Bocchini Claire
Published: December 2022

Background

EBV infections cause significant morbidity and mortality in pediatric SOTR and can be complicated by post-transplant lymphoproliferative disorder (PTLD). Contemporary data on CHL EBV DNAemia and the development of PTLD are limited.

Methods

A retrospective cohort study of patients ≤ 21 years of age who received heart, lung, liver, kidney, or multi-organ transplants at TCH between 2011–2018 was conducted. Primary outcome was CHL EBV DNAemia, defined as peripheral blood lymphocyte EBV values ≥ 500 copies/ug or whole blood EBV values ≥ 10,000 IU/mL for ≥ 6 months. Associations with CHL EBV DNAemia were measured using chi-squared or Fisher exact test and multivariate logistic regression. Time to CHL EBV DNAemia was assessed using Kaplan-Meier method.

Results

Among 687 SOTR (152 heart, 87 lung, 259 liver, 175 kidney, 14 multi-organ), 87 (13%) developed CHL EBV DNAemia; this included 15 (9%) heart, 9 (10%) lung, 59 (22%) liver, 2 (1%) kidney, and 2 (14%) multi-organ recipients. Receiving a heart [OR 2.1, 95% CI (2.1 – 62.4)], lung [7.7, 95% CI (1.5 – 39.3)], liver [OR 31.8, 95% CI (4.9 – 208.7)], or multi-organ [OR 18.3, 95% CI (2.0 – 170)] transplant and being 1–5 years of age [OR 4.0, 95% CI (1.6 – 9.8)] were associated with CHL EBV DNAemia. SOTR transplanted from 2015–2018 were less likely to develop CHL EBV DNAemia than those transplanted from 2011–2014 [OR 0.5, 95% CI (0.3 – 0.8)]. EBV risk status, CMV risk status, gender, and induction therapy were not associated with developing CHL EBV DNAemia.

The median maximum peripheral blood lymphocyte and whole blood EBV values for those with CHL EBV DNAemia were 9475 (993 – 258151) copies/ug and 22093 (564 – 550000) IU/mL, respectively. Organ transplanted (p< 0.01), age (p< 0.01), and EBV risk status (p< 0.01) were associated with time to CHL EBV DNAemia (Figure 1). PTLD occurred in 28 (4%) of SOTR; 14 (50%) had preceding CHL EBV DNAemia (p< 0.01).

Figure 1 Time to CHL EBV DNAemia.

Conclusion

This cohort of pediatric SOTR demonstrates a low prevalence of CHL EBV DNAemia and PTLD. Receiving a heart, lung, liver, or multi-organ transplant and being 1–5 years of age were associated with developing CHL EBV DNAemia. SOTR who developed CHL EBV DNAemia were more likely to develop PTLD, suggesting that further interventions targeting this group may be warranted.

Disclosures

Flor M. Munoz, MD, MSc, Gilead: Grant/Research Support Elizabeth A. Moulton, MD, PhD, Pfizer: Co-investigator for SARS-CoV-2 pediatric vaccine trials.
1287. Understanding Factors Associated with Polypharmacy and Differential Medication Adherence in People with HIV
Authors: Schwartz Rebecca M , Charlton Jessica , Gorlin Margaret , Weinberg Amy , Wallach Frances , McGowan Joseph
Published: December 2022

Background

For people with HIV (PWH), number of chronic medications (meds) used to treat comorbidities may impact quality of life (QoL), illness perception, medication beliefs, and clinical outcomes. Factors associated with adherence to antiretrovirals (ARVs) may differ from adherence to other chronic meds. This study aims to assess these factors to promote better med management and adherence among PWH taking chronic meds and ARVs.

Methods

174 participants (pts) were enrolled from an HIV program in a large health system. Inclusion criteria were age > 18 years, English speaking, prescribed ARVs, and having > 1 comorbidity requiring a chronic med (non-ARV). Measures included validated scales of QoL, illness perceptions, med beliefs, and adherence barriers (e.g., forgot, too many pills, avoiding side effects); and past 6-month emergency department (ED) use and hospitalization. Generalized linear models, ANOVA, and Wilcoxon sum rank tests assessed associations between number of chronic meds (< 4 vs > 5) and outcomes. Multivariable logistic regression models using backwards elimination were used to assess factors associated with adherence (overall, HIV-meds, non-HIV meds).

