bluuebunny/crossref_metadata_2025_split huggingface dataset:
2479. Trends and Regional Differences in Extended Spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, 2012–2017
Authors: Wolford Hannah , Hatfield Kelly M , Olubajo Babatunde , Reddy Sujan , Jernigan John A , Baggs James 
Published: October 2019

Abstract

Background
Extended spectrum β-lactamase-producing Enterobacteriaceae (ESBLs) have been identified as a serious antibiotic-resistant threat. Studies have shown that ESBL infection rates were increasing through 2014. Our objective was to examine more recent ESBL trends and to evaluate differences across regions in the United States.

Methods
We measured the incidence of positive clinical cultures from inpatient encounters in a cohort of hospitals submitting data to the Premier Healthcare Database and Cerner Health Facts from 2012 through 2017. We included Escherichia coli and Klebsiella spp. cultures and defined ESBL as non-susceptibility to cefotaxime, ceftriaxone, ceftazidime, or cefepime. Cultures collected on days 1, 2, or 3 of hospitalization were considered community-onset (CO); cultures from day 4 or later were considered hospital onset (HO). We developed weights using a raking procedure to match the American Hospital Association distribution for acute care hospitals based on US census division, bed size category, teaching status, and urban/rural designation. We used weighted multivariable logistic regression adjusting for hospital characteristics to examine trends and regional differences in ESBL rates.

Results
In 2017, the estimated rate of ESBLs was 40.3 per 10,000 discharges for CO and 6.4 per 10,000 discharges for HO; 86% of all ESBLs were CO. The percent that were ESBLs among all included cultures increased for CO (8.2% in 2012 to 11.6% in 2017) and HO (13.1 to 16.8%) cultures. From 2012 – 2017, adjusted ESBL rates increased for CO (7.9% annually, P < 0.0001), while HO rates did not change significantly over time (P = 0.39, Figure 1). We found significant regional differences in the rates of ESBL (P < 0.0001) across US census divisions in 2017 (Figure 2). Estimated rates for 2017 varied 5-fold from 15.3 ESBLs per 10,000 discharges in the Northwest Central to 82.4 ESBLs in the Mid-Atlantic.

Conclusion
We estimated a 40% increase in the rate of CO-ESBLs among hospitalized patients from 2012 to 2017, but no increase in HO rates. ESBL rates varied greatly by region of the country and are estimated as much as 5× higher in some areas. A better understanding of factors contributing to community transmission and regional variation is necessary in order to inform ESBL prevention efforts.

Disclosures
All authors: No reported disclosures.
2494. Real-World Use of Ibalizumab in Physician Office Infusion Centers (POICs)
Authors: Prokesch Richard C , Schroeder Claudia P , Hardin Thomas C , Van Anglen Lucinda J 
Published: October 2019

Abstract

Background
Ibalizumab-uiyk (IBA) was recently approved for the treatment of multi-drug-resistant HIV-1 infection in patients (pts) failing other antiretroviral regimens. Clinical trial data demonstrated a decrease in HIV-1 viral load in 83% and 43% of patients (n = 40) receiving IBA for 2 and 25 weeks (weeks), respectively. Real-world post marketing data are needed. This pilot study reports the experience of IBA utilization in POICs.

Methods
Medical records of patients receiving intravenous IBA from approval through April 2019 were reviewed. Data collected include demographics, infection and treatment history, IBA regimen and adverse events. Plasma HIV-1 RNA viral load (log10 copies/mL) and CD4 count (cells/µL) were collected at baseline and as available during therapy. Based on available follow-up (FU) labs, response was assessed at 4–10 weeks (FU 1), 14–22 weeks (FU 2), and 24–37 weeks (FU 3).

