bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-392. Use of Oral Tobramycin to Prevent Surgical Site Infections in the Setting of an Oral Neomycin Shortage for Patients Undergoing Colorectal Procedures: A Retrospective Chart Review
Authors: Radziszewski Skyler , Altar Melanie , Ondrush Nicole M , Patel Gopi , Adams-Sommer Victoria , Sadler Eleanor D , Santeusanio Andrew , Walits Emily , Lerner Polina 
Published: January 2025

Abstract

Background
Oral neomycin tablets have been the standard of care for gut decontamination to prevent surgical site infections (SSIs) in patients undergoing colorectal procedures. In August 2022, a shortage of oral neomycin tablets prompted the need for an alternative agent. Based on previously published data, intravenous tobramycin solution administered orally was selected at our institution. The objective was to compare rates of SSIs between oral neomycin and oral tobramycin in patients undergoing colorectal procedures.

Methods
A single-center, retrospective cohort study was conducted in adult patients at The Mount Sinai Hospital who received preoperative oral antibiotics for gut decontamination prior to colorectal procedures. Patients who received oral neomycin between November 2021 and April 2022 were compared to those who received oral tobramycin between November 2022 and April 2023. Patients who did not receive a companion antibiotic (erythromycin or metronidazole) were excluded. The primary outcome was incidence of SSI within 30 days following colorectal procedure. Secondary outcomes included return to operating room (OR), re-admission, and mortality within 30 days of procedure, post-operative length of stay, and incidence of C. difficile infection.

Results
A total of 119 patients were identified with oral gut decontamination regimens using neomycin (n = 63) and tobramycin (n = 56), who met study criteria. Baseline characteristics, including age, body mass index, and infection present at the time of surgery were similar between the two groups. The incidence of SSI was 3.2 per 100 procedures in the neomycin group and 3.6 per 100 procedures in the tobramycin group (p=1.00). There were no statistically significant differences in secondary outcomes including return to OR, readmission, incidence of C. difficile infection, or mortality within 30 days of the colorectal procedure. The median post-operative length of stay was 6 days in the neomycin group and 5 days in the tobramycin group (p=0.22).

Conclusion
Intravenous tobramycin solution administered orally was not associated with a higher rate of SSIs than standard of care for decontamination prior to colorectal procedures. These findings will contribute to the limited literature on this topic in the United States.

Disclosures
All Authors: No reported disclosures
P-398. External Validation of the Korean National Healthcare-Associated Infections Surveillance System (KONIS): A Surgical Site Infection Module Report
Authors: Kim Young Keun , Song Kyoung-Ho , Kim Su Hyun , Jeong Hye Ran , Shin Eunjeong , Song Jeongsuk , Park Sook-Kyung , Jang Sohee 
Published: January 2025

Abstract

Background
Validation of national surveillance data is necessary to identify methodological problems within the surveillance program, to help increase compliance and participation in the surveillance program, and to identify data quality issues.Table.Validation of the data of cholecystectomy, colectomy and spinal fusion from Korean National Healthcare-associated Infections Surveillance System (KONIS): A Surgical Site Infection Module Report

Methods
To determine the reliability and consistency of the application of surveillance definitions of the Korean Surgical Site Infections Surveillance System (KONIS-SSI), a validation study was conducted on data collected during the 4th quarter of 2022 for cholecystectomy, colectomy and spinal fusion. The 36,032 cholecystectomy of 162 hospitals, 11,819 colectomy of 60 hospitals and 14,949 spinal fusion of 57 hospitals were surveilled during 2022. Among them, a total of 2,508 operative procedures from 1,011 cholecystectomy of 27 hospitals, 702 colectomy of 20 hospitals and 795 spinal fusion of 20 hospitals were evaluated. Using the reviewers' classification of infection as the "gold standard", the sensitivity, specificity, positive and negative predictive value of the surveillance data were determined.

Results
The sensitivity, specificity, positive predictive value and negative predictive value for surgical site infections was 80.43%, 99.96%, 98.67% and 99.26%, respectively. The rate of disagreement was 99.24%. The rate of agreement of cholecystectomy, colectomy and spinal fusion was 99.70% (95% CI 99.13-99.90, 1,008/1,011), 98.43% (95% CI 97.22-99.12, 691/702) and 99.37% (95% CI 98.54-99.73, 90/795), respectively. The reasons of disagreement were a disagreement of surgeons, lack of medical records and system instablity of each hospital.

Conclusion
This study shows the necessity of continuous training and contact with surveillance personnel for maintaining data accuracy of surveillance data.

