bluuebunny/crossref_metadata_2025_split huggingface dataset:
1818. A Network Meta-Analysis of Antibiotic Efficacy for the Treatment of Skin and Soft Tissue Infections
Authors: Go-Wheeler Marianne , Mann Sarah C , Hean Sindalisa , Schwartz Matthew H , Pham Ann , Judge Stephen , Kang Amy Y , Lee Pamela , Gil Raul Macias , Launer Bryn M , Tao Li , Miller Elliot I , Flores Evelyn A , Nguyen Megan H , Yeh Maddie , Speciale Christiana , Miller Loren G 
Published: November 2023

Abstract

Background
Skin and soft tissue infections (SSTIs) are very common bacterial infections. Numerous clinical trials have compared antibiotics for SSTI treatment. However, trials typically have non-inferiority designs that give little insight as to which antibiotic classes have superior efficacy.

Methods
We performed a systematic literature review and a network meta-analysis of published SSTI treatment trials. Using standardized key words, we searched PubMed and Embase for SSTI clinical trials published from 1/1/66 to 5/31/22. We excluded trials on diabetic foot infections, non-generalizable populations (e.g., burn associated), and studies with outcomes not involving clinical resolution or cure. Abstracts with relevant clinical trial data were pulled and, if inclusion criteria met, had manuscript data abstracted. Two reviewers independently performed abstract and manuscripts reviews and data abstraction. For the network meta-analyses, the comparator antibiotic class was glycopeptides. Two analyses were performed using intention to treat (ITT) and clinically evaluable (CE) populations. Clinical trial quality was measured using the PEDro score.

Results
We reviewed 5,469 abstracts, of which 260 were pulled for data abstraction and 93 contained analyzable trial data (Fig. 1). Clinical trial quality varied widely (PEDro score range 2-10, median 8). We identified 26 analyzable antibiotic classes or combinations for comparison. In the ITT model, cure rate for oxazolidinones (OR 1.28 [95% CI 1.10-1.49]), flucloxacillin plus clindamycin (OR 1.61 [95% CI 1.03-2.53]), lipopeptides (OR 1.66 [95% CI 1.04-2.66]), and tetracyclines OR 1.69 [95% CI 1.24-2.30]), significantly differed from glycopeptides. (Fig. 2) In the CE model, cure rate for oxazolidinones (OR 1.29 [95% CI 1.01-1.64]) and tetracyclines (OR 2.05 [95% CI 1.37-3.06]) significantly differed.

Conclusion
We found that most (22/26) antibiotic classes or combinations used for SSTI treatment had similar efficacy to glycopeptides. However, oxazolidinones, lipopeptides, flucloxacillin plus clindamycin, and tetracyclines may have superior efficacy compared to glycopeptides. Treatment guidelines may wish to favor these latter classes for patients at high risk of treatment failure.

Disclosures
Amy Y. Kang, Pharm.D., BCIDP, Paratek: Grant/Research Support Elliot I. Miller, BS, Epic Systems, Verona, WI: Employee Loren G. Miller, MD MPH, ContraFect: Grant/Research Support|GSK: Grant/Research Support|Medline: Grant/Research Support|Merck: Grant/Research Support|Paratek: Grant/Research Support
1829. The Impact of Social Determinants of Health on Treatment Route, Duration, and Outcomes in Bone and Joint Infections
Authors: Cummins Heather , Gallagher Chanah , Gray Julie , Benefield Russell J , Certain Laura 
Published: November 2023

Abstract

Background
The Oral versus Intravenous Antibiotics for Bone and Joint Infection (OVIVA) trial concluded that oral antibiotic therapy was noninferior to intravenous antibiotic therapy for complex orthopedic infections. Similar studies have confirmed the OVIVA trials findings. However, there is limited information regarding the impact of Social Determinants of Health (SDOH) on decisions regarding IV vs. PO treatment and treatment outcomes of bone and joint infections. This study aimed to determine how SDOH affect IV vs. PO treatment choices and overall treatment outcomes for patients with bone and joint infections.

