bluuebunny/crossref_metadata_2025_split huggingface dataset:
1237. Review of Implant Surgical Site Infections and Staphylococcus aureus Screening Compliance for 2018 at a Large Healthcare System
Authors: Strollo Stephanie L , Passaretti Catherine 
Published: October 2019

Abstract

Background
Surgical site infections (SSIs) following hip arthroplasty (THA), knee arthroplasty (TKA) and spinal fusions result in substantial morbidity, mortality and increased cost. Guidelines recommend preoperative Staphylococcus aureus (SA) screening and decolonization; however, there are numerous logistical challenges with implementing this process. We reviewed compliance with SA screening and decolonization practices and relation to THA, TKA, and fusion SSI performance

Methods
Preoperative SA screening programs and associated data were reviewed for THA, TKA and fusion procedures between September and December 2018 across 9 hospitals in a large healthcare system. Compliance with preoperative SA screening was counted if SA nares culture or polymerase chain reaction (PCR) was completed at any point in the 28 days prior to surgery. This SA screening compliance snapshot was compared with year end 2018 SSI rates per 100 procedures and National Health Safety Network (NHSN) all SSI Standardized Infection Ratio (SIR). All 2018 SSIs were reviewed to determine whether infection was due to SA and for compliance with preoperative SA surveillance.

Results
Overall preoperative SA screening compliance for September through December 2018 was 49% (32%, 54% and 62% for fusions, THA and TKA respectively). Sixty-nine implant-related SSIs were identified in 2018. 33% were due to SA. 2018 all SSI rate per 100 procedures was 0.78 (1.437 with SIR of 1.05, 0.783 with SIR of 0.67, and 0.315 with SIR 0.45 for fusions, THA and TKA respectively). Only 36% (25/69) of all SSI and 30% (7/23) of SA SSIs had preoperative SA screening completed. (Table 1). While overall preoperative SA screening compliance was poor, day of surgery SA screening with immediate decolonization using nasal iodine was 75% compared with 58% and 44% for those screened at preoperative medical visit or by surgeon order.

Conclusion
One-third of our implant surgeries were complicated by SSIs due to SA. Overall compliance with preoperative SA screening was poor however SSI rates trended down with higher preoperative SA screening compliance. Better operationalization of preoperative SA screening programs or further data on impact of day of surgery screening and immediate decolonization are needed.

Disclosures
All authors: No reported disclosures.
1244. Evaluation of Intraoperative Topical Vancomycin and the Incidence of Acute Kidney Injury
Authors: Blackman Alison L , Ali Sabeen , Gao Xin , Mesumbe Rosina , Cheng Carly , Seung Hyunuk , Banoub Mary , Claeys Kimberly C , Heil Emily 
Published: October 2019

Abstract

Background
The use of intraoperative topical vancomycin (VAN) is a strategy aimed to prevent surgical site infections (SSI). Although there is evidence to support its efficacy in SSI prevention following orthopedic spine surgeries, data describing its safety, specifically acute kidney injury (AKI) risk, is limited. The purpose of this study was to determine the AKI incidence associated with intraoperative topical VAN.

Methods
This is a retrospective cohort study reviewing patient encounters where intraoperative topical VAN was administered from February 2018 to July 2018. All adult patients ( ≥18 years) that received topical VAN in the form of powder, beads, rods, paste, cement spacers, or unspecified topical routes were included. Patient encounters were excluded for AKI or renal replacement therapy (RRT) at baseline, ≤ 2 serum creatinine values drawn after surgery, and/or if irrigation was the only topical formulation given. The primary outcome was the percentage of patients who developed AKI after intraoperative topical VAN administration. AKI was defined as an increase in serum creatinine (SCr) ≥50% from baseline, an increase in SCr >0.5 from baseline, or0 if RRT was initiated after topical VAN was given. Secondary outcomes included analysis of AKI risk factors and SSI incidence. AKI risk factors were analyzed using a multivariable logistic regression model.

Results
A total of 589 patient encounters met study criteria. VAN powder was the most common formulation (40.9%), followed by unspecified topical routes (30.7%) and beads (9.9%%). Nonspinal orthopedic surgeries were the most common procedure performed 46.7%. The incidence of AKI was 8.7%. In a multivariable logistic regression model, AKI was associated with concomitant systemic VAN (OR 3.39, [3.39–6.22]) and total topical VAN dose. Each doubling of the topical dose was associated with increased odds of developing AKI (OR = 1.42, [1.08–1.86]). The incidence of SSI was 5.3%.