Results
Nine patients (mean age: 48 ± 11 years, 67% male) from 7 POICs received IBA for a median duration of 33 weeks (range 4–43). Median length of HIV-1 diagnosis was 22 years (range 8–25). Resistance to ≥1 drug in at least 3 drug classes was reported in 56%. All patients received at least one concurrent anti-retroviral agent. IBA was initiated at 2000 mg followed by 800 mg every 2 weeks. All patients received infusions as scheduled (151 total infusions) except for one requiring a second loading dose. Baseline mean CD4 count and viral load were 49 cells/µL and 4.9 log10 copies/mL, respectively. Labs obtained at FU 1 indicated a decrease in viral load of at least 0.5 log10 copies/mL in 6/8 patients (75%); a mean reduction of 2.1 ± 1.8 log10 copies/mL (Table 1). Mean HIV-1 titers available for patients at FU 2 (n = 6) and FU 3 (n = 7) were 3.1 ± 2.0 and 3.2 ± 2.6 log10 copies/mL, respectively. Mean CD4 counts were 65 ± 57 cells/µL at FU 1, 96 ± 61 cells/µL at FU 2 and 88 ± 82 cells/µL at FU 3. Adverse events were reported in 8 patients (89%), most common itching/rash, diarrhea and abdominal pain. None resulted in discontinuation of IBA.

Conclusion
This study confirms the antiviral activity of IBA in patients with advanced HIV-1 infection in the real-world setting. We observed well-tolerated therapy with an early reduction in HIV-1 viral load of 75%, followed by a 43% reduction ≥24 weeks, consistent with the clinical trial.

Disclosures
All authors: No reported disclosures.
143. Opioid Use and Hospitalizations for Endocarditis, Osteomyelitis, and Central Nervous System Abscess among Adults — New York City, 2001–2014
Authors: Huang Chaorui , Lucero David , Paone Denise , Tuazon Ellenie , Daskalakis Demetre 
Published: October 2019

Abstract

Background
Along with a growing opioid epidemic nationwide, opioid users often have an increased risk of severe infectious diseases including endocarditis, osteomyelitis, and central nervous system (CNS) abscess. As the largest city in the United States, New York City (NYC) may serve as a study model for opioid use and infectious diseases. We investigated the association between opioid use and hospitalizations for endocarditis, osteomyelitis, and CNS abscess in NYC.

Methods
Data for NYC residents aged ≥18 years discharged from New York State hospitals during 2001–2014 were analyzed using a hospital discharge dataset. We defined a hospitalization for endocarditis, osteomyelitis, and CNS abscess as one with a principal or secondary diagnosis for these conditions within the discharge record. We identified opioid users by examining principal or secondary diagnoses for opioid use within the discharge record at the time of hospitalization for endocarditis, osteomyelitis, and CNS abscess. Log-binomial model was applied among all hospitalized patients using endocarditis, osteomyelitis, and CNS abscess as the outcome, adjusting for age, sex, race, and borough.

Results
During 2001–2014, there were 139,392 hospitalizations in total for endocarditis, osteomyelitis, or CNS abscess, of which 8,823 (6.3%) were among opioid users. There was an increased risk of hospitalization for endocarditis [RR: 2.6 (95% CI: 2.5–2.7)], osteomyelitis [RR: 1.1 (95% CI: 1.1–1.1)], and CNS abscesses [RR: 1.9 (95% CI: 1.8–2.1)] among hospitalized opioid users compared with hospitalized nonopioid users, adjusted by age, sex, race, and borough. Hospitalized opioid users had four times the risk for endocarditis hospitalization compared with hospitalized nonopioid users in the 18–44 year age group (RR: 4.2 [95% CI: 3.9–4.5]) (Table 1).

Conclusion
These results provide further evidence that opioid use is associated with an increased risk of endocarditis, osteomyelitis, and CNS abscess. Efforts to combat the opioid epidemic might lower the overall incidence of endocarditis, osteomyelitis, and CNS abscess.

Disclosures
All authors: No reported disclosures.
2513. The Effect of Treatment Supporter Interventions on ART Adherence in Eastern and Southern Africa: a systematic review and meta-analysis
Authors: Haddy Sallah Ya , Nyoni Thabani , Lipsey Kim 
Published: October 2019

Abstract

Background
Access to ART has significantly reduced morbidity and mortality and improved quality of life in people living with HIV (PLWH). Treatment supporter interventions (TSIs) utilize patient or facility selected individuals to increase optimal ART adherence through home visits, peer support and medication management. This aim of this meta-analysis is to evaluate the effectiveness of TSIs in improving optimal ART adherence among PLWH in SSA using process- and outcome-oriented measures.