Disclosures
All Authors: No reported disclosures
P-436. Anal Pap Cytology for Anal Intraepithelial Neoplasia in Individuals under 45 Years of Age
Authors: Choudhuri Irada , Layden Alexander , Baran James , Faaborg Kevin B , McMahon Deborah , Ho Ken , Li Yijia 
Published: January 2025

Abstract

Background
Human Papilloma Virus (HPV)-related high-grade anal intraepithelial neoplasia (AIN) is the precursor of anal cancer. There are limited data identifying factors that influence AIN progression in adults eligible to HPV vaccines.Figure 1.Distribution of anal cytology and reference test results (n=488). (A) Anal cytology. (B) Reference testASCUS, atypical squamous cells of undetermined significance; LSIL, low grade squamous intraepithelial lesions; ASC-H, atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions; HSIL, high-grade squamous intraepithelial lesions; SCCIS, squamous cell carcinoma in situ.

Methods
This retrospective study includes individuals followed at University of Pittsburgh Anal Dysplasia Clinic from 2020-2024. Inclusion criteria were ages 18-45 years as of 2020, all sexes/genders, people with HIV (PWH) or without, and at least one anal cytology paired with pathology (reference standard) or high-resolution anoscopy (HRA) appearance (reference standard if pathology unavailable). We used Logistic regression to evaluate factors associated with high-grade squamous intraepithelial lesion (HSIL) or squamous cell carcinoma in situ (SCCIS) on reference tests (designated as ref-HSIL here). The University of Pittsburgh IRB approved this study.Table 1.Baseline demographics.

Results
We included 239 individuals, with median age 37 years, 16% female, and 95 (40%) received at least one dose of HPV vaccine at initial median age of 26 years (Table 1). Of 191 PWH, 93% were virologically suppressed, with median CD4 count 748 cells/µl at initial visits (2020 or after), and median nadir CD4 count 360 cells/µl. Distribution of cytology and reference tests (149 from pathology and 339 from HRA) was shown in Figure 1. Anal cytology had low-moderate sensitivity (55%) and specificity (82%), but an acceptable negative predictive value of 96% for ref-HSIL. In full cohort, risk factors for ref-HSIL were ASC-H (atypical squamous cells, cannot exclude HSIL) or HSIL on cytology (adjusted odds ratio [aOR] 6.19, P&lt; 0.001). In PWH, nadir CD4 count &lt;200 cells/µl (aOR 4.08, P=0.008) was associated with ref-HSIL while viral suppression tended to be protective (Table 2). Seven individuals with initial non-ref-HSIL progressed to ref-HSIL. Nadir CD4 &lt; 100 cells/µl (aOR 25.0, P=0.010) and current smoking (aOR 6.2, P=0.095, Table 3) showed a trend in association with progression.Table 2.Factors associated with HSIL or SCCIS on reference tests in PWH.Table 3.Factors associated with progression to HSIL/SCCIS.

Conclusion
In this cohort of adults ≤45 years, cytologic ASC-H or HSIL predicts ref-HSIL. In PWH, low nadir CD4 count is a risk factor for ref-HSIL, while viral suppression is protective. Low nadir CD4 count is also a risk factor for AIN progression to ref-HIL. Our study helps prioritize target individuals who need HRA the most.

Disclosures
All Authors: No reported disclosures
P-450. Burden of Fungal Infection among People Living with HIV (PLHIV): A Nationwide Inpatient Data Analysis (2019-2021)
Authors: Macaraeg Chef Stan L , Aldecoa Kim Abbegail 
Published: January 2025

Abstract

Background
Fungal diseases represent a significant healthcare concern in the general population. Their prevalence and impact are even more pronounced among PLHIV, yet data within this population remains limited. The study aims to investigate the most prevalent fungal infection among PLHIV and its corresponding healthcare burden. Additionally, it explores the sociodemographic of fungal infection among PLHIV.

Methods
The National Inpatient Sample database from 2019 to 2021 was utilized to identify all patients with a primary diagnosis of fungal infection. Patients were categorized into HIV and non-HIV. We used Stata 18.0, with a p-value &lt; 0.05 indicating statistical significance.

