bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1407. The Growing Trend of Clinical Tick-Borne Diseases in South Carolina
Authors: Bramlett Kayla E , Pickle Emily Owens , Waltz Hanna , Saunders Eleanor , Vorobiov Julia , Commins Scott , Haldeman Matthew , Nolan Melissa 
Published: January 2025

Abstract

Background
The trend of human tick-borne disease (TBD) incidence has increased exponentially over the past two decades. Limited healthcare access, substandard housing, socioeconomic fragility, and absence of government-backed tick control initiatives significantly contribute to the high disease burdens nationwide. Given the wide prevalence of socioeconomic and health inequalities in the USA, the risk of TBDs often goes undetected in impoverished and minority communities. Alpha-gal syndrome (AGS) is one TBD that is often overrepresented in white, middle-income individuals, and little information on the incidence in populations of Color exists. Therefore, the current study aims to estimate the seroprevalence and exposure-associated risk factors of AGS among vulnerable populations in South Carolina.

Methods
First, a five-year retrospective clinical chart abstraction of AGS patients within a large healthcare system covering half of South Carolina was completed to characterize the clinical burden and natural history of AGS. Next, banked serum samples and associated surveys from a cross-sectional minority-represented COVID-19 study were analyzed for AGS seropositivity.

Results
Fifty patients with positive AGS IgE labs were identified via retrospective chart review. Of these, the majority were male (70%), covered by Medicare (84%), and had a history of tick bites or spent extended periods outdoors (46%). The cross-sectional AGS seroprevalence study detected 3.5% seropositivity among 753 serum samples. Risk factors associated with a positive titer included being male (58%), and regularly spending time outdoors (58%). Notably, the seroprevalence cohort consisted of primarily Black residents and individuals who live below the poverty line.

Conclusion
These findings highlight the growing issue of TBDs, namely AGS, among minority populations in South Carolina, urging healthcare providers to be more informed.

Disclosures
All Authors: No reported disclosures
P-1409. Differential Impact of a Penicillin Allergy Assessment Tool on Orthopedic Surgical Patients from Areas of High Social Vulnerability
Authors: Passaretti Catherine , Boger Michael S , Jaffa Rupal K , Neelakanta Anupama , Inman Michael , Davidson Lisa 
Published: January 2025

Abstract

Background
Penicillin allergy labels (PAL) have been associated with increased risk of surgical site infections. Many penicillin allergy assessment tools are being trialed to improve perioperative β-lactam utilization. We report on the sociodemographic characteristics associated with receipt of β-lactam antibiotics (BLA) in orthopedic surgical patients with a PAL after implementation of a penicillin allergy assessment tool built into the electronic health record (EHR).Table 1:Clinical and Sociodemographic Characteristics of Penicillin Allergy Label Patients by Preoperative β-Lactam Antibiotic (BLA) Administration Following Implementation of Penicillin Allergy Assessment Tool in the Electronic Health Record

Methods
We performed a retrospective cohort study of patients who underwent hip (HPRO) and knee arthroplasty (KPRO) procedures in a large health system between August 2022 and December 2023. Patients with a PAL were identified and demographic, clinical and antibiotic administration data were obtained from the EHR. Clinical data was merged with Social Vulnerability Index (SVI) census-track data comprising 4 subthemes (socioeconomic status, household characteristics, racial/ethnic minority status and housing type/transportation). Higher SVI indicates higher vulnerability. Patients with a PAL who did and did not receive a BLA post protocol implementation were compared.Figure 1:Impact of a Penicillin Allergy Assessment Tool on Beta Lactam Utilization in Patients who Live in High vs Low Social Vulnerability Index Census Tracks*Statistically significant p&lt;0.05

Results
1851 patients with a PAL who had undergone a HPRO and/or KPRO were identified. After implementation of the penicillin allergy assessment tool, 443 (24%) did not receive a BLA preoperatively. PAL Patients that did not receive a BLA after implementation of the tool were more likely to be female and less likely to have an admit status at the time of surgery. Other clinical characteristics including surgical site infection rates were similar between the groups. (Table 1) PAL patients who did not receive BLA were more likely to live in areas with higher socioeconomic status SVI (26% vs 20%), higher household characteristics SVI (27% &gt; vs 22%), and higher housing type SVI (20% vs 15%) than those who did receive BLA. (Figure 1)

Conclusion
Following implementation of an electronic penicillin assessment tool, most patients with a PAL were able to receive BLA safely. The subset of PAL patients who still did not receive BLA more frequently lived in areas with increased social vulnerability. Additional efforts may be needed to ensure the full benefit of tools is achieved in operative patients from areas with high SVI.