Methods
We searched PubMed, EMBASE, SCOPUS, Web of Science (WOS), Cochrane Library, and ClinicalTrials.gov for randomized controlled trials or cohort studies comparing treatment supporter interventions to the standard of care conducted in Eastern and Southern Africa. The primary outcomes were ART adherence measured by pill counts and virologic suppression. Pooled risk ratios with 95% confidence intervals were calculated using random-effects models. Stratified analyses and meta-regression were conducted to determine the effect of study type and patient nomination of treatment supporters on ART adherence.

Results
Sixteen studies, 10 RCTs and 6 cohort studies, were selected for inclusion. Virologic suppression was reported in 14 studies with 12,457 individuals in TSIs and 23,592 receiving the standard of care. Optimal ART adherence was reported in 7 RCTs only (2,185 individuals in TSI and 1,545 receiving SOC). Optimal ART adherence was 7.6% higher in TSIs compared with SOC (pooled RR 1.076, 95% CI 1.005–1.151, p = 0.035). Heterogeneity of these studies was high (I2 = 91.1%). Virologic suppression was 5% higher in TSIs compared with the standard of care (pooled RR 1.05, 95% CI 1.019–1.081, P = 0.001). Meta-regression demonstrated that virologic suppression did not significantly vary by study type (b = −0.042, 95% CI −0.09–0.001, P = 0.057) and patient selection of the treatment supporter (b = 0.026, 95% CI −0.07–0.12, P = 0.554).

Conclusion
Optimal ART adherence is marginally higher in treatment supporter interventions compared with the standard of care. Patient-nominated supporters achieve similar rates of virologic suppression to facility-selected supporters, and could play a critical role in addressing disparities in health outcomes among PLWH.

Disclosures
All authors: No reported disclosures.
2530. TACO Tuesday as a Medical Education Tool
Authors: McCauley Melanie , Benson Constance , Wooten Darcy 
Published: October 2019

Abstract

Background
Novel strategies in medical education including the flipped classroom, test-enhanced learning, and gaming have proven to be effective for preclinical learners but little is known about their efficacy in post-graduate education. We implemented an educational tool in our Infectious Diseases (ID) Fellowship Training program called TACO (To Assess Cognitive Operations) Tuesday that utilizes aspects of the flipped classroom, test-enhanced learning, and gaming to improve ID fellow engagement, satisfaction, knowledge retention, and board examination preparation in association with a weekly ID core didactic curriculum.

Methods
One to three multiple choice clinical vignettes were emailed to ID fellows the day prior to their weekly didactic lecture. The first fellow to answer all questions correctly was the winner for the week. The correct answer choices along with detailed rationales were distributed to all fellows at the end of the week. After one year of using this educational tool, we surveyed fellows to evaluate its impact on their engagement with the weekly didactic sessions, self-perception of content retention, and sense of preparation for the ID board examination.

Results
We had a response rate of 82% with 9 of 11 fellows polled participating. Of those, two-thirds attempted to answer the multiple-choice questions prior to lecture and most (77%) reviewed the correct answer choices and rationales weekly. All participants felt the educational tool helped improve their engagement with the lectures and half felt it increased overall satisfaction with their educational experience. The majority felt the tool increased content retention and their level of preparation for the ID board examination. Implementation of this tool was associated with a higher mean IDSA in-training examination score compared with scores from the previous year (518 vs 469).

Conclusion
ID fellows found that an educational tool utilizing a flipped classroom, test-enhanced learning, and gaming in association with a weekly core didactic curriculum increased their engagement, satisfaction, knowledge retention, and board examination preparation. Future studies will investigate the impact of this tool on knowledge retention and ID board examination scores within our institution as well as across institutions.