Results
Among the 66, 225 hospitalized patients with fungal infection, there were 3543 weighted HIV patients (4.9%). HIV patients were significantly younger (43.8 vs. 62.9), Black (52.7%), with Medicaid (51.2%), and with a low median income of ≤ $49,000 (50.2%). No specific trend was observed from 2019 to 2021 in the prevalence of fungal infections among PLHIV (4.9%, 5.1%, 4.7%) and total hospital costs ($25600, $26913, $25869)
There remains an increased likelihood of cryptococcus (OR: 5.69, 95% CI: 4.6-7.0) and pneumocystis (OR: 10.71, 95% CI: 8.7-13.2) among PLHIV compared to the general population after adjusting for age and sex. Cryptococcus infection has a longer length of stay (LOS) compared to other fungal infections among PLHIV (13.5 vs. 7.6, p&lt; 0.05) and higher total hospital costs ($52470 vs. $20153, p&lt; 0.05). The result was consistent with multivariate analysis after adjusting for age, sex, and Charlson comorbidity index (CCI).
In contrast, pneumocystis infection among PLHIV had shorter LOS compared to other fungal infections (8.3 vs. 9.8, p&lt; 0.05), and the total hospital costs were significantly lower ($21331 vs. $33542, p&lt; 0.05). However, in a multivariate analysis after adjusting for age, sex, and CCI, only the difference in total hospital costs remained significant.

Conclusion
Fungal diseases remain a serious concern among PLHIV, presenting with unique sociodemographic characteristics and significant healthcare costs, particularly with cryptococcus infection. Future strategies should be directed at ways to reduce this significant healthcare burden.

Disclosures
All Authors: No reported disclosures
P-463. Diversity of KSHV Subtypes in People Living with HIV in a Large Urban Center in Dallas, Texas
Authors: Knights Sheena , Marshall Vickie A , Labo Nazzarena , Miley Wendell , Castro Elena Cornejo , Lazarte Susana , Chiao Elizabeth , Whitby Denise , Nijhawan Ank E 
Published: January 2025

Abstract

Background
Human herpesvirus-8 (HHV-8), also known as Kaposi’s sarcoma-associated herpesvirus (KSHV), causes Kaposi’s sarcoma (KS) and other KSHV-associated disease (KAD). We previously described high KSHV seroprevalence and high KS incidence in a population of men who have sex with men (MSM) with HIV in Dallas, Texas. We now describe viral genetics in the same population.Table 1:Participant Characteristics

Methods
We analyzed samples from participants recruited in 2 different studies, one enrolling MSM with HIV with and without KAD, and the other enrolling MSM with HIV and KAD. We measured KSHV IgG in serum using a combination of ELISA and a bead-based multiplex assay. Oral fluid samples of all individuals with KAD and seropositive individuals with no KAD were analyzed by RT-PCR to detect and quantify KSHV DNA. Samples with detectable KSHV underwent Sanger and/or next generation sequencing to determine K1 subtype.Figure 1:Phylogenetic Tree of Participant Samples

Results
Overall, 281 participants were recruited; 59 shed enough virus for K1 subtyping. Of these, 37 did not have KAD, and 22 had KAD, all had KS. Table 1 describes the demographic characteristics of these participants. Notably, those with KS had lower median CD4 countsthan those without KS (p &lt; 0.01). All known K1 subtypes, except for D, were identified in this cohort, including the rare E and F subtypes. The latter, which only recently had been described outside Africa was identified in 6 individuals. Four participants had mixed infections with 2 or more KSHV subtype (Figure 1). Figure 2 illustrates clinical presentations by KSHV subtype. Limitations in sequencing technology and study design permit no inferences on possible associations between KSHV subtype and KS onset or severity. We observed a larger proportion of subtypes B and F, typical of African populations, in participants with KS, than those with no KAD (8/27 subtypes detected vs 3/37). However, A and C were the most commonly identified subtypes in KS (19/27 subtypes in those with KS vs 32/37 subtypes in those without KS), including in advanced cases (i.e. T1 stage, 10/13).Figure 2:KSHV Subtypes and Clinical Presentation

Conclusion
In conclusion, we observed extreme diversity in KSHV genomes sequenced in a single institution in Dallas, TX. Further studies are needed to better understand the relationship between viral genetics and KSHV epidemiology and disease risk in the southern US.

Disclosures
Ank E. Nijhawan, MD, MPH, MSCS, Gilead Sciences: Grant/Research Support
P-468. Prevalence and Associated Factors of Patients Presenting with Advanced HIV Disease in Tertiary Hospital in Bangkok
Authors: Songaurailam Artima , Chumsantivut Suppavit , Piyapan Pattraporn 
Published: January 2025

Abstract

Background
Late entry to healthcare services for HIV patients leads to adverse outcomes and increased mortality particularly advanced HIV disease (AHD) who first presented with opportunistic infection (OI). However, epidemiological data on AHD among Thai patients in suburban government hospital during the Treat-All era was lacking and required to guide the healthcare strategies. This study aims to assess the prevalence, clinical characteristics and risk factors of patients presenting with AHD at Bhumibol Adulyadej Hospital, a tertiary hospital in Bangkok.