Methods
In this single-center cohort, patients discharged between 4/1/2018 and 4/1/2022 were examined. Inclusion criteria were patients who had bone and joint infections, inpatient Infectious Disease (ID) consult, discharged on IV vancomycin, age &gt;18 years, and scheduled follow up in the University of Utah Infectious Disease Clinic. SDOH assessed included primary language, race/ethnicity, insurance, history of intravenous drug use (IVDU), and history of homelessness. The primary outcome was the number of patients switched from IV to PO antibiotics two weeks after discharge. Secondary outcomes included total duration of antibiotics, duration of follow up with ID, and rate of treatment failure.

Results
Two hundred seventy-seven patients met inclusion criteria for the cohort. There was no difference with respect to history of homelessness, primary language, history of IVDU, race, ethnicity, or insurance status in patients who were switched to PO antibiotics within two weeks of discharge compared to patients maintained on IV antibiotics. With respect to secondary outcomes, individuals on Medicaid were more likely to experience treatment failure (Table 1B).

Conclusion
For patients with bone and joint infections, SDOH were not associated with a switch from IV to PO antibiotics. However, patients on Medicaid experienced higher rates of treatment failure despite no difference in antibiotic route. The examined SDOH and transition to PO regimens were infrequently observed among study participants which created difficulty with drawing further conclusions. Further examination of these SDOH is important to understand their impact on treatment failure and improve patient care.

Disclosures
Russell J. Benefield, PharmD, BCPS-AQ ID, Paratek Pharmaceuticals: Grant/Research Support
1853. Examining the Role of Race-Ethnicity and Neighborhood Socioeconomic Disadvantage in Influenza Vaccine Uptake
Authors: Sarode Anuja , Speyer Caitlin , Tisch Daniel J , Saade Elie , Salata Robert 
Published: November 2023

Abstract

Background
Negative influenza-associated outcomes disproportionately impact non-White individuals. Targeted influenza vaccine coverage could improve outcomes in minority groups. This study examined the role of race-ethnicity and resource inequity in vaccine coverage.

Methods
We analyzed data from all outpatient visits at University Hospitals CMC from October 01, 2022 to February 28, 2023. Race, ethnicity, age, sex, income, home address, ICD diagnosis, and influenza immunization records were collected. Patients who received an influenza vaccine between July 01, 2022 and February 28, 2023 were considered immunized. A 9-digit patient zip code was used to obtain state Area Depravity Index (ADI) data provided by University of Wisconsin School of Medicine and Public Health. The state ADI ranges from 1 to 10, with group 1 being the least disadvantaged and 10 being the most disadvantaged. We used logistic regression analysis to estimate the odds for being vaccinated predicted by race-ethnicity, state ADI, age, and sex.

Results
Out of 301,572 hospitalizations, 59.0% were women, 81.2% were White non-Hispanic, 16.0% were Black non-Hispanic, and 2.7% were Hispanic. Black non-Hispanics were most disadvantaged with a mean State ADI of 7.54, followed by Hispanics at 5.64. White non-Hispanics were least disadvantaged with a mean State ADI of 3.99 (p&lt; 0.001)(Table 1). Black non-Hispanics were disproportionately represented in the most disadvantaged areas (27.93%). Black non-Hispanics were 38% less likely to be vaccinated than White non-Hispanics. After ADI, sex, and age adjustment, Black non-Hispanics were 11% less likely to be vaccinated (OR: 0.89; 95% CI: 0.868 - 0.912). With each point increase in State ADI, vaccination rate decreased by 7% (OR: 0.93; 95% CI: 0.928 – 0.933)(Table 3). Regression analysis suggested significant interaction between race-ethnicity and State ADI.
Influenza Vaccination by individual characteristics within overall population and race-ethnicity

Influenza vaccination by race-ethnicity adjusting for State ADI, age, and sex
Influenza vaccination by race-ethnicity adjusting for State ADI and sex, and stratified by age groups

Conclusion
This cross-sectional study found racial and ethnic disparities in rates of influenza vaccination. The effect of race-ethnicity on vaccination rate is dependent on ADI. These data identified subgroups on which to focus future influenza prevention efforts. The generalization of the study is limited and similar analysis from other areas and vaccines would be beneficial.