Disclosures
All authors: No reported disclosures.
2553. Addressing Knowledge and Practice Gaps in HIV Management with Engaging Continuing Education
Authors: Robinson Katie , Frederick Jennifer , A. Esgro Robert , Heeg Marlene , Kays Michael B , Elion Richard 
Published: October 2019

Abstract

Background
Given the rapid evolution of HIV management guidelines and the emergence of new treatment paradigms, infectious disease specialists are challenged to stay current on the latest evidence-based care and how to tailor treatment to optimally meet an individual patient’s needs. To address identified knowledge and practice gaps regarding the care of patients with HIV, an engaging continuing education (CE) initiative was implemented, and the impact of the education on provider knowledge and practice was measured.

Methods
Vindico Medical Education partnered with Purdue University College of Pharmacy to deliver a highly engaging, 2.0-credit hour, CE initiative at ID week in October 2018. The symposium was comprised of multiple formats, including didactic presentations, case-based discussion, and the gamified segment, Wheel of HIV Knowledge. Coverage of the live program was posted to Healio.com, extending the reach of the education. Analysis of the impact of this education was achieved via pre- and post-test test assessment.

Results
357 healthcare providers participated in the live session, and 236 have accessed the web activity as of April 2019. The gamified and case-based segments of the live activity engaged on average 70% of learners and revealed insights into current practice patterns and persisting gaps in knowledge regarding the latest, evidence-based HIV care. Across the curriculum, there was a 46% relative increase in knowledge and competence. A total of 223 providers who see on average 15 patients per month with HIV completed the education, resulting in approximately 2,500 patients with HIV per month who are more likely to receive the latest evidence-based care. Moreover, 3 months following the education, 55% of providers reported implementing practice improvements, including applying the latest clinical guidelines and recommendations. Of those providers who implemented changes, 47% observed patient improvements such as improved adherence, satisfaction, and reduced viral loads.

Conclusion
In recent years of rapid advances for HIV management, providers are challenged to administer the latest evidence-based care. This study highlights the power of engaging CE to address persisting knowledge and practice gaps toward the delivery of enhanced care for patients with HIV.

Disclosures
All authors: No reported disclosures.
2554. A Standardized Medicine Resident Curriculum: Content Survey for an Infectious Diseases Rotation
Authors: Enriquez Matthew , Lio Jonathan , Pitrak David , Sherer Renslow 
Published: October 2019

Abstract

Background
There have been few studies performed or guidelines made to address which topics in Infectious Diseases (ID) should be essential for medicine residents to learn during their training for their future practice of clinical medicine. Furthermore, when residents rotate on ID specialty electives, rarely is there formalized, standardized instruction tailored to residents. Thus, the purpose of this project is to define which core topics in ID residents should focus on learning during their training as pertains to clinical practice rather than for simply passing Internal Medicine (IM) board exams, which many programs tend to instead use as a guide for teaching ID content.

Methods
An online survey was designed and distributed to the faculty of the University of Chicago Medicine (UChicago) IM and ID sections. The survey was 8 questions, one of which was to rank 28 topics in ID on a modified 5-point Likert scale (1 = “absolutely unimportant;” 5 = “absolutely essential”) with regards to importance for a resident to practice general medicine. A cutoff for inclusion was ≥ 4.0 (moderate importance) and ≥ 25% of the faculty ranking the topic as absolutely essential. Open-ended feedback was encouraged and evaluated via a semi-structured evaluation.

Results
The survey was distributed to the 88 attendings in the UChicago ID and general IM sections. The response rates were 85% (ID) and 44% (IM). Ten of the 28 topics were ranked ≥ 4.0 (moderate importance) and had ≥ 25% of the faculty designate the topic as absolutely essential (Figure 1). Open-ended feedback included to focus on value-based care, to include Infection Control, and to focus on areas not taught in other aspects of their residency curriculum such as in their outpatient rotations. A majority (61%) indicated that 2–5 hours of structured teaching (lectures, online modules, etc.) would be most appropriate during a 2-week ID specialty rotation.

Conclusion
This project defined the core topics in ID that medicine residents should focus on learning during their training. The next step will be a needs-assessment to survey baseline resident knowledge of the above topics. The ultimate the goal will be to design, deliver, and evaluate an ID curriculum that focuses on teaching this core content.