Conclusion
AKI rates associated with intraoperative topical VAN are comparable to that of systemic VAN. Total topical vancomycin dose and concomitant systemic VAN was associated with an increased AKI risk. Additional analysis is warranted to compare these patients to a similar population that did not receive topical VAN.

Disclosures
All authors: No reported disclosures.
1263. Anti-Retroviral (ART) Success in an Active Duty Military Cohort from 2002 to 2016, A Model for Ending the HIV Epidemic in the United States
Authors: Schofield Christina , Colombo Rhonda , Won Seunghyun , Okulicz Jason , Ganesan Anuradha , Blaylock Jason M , Maves Ryan , Lalani Tahaniyat , Gleeson Todd , Murray Clinton , Agan Brian 
Published: October 2019

Abstract

Background
Since 1985, all active duty (AD) U.S. military service members have undergone periodic mandatory HIV screening. Subsequent care in the Military Health System (MHS) allows evaluation of clinical outcomes in a setting of open access to healthcare and medications. We describe ART outcomes in HIV-positive AD military utilizing data collected over 15 years in our prospective, multi-center HIV Natural History Study (NHS).

Methods
We included AD NHS participants diagnosed with HIV from 2002–2016 with ≥1 year of follow-up. Demographics, clinical diagnoses and laboratory data collected at study visits were compared for those on vs. never on ART by HIV diagnosis era at 5-year intervals. Among participants who initiated ART with ≥1 year of follow-up after ART initiation (AI), we assessed rates of virologic suppression (VS) and virologic failure (VF).

Results
From 2002 to 2016, 1,599 NHS participants were diagnosed with HIV infection; 1,482 had ≥1 year of follow-up. 1,337 (90.2%) received ART; ART recipients were more likely male (OR 2.5 [95% CI 1.2–5.3]), Caucasian (1.6 [1.1–2.3]), older (1.5 per 10 years [1.1–2.0]), diagnosed from 2012–2016 (14.6 [6.6–31.9]), and have lower CD4 counts (0.8 per 100 cells [0.7–0.8]) and higher VL at diagnosis (2.1 [1.8–2.5]). The median time from diagnosis to AI was 0.3 years [0.1–1.3], decreasing by era (P <0.0001). Of those ever on ART, 1,212 (90.7%) had ≥1 year of follow-up on ART; of whom, 1,196 (98.7%) achieved ≥1 measure with VS, 91% on their first regimen and 69% within 6 months. Participants not achieving VS were younger at diagnosis (0.87 per year [0.78–0.98]) and at AI (0.89 per year [0.81–0.98]), were diagnosed in 2002–2011 (9.11 [1.20–69.22]), and had lower CD4 counts at AI (0.50 per 100 cells [0.33–0.75]). 92 (7.7%) had subsequent VF after initial VS. VF was more likely in participants diagnosed in 2002–2006 (3.0 [2.0–4.7]). 281 (23.2%) had an AIDS-defining diagnosis (CD4<200 cells/uL in 88%), which decreased by era (P <0.05). There were 6 deaths in the cohort, all prior to 2012.

Conclusion
Universal HIV testing and open access to care has resulted in excellent outcomes for AD HIV-positive military members. The MHS model reinforces the benefits of the Department of Health and Human Services’ recommendations for universal testing, linkage to care and ART.

Disclosures
All authors: No reported disclosures.
1269. Cohort Profile: The Translational Platform HIV (TP-HIV), a Multicenter Cohort Project in Germany
Authors: Stecher Melanie , Wasmuth Jan-Christian , Knops Elena , Eis-Hübinger Anna , Bogner Johannes , Spinner Christoph , Eberle Josef , Lehmann Clara , Degen Olaf , Rockstroh Jürgen , Altfeld Markus , Wolf Timo , Mueller Matthias C , Scholten Stefan , Wyen Christoph , Jessen Heiko , Postel Nils , Pauli Ramona , Wolf Eva , Eger Johanna , Schäfer Guido , Stellbrink Hans-Jürgen , Krsnaric Ivanka , Heger Eva , Kastenbauer Ulrich , Behrens Georg , Fätkenheuer Gerd , Vehreschild Jörg 
Published: October 2019

Abstract

Background
While Germany has a long tradition in HIV research with many well-established regional cohorts, there was a lack of collaborative efforts toward harmonized data collection and biobanking, both key strategies for efficient translational research projects. Key challenges are heterogeneity of data systems and privacy concepts, of existing study and data collection protocols, and sample collection, storage, and sharing.

