bluuebunny/crossref_metadata_2025_split huggingface dataset:
1459. Association of Antibiotic Prophylaxis Duration and Length of Stay in Patients Undergoing Coronary Artery Bypass Graft Procedure
Authors: Alnaimi Shaikha , Obaidi Warda , Habra Masa , Shoman Bassam , Carr Cornelia , Alhail Moza 
Published: November 2023

Abstract

Background
Antibiotic prophylaxis in surgery is a standard measure to reduce the risk of microbial contamination following an incision. For most surgeries, a single dose of antibiotics is generally required. However, in patients undergoing coronary artery bypass graft (CABG) procedure, antibiotics have been administered for ≥ 24 hours as data on the optimal duration is not sufficient. We aimed to correlate the duration of antibiotic prophylaxis in patients undergoing CABG with length of hospital stay (LOS).

Methods
We conducted a retrospective cohort study comparing LOS of patients undergoing CABG who received antibiotic prophylaxis for ≥ 24 hours (extended course group) and those who received it for &lt; 24 hours (short course group). Inclusion criteria were adults who had undergone CABG between 01/09/2015 –01/03/2019 in a cardiology and cardiothoracic surgery hospital. Exclusion criteria were immunocompromised patients, in-hospital mortality and patients with a pre-existing infection. The primary outcome was LOS and we also explored other variables that may predict LOS. Effects were adjusted for confounders using a multivariate linear regression model.

Results
A total of 855 patients were identified. After exclusion, 840 were included in the analysis of which 425 (50.6%) received antibiotics for ≥ 24 hours and 415 (49.4%) received them for &lt; 24 hours. The median LOS was 12.2 [IQR 11.0] days in the extended course group and 8.4 [IQR 8.8] days in the short course group, with a difference of 3.8 days (95% CI: 1.8-5.7), p-value &lt; 0.001. However, after adjusting for potential confounders the difference was no longer significant, 1.7 days (95% CI: -0.23-3.7), p-value 0.083. Independent predictors of length of stay were, male gender, presence of chronic kidney disease, American Society of Anesthesiologists class, priority of the surgery and history of infection in the last 90 days.

Conclusion
There is no statistically significant difference in LOS between short and extended antibiotic prophylaxis course in patients undergoing CABG procedure. Future work should explore the cost-effectiveness of short versus extended course antibiotic prophylaxis.

Disclosures
All Authors: No reported disclosures
2003. Igniting the Spark: An Exploratory Qualitative Study of Medical Student Preclinical Infectious Diseases Learning
Authors: Scruggs-Wodkowski Elizabeth , Abdoler Emily 
Published: November 2023

Abstract

Background
Major educational goals of Infectious Diseases (ID) are to recruit more trainees into ID and promote good antimicrobial decision-making. National survey research (Bonura et al, 2016) revealed that ID curricula that deemphasize memorization are associated with greater odds of trainees entering the field of ID. As ID electives are not required during medical school, preclinical ID courses could represent the last dedicated opportunity for students to gain exposure to the field and acquire key clinical skills for antimicrobial selection. Yet little is known about how students experience preclinical ID courses. We aimed to explore how students experience and engage with these courses to better understand how best to augment their learning and interest in ID.

Methods
We conducted individual interviews with a purposeful sample of medical students who took the preclinical ID course during three curricular years (2019-2021). Our semi-structured interviews explored students' challenges in learning ID, as well as the motivations, learning principles, and strategies guiding that learning. We generated a codebook through an iterative, inductive process using Dedoose to code interviews and facilitate analysis. We confirmed and refined major themes over 19 interviews.

Results
Students face unique challenges learning ID but are motivated to succeed by both intrinsic and extrinsic factors (Table 1). We identified six core learning principles (Establishing Relevance, Organized Study, Relating Ideas, Multi-Modal Learning, Socially Constructed Learning, and Active Engagement with Material) that support student learning, deployed through four main strategies (Peer Advice, Writing it Out, Talking it Out, and Use of External Resources) (Table 2; Figure 1).Table 1.Challenges and Motivations in Learning Infectious Diseases (ID)Table 2.Infectious Diseases (ID) Learning Principles and StrategiesFigure 1.Infectious Diseases (ID) Learning Principles with Supportive Strategies

Conclusion
Our results build on prior research indicating that students learning ID benefit from incorporation of educational principles and strategies that move beyond rote memorization to encourage active engagement and self-reflection. We found that students preference deep, strategic learning methods propelled by intrinsic motivation, despite external pressures. Our findings have implications for optimizing ID education and ultimately increasing interest in the field.