Results

Complete data from 160 pts were analyzed: 50% male; 84% US-born; 46% taking > 5 chronic meds. Pts taking > 5 meds were older, less likely to be employed, had significantly lower QoL (mean difference=5.23, 95%CI=0.19-10.27. p< .05), significantly higher med side effects (mean ranks=88.51 vs 73.77, p< .05), and 3-fold greater ED visits (mean estimate=2.99, 95%CI=1.52-5.89, p< .05). Regression models indicated that number of adherence barriers (but not other predictors) was consistently associated with lower adherence after controlling for demographics: (overall adherence: OR=0.85, 95%CI=0.79=0.91; HIV med adherence: OR=0.88, 95%CI=0.81-0.94; non-HIV med adherence: OR=0.86, 95%CI=0.80-0.92).

Conclusion

Adverse events (i.e., ED use, poor QoL, med side effects) are associated with number of chronic meds. Number of adherence barriers is associated with poor adherence across med type, highlighting the importance of interventions to address polypharmacy and the complexities of managing HIV and comorbidities. Assessment of barriers can contribute to the promotion of adherence for both HIV and non-HIV meds.

Disclosures

Amy Weinberg, DNP, MS, Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds.
1291. Acceptability and Perceptions towards an International Infectious Disease Videoconferencing Program among medical students and physicians-in-training in Miami.
Authors: Fernandez Anmary A , Lima Daniela De , Lichtenberger Paola , Alave Jorge , Solar Sebastian , Kaswan Daniel , Lopez-Medrano Francisco , Gonzales-Zamora Jose A
Published: December 2022

Background

Tele-education has emerged as an excellent alternative for traditional face-to-face education. It has allowed to connect first-world countries to developing countries for learning about low prevalent pathologies, such as tropical diseases, parasite infections, etc.

Methods

The Division of Infectious Diseases at University of Miami started an international videoconferencing program in 2018 in collaboration with 4 teaching sites (Miami, Peru, Chile, and Spain), in which 2 challenging cases were presented via Skype TM or Zoom TM. The cases were discussed by a partner institution member; all sites were invited to comment about the cases. After each conference, the medical students and physicians-in-training were asked to fill out a survey to evaluate their acceptance and perceptions towards this program.

Results

54 participants completed the survey. 50% were residents or fellows, 18.5% were medical students, and 27.7% were visiting trainees. The overall acceptance was favorable, 64.9 % of participants reported that videoconferencing was as effective or more effective than face-to-face conferences, 96.3% wanted to continue participating in this program, and 87.04% would recommend it as an educational tool. Regarding the collaboration with international sites, 87% of participants felt they learned about diseases not commonly encountered in their countries, 85.2% considered that this program allowed them to learn about different treatment approaches, and 68.5% believed that it helped to learn about novel diagnostic tests. In terms of the content, 85.2% considered that the cases were interesting and 83.3 % believed that the cases were presented in an organized fashion. Regarding the software performance, 75.9 % believed that images were above average or outstanding, but only 48.1% felt the same about the audio. In terms of participation, 57.4% believed that interaction between the local audience and physicians from different sites was easily accomplished.

Conclusion

This videoconferencing program was widely accepted among trainees. The collaboration with international sites was perceived as one of the program assets. We believe that implementation of programs like this would be highly beneficial in Infectious Disease education.

Disclosures

Daniela De Lima, MD, Astra Zeneca: Stocks/Bonds|Pfizer: Stocks/Bonds.
1294. Covid-19: Impacts on Medical Students’ Mental Health in Medical Education Center of Chaophya Abhaibhubejhr Hospital
Authors: Pinsai Subencha , Klaipim Chalalai
Published: December 2022

Background

Thailand has experienced a repeated pandemic of COVID-19, which placed overwhelming demands on health care services. Medical students are affected by the pandemics of COVID-19, and adjustments are needed to produce medical providers for health care services as planned. Medical students have experienced consequences, especially on their mental health, due to a fear of COVID-19 infection adjustments to new learning styles.

Methods

A cross-sectional study was conducted among medical students in our hospital. We used an online platform to assess knowledge, sources of information and evaluate anxiety levels using the generalized anxiety disorder 7 (GAD-7) scale.

Results

Thirty-seven patients (20 women (54.1%), mean age 22.9 years) were included. The majority of students demonstrated average levels of knowledge and utilized reliable sources of information.

51.35% of students reported anxiety levels ranging from mild to severe, with sixth-year medical students whom on-site study reporting higher anxiety than the fourth and fifth-year medical students whom hybrid study (online and On-site study) (OR=5.9, P=0.02).