Disclosures
Elie Saade, MD, MPH, FIDSA, Envision Pharma: Speaker, Presenter|Johnson and Johnson: Speaker, Travel, Lodging|Protein Sciences Corp: Grant/Research Support|Sanofi Pasteur: Speaker, Travel and Lodging
1861. Prevalence of COVID-19 within Predominantly Black Church Congregations in Ontario, Canada
Authors: Wisener Nicole , Litosh Alice , Byrne Walter , Hwang Matthew , Thompson Kimberly , Allen Upton D 
Published: November 2023

Abstract

Background
Seroprevalence data provide useful information on COVID-19 burden among various communities by detecting infection in both symptomatic and asymptomatic persons. One challenge is the extent to which potential participants agree to blood testing. To address this, we conducted a community-based survey to assess infection rates within church congregations to understand COVID-19 prevalence in a closed group setting in contrast to a conventional open community setting.

Methods
A cross-sectional survey was conducted within church congregations consisting of mainly Black members from 09/2022 to 05/2023 in Ontario, Canada. Participants completed the survey in person or online. Demographic data and COVID-19-related information, such as polymerase chain reaction (PCR) or rapid antigen positivity and vaccination status, were collected. Survey data were compared with seroprevalence data collected in a related study.

Results
The survey was completed by 434 persons from 5 different congregations. Male to female ratio 1:2.6. Most participants, 319 (73.5%) completed the survey on paper, in person. The remaining surveys were completed online. Among persons who provided information on age, 50 (12%) survey respondents were 18-30 years of age, 90 (21%) were 31-45, 163 (38%) were 46-60, and 121 (29%) were above 60 years of age. Across all congregations, 46.1% (200/434; 95% CI 41.3-50.9%) reported that they thought they had COVID-19, compared with 39.4% (171/434; 95% CI 34.7-44.1%) who reported testing positive for COVID-19. Among all participants, 9% (40/434) did not receive the COVID-19 vaccine while 88.7% (385/434) completed their primary vaccine series.
Seroprevalence data collected by our team revealed a seropositivity rate of up to 80% for the area where most participants reside or work. Among a subset of persons providing both seroprevalence and survey data, there was concordance in approximately 62% (8/13) of seropositive cases.

Conclusion
The data suggest infection rates reported by a relatively highly vaccinated group of predominantly Black congregants were below that of the general community. Further analyses will examine reasons for these findings.

Disclosures
All Authors: No reported disclosures
1889. The Epidemiology of Nontuberculosis Mycobacteria in a Single Urban Center
Authors: Alsoubani Majd , Park Heidi , Vindenes Tine 
Published: November 2023

Abstract

Background
Non tuberculosis mycobacteria (NTM) are ubiquitous in the environment. The prevalence of NTM has increased worldwide, which is thought to be partly related to increased diagnostic testing but also possible aging populations, increased comorbid conditions and immunosuppression. NTM are considered rapidly emerging infections and often hard to treat. We aim to explore the true burden of NTM at Tufts Medical Center, a tertiary hospital serving a diverse patient population including a large immigrant Asian population

Methods
This was a retrospective case review study done at Tufts Medical Center, a tertiary academic hospital in Boston, MA. We identified adult patients with an ICD-10 diagnosis of NTM between January 2012 and March 2022. Clinical and microbiologic data was collected from the medical record. Patients without microbiology data in our institution were excluded. Chi-square and Fisher’s exact tests were used for categorical variables, student T-test was used for age.

Results
Out of 342 cases with an ICD-10 diagnosis of NTM, 197 patients met our inclusion criteria. In our sample, females represented 51.5% of cases. The majority of cases were white (48.2%) followed by Asian (42.6%). A third of patients with pulmonary NTM had a diagnosis of COPD and only 20% had documented past or current smoking history (Table 1). White patients were more likely to have extra pulmonary NTM compared to Asian patients (24 vs 5, p &lt; 0.001). The most common site of NTM second to lung was skin and soft tissue (n=22, 10.9%). The most common NTM isolated from pulmonary site was Mycobacterium avium (n=85, 51.5%) while rapid growers [Mycobacterium chelonae (n=8, 25%), M.fortuitum (n=7,21.7%), and M. abscessus (n=7, 21.9%)] were the most common NTM isolated in extra pulmonary sites (Table 2).

