bluuebunny/crossref_metadata_2025_split huggingface dataset:
610. Incidence of Acute Kidney Injury in Outpatient Parenteral Antimicrobial Therapy (OPAT) Patients Receiving Vancomycin
Authors: Hamad Yasir , Nickel Katelin B , Burnett Yvonne , Olsen Margaret A 
Published: January 2021

Abstract

Background
Vancomycin therapy is known to be associated with nephrotoxicity. Predictors of nephrotoxicity in outpatients are not well defined and have only been reported in relatively small studies. We examined the factors associated with incidence of nephrotoxicity during outpatient parenteral antimicrobial therapy (OPAT) using administrative data.

Methods
A large insurance claims database of privately insured patients (IBM-MarketScan) ages 18 - 64 from 2010 to 2016 was queried for patients discharged from the hospital on vancomycin OPAT. The primary endpoint was 42-day hospital readmission with acute kidney injury (AKI). A Chi-square test was used to examine associations with AKI. Factors with significant associations in univariate analysis were then incorporated into a multivariable logistic regression model.

Results
A total of 14,196 patients were included in the study, median age was 54 years and 53.8% were male. Hospital readmission with AKI occurred in 385 (2.7 %). Factors associated with AKI in univariate analysis included older age, living in a rural area, heart failure (CHF), chronic kidney disease (CKD), liver disease, diabetes, cancer, septicemia, MRSA infection, concomitant penicillin therapy, receiving therapy at home versus an infusion center, and infectious diseases consult during index hospitalization. In the multivariable model, septicemia, CHF, CKD, liver disease, and concomitant use of a penicillin family drug were independently associated with increased risk of acute kidney injury (Table).

Conclusion
Septicemia, use of penicillins and some comorbidities were associated with AKI in patients treated with vancomycin OPAT. Patients at high risk for vancomycin nephrotoxicity should be monitored closely and an alternative therapy should be considered.
Table

Disclosures
Margaret A. Olsen, PhD, MPH, Merck (Grant/Research Support)Pfizer (Consultant, Grant/Research Support)
611. Infectious Disease Management of Homeless and Non-Homeless Populations in United States Emergency Departments
Authors: Barnes Jessica , Segars Larry , Wasserman Jason , Karabon Patrick , Taylor Tracey A 
Published: January 2021

Abstract

Background
Studies have long documented the increased emergency department usage in the United States by homeless persons compared to their housed counterparts, as well as an increased overall prevalence of infectious diseases. However, there is a gap in knowledge on the treatment that homeless persons receive for these infectious diseases within United States emergency departments compared to their housed counterparts. This study seeks to understand this potential difference in treatment, including diagnostic services tested, procedures performed, and medications prescribed.

Methods
This study utilized a retrospective, cohort study design to analyze data from the 2007-2010 National Hospital Ambulatory Medical Care Survey (NHAMCS) database. Complex sample logistic regression analysis was used to compare variables, including diagnostic services, procedures, and medication classes prescribed between homeless and private residence individuals seeking emergency department treatment for infectious diseases. This provided an odds ratio to compare the two populations, which was then adjusted for confounding variables.

Results
Compared to private residence individuals, homeless persons were more likely (OR: 10.99, p&lt; 0.05, CI: 1.08-111.40) to receive sutures or staples when presenting with an infectious disease in United States emergency departments. Compared to private residence persons, homeless individuals were less likely (OR: 0.29, p&lt; 0.05, CI: 0.10-0.87) to be provided medications or immunizations when presenting with an infectious disease in United States emergency departments, and significant differences were detected in prescribing habits of multiple medication classes.

Conclusion
This study detected a significant difference in suturing/stapling and medication prescribing patterns for homeless persons with an infectious disease in United States emergency departments, compared to their housed counterparts. These results provide a platform for continual research.

Disclosures
All Authors: No reported disclosures
613. Lessons learned from a Rhode Island academic out-patient Lyme and tick-borne disease clinic
Authors: McCarthy Meghan L , Reece Rebecca , Vargas Sara E , Johnson Jennie , Adelson-Mitty Jennifer , Flanigan Timothy P 
Published: January 2021

Abstract

Background
Although the prevalence of tick-borne diseases (TBD) continues to increase, there remains significant confusion regarding treatment for Lyme and other TBDs. We conducted a chart review of all new patients that came to an academic center for Lyme and TBDs. We then initiated a quality improvement project for feedback from a small subset of patients with Post-treatment Lyme disease syndrome (PTLDS).

