bluuebunny/crossref_metadata_2025_split huggingface dataset:
353. A Comparison Study of Prevalence and Risk Factors for Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH) by Transient Elastography (TE) in HIV-Infected Patients
Authors: Choe Sunny , Al-Saleh Hend , Fallon James , Galang Herbert , Mathew Justin , Lakkasani Saraswathi , Malekazari Pegah , Shukla Prerak , Slim Jihad 
Published: October 2019

Abstract

Background
There are limited data on the prevalence and risk factors of NAFLD and NASH in HIV-infected individuals receiving ART. A large study on this subject was presented at Glasgow 2018, from the University Hospital of Palermo (UHP).

Methods
We prospectively collected data on epidemiology, comorbidities, CD4, HIV virus load and ART from November 2017 to September 2018 in patients undergoing TE examination with Controlled Attenuation Parameter (CAP) in our HIV clinic at Saint Michael’s Medical Center in Newark, NJ. We used the same parameters to define NAFLD and fibrosis severity that were used for the UHP (CAP >248 dB/m and TE > 7.1 Kpa). We present comparative data between those 2 cohorts.

Results
We enrolled 624 consecutive HIV-infected individuals (group 1) their baseline epidemiologic characteristics were not significantly different from the UHP cohort (group 2) for age and sex. Prevalence of NAFLD was 51.6% in group 1compared with 42.7% in group 2, and the prevalence of significant fibrosis in those with NAFLD was 31% in group 1, and 23% in group 2. The main differences we found between those 2 cohorts were race: group 1, 68% black and group 2, 87% White, incidence of Diabetes mellitus was 20% in group 1, and 6% in group 2, despite the fact that BMI was not significantly higher in group 1. Other important differences were the mean time on ART, it was 5 years longer for group 1. Finally, there was a trend for a higher incidence of hypertension, a lower percentage of patients with Virus load < 20 c/mL, a lower mean CD4 count, and a higher percentage of integrase strand transfer inhibitors current users in group1.

Conclusion
NAFLD prevalence is alarming high in patients with HIV disease, it is of utmost importance to understand its natural history, in order to prevent the potentially severe consequences of NASH. Our study suggests that a longer duration on ART might correlate with higher incidence of NAFLD, which would suggest better monitoring of liver health with new ART.

Disclosures
All authors: No reported disclosures.
369. Association Between Depression and HIV Treatment Outcomes in a US Military Population with HIV Infection
Authors: Carney Brandon , Daniels Colton , Xu Xiaohe , Sunil Thankam , Ganesan Anuradha , Blaylock Jason M , Kronmann Karl , Schofield Christina , Tahaniyat Lalani , Agan Brian , Okulicz Jason 
Published: October 2019

Abstract

Background
Depression is common among HIV-infected individuals and may contribute to suboptimal adherence to antiretroviral therapy (ART) and reduced rates of viral load (VL) suppression. We evaluated longitudinal HIV treatment outcomes in US Military HIV Natural History Study (NHS) participants with or without a diagnosis depression.

Methods
Male NHS participants with available ICD-9 data for mental health diagnoses and self-reported adherence (SRA) were included (n = 549). Groups were defined as having a history of depression (n = 188, 34.2%), classified as major depressive disorder and/or anxiety disorder, or no history of depression (n = 361, 65.8%). Delay in ART initiation was defined as the time from HIV diagnosis to ART start greater than the group mean (4.91 ± 4.69 years). SRA was defined as taking ≥95% of ART doses and continuous ART was defined as longitudinal ART use with gaps < 30 days. Continuous VL suppression was defined as maintaining VLs < 200 c/mL on ART. Logistic regression analysis was performed comparing variables for those with and without a coded diagnosis of depression.

Results
Participants had a mean age of 33 (±8.36) years at HIV diagnosis, and similar proportions were Caucasian (44.3%) or African American (40.8%). At ART initiation, the mean CD4 count was 370 (±154 cells/μL) and 362 (±163 cells/μL) for those with and without a history of depression, respectively. Overall, older participants at HIV diagnosis had greater odds of having high SRA (OR 1.07, 95% CI 1.03–1.11), and compared with Caucasians, African Americans had lower odds of having high SRA (OR 0.43, 95% CI 0.25–0.75; table). Participants with a history of depression had greater odds of experiencing delayed ART initiation (OR 2.12, 95% CI 1.11–4.05). However, they also had greater odds of remaining on continuous ART (OR 1.38, 95% CI 0.95–2.02) during follow-up compared with those without a history of depression.

