bluuebunny/crossref_metadata_2025_split huggingface dataset:
1440. Hand Hygiene in Nursing Homes During And After The Covid-19 Pandemic Outbreak
Authors: Sandbekken Ida H , Løyland Borghild , Hermansen Åsmund , Utne Inger , Grov Ellen Karine 
Published: November 2023

Abstract

Background
Residents in Norwegian nursing homes are vulnerable and fragile, and hand hygiene adherence is too low to prevent transmission of all infections. This study aimed to investigate hand hygiene in nursing homes during and after the COVID-19 pandemic, and if interventions targeting behavior change can improve adherence.

Methods
Observations of hand hygiene were collected in February and March 2021 and September and October 2022, using the WHO observation tool. The observations were carried out by trained nursing students and researchers. The first observations were during the pandemic when it was strict regulations in nursing homes, and the last observations were when there were no regulations related to COVID-19. Over 12 months, from August 2021 to August 2022, three of the 22 participating nursing home wards implemented interventions to improve hand hygiene. Multimodal interventions targeting behavior change, including education, UV-light box, and posters, were implemented.

Results
Hand hygiene adherence in total was 58.3% during the pandemic and decreased to 52.5% after the pandemic. The control wards experienced a decrease from 59.5% in 2021 to 51.3% in 2022, while the intervention wards experienced an increase from 54.7% to 60.9% (p-value: &lt; 0.001). Hand hygiene adherence in total was lower when wearing gloves (32.8% vs. 61.7%), and inappropriate glove use was significantly higher after the pandemic. Hand hygiene adherence was 35.3% when using gloves in 2021, in 2022 the adherence had decreased to 27.7% (p-value: &lt; 0.001).

Conclusion
This study shows that the implementation of interventions aimed at behavioral change increased hand hygiene adherence in nursing home wards. Despite hand hygiene adherence being lower, and inappropriate glove use higher than hoped for during the pandemic, we can see that attention and focus on hand hygiene during the pandemic probably had an increased effect on adherence. Attention to hand hygiene and activation of the motivation of healthcare workers is crucial, for receiving an effect of interventions. Hand hygiene adherence decreased after the pandemic when the focus on hand hygiene diminished. Behavior is likely to decline over time, and continuous reinforcement is needed to maintain a behavior change.

Disclosures
All Authors: No reported disclosures
1454. Descriptive Epidemiology of Candida auris Infections in African-American population in Tertiary Care Center in Greater Detroit Area
Authors: Pollock Erin , Sandhu Avnish , Keri Vishakh C , Maples Catherine , Salimnia Hossein , Chopra Teena 
Published: November 2023

Abstract

Background
The first reported Candida auris (C. auris) cases in United States, were associated with global travel. It has emerged as a nosocomial pathogen among critically ill patients with prolong hospital stay, patients in long-term-acute hospitals, and skilled nursing facilities. Given the increase in cases (59% in 2019 to 95% in 2021) and C. auris being multidrug-resistant, Centers for Disease Control and Prevention has declared it to be a pathogen of urgent public health threat. The purpose of this study is to describe the epidemiology of C. auris among patients in a tertiary care center in greater Detroit area.

Methods
A retrospective cohort study was conducted among patients who tested positive for C. auris between January 2021 to January 2023. See Figure 1 flow chart of screening and culture method used to identify C. auris. Patients were defined as infected or colonized based on review of medical documentation. Data on demographics, length of stay, source of admission, treatment and susceptibility report were collected.

Results
One hundred and eight patients tested positive for C. Auris with 10 infections and 98 colonizations. 90% of infected patients were in intensive care unit, 80% required a ventilator, 50% had fungemia and 40% died within 30 days of C. auris infection (Table1). Among the 4 patient that died, median age was 67.5, one patient had persistent C. auris fungemia due to endocarditis, one patient had decompensated cirrhosis with concomitant bacteremia and urinary tract infection with C. auris, one patient had C. auris mediastinitis with severe cardiac comorbidities, and one patient had abdominal aortic aneurysm repair developed ventilator associated pneumonia with C. auris and Aspergillus Niger complicated by severe acute respiratory distress syndrome. 80% of patients were treated with micafungin and one patient was treated with micafungin and amphotericin B given C. auris endocarditis (Table 1). Voriconazole was used for treatment in one patient due to concomitant Aspergillus infection (Table 1). See Table 2 for minimum inhibitory concentration for 8 of 10 isolates.

Conclusion
C. auris is an emerging pathogen that can colonize the skin and has a potential of causing invasive infections leading to high morbidity and mortality.

