bluuebunny/crossref_metadata_2025_split huggingface dataset:
339. Implementing a Smoking Cessation Intervention Among People Living With HIV (PLWH)
Authors: Beckett Sadie , Richey Lauren E 
Published: October 2019

Abstract

Background
PLWH who smoke have increased mortality and decreased quality of life. Our clinic is a large, urban academic center that cares for over 1,600 PLWH with a large proportion of smokers (recent estimates 61% current, 16% former). Our goal was to assess the outcomes of our new clinic-wide smoking cessation intervention. We hypothesize that our intervention will increase smoking cessation among our patients.

Methods
A multidisciplinary committee met to design a cessation pathway to increase smoking cessation in the clinic. The pathway began with an assessment of smoking during triage. The provider then discussed cessation during the visit and patients who were ready to quit were referred to a health educator. Upon referral, participants were enrolled in the smoking cessation trust (SCT) which is a free program for patients who have been smoking before 1988 (N = 33) and provides NRT. Participants who were born after 1980 (N = 10) received their NRT through the Ryan White formulary. The intervention consisted of a baseline interview and 5 modules. Participants received their NRT or pharmacologic agent prior to the intervention. Participants (N = 43) were PLWH from our clinic who smoke and were referred from May 1, 2018 through March 1, 2019.

Results
Participants were 79% black, 74% male and on average were 47 years old. Among participants, 21 participants met with a health educator for the initial interview and participated in the intervention, while 22 only met with the health educator for an introductory interview to determine which pharmacologic/NRT agent would work best for them. Of the 43 participants, 30 participants received pharmacologic/NRT agents. Among all participants, 23% of individuals quit smoking cigarettes within 2 months of completing the baseline interview and first module. Of those that quit, 50% used Chantix and 70% attended counseling sessions with the health educators. Of the participants who did not quit, 21 participants cut down on the amount they smoked with almost 81% of them cutting the number of cigarettes they smoked in half.

Conclusion
A multidisciplinary intervention consisting of assessment, counseling, and pharmacologic therapy and/or NRT can improve cessation in PLWH that smoke (23%). Future studies are needed to confirm these results among larger populations.

Disclosures
All authors: No reported disclosures.
367. Use of a Brief Task-Based Measure to Assess the Functional Consequences of Cognitive Impairment in HIV
Authors: Agan Brian , Smith Bryan , Hsieh Hsing-Chuan , Won Seunghyun , Ganesan Anuradha , Maves Ryan , Utz Gregory , Tramont Edmund , Nath Avindra , snow Joseph 
Published: October 2019

Abstract

Background
In spite of viral suppression with antiretroviral therapy (ART), neurocognitive impairment (NCI) affects ~20% of those infected with HIV; most are asymptomatic or only mildly impaired based on instrumental activity of daily living (IADL) self-reported questionnaires. Previous studies have shown a strong association between depression, common among HIV+, and self-reported IADL impairment, potentially confounding evaluation of the functional impact of NCI. We studied a brief (15–20 minutes) task-based measure of function, the Texas Functional Living Scale (TFLS), in the context of HIV, NCI, and depression.

Methods
Baseline data were analyzed from parallel, longitudinal cohort studies of neurocognitive function among HIV+ and demographically matched HIV-subjects enrolled at NIH and DoD sites. Subjects recruited at NIH were on ART with viral suppression (VS) ≥1 year and nearly all in the DoD also had long-term VS. All participants underwent a standardized, comprehensive neurocognitive battery (7 domains), as well as the TFLS. Global deficit score (GDS) ≥0.5 defined neurocognitive impairment (NCI) and TFLS impairment was defined as T-score >1 standard deviation below mean (i.e., < 40).

Results
420 subjects were evaluated with demographics in Table 1. Eighty-five subjects (20%) had NCI by GDS and 57 (13%) subjects had TFLS impairment. 17% had a Beck Depression Inventory II (BDI) score ≥13 indicating significant depressive symptoms. In univariate analysis of Table 1 variables, only HIV status was not significantly different between those with or without TFLS impairment, however after adjustment using multivariable logistic regression, only education level, race, and NCI were associated with TFLS impairment; depressive symptoms (BDI ≥13) were not associated with functional impairment measured by TFLS.