Conclusion
Although HIV-infected individuals with depression were more likely to experience delays in ART initiation, there were no observed differences in SRA or VL suppression. Continued efforts to identify and aggressively manage mental health disorders are important to success along the HIV care continuum.

Disclosures
All authors: No reported disclosures.
397. Operative Intervention in Pediatric Lyme Arthritis Increases Healthcare Resource Utilization Without Improved Outcomes
Authors: Tout Andrew R , Nowalk Andrew J , Campfield Brian T 
Published: October 2019

Abstract

Background
Lyme arthritis commonly presents as an acute inflammatory monoarticular arthritis, frequently challenging to distinguish from septic arthritis. While management for Lyme arthritis focuses on antibiotic therapy, septic arthritis requires operative debridement plus antibiotic therapy. Delay in Lyme serology results may complicate decisions on surgical intervention in Lyme endemic areas. During the transition period of western Pennsylvania to a Lyme endemic region many children ultimately diagnosed with Lyme arthritis were managed by operative intervention due to diagnostic ambiguity. The impact of an operative intervention on outcomes of pediatric Lyme arthritis is unknown.

Methods
We conducted a retrospective chart review from 2008 to 2018 of patients admitted to UPMC Children’s Hospital of Pittsburgh and diagnosed with Lyme arthritis. We recorded the clinical presentation, laboratory data, details of hospitalization and follow-up, costs and outcome after therapy to compare the impact of antibiotic therapy alone (non-operative group) vs. antibiotics plus operative debridement (operative group).

Results
We identified 164 patients admitted for management of arthritis with the eventual diagnosis of Lyme arthritis. Fifty-two patients underwent operative debridement in addition to antibiotic therapy. Operative debridement plus antibiotics was associated with increased duration of admission, increased the cost of hospitalization, and increased PICC line placement compared with antibiotics alone. In patients for whom follow-up information was available, resolution of symptoms was documented in 62 of 66 patients in the non-operative group and 46 of 47 patients in the operative group with a median duration to symptom resolution of 17 and 23 days,, respectively.

Conclusion
Operative debridement for pediatric patients with Lyme arthritis was associated with increased cost and duration of hospitalization, and a greater number of procedures, while being similarly efficacious to non-operative management with antibiotic therapy alone.

Disclosures
All authors: No reported disclosures.
398. Description of a Large Pediatric Lyme Arthritis Cohort in an Endemic Region
Authors: Abney Ancil J , Reinhard Megan , Sharon Bazak 
Published: October 2019

Abstract

Background
In endemic areas, Lyme arthritis (LA) is a leading cause of joint swelling. Due to the shared inflammatory nature and common clinical features, acute LA is often misdiagnosed as septic arthritis (SA) while recurrent disease is at times difficult to differentiate from other causes of chronic arthritis. In Minnesota, there has been a steady increase in cases of Lyme disease. This has not been met by a clear guideline and there is no consensus for the management of pediatric arthritis. In this context, we sought to characterize the epidemiology and clinical presentation of a large local cohort.

Methods
This is a retrospective review of medical charts from children with confirmed LA, presented at a large academic medical organization in the Upper Midwest between January 2011 to December 2017. Demographic, clinical, and laboratory data were collected and analyzed.

Results
Lyme arthritis was confirmed in 109 children. Acute presentation was more common (67) while the rest (42) had either persistence or reoccurrence of symptoms [Figure 1]. Elevated inflammatory markers and synovial pleocytosis were common, unlike fever and refusal to bear weight which were seen occasionally [Figure 2]. Seasonal distribution and the clinical setting for initial presentation as well as admissions are summarized in Figure 3. The knee was involved in all but 2 patients, both had acute monoarthritis (elbow and hip) [Figure 4].

Conclusion
LA causes a spectrum of disease, is seen year round, and across the clinical setting continuum. Acute knee monoarthritis is the most common presentation (54% in our cohort) and is often misdiagnosed as SA leading to unnecessary hospitalizations and aggressive interventions. This occurs more frequently at the ED setting and for children with significant synovial pleocytosis. When evaluating a child with arthritis, laboratory findings are none specific and should be used in caution. Pediatric providers in endemic regions, especially those in primary, hospital, or emergency care must be familiar with the clinical presentation and have a high index of suspicion for LA in order to prevent mismanagement.