Methods
A retrospective cross-sectional study was conducted among newly diagnosed adult HIV patients from 1 October 2019 to 30 September 2023, through electronic chart review. The WHO clinical staging 3-4 was used to define AHD. Logistic regression was used to identify factors associated with AHD.

Results
Among 372 patients, 40.32% presented with AHD, with a median CD4 cell count of 36 (IQR 13-137) cells/mm3. Most of the newly diagnosed HIV patients were single males residing in the hospital’s service area. AHD patients were predominantly aged 30-59 years (62.00%) and identified through clinical suspicious testing (88.67%) rather than voluntary counseling testing (VCT). Risk factors of AHD included ages 30-59 years (adjusted OR (aOR) 1.94 [95%CI 1.13-3.34]) and &gt; 59 years (aOR 4.58 [95%CI 1.49-14.06]), clinical suspicious testing (aOR 11.98 [95%CI 6.61-21.71]), unprotected sex (aOR 1.74 [95%CI 1.01-2.98]), and partner seropositive (aOR 0.18 [95%CI 0.05-0.62]). One-year mortality was significantly higher in AHD who were diagnosed from 2019-2022 (20.31% V.S. 9.88%, p=0.011). The most common OIs among AHD were tuberculosis (54.00%), pneumocystis pneumonia (40.67%) and cryptococcosis (17.33%) consecutively.

Conclusion
Presenting with AHD was common and associated with high mortality. VCT plays a minor role in the study population. The early HIV infection detection program remains needed in all risk groups but should target heterosexual males aged &gt; 30.

Disclosures
All Authors: No reported disclosures
P-472. Development of a Local HIV Care Continuum for the Kansas City Metropolitan Area (KCMA)
Authors: Price Austin , El Atrouni Wissam 
Published: January 2025

Abstract

Background
There were 36,136 new HIV diagnoses in the USA in 2021. Still, an estimated 13% of persons living with HIV (PLHIV) are unaware of their infection. The status of the HIV epidemic can be better understood by constructing an HIV care continuum.Figure 1.Diagnosis-Based KCMA HIV Care Continuums 2019-2022Local diagnosis-based care continuums for 2019-2022 compared with the most recent national HIV surveillance data.

Methods
HIV surveillance data reported to the Kansas Department of Health and Environment (KDHE) and Missouri Department of Health and Senior Services (DHSS) were utilized to create diagnosis-based HIV care continuums for 2019-2022. This included data from Johnson, Wyandotte, and Leavenworth counties in Kansas, and Jackson, Clay, and Platte counties in Missouri. Prevalence-based care continuums were constructed for Kansas City, Missouri for 2019-2021 utilizing the CD4-depletion model employed by CDC. Diagnosis, receipt of care, retention in care and viral suppression are per CDC definitions.Figure 2.Prevalence-Based Kansas City, MO HIV Care Continuums 2019-2021Local prevalence-based care continuums for 2019-2021 compared with the most recent national HIV surveillance data.

Results
From 2019 to 2021, receipt of HIV care in KCMA remained stable, while retention in care (49% to 41.6%) and HIV viral suppression (65.6% to 57.2%) decreased (Figure 1). From 2019 to 2021, HIV diagnosis rates in the 3 counties of Kansas City, Missouri, remained stable at about 87%, but receipt of care rates decreased (41.7% to 35.9%), with stable viral suppression rates (∼54%) (Figure 2). Linkage to care improved from 70% to 75% for the 6-county KCMA from 2019 to 2022 (Figure 3).Figure 3.KCMA Linkage to HIV Care 2019-2022Local linkage to HIV care estimates compared with the most recent national linkage to care estimates.

Conclusion
Knowledge of status appeared to approximate national estimates. However, linkage to care was significantly lower (70-75% vs 82%), which likely negatively impacted downstream stages of the continuum. Local estimates for receipt of care, retention in care, and viral suppression were consistently below national levels. This highlights the importance of ongoing initiatives targeted at the more proximal stages. Reaching undiagnosed PLHIV requires a robust public health infrastructure which utilizes innovative diagnostic approaches to meet at-risk individuals in the spaces where they live and interact. Optimizing more distal stages of the continuum is contingent upon ongoing efforts to ensure all diagnosed PLHIV are efficiently linked to care and started on antiretroviral therapy (ART) in a timely fashion.