Disclosures
All Authors: No reported disclosures
1467. Effects Of Oral Antibiotic Prophylaxis For Surgical Site Infections In Colorectal Surgery: Insights From Real World Data
Authors: Hata Hiroaki , Nakanishi Hiroki , Nishikawa Gen , Matsusue Ryo 
Published: November 2023

Abstract

Background
Surgical site infection (SSI) after colorectal surgery is a significant burden on healthcare costs and patient quality of life. Preventive strategies are very important to working on this problem. In a multicenter randomized controlled trial (RCT) published in Annals of Surgery(2016;263:1085-1091), we reported the efficacy of oral antimicrobial prophylaxis in preventing SSI before colorectal surgery. Since the end of the RCT in 2012, we have applied this prophylaxis in our clinical practice and have experienced a large number of cases. Here, we report the incidence of SSIs when this prophylactic measure is applied in real-world clinical practice.

Methods
We retrospectively evaluated the incidence of SSI in 1192 patients who underwent elective laparoscopic colorectal resection for colorectal tumors between January 2013 and June 2022. We excluded 24 patients who were unable to receive oral prophylaxis. Antimicrobial prophylaxis consisted of oral kanamycin (1 g) and metronidazole (750 mg) twice on the day before surgery and intravenous cefmetazole (1 g) just before and every 3 hours during surgery. The diagnosis of SSI follows the CDC/NHSN definition.

Results
Our study included 647 males and 545 females, with a mean age of 69.3 years (IQR 63-77) and BMI of 22.6 kg/m2 (IQR 20.2-24.7). The incidence of SSI in all surgical cases was 61/1192 (5.1%; 95% CI 4.0-6.5). The incidence of SSIs in colon surgery was 16/769 (2.1%; 95% CI 1.3-3.4), and in rectal surgery, 45/400 (11.3%; 95% CI 8.5-14.7). The incidence of Clostridioides difficile colitis, which is regarded as a side effect of oral antimicrobial agents, was low at 6/1192 cases (0.5%; 05%CI 0.2-1.1).
In our previous RCT, the incidence of SSI was 21/289 (7.26%) in patients treated with oral antibiotics. In a subanalysis of this trial published in the International Journal of Colorectal Disease(2016;31:1775-1784), the incidence of SSI was 9/188 (4.8%) in colon surgery and 13/103 (13%) in rectal surgery. The incidence of SSIs in the present data was similar to or lower than the incidence of SSIs in well-conditioned patients selected in the RCT.

Conclusion
Our results suggest that preoperative oral antibiotic prophylaxis in colorectal surgery is an effective method to reduce SSIs in a wide variety of patients in real-world clinical practice.

Disclosures
All Authors: No reported disclosures
1480. Detection of Multiple HIV Strains in an HIV-positive Transplant Recipient from an Acutely HIV Infected Donor.
Authors: Alavian Naseem , Travieso Tatianna , Blasi Maria , Wolfe Cameron R 
Published: November 2023

Abstract

Background
The HIV Organ Policy Equity (HOPE) Act allows persons living with human immunodeficiency virus (HIV) infection to accept HIV-positive donor organs. Risk of superinfection or viral recombination resulting from the transmission of a genetically distinct donor HIV-1 strain may be a concern. It is unknown if transplantation from acutely infected donors pose additional risk. Analysis of viral quasispecies from donor and recipient samples provides an opportunity to evaluate the transplanted kidney as a viral reservoir and explore the potential for viral superinfection or recombination in the recipient.

Methods
A 63-year-old HIV-positive recipient with focal segmental glomerulosclerosis and suppressed viral load (&lt; 20 copies/mL) on antiretroviral therapy (ART) with dolutegravir and lamivudine, received a kidney from an acutely infected deceased HIV-positive donor (Table 1). Single genome amplification of the HIV-1 env gene was performed with viral RNA extracted from recipient urine and plasma and viral DNA from donor kidney cells, recipient PBMC and renal cells. We constructed phylogenetic trees assessed recombination probabilities.