Conclusion

This study provides essential information in our hospital on the initial response and anxiety levels in medical students during a clinical rotation in the COVID-19 pandemic. In the COVID-19 pandemic or any other public health emergencies, we need to provide clinical knowledge support and psychological support for our medical students.

Essential knowledge and prompt screening and response for anxiety and stress during the COVID-19 pandemic are necessary for the medical student.

Disclosures

All Authors: No reported disclosures.
1297. Design and Testing of an Interactive Module for Improving Understanding and Application of Institutional Antibiograms
Authors: MacDougall Conan
Published: December 2022

Background

Many infectious diseases treatment guidelines recommend incorporating local antibiograms (ABs) into treatment decisionmaking. However, studies suggest many healthcare provider trainees are uncomfortable using ABs and rarely incorporate them into their decisionmaking. Our purpose was to develop a brief online module to develop skills in locating and utilizing an institutional AB and to gather feedback on its utility.

Interactive Module for Understanding and Interpreting Antibiograms

Screen captures displaying initial framing case with learner response (upper left), stepwise navigation of an antibiogram (upper right), embedded task practice (lower left) , and question from final competency assessment (lower right).

Methods

We developed and tested the module at the University of California San Francisco, with initial testing among 340 pharmacy students during microbiology instruction. We used the Four-Component Instructional Design framework to inform our design approach. Using the Articulate Storyline platform, we developed an interactive online learning module (Figure 1). The module began with a patient case to introduce the whole task and activate prior knowledge, with learners required to enter a freetext answer to the case prompt. Using visuals and narration with captions, the module then reviewed the basics of an AB and how to use an AB for therapy with known pathogens and for empiric therapy, and use of location-specific and combination ABs. Task practice was provided by case-based questions requiring learner response and providing immediate feedback. The module ended with competency assessment questions including revisiting the original case and the learner's initial answer. Learners completing the module were directed to complete a survey to provide feedback on the module; we report quantitative and qualitative feedback from the survey.

Results

We received 131 survey responses (38.5%). 111/131 (85%) rated the educational value of the module as “Extremely valuable”, and 103/131 (79%) rated the module as having “Excellent usability”. Primary themes among positive feedback included the interactive elements, stepwise approach, and questions with feedback; constructive feedback included desire for speed control of the narration and sound quality.

Conclusion

An interactive online module for learning about ABs was highly rated by learners and may be valuable to help clinicians apply ABs in practice. Future studies should include other health professions learners, delayed assessment to measure retention, and customization for different institutional ABs.

Disclosures

Conan MacDougall, PharmD, MAS, Merck: Advisor/Consultant.
1306. Real-World Experience of Cefiderocol in Treating Bacterial Infection in US Hospitals (Jan 2020-June 2021)
Authors: Cai Bin , Zhou Yun , Cooper Andrew , Marcella Stephen
Published: December 2022

Background

Cefiderocol (CFDC) is a Gram-negative antibiotic (GNA) with a unique mode of cell entry against carbapenem resistance. This study described the initial use of CFDC in US hospitals since its approval in November 2019.

Methods

This was a retrospective study of patients treated with CFDC consecutively for ≥3 days in US hospitals, as captured in Premier Healthcare Data from January 2020 to June 2021. This study described the clinical characteristics, CFDC usage, and Post-CFDC initiation 14-day and 28-day in-hospital all-cause mortality (IH-ACM). For patients with microbiology results, the pathogen, susceptibility and culture site associated with CFDC use were described. Index culture was the culture(s) taken on the day closest to CFDC initiation.

Results

Among 313 of 360 in-patients who received ≥3 days CFDC, the median age was 58 years (range: 17 - 89 years), and 91% were hospitalized via emergency room, trauma, or urgent admission. The most common conditions were severe sepsis with septic shock, palliative care, and multi-drug resistant infection. Also 34% had a ‘do not resuscitate order’. About 64% of patients received mechanical ventilation and 79% had ICU stay. Median length of hospital stay was 27 days (range: 3-310 days). Median days on CFDC was 8 days (range: 3 - 66 days). Over 58% received ≥2 other GNAs within 14-days of initiating CFDC. Among 187 patients with microbiology results, 75% had index cultures with one pathogen, and 73% had confirmed carbapenem resistant pathogens. The most common pathogens were Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Klebsiella pneumoniae and Acinetobacter baumannii. The most common index culture site was respiratory. The 14-day and 28-day crude IH-ACM from CFDC initiation was 16.3% (95%CI: 12.2%-20.4%) and 23.6% (95%CI: 18.9 – 28.4%), respectively. Among those with microbiology results, 14-day and 28-day IH-ACM was 17.1% (95%CI: 11.7% - 22.5%) and 23.5% (95%CI: 17.4-29.6%), respectively. Among patients who died, 83% had severe sepsis with septic shock, 76% were in palliative care, 71% had a ‘do not resuscitate order’, and 44% had COVID-19.

