bluuebunny/crossref_metadata_2025 huggingface dataset:
810. Cardiac Pacemaker Implantation Surgery: Automated Prediction of Surgical Site Infection
Authors: de Souza Flávio Henrique Batista , Couto Bráulio R G M , da Conceição Felipe Leandro Andrade , da Silva Gabriel Henrique Silvestre , Dias Igor Gonçalves , Rigueira Rafael Vieira Magno , Pimenta Gustavo Maciel , Martins Maurilio B , Mendes Júlio César O , Januário Guilherme Brangioni , Oliveira Rayane Thamires , de Vasconcelos Laura Ferraz , de Araújo Laís L , Rodrigues Ana Clara Resende , E Silva Camila Morais Oliveira , De Souza Eduarda Viana , Melo Júlia Faria , Assunção De Sá Maria Cláudia , Silva Walquíria Magalhães , Figueiredo Gabriella Mourão Cerqueira , Colares Jamile Doffénond , Junqueira Ludmila Paula Guimarães , Reis Maiara Cristina , Nobre Mariana Ribeiro
Published: December 2021

Background

A research focused on surgical site infection (SSI) was performed in patients undergoing cardiac pacemaker implantation surgery. The main objective is to statistically evaluate such incidences and enable a study of the prediction power of SSI through pattern recognition algorithms, in this case the Multilayer Perceptron (MLP).

Methods

Data were collected from five hospitals in the city of Belo Horizonte (more than 3,000,000 inhabitants), between July 2016 and June 2018, on SSI by the Hospital Infection Control Committees (CCIH) of the hospitals involved in the search. All data used in the analysis during their routine SSI surveillance procedures were collected. So, three procedures were performed: a treatment of the collected database for use of intact samples; a statistical analysis on the profile of the hospitals collected and; an assessment of the predictive power of five types of MLP (Backpropagation Standard, Momentum, Resilient Propagation, Weight Decay, and Quick Propagation) for SSI prediction. MLPs were tested with 3, 5, 7, and 10 hidden layer neurons and a database split for the resampling process (65% and 75% for testing, 35% and 25% for validation). They were compared by measuring AUC (Area Under the Curve - from 0 to 1) presented for each of the configurations.

Results

From 1394, 572 records were: 21% of deaths and 2.4% patients had SSI; from the confirmed SSI cases, approximately 64.3% had sites classified as “clean”; length of hospital stay ranged from 0 to 175 days (from 1 to 70 days); the average age is 67 years. The prediction power of SSI, the experiments achieved from 0.409 to 0.722.

Conclusion

Despite the considerable loss rate of more than 65% of the database samples due to the presence of noise, it was possible to have a relevant sampling for the profile evaluation of Belo Horizonte hospitals. Moreover, for the predictive process, although some configurations reached 0.722. To optimize data collection and enable other hospitals to use the SSI prediction tool (available in www.nois.org.br ), two mobile application were developed: one for monitoring the patient in the hospital and the other for monitoring after hospital discharge.

Disclosures

All Authors: No reported disclosures
812. The Impact of Post-Operative Cephalexin on Surgical Site (SSI) Infections During a Cefazolin Shortage
Authors: Brown Sara , Brigg Turner R , Chan Dominic
Published: December 2021

Background

Drug shortages directly impact patient care. Rates of drug shortages have declined except for antimicrobials, where shortage rates remain similar each year.1 In November 2018, a national cefazolin shortage occurred driving health systems to implement a therapeutic interchange of cefazolin for cephalexin for post-operative antimicrobial prophylaxis. The objective of this study is to determine whether SSI-rates change when post-operative cephalexin is used in placed of cefazolin.

Methods

This was a retrospective, observational cohort study of patients receiving post-operative antimicrobial prophylaxis at a community-based health system in Oregon and Washington between May 2018 – August 2019. Participants were divided into 3 periods for SSI-rate trend analysis: pre-shortage (May 2018 – October 2018), shortage (November 2018 – February 2019), and post-shortage (March 2019 – August 2019). The primary outcome was SSI-rates between groups.

Results

There were 6,378 patients in total (5,840 cefazolin vs. 538 cephalexin). There were no significant differences in baseline characteristics of age, sex, body mass index (BMI), or hospital location. The rate of SSI between pre-shortage and post-shortage cefazolin groups was not statistically different (14 [0.5%] vs. 23 [0.8%]; p=0.16). The primary outcome of SSI in the shortage group who received cephalexin was not statistically different (37 [0.6%] vs. 0 [0%]; p=0.07).

Conclusion

National drug shortages significantly impact patient care, often leading to seeking evidence-poor alternative medications. These results suggest cephalexin may be an acceptable post-operative prophylaxis antimicrobial if cefazolin is unavailable.

Disclosures

All Authors: No reported disclosures
814. Successful Treatment of Cutibacterium acnes (CA) Prosthetic Device Infection (PDI) with Oral Linezolid and Rifampin (LR)
Authors: Nahass Ronald G , Esquivel Maalikat , Smith Krystle , Heinemann Danielle , Seneca Kathleen H
Published: December 2021

Background

CA PDI is increasingly recognized. CA is felt to create a slime layer that makes infection more likely and treatment more difficult in this setting. Traditional management has included prosthetic device explantation (PDE), prolonged antibiotic treatment, and delayed reimplantation. Recent interest in the use of oral treatment regimens and single stage procedures with long duration antibiotic therapy led us to treat a series of patients with oral treatment and retained prosthesis after debridement. We report those results.

Methods

Sequential patients with CA PDI treated with oral therapy were identified. All patients underwent debridement of the tissue, exchange of components and/or reimplantation of the prosthetic device. Only patients with exchanges were included. PDE was excluded. MIC testing for CA isolates was obtained when possible. Initial treatment was recorded at time of surgery. LR was the treatment of choice unless toxicity developed. A minimum of a 3-month follow-up post treatment was required to be included. 6 and 12 month follow up were obtained for all patients but 1 at this time.