Methods
Charts of patients visiting the clinic between March and November 2018 were reviewed. Data abstracted from the electronic health record included demographics, laboratory and clinical data. A small subset of patients who reported a history of Lyme and at least 6 months of symptoms after antibiotic treatment were enrolled in a phone survey to evaluate their experience with treatment for PTLDS.

Results
Symptoms most commonly seen in 218 new patients included fatigue (66.5%), joint pain (58.2%), cognitive difficulty (32.1%), headache (27.9%) and sleep disturbance (27.5%). 87% had already received tick-borne disease directed antibiotic treatment. Over half (60.5%) of patients report having symptoms for more than 6 months. More than half of patients (54.8%) who had more than 6 months of Lyme-related symptoms had positive serological testing. Common themes identified in the 16 phone surveys of patients with PTLDS conducted so far included significant frustration related to the dismissive attitudes from medical professionals (n=9/16), and many sought alternative or complementary therapies (n=11/16). Six patients reported receiving very long-term antibiotic regimens from other Lyme specialists. Many patients expressed satisfaction with the visit and medical advice even in the absence of curative therapy (n=9/16), although a significant number continued to seek care elsewhere (n=6/16).

Conclusion
More than half of new patients reported symptoms lasting more than 6 months after targeted antibiotic therapy. Further research is needed to develop interventions for the common symptoms of fatigue, joint pain, cognitive difficulty and sleep disturbance. Treatments to improve sleep, diet, and physical activity and decrease inflammation among patients who suffer from PTLDS are needed.

Disclosures
All Authors: No reported disclosures
615. Overlooking those at Intermediate Risk? ASCVD Prevention Measures among People Living with HIV at an Urban Academic Medical Center
Authors: Liotta Mark , Cangialosi Peter , Ho Jeanne , Finkel Diana , Swaminathan Shobha , Keller Steven 
Published: January 2021

Abstract

Background
The American College of Cardiology (ACC) recognizes HIV as a risk factor for atherosclerotic cardiovascular disease (ASCVD). However, 2019 guidelines do not address people living with HIV (PLWH), aside from stating that their Risk Estimator Plus tool, which is used to calculate a 10-year risk for ASCVD and advise management, likely underestimates CVD risk in PLWH. This quality assessment project examines rates of ACC guideline adherence for ASCVD prevention for PLWH who have calculated risk scores in the low (&lt; 7.5%), intermediate (&gt; 7.5% & &lt; 20%), and high-risk (&gt; 20%) ranges. Patients analyzed are from an HIV registry of University Hospital Infectious Disease Outpatient clinic in Newark, NJ. The clinic’s 2451 total patients are 40% female, 63% non-Hispanic black, 23% Hispanic, and 64% &gt; 45 years old.

Methods
This project was approved by the Rutgers IRB. Patients (40-79 years) with a clinic visit from 2/1/2019 to 1/31/2020 were reviewed. ASCVD risk scores were calculated using the Risk Estimator Plus for all patients when data was available. Guideline adherence rate was defined as following 2019 ACC guidelines for appropriate statin therapy, while considering medication interactions.

Results
Of the 1127 patients who met criteria, 744 ASCVD risk scores were calculated. Lipid values outside the calculator range (229) or no documented lipids (154) resulted in non-calculatable scores. Guideline adherence rate for the intermediate-risk group was significantly less than the high-risk and low-risk groups (P&lt; 0.05): low-risk 92.8% (95% CI 90.0-95.1, n=346), intermediate-risk 35.2% (95% CI 29.7-41.1, n=270), and high-risk 52.3% (95% CI 43.8-60.8, n=128). Adherence rates within the intermediate-risk group for patients with hypertension (HTN) and smokers were significantly less than those with CVD (P&lt; 0.05).
Table 1: Patients with Calculated ASCVD Risk Score &gt; 20 for PLWH from 2/1/2019 – 1/31/2020

Table 2: Patients with Calculated ASCVD Risk Score &gt; 7.5 & &lt; 20 for PLWH from 2/1/2019 – 1/31/2020

Table 3: Patients with Calculated ASCVD Risk Score &lt; 7.5 for PLWH from 2/1/2019 – 1/31/2020

Conclusion
Lower overall guideline adherence rates within the intermediate risk group, and particularly among those with a history of HTN and smoking, highlights the need for targeted care. Provider education on the calculation and application of ASCVD risk scores, as well as increased awareness of the risk-enhancing nature of HIV infection in coexistence with the traditional risk factors of CVD history, diabetes, HTN, and smoking are important steps to increase adherence rates.