Disclosures
All Authors: No reported disclosures
P-1416. Association Between Adherence Barriers and Pharmacy Refill History in Patients with HIV After Medicaid Expansion in Nebraska: An Observational Retrospective Cohort Study
Authors: Amato-Hanner Elizabeth A , Essam Nkodo Emmanuel Nazaire , Furl Renae , Lyden Elizabeth , Timblin Quentin , Havens Josh , Fadul Nada 
Published: January 2025

Abstract

Background
Despite effective HIV treatment, Nebraska's viral suppression rate falls short of national targets (66% vs. 90%). Adherence to Antiretroviral (ART) is a major factor in achieving viral suppression (VS). ART refill history has been shown to correlate with VS, but limited data exists on factors that influence ART refill history. We aimed to explore the relationship between self-reported adherence barriers and ART pharmacy refill data in PWH who gained Medicaid coverage through recent expansion.

Methods
We conducted a prospective cohort study of PWH who enrolled in Medicaid, between October 1, 2020, and December 31, 2021. Adherence Barrier Questionnaire for HIV (ABQ HIV), a validated self-reported 17 items questionnaire and ART refill history, as measured by the percentage of days covered (PDC) were recorded at baseline and 12 months post Medicaid enrollment. PDC was categorized as &lt; 82% or ≥82% which correlates with viral suppression, and ABQ HIV score on a single item &gt;2 indicated a barrier. We performed a Fisher Exact test to look at the association between PDC (categorized &lt; 82 and ≥82) and ABQ-HIV scores (categorized &lt; 2 and ≥2) at baseline and post Medicaid enrollment.

Results
98 PWH completed the ABQ HIV and had PDC data at baseline and follow-up. An average of 42 (SD 33) reported barriers at baseline, compared to 40 (SD 30) at the end of the study. Mean baseline PDC was 73% (SD 25%), increasing to 76% (SD 25%) at the end. At baseline, the majority of respondents for 12 of the 17 ABQ HIV items faced barriers, with items 4 (p=.03), 9 (p=.00), 13 (p=.03), and 15 (p=.00) associated with PDC &lt; 82% (Table 1). Following Medicaid enrollment, majority of respondents still faced barriers, with items 7 (p=0.04), 11 (p=0.00), 13 (p=0.04), 15 (p=0.04), and 17 (p=0.00) significantly associated with PDC ≥82%.

Conclusion
While a substantial proportion of participants continued to face adherence barriers after Medicaid enrollment, there was an improvement in medication adherence from baseline to the end of the study. Self-reported barriers appeared to have a mixed impact on refill history before and after Medicaid enrollment suggesting an indirect impact of insurance status. Future studies are needed to further examine these associations.

Disclosures
Josh Havens, PharmD, Gilead Sciences: Grant/Research Support|Medscape: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant Nada Fadul, MD, ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support
P-1430. Use of Patient-Informed Resources Tailored to Diverse Populations Living with HIV to Improve Shared Decision-Making (SDM)
Authors: Nall Ryan W , Collins-Ogle Michelle , Short William R , Springer Sandra Ann , Molloy Leah , Simone Laura , Napolitan Chris , Carter Jeffrey D , Meza Jimenez Jenniffer A , Pillinger Kelly E 
Published: January 2025

Abstract

Background
People with HIV (PWH) who are engaged in decision-making with their provider are more likely to report treatment satisfaction. Yet, tailored SDM tools for diverse populations of PWH are lacking.

