bluuebunny/crossref_metadata_2025_split huggingface dataset:
1656. Factors associated with low TB preventative therapy prescription rates among healthcare workers in rural South Africa
Authors: Ahmed Amiya A , Grammatico Megan A , Malinga Sipho , Makhunga Philile , Moll Anthony , Ladines-Lim Joseph B , Jones Justin , Choi Koeun , Shenoi Sheela 
Published: January 2021

Abstract

Background
Despite South Africa’s initial successful rollout of tuberculosis preventative therapy (TPT) to reduce tuberculosis (TB) incidence among HIV-infected patients, recent data suggest prescription rates have decreased. This study aimed to identify associations with low prescription rates among healthcare workers (HCWs) in rural South Africa.

Methods
A cross-sectional survey was administered Nov-Dec 2019 to HCWs at a 350 bed rural district hospital and 14 primary care clinics (PCCs) in the Msinga sub-district, South Africa to obtain self-reported data on prescription rates as well as knowledge, attitudes, practices, and beliefs regarding isoniazid preventive therapy, the current TPT regimen. HCWs included professional nurses, staff nurses, counselors, and medical officers. Survey questions were consolidated into scores using exploratory factor analysis. Univariate and multivariate associations with low prescription rates, defined as &lt; 50% of eligible patients, were determined for prescribers.

Results
Among 160 participants, the median (+ IQR) age was 39 (+13) years, 76% were women, 78% worked at a PCC, and 35% were prescribers, including professional nurses (82%) and medical officers (19%). The median (+ IQR) years as a HCW and managing patients living with HIV (PLH) among prescribers was 14 (+ 15.5) and 10 (+ 11.5) years, respectively. Compared to prescribers, non-prescribers reported more stigma (71% v. 54%; p=0.04) and placed less priority on prevention compared to treatment (32% v. 58%; p&lt; 0.01). Among prescribers (n=54), univariate analysis identified that patient nondisclosure (OR 4.17 95% CI 1.23-14.14; p=0.02) was associated with low TPT prescription rates. Poor self-reported knowledge also trended towards significance (OR 5.23 95% CI 0.85-32.08; p=0.07). After multivariate analysis, only perceived patient nondisclosure was significantly associated with low prescription TPT rates (aOR 4.17 95% CI 1.23-14.14; p=0.02).

Conclusion
HCWs who believed their patients had not disclosed that they were taking TPT were significantly less likely to prescribe it to their patients. Strengthening HCW training about indications for and mortality benefit of TPT as well as stigma reduction is critical to enhancing TPT implementation.

Disclosures
All Authors: No reported disclosures
1660. Prevalence and Predictors of Anxiety and Depression among Leprosy Patients using the Hospital Anxiety and Depression Scale-Pilipino Score in a Tertiary Hospital
Authors: Clarito Eunice Lovelle R , Valiente Melchy V , Zabat Gelza Mae A 
Published: January 2021

Abstract

Background
This study was prompted by significant reports of anxiety and depression among people with skin disorders in clinical settings and primarily focuses on leprosy patients.

Methods
This is a cross-sectional descriptive study conducted at Dr Jose N. Rodriguez Memorial Hospital located at Tala, Caloocan City, Philippines. All patients admitted at the Custodial ward and seen at the outpatient during the study period will be included using convenience sampling. The prevalence of anxiety and depression was determined by a score of 8 points or higher on the HADS-P. Logistic regression analysis was utilized to determine the relationship between the socio demographic data and clinical variables with anxiety and depression. Odds ratio were calculated and P-value &lt; 0.05 were considered as statistically significant.