Results

10 patients were treated (Table 1). Shoulder joint infections were most common. All patients were treated with LR. All completed a minimum of 42 days of treatment (Table 2). The medication was well tolerated. The most common adverse events were nausea. 9/10 patients with 12 month follow up had no evidence of relapse. 1/10 had no relapse at 3 months. Typical for CA infection laboratory markers for infection were not markedly elevated. Notably thrombocytopenia did not occur (Table 3).

Table 1. Distribution of Prosthetic Device Infections

Table 2. Duration of Treatment

Table 3. Selected Laboratory Results

Conclusion

We demonstrated the ability to successfully treat 10/10 patients with CA PDI without explantation using prolonged oral treatment with LR after debridement. This combination should be considered a treatment option and explored further as a low cost, well tolerated, high value treatment approach to this difficult infection.

Disclosures

Ronald G. Nahass, MD, Abbvie (Grant/Research Support, Speaker’s Bureau)Alkermes (Grant/Research Support)Gilead (Grant/Research Support, Speaker’s Bureau)Merck (Grant/Research Support, Speaker’s Bureau) Kathleen H. Seneca, MSN, Abbvie (Research Grant or Support)Alkermes (Research Grant or Support)Gilead (Speaker’s Bureau)
815. Short-Course vs. Extended-Course Perioperative Antibiotic Prophylaxis in Patients Receiving Unilateral Primary Total Knee Arthroplasty
Authors: Lim Jia Le , Yii Daphne Yah Chieh , Hung Kai Chee , Lee Winnie , Kwa Lay Hoon Andrea , Yeo Nicholas Eng Meng , Tan Andrew Hwee Chye , Chung Shimin Jasmine
Published: December 2021

Background

International guidelines recommend up to 24 hours of perioperative antibiotic prophylaxis (AP) in joint replacement procedures. However, some observational studies support AP beyond 24 hours for the prevention of surgical site infections (SSI) and prosthetic joint infections (PJI), and this practice is also observed in our institution. This study aims to evaluate the incidence of SSI and PJI in patients receiving short- vs extended-course AP after unilateral primary total knee arthroplasty (TKA) at our center.

Methods

This was a retrospective cohort study of patients who underwent elective unilateral primary TKA from October to December 2019 at Singapore General Hospital. Patients were excluded if they received antibiotics for reasons other than post-operative AP or underwent other procedures in addition to unilateral primary TKA. Data was collected from electronic medical records and patients who received a short-course of AP (≤24 hours) were compared with patients who received an extended-course of AP. Primary outcomes were 30-day SSI and 30-day PJI rates. Secondary outcome was the impact of duration of AP on length of stay. Statistical analysis was performed using SPSS software version 20.

Results

There were 394 patients included in the study. 247 received short-course and 147 received extended-course AP. There were no differences in demographics (Table 1). Amongst those who received extended-course AP, median duration was 7 (IQR 4, 8) days, during which 119 (81.0%) patients switched from intravenous to oral route of antibiotics. Between the short- and extended-course arms, there were no differences observed in 30-day SSI (6.9% vs 6.1%, p=0.769) or PJI rates (0.4% vs 0.7%, p=0.999). However, extended-course AP was associated with a longer median length of stay (4 [IQR 3, 6] vs 5 [IQR 4, 7] days, p=0.001). In a subgroup analysis of 106 diabetic patients, there were no differences in 30-day SSI rates (12.3% vs 9.8%, p=0.763) and 30-day PJI rates (0% vs 2.4%, p=0.387) between both groups.

Conclusion

In this single center study, short-course AP in elective TKA was safe and effective. Extending AP did not reduce SSI or PJI rates, even in diabetic patients. In addition, extending AP was associated with increased length of stay, which translates to higher healthcare costs.

Disclosures

All Authors: No reported disclosures
816. Early Surgical Site Infections in High Risk Orthopedic Surgery Patients Following Change in Perioperative Antibiotic Selection
Authors: Lee Benjamin , Pasikhova Yanina , Morrison Austin R , Baluch Aliyah , Binitie Odion
Published: December 2021

Background

Endoprosthestic or allograft reconstruction has become common following resection of malignant musculoskeletal tumors. Reported SSI rates after resection and reconstruction have been reported as high as 10 – 39% due to concurrent radiation and/or chemotherapy, compared to 0.6% - 2.0% in other orthopedic procedures. Though the optimal duration and perioperative antibiotic prophylaxis is well defined in other orthopedic procedures, there is little evidence to guide management in patients undergoing reconstruction with large endoprosthesis. At Moffitt Cancer Center (MCC), cefepime and vancomycin (FEP/VAN) were historically used for perioperative antibiotic prophylaxis; however, due to national logistical issues, these antibiotics were modified on June 6th, 2015 to cefazolin and vancomycin (CFZ/VAN).

Methods

We report a pre-post quasi-experimental interrupted time-series non-inferiority study conducted at MCC with 150 high-risk orthopedic surgery patients with a primary objective of demonstrating non-inferiority of CFZ/VAN to FEP/VAN with reducing early SSI rates for patients after tumor resection followed by reconstruction. Statistical analysis was performed utilizing a multivariate logistic regression analysis of the interventions and primary outcome. Data were processed and analyzed within the R version 4.0.2 software.

Results

Both groups included 75 patients with most common indications for surgery being sarcoma of any type (53%) and metastatic bone disease (27%), with the most common location of reconstruction at the distal femur (25%) and acetabulum (24%). Rates of early SSIs were low and numerically similar with 3 (4%) in the FEP/VAN group and 4 (5.4%) in the CFZ/VAN group. There was one instance of hardware removal due to infection within the FEP/VAN group.