Conclusion
In parallel DoD and NIH cohorts of well-treated HIV+ and matched HIV- subjects, task-based functional impairment measured by TFLS was strongly associated with NCI, but not with depressive symptoms, suggesting the potential utility of this measure to better understand the functional consequences of HIV associated neurocognitive disorders. While the association of TFLS with education was expected, that with race was not and requires further study.

Disclosures
All authors: No reported disclosures.
372. Prevalence of Urethral, Rectal, and Pharyngeal Gonorrhea and Chlamydia among Newly Diagnosed Filipino HIV Patients
Authors: Li Kingbherly L , B. Valencia Jose Carlo , Taladtad Florida F , Hernaez Mary Grace T , Luzentales Vivienne V , Abad Cybele Lara R , Salvana Edsel Maurice T 
Published: October 2019

Abstract

Background
The Philippines has the fastest-growing HIV epidemic in the Asia-Pacific. Concurrent sexually-transmitted infections increase the risk of HIV transmission and complications. The prevalence of Neisseria gonorrheae (NG) and Chlamydia trachomatis (CT) infection among Filipino HIV patients is unknown and screening is not universal. A symptom-based approach likely underestimates the prevalence of NG and CT among men who have sex with men (MSM). We determined the rectal, pharyngeal, and urethral prevalence of gonorrhea and chlamydia infection in our patient population using nucleic acid testing (NAT).

Methods
This is a single-center, prospective cross-sectional study at Philippine General Hospital. Following ethical approval and informed consent, pharyngeal, rectal, and urine samples from newly-diagnosed, treatment-naïve HIV adult patients were tested using the Xpert® CT/NG assay (Cepheid, Sunnydale, CA). Patients with recent (≤21 days) antibiotic use with activity against NG or CT were excluded. Demographic and clinical data were also collected.

Results
46 subjects were enrolled. Mean age was 31 years (range 19–49), 83% (38/46) were male, 96% (44/46) were asymptomatic, and 92% (35/38) of the males were MSM. Median CD4 count was 225 cells/μL (range 0–1,335). The overall prevalence of CT/NG was 33% (15/46). Table 1 shows the prevalence of CT and NG by site. Four patients had both genital and rectal CT. More patients had rectal NG/CT compared with urethral and pharyngeal sites. No gonorrhea was found in the urine specimens; no chlamydia was found in the pharynx.

Conclusion
The prevalence of CT and NG among newly diagnosed Filipino HIV patients at 33% is sufficiently high to warrant routine NAT screening. Urine testing alone will miss a significant number of cases in an MSM-predominant population. We recommend NAT screening of both urethral and rectal sites for newly-diagnosed Filipino HIV patients.

Disclosures
All authors: No reported disclosures.
399. Treatment and Outcome of Prosthetic Joint Infection in Unicompartmental Knee Arthroplasty
Authors: Carli Alberto V , Kapadia Milan , Chiu Yu-fen , Henry Michael , Miller Andy O 
Published: October 2019

Abstract

Background
Unicompartmental knee arthroplasty (UKA) is an increasingly popular alternative to total knee replacement due to easier recovery and greater satisfaction. However, limited evidence guides the management of periprosthetic joint infection (PJI) in UKA specifically. We retrospectively reviewed the largest cohort of UKA PJI to date, providing our experience in a high volume tertiary institution.

Methods
An institutional PJI database was queried from 2008 to 2016 to identify all PJI cases with an index procedure of UKA. Treatment, diagnostic criteria, Charlson Comorbidity Index (CCI) and microbiology data were collected. Success was defined as no further surgical treatment for infection at 2 years. A chi-square test or Fisher’s exact test was used for comparisons between treatment success and failure groups. Survival probability was calculated using the Kaplan–Meier method.