Methods
In 2013, we established the Translational Platform HIV (TP-HIV) with support of the German Centre for Infection Research (DZIF) as a collaboration between university hospitals and specialized HIV care centers throughout Germany. After assessing the individual needs of all partner sites, we have taken comprehensive action to create a common platform for collaboration in all research stages. We developed protocols, rules of operation, biobanking strategies, and privacy concepts for all collaborating partner sites. Patients infected with HIV (PLWH) who sign the informed consent for the TP-HIV are pro- and retrospectively included in the cohort.

Results
To date, the TP-HIV infrastructure is implemented at 27 member sites from 11 cities, potentially extending to more than 20,000 patients currently treated for HIV across Germany. Facing the special needs in the German research environment, the TP-HIV established a unique data- and biomaterial collection allowing expedited translational research and reduce project overheads, regulatory burden, and data security regulations for investigators. By active surveillance, rapid access to individual patient groups such as patients with acute HIV infection, TP-HIV is an ideal platform for early phase clinical trials with new drug candidates. Researchers with clinical, biological, epidemiological, and statistical expertise have been brought together within the TP-HIV, which enables an effective translational chain from bench to bedside and back. New collaborations have been established with currently 23 active study protocols.

Conclusion
The TP-HIV has demonstrated to be a powerful tool for generating and testing research hypotheses in PLWH. In the future, we will work to further expand our network and address the pressing needs in the German research environment.

Disclosures
All authors: No reported disclosures.
1284. Pre-exposure Prophylaxis (PrEP) for HIV in Vermont: an Assessment of Prescribing in a Uniquely Rural State
Authors: DiMarco Daniela E , Kennedy Amanda , Tompkins Bradley , Read Jennifer , Pierce Kristen 
Published: October 2019

Abstract

Background
In the United States and Vermont, men who have sex with men (MSM) make up the majority of new human immunodeficiency virus (HIV) infections every year. Despite HIV prevention campaigns and approval of antiviral therapy for pharmacologic HIV pre-exposure prophylaxis (PrEP), HIV cases in Vermont—a predominantly rural state—are on the rise. The primary objective of this study was to assess prescribing practices and barriers surrounding PrEP for adult MSM in Vermont.

Methods
A web-based healthcare provider survey was deployed electronically over a 10 week period in 2019 to a convenience sample of licensed primary care, sexual health, and infectious disease providers in Vermont. Questions were designed to target factors thought to influence PrEP prescribing, with a focus on prescribing behaviors and perceived barriers.

Results
An estimated 500 providers received the survey. There were 137 survey respondents, 106 (77%) were physicians, primarily in internal medicine. Though only 47 (34%) providers had experience prescribing PrEP to MSM patients, over 89% identified as willing to prescribe PrEP to high-risk groups. Among PrEP prescribers, screening frequency for HIV and bacterial sexually transmitted infections (STIs) while on PrEP fell below the current guideline recommendations at 72% and 53%, respectively. Less than 70% of providers routinely obtain sexual history for male patients. Among providers willing to prescribe PrEP, concern regarding medication toxicity was the only statistically significant barrier (χ 2 = 5.5, P = 0.02). Concerns regarding risk compensation behavior and lack of knowledge or experience regarding prescribing PrEP also demonstrated an association with provider willingness to prescribe PrEP, however did not reach statistical significance.

Conclusion
The majority of Vermont providers sampled are willing to prescribe PrEP, suggesting there is great opportunity to increase prescribing and use, potentially having an impact on reducing HIV transmission among MSM in the state. Provider education targeted toward guidelines for STI and HIV screening on therapy, obtaining sexual histories, and minimal toxicity risk may serve to increase prescribing of PrEP among Vermont providers.

Disclosures
All authors: No reported disclosures.
1305. Use of a Clinical Pharmacist to Reduce Inpatient ART (Antiretroviral Therapy) Errors
Authors: Mitchner DeMaurian , Richey Lauren E 
Published: October 2019

Abstract

Background
Continuous antiretroviral therapy (ART) that results in viral suppression is the goal of therapy for people living with HIV (PLWH). This results in improved clinical outcomes and prevents transmission to partners. University Medical Center is an urban charity hospital that provides the majority of inpatient care to PLWH in the city of New Orleans. HIV care providers noticed many ART errors during transitions of care, particularly during inpatient admissions. Impartial regimens and interactions can occur when non-HIV providers manage patients in the hospital leading to resistance and viral failure.