Baseline Characteristics

Baseline characteristics for total study population, FEP/VAN, and CFZ/VAN

Results including SSI rate, pathogens, infection

Surgical site infection rates, culture site, group and interventions

Conclusion

Overall, the rates of early SSI rates at MCC between both groups are numerically lower compared to previous studies. Between groups, the rates are similar and supports the use of CFZ/VAN in this patient population. The low rate of early SSIs in this study may be attributed to several factors such as extended oral antibiotic prophylaxis at discharge. Further analysis is ongoing to determine the statistical significance of any differences between confounding variables.

Disclosures

All Authors: No reported disclosures
818. Understanding Current Practices of an Electronic Antimicrobial Resistant Organism (ARO) Screening Tool Used in Healthcare Facilities in Alberta, Canada
Authors: Leal Jenine , Versluys Kristen , Pfister Ted , Ellison Jennifer , Bush Kathryn , Pitchko Janice , Woolsey Samantha , Vayalumkal Joseph V , Lee Bonita , Smith Stephanie , Kim Joseph , May Elissa Rennert
Published: December 2021

Background

Increasing antibiotic resistance is a global problem. By detecting individuals colonized with antimicrobial resistant organisms (AROs) through hospital admission screening, enhanced precautions can be implemented to interrupt transmission during their hospitalization. The objective is to understand current practices of ARO screening in Alberta hospitals by evaluating completeness of an electronic ARO screening tool.

Methods

A retrospective cohort study using electronic medical record (EMR) data from Connect Care (Epic Systems Corp.) at one adult and one pediatric tertiary hospital in Edmonton, Alberta between January 1, and December 31, 2020 was conducted. All hospital admissions were included. Outcomes included proportion of admissions with a completed ARO tool and a comparison of the best practice actions triggered (e.g. ARO screening swab and/or isolate) between those with and without a completed ARO tool. Test of proportions was used, with a two-sided α of 0.05 and was conducted using STATA/SE 16.1.

Results

During the study period, there were 32,600 total admissions, of which 16,342 (50.1%) had the ARO tool completed. The overall compliance was greater in the adult hospital (53.9%) compared to the pediatric hospital (36.3%) (< 0.001). For both hospitals, the compliance rate in December 2020 was 30.0% lower than in January 2020, with a continuous decline during the 12 months. An isolation order or screening swab was ordered in 40.6% of admissions without an ARO tool completed compared to 56.5% of admissions with the ARO tool completed. Based on responses in the completed ARO tool, 81.2% of patient admissions had a microbiologic swab ordered when indicated, of which only 4.7% were positive. However, only 35.9% of patient admissions had additional precautions ordered when indicated.

Conclusion

ARO screening is a required organizational practice and although standardized across all Alberta hospitals and embedded within an EMR, compliance was poor. Further work is needed to understand point-of-care risk assessment processes to inform future interventions aimed at early identification and decreased transmission of ARO in hospitals.

Disclosures

All Authors: No reported disclosures
819. Antibiotic Resistance in Pathogens Causing Hospital Acquired Infections in Brazil: A Multicenter Study
Authors: Starling Carlos , Couto Bráulio R G M , Silva Estevão Urbano , Andrade Virginia , Leite Edna M M , Gonçalves Simony , Melo Mariana , Bandeira Raquel , Carvalho Priscila , Pereira Hoberdan , Fernandes Rafael , Mata Camila , Vasconcelos Débora , Vieira Laura , Silva Magda , Aguiar Lilian , Gomes Luciene , Rocha Maria Izabella , Silva Raphael , Filho Graccho Cesarino , Pessoa Jussara , Alvim André Luiz , Maia Amanda , Matoso Roberta , Mara Thalita
Published: December 2021

Background

In the present study we determined the prevalence of antibiotic resistance in the most common organisms causing healthcare-associated infections in tertiary-care hospitals in Belo Horizonte, a 3,000,000 inhabitants city from Brazil.

Methods

Microbiology data of hospital acquired infections (HAI) defined by the National Healthcare Safety Network (NHSN)/CDC protocols of seven general hospitals were analyzed: three public institutions, two philanthropic, and two private hospitals.

Samples from different topographies were plate in an ideal culture medium and after growth, the microorganisms were identified by standard biochemical and microbiological methods, using the VITEK 2 compact system (Biomerieux), which allows the simultaneous identification of Gram-positive and Gram bacteria -negative and combine the identification and TSA results in a single report. Six hospitals used automated methods and one institution used manual method for antimicrobial susceptibility testing.

Results

Samples of seven Gram-negative and two Gram-positive bacteria collected between Dec/2019-Nov/2020 from HAI isolates were analyzed: 565 Klebsiella, 293 Escherichia coli, 153 Proteus, 403 Pseudomonas, 275 Acinetobacter, 174 Serratia, 153, 361 Staphylococcus aureus, and 176 Enterococcus. Antibiotic resistance profile of each strain is summarized in Figures 1, 2, and 3.

Resistance profile: Klebsiella, E. coli, Proteus.

ATB profile: Pseudomonas, Acinetobacter, Serratia.

ATB profile: Enterobacter, S. aureus, Enterococcus .

Conclusion

Benchmarks for antibiotic resistance in the most common organisms causing healthcare-associated infections were defined, and can be used as indicators for healthcare assessment, specially in developing countries institutions.