Results
Among the 150 Leprosy patients included in the study with a HADS-P score of 8 and above per category showed that 86 (57.33%) of the respondents have anxiety and 37 (24.67%) have depression. Running a logistic model that predicts a person having an anxiety, having hypertension as well as having a minor disability were proven to be significant with p-value 0.02 and 0.09 respectively. An odds ratio of 3.01 denotes that a person with hypertension is twice (2.01) as likely to have anxiety than a person with no comorbidities. Running a logistic model that predicts a person having a depression, educational attainment was shown to be significant at p-value equal to .04. Having a high school degree in particular is significant at .05 alpha. An odds ratio of 3.01 denotes that a person with hypertension is twice (2.01) as likely to have anxiety than a person with no comorbidities.
Table 1. HADS-P Scores of Participants

Table 2. Predictors of Anxiety

Table 3. Predictors of Depression

Conclusion
In this study, the prevalence of anxiety is 57.33% and depression is 24.67%. Factors predictive of depression is lower educational attainment and factors predictive of anxiety is presence of comorbidity specifically Hypertension and minor physical disability. This psychiatric comorbidity will have impact on the overall well being of patients. Therefore, the need for psychiatric evaluation among patients with leprosy cannot be overemphasized, as this will provide a holistic approach in the management of these patients.

Disclosures
All Authors: No reported disclosures
1661. The association of spirometric impairment and history of TB: a population based study in Uganda
Authors: Robertson Nicole M , Porterfield J Zachary , Kayongo Alex , Kirenga Bruce , Kalyesubula Robert , Checkley William , Thornton Alice , Siddharthan Trishul 
Published: January 2021

Abstract

Background
Pulmonary tuberculosis (TB) is the leading infectious cause of death globally with an estimated 1.7 billion people currently infected with Mycobacterium tuberculosis and at risk of developing TB. While the treatment of drug-susceptible pulmonary TB is highly effective, up to 50% of TB survivors have varying degrees of residual pathological and functional conditions potentially leading to chronic sequelae. Post-TB patients have reported respiratory symptoms, reduced quality of life, and increased risk of mortality. The objectives of this study are to describe the prevalence and lung function in individuals with post-TB exposure status in Uganda.

Methods
We performed a secondary data analysis of the Lung Function in Nakaseke and Kampala (LiNK) study, which is a population-based cohort in urban and rural settings in Uganda. Trained fieldworkers randomly selected homes and administered standard questionnaires to adults 35 years or older that were full-time residents of each setting. Prior TB diagnosis and treatment was self-reported by participants.

Results
Among the study population (N = 1559), 50 participants (3.2%) self-reported successfully treated TB. Among this subset of participants 21 (42.0%) were HIV positive, 9 (18.0%) were ever smokers, 6 (12.0%) were current smokers, and no participants had a prior COPD diagnosis. Mean (SD) age and body-mass index (BMI) at enrollment was 48.5 (SD 10.7) years and 22.2 (SD 3.9) kg/m2 respectively. The mean ± SD pre-bronchodilator FEV1/FVC was 72.9% (12.1%) for patients with successfully treated TB and 79.6% (0.08%) (p&lt; 0.0001) for those without prior TB. Within these groups, 30% of patients with successfully treated TB and 9% of patients without prior TB had an FEV1/FVC suggestive of possible COPD.
Comparison of FEV1/FVC

Conclusion
We found a high burden of residual effects of pulmonary TB on lung function and development of COPD, potentially increasing the global burden of COPD. Screening for chronic respiratory diseases following successful TB treatment is needed to improve lung function. Further research is needed to study lung function and quality of life in TB survivors in LMICs, where the burden of pulmonary TB is highest.

Disclosures
All Authors: No reported disclosures
139. Impact of Pharmacist Driven Outpatient Fluoroquinolone Stewardship Initiative in Community Based Setting
Authors: Norman Sarah , Jones Sara , Acklin Cara , Cheatham Christian 
Published: January 2021

Abstract

Background
Antimicrobial stewardship initiatives and efforts have historically had a greater emphasis in the inpatient hospital setting. There is a need for outpatient stewardship, and additionally, accreditation standards are starting to require antimicrobial stewardship efforts in the ambulatory care setting. Fluoroquinolones are a target for antimicrobial stewardship based on their broad-spectrum activity, pharmacokinetics/pharmacodynamics, safety profile, downstream resistance, and risk of super infections. The objective of this study was to compare outpatient fluoroquinolone prescribing rates before and after pharmacist led initiative.