Methods
A clinical pharmacist was hired to improve the quality of HIV care, both in the inpatient and outpatient setting. An electronic medical records alert was created for any patient with HIV who was admitted to the hospital. The clinical pharmacist then reviewed the ART orders Monday through Friday and provided recommendations to the inpatient teams. Data on the frequency and types of errors on the medication administration record (MAR) were recorded. Data were collected for 6 months, from October 2018 to March 2019. Three-month data from October 2018 to December 2018 was compared with three-month data from January 2019 to March 2019 for quality improvement purposes.

Results
One hundred forty-eight people living with HIV were admitted to the hospital during the specified time period. A minority of the patients (25%) had a consult to an HIV Specialist. Eight (5%) were omission of ART (no regimen or partial regimen), 19 (13%) had food or drug interactions, and 14 (10%) had the incorrect ART regimen ordered. The clinical pharmacist was able to contact the inpatient team and have these errors corrected. There was a 20% decrease in the patients with errors in their inpatient ART order on the MAR during the review period, due to physicians and pharmacists proactively contacting the pharmacist prior to orders being placed and processed.

Conclusion
Errors in ART in the inpatient setting are common. A clinical pharmacist intervention can successfully decrease ART errors as patients’ transition between inpatient and outpatient care.

Disclosures
All authors: No reported disclosures.
1308. The Association Between Refill History and Viral Load Suppression in HIV-infected Patients at a University-Based HIV Clinic in the Midwest
Authors: Havens Josh , New-Aaron Moses , Gao Yangyang , He Qingfeng , Bares Sara H , Nada Fadul 
Published: October 2019

Abstract

Background
Patients with HIV (PWH) with sustained virologic suppression (VS) on antiretroviral therapy (ART) achieve better health outcomes and pose effectively no risk of transmitting HIV to their sexual contacts. Adherence to ART is the main predictor of VS in PWH, yet no adherence benchmark has been identified. The clinical utility of ART pharmacy refill history collection is unknown. We hypothesize that pharmacy refill histories of ART represented as a percentage of days covered (PDC) will correlate with VS in PWH.

Methods
We conducted a single-center, retrospective cohort study of PWH ( ≥19 years) receiving care at a Midwestern HIV clinic between January 1, 2018 and December 31, 2018, with at least 1 HIV RNA reading during the study period. Refill histories were collected for each eligible study patient and a PDC was calculated as the “number of tablets dispensed / number of days within study period” to provide an ART coverage measure. ART regimen, sociodemographic, and clinical characteristics were abstracted from the HIV registry. An HIV RNA ≤ 50 copies/mL and a PDC of ≥80% were used as measures of VS and sufficient adherence, respectively. Pearson’s chi-square tests and binary logistic regression were used to determine the effect of PDC on VS.

Results
A total of 1019 patients were included in the study. 705 (69%) patients had a PDC ≥80% and 314 (31%) had a PDC <80%. VS between groups was 96% (PDC ≥80%) vs. 74% (PDC < 80%). A significant association was observed between VS and PDC (P < 0.0001) [HJP1]. Patients with a PDC ≥80% were 9.5 times more likely to attain VS as compared with patients with PDC < 80% (95% CI, 5.89–15.17). After adjusting for ART regimen, sociodemographic, and other clinical characteristics, the likelihood of VS remained higher for patients with a PDC ≥ 80% (aOR: 6.3; 95% CI, 3.7–11.0). Factors found to be negatively associated with VS were single marital status (aOR: 0.49; 95% CI, 0.24–0.95), current or historical opportunistic infection (aOR: 0.51; 95% CI, 0.26–0.99), and usage of a multiclass or dual ART regimen (aOR: 0.40; 95% CI, 0.16–0.98).

Conclusion
The utilization of PDC as an ART adherence benchmark was significantly associated with VS. PDC is an easy measure to calculate and could be useful in the clinical care of PWH. Future prospective studies are needed to confirm these findings.

