bluuebunny/crossref_metadata_2025_split huggingface dataset:
1821. Time Until Definitive Grafting of Battlefield-Related Burn Injuries Is Associated with Burn Wound Infection
Authors: Wakefield Connor , Geringer Matthew , Stewart Laveta , Shaikh Faraz , Carson M Leigh , Lu Dan , Cancio Leopoldo , Gurney Jennifer , Tribble David R , Tribble David R , Kiley John 
Published: November 2023

Abstract

Background
With thermal injuries, infection is the leading cause of mortality after initial injury. We examined factors associated with development of skin and soft-tissue infections (SSTIs) in military personnel who sustained burns.

IQR= interquartile range
Multivariate Analysis of Factors Associated with Development of Skin and Soft-Tissue Infections

Methods
Military personnel with burn injuries sustained during deployment (6/09-12/14) who required admission to the Burn Center at Brooke Army Medical Center were included in this analysis. Definitive grafting was defined as effective, successful wound closure noted in the surgical/wound care record. Infection outcomes were grouped by syndrome and comparative analysis using Fisher’s Exact test, Wilcoxon rank-sum test, and logistic regression were performed.

Results
A total of 144 burn patients were included, of whom 143 (99%) were male with a median age of 24 years (Table 1). Approximately 57% sustained blast trauma and the median injury severity score (ISS) was 9. Total body surface area of the burn was a median of 5.75% (interquartile range [IQR]: 3-95%). Twenty-six (18%) burn patients developed an infection with 57% having ≥1 infection: 8% had SSTIs, 15% had pneumonia, 8% had bloodstream infections, and 3% had urinary tract infections. For the 57 (40%) patients who required grafting, the median days to definitive grafting was 9 (IQR: 6-56 days) for those without infections vs 35 days (IQR: 15-127 days) for those with ≥1 infection. Median hospital length of stay (LOS) was 14.5 days and 3% of patients died. On univariate analysis, time to surgery (p=0.032), duration of time until definitive graft (p&lt; 0.001), increasing ISS (p&lt; 0.001), and hospital LOS (p&lt; 0.001) were associated with SSTI development, while injury mechanism (blast vs non-blast) was not significantly associated (p &gt;0.05). On multivariate logistic analysis, increasing duration of time until definitive graft was associated with SSTI development when adjusted for ISS (regression coefficient: 0.07, 95% confidence interval: 0.02-0.12, p=0.005, Table 2), indicating a weak correlation.

Conclusion
A longer time until definitive graft in wounded military personnel with burn injuries was associated with the development of SSTIs. Studies examining medical and surgical management strategies are needed to mitigate impact of infectious outcomes and reduce the time to definitive grafting in these patients.

Disclosures
All Authors: No reported disclosures
1831. Beyond the Viral Load: Infectious Disease Clinicians as Primary Providers for People Living with HIV
Authors: Daudelin Isaac , Salim Tanzila , Khurana Sahiba , Murthy Ashish , Keller Steven , Finkel Diana , Goshorn Eli S 
Published: November 2023

Abstract

Background
With advances in antiretroviral therapy, life-expectancy for people living with HIV (PLWH) has increased. Many HIV specialists function as primary care providers for PLWH and are often the front-line of defense when it comes to preventative healthcare. The Infectious Disease Practice (IDP) at University Hospital in Newark, NJ serves as a medical home and primary care site for many PLWH. The clinic incorporates preventative healthcare measures into providing whole patient care as well as focusing on HIV specific care. Here, we present data from multiple quality assessment projects at our clinic assessing preventative health measures in PLWH.

Methods
Following IRB NHS determination, data was collected from an EPIC database of PLWH seen at IDP. Guidelines for Primary Care by Infectious Disease Society of America, the Advisory Committee on Immunization Practices, JNC8, and the US Department of Health and Human Services were reviewed.

Results
Bone mineral density (BMD) screening was ordered for 59% and completed in 39% of PLWH who met guideline criteria compared to national average of 7.4%
Among PLWH with Diabetes mellitus (DM), 62% achieved A1C goals, 65% achieved blood pressure goals and 67% achieved LDL-c goals. National averages for achieving A1C, blood pressure, and LDL-C goals in people with DM were 51%, 70%, and 66% respectively in 2018.
Hypertension pharmacologic therapy was initiated, and blood pressure controlled to systolic blood pressure &lt; 150 diastolic blood pressure &lt; 90 in 72% of PLWH compared to national average of 65%
Among PLWH, 64% received at least one dose of PCV13, 60% received at least one dose of PPSV23, and 38% were fully up to date compared with national average 23% in PLWH in 2018 receiving at least one dose of either vaccine.