Disclosures

All Authors: No reported disclosures
820. Optimal Specimen Source(s) for Carbapenemase-Producing Acinetobacter Colonization Screening
Authors: Dale Jennifer , Anacker Melissa , Craft Bradley , Gross Annastasia , Fischer Jill , Blanding Justin , Lindemann Stephanie , Tang Angela , Brister Sarah , Dowdell Ashlie , Stein Emma , O’Malley Sean , Pattee Brittany , Vagnone Paula Snippes
Published: December 2021

Background

Infection prevention (IP) strategies are implemented to limit the transmission of healthcare-associated infections (HAIs), which are estimated to occur in 1 out of 31 hospitalized patients per day in the United States. Carbapenem-resistant Acinetobacter (CRA) cause HAIs classified as an urgent threat by CDC. When carbapenemase-producing CRA (CP-CRA) are identified, containment strategies are implemented, including screening patients at high risk for colonization with CP-CRA. Point prevalence surveys (PPS) are conducted to assist with HAI outbreak investigations and identify colonized patients.

Methods

Herein, we describe results from culture-based CP-CRA colonization testing of multiple specimen sources (rectal, skin [axilla/groin or groin], respiratory, and/or wound). A total of 744 PPS specimens from 356 patients, across six states, were obtained from February 2019 to May 2021 for CP-CRA colonization screening including 30% (224/744) rectal, 52% (390/744) skin, 10% (73/744) respiratory, and 8% (57/744) wound sources. The specimens were plated onto both non-selective (blood agar) and selective media (MacConkey, ESBL CHROMagar, Acinetobacter CHROMagar), and RT-PCR was performed for detection of the Acinetobacter-specific carbapenemase genes blaOXA-23, blaOXA-24, and blaOXA-58.

Results

Twelve percent (90/744) of specimens, representing 17% (62/356) of patients, were positive for detection of blaOXA-23 and/or blaOXA-24 CP-CRA. The majority (96%) of CP-CRA harbored blaOXA-24. Of the 62 colonized patients, 52% (32/62) had more than one collection source and 47% (15/32) of those had more than one source positive for CP-CRA. There was no consensus regarding a single source type across positive specimens. However, rectal or skin swab collection alone would potentially miss 2% (4/163) or 8% (14/186) of positive specimens, respectively.

Conclusion

These data suggest that rectal or skin source collection alone could be sufficient for detection of CP-CRA. Overall, multiple factors should be considered to guide the source(s) for CP-CRA specimen collection, such as infection type, regional prevalence, patient factors, and/or IP gap(s) within a facility.

Disclosures

All Authors: No reported disclosures
822. Tenofovir Alafenamide (TAF) is an Independent Risk Factor for Hyperlipidemia in Persons with Human Immunodeficiency Virus (HIV) on Antiretroviral Therapy (ART)
Authors: Patel Yesha , Doshi Anjali , Levesque Anna , Lindor Shelsie , Moranville Robert , Okere Sheila , Robinson Danielle , Taylor Lauren , Lustberg Mark , Malvestutto Carlos
Published: December 2021

Background

ART-associated weight gain, metabolic disorders, and co-morbidities such as cardiovascular disease are challenges in long-term human immunodeficiency virus (HIV) care. We explore the effects of different ART classes on lipids at The Ohio State University Medical Center Infectious Diseases Clinic.

Methods

This was a retrospective, cohort study of adult PWH on ART for ≥ 3 months seen at our clinic from 1/1/2015 to 1/1/2017. Patients with CD4+ count < 200 cells/mm3 and viral load >200 copies/mL, history of malignancy, or pregnancy were excluded. Lipid values were collected over the study period. The primary outcome was change in total cholesterol (TC), high density lipoprotein (HDL) cholesterol, and non-HDL cholesterol over the study period. Multivariable regression was used to model these outcomes.

Results

Among 411 PWH who met criteria, 87.4% were male, and 43.3% had a baseline diagnosis of hyperlipidemia. 21.1% were on a protease inhibitor (PI), 45% were on a non-nucleoside reverse transcriptase inhibitor (NNRTI), and 37% were on an integrase strand transfer inhibitor (INSTI). 70.1% were on tenofovir disoproxil fumarate (TDF)/ emtricitabine (FTC), 20.7% were on abacavir (ABC)/ lamivudine (3TC), and 4.4% were on TAF/FTC. The mean population (MP) difference in TC was -1.54 ± 1.34 mg/dL (p=0.25), the MP difference in non-HDL cholesterol was -1.78 ± 1.26 mg/dL (p=0.16), and the MP difference in HDL cholesterol was 0.24 ± 0.43 mg/dL (p=0.6). In multivariable linear regression models (Table 1), TAF/FTC was associated with a change of TC of 18.2 ± 6.4 mg/dL (P= 0.005), a change of non-HDL cholesterol of 12.0 ± 6.0 mg/dL (p=0.046), and a change of HDL cholesterol of 6.2 ± 2.1 mg/dL (p=0.003). These models included terms for months of follow up, male gender and baseline hyperlipidemia. Though race, diabetes mellitus, and ethnicity were not significant in the model, after adjustments for them, PWH on TAF/FTC showed a change of TC of 18.0 ± 6.4 mg/dL (p=0.005), a change of non-HDL cholesterol of 11.8 ± 6.0 mg/dL (P=0.051), and a change of HDL of 6.2 ± 2.1 (p=0.03).

Multivariable Linear Regression Models for Change in Total Cholesterol and Non-HDL Cholesterol

Conclusion

Prior studies have shown an increase in lipid levels associated with TAF compared to TDF. This study shows that TAF is an independent risk factor for increased TC, non-HDL cholesterol, and HDL cholesterol in the PWH population as a whole.