Conclusion

CFDC was used most frequently in critically ill patients. IH-ACM was comparable with other studies.

Disclosures

Bin Cai, MD, PhD, Shionogi: Shionogi employee Yun Zhou, MS, Shionogi: Employee of CRO hired by Shionogi Andrew Cooper, PhD, Shionogi: Shionogi employee Stephen Marcella, MD, MPH, Shionogi: Shionogi employee|Shionogi, Inc: Employee.
1592. SHEA Featured Oral Abstract: Reducing Unnecessary Antibiotic Treatment for Asymptomatic Bacteriuria: A Statewide Collaborative Quality Initiative
Authors: Vaughn Valerie , Gupta Ashwin , Petty Lindsay A , Malani Anurag N , Osterholzer Danielle , Patel Payal K , Younas Mariam , Bernstein Steven , Ratz David , McLaughlin Elizabeth , Czilok Tawny , Horowitz Jennifer , Flanders Scott A , Gandhi Tejal N
Published: December 2022

Background

Up to one-third of hospitalized patients treated for urinary tract infection (UTI) have asymptomatic bacteriuria (ASB). Both diagnostic (avoiding inappropriate urine cultures) and antibiotic stewardship (reducing unnecessary antibiotic use in asymptomatic patients) have been proposed to reduce unnecessary antibiotic use for ASB. However, it's unclear which method is most effective.

Methods

The Michigan Hospital Medicine Safety Consortium aimed to improve antibiotic use and outcomes of hospitalized patients with a positive urine culture between 7/1/2017—3/31/2020 (see Table 1 for patient characteristics) by benchmarking performance across 46 Michigan hospitals, sharing best practices, and implementing pay-for-performance metrics related to unnecessary treatment of ASB (see Figure 1). Using logistic regression models controlling for hospital clustering, we assessed change over time in percentage of hospitalized patients treated for UTI who had ASB (i.e., had no documented signs or symptoms of UTI) and hospital characteristics associated with baseline or change in unnecessary antibiotic prescribing. We then estimated the percentage of avoided ASB treatment attributable to diagnostic (decrease in urine cultures ordered on asymptomatic patients) vs. antibiotic stewardship (decrease duration or avoidance of antibiotic treatment).

Results

Across 46 hospitals, there were 15,493 patients with a positive urine culture. Of 13,805 patients treated for a UTI, 23.2% (3,197) had ASB. The percentage of patients treated for UTI who had ASB declined over time from 29.0% (95% CI: 26.1%, 32.0%) to 16.9% (95% CI: 14.2%, 20.1%; aOR 0.94 per quarter, 95% CI: 0.92-0.96; Figure 1) with hospitals not belonging to a larger healthcare system having the largest decrease over time (Table 2). Neither the proportion of patients with ASB who were treated with antibiotics (P=0.07) nor the duration of therapy for ASB changed over time (P=0.09); thus, nearly all avoided antibiotic therapy for ASB appeared due to diagnostic stewardship.

Conclusions

Across 46 hospitals, there was a decrease over time in unnecessary treatment for ASB with independent hospitals improving most. Diagnostic stewardship appeared responsible for nearly all improvement.

Disclosures

Payal K. Patel, MD, MPH, Qiagen: Honoraria.
1319. Evolution of Invasive and Colonizing Pediatric Staphylococcus aureus Isolates
Authors: Free Margaret , Soper Nicole , Shrestha Shristi , Cartailler Jean-Philippe , Thomsen Isaac
Published: December 2022

Background

Staphylococcus aureus is the most common invasive bacterial pathogen in children. The constant evolution of S. aureus is a barrier to the development of successful interventions. A detailed understanding of the current molecular epidemiology of actively circulating, invasive S. aureus strains and a comparison to both colonization strains and historical invasive strains to determine which virulence factors and genetic lineages are preserved over time are important unmet needs in this field.

Methods

We compared four groups of S. aureus isolates: 45 invasive strains obtained during the epidemic methicillin-resistance S. aureus (MRSA) peak (2010-2012); 74 invasive contemporary strains (2015-2021); 61 colonizing strains from 2004; and 30 colonizing strains from 2021. Genetic relatedness (via clonal complex typing) and virulence factor presence were determined via whole genome sequencing.