Disclosures
All Authors: No reported disclosures
618. Post-discharge Care Coordination Telephone Call for Patients Enrolled in the UNC OPAT Program
Authors: Boerneke Renae A , Swartwood Michael J , Kinlaw Alan C , Holt Anita , Mavrogiorgos Nikolaos , Marx Ashley , Ciccone Emily J , Schranz Asher J , Bowman Mary C , Farel Claire E 
Published: January 2021

Abstract

Background
At hospital discharge, patients enter a transition period that carries risks for their health and access to care, particularly those receiving home infusion. In April 2019, to enhance care coordination at discharge, our OPAT program implemented a structured telephone outreach program.

Methods
Starting in April 2019, the UNC OPAT program rolled out a patient outreach intervention. Within approximately 3 days after discharge, a pharmacist or nurse coordinator called the patient or caregiver to discuss UNC’s OPAT program, review all medications and potential adverse effects, discuss home infusion and line care, schedule relevant follow-up appointments and transportation, and address patient/caregiver concerns. To evaluate dissemination and impact, we analyzed data from UNC OPAT patients from April 2019-May 2020. We abstracted EHR data for unplanned readmissions and adverse events (hepatotoxicity, nephrotoxicity, neutropenia, eosinophilia, thrombocytopenia, creatine kinase elevation, rash, Clostridioides difficile infection, line complications). We estimated risk differences (RD) to compare outcomes between contacted versus uncontacted patients. To provide context, we also assessed unplanned readmissions and adverse events in a historical control period from April 2018-March 2019, before implementation of the outreach program.

Results
After rollout of the outreach program, 374 patients completed their OPAT course and all were targeted for outreach. The success rate of contacting patients was 61%. Median age was similar between contacted and uncontacted patients (52 versus 55). Unplanned readmissions occurred less frequently for contacted patients (14% versus 21%; RD -7%; 95%CI -15%, 1%). Risk of adverse events was similar between contact groups (58% versus 54%; RD 4%; 95%CI -6%, 15%). In the historical control period (n=287, median age 56), unplanned readmission risk was 22% and adverse event risk was 63%.

Conclusion
Patients who completed the outreach phone call had lower risk of readmission compared to those who could not be reached. This intervention may be a simple, low-cost way to reduce readmissions for OPAT patients, but further study and a sustainable reimbursement structure are needed.

Disclosures
All Authors: No reported disclosures
625. Sustained Efforts Improve Adherence to Monitoring for Solid Tumor Patients Discharged on Outpatient Parenteral Antimicrobial Therapy (OPAT) at a Comprehensive Cancer Center
Authors: Robins Alison , McDaneld Patrick , Garnes Natalie J Dailey , Rowan Meagan , Bartek Jalen 
Published: January 2021

Abstract

Background
OPAT helps reduce hospital length of stay, but 1 in 4 patients is readmitted within 30 days of discharge. Follow up &lt; 30 days after discharge and laboratory monitoring during therapy have been shown to reduce hospital readmissions. However, few OPAT studies have included patients with malignancies, who may not experience the same benefits due to increased risks for hospital admission and infection related to antineoplastic therapy. We started an OPAT program to increase laboratory monitoring and clinic follow up among patients with solid tumors, attempting to also decrease readmissions.

Methods
We obtained demographic data and baseline frequencies of laboratory monitoring, ID clinic follow up, 30-day OPAT-related readmissions, Emergency Center (EC) visits, and deaths by retrospective chart review. We conducted multiple interventions from June 2018-January 2020: clarifying physician recommendations for laboratory monitoring and follow up by using a standardized electronic medical record template, communicating recommendations to case management, and changing the lab ordering workflow. We compared frequencies after interventions to baseline by using Fisher’s exact test.

Results
Most commonly observed malignancies in our patient cohort included genitourinary, breast, gastrointestinal, gynecologic, and head and neck. The most commonly treated infections included abscess, bacteremia, and skin and soft tissue. The percentage of patients without recommended lab monitoring decreased from 32.3% to 15.3% (p=0.03). We observed trends toward improved ID clinic follow up (54.8% to 71.8%; p=0.12) and decreased 30-day OPAT-related readmissions from 16.7% to 8.6% (p = 0.17). We observed no difference in mortality or EC visits.