Methods
This was a prospective, quality improvement initiative between October 1, 2019 to June 1, 2020 at a community-based physician network across Indiana. The pharmacist initiative incorporated a live, educational presentation with intervention 1 and an informational letter to healthcare providers across the outpatient physician network with intervention 2. Data was collected from a computer-generated, prescription report. The primary outcome was fluoroquinolone prescribing rates at Central Indiana (CI) sites before and after pharmacist led interventions. Rate of fluoroquinolone prescribing was defined as total number of fluoroquinolone prescriptions per month. The secondary outcome included percentage of fluoroquinolone use at CI sites. Percentage of fluoroquinolone use was defined as monthly number of fluoroquinolones prescriptions compared to monthly number of all oral antibiotic prescriptions.

Results
There was a 29.8% decrease (382 vs 268 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 1 compared to same month of previous year. There was a 43.7% decrease (428 vs 241 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 2. There was an overall 2.4% decrease (4.9% vs 2.5%) in percentage of fluoroquinolone use compared to all oral antibiotics at CI sites after intervention 2 compared to same month of previous year.

Conclusion
These findings suggest the pharmacist led outpatient antimicrobial stewardship initiative successfully decreased fluoroquinolone prescribing rates across the network.

Disclosures
Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)
1664. The Utilization of Hospital Inpatient Care due to Tuberculosis, Republic of Ireland, 2015-2018
Authors: O’Connell James A , de barra Eoghan , McConkey Samuel 
Published: January 2021

Abstract

Background
The Republic of Ireland (ROI) is a low incidence TB country. The last reform of TB services in the ROI in 2003 recommended that most TB management should be delivered on an outpatient basis with 3 hospitals being designated as TB centres. Our aim was to describe the utilization of hospital inpatient care by patients with TB in the Republic of Ireland.

Methods
Hospital coding data were searched to identify TB hospital discharges between 01/01/2015-31/12/18. The projected cost of TB episodes of care was calculated using payment rules for public hospitals in Ireland.

Results
1185 admissions with TB as the principal diagnosis were identified. 801/1185 (68%) episodes of care were emergencies and 384/1185 (32%) were elective We estimate that 65.1% (818/1257) patients with TB notified in the Republic of Ireland from 2015-2018 had an episode of care in a public hospital and (50.8%) 639/818 had an emergency episode of care. We estimate that mean annual cost of TB inpatient care per year in the ROI from 2015-2018 was €2,638,828 - 2,955,047, with emergency episodes of care costing an average of €2,250,926 - 2,557,397 per year.

Conclusion
The burden of TB on hospital inpatient care in the Republic of Ireland is significant.
The national TB policy should change in recognition of this.

Disclosures
All Authors: No reported disclosures
1669. Antimicrobial Resistance Patterns of Uropathogenic Escherichia coli: Comparison of Infection Setting and Community Classification
Authors: Muradyan Adriana , Miller Alexandra S , Ahiawodzi Peter D , Thompson Dorothea K 
Published: January 2021

Abstract

Background
This study describes antibiotic resistance rates for Escherichia coli (E. coli) urinary tract infections (UTIs) and assesses differences in resistance patterns based on setting and community classification.

Methods
A cross-sectional study design was used to analyze antibiotic resistance patterns of E. coli isolates from 12,600 urine cultures processed at a large hospital system in North Carolina from 2016 to 2018. Overall 3-year and annual resistance rates of uropathogenic E. coli to routinely tested first-line antibiotics were determined. Antibiotic resistance rates per 1000 patients were compared based on setting of infection acquisition (hospital vs. community) and community classification (urban vs. rural). T-test and chi-square tests were used to compare extended spectrum beta-lactamases (ESBLs) by demographic factors and setting. Analyses were performed using SAS Version 9.3 (SAS Institute, Cary, NC) at alpha=0.05.