Results

Among invasive isolates, the prevalence of clonal complex 8 (CC8) decreased significantly over time from 87% to 46% among typeable strains (p< 0.05, Fig.1). Similarly, the presence of Panton-Valentine leucocidin (PVL) decreased from 71% to 40% (p< 0.01). 56% of invasive isolates from 2010-2012 were MRSA, vs 37% from 2015-2021 (p= 0.05, Fig. 2). In contrast to PVL, the presence of leukocidins LukED and LukAB remained stably prevalent over time at 84% and 100% (Fig. 3). Colonization isolates overall remained diverse, with no dominant clonal complex (Fig. 1). Figure 1Figure 2Figure 3

Conclusion

Invasive S. aureus molecular epidemiology has changed significantly over the past decade. The former dominance of CC8 and PVL-positive MRSA strains has shifted to a more diverse, predominantly MSSA group of contemporary strains. Other virulence factors (LukED, LukAB) have remained prevalent among invasive strains regardless of genetic lineage. Targets of intervention should be those that are preserved throughout the evolution of this major human pathogen.

Disclosures

All Authors: No reported disclosures.
1340. Yield of Repeat Blood Cultures beyond 48 Hours after Negative Initial Cultures in Patients Hospitalized on a Pediatric Hematology/Oncology Unit
Authors: Prather Cassandra S , Alali Muayad
Published: December 2022

Background

Repeat blood cultures (BCxs) beyond 48 hours are often obtained despite negative initial BCxs in hospitalized pediatric hematology/oncology patients. This study seeks to determine the yield of repeat BCxs after negative initial cultures in these patients and to characterize new positive BCxs beyond 48 hours and the clinical contexts in which they were obtained.

Methods

A retrospective review utilizing MedMined Inc. Data Mining Surveillance database was conducted on all BCxs obtained on hospitalized patients on the pediatric hematology/oncology unit at Riley Hospital for Children in Indianapolis, IN from January 2015 to February 2021. Exclusion criteria are shown in Fig. 1. Patient episodes in which a new pathogen (or commensal treated by the primary team as a pathogen) was identified on a repeat BCx more than 48 hours after negative initial BCxs were further investigated via electronic medical record review.

Results

A total of 1,362 BCx sets were obtained beyond 48 hours in 792 patient hospitalizations, resulting in 303 positive BCxs (Fig. 2). Of these positive cultures, 193 were the same pathogen cultured on day 0 and 74 were contaminant cultures (in 4.0% (23/573) of patient hospitalizations without a positive BCx before 48 hours). Only 36 (2.6%) of positive BCxs beyond 48 hours were determined to be new pathogens, or commensals treated as pathogens, that were not cultured before 48 hours, corresponding to seven patient hospitalizations (1.2% (7/573) of patient hospitalizations without a positive BCx before 48 hours). The majority (6/7) of these patients were neutropenic and on broad spectrum antibiotics when the new positive BCxs were obtained. Fever pattern was prolonged in one patient and recurrent in six. No deaths occurred in these seven patients. All patients with new, true pathogens on BCxs beyond 48 hours (n=5) were either hemodynamically unstable (n=3) or had clinical changes (n=2, mucositis, diarrhea) the day the new positive BCx was drawn.

Conclusion

The yield of repeat BCxs beyond 48 hours in hospitalized pediatric hematology/oncology patients with negative initial BCxs is low, while the associated costs are high. Repeat BCxs beyond 48 hours after negative initial cultures need not be obtained in febrile patients that remain hemodynamically stable and without clinical changes.

Disclosures

Cassandra S. Prather, MD, Eli Lilly and Company: Spouse is employed by Eli Lilly and Company. Spouse owns stock in the company.|Eli Lilly and Company: Stocks/Bonds.
1347. @Women_in_ID : A Social Media Platform for Advocacy and Amplification of Women in Infectious Diseases
Authors: Krishnan Gayathri , Mattar Caline , Babcock Hilary
Published: December 2022

Background

In 2015, 39.7% of active infectious diseases (ID) physicians in USA were women. This calculation does not include the many other women professionals in ID such as Advanced Practice Providers, ID pharmacists, researchers in ID and Infection Preventionists. There is no dedicated national platform for women in ID and no Twitter representation of groups dedicated to women in ID. Women in Infectious Disease (WIID) with twitter handle @Women_in_ID was created April 22nd 2021, for women providers in ID to collaborate, promote, and advocate for each other through a social media platform; and to highlight significant issues like gender pay gap, inequity in career advancement and leadership, research funding etc. We sought to explore the social media impact of this account over the last year.