Disclosures
All authors: No reported disclosures.
423. Self-Reported Screening for Rectal Sexually Transmitted Infections Among Men Who Have Sex with Men
Authors: William. Menza Timothy , Lipira Lauren , Bhattarai Amisha , Ramirez Joseph , Orellana Roberto 
Published: October 2019

Abstract

Background
Rectal gonorrhea and Chlamydia are common and predict HIV acquisition among men who have sex with men (MSM); however, screening for rectal sexually transmitted infections (STIs) is not routine.

Methods
In 2017, we recruited sexually-active MSM in the Portland, Oregon metropolitan area through venue-based sampling. Our outcome of interest was self-reported rectal STI screening in the prior 12 months. Stratified by HIV status, we assessed the prevalence and demographic, healthcare, clinical, and behavioral predictors of screening.

Results
Of 448 participants, 168 (37.5%) reported rectal STI screening. One hundred twenty-seven (35.8%) of 355 HIV-negative men, 41 (58.6%) of 70 HIV-positive men, and none of 23 men who did not know their HIV status reported screening. Among HIV-negative men, having a healthcare provider who offered HIV testing (adjusted prevalence ratio [aPR]=2.09; 95% confidence interval [CI]: 1.43, 3.04), a syphilis diagnosis (aPR=1.32; 95% CI: 1.03, 1.69), use of pre-exposure prophylaxis (aPR=1.57; 95% CI 1.21, 2.04), and condomless anal sex with casual partners in the prior 12 months (aPR=1.74; 95% CI: 1.36, 2.22) independently predicted screening for rectal STI in multivariable analysis. HIV-positive men who reported having a provider who always or often initiates conversations about sex were significantly more likely to report screening compared with men who did not have such a provider (aPR=1.48; 95% CI: 1.06, 2.06).

Conclusion
Rectal STI screening is not universal in a venue-based sample of sexually-active MSM. Implementing innovative, acceptable, and accessible screening practices and improving provider comfort with talking about sex are paramount to increasing rectal STI screening.

Disclosures
All authors: No reported disclosures.
436. Skin and Soft-tissue Infections Are a Common Reason for Potentially Inappropriate Antimicrobial Use among Inpatients in Sri Lanka
Authors: Sheng Tianchen , Wijayaratne Gaya B , Dabrera Thushani M , Nagahawatte Ajith , Bodinayake Champica K , Kurukulasooriya Ruvini , Nagaro Kristin J , De Silva Cherin , Ranawakaarachchi Hasini , Thusitha Sudarshana Arambegedara , Anderson Deverick J , Drew Richard H , Drew Richard H , Ostbye Truls , Woods Chris W , Tillekeratne L Gayani 
Published: October 2019

Abstract

Background
Skin and soft-tissue infections (SSTI) are a common reason for antimicrobial use in the outpatient and inpatient settings. Inappropriate antimicrobial use for SSTI is common. We determined the prevalence of SSTI and associated inappropriate antimicrobial use among inpatients in Sri Lanka.

Methods
A point-prevalence study of antimicrobial use was conducted using one-day cross-sectional surveys at five public hospitals in Southern Province, Sri Lanka from Jun-August 2017. Inpatients’ medical records were reviewed for clinical data including antimicrobials prescribed. Inappropriate antimicrobial use was identified as (1) antimicrobial use discordant with guidelines by the Sri Lanka College of Microbiologists (SLCM), and (2) redundant combinations of antimicrobials.

Results
Of 1,709 surveyed patients, 935 (54.7%) received antimicrobials, of whom 779 (83.3%) had a specified or inferred indication for antimicrobial use. Among patients with an indication for antimicrobial use, SSTI was the second leading indication (181 patients, 23.2%) after lower respiratory tract infection (194, 24.9%). One-third (62, 34.2%) of patients with SSTI had a history of diabetes. Commonly used antimicrobials for SSTI included amoxicillin and clavulanic acid (40.3%), extended-spectrum penicillins (24.9%), and metronidazole (22.1%). inappropriate antimicrobial use was observed in 53.0% of SSTI patients, with redundant antibiotic therapy in 35.9% and antimicrobials discordant with SLCM guidelines in 32.6%.

Conclusion
SSTI was a common reason for antimicrobial use among inpatients in Sri Lanka, with more than half of patients receiving potentially inappropriate antimicrobial therapy. We identified targets for future antimicrobial stewardship efforts.