Results
A total of 24 UKA PJIs were identified with 22 meeting MSIS criteria. Median age at infection was 65.9 years (range, 50.8–87.4), median BMI was 26.7 kg/m2 (range, 21.2–49.5), 75% male (18/24).The average follow-up time was 2.83 years. 9 patients presented with early (4 weeks of symptoms). 63% (15/24) of PJI cases were staphylococcal and 8.3% (2/24) were culture negative. Patients were either treated with 1 stage exchange (n = 3, 100% success), two-stage exchange (n = 5, 80% success) or implant retention (n = 16, 75% success). Overall survivorship was 79% at 2 years (95% confidence interval [CI], 63%–95%). Overall there was no significant association between success and CCI (P = 0.46), infection type (P = 0.29), surgical therapy (P = 0.62), and microorganism (P = 0.05).

Conclusion
In this series, UKA PJIs tended to present more often as early post-operative or hematogenous infections. We observed no significant benefit with revision surgery and therefore conclude that implant retention should be considered as first-line surgical treatment. Outcomes of UKA PJI appear comparable to those in TKA PJIs.

Disclosures
All authors: No reported disclosures.
404. miRNA-Gene Pairs Associated with Shock and Renal Failure in Filipino Septic Patients
Authors: Deguit Christian Deo T , Yoro Manuel D , Erric Cinco Jude , Sonia Salamat Maria , Adrian Buensalido Joseph , Silao Catherine , Alejandria Marissa M , Nevado Jose 
Published: October 2019

Abstract

Background
Small non-coding microRNAs (miRNAs) are increasingly recognized as key regulators of the host response to sepsis. However, the molecular mechanisms implicated in the role of miRNAs during sepsis progression is still unclear. It is hypothesized that differentially expressed genes in septic patients with worse outcomes are associated with dysregulation of miRNA expression. This study aimed to identify specific miRNA-gene pairs that may be implicated in the development of shock and renal failure in sepsis.

Methods
miRNA from serum and RNA from PBMCs were acquired from n = 40 participants in a prospective cohort of Filipino septic patients: n = 15 developed septic shock and n = 17 developed renal failure. RT-qPCR was done to measure the expression of 21 sepsis-associated miRNAs. Differentially expressed miRNAs (DEMs) for each outcome was identified, followed by gene target prediction for each DEM. Gene expression microarrays covering 18,616 genes were also performed to identify differentially expressed genes (DEGs; P < 0.05, log FC> |0.3|) for each outcome. Significant miRNA-gene pairs were selected by evaluating the overlap of the predicted gene targets of the DEMs with the DEGs for each corresponding outcome. Given the gene-silencing mechanism of miRNAs, overlap analysis was performed on only the downregulated DEGs when the specific DEM was upregulated (and vice versa).

Results
Septic participants who developed shock, compared with those who did not, had higher expression of 1 DEM, miR-223-5p, and downregulation of 20 DEGs. NUS1 was the only predicted gene target of miR-223-5p that was also downregulated in septic shock. Participants who developed renal failure, vs. those who did not, had lower expression 6 DEMs and upregulation of 6 DEGs. KPNA4 is a gene target of the DEMs, miR-126-5p, and miR-181a-5p, that was also upregulated in renal failure.

Conclusion
Significant miRNA–gene pairs related to worse clinical outcomes in sepsis were identified: miR-223-5p with NUS1 for shock and either miR-126-5p or miR-181-5p with KPNA4 for renal failure. While the biological significance of these miRNA-gene pairs still needs to be evaluated, these findings can potentially help future efforts in developing prognostic markers or therapeutic targets for shock and renal failure in sepsis.

Disclosures
All authors: No reported disclosures.
409. Using the Host Response to Reduce Unnecessary Antibiotic Use in Outpatient Acute Respiratory Infections
Authors: Sambursky Robert , Bell Annie 
Published: October 2019

Abstract

Background
Acute respiratory tract infections (ARI) often resolve without antibiotics. Yet, antibiotics are prescribed in 60–98% of cases despite lack of confirmed bacterial etiology. Antigen, culture and molecular testing identify pathogens; however, do not differentiate colonization from invasive infection. Since antibiotics are often prescribed despite the low prevalence of confirmed bacterial infection in patients with ARI, we analyzed the impact of adding host response biomarkers to the clinical and microbiological evaluation of outpatients with ARI.