Methods
Four steering committees of PWH and expert providers convened to develop SDM tools for diverse groups living with HIV, including gay and bisexual men, cisgender women, aging adults, and transgender individuals. From 9/23 – 12/23, the tools were implemented in 4 HIV clinics which entailed a short video introducing the concept of SDM and survey on a tablet during check-in, a paper conversation guide with prompts to identify specific health needs, and a survey at the end of the visit. An on-demand video describing SDM and the initiative’s results was disseminated to HCPs nationwide.

Results
There were 87 PWH who participated in the use of the SDM tools (Table 1). A majority felt the SDM tools were helpful (83%) and were empowered to bring up questions about specific health care needs to their team (61% pre- vs. 74% post-survey; p = 0.063). 64% reported discussing their concerns and questions with their HIV care team more or much more than in previous visits, with 50% feeling very involved in decisions at their visit. Interestingly, a third of participants felt it was the care team’s role to make the decisions or they did not want to be involved in SDM. Of the 15 HCPs involved, 67% had previous formal training in SDM. They felt the biggest barriers to SDM were lack of time during visits (40%) and lack of patient interest (33%).
Of HCPs who participated in the on-demand video (N = 405), there was an increase in commitment to talking about barriers to staying engaged in HIV care (34% pre vs. 50% post; p &lt; 0.001) and involving PWH in treatment decisions (45% pre vs. 62% post; p &lt; 0.001). Top barriers to SDM among this group were low health literacy (38%), lack of professional training in SDM (28%), and scarcity of resources for PWH with diverse needs (27%). Confidence in engaging people from diverse backgrounds in SDM increased from 65% to 77% (p &lt; 0.001).

Conclusion
Implementation of SDM tools tailored to diverse populations of PWH are needed and can improve engagement in care. Reasons for lack of interest in SDM among some PWH should be explored further. Formal training in SDM for HCPs can increase confidence and use in real-world settings.

Disclosures
William R. Short, MD, Gilead: Grant/Research Support|Janssen: Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Honoraria Sandra Ann Springer, MD, Alkermes Inc: Honoraria|Alkermes Inc: In kind study drug donation for NIH sponsored research|Indivior Pharmaceutical company: In kind study drug donation for NIH sponsored research Kelly E. Pillinger, PharmD, AHFS: Contractor
P-1432. Assessing Equitable Access to Carbapenemase Production Testing in Los Angeles County Hospitals
Authors: OYong Kelsey , Bhaurla Sandeep , Knight Wendy , Hindler Janet A , Rubin Zachary A 
Published: January 2025

Abstract

Background
Carbapenemase producing organisms (CPO) are the cause of difficult-to-treat infections that result in substantial morbidity and mortality. Due to this and because CPOs can spread quickly between patients, hospital microbiology laboratories should be incentivized to test for carbapenemase production (CP), yet testing costs have stifled uptake. In Los Angeles County (LAC), laboratory professional organizations and the LAC Department of Public Health have broadly promoted CP testing, without emphasis on hospitals that accept patients of highest risk of acquiring a CPO, including patients with a history of long-term care. This analysis assesses CP testing uptake in LAC hospitals and association with patient population and social vulnerability.

Methods
CP testing in hospitals was assessed using the 2022 National Healthcare Safety Network Annual Facility Survey. We assessed patient origin from the Centers for Medicare and Medicaid Services claims and Minimum Data Set and patient characteristics from the California Department of Health Care Access and Information Healthcare Utilization. Frequencies, logistic regression, and Fisher’s exact tests were performed to evaluate the relationship between CP testing and hospital patient and facility-level characteristics.

Results
Of the 79 surveyed hospitals in LAC, 51 (65%) tested for CP. No significant relationship was identified between access to CP testing and the number of patient transfers from high-risk facilities (OR=1.00 , 95% CI [1.00, 1.00]), area poverty (OR=1.01 , 95% CI [0.95, 1.07]), the percent of patients with Medicaid or Medicare (OR=0.94 , 95% CI [0.91, 0.98]), the percent of non-white patients (OR=1.01 , 95% CI (0.99, 1.03]), and hospital ownership (p=0.66).