Methods

A descriptive content analysis of this account from April 2021 to May 1st, 2022 was done to reflect on lessons learned, plan future directions, and highlight some real-world changes that happened after creation of WIID. Twitter analytics were used, and manual review of followers’ accounts and tweet activities were done to assess engagement.

Results

In 12 months, this account has gained 1709 followers (Image 1). Out of the followers, 109 are twitter accounts of organizations, such as fellowship programs, ID societies and their foundations, ID divisions, and journals. The rest appear to be individuals. Since demographics of followers are not revealed in twitter accounts, this could not be assessed. Table 1 provides detailed twitter analytics and content that got the most engagement each month. During the month of September, the account highlighted 20 nominated profiles (including women from other countries), and several other women in ID with significant historical contributions (Image 2). This content resulted in our highest engagement and new members. Some previously unnoticed women in history had Wikipedia pages created after their work was amplified. Image 1:Women in ID (WIID) twitter profile pageImage 2:Women in Medicine Month call for nominations created to amplify women in ID

Conclusion

@Women_in_ID is the first and only twitter platform dedicated for women in ID. This platform is accessible to every woman in ID with a twitter account, hence networking, amplification and collaboration transcends local or institutional boundaries. In future, social media work must translate to real life changes to have meaningful impact.

Disclosures

All Authors: No reported disclosures.
1360. Investigating Transmission Dynamics Between Pets and Caretakers in Households of Children with Methicillin-resistant S. aureus Skin and Soft Tissue Infections
Authors: Kinzer Hannah , Malone Sara , Boyle Mary G , Norton Lauren , Tal Rinat , Olson Hunter , Fritz Stephanie A
Published: December 2022

Background

Household pets are susceptible to Staphylococcus aureus (S. aureus) colonization. Our objective was to examine transmission of S. aureus between pets and their caretakers following a human household decolonization intervention.

Methods

From 2015-2021, a pragmatic randomized trial enrolled 196 households of children with community-associated methicillin-resistant S. aureus skin and soft tissue infection. Mouth and dorsal fur samples from indoor dogs and cats were cultured. Human nares, axillae, and inguinal fold samples were cultured. Samples were collected at enrollment and 1, 3, 6, and 9 months post-intervention. Participants were asked about pet daycare use, whether pets slept with caretakers, and pet skin conditions. Univariate and bivariate analyses, including McNemar tests, were conducted. Inclusion criteria were cat or dogs with at least one swab pre- and post-intervention.

Results

Our populations included 95 households with 161 pets; 35 households (39%) had ≥1 pet colonized with S. aureus. Within 2 weeks prior to enrollment, 3 (2%) pets had attended daycare, 70 (44%) slept with a caretaker, and 16 (10%) had skin conditions (see Table 1). 27 (17%) pets were colonized at enrollment. Of the 121 dogs, 20 (17%) were colonized at enrollment, 9 (7%) with MRSA. Of the 40 cats, 7 (18%) were colonized at enrollment, and 4 (10%) were colonized with MRSA. 72 (45%) pets had ≥1 caretakers who were colonized at enrollment; 18 (25%) of these pets were also colonized. Of the 137 caretakers, 48 (35%) were colonized at enrollment, and 16 (12%) were colonized with MRSA.

Whether a pet was colonized at enrollment was associated with colonization post-intervention (p< 0.001, see Table 2). All pets that were colonized at enrollment remained colonized post-intervention. Caretaker colonization at enrollment was associated with pet colonization post-intervention (p=0.04). Of the 72 pets whose caretakers were colonized at baseline, 36 (50%) pets were colonized post-intervention.

Conclusion

Both pet colonization and caretaker colonization at enrollment are significantly associated with pet colonization after human household member decolonization. This indicates that S. aureus may transmit from human caretakers to pets and human decolonization may not be fully protective against pet colonization.

Disclosures

Sara Malone, PhD, LCSW, AHRQ: Grant/Research Support|NIH: Grant/Research Support.
1373. Using Geospatial Analysis to Describe the Association between Active Tick Surveillance Data and Clinical Cases of Anaplasmosis
Authors: Desiato Julia T , Banach David , Chan Grace , Palmeri Marco
Published: December 2022

Background

Anaplasmosis is a vector-borne disease spread by Ixodes scapularis ticks mainly in the Northeastern United States. The Connecticut Department of Public Health (CT DPH) made anaplasmosis a state-wide reportable disease in 2008 and a large increase in reportable cases was seen in Connecticut between 2014 and 2019.