Methods
A secondary analysis was performed using data from su suspected ARI cohorts derived from two clinical studies. A clinical reference algorithm, which included bacterial culture, respiratory PCR panels for viral and atypical pathogens, procalcitonin, CBC, serology, and Myxovirus resistance protein A (MxA), was used to define invasive infection based on pathogen detection plus host response and classify infections that may benefit from antibiotics. Antibiotics were considered “warranted” if patients exhibited a bacterial-specific host response, with or without bacterial pathogen detection, and a detected bacterial pathogen without a host response was deemed to be colonization and “at risk for antibiotics.” The percentage requiring antibiotics was calculated by dividing the number of patients with a host response for bacteria by the total number of patients at risk for receiving antibiotics (warranted + at risk). A Chi-square test was performed to determine the difference between patients likely to be treated with antibiotics, bacteria detected with or without host response and bacteria detected with a host response.

Results
Each dataset (Self, n = 205) and (Shapiro, n = 220) was analyzed separately and pooled (n = 445). Upon enrollment, 15% (Self) and 55% (Shapiro) were febrile. A pathogen was detected in 67% (Self) vs. 82% (Shapiro) subjects. Reduction in antibiotic prescription was calculated to be 35–44%, (P < 0.001–0.004), when host response was evaluated in addition to bacterial pathogen detection. Results presented in Table 1.

Conclusion
Host response may aid in differentiating viral infection and bacterial colonization from invasive bacterial infections requiring antibiotics.

Disclosures
All authors: No reported disclosures.
411. Does an Early Cytokine Response During Ebola Virus Disease Improve the Duration of Survival in Rhesus Macaques?
Authors: Blair Paul W , Martins Karen A O , Maryam Keshtkar-Jahromi , Kortepeter Mark G , Michael Keebaugh , Downs Isaac L , Cardile Anthony P 
Published: October 2019

Abstract

Background
Ebola virus disease results in a severe cytokine release resulting in organ failure and disseminated intravascular coagulation, often leading to death. An early post-exposure immune response may improve outcomes but that remains poorly characterized. Therefore, we evaluated select serum cytokine markers of immune activation in nonhuman primates (NHPs) for their association with duration of survival.

Methods
This was a post-hoc analysis of an interventional supportive care NHP study in which 13 rhesus macaques were inoculated intramuscularly with a target dose of 1000 PFU Zaire ebolavirus (Kikwit). We measured cytokines with a Luminex MAGPIX panel at baseline and daily starting day 3 post-exposure until euthanasia. Based on human clinical data, 10 cytokines and proteins were included in our analysis: IL-1ra, IL-6, IL-10, GM-CSF, MCP-1, MIP-1α, MIP-1β, IFN-γ, TNF-α, and C-reactive protein levels. After NHPs were divided into two groups by k-means clustering, we developed Kaplan–Meier curves for time to death (Figure 1). We visually explored Pearson’s correlation and kinetics of serum cytokines and log10viral load (Figure 1; Figure 2). We fitted cox regression models with each cytokine to evaluate the risk of early disease for each cytokine log10 level or log2-fold change. We performed a sensitivity analysis for MIP-1β centering the data at dpe 0.

Results
Among NHPs with temperature data, 83% (N = 10) developed fevers (>3 SD baseline) from dpe 3 to 4.The macrophage markerMIP-1β was associated with an increased risk of early death (per log10pg/mL increase, HR= 52.83 at dpe 3, adjusted P = 0.045). Surprisingly, this association was also observed at dpe 0 (HR= 36.88 at dpe 0, adjusted P = 0.044). Other cytokine levels or changes were not associated with an increased hazard of death.

Conclusion
Our findings did not support a role for early systemic cytokine release in improving survival. However, elevated baseline levels of the MIP-1β may predispose NHPs to early death from EVD. This finding could represent a target for therapeutic strategies and should be further researched.