Conclusion
The epidemiological review of NTM at our urban institution has improved the understanding of the population we serve. Our data show high percentage of Asians with pulmonary NTM cultures and suggest higher predominance of extrapulmonary NTM in Caucasians compared to Asians. The majority of the extrapulmonary NTM were rapid growers. Larger epidemiologic studies and surveillance data are needed to better understand NTM in various environments and hosts.

Disclosures
All Authors: No reported disclosures
1894. Delay in TB care before and during the COVID-19 pandemic, Dushanbe, Tajikistan, 2022
Authors: Sharifov Rajabali , Nabirova Dilyara , Tilloeva Zulfiya Haybullo , Zikriyarova Sanam , Yusufi Salomudin , Jafarov Navruz , Horth Roberta 
Published: November 2023

Abstract

Background
Delays in TB treatment prolong the period of infectivity and are associated with drug resistance. Tajikistan has a high and increasing burden of multidrug-resistant tuberculosis (incidence of 28/100,000 in 2021). Many new cases present with severe disease, indicating delayed care. The COVID-19 pandemic further threatened to undo progress.

Methods
We conducted a retrospective cohort study of people &gt;15 years old newly diagnosed with pulmonary TB in Dushanbe in 2019-2021. We conducted face-to-face interviews using structured questionnaires and abstracted data from medical records. We defined patient-delay as &gt;14 days between TB symptom onset and initial visit, and provider-delay as &gt;3 days from initial visit to treatment initiation. We ran multivariable Poisson regressions to estimate variables associated with presentation-delay and provider-delay.

Results
From 2019-21, 472 people were newly diagnosed with pulmonary TB. Of these, 82% had delayed treatment, 49% were male, 61% had lung tissue decay, 11% had diabetes, and 4% had HIV. Additionally, 42% had been diagnosed in 2019. The proportion with patient-delay was similar before and during the pandemic (83% vs. 82%, respectively, p=0.8). However, the proportion with provider-delay was higher before than during the pandemic (44% vs. 34%, p=0.02). There was no statistical difference in median days of patient-delay before (60 days; interquartile range [IQR]: 15–541) and after (60 days; IQR: 15–360, p=0.6) the pandemic, nor in median days of provider-delay before (7 days; IQR: 4–336) and after (7 days; IQR: 4–225, p=0.6) the pandemic. In multivariable analysis, the COVID-19 pandemic was not associated patient-delay (adjusted risk ratio and 95% confidence interval=1.00; 0.96-1.04). Patient-delay was significantly higher in people who ignored disease symptoms (1.41; 1.20-1.65) and thought services were expensive (1.10; 1.01-1.20) even though they are free of charge (Table 1).

Conclusion
Contrary to expected, presentation-delay for TB diagnosis did not differ before and during the COVID-19 pandemic, and provider-delay was lower. Increased vigilance of respiratory diseases and differential diagnosis for SARS-CoV-2 may have resulted in timelier TB diagnosis. However, interventions to further reduce delays are still needed.

Disclosures
All Authors: No reported disclosures
1899. Core Outcome Domains for Mycobacterium avium complex Pulmonary Disease Clinical Trials: Mycobacterium avium complex Core Outcomes Research (MACCOR)
Authors: Varley Cara D , Stadnik Ryan , Bingham Clifton , Quittner Alexandra L , Lewinsohn David , Winthrop Kevin L 
Published: November 2023

Abstract

Background
Mycobacterium avium complex pulmonary disease (MAC-PD) is a chronic, inflammatory disease with systemic manifestations affecting multiple aspects of patients’ lives. It can require lifelong management, as recurrence is common, however current microbiologic outcomes are often difficult to obtain and insufficient to reflect the impact on patients. We aim to identify the core outcome domains essential to evaluate in future clinical research studies of outcomes in MAC-PD, using an international consensus process, and we describe the Round 1 preliminary results.

Methods
We invited relevant stakeholders in MAC-PD research including patients, caregivers/family members, clinicians, researchers, nonprofit and patient education organizations, and federal research funding organizations to participate in the Delphi consensus process. We used respondent driven sampling to expand our cohort. Participants were asked to rate preliminary domain importance, without regard to availability, feasibility, or validity of measurement instruments, using the Grading of Recommendations Assessment, Development and Evaluation scale (score 1-9). We administered surveys via email through DelphiManager software. We used SAS version 9.4 to describe our participants and the Round 1 core outcome domain scores.