Disclosures
All authors: No reported disclosures.
438. Dalbavancin Clinical Experience at an NCI Designated Cancer Center
Authors: McDaneld Patrick , Smith Devlin , Tverdek Frank 
Published: October 2019

Abstract

Background
Dalbavancin (DAL) is a long-acting lipoglycopeptide, which allows for up to 2 weeks of therapy from a single dose. Outside of its FDA-approved indication for the treatment of acute bacterial skin and skin structure infections (ABSSSI), there is a growing interest in the utilization of DAL for other indications, including catheter-related bloodstream infection (CRBSI). The long-acting formulation potentially facilitates patient discharge or admission deferral without the need for daily outpatient parenteral antimicrobial therapy (OPAT). However, there is limited experience reporting DAL utilization in an oncology population. The objective of this study was to report our experience with DAL in an oncology patient population at a National Cancer Institute (NCI) Designated Cancer Center.

Methods
We conducted a retrospective review of all patients receiving DAL therapy in June 2016–June 2017. The primary outcome was a clinical success at 30 days (complete/partial resolution of symptoms without readmission for a same/similar infection), with secondary outcomes including readmission rate, acute kidney injury (AKI) incidence (Acute Kidney Injury Network [AKIN] criteria) and additional antimicrobial use within 30 days.

Results
We identified 76 unique subjects, with 77 unique infectious episodes, receiving 78 DAL doses. The majority of the subjects were male (57%), the median age was 61 years old, 55% had a solid tumor type and most were treated for ABSSSI (86%). Doses were administered inpatient 76% of the time and most patients received 1500 mg (90%). The most common pathogen isolated was Staphylococcus aureus (19%). Patients frequently received additional methicillin-resistant Staphylococcus aureus active oral antibiotics (39%). Clinical success was reported in 78% of infections. Potential DAL-related AKI was identified in 4 subjects (5%).

Conclusion
We reported on the use of DAL in a variety of oncology patients at a major cancer center. Clinical success was often achieved in ABSSSI with a single DAL dose and nephrotoxicity was infrequently encountered. Limitations include the frequent use of additional, potentially active antimicrobials and difficulty in assessment of clinical success and AKI in patients after discharge.

Disclosures
All authors: No reported disclosures.
440. Necrotizing Soft-Tissue Infections Involving Actinomyces Species
Authors: Jakharia Niyati , Schrank Gregory , Luethy Paul , Rabinowitz Ronald 
Published: October 2019

Abstract

Background
Actinomyces sp. are associated with numerous clinical diseases in humans; however, there are few case reports of necrotizing soft-tissue infections (NSTIs) involving these organisms. Their role in NSTIs has not been well described. At our medical center, we noted an increase in Actinomyces sp. isolated from the tissue specimens of patients with NSTIs, prompting further evaluation.

Methods
Microbiology databases were utilized to identify patients with clinical cultures growing Actinomyces sp. from January 2008 to December 2018. Adult patients admitted to the R Adams Cowley Shock Trauma Center with a diagnosis of NSTI were included for analysis.

Results
Nine patients were identified meeting inclusion criteria, the first in February 2018–none prior. Organisms isolated from culture included Actinomyces turicensis (n = 3), Actinomyces europeaus (n = 1), and five organisms identified only as Actinomyces species. 89% of patients had additional co-pathogens identified in their tissue cultures. Eight patients had NSTIs of the lower extremity (n = 5) and/or the genitourinary area (n = 6), and one had chronic decubitus ulcers. Comorbidities included diabetes mellitus (77%), chronic kidney disease (33%). 44% patients were in septic shock at presentation. Surgical debridement was performed in all patients. Eight patients were discharged on amoxicillin, with a mean treatment duration of 75 days (range 31–90). One patient was treated with ampicillin–sulbactam. Readmission rate at 90 days was 37%; only one was related to the index infection. One death occurred during the index hospitalization, secondary to NSTI. No patients experienced adverse drug reactions during therapy.

Conclusion
We describe one of the largest case series to date of Actinomyces sp. associated with NSTI. The startling appearance of Actinomyces sp. at our institution directly followed the implementation of matrix-assisted laser desorption/ionization time of flight mass spectrometry in January 2018. Actinomyces sp. may act as co-pathogens contributing to the severity of NSTIs, augmenting the virulence of other organisms. As more advanced technology is used in laboratories to identify these organisms, further study is needed to determine pathogenicity and appropriate treatment.

Disclosures
All authors: No reported disclosures.
443. The CHROME Study, a Real-World Experiential Registry of the Use of Oritavancin for Treatment of Gram-Positive Infections
Authors: Redell Mark , Sierra-Hoffman Miguel , Assi Maha , Bochan Markian , Chansolme David , Gandhi Anurag , Sheridan Kathleen R , Soosaipillai Ivan , Walsh Thomas L , Massey Jill 
Published: October 2019

Abstract

Background
Oritavancin (ORI) is a long-acting lipoglycopeptide antibiotic indicated for the treatment of adult patients with acute bacterial skin and skin structure infections (ABSSSI) caused or suspected to be caused by susceptible Gram-positive (GP) pathogens.