Conclusion
Clinicians practicing in HIV clinics should be up to date on age-appropriate screenings and vaccinations. The IDP has matched or outperformed national standards in several aspects of preventative healthcare for PLWH including DM, hypertension, vaccinations, and BMD screening. Infectious disease specialists who provide care for PLWH are in a unique, trusted position to deliver preventative healthcare and should have expertise in primary care to optimize patient centered care.

Disclosures
Eli S. Goshorn, MD, Genmark Diagnostics Inc: Advisor/Consultant
1833. Infectious Diseases in Patients Experiencing Homelessness in Detroit, MI Over a Three-Year Period (2020-2023)
Authors: Failla Andrew J , Zervos Marcus 
Published: November 2023

Abstract

Background
The homeless population has many health challenges. In Detroit there are estimated 8000 people experiencing homelessness, 62% with a disabling condition, and an estimated readmission rate 4x greater than non homeless (Homeless Action Network Detroit). Coordinating care presents unique challenges. It is imperative to examine infections over the long term to identify areas for care improvement, education, infection prevention and better access. We show an infection profile in patients experiencing homelessness from admissions over 3 years at a large hospital in Detroit. This will bring to light the needs of this population and foster delivery of equitable care to the classically underserved.

Methods
This is a retrospective cohort study done over a 3 year period from 2020-2023 in homeless patients hospitalized at a 850 bed urban hospital. In total we were able to identify 200 patients, and 31 patients had information collected from the EMR.

Results
Patients were mostly Black (83%) males (77%). 48% had primary care providers. 87% had history of substance abuse (35% endorsing IV). Of the 31 patients, all had an infection during the study period. 16% with diagnosis of HIV, and 42% had Hep C. Most common infections were as follows: soft tissue (51.6%), pneumonia (29%), urinary tract (16%). Most common organism in culture was Staph aureus (42%; 46% MRSA), Strep (13%) and E coli (13%). Of gram negatives, 20% were ESBL and 20% AmpC. 35% had a surgical procedure while inpatient. The most common antibiotics were vancomycin (35%) and cephalosporins (32%). Treatment duration was usually 7-10 days (29%). 61.3% completed treatment, 16% had recurrent infection, and 9.6% lost to follow up. 55% received ID consult, but only 9.6% followed up in clinic. 19.3% saw a street medicine organization. Readmission was low (9.6%), although 19.3% had an ER visit post discharge.

Conclusion
This preliminary study establishes a profile of infections in those experiencing homelessness in Detroit. This data will help educate providers, allow equitable and targeted care to be delivered, and lead to intervention options that improve access to care. In the future we plan to create useful tools such as an antibiogram specific to this population that can help community health organizations impact care delivered at initial contact.

Disclosures
Marcus Zervos, MD, Contrafect: Advisor/Consultant|GSK: Grant/Research Support|Johnson and Johnson: Grant/Research Support|Pfizer: Grant/Research Support
1834. Impact of COVID-19 and Socioeconomic Status on Food Insecurity in the US Adult Population: Analysis of the 2021 National Health Interview Survey
Authors: Freeman Jincong Q , Li Xinyi , Lee Yong Gun , Scott Adam W , Xiang Yijin 
Published: November 2023

Abstract

Background
Food insecurity (FI) is a public health concern and negatively affects the health and well-being of many adults in the US, which may have been exacerbated since the COVID-19 pandemic. However, the relationship between COVID-19 and FI among US adults has not been elucidated.

Methods
Data were from the 2021 National Health Interview Survey that used stratified clustering sampling to interview US adults aged ≥ 18 years. COVID-19 infection (yes/no) was per self-report. FI, determined by a 10-item questionnaire assessing household food situations in the past 30 days, was dichotomized (yes/no). Unweighted frequencies and weighted percentages were calculated and compared using Rao-Scott chi-square tests. Multivariable logistic regression was used to examine differences in FI prevalence by COVID-19. All analyses accounted for complex survey design and weights.