Conclusion
OPAT-treated infections in our solid tumor patient cohort differed from those reported commonly. Through continued interventions, we improved lab monitoring rates among solid tumor patients with trends toward improved ID clinic follow up and decreased readmission rates. Our findings suggest that despite competing reasons for hospital readmission, OPAT may still benefit this population.

Disclosures
All Authors: No reported disclosures
626. Tackling the HIV Epidemic in South Florida: Patient Insights on Approaches for HIV Counseling, Testing, and Access to Prevention or Treatment
Authors: Fallon Stephen J , Molnar Kimberly , Taneva Ekaterina S , Simone Laura , Carter Jeffrey , Sapir Tamar 
Published: January 2021

Abstract

Background
The South Florida Metropolitan Statistical Area has for several years recorded the highest HIV incidence in the nation, and prevalence in the top three of all counties. To address the alarming disparity in HIV impact, we developed a survey study to learn about the beliefs, attitudes, and perspectives of persons who accessed services at an HIV community-based organization in South Florida.

Methods
Surveys were administered in English and Spanish to 109 persons who visited a community-based HIV service provider (Latinos Salud) at any of its three South Florida sites in April 2019. The survey evaluated the participants’ perspectives on different avenues for HIV counseling, screening, and accessing HIV medications for prevention or treatment.

Results
The majority of survey participants were male (90%), homosexual/gay/queer (75%), and Hispanic/Latino (56%; Table 1). Participants’ self-reported their HIV status as negative (64%), positive (30%), or unknown (6%; Table 1). Of those not currently living with HIV, 77% reported having been tested within the past 6 months, and 81% reported recent engagement in high-risk activities (Table 1).
Most participants considered using social media to promote awareness of HIV and related services a good idea (Table 2). Large proportions of participants endorsed receiving HIV counseling through in-person conversations with clinicians (91%), staff at community-based organizations (83%), friends (83%), telehealth visits (69%), conversations with teachers (63%), or church members (56%; Table 2). Most participants endorsed a range of both clinical (e.g. local health clinic) and non-clinical (e.g. mobile van) locations as acceptable settings for HIV testing (Table 2). Large proportions of participants endorsed receiving medications to prevent or treat HIV immediately after testing (82%), by home delivery (78%), or through telehealth (60%; Table 2). Meaningful associations were found between certain patient demographics (race/ethnicity, testing history, or insurance status) and the participants’ perspectives on specific strategies (Table 3).
Table 1. Participant Characteristics

Table 2. Participants’ Views on Strategies for HIV Counseling, Testing, and Access to Medications

Table 3. Participants’ Views on Strategies for HIV Counseling, Testing, and Access to Medications Stratified by Patient Characteristics

Conclusion
These real-world findings can be used to inform clinic- and community-based interventions tailored to individual patient characteristics.

Disclosures
Tamar Sapir, PhD, Gilead Sciences, Inc. (Other Financial or Material Support, Independent medical education grant)
627. Tele-OPAT Outcomes at Two Community Hospitals
Authors: Sheridan Kathleen R , Abdel-Massih Rima , Gupta Nupur , Mellors John 
Published: January 2021

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) is well-established for the care of patients requiring IV antibiotics after hospital discharge but little is known about the effectiveness of OPAT delivered through telemedicine.1-3 We therefore investigated outcomes from telemedicine OPAT services (Tele-OPAT) at two community hospitals.

Methods
Data was collected from two community hospitals in the UPMC system for which both inpatient and outpatient telemedicine ID services (Tele-ID), including Tele-OPAT services, are provided. Tele-ID services at Site 1 (171 beds) began in January 2014 and at Site 2 (133 beds) in January 2018. All patients had inpatient Tele-ID consults via live audio-video (AV) visits or EHR review. After discharge, patients were managed by a Tele-OPAT team consisting of an ID pharmacist, RN and ID physician. Live AV Tele-OPAT outpatient follow-up visits were conducted with the assistance of a tele-presenter at 2 clinic sites.