Methods
Data collected from a retrospective observational registry program (2014–2017), Clinical and Historic Registry and Orbactiv Medical Evaluation (CHROME), describe the utilization, outcomes, and adverse events (AEs) associated with ORI in 440 patients treated at 26 US sites.

Results
Mean (SD) age was 58 (16) years; 37% of patients were = 65 years old (range, 18–98). Mean (SD) BMI was 32.8 (9.0) (range, 14–65). At least 1 co-morbidity was observed in 85% of patients. Patients were treated for cellulitis (61%), wound infection (15%) or abscess (15%); 32 patients received ORI to treat other infections, such as bone and joint. Ten patients received single-dose ORI for completion of osteomyelitis therapy. Of recovered GP isolates, MRSA was the most common (46%). Infusion of ORI was mostly in infusion center settings (72%). Clinical success was 88% in the single-dose group (387 patients) and 86% in the multi-dose group (51 patients). A cohort of 32 patients received 2 to 10 ORI doses separated by no more than 14 days for complicated GP infections. Clinical success was observed in 30 of 32 patients (94%), including 10 of 11 (91%) patients with bone and joint infections and 7 of 8 (88%) patients with osteomyelitis. AEs were observed for 29 of 440 (6.6%) of patients; there was a single serious AE. Six (1.4%) patients discontinued ORI infusions due to an AE.

Conclusion
The CHROME program confirms that ORI is an effective and well-tolerated long-acting lipoglycopeptide antibiotic for the treatment of a range of Gram-positive infections.

Disclosures
All authors: No reported disclosures.
455. Gender Differences in Clinical, Microbiological and Treatment Characteristics of Adult Hospitalized Patients with Cellulitis: A Large, Prospective Multicenter Study
Authors: Collazos Julio , De la Fuente Belén , De la Fuente Javier , Garcia Alicia , Gomez Helena , Rivas-Carmenado Maria , Suárez-Zarracina Tomás , Enriquez Hector , Sánchez Paula , Alonso María , López-Cruz Ian , Martin-Regidor Manuel , Martinez-Alonso Ana , Guerra José , Artero Arturo , Blanes Marino , Asensi Victor 
Published: October 2019

Abstract

Background
Studies comparing gender differences between cellulitis features are lacking and might be useful for the knowledge, prevention and management of this infection.

Methods
Prospective, observational, multicenter study of 606 adult patients (314, 51.8% men) with cellulitis. Comorbidities, microbiological, clinical, lab, diagnostic, and treatment data were analyzed. Multiple logistic regression modeling was performed to determine the variables independently associated with gender.

Results
Women were older (P < 0.0001), less likely to have prior wounds (P = 0.02), and more likely to have venous insufficiency (P = 0.0002), edema/ lymphedema (P < 0.0003) and prior cellulitis episodes than men (P = 0.07). Cellulitis location also differed between genders (P = 0.02). Regarding microbiology, male patients were more likely to have positive pus cultures than women (P = 0.0008), mainly monomicrobial (P = 0.03).There were differences in microorganisms isolated from pus (P = 0.002), with higher S.aureus infection rates among men than women (P = 0.04).Drawing of blood for culture was also more common in men (P = 0.03). Overall, any microorganism (P = 0.006) and the causative microorganism (P = 0.04) were more commonly identified in male than in female patients, due exclusively to the pus culture results, because there were no differences in the positivity of blood cultures (P = 0.9).Of the 61 S.aureus isolates 15 (24.6%) were methicillin-resistant, without significant differences between genders (P = 0.5). Regarding therapy, men had longer treatments (P = 0.03) and higher rates of antibiotic treatment after discharge (P = 0.04). Factors independently associated with female gender in multivariate analysis were:older age (P < 0.0001), prior episodes of cellulitis (P = 0.01), presence of edema/lymphedema as predisposing factor (P = 0.004), negative pus culture (P = 0.0002) and location of cellulitis in thorax/abdomen (P = 0.035) and head/neck (P = 0.0003) as compared with lower extremities

Conclusion
Cellulitis in women as compared with men present at older ages, recur more frequently, are more commonly related to edema/lymphedema, affect more frequently other locations compared with lower extremities, and have less frequently positive pus cultures.

Disclosures
All authors: No reported disclosures.