Conclusion
Access to CP testing was lower among hospitals serving more patients with public insurance and did not differ based on number of high-risk patients. This analysis is limited in that testing capacity was assessed, but data were not available on frequency of testing or implementation of a process to test at-risk individuals. Testing performed at the LAC Public Health Laboratory can supplement testing gaps for facilities of high need. More outreach to hospitals serving highest risk patients to support access to CP testing is needed.

Disclosures
All Authors: No reported disclosures
P-1459. Racial Disparities in Treatment of Community-Acquired Pneumonia in Hospitalized Patients
Authors: Walker Ramara E , Schulte Rebecca , Pallotta Andrea , Wang Ming , Criswell Victoria A , Rothberg Michael , Deshpande Abhishek 
Published: January 2025

Abstract

Background
Community-acquired pneumonia (CAP) is a leading cause of hospitalizations and mortality in the US. Studies have reported racial disparities in various infectious syndromes, but race is not known to be associated with antimicrobial resistance. Limited data exist on racial differences in CAP treatment in the inpatient setting. The aim of this study was to assess the impact of racial/ethnic differences on prescribing habits in hospitalized patients with CAP.

Methods
This retrospective cohort study of 10,224 patients assessed associations between race/ethnicity and initiation of extended spectrum antibiotics (ESA) for non-Hispanic White (NHW), non-Hispanic Black (NHB), and other minoritized patients ≥ 18 years hospitalized at 12 Cleveland Clinic hospitals with CAP between November 1, 2022 – January 31, 2024. Parametric and non-parametric methods were used to describe demographic and clinical differences amongst the comparator groups. The association between race/ethnicity and ESA initiation was assessed using a multivariate logistic regression model adjusting for age, gender, area of deprivation index (ADI), certain comorbidities, clinical instability on day 1, and CURB65 score upon admission.

Results
Compared to NHW patients, NHB patients lived in areas with higher ADI and were more likely to have Medicaid insurance, diabetes, cardiovascular disease, renal failure, and alcohol and substance abuse. Viral respiratory pathogens were more common among NHW and others versus NHB (12% vs 15% vs 10%; p &lt; 0.001), but bacterial respiratory pathogens were similar for NHW and NHB patients with lower rates for others (8% vs 6%; p &lt; 0.001). No racial differences were observed amongst comparator groups regarding rates of clinical stability or resistant organisms. NHB patients were initiated on ESA more often than NHW and other patients (29% vs. 26% vs. 28%, respectively; p = 0.04). In the multivariable logistic regression, NHB patients had 23% higher odds of being initiated on ESA than NHW patients (adjusted OR = 1.23; 95% CI = 1.09-1.39).

Conclusion
After adjustment for clinical and sociodemographic characteristics, NHB patients with CAP were more likely to be initiated on ESA than NHW patients. Further studies are warranted to understand these differences.

Disclosures
Andrea Pallotta, PharmD, Astra Zeneca: Advisor/Consultant|Viiv: Advisor/Consultant Michael Rothberg, MD, MPH, Blue Cross Blue Shield: Advisor/Consultant|CRISPER: Stocks/Bonds (Public Company)|Moderna: Stocks/Bonds (Public Company) Abhishek Deshpande, MD, PhD, AHRQ: Grant/Research Support|Clorox Healthcare: Grant/Research Support
P-1473. Amoxicillin-Clavulanate Transition Therapy in ESBL Urinary Tract Infections
Authors: Radoncic Abigail , Box Maggie 
Published: January 2025

Abstract

Background
Extended-spectrum beta-lactamase (ESBL)-producing bacteria are notoriously resistant to many antibiotics, resulting in limited treatment options for such infections. Pathogens that possess this resistance mechanism typically necessitate the use of broad-spectrum antibiotics. An often-overlooked option for ESBL urinary tract infections (UTIs) is amoxicillin-clavulanate (AMC). Currently, there is a dearth of evidence supporting its use. This analysis was done to assess the efficacy of AMC on ESBL UTI clinical cure and associated outcomes.