Methods

This study used clinical cases of anaplasmosis reported to the CT DPH and tick infection prevalence data to understand emerging geographic hotspots for the disease in the state and to evaluate the association between the human and tick infections. Human incidence rates (IR) were calculated per 100,000 in the population by county. Tick infection prevalence was calculated as an acarological risk index (ARI) using active tick surveillance data from the Connecticut Agricultural Experiment Station (CAES). These two calculations were analyzed with a Spearman rank correlation in SAS version 9.4 and overlaid on ArcMap.

Results

During the 2019-2020 period, 420 human cases of anaplasmosis were included and 148 infected ticks were identified. There was a significant positive correlation between IR and ARI identified (Spearman correlation 0.54, p = 0.03). Litchfield County had the highest number of human cases (128) and Fairfield County had the highest proportion of infected ticks (11.25%). The area with the greatest increase in both ARI and IR in Connecticut from 2019-2020 was New London County (ARI increased from 0.073 to 0.108, IR increased from 2.64 to 8.57).

Conclusion

This study supports the use of active tick surveillance in identifying geographic areas high incidence of human anaplasmosis and provides a strategy to evaluate tick surveillance for anaplasma infection. Active tick surveillance can be useful in guiding public health interventions and inform public health and clinician education on anaplasmosis.

Disclosures

All Authors: No reported disclosures.
1376. An Analysis of Weight Based Dosing for Sulfamethoxazole-Trimethoprim in Skin and Soft Tissue Infections
Authors: Melgarejo Gabriel , Conklin Taylor , Weihs Sayo
Published: December 2022

Background

Guideline recommendations for sulfamethoxazole-trimethoprim (TMP/SMX) in skin and soft tissue infections (SSTIs) are 1 to 2 double strength (DS) tablets by mouth twice daily. Studies suggest that weight-based dosing of TMP/SMX for SSTIs has a clinical impact on treatment failures. One study suggested TMP/SMX dosed at < 5mg/kg/day, based on the trimethoprim component, was inadequate for the treatment of SSTIs. There are currently no studies to date that assess the incidence of treatment failures with TMP/SMX dosed at ≥ 5mg/kg/day compared to < 5mg/kg/day.

Methods

A single center, retrospective chart review was conducted on adult patients diagnosed with a SSTI based on ICD-9/10 codes from January 2009 through August 2021 at University Health Truman Medical Center. Patients included were divided into two groups based on the dosing strategy of TMP/SMX (< 5mg/kg/day or ≥ 5mg/kg/day). The primary and secondary outcome was incidence of treatment failures and incidence of adverse events, respectively. Exploratory variables that may influence treatment failures were also collected.

Results

A total of 351 patients were included in the analysis with 190 in the < 5mg/kg/day group and 161 in the ≥ 5mg/kg/day group. Patients dosed at ≥ 5mg/kg/day had significantly less treatment failures compared to those dosed at < 5mg/kg/day (17.4% vs 7.5%, p=0.006). After a multivariate analysis, patients dosed with TMP/SMX at ≥ 5mg/kg/day were 58% less likely to have a treatment failure (OR 0.42, 95% CI 0.17 to 0.96, p=0.044). Incidence of adverse events were similar in both groups (p=0.105).

Conclusion

TMP/SMX dosed at ≥ 5mg/kg/day had significantly fewer treatment failures for SSTIs compared to TMP/SMX dosed at < 5mg/kg/day and was not associated with increased adverse events. These findings suggest that the current recommendations for dosing of TMP/SMX in SSTIs may need to be addressed.

Disclosures

All Authors: No reported disclosures.
1381. Infectious Disease Complications in Hospitalized Patients with Opioid Use Disorder at a Southern County Hospital
Authors: Balakrishnan Harini , Campalans Nicholas A , Marambage Kapila , Nijhawan Ank E
Published: December 2022

Background

Injection drug-use (IDU) has increased over the past two decades and contributes towards the morbidity and mortality of opioid use disorder (OUD). Recent studies of IDU-associated infections have primarily focused on regions outside of the southern United States; however, this area presents greater barriers to healthcare funding and harm reduction services for patients with OUD seeking care. This study aims to describe the burden of IDU-associated infections amongst patients with OUD referred to addiction psychiatry at a southern county hospital.