Disclosures

Carlos Malvestutto, M.D., Lilly (Scientific Research Study Investigator)Regeneron Inc. (Scientific Research Study Investigator)ViiV Healthcare (Advisor or Review Panel member)
102. A Retrospective Case Series of West Nile Neuroinvasive Disease in Two Tertiary Health Centers in Miami
Authors: Cordova Leopoldo , Rehman Aliya F , Balan Shuba , Ayoade Folusakin , Paniagua Lizy , Bini Julia , Rivera Cynthia
Published: December 2021

Background

According to the Centers for Disease Control and Prevention, Florida was the third leading state in reported West Nile Neuroinvasive Disease (WNND) infections in 2020. WNND accounts for less than 1% of all West Nile virus (WNV) infections but carries a 10% mortality rate. The clinical characteristics of WNND have not been well described in Florida, an area with high mosquito activity. We hereby describe the clinical characteristics of WNND at two large hospitals in Miami.

Methods

A 10-year retrospective study was performed at the University of Miami Hospital and Mount Sinai Medical Center to identify adult patients with confirmed WNV infection and neuroinvasion. Patient demographics, symptoms, neurological exam findings, laboratory diagnostics, intensive care unit (ICU), and hospital length of stay (LOS), and outcomes were described.

Results

Eleven patients (73% male, mean age 64.4 ± 16.3 years) were identified between January 2010 to December 2020. The most prevalent comorbidities were HTN (64%) and DM (27%). The most common positive findings on the review of symptoms were fever (100%), confusion (81.8%), and headache (63.6%). The mean hospital LOS was 15.5 ±11.3 days, while the mean ICU LOS was 7.2 ± 11.9 days. The majority of patients (75%) spent more than 2 weeks in the ICU. Subject age was correlated with hospital LOS with a Pearson correlation of 0.624 (p=0.04). The survival rate was 91%. At the time of discharge, 80% of patients continued to have neurological symptoms.

Figure 1: The percentage of subjects with different types of WNND. The section titled others, includes atypical presentations such as amnesia, focal neurological deficits (ataxia, hemiparesis), and myelopathy.

Figure 2: Month and year of presentation at the time of hospital admission.

Figure 3: Clinical presentation (%).

Conclusion

This is the largest case series of WNND in Florida. Most cases occurred during summer 2020, which corresponds to the peak of the COVID-19 pandemic. Despite pandemic restrictions, we may have seen an increase in WNV cases due to higher-than-normal temperatures promoting mosquito abundance, increased outdoor activities due to the COVID-19 pandemic, and/or the redistribution of public health resources towards the pandemic rather than mosquito control. Residual neurological symptoms and impaired functional outcomes are common. Within the limitation of our small sample size, subject age appeared to correlate with hospital LOS. This correlation should be further explored in a larger case series. A high index of suspicion for WNND is suggested for patients presenting with fever and neurologic symptoms in Florida.

Disclosures

Cynthia Rivera, MD, Gilead Sciences (Advisor or Review Panel member)Viiv Healthcare (Advisor or Review Panel member)
825. Immunosuppressive Agent Use in Patients with Comorbid HIV and Inflammatory Bowel Disease
Authors: Hunt Travis J , Kozuch Patricia L , Spacek Lisa A
Published: December 2021

Background

Epidemiologic data from HIV/AIDS registries and inflammatory bowel disease (IBD) centers have identified comorbid IBD to be a challenge in the long-term care of patients with HIV, but data on management are sparse. At a multisite tertiary center, we examined medical management, disease control, and complications of patients with comorbid HIV and IBD.

Methods

We reviewed 126 charts between April 2017 and December 2020 for subjects 18+ years with HIV-1 infection and Crohn’s disease (CD) or ulcerative colitis (UC). Participants received HIV and/or IBD care at Jefferson. We documented CD4 count, HIV viral load, IBD regimen, and the Harvey-Bradshaw Index (HBI) for CD and the Mayo Score for UC (DAI).

Results

Twelve patients met criteria for inclusion, n=6 with CD and n=6 with UC. They were all prescribed antiretroviral therapy (ART), with median CD4 722 and 83% virally suppressed (Table 1). 67% had ever been prescribed immunosuppressive IBD regimens while known to be HIV+. Eight patients had CD4s > 200 with low HBI or DAI. Patient #s 4, 8 and 10 were managed with only mesalamine. Patient #s 5 and 12 had received immunomodulators, with #5 controlled on azathioprine for years but stopped following admission for septic shock due to a thigh abscess, and #12 newly trialed methotrexate in the setting of IBD-related arthritis. Patient #s 2, 6, and 7 were treated with adalimumab: #2 newly for IBD-related arthritis, while #6 and #7 had been maintained long-term for luminal disease, but #7 was a new HIV diagnosis recently initiated on ART. Two patients were AIDS-defined with low HBI: #1 on mesalamine only, as infliximab was discontinued on HIV diagnosis with CD4 36, and #9 who was not on an IBD regimen. Two patients CD4 200+ had inconsistent viral suppression and moderate HBI/DAI: #3, who had responded to vedolizumab prescribed briefly during viral suppression but stopped due to poor follow-up and ART non-adherence, and #11, whose only documented IBD regimen since HIV diagnosis was chronic prednisone.

Table 1. Cohort Background and Currently Prescribed Regimens

These data observe the cohort’s current regimens and longitudinal control. They do not include windows of prior medication trials that were not maintained, which are detailed in the text.

Conclusion

This small case series suggests that comorbid IBD and HIV patients may be managed successfully with immunosuppressive therapy when indicated. More information is needed regarding whether immunomodulators and biologics may affect CD4 and viral loads and conversely how poor control of HIV affects IBD activity.