Results
A new, genetically distinct env sequence was amplified from the recipient’s urine 30 hours post-transplant suggesting transfer of donor virus to recipient. Donor virus became undetectable on subsequent visits while recipient was maintained on ART. Notably, a third virus was detected 1.5 months post-transplant in urine-derived renal tubular epithelial cells and 5 months post-transplant in urine which was genetically distinct from previously detected donor and recipient strains (Figure 1). This third strain did not have genetic features suggestive of recombination. Our findings suggest potential superinfection in the donor or recipient.
Figure 1. Phylogenetic Analysis of HIV Quasispecies Isolated from an HIV-Positive Kidney Transplant Recipient, Showing Three Distinct Viral Lineages*

Conclusion
We documented presence of three unrelated HIV strains within a transplanted recipient and within different viral reservoirs. Donor and recipient recombination did not occur. In acutely infected donors, when the transfer of virus within the kidney occurs, ongoing virologic suppression can be achieved if appropriate ART is maintained. Additional long-term monitoring of viral populations in the recipient is important to fully assess any clinical and virologic implications of this finding.

Disclosures
All Authors: No reported disclosures
1481. Clinical profile of cerebral small vessel disease in people with HIV hospitalized for ischemic stroke
Authors: Ayoade Folusakin , Hernandez Salma 
Published: November 2023

Abstract

Background
The risk of ischemic stroke (IS) is twice as likely in people with HIV (PWH) than in the normal population. Cerebral small vessel disease (CSVD), a well-recognized risk factor for IS is poorly studied in PWH and represents a missed opportunity for targeted surveillance and risk mitigation for IS in this population.

Methods
We retrospectively analyzed brain imaging (Computerized tomography and magnetic resonance imaging) findings of PWH obtained up to 8 years prior to the time of current admission for IS at our health institution. IS admission was between January 1, 2008 and December 31, 2018. We extracted information that suggests CSVD either in the imaging description or report summary. The terminologies include "ischemic leukomalacia", "white matter hyperintensities", "age related white matter changes", "lacunar infarcts" and "microbleeds". We analyzed demographic and clinical information including co-morbidities, HIV data, stroke severity data, hospital course and outcome. Several parameters of interest were analyzed in those with CSVD on brain imaging versus those without.

Results
Out of the 70 HIV positive patients analyzed who presented with IS during the time period, 54 or 77% had CSVD on a previous brain scan within the prior 8 years preceding the current stroke. Other demographic and clinical information are illustrated in Table 1.
Only 66% of the cohort had a Glasgow coma scale (GCS) of 15 at admission. The NIH stroke scale of 5 or greater was 50%. Individuals without CSVD were younger (Mean 52.8 ± 9.5) compared to those with CSVD (Mean 60.1 ± 9.3), p=0.01. CSVD was correlated to age and CD4 counts with Pearson correlation of 0.319, p=0.007 (age) and 0.364, p=0.012 (CD4) respectively. There was no difference in stroke severity scores, ICU and hospital length of stay, and outcome in both groups.Table 1:Demographic and Clinical information of CSVD in PWH (N=70). Legend: ART: Antiretroviral therapy VL: Viral load GCS: Glasgow Coma scale ICU: Intensive care unit LOS: Length of stay Min: Minimum value Max: Maximum value

Conclusion
In this descriptive analysis of PWH presenting for hospital admission due to ischemic stroke, 77% had CSVD on a previous brain scan. Mortality was 20% with over 60% surviving with disabilities. CSVD in PWH is correlated to age and CD4 count. Further studies are needed to understand the interaction between CSVD and other host specific mitigating factors including demographics, co-morbidities, HIV factors and microbiome and their roles in contributing to excess stroke risk in PWH.

Disclosures
All Authors: No reported disclosures
1483. Real-time Creation of HCV Treatment Cascades in Clinics to Improve HCV Treatment Rates Among Patients with HIV/HCV Co-infection
Authors: Wegener Maximilian D , Brooks Ralph P , Nichols Lisa G , Villanueva Merceditas 
Published: November 2023

Abstract

Background
U.S. National Viral Hepatitis strategy advocates Health Departments (HDs) use surveillance-based viral clearance cascades to track progress of HCV care. Cascades are also useful at the clinic level, but creation can be challenging. We developed and piloted a novel Data to Care (D2C) case conferencing tool which merges jurisdictional HD and clinic data, and automatically generates HCV treatment cascades for clinic clients with HIV/HCV co-infection, identifying gaps to be improved.