Results
Three-year resistance rates were highest to ampicillin (42.2%), ampicillin-sulbactam (24.7%), ciprofloxacin (21.8%), trimethoprim-sulfamethoxazole (21.6%), and levoflaxacin (21.4%). Resistance was lowest for amikacin (0.06%), meropenem (0.08%), piperacillin-tazobactam (1.3%), nitrofurantoin (1.4%), and tobramycin (1.8%). Overall resistance rates were significantly higher in hospital- compared to community-acquired UTIs (p&lt; 0.05) with the exception of amikacin, gentamicin, and meropenem. Significant differences in E. coli resistance rates were observed for patients from rural compared to urban counties for these antibiotics: levoflaxacin (233.6 vs. 208.3, p=0.003), ciprofloxacin (239.3 vs. 211.8, p=0.002), and nitrofurantoin (19.6 vs. 12.2, p=0.003). Prevalence of ESBL-producing E. coli was significantly higher among the elderly (p&lt; 0.001), males (p&lt; 0.001), inpatients (p&lt; 0.001), and catheterized patients (p&lt; 0.001).

Conclusion
Resistance to first-line fluoroquinolones and nitrofurantoin was more prevalent in patients from rural compared to urban areas. Resistance rates and ESBL prevalence were significantly higher for hospital-acquired UTIs. Our findings have important implications for the empirical treatment of UTIs based on geographical area and setting.

Disclosures
All Authors: No reported disclosures
1670. Clinical Characteristics and Demographics of Patients with Complicated Urinary Tract Infections (cUTI) and Antibiotic Resistance or Treatment Failure: A Retrospective Database Analysis
Authors: Sulham Katherine , Reese Jennifer 
Published: January 2021

Abstract

Background
The incidence of complicated urinary tract infection (cUTI) in the United States estimated to be approximately 1%; however, the majority of published literature focuses on characterizing hospitalized cUTI patients. Limited data exists detailing the clinical characteristics and demographics of cUTI patients more generally; in particular, those experiencing antibiotic resistance and/or treatment failure, many of whom currently lack effective oral treatment options in the outpatient setting, yet may not have severe enough disease to warrant hospitalization. Here, we examine the clinical and demographic characteristics of this patient group.

Methods
A retrospective study was performed in partnership with Komodo Health, Inc., using aggregate data from the Komodo Healthcare Map™ for cUTI-related events. Inclusion criteria: (1) 2+ UTI-related encounters within 35 days, beginning in 2017-2018, (2) clinical/coding features indicative of recurrence, treatment failure or antibiotic resistance, or treatment with carbapenem or piperacillin/tazobactam. Clinical and demographic characteristics were examined.

Results
3,334,497 cUTI patients were identified; 1,889,216 patients with evidence of treatment failure and/or antibiotic resistance were eligible for analysis. 76.7% were female, and 40.2% were &gt;65 years of age. 61.8% of patients had hypertension, 42.5% had hyperlipidemia, and 32.3% had uncomplicated type 2 diabetes. 38.7% had concomitant gastroesophageal reflux disease; 17.0% had mild renal impairment and 29.5% had moderate/severe renal impairment. Most common treatments were nitrofurantoin (21.8%), trimethoprim-sulfamethoxazole (19.2%), and cephalexin (14.4%). Approximately half (48.9%) of patients had an inpatient hospital stay during the study period.

Conclusion
cUTI patients with antibiotic resistance and/or treatment failure are predominantly female and present with a variety of common comorbidities, the most common being hypertension. Approximately half of patients in this cohort were treated successfully in outpatient settings and did not require hospitalization during the study period.

Disclosures
Katherine Sulham, MPH, Spero Therapeutics (Independent Contractor) Jennifer Reese, PharmD, Spero Therapeutics (Employee)
140. Impact of Pharmacist-led Audit & Feedback on Outpatient Antibiotic Prescribing for UTIs and SSTIs
Authors: Choi Patricia , Benzer Jessica , Coon Joel , Egwuatu Nnaemeka , Dumkow Lisa E 
Published: January 2021

Abstract

Background
An estimated 30% of all outpatient antibiotic prescriptions in the U.S. are unnecessary. Effective January 2020, The Joint Commission has implemented new core elements of performance requiring antimicrobial stewardship programs (ASP) to expand to outpatient practice settings. The purpose of this study was to determine whether pharmacist-led audit-and-feedback would improve antibiotic prescribing for urinary tract infections (UTI) and skin and soft tissue infection (SSTI) at two primary care practices.