Disclosures
All authors: No reported disclosures.
446. Epidemiology of Necrotizing Fasciitis in Korea: A Nationwide Study Using Claims Data
Authors: Kyoung Choi Hee , Seo GiHyeon , Han Euna 
Published: October 2019

Abstract

Background
Necrotizing fasciitis (NF) is a rare but fatal infectious disease that causes economic burdens on patient and the healthcare system. We investigated the incidence of necrotizing fasciitis (NF) and the seasonal variation of necrotizing fasciitis in Korea.

Methods
We analyzed a nationwide claims database from the Korean Health Insurance Review and Assessment Service from 2011 to 2017. For case definition, we used two different methods. First, patients who hospitalized with NF diagnosis code and received surgical intervention (NF code method) were defined as NF. Second, patients hospitalized with sepsis codes accompanying surgical intervention codes were defined as NF (sepsis code method). The annual incidence rate per 100,000 population of NF was calculated using the number of identified NF cases as numerator and age- and sex-specific midyear population as the denominator. Poisson regression models were used to assess the relationship of crude incidence rates to year, age, and sex. A multivariate Poisson regression model was used to investigate variations in trends in the monthly NF cases.

Results
The overall average annual incidence rate of NF during 2012–2017 was 0.86/100,000 by NF code method and 1.47/100,000 by the sepsis code method. The incidence of NF increased with age and 2.5 times higher in males than females across all age groups. Two-thirds of episodes occurred in diabetes patients. The incidence of NF occurred the most during summer. A multivariate Poisson regression model using national meteorological variables suggested that higher mean temperature of and larger numbers of NF cases during a prior month increased NF cases.

Conclusion
The possibility of NF should be suspected for the cases for an elderly man with diabetes in summer. From a national management perspective, the prior information on the number of NF incidences and the mean temperature can help predict NF outbreak.

Disclosures
All authors: No reported disclosures.
452. Antibiotic Duration, but Not Size, Impacts Clinical Cure of Limited Skin and Soft-Tissue Infection After Incision and Drainage
Authors: Lake Jason G , Fritz Stephanie 
Published: October 2019

Abstract

Background
Incision and drainage (I&D) is the most common treatment for skin abscesses. A recent randomized clinical trial (RCT) of outpatients with limited (≤5 cm) skin abscesses demonstrated antibiotic therapy with clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX) was superior to I&D alone. We performed a subgroup analysis to measure the effect of antibiotic duration and abscess size on clinical cure at 7–10 days after antibiotic completion.

Methods
Participants with complete data regarding adherence to the 10-day treatment were included. Demographic and baseline clinical features were compared using t-test, Pearson’s chi-square or Fisher’s exact test, or a non-parametric equivalent where appropriate. Largest abscess dimension (cm) was dichotomized by median size. The effect of antibiotic duration, abscess size (≤ median vs. >median) and covariates on clinical cure were measured using logistic regression. Breslow-Day Test for Homogeneity was used to assess the interaction between treatment and abscess size.

Results
Of 786 participants in the intention-to-treat analysis, complete adherence data were available for 680 (87%) participants. Of these, 463 (68%) received either antibiotic: 421 (91%) completed 10 days of therapy, 29 (6.3%) ≤7 days and 20 (4.3%) ≤5 days. Only antibiotic treatment duration was associated with clinical cure (table). Odds of clinical cure were 1.7 (95% CI: 1.5, 2.0) times higher for each additional day of treatment. Median abscess size was 2.5 cm (range: 0.2–5); 364 participants had abscesses ≤ median vs. 316 >median. Assessed continuously, abscess size was not associated with cure within antibiotic groups (table) or between placebo and treatment groups (OR 0.94, 95% CI: 0.58–1.5). Stratifying on size, no significant interaction was observed with antibiotic treatment (Breslow-Day P = 0.13).

Conclusion
Adherence to the treatment protocol was high. These data suggest that longer courses of antibiotic therapy in conjunction with I&D are associated with successful treatment of limited skin abscesses. Size was not associated with clinical cure. Prospective RCTs to determine the optimal length of treatment are needed.

Disclosures
All authors: No reported disclosures.