Results
The unweighted sample size was 28,274 (mean age 48.3 years). Overall, 13.5% (95% CI: 13.0%-14.1%) had COVID-19, and 5.9% (95% CI: 5.5%-6.3%) experienced FI. Adults with COVID-19 reported a significantly higher percentage of FI than those without (7.3% [95% CI: 6.1%-8.6%] vs. 5.6% [95% CI: 5.2%-6.0%], p=0.003). Most (63.2%) were White, followed by 16.7% Hispanic, 11.5% Black, 5.9% Asian, and 2.6% other races; 22.6% were on Medicaid/Medicare and 9.8% were uninsured; 12.9% received food stamps in the past 12 months. In the adjusted model, adults with COVID-19 were more likely to have experienced FI than those without (adjusted odds ratio [aOR]=1.29, 95% CI: 1.07-1.56). Black (aOR=2.08, 95% CI: 1.72-2.50) or Hispanic (aOR=1.26, 95% CI: 1.03-1.53) adults were more likely than their White counterparts to have experienced FI. Uninsured adults (aOR=2.67, 95% CI: 2.15-3.31) or those on Medicaid/Medicare (aOR=1.94, 95% CI: 1.60-2.35) had greater odds of having experienced FI than those privately insured. Adults receiving food stamps were more likely to have experienced FI than those not receiving (aOR=2.87, 95% CI: 2.36-3.50).

Conclusion
In this study of a nationally representative sample, our findings highlight a higher prevalence of FI among adults with COVID-19, with lower socioeconomic status, or in racial/ethnic minority communities and suggest the need for intervention strategies addressing FI in these adult populations.

Disclosures
All Authors: No reported disclosures
1836. Disparities in COVID-19 Vaccination Coverage Among a Large Patient Population in a Network of Community-Based Healthcare Organizations
Authors: Groom Holly C , Biel Frances , Crane Bradley , Sun Evelyn , Georgescu Joanna , Weintraub Eric , McNeil Michael , Jazwa Amelia , Owens Constance , Naleway Allison L , Schmidt Teresa 
Published: November 2023

Abstract

Background
There are known disparities in U.S. COVID-19 vaccination by race, ethnicity, and rurality, but there is limited information on national trends in vaccine uptake in a large, racially diverse population spanning all ages. Here we describe COVID-19 vaccination coverage in a large US population accessing care in a national network of community-based healthcare organizations (OCHIN).

Methods
Within the OCHIN network, we identified all individuals aged 6 months and older who had at least one completed encounter in an OCHIN facility across 26 U.S. states since becoming age-eligible for the COVID-19 vaccine, through 2022. Patients’ COVID-19 vaccination status was assessed from the OCHIN Electronic Health Record which includes data from state immunization information systems. Individuals were categorized as vaccinated with the primary series if ≥2 appropriately spaced doses of either mRNA monovalent product, or a single dose of Johnson & Johnson® vaccine, were documented. Coverage was assessed by age groups based on the roll-out of COVID-19 vaccine recommendations (6 months-4 years; 5-11 years, 12-15 years, 16+ years).

Results
The cohort of over 3.3 million identified as Hispanics (37%), non-Hispanic (NH) Whites (31%), NH Blacks (15%), and NH Asians (7%); 44% of whom were Medicaid-enrolled, 19% without health insurance, and 53% with a household income below 100% of the federal poverty level.
The proportion fully vaccinated increased incrementally with age and ranges from a low of 7.2% (6 months through 4 years) to a high of 63.4% (75 years and older); consistently lower than national coverage estimates across age groups (Figure 1). Patterns are consistent across age groups, where coverage is highest among NH Asians (range: 13%-64%) and lowest for NH Blacks (3%-40%) (Figure 2); and lowest among the people without insurance (7%-41%). Those with ≥ 1 prior influenza vaccine since 2019 had higher coverage than those without, most notably among those aged 16+ years (71% vs. 16% fully vaccinated, respectively). (Figure 3)Figure 1.COVID-19 Vaccine Primary Series Coverage, OCHIN vs. CDC National Estimates*, OCHIN, December 2022

Conclusion
We identified disparities in primary series COVID-19 vaccine coverage by age, race and ethnicity, household income, insurance status, and by prior influenza vaccination within this large, diverse population accessing care in community-based healthcare organizations.