Methods
This retrospective, quasi-experimental study was conducted evaluating patients treated for UTI and SSTI at two outpatient primary care offices, one Family Medicine and the other Internal Medicine. The primary objective was to compare rates of total appropriateness of antibiotic prescribing before (Pre-ASP) versus after (Post-ASP) implementing a pharmacist-led audit-and-feedback process reviewing antibiotics prescribed for UTIs and SSTIs. Total appropriateness was defined by appropriate antibiotic selection, dose, duration, and therapy indication in accordance with institutional outpatient empiric therapy antimicrobial guidelines. Secondary objectives included comparing patient outcomes, including infection-related re-visits and Clostridioides difficile infections between groups.

Results
A total of 400 patients were included in this study (Pre-ASP n=200, Post-ASP n=200) Total antibiotic appropriateness improved significantly from 27.5% to 50.5% after implementation of the audit-and-feedback process (p&lt; 0.0001). Significant improvement was also seen for individual prescribing components including appropriate drug selection (94% vs. 98%, p=0.041), duration (57.5% vs.83.5%, p&lt; 0.0001), and therapy indication (94% vs. 98%, p=0.041). There were no differences in patient outcomes between groups including adverse drug events, treatment failure, C.difficile infections, and infection-related re-visits or hospitalizations within 30 days.

Conclusion
A pharmacist-led audit-and-feedback outpatient stewardship strategy demonstrated significant improvement in outpatient antibiotic prescribing for UTI and SSTI.

Disclosures
All Authors: No reported disclosures
1672. Eligibility and Outcomes of Conversion to Oral (PO) Therapy in Patients Hospitalized with Enterobacteriaceae (ENT) Urinary Tract Infection (UTI) in the United States (US): A Multicenter Analysis
Authors: Melnick David , Jain Akash , Gupta Vikas , Sulham Katherine 
Published: January 2021

Abstract

Background
Rising rates of fluoroquinolone resistance (FQ-R) and third-generation cephalosporin resistance/extended-spectrum beta-lactamases (ESBL+) have left patients with urinary tract infections (UTI) few oral options. Here, we evaluate the eligibility of hospitalized UTI patients to take PO medications and estimate the potential impact on hospital cost and length of stay (LOS).

Methods
We analyzed the first positive enterobacteriaceae (ENT) urine culture ≤ 3 days from hospital admission in patients with a primary or secondary UTI ICD10 discharge diagnosis from 68 US hospitals admitted October 1, 2015-2017. Eligibility for PO was classified as: (1) received at least 24 hours intravenous (IV) antimicrobial, (2) ability to tolerate PO drug as evidenced by a pharmacy order for non-antibiotic PO medication, (3) stable/normal white blood count (WBC). Fisher’s exact test was used to test for significance; results were examined by severity quartile, PO conversion and resistance status (FQ-R and ESBL+)

Results
5,842 patients were eligible for PO conversion and analysis; 1,890 (32.5%) actually converted to PO during their hospital stay; 2,199 (37.6%) were either FQ-R, ESBL+, or both. Baseline demographics were similar between groups. Highly resistant patients (FQ-R and ESBL+) were less likely to transition to PO compared to those with neither FQ-R nor ESBL infections (16.7% vs. 37.0%). Among patients who did convert to PO, post-PO-eligible LOS was shorter across all severity strata compared to patients who did not convert (p&lt; 0.0001). For those who did not convert, post PO-eligible LOS was 2.6, 2.9, 3.3, and 4.0 days by severity quartile, respectively. Among patients who did convert to PO, the total cost was $1,043 less (p=0.024) for patients in the 3rd quartile of severity and $1,512 less (p=0.004) for patients in the 4th quartile of severity, compared to the patients who did not convert.

Conclusion
Only ~1/3 of patents eligible for PO therapy are converted during hospitalization. Reduced LOS and substantial cost savings could be recognized by efficient PO conversion and hospital discharge. Lack of PO therapies with activity against resistant pathogens has made this challenging; new PO options may help reduce hospital costs and resources required to treat these UTI patients.

Disclosures
David Melnick, MD, Spero Therapeutics (Employee)Spero Therapeutics (Employee) Akash Jain, PhD, Spero Therapeutics (Employee) Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Katherine Sulham, MPH, Spero Therapeutics (Independent Contractor)