Methods
Six diverse state/county health departments (HDs) used the excel-based tool with 14 Ryan White-funded clinics to create real-time HCV treatment cascades for clients who received HIV related medical services (1/1/2018–8/31/2021) with a HCV diagnosis (through 11/30/2021). Cascade steps included: HCV PCR testing, treatment eligibility, treatment initiation, and cure (SVR). Barriers to treatment were captured to aid in developing personalized engagement plans. Virtual case conferencing occurred quarterly with HD champions and clinic staff for 1 year. Three models, dependent on HD resources and statutory limitations, were used to identify co-infection: A) HD generated a co-infection list from centralized HIV/HCV surveillance data, B) clinic created a list of persons with HIV that HD matched to HCV surveillance or C) clinic generated a co-infection list from medical records.

Results
For list creation: 1 HD used model A, 2 used model B, 1 used model C, and 2 used a combination of B and C. Among 1249 overall clients with co-infection, 282 (23%) were Black; 842 (67%) were born male. Baseline cascades as of 11/30/2021 showed 102 (8%) needed PCR, 685 (55%) were eligible for HCV treatment and 357 (52% of eligible) achieved SVR. SVR rates varied by clinic. Substance use was a primary barrier to treatment, although most clients experienced multiple barriers.

Conclusion
Our tool uses both surveillance and clinical care data to generate a real-time clinic-specific HCV treatment cascade for clients with HIV/HCV co-infection. It is more granular than using surveillance data alone, enabling clinics in collaboration with jurisdictional HDs to overcome personal barriers to care. Used longitudinally, quarterly case conference cascades allow for insight into progress.

Disclosures
Ralph P. Brooks, MS, Merck: Stocks/Bonds
1485. Landscape of peripheral blood mononuclear cell single-cell transcriptomes in HIV-infected patients with cryptococcal meningitis
Authors: Chen Yaokai , Li Yao , Zhao Ting 
Published: November 2023

Abstract

Background
Cryptococcal meningitis (CM) is a lethal opportunistic infection in patients with human immunodeficiency virus (HIV); however, the immunopathogenic mechanisms underlying HIV-associated cryptococcal meningitis (HIV-CM) remain largely unknown.

Methods
Here, using the single-cell nucleus sequencing approach, we compared peripheral blood mononuclear cell (PBMC) transcriptomic alterations among ART-naïve HIV-CM patients (N=8), ART-naïve HIV-infected individuals (N=8), and healthy controls (HC, N=8). Additionally, alteration of the single-cell transcriptomes of HIV-CM patients before and after four-week antifungal treatment was also analyzed, to estimate the influence of treatment.

Results
In total, we obtained 318,718 PBMCs and identified 20 cell subclusters based on gene expression. In our PBMC sample, we observed the significantly decreased percentage of CD4+ T-cells and NK cells, as well as an increased percentage of CD14 monocytes in HIV-CM patients, relative to HC. Only the percentage of CD4+ T-cells was significantly altered in HIV-CM patients, compared to HIV-infected individuals. Moreover, after four-week of antifungal treatment, the percentage of these three cell types were significantly altered. After treatment, the proportion of CD4+ T-cells in HIV-CM patients was observed to be lower compared to HC, but was comparable to HIV-infected individuals. The relative fractions of NK and CD14 monocytes were also reversed, to revert to normal levels. The functions of the HIV-CM-specific differentially expressed genes (DEGs) among the three cell types are related to cytoplasmic translation, signal recognition particle (SRP)-dependent co-translational protein targeting, viral processes, and others. After antifungal treatment, the rate of reversal of the DEGs ranged from 11.7% to 22.9%. The reversed genes are mainly associated with neutrophil degranulation and immune system processes.

Conclusion
Together, the preceding findings suggest that the degree of change to the transcriptomes of PBMCs may be utilized as a potential marker for HIV-CM patients and for functional assessment of antifungal treatment. Furthermore, the disturbed molecular pathways may aid in understanding fundamental immunopathogenic pathways inherent to HIV-CM patients.

Disclosures
All Authors: No reported disclosures
1488. The Performance of a Multidimensional Frailty Index in Comparison to the Frailty Phenotype to Assess Frailty in an Urban HIV clinic.
Authors: Eke Uzoamaka A , Mohanty Kareshma , Schmalzle Sarah , Viviano Nicole , Hoffman Jennifer , Neha Pandit , Palmeiro Robyn , Lee Judith , Stafford Kristen A , Gruber-Baldini Ann 
Published: November 2023

Abstract

Background
Frailty is increasingly recognized in people living with HIV (PLWH), but optimal diagnostics are yet to be determined. Frailty indices (FI) represent accumulation of health deficits over time and have been shown to correlate better with mortality and adverse effects of aging than the phenotypic description of frailty or chronological age. This study compares a new FI to the Fried frailty phenotype (FP) to diagnose frailty and determine factors associated with frailty.