Disclosures

All Authors: No reported disclosures
826. HIV Infection and HPV Genotype Patterns among Young Women with Advanced Cervical Neoplasia in Davidson County, Tennessee
Authors: Giffin Leahanne , Zhu Yuwei , Pemmaraju Manideepthi , Blankenship Sheelah , Sackey Emmanuel , Querec Troy , Unger Elizabeth R , Cleveland Angela , Gargano Julia , Castilho Jessica L
Published: December 2021

Background

Women living with HIV (WLWH) experience high rates of human papillomavirus (HPV) infection and increased risk of cervical cancer. High-risk HPV (HR-HPV) types 16/18 cause most cervical precancers and cancers in women with and without HIV. However, contributions of other HR-HPV types to cervical disease among WLWH are not fully understood. We compared CIN2+ cases (cervical intraepithelial neoplasia grade 2 or higher or adenocarcinoma in situ) and the association between non-16/18 HPV types among women with and without HIV.

Methods

Davidson County, Tennessee, women aged 18-39 years with CIN2+ diagnosed between 2008-2016 with HPV genotyping were included. HIV status, demographics, and histology were abstracted from medical records. Neighborhood-level socioeconomic factors were derived from Integrated Public Use Microdata Series. Archived cervical tissue was tested for 37 HPV types to define CIN2+ cases negative for HPV 16/18, regardless of presence of other HR-HPV strains. Characteristics of women with CIN2+ and HPV typing patterns were compared between women with and without HIV using Wilcoxon and Chi-square tests. Logistic regression assessed the association of non-16/18 HPV types and HIV infection, adjusting for age, race, calendar year, insurance, HPV vaccination, and neighborhood socioeconomic factors (selected a priori).

Results

Among 2,116 women included, 1,093 (52%) had neither HPV16 nor HPV18. Compared to women without HIV, the 27 WLWH included were more likely to be >30 years of age, Black race, and live in neighborhoods with higher measures of poverty (Table 1). HPV types did not statistically differ by HIV status, though WLWH had a higher number of HR-HPV types present (Table 2). HIV infection was not significantly associated with non-16/18 HPV type after adjusting for confounders (adjusted OR 0.86 [95%CI: 0.4-1.88]).

Conclusion

Among women with CIN2+, HIV infection was not significantly associated with non-16/18 HPV types. However, WLWH had a higher number of high-risk HPV types detected. Our study was limited by the small number of WLWH included.

Disclosures

All Authors: No reported disclosures
827. High KSHV Seroprevalence Among MSM with HIV Associated with Oral Intercourse and Methamphetamine Use in the Southern United States
Authors: Knights Sheena , Salyards Maverick , Kendall Noelle , Lazarte Susana , Kainthla Radhika , Miley Wendell , Marshall Vickie A , Labo Nazzarena , Whitby Denise , Chiao Elizabeth , Nijhawan Ank E
Published: December 2021

Background

Despite a decrease in Kaposi’s sarcoma (KS) cases in much of the US, the incidence of KS and associated mortality is increasing in specific subpopulations, particularly young, African American men in the South. To further understand this disparity, we sought to describe the seroprevalence and risk factors associated with Kaposi’s sarcoma herpesvirus (KSHV) among men who have sex with men (MSM) and transgender women (TGW) with HIV in Dallas, Texas.

Methods

We enrolled MSM and TGW with HIV and without known KSHV-related disease from a large urban safety-net clinic in Dallas. Blood samples were collected from participants for IgG testing (K8.1 and ORF73), followed by KSHV PCR on blood and saliva samples for those with positive IgG results. We also collected demographics, sexual history, sexual practices, HIV history, substance use, and insurance status. Multivariate logistic regression modeling was performed to identify associations with KSHV seropositivity.

Results

Of 159 participants, 110 (69.2%) were seropositive for KSHV. Seroprevalence varied by race/ethnicity, with 27/34 (79.4%) Hispanic, 27/37 (73.0%) white, and 54/84 (64.3%) black participants testing positive for KSHV IgG, though this difference was not statistically significant. 31/104 (29.8%) seropositive participants had detectable KSHV in saliva and 10/104 (9.6%) seropositive participants had detectable KSHV in blood. Risk factors independently associated with KSHV seropositivity include oral-anal sex (OR 4.02, 95% CI 1.89 – 8.54), oral-penile sex (OR 3.66, 95% CI 1.16 – 11.57), and methamphetamine use (OR 2.73, 95% CI 1.23 – 6.04). Current CD4 count, HIV viral load, history of intravenous drug use, tobacco or alcohol use were not associated with KSHV seropositivity.

Table 1. Patient Characteristics

Conclusion

We found that over two-thirds of MSM and TGW with HIV in Dallas are KSHV seropositive, which is relatively high compared to other studies of US MSM with HIV (30-70%). In our study, KSHV was more common among Hispanic and white individuals, and was associated with higher rates of oral sex and methamphetamine use. Differences in KSHV seroprevalence alone are unlikely to explain racial disparities in the incidence of KS. Further study is needed to better understand drivers of KSHV infection and KSHV-related diseases in highly impacted groups in the US.

Disclosures

All Authors: No reported disclosures
828. Short- and Long-Term Metabolic Changes in Virologically Suppressed Patients Switching from TDF to TAF Containing Antiretroviral Therapy
Authors: Schafer Jason J , Zimmerman Matty , Walshe Ciara E , Cerankowski Jessie , Shimada Ayako , Keith Scott
Published: December 2021

Background

Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) containing antiretroviral therapy (ART) may negatively influence weight, cholesterol, and atherosclerotic cardiovascular disease (ASCVD) risk. The timing, duration, and extent of these changes and their definitive associations with TAF remain unclear.

Methods

This retrospective observational study evaluated weight, body mass index (BMI), cholesterol, and ASCVD risk score changes in virologically suppressed patients living with HIV infection (PLWH) who switched from TDF to TAF without switching any other ART regimen components. Adult patients on TDF and no HIV viral load values > 200 copies/mL for ≥ 2 years prior to and following a TAF switch were included. Body weight, BMI, cholesterol and other variables were collected for the 2 years before and after the switch. The Wilcoxon signed-rank test compared median values for each measurement pre and post switch in a univariate analysis. Longitudinal linear mixed effects models evaluated changes for each outcome measure at 1 and 2 years after the switch. Models were built with random effects for patients and included covariates such as time on TAF, age, sex, race, time with HIV, diabetes, smoking status, and concomitant medications associated with weight gain or loss.