Disclosures
All Authors: No reported disclosures
1841. Younger age and female gender are associated with delayed antibiotics in pediatric sepsis
Authors: Kandil Sarah B , Lee Seohyuk , Feinn Richard , Murray Thomas S 
Published: November 2023

Abstract

Background
Sepsis is a leading cause of pediatric mortality, with nearly 5,000 children dying annually.(Weiss, Fitzgerald et al. 2015) Clinical advances in care bundles to improve sepsis recognition and timely treatment have demonstrated improved outcomes.(Lane, Funai et al. 2016) Recently, literature suggests an association between pediatric sepsis mortality and various social determinants of health, including race and socioeconomic status.(Reddy, Badolato et al. 2022, Li, Ng et al. 2023) It is unclear what may contribute to these disparities; therefore, we chose to evaluate if race, ethnicity or other factors resulted in delayed antibiotic administration.

Methods
This retrospective cohort review of a single center quality improvement pediatric sepsis dataset included admitted patients with a blood culture and intravenous antibiotics within 4 hours and a hospital diagnosis of sepsis. Patients admitted to the neonatal intensive care unit were excluded. The primary outcome was antibiotic administration &gt; 60 minutes. Exposures of interest included age, gender, race, ethnicity, language, sepsis severity level, ICU admission and mortality. Analysis included descriptive statistics and Chi-Square testing.

Results
From 2016 – 2023 there were 322 patients [43% White, 19% Black, 38% Other (Asian, multiple racial, or unavailable)], with 61% identified as non-Hispanic and 39% Hispanic. English was the primary language (83%) and there were 52% females, and 48% males. Overall, 58% of patients required intensive level care and 6.8% died. The mean time to antibiotics was 75 minutes. There was no statistical significance when evaluating if race, ethnicity, language, or sepsis severity contributed to antibiotic delays of &gt; 60 minutes. Factor associated with a statistically significant delay in antibiotic administration were: mortality (68.2 died % vs 31.8% survived; p &lt; 0.003) and female gender (46% female vs 29% male ; p &lt; 0.002); regardless of sepsis severity and infants &lt; 1 year (59% &lt; 1 year, 32%, 1-17 years, and 31 % &gt;18 years; p&lt; 0.001).

Conclusion
Inequities exist in the timely delivery of antibiotics for younger infants and female patients with an admitting diagnosis of sepsis. Further investigation is warranted to identify drivers for these inequities.

Disclosures
All Authors: No reported disclosures
1842. Low Birthweight and Retention in HIV Care among Postpartum Women Living with HIV in Ghana
Authors: Kazanji Noora , Sakyi Kwame , Edler Bianca 
Published: November 2023

Abstract

Background
In Ghana, caring for small babies is associated with low social support, delayed care seeking, and experience of perceived stigma. These psychosocial factors can affect retention in HIV care for mothers living with HIV (MHIV). This has implications for maternal health and continuous access to lifesaving antiretroviral therapy (ART). Consequently, these women have higher risks of mortality, disease progression, and elevated viral load which can place the infant at risk of HIV acquisition through breastfeeding. The goal of this study was to examine the effect of infant birthweight on retention in HIV care among postpartum MHIV in Ghana.

Methods
A secondary analysis was conducted on a longitudinal study which examined how caring for low birthweight infants influenced maternal ART adherence. Study participants included 126 postpartum MHIV who delivered at hospitals in Accra, Ghana. Participants were enrolled at time of birth and followed for six months. Modified Poisson and Poisson Bivariate and Multivariate regression models were performed to examine two primary outcomes: missing one or more of the three expected visits for HIV care within six months after birth and total number of HIV clinic days missed within six months after birth. Primary exposure variables included hospital recorded birthweight and the size of the infant as perceived by the mother.

Results
In multivariate analysis, controlling for ART adherence, time on ART, education, income, baby health, age, hospital site, and internalized HIV stigma, for every 1 unit increase in birthweight, MHIV missed significantly less days of HIV care [IRR = 0.71, CI: 0.66 - 0.8, p&lt; 0.001]. MHIV who perceived their infant size to be less than average missed significantly more visits when compared to MHIV who perceived their infant size to be average, while controlling for the same covariates [IRR = 1.41, CI: 1.27- 1.56, p&lt; 0.001].

Conclusion
For MHIV, the size of the baby affects retention in HIV care from both hospital-recorded birthweight and perceived infant size by the mother. Further interventions are needed at the individual and health system levels, especially towards reducing internalized stigma, to help mothers remain engaged in HIV care.