Disclosures
All authors: No reported disclosures.
1346. Ruling out TB in New York City: Are Two NAATs (Nucleic Acid Amplification Testing) Enough?
Authors: Greendyke William G , Pike Janett , Andrada Lilibeth V , Balzer Krystal , Gray Thelesha , Russell Patrice M , Sharma Manu , Steinberg Ari , Whittier Susan , Furuya E Yoko 
Published: October 2019

Abstract

Background
Prompt diagnosis of pulmonary Mycobacterium tuberculosis (TB) infection can prevent nosocomial exposure. However, sputum smears are insensitive, and turnaround time for cultures can take weeks. Rapid diagnostics, such as nucleic acid amplification testing (NAAT), on respiratory specimens of patients suspected to have TB can improve diagnostic accuracy. Current practice at our institution is to obtain ≥ 3 NAATs in high-risk patients prior to discontinuing airborne isolation, but some studies have suggested that 2 negative NAATs may be sufficient. We conducted a retrospective study of patients at our institution diagnosed with TB.

Methods
The study was conducted at an academic adult hospital, an academic pediatric hospital, and a community hospital in New York City. Line lists of positive cultures for TB and positive NAATs from 2014 to mid-2018 were obtained from microbiology. Chart review was performed. Patient demographics, comorbidities, and radiographic findings were collected. Concordance between culture results and NAATs was evaluated. Incidence of inpatient TB exposure was noted.

Results
82 cases of TB were found in the study period (see Figure 1). 45 cases were new inpatient diagnoses of pulmonary TB. The most common presenting symptoms were cough (69%), weight loss (49%), and fever (42%, see Table 1). 38/45 (84%) of patients were originally from a country other than the United States. 43/45 (96%) of patients had abnormal lung imaging. Cavitary disease was seen in 29%; other upper lobe disease was seen in 42%. Among smear-negative pulmonary TB cases, NAAT was positive in 11/16 (69%) of patients. Within this subgroup, the sensitivity of one NAAT was 41% when compared with culture. In smear-negative, NAAT-positive patients, NAATs were fully concordant with cultures in 4/11 patients (36%, see Table 2). The median number of positive NAATs was 1; the median number of positive cultures was 2. Five patients with pulmonary TB had negative NAATs altogether (median = 3); 2/5 resulted in TB exposure investigations after airborne precautions were discontinued following NAAT results. Overall, 13/45 (28%) of new diagnoses resulted in an exposure investigation.

Conclusion
Obtaining ≥ 3 NAATs in patients suspected of pulmonary TB improved diagnostic accuracy compared with obtaining 2 or fewer.

Disclosures
All authors: No reported disclosures.
1354. Nocardia bejingensis: A Novel Isolate Affecting Immunocompromised Patients in the United States
Authors: Moore-Pardo Shylah M , Asquith Johonna , Aslam Sadaf , Mayer Cynthia , Greene John , Alrabaa Sally 
Published: October 2019

Abstract

Background
Nocardia species can cause localized or disseminated disease in humans. Infection results from direct inoculation or inhalation. In recent years, several new species have been identified via molecular methods. Further speciation is crucial as each organism has its own spectrum of disease and unique antibiotic susceptibility patterns. Immunosuppression, alcoholism, and certain lung diseases are well-established risk factors for nocardiosis. In fact, cases have incremented in association with increasing population of immunocompromised hosts as well as improved methods for detection and identification. Thus, Nocardia species may be considered opportunistic pathogens.
Nocardia bejingensis was first isolated in 2001 by Wang et al from sewage soil in China. The first human infections were reported in Asia. Subsequently, cases were reported in Europe and a few cases have been described in the United States but it has been infrequently cited in the literature. Thus, not much is known about its spectrum of disease.

Methods
The primary objective of this study was to determine the risk factors and clinical manifestations of Nocardia bejingensis infection via retrospective chart review of 6 cases identified in Tampa General Hospital and Moffitt Cancer Center within a 5-year period. We aimed to evaluate the treatment used and the antibiotic susceptibility patterns of the isolates.

Results
All patients were immunocompromised (1/3 HIV/AIDS, 1/3 hematologic malignancy, 1/3 solid-organ transplant). Most were male (67%) and mean age of 48. The majority had lung involvement (67%). Thecal sac infection and femur osteomyelitis (OM) were atypical manifestations. Localized disease predominated. Combination therapy was preferred. Trimethoprim-sulfamethoxazole (TMP-SMX), Ceftriaxone, and carbapenems were mostly used. All isolates were susceptible to TMP-SMX. See Table 1.

Conclusion
This case series depicts clinical features, risk factors, and epidemiology of Nocardia bejingensis infections. Our observations suggest that it is a novel pathogen in the United States, affecting mainly immunocompromised hosts. Early detection, appropriate antibiotics, and surgery were keys in successful management. However, further studies are needed to further elucidate its pathogenesis.

Disclosures
All authors: No reported disclosures.