Results
A total of 489 unique patients with 536 encounters were evaluated. Site 1 accounted for 284 patients, Site 2 had 252. Demographics are listed in Table 1. 47% of the patients were male with an average age of 65. 51% of the patients were diabetic. Half of the patients were discharged to home. Bacteremia (24.4%) and osteomyelitis (23.3%) were the most frequent diagnoses. Vancomycin was the most commonly used antibiotic (25.6%). Tele-ID Clinic follow up rates varied by year and site between 19 to 26.6% (Figure 1). The choice of follow-up was determined by the primary inpatient physician. 30 Day Readmission Rates were lower for patients that were seen by the Tele-OPAT service (combined rate of 7.4%) vs. no follow up (62%) vs. PCP follow up (22%) vs. follow up with another MD (12.8%) (Figure 2a). Most patients seen by Tele-OPAT were readmitted for reasons not related to their initial infection or their antibiotic course (Figure 2b).
Table 1. Patient Demographics

Figure 1. Clinic Follow Up Rates

Figure 2. Readmission Rates & Reasons for Readmission

Conclusion
Patients discharged on IV antibiotics who were managed via a Tele-OPAT service in an outpatient clinic had lower readmission rates than those who were seen by non-ID physicians or who had no outpatient follow-up. Tele-OPAT is an important option for patients residing in rural areas who are discharged on parenteral antibiotics.

Disclosures
Rima Abdel-Massih, MD, Infectious Disease Connect (Shareholder, Other Financial or Material Support, Chief Medical Officer) John Mellors, MD, Abound Bio (Shareholder)Accelevir Diagnostics (Consultant)Co-Crystal Pharmaceuticals (Shareholder)Gilead (Consultant, Grant/Research Support)Merck (Consultant)
633. Bictegravir/Emtricitabine/Tenofovir Alafenamide (B/F/TAF) Efficacy in Participants with Pre-Existing Primary Integrase Inhibitor Resistance Through 48 Weeks of Phase 3 Clinical Trials
Authors: D’Antoni Michelle L , Andreatta Kristen , Acosta Rima K , Chang Silvia , Martin Ross , White Kirsten L 
Published: January 2021

Abstract

Background
Pre-existing drug resistance can affect the efficacy of antiretroviral therapy. Studies in treatment-naïve and virologically suppressed participants have demonstrated safety and efficacy of B/F/TAF, including in patients with M184V/I mutations. In this pooled analysis, we investigated virologic outcomes after 48 weeks of B/F/TAF treatment in individuals with pre-existing integrase strand transfer inhibitor resistance (INSTI-R).

Methods
Although INSTI-R was prohibited per study entry criteria, pre-existing INSTI-R (T66A/I/K, E92G/Q, F121Y, Y143C/H/R, S147G, Q148H/K/R, N155H/S, R263K) was evaluated in participants from studies 1489, 1490, 1844, 1878, 4030. INSTI-R was assessed by historical genotypes and/or retrospective deepType HIV assay (Seq-IT, Germany), GenoSure IN, GenoSure Archive (Monogram Biosciences). Virologic outcomes were defined by last on-treatment observation carried forward (LOCF) method.

Results
Pre-existing primary INSTI-R substitutions were detected in 20/1907 participants (1.0%) after enrolment. Of the 20, 75% were male, 30% white, and 85% had HIV-1 subtype B, baseline median CD4 counts of 594 (IQR 517, 700), and median age of 52 (43, 59) years. One participant was treatment-naïve with a baseline viral load of 30,000 copies/ml and had Q148H (+ G140S on plasma RNA genotype) and was sensitive to bictegravir (&lt; 2.5-fold change). The other 19 participants were virologically suppressed and had E92G (n=3), Y143C (n=2), Y143H (n=4), S147G (n=2), N155S (n=1), Q148H (n=3), Q148K (n=1), Q148R (n=1), or R263K (n=2) INSTI-R mutations by DNA genotype. The treatment-naïve individual was suppressed by Week 4 and maintained viral loads of &lt; 50 copies/mL through Week 48. All suppressed participants had HIV RNA &lt; 50 copies/mL throughout Week 48. All study participants had virologic success by LOCF (&lt; 50 copies/mL) at Week 48.

Conclusion
Participants with primary INSTI-R substitutions had or maintained virologic suppression through 48 weeks of B/F/TAF treatment. Consistent with the potent in vitro activity of bictegravir against many INSTI-R mutations, these virologic outcomes suggest that B/F/TAF may have potential as a treatment option for some patients with pre-existing INSTI-R, if confirmed by further studies.

Disclosures
Michelle L. D’Antoni, PhD, Gilead Sciences (Employee, Shareholder) Kristen Andreatta, MSc, Gilead Sciences (Employee, Shareholder) Rima K. Acosta, BS, Gilead Sciences, Inc. (Employee, Shareholder) Silvia Chang, Masters, Gilead Sciences (Employee, Shareholder) Ross Martin, PhD, Gilead Sciences (Employee, Shareholder) Kirsten L. White, PhD, Gilead Sciences, Inc. (Employee, Shareholder)