Disclosures
All Authors: No reported disclosures
1844. HIV Home Care - The First Five Years
Authors: Khaja Sumaiya F , Keri Vishakh C , McClendon Tammie , Veltman Jennifer , Newman Gretchen Snoeyenbos 
Published: November 2023

Abstract

Background
To achieve HIV care continuum goals, novel modes of HIV care are needed. In 2017, the Wayne State University Home Care Program (HCP) was launched in Detroit, Michigan. The primary purpose of this program is to re-engage people with HIV (PWH) who have been unable to attend regular clinic visits through an intensive, in-home model of HIV care. This study evaluates the outcomes of the first 5 years of this program.

Methods
We conducted a retrospective cohort analysis of the 81 patients enrolled in the HCP from inception in 2017 to December, 2022. We evaluated duration of participation, reason for discharge from the program, and effect of a full year of program participation on viral suppression (viral load ≤ 20 copies/mL) and CD4 count (above or below 200 cells/mm3). Patients who did not have at least 1 year of participation were excluded from analysis of change in VL and CD4 count. McNemar test of significance was used, p value of &lt; 0.05 was considered significant.

Results
Most of the patients enrolled in the HCP were African American (95.1%) and male (65.4%). Common primary barriers to clinic visits were transportation (27.2%) and stigma (25.9%). The median duration spent in the HCP was 924 days (approximately 2.5 years). At entry, 15.3% of patients had a suppressed viral load, and after the first year of enrollment, 52.5% of patients achieved viral load suppression (p&lt; 0.001). Similarly, 72.9% of patients achieved a CD4 ≥ 200 cells/mm3 after a year when compared to 57.6% of patients at entry with CD4 ≥ 200 cells/mm3 (p=0.012). Of the 81 patients enrolled during the study period, 28 patients (50%) returned to clinic-based care, out of which 21 patients (91.3%) were retained in care and 2 (8.7%) were lost to follow-up. Total of 11 patients (19.6%) died during the study period.Table 2:Home Care Program Outcomes

Conclusion
The Wayne State University Home Care Program is an innovative model to re-engage and maintain PWH who are unable to receive care in traditional settings. By removing physical and stigma-related barriers, the HCP was able to improve viral load suppression and CD4 count among an ill and “hard to reach” cohort. Additionally, the HCP empowered patients to successfully return to clinic-based care.

Disclosures
All Authors: No reported disclosures
1849. Impact of Medicaid Expansion on Human Immunodeficiency Virus Outcomes in Nebraska
Authors: McCluskey James M , Furl Renae , Arroyo Monica , Fadul Nada 
Published: November 2023

Abstract

Background
Human immunodeficiency virus (HIV) viral suppression (VS) is a major predictor for improved clinical outcomes and decreased viral transmission in patients with HIV (PWH). There is evidence to suggest that enrollment in the Affordable Care Act (ACA) qualified health plan is associated with improved VS, however there is inconsistency in the literature on whether Medicaid enrollment can lead to similar outcomes. Previous research has shown that PWH living in Medicaid expansion states are more likely to be covered by Medicaid and less likely to be uninsured compared to those who live in non-expansion states. In 2014, the ACA Medicaid expansion went into effect and expanded Medicaid coverage to most adults with an income up to 138% of the Federal Poverty Level (PFL), which is $14,580 for an individual in 2023. Nebraska implemented the expansion October 2020. This provided an opportunity to further evaluate this gap in the literature using the data from the main provider of HIV care in Nebraska, the University of Nebraska Medical Center Specialty Care Center (UNMC SCC).

Methods
PWH were recruited from UNMC SCC for a retrospective observational study that included all patients 19 years of age or older that had at least one HIV provider clinic visit in the preceding 12 months before October 2020. If the patients had unknown income or were below 138% FPL and were not already enrolled in Medicare or out of state Medicaid, they were considered eligible for Medicaid expansion. PWH that were eligible and those that were not eligible for Medicaid expansion then had follow up viral loads compared to assess for VS.

Results
A diverse group of 1,069 patients were included in the study (Table 1). No statistically significant result was found between baseline VS, however those that were not eligible for Medicaid expansion showed a greater level of VS at follow up (Table 2), p=0.003.

Conclusion
This retrospective study found that approximately 1 year after Medicaid expansion in Nebraska, PWH that were not eligible for Medicaid expansion had better VS. This could be explained by a lack of those that were newly eligible for Medicaid being able to enroll among other reasons. This finding warrants further evaluation to assess for barriers to care, including but not limited to, Medicaid enrollment and its contribution to HIV VS.

Disclosures
All Authors: No reported disclosures