Disclosures
All Authors: No reported disclosures
1461. Risk Factor Evaluation and Performance Improvement for Surgical Site Infections in Patients Undergoing Abdominal Hysterectomy at a Large Academic Public Safety Net Hospital
Authors: Buford Anna , Anderson Tyler D , Jandarov Roman , Schaffer Joseph , Wells Jacqueline , Bartlett Marianne , Houston Latitia , White Calvin , Buford Laura , Sopirala Madhuri 
Published: November 2023

Abstract

Background
Incidence of deep and organ space surgical site infections (SSI) after abdominal hysterectomy ranges from 1.1% - 5.7%, with higher rates for women without private insurance. Parkland Hospital is one of the largest safety net hospitals in the United States, serving mostly uninsured and Medicaid-enrolled patients. In 2021, our deep and organ space SSI rate for abdominal hysterectomies was 1.39%, with a standardized infection ratio (SIR) of 1.456. We studied SSI risk factors and report performance improvement (PI) initiative that decreased SSI incidence.

Methods
This retrospective case-control study randomly matched 37 patients with deep and organ space abdominal hysterectomy SSI from 2019 to 2021 with controls undergoing the same procedure during the same calendar month. We evaluated 18 variables as potential risk factors (Tables 1&2). We conducted a multidisciplinary PI intervention focusing on a modifiable risk factor identified during our investigation to reduce SSI post-hysterectomy. Evaluation showed vaginal and enteric organisms causing SSI leading to observations indicating improper vaginal preparation even though it was being performed.Table 1.Risk factors for SSI after Abdominal Hysterectomy (Univariate Analysis)

Results
Univariate analysis found one variable to be associated with lower risk and eight variables to be associated with higher risk (Table 1). Diabetes (OR, 3.89; 95% CI,1.25-12.08; p=0.0188) was found to be a risk factor in multivariate analysis while being Hispanic seems to be protective (OR, 0.31; 95% CI,0.12-0.80; p=0.0160). After the intervention of educating nursing staff on the right way of doing vaginal preparation, and weekly OR observations, our deep and organ space SIR in 2022 decreased to 0.63. Vaginal preparation was found to be a risk factor in our univariate analysis, but the coefficient was not estimable in multivariate analysis.Table 2.Independent Risk Factors for SSI After Abdominal Hysterectomy (Multivariate Logistic Regression)

Conclusion
Multidisciplinary intervention significantly decreased deep and organ space SSI rates. Ensuring standardized pre-operative vaginal preparation also enhanced SSI risk reduction. We suspect that our intervention improved SSI rates by improving the accuracy of vaginal preparation. Performance of vaginal preparation was a risk factor in univariate analysis but was not significant on multivariate analysis.

Disclosures
All Authors: No reported disclosures
1465. Two- versus Three-Gram Cefazolin Dosing for Surgical Prophylaxis in Colorectal Surgery Procedures
Authors: Collins Curtis D , Hartsfield Eric , Cleary Robert K , Brockhaus Kara K 
Published: November 2023

Abstract

Background
International guidelines recommend an elevated dose of cefazolin 3 grams for surgical prophylaxis in patients weighing ≥ 120 kg. This recommendation was made based on limited pharmacokinetic data, low cost, and favorable safety profile of cefazolin. Since the release of these recommendations nearly a decade ago few analyses have investigated the impact of these elevated dosing recommendations on surgical outcomes.

Methods
A multi-center, retrospective cohort study was performed utilizing available data from a large, validated database of elective colorectal surgeries in Michigan. Adult patients weighing ≥ 120 kg who received cefazolin and metronidazole for surgical prophylaxis between July 2012 and June 2021 were included. Emergent or urgent surgeries, missing follow-up and antibiotic information, and patients who did not receive either 2 or 3-grams of cefazolin with 500 mg metronidazole were excluded. The primary objective was to evaluate the incidence of surgical site infections (SSIs) between patients receiving 2 grams versus 3 grams of cefazolin. Secondary objectives analyzed the incidence Clostridioides difficile infection (CDI) between cohorts. The impact of cefazolin dosing and confounders was tested through a multivariable logistic regression model.

Results
Six-hundred-fifty procedures were included. Four-hundred nine patients (62.9%) received 3-grams cefazolin prophylaxis and 241 (37.1%) received 2-grams. The cohorts were similar with a significant difference in median body mass index in the 3-gram cohort (41 vs. 41; p = 0.023). There was no difference between 2- and 3-gram cohorts in SSIs (8% vs. 9%, p = 0.745) or CDI (1.2% vs. 0.7%; p =0.510). A significant difference in compliance with recommended antibiotic timing (93.8% vs. 88%; p = 0.017) was noted. Multivariable logistic regression showed 3-gram prophylaxis was not associated with a change in SSIs (adjusted odds ratio (aOR) 1; 95% CI 0.54 to 1.85; p = 0.994).

Conclusion
Three-gram cefazolin dosing in combination with metronidazole in obese patients for surgical prophylaxis in elective colorectal surgery procedures was not associated with changes in SSIs or CDI.

Disclosures
Robert K. Cleary, MD, FASCRS, FACS, Intuitive Surgical Inc: Honoraria
1468. Antibiotic Prophylaxis Prior to Dental Procedures for Total Hip Arthroplasty and