Methods
The Strengthening Therapeutic Resources in Older Adults Aging with HIV (STRONG) study incorporated standardized geriatric assessments in an adult HIV clinic in PLWH ≥50 years. FP scores of 0, 1-2, and ≥3 out of 5 criteria represented robust, pre-frail and frail, respectively. A 40-variable FI construct comprising demographic, clinical, and laboratory values was derived to calculate the FI as a fraction of the deficits present in each patient to the total variables that comprised the index. FI scores of ≤0.15, &gt;0.15-0.4 and &gt;0.4 were categorized as robust, pre-frail and frail respectively. FI and FP were compared with respect to frailty prevalence. Multivariate logistic regression models adjusted for age and sex were used to examine the association between FI frailty and each of the following factors: multimorbidity, falls, poor cognition history, polypharmacy (≥5 medications) and HIV duration.

Results
The 165 participants were mostly black (94%) and male (56%), with median age 59 years (IQR 55-63). 78% were virally suppressed (HIV viral load ≤40) with median CD4 count 606 cells/μl (IQR 393-873). 70% had multimorbidity (≥2 comorbidities), 38% falls, 25% poor cognition history, 24% polypharmacy and 32% &lt; high school education. Using FP, 65% were prefrail, 2% frail, and 33% robust. Using FI, 67% were prefrail, 26% frail and 7% robust (range 0.08-0.57; mean 0.34 ±0.11). For FP categorized as robust, prefrail and frail, the mean FI was 0.31±0.1, 0.35±0.11 and 0.38±0.08 respectively (P=0.06). Poor cognition (OR 3.91, p=0.001), falls (OR 4.49, p &lt; 0.001) and multimorbidity (OR 5.09, p=0.004) were associated with FI frailty, after adjusting for age and sex.

Conclusion
The majority of our PLWH are pre-frail or frail. The FI identified more patients as frail and had significant clinical associations compared to FP.

Disclosures
All Authors: No reported disclosures
1497. Cryptococcal Antigen Screening and Pre-emptive Fluconazole Therapy in HIV-infected Patients: A Multicenter, Retrospective Study in China
Authors: Lu Yanqiu , Chen Yaokai 
Published: November 2023

Abstract

Background
The implementation and effectivention of CrAg screening programs and pre-emptive treatment remains unclear in China.

Methods
We performed a multicenter, retrospective study at eight hospitals from 1st Jan 2019 to 31st Dec 2020, to evaluate whether CrAg screening programs and preemptive treatment are beneficial for saving lives in China.

Results
A total of 12768 PLWH were screened for serum CrAg. The prevalence of serum CrAg positivity was 5.3% (678/12768). Lumbar puncture (LP) records were completed and available in 580 patients. Among them, 36.4% (369/580) were diagnosed with CM, and 63.6% (211/580) were diagnosed with isolated cryptococcal antigenemia (ICA). 123 HIV/ICA patients have available clinical data. Of these patients, a median CD4+ T-cell counts were 41cells/µL (IQR, 19-83). Upon Cox proportional-hazards regression analysis, patients with no preemptive fluconazole treatment had a threefold higher risk of CM and/or death [19.0% (8/42) vs 8.6% (7/81), p=0.037] compared to the preemptive fluconazole treatment participants. However, there was no statistically significant difference for the development of CM and/or death in different dosage (therapy as per WHO recommendations vs oral fluconazole 400mg daily therapy) of fluconazole therapy (p=0.836). Also, we found no statistically significant difference in the proportion of CrAg negativity [60.0% (12/20) vs 54.5% (18/33), p=0.779] and the median time from positivity to negativity of serum CrAg [14 (IOR:9.25, 14) vs 14 (10.5, 15), p=1.000] within one year follow up. In our study, Patients who with virological suppression had a lower incidence of CM and/or death than patients who with virological non-suppression [5.6% (1/18) vs (17.2% (5/29), p=0.384], however, there was no statistically significant difference in Cox proportional-hazards regression analysis.

Conclusion
Rapid ART initiation, appropriate CrAg screening are essential for advanced PLWH. Lp is a necessary intervention in advanced HIV-infected patients for CrAg positive individual to prevent potential missed diagnosis and mistreatment of CM. Targeted improvements to pre-emptive antifungal therapy for cryptococcal antigenemia are required to further improve patient outcomes in CrAg-positive severely immunocompromised people with HIV/AIDS.

Disclosures
All Authors: No reported disclosures