Results

A total of 86 patients met study criteria (table 1). In the univariate analysis, there were significant increases in weight, BMI, total cholesterol, LDL, HDL, triglycerides, and ASCVD risk scores 2 years after switching to TAF (each p ≤ 0.05, table 2). However, after controlling for covariates, only the increases in total and LDL cholesterol were associated with switching to TAF and significantly different from expected changes predicted in the linear model. In terms of weight gain with TAF, patients gained an average of 4.3 pounds in year 1 and 3.8 pounds in year 2 after the switch. Neither of these increases were statistically different from the expected changes in weight predicted in the linear model (3.1 pounds/year, 95% CI: 1.6-4.6).

Conclusion

Despite observing significant increases in weight, BMI, cholesterol and ASCVD risk scores after switching to TAF, only the changes in cholesterol were significantly associated with TAF and different from changes expected in PLWH over time.

Disclosures

Jason J. Schafer, PharmD, MPH, Gilead (Research Grant or Support)Merck (Advisor or Review Panel member, Research Grant or Support)ViiV (Advisor or Review Panel member)
829. Incidence of Low BMD and Barriers to Routine Screening for Osteoporosis in HIV Patients in Eastern North Carolina
Authors: Rajput Smit , Lebron Dora , Lagasca Alicia , Hussain Jaffer , Odili Ogheneruona , Nichols Suzy
Published: December 2021

Background

With HIV therapy, the life expectancy of persons with HIV (PWH) has improved and complications associated with long-standing HIV and antiretroviral drugs have become more apparent. Low bone mineral density (BMD) (defined by T score < -1) and osteoporosis (defined by T-score < -2.5) are common in PWH. In a meta-analysis of 884 HIV-infected patients, 67% had reduced BMD, of whom 15% had osteoporosis which is 3 times greater than HIV uninfected controls. IDSA guidelines recommend routine screening for osteoporosis in PWH aged ≥ 50 years, yet the rate of screening for osteoporosis in these patients remains low (7.4%-17%). This QI project aimed to estimate the frequency of and identify the barriers to screening for osteoporosis in eligible HIV patients.

Methods

This prospective observational study was conducted in the HIV clinic at East Carolina University from 2018-2019. A sample of 104 HIV patients, ≥ 50 years were selected randomly. Data regarding referral for DXA (dual X-ray absorptiometry) scan, its results, and their insurance provider was collected. The plan was to analyze the barriers associated with guideline-recommended BMD screening and implement it in eligible patients.

Results

From a total of 104, 89 patients (85.6%) were referred for a DXA scan. The reasons for lack of referral were obesity, insurance barrier, wheelchair-bound, and test ordered by another provider. Of the 89 patients referred for DXA, only 49 (47% of total) underwent the scan. In terms of barriers, insurance limitation was the most common reason. Out of the patients that had DXA scans, 19 (39%) were found to have low bone density and 1 had osteoporosis. Low BMD was more common in men (63%) as compared to women (37%) in this group.

Percentage of patients who underwent a DXA scan and the barriers in those who didn’t

Frequency of BMD screening

Incidence of Low BMD

BMD results

Conclusion

In our study, 47% of patients had a BMD assessment. This is better than what has been reported in other single-center studies, however, it is not ideal. About 34% of the patients had insurance coverage as the major barrier for routine screening, as has been mentioned in other similar studies. Of the patients who underwent the DXA scan, 41 % had a low BMD. Other studies have reported variable prevalence of abnormal BMD, from 47-93%. Interestingly, the prevalence of low BMD in our cohort was close to the national average in non-HIV patients.

Disclosures

All Authors: No reported disclosures
831. Hepatitis C Virus Micro-elimination Within a Human Immunodeficiency Virus Clinic: Challenges in the Home Stretch
Authors: Hanna Jaklin , Suh Jin S , Jimenez Humberto
Published: December 2021

Background

Hepatitis c virus (HCV) eradication among persons with HIV (PWH) is alluring since DAAs efficacy is high regardless of HIV status and PWH in care are usually screened for HCV. Despite the potential, barriers to care have prevented many from achieving sustained virologic response (SVR). We performed a pharmacist-led campaign to reduce the proportion of PWH with active HCV and describe the barriers to care.

Methods

This retrospective review evaluated patients receiving care at a Ryan White-funded clinic from 07/2018 to 12/2020. Patients were eligible if HCV diagnosed ≥1 year and receiving HIV care. The primary endpoint was to compare the prevalence HCV before and after a pharmacy initiative to target the remaining patients at the clinic not treated during first 3 ½ year period of oral DAA therapy availability. Secondary analysis was to identify barriers to care, measure the proportion of patients in each step of the HCV care cascade, and determine predictors of SVR. Among barriers to care, inconsistent engagement was defined as patients with habitual missed appointments. Logistic regression and Chi-square tests were performed.

Results

46 of 1,100 PWH had active HCV for ≥1 year. Median age, years since HIV and HCV diagnoses were 58.5 years of age, 17 years, and 11.5 years, respectively. Most patients were male (70%), Black (61%), Latinx (28%), HCV genotype 1 (90%), had an HIV RNA < 200 copies/mL (72%), & had Medicaid (87%). 32/46 patients agreed to therapy, with all getting insurance approval and DAAs delivered. Glecaprevir/pibrentasvir (73%) was the preferred by payors, followed by sofosbuvir/velpatasvir (15%). Eight remained with active HCV and 19 achieved SVR. The prevalence rate dropped from 4.2% to 0.7% (P < 0.0001). Active drug use, inconsistent engagement, mental health disorder and nonadherence were initial barriers to care. After multivariate analysis, patients with inconsistent engagement continued to be less likely achieve SVR compared to those we remained consistently in care (aOR: 0.062, 95 CI: 0.009-0.421).