Methods
This was a retrospective chart review conducted at Scripps Memorial Hospital La Jolla between January 1st, 2018 and January 31st, 2023. Adults with UTIs caused by ESBL pathogens who completed an AMC course as UTI treatment were included. The primary outcome was clinical cure, defined by the absence of reported symptoms in hospital or clinic encounters within 7 days of AMC completion. Secondary outcomes included 30-day relapse (UTI with the same organism within 30 days), 30-day reinfection (UTI with a different organism within 30 days), or 90-day recurrence (infection with same organism within 90 days).

Results
A total of 196 patients were screened for enrollment, of which 100 were included. Uncomplicated cystitis (UC) was identified in 39% of patients, complicated cystitis (CC) in 17%, pyelonephritis in 25%, and catheter-associated UTI (CAUTI) in 19%. Concomitant bacteremia was identified in 9% of patients. AMC oral transition (IV step down) therapy was used in 61% of patients. Overall, 7-day clinical cure regardless UTI type was 96%. Clinical cure was 97.4% for UC, 94.1% for CC, 92% for pyelonephritis, and 100% for CAUTI. Of the patients who received AMC as primary therapy (n = 39), 100% achieved 7-day clinical cure. Clinical cure in those with an AMC MIC of ≤ 4/2 was 95.8% (n =56) and in those with a MIC of 8/4 was 96.2% (n = 53). In those with concomitant bacteremia, 77.8% (7/9) achieved 7-day clinical cure. UTI 30-day relapse, 30-day reinfection, and 90-day recurrence occurred in 17%, 8%, and 16% of patients, respectively.

Conclusion
Amoxicillin-clavulanate may be a promising oral transition therapy for ESBL UTIs. Larger, more robust studies should be done to analyze the efficacy of AMC as an option for primary or transition therapy for ESBL UTIs.

Disclosures
All Authors: No reported disclosures
P-1478. Assessment of Beta-lactam Susceptibility Profiles in Pseudomonas aeruginosa: A Comprehensive Analysis at an Academic Medical Center
Authors: Burgess David S , Olney Katie B , Burgess Donna R 
Published: January 2025

Abstract

Background
Pseudomonas aeruginosa is one of the most difficult bacterial pathogens to treat. As beta-lactams remain the most prescribed class of antimicrobials to treat P. aeruginosa infections, the objective of this study was to describe susceptibility profiles of first line beta-lactam antimicrobials against P. aeruginosa at our academic medical center.

Methods
All non-duplicate P. aeruginosa isolates from 2021-2023 were analyzed. First line beta-lactams evaluated included aztreonam (AZT), ceftazidime (CAZ), cefepime (CFP), piperacillin/tazobactam (PTZ), meropenem (MEM) as well as newer beta-lactams ceftolozane-tazobactam (C/T), and ceftazidime/avibactam (C/A). Susceptibility testing was performed with the BD Phoenix™ automated system or E-test. Data obtained for each patient included culture date, source of infection, hospital location, and MIC. Each MIC was categorized as susceptible, intermediate, or resistant based on 2024 CLSI MIC breakpoints.

Results
Overall susceptibility rates for each beta-lactam for 1177 isolates were as follows: AZT (75%), CAZ (82%), CFP (83%), PTZ (79%), MEM (84%), C/T (99%), and C/A (99%). Moreover, 70% of P. aeruginosa strains were susceptible to all first line beta-lactams tested, while 25% displayed non-susceptibility to at least 1 first line beta-lactam, and 5% exhibited non-susceptibility to all first line beta-lactams tested. Among strains non-susceptible to at least 1 first line beta-lactam, the majority (37%) exhibited non-susceptibility to only 1 beta-lactam, while 20% and 19% displayed non-susceptibility to 2 or 3 beta-lactams, respectively. Additionally, 25% demonstrated non-susceptibility to 4 beta-lactams. Finally, respiratory isolates consistently displayed the highest incidence of non-susceptibility for each beta-lactam compared to blood, urine, wound, and miscellaneous body sites.

Conclusion
This study highlights the variable susceptibility of first-line beta-lactam antimicrobials against P. aeruginosa infections. These findings stress the importance of customized treatment strategies, surveillance for evolving resistance, and considering newer beta-lactams such as ceftolozane-tazobactam and ceftazidime-avibactam, alongside prudent antibiotic utilization in clinical practice.

Disclosures
All Authors: No reported disclosures