Methods

A retrospective electronic health record review was conducted for patients admitted to a large urban county hospital from February 2018 to December 2019. Inclusion criteria included active OUD within the last 12 months and an addiction psychiatry consultation. Frequency of baseline patient characteristics were compared between those with and without IDU-associated infections, and IDU-associated infections were characterized. Additionally, medication for opioid use disorder (MOUD) uptake was described.

Results

260 charts were reviewed, and 229 individuals met inclusion criteria. 36% were female, 47% non-Hispanic white, and 36% Hispanic. 62% reported IDU in the past 30 days. 45% had IDU-associated infections, with skin and soft-tissue infections (SSTI) being most common (77%), followed by bacteremia (23%), osteomyelitis, (13%), and endocarditis (9%). Comorbid stimulant use disorder was also prevalent (72%). Patients with IDU-associated infections were uninsured at higher rates (79% vs. 60%). 48% of patients with IDU-associated infections had monomicrobial infections, and 23% had polymicrobial infections. While patients with no IDU-associated infections had higher rates of active MOUD on admission (28% vs. 10%), new MOUD uptake was higher among patients with IDU-associated infections (80% vs. 53%).

Abbreviations: OUD, opioid use disorder; IDU, injection drug-use; COPD, chronic obstructive pulmonary disease; HTN, hypertension; CHF, congestive heart failure; Hep, hepatitis; HIV, human immunodeficiency virus

Abbreviations: OUD, opioid use disorder; IDU, injection drug-use; SSTI, skin and soft tissue infection; Hep, hepatitis; HIV, human immunodeficiency virus; ID, infectious diseases

Abbreviations: IDU, injection drug-use

Conclusion

These findings indicate that SSTIs compose most IDU-associated infections in hospitalized patients with OUD, which may reflect greater black tar heroin availability in the southern United States. Furthermore, increased rates of MOUD uptake amongst those with IDU-associated infections support the notion that hospitalization can be an effective circumstance in which to initiate substance use treatment.

Disclosures

Ank E. Nijhawan, MD, MPH, MSCS, Gilead Sciences: Grant/Research Support.
1384. NSTI Outcomes with and without Hyperbaric Oxygen Therapy
Authors: Shishido Akira A , Vostal Alexander C , Tripathi Ravi , Uehling Megan , Chintalapati Sai Pavan Kumar , Conway Lauren , Kus Nicole J , Schrank Gregory M , Rabinowitz Ronald , DiChiacchio Laura
Published: December 2022

Background

Necrotizing soft tissue infections (NSTI) are characterized by fulminant tissue destruction and high mortality rates. Primary treatment is surgical debridement and antibiotics; hyperbaric oxygen therapy (HBOT) may be considered as adjuvant therapy. HBOT for NSTI remains controversial given the lack of quality evidence. HBOT is frequently used for NSTI at our institution; however, the early COVID-19 pandemic forced a significant decrease in its utilization. This practice change created an unusually high proportion of NSTI patients who did not receive HBOT at our institution and thus provided an opportunity to compare outcomes amongst NSTI patients who received HBOT against those who did not.

Methods

We performed a retrospective cohort study of patients aged 18 years and older admitted with the diagnosis of NSTI between January 2018 and December 2020, a period that included the first 6 months of the pandemic (Figure 1). We collected data on patient demographics, comorbidities, infection location, pathogen, severity of illness (APACHE II score), whether HBOT was provided and number of dives. Outcomes included 90-day mortality, amputations, inpatient antibiotic days, ventilator days, and hospital length of stay. Figure 1Proportion of NSTI patients admitted to R Adams Cowley Shock Trauma Center who received HBOT between January 2018 through December 2020. Proportions were averaged over six month blocks.

Results

253 patients were included of whom 143 (56%) received HBOT and 110 (43.3%) did not. Baseline characteristics were similar between the groups except for Wound Surface Area (WSA) and APACHE II score (Table 1). Length of stay was significantly longer in HBOT patients (15.3 days vs 11.7 days p=0.005, Table 2). Fewer HBOT patients had amputations (7.5% vs 21% p=0.007) and fewer died within 90 days of admission (6.3% vs 14.5% p=0.029). When stratifying patients by APACHE II score, HBOT patients with APACHE II scores > 18 had significantly lower mortality than non-HBOT patients (9.7% vs 32.4% p=0.035).

Conclusion

In this population of NSTI patients who underwent surgical debridement, HBOT was associated with lower incidence of amputation, and lower mortality. Patients with APACHE II scores >18 who received HBOT had lower mortality than those who did not. A prospective study should further evaluate the impact of HBOT on mortality and amputations.

Disclosures

All Authors: No reported disclosures.