Results
We had a total of 48 participants, including 30 (62.5%) clinicians, 10 (20.8%) researchers, 6 (12.5%) patients, and 2 (4.2%) from organizations that fund MAC-PD research. A majority were women (27, 56.3%), ages 60-69 (16, 33.3%) who identified as White (39, 81.3%) and were from North America (45, 93.8%). Most had 10 years or more experience (33, 68.8%) in their MAC-PD stakeholder role. Symptoms, Microbiology, Treatment Side effects, Chest imaging, Physical function, Treatment burden, and Vitality/Energy domains were rated as Critical (score &gt;7) by more than 70% and had fewer than 15% identifying the domain as Not Important (score &lt;3).

Conclusion
We report the initial evaluation of core outcome domains for MAC-PD through an international consensus process. Identification and dissemination of these domains will help guide research priorities on future outcome measures.

Disclosures
Alexandra L. Quittner, PhD, AN2: Advisor/Consultant|Insmed Pharmaceutical Corp: Advisor/Consultant Kevin L. Winthrop, MD, MPH, AN2: Advisor/Consultant|AN2: Grant/Research Support|Insmed: Advisor/Consultant|Insmed: Grant/Research Support|Insmed: This study was funded by Insmed Inc.|Paratek: Advisor/Consultant|Paratek: Grant/Research Support|Red Hill Biopharma: Advisor/Consultant|Red Hill Biopharma: Board Member|Red Hill Biopharma: Grant/Research Support|Renovion: Advisor/Consultant|Renovion: Grant/Research Support|Spero: Advisor/Consultant|Spero: Grant/Research Support
2110. Enhancing Antibiotic Efficacy Against Enterococcal faecium with Bacteriophage and Antimicrobial Peptides
Authors: Bleick Callan , Stamper Kyle , Mohib Sumaiya , Avery Shaylyn , Biswas Biswagit , Arias Cesar A , Rybak Michael J 
Published: November 2023

Abstract

Background
The urgency to find new alternatives has increased as multidrug-resistant organisms enhance their defense mechanisms. In recent years, there has been a renewed interest in bacteriophages as potential alternatives or adjuncts to antibiotic therapy. However, there is limited information on the impact of bacteriophages with the innate immune system. Cathelicidin LL-37, a cationic peptide with antimicrobial properties, functions in coordination with the immune system to eradicate pathogens. We aim to evaluate how the survival of daptomycin (DAP) and ampicillin (AMP) resistant or non-susceptible Enterococcus faecium isolates are impacted by the interaction between bacteriophage, LL-37, and the addition of DAP/AMP.

Methods
Two E. faecium clinical isolates were utilized: R497 and HOU503. Bacteriophages provided by the Naval Medical Research Command, NV- 503-01 and NV-497 were quantified and propagated to approximately 108 PFU/mL. LL-37 was prepared at a final concentration of 640μM and diluted in RPMI intentionally to a suboptimal concentration of 0.5μM to adjust for a 70-80% survival rate. This was done to detect a synergistic interaction more easily with the addition of phage. Samples were incubated at 37 °C and plated in triplicate on brain heart infusion agar at 2h. After 24h of incubation, colonies were counted for and analyzed. Data was expressed as a mean percent survival with standard deviation. ANOVA with Tukey's HSD post-hoc test was used to determine the variations between each combination used.

Results
The targeted bacterial survival rate against E. faecium isolates was attained by LL-37 at a concentration of 0.5μM. However, when R497 and HOU503 was combined with LL-37, bacteriophage, and DAP/AMP the percentage of bacterial survival was significantly (P&lt; 0.05) lower than that of the growth control, LL-37, AMP/DAP, and bacteriophage alone.

Conclusion
By conducting bacterial survival assays, we observed a notable enhancement in the elimination of multi-drug resistant E. faecium when LL-37, bacteriophage, and DAP/AMP were added. Examining this interaction over longer periods, both with and without varying antimicrobials, will yield more understanding regarding the potential involvement of bacteriophage in the innate immune system's response to fighting infections.

Disclosures
Michael J. Rybak, PharmD, PhD, MPH, Abbvie, Merck, Paratek, Shionogi, Entasis, La Jolla, T2 Biosystems: Advisor/Consultant