Disclosures
Wissam El Atrouni, MD, ViiV Healthcare: Advisor/Consultant
P-476. Pilot Implementation of HIV Self-Testing in Ghana: Analysis of the Community-Based Demand Generation Approach
Authors: Amoabeng Ortsin Ernest , Teye Jonathan Tetteh-Kwao , Adzesi Richard Socrate , Owusu Kwadwo , Ashinyo Anthony , Ayisi Addo Stephen 
Published: January 2025

Abstract

Background
Under the auspices of the Ministry of Health (MoH) and National AIDS/STI Control Programme (NACP), Ghana piloted an HIV Self-Testing (HIVST) project in 2023. The implementation took place in 50 HIV high burden districts and it was spearheaded by Ghana HIV and AIDS Network (GHANET), a grassroots civil society organization (CSO) with membership across the country. This paper examines the strategies and outcomes of the project which was sponsored by the Global Fund and currently being expanded as part of Grant Cycle Seven (GC7) implementation from 2024 to 2026.

Methods
One hundred and fifty (150) volunteers from 50 community-based organizations (CBOs) were trained to distribute ORAQUICK HIVST kits to local residents in the selected districts. Video instructions on the effective use of the test kits (produced in English and six different Ghanaian dialects) were made available to persons who voluntarily received the kits. Through an online portal (GHANET Information Management System (GIMS)) data about the distributions were recorded. Follow-ups were conducted to ascertain, among others, how the kits were used. The data was quantitatively analyzed and descriptive statistics was used to summarize the data using Statistical Package for Social Science (SPSS v.28).

Results
A total of 123,088 ORAQUICK HIVST kits were distributed (with follow-ups) to 73,853 (60%) females and 49,235 (40%) males. Young people aged 20 – 24 received the highest number of kits totaling 28,790 which is about 23%, followed by those aged 25 – 29 who received 25,006 which is about 20% and those aged 30 – 34 who received 17,460 which is about 14%. A total of 422 persons comprising 304 (72%) females and 118 (28%) males self-reported their results as reactive. Of this number, 329 persons comprising 72% of females and 28% of males were confirmed positive. And, out of that number, 202 persons comprising 73% females and 27% males were successfully initiated on antiretroviral therapy (ART) in health facilities.

Conclusion
Male participation of 40% in the testing exercise was encouraging as it above the national average of 20% . It is therefore recommended that in Ghana, HIVST should, particularly, be targeted men.

Disclosures
All Authors: No reported disclosures
P-499. HIV Risk Perception, Substance Use, and Sexual Practices Among Circuit Party Attendees
Authors: Dubov Alex , Veltman Jennifer , Miles Ethan 
Published: January 2025

Abstract

Background
Circuit parties are large-scale dance events catering to the LGBTQ+ community. Research suggests high rates of HIV and substance use among participants. This study explores HIV knowledge, awareness of prevention services, perceived and actual HIV risk among attendees of the White Party, a circuit party held in California with an estimated 30,000 participants.

Methods
Data were gathered from 137 attendees who visited a health booth, where interested individuals completed a self-administered survey on a tablet computer. The survey used the validated Minority AIDS Initiative (MAI) Adult Questionnaire assessing demographics, perceived risk related to substance use and sexual activities, and self-reported risk behaviors in these domains. Following survey completion, participants received a non-monetary incentive (event merchandise).

Results
The average age of respondents was 38 years, with 26% identifying as Hispanic, 63% as White, 8% as Black, and 17% as Asian. Bivariate and multivariable logistic regression analyses were conducted to explore associations between knowledge of HIV status, awareness of HIV prevention resources, reports of unprotected sex, and the number of sexual partners. Younger participants and those with lower income levels were less likely to know their HIV status. Similarly, Hispanic respondents and those with lower income levels were less likely to know how to access HIV and SUD prevention. A higher perceived risk did not reduce a high incidence (82%) of unprotected sex. Individuals with a history of intimate partner violence (IPV) (18%) were more likely to engage in unprotected sex. Additionally, non-injection substance use was correlated with binge drinking and a higher number of sexual partners.

Conclusion
This study highlights the need for comprehensive interventions at LGBTQ+ events, addressing substance use and HIV risk simultaneously. Interventions focusing on raising awareness of HIV risks may not be effective in changing behavior. Available interventions should include screening and support for IPV, prioritizing HIV testing among younger attendees, offering culturally tailored outreach in Spanish, and addressing socioeconomic barriers to accessing prevention services.

Disclosures
All Authors: No reported disclosures