HCV care cascade in PWH within a Ryan White-funded clinic

Active HCV includes 46 patients with chronic HCV infection receiving HIV in care at clinic, DAA approval process describes patients agreeing to HCV treatment along a continuum of pending laboratory results or pending prior authorization requests, DAA procurement depicts patients that have received approval and delivery of medications, DAA initiation describes patients who started treatment (27 patients), and SVR documented defines patients with an undetectable HCV RNA 12 weeks after therapy (19 patients).

Conclusion

Pharmacists can impact the burden of HCV among PWH receiving care. The HCV care cascade remains tied to the HIV continuum of care, with disengagement from care remaining an important rate-limiting step impeding micro-elimination.

Disclosures

All Authors: No reported disclosures
103. An Association Between Abnormal CSF Analysis and Inpatient Mortality in Cryptococcal Meningitis, a Tertiary Care Center Experience
Authors: Resnick Jordan , Chishti Emad A , Bhatt Mahesh , Myint Thein
Published: December 2021

Background

Cryptococcal meningitis (CM) is a life-threatening condition that requires prompt recognition and management. With high morbidity in mind, we elected to compare the key CSF analysis, blood culture and serum cryptococcal antigen (CrAg) to prognosticate the probability of mortality in this population.

Table 1. Comparison of demographics, serum and CSF analysis

Methods

We retrospectively reviewed all charts of patients admitted to our tertiary care center from 10/2005 to 10/2017. Inclusion criteria encompassed patients with positive CSF CrAg, positive CSF cultures, India ink, cytopathology, or CSF cell count >5 with CNS symptoms, positive serum CrAg titer or blood cultures.

Results

Sixty patients who met the inclusion criteria were divided into the survivor (n=41) and the non-survivor (n=19) groups based on the inpatient mortality. There was no difference in age, sex, and immune status between the two groups. The median CSF nucleated cell counts in the non-survivor group was 39 cells/µL with median lymphocyte 59.5% whereas in the survivor group was 72 cells/µL with median lymphocyte 76% (P< 0.001 and 0.04 respectively). The median CSF glucose was 27 mg/ml in the non-survivor compared to 35 mg/ml in the survivor group (P=0.02). Median CSF CrAg was higher at 1:1024 in the non-survivor group whereas the survivor group was 1:256 (P < 0.01). CSF opening pressure (cm H2O), blood culture, and serum CrAg level were not statistically significant between the two groups.

Conclusion

Low CSF cell count, low glucose, and high CSF CrAg were independently associated with inpatient mortality in CM. This is in line with the prior findings. A novel finding in this study is significantly decreased median CSF lymphocyte % in the non-survivor group. Serum CrAg titer, positive blood cultures, and median CSF protein were not statistically significant between the two groups. However, a study with a larger sample size may be needed to confirm these findings.

Disclosures

All Authors: No reported disclosures
835. Improvement in Diet Attenuates Antiretroviral Therapy (ART) Associated Weight Gain in Persons with Human Immunodeficiency Virus (PWH)
Authors: Patel Yesha , Doshi Anjali , Levesque Anna , Lindor Shelsie , Moranville Robert , Okere Sheila , Robinson Danielle , Taylor Lauren , Lustberg Mark , Malvestutto Carlos
Published: December 2021

Background

Weight gain among PWH on ART is a growing clinical concern. We explore factors associated with weight gain at The Ohio State University Wexner Medical Center Infectious Diseases Clinic.

Methods

This was a single-center, retrospective, cohort study of adult PWH on ART for at least 3 months seen at our clinic from 1/1/2015 to 1/1/2019. Patients with CD4+ T cell count < 200 cells/mm3, viral load >200 copies/mL, history of malignancy, or pregnancy were excluded. 870 patients met criteria. Patient demographics, lifestyle factors, medical co-morbidities, concurrent medications, and ART regimens were documented during the study period. The primary outcome was percent weight change over the follow up period. Secondary outcome was the odds of > 5kg weight gain over the study period. The effects of concurrent medications, medical comorbidities, ART combinations, and self-reported lifestyle behaviors on these outcomes were modeled using mixed effect linear and logistic regression analysis.

Results

At baseline, 83.6% were male, 29.2% were African American, and 65.6% had a body mass index ≥ 25 kg/m. Over a mean follow up of 1.86 years, the study population gained a mean percent weight of 2.12 ± 0.21% (p< 0.001) with an odds of weight gain >5kg of 0.293 (p< 0.001). Male sex and increasing age were significantly associated with a decrease in percent weight over the study period as reflected in the table below. Diet was also significantly associated with a decrease in percent weight change over the study period of -1.99 ± 0.47 %, p= < 0.001 and a lower odds of > 5kg of weight gain (OR= 0.70, 95% CI= 0.50 – 0.97, p=0.03). In regression models, combination therapy with tenofovir alafenamide (TAF) and integrase strand transfer inhibitor (INSTI) containing regimens were significantly associated with an increase in percent weight over the study period. Other significant factors including demographics and ART regimens are noted in Table 1.

Table 1. Multivariable Regression Models*

Conclusion

Weight gain in PWH is multifactorial. Key factors associated with weight gain include combination therapy with TAF, particularly when combined with an INSTI. This data highlights the influential role of diet in PWH at risk of ART-associated weight gain.

Disclosures

Carlos Malvestutto, M.D., Lilly (Scientific Research Study Investigator)Regeneron Inc. (Scientific Research Study Investigator)ViiV Healthcare (Advisor or Review Panel member)