Disclosures
All authors: No reported disclosures.
2562. Implementation of Current Event Assignments to Engage Students and Enhance Public Health and Infectious Diseases Awareness in a Doctor of Pharmacy Program
Authors: Ernst Erika 
Published: October 2019

Abstract

Background
The Accreditation Council for Pharmacy Education standards for Doctor of Pharmacy (PharmD) programs include a required Public Health element. An ID-related current event assignment series was introduced into the PharmD ID Integrated Pharmacotherapy course in 2018.

Methods
Students were required to submit one ID-related current event weekly for 3 weeks and one reflection. A written summary and opinion about the article was submitted using the on-line course system. Instructions suggested they consider the public health implications of the article and how the article may impact practice (significance). They were asked to include any errors in reporting and could also include how they might respond to questions from patients or practitioners about the topic. For the reflection, students were asked to consider whether the assignments impacted their view of ID, public health and reporting to the public. In addition, they were asked if the assignments influenced how they stay informed for their patients. Suggestions for improvement and comments regarding whether the assignment should be retained for future classes were solicited. Student responses for each of 2 years were evaluated and summarized into themes.

Results
Overwhelmingly, students felt the current events were beneficial to their appreciation of ID-related topics and public health awareness. Students noted the open-ended nature of the assignment encouraged their own curiosity. Many said their first impression was that it would be difficult to find an article, and were surprised how easily they found articles and spent additional time researching topics of interest. Student stated the requirement to add an opinion enhanced their effort in finding, reading, researching and writing about the topic. Students suggested more time for sharing and discussing articles with the class. Most stated the assignments should be continued for future classes.

Conclusion
The addition of an open-ended, ID-related current event assignment provided PharmD students with exposure to public health-related issues. These assignments were positively received by students and served as a simple means to engage the students in self-directed learning of ID-related topics. It also enlightened students toward global public health issues and encouraged many to stay informed.

Disclosures
All authors: No reported disclosures.
2566. infection Dynamics of Pseudomonas aeruginosa Bloodstream Infections
Authors: Bachta Kelly E R , Allen Jonathan P , Hauser Alan R 
Published: October 2019

Abstract

Background
Pseudomonas aeruginosa (PA) is a critically important healthcare-associated pathogen responsible for a variety of infections including bloodstream infection (bacteremia), pneumonia, and urinary tract infection. PA bacteremia is a significant cause of morbidity and mortality, especially in immunocompromised patients; However, little is known about the in-host infection dynamics of PA bacteremia and the impact of individually infected patients on transmission in the healthcare environment.

Methods
We utilized animal modeling in conjunction with sequencing technology to dissect the infection dynamics of PA bloodstream infections. BALB/c mice were challenged intravenously with a human bacteremia isolate, PABL012. At various time points post infection, organs were harvested and the surviving PA enumerated. In parallel, PABL012 engineered to express the luciferase cassette was used to track PA in live mice over time using the IVIS imaging system. STAMP (sequence tag-based analysis of microbial populations) analysis was then applied to define the population dynamics of PA bloodstream infection.

Results
Bacterial enumeration and IVIS imaging revealed that systemically infected mice have a focus of bacterial expansion in their gallbladders (GB). Surprisingly, the same mice also shed PA in their gastrointestinal tract (GI), a phenomenon not previously appreciated following bloodstream infection. Finally, STAMP analysis revealed that (1) PA experiences a severe in vivo bottleneck when trafficking to the GB, (2) the population in the GB expands tremendously during infection and (3) this population is ultimately the source of excreted bacteria in the GI tract.

Conclusion
Our research, using murine models, provides the first evidence that the GB acts as a sanctuary site for PA replication following systemic infection and links replication with fecal excretion. Fecal excretion of PA from hospitalized patients is observed, but the direct link between acute infection, GI shedding, and transmission remains unclear. Our observations have significant implications on understanding how PA evades initial host clearance, the identity of protected expansion niches, and how PA might exit the human host in the healthcare environment facilitating a transmission event.

Disclosures
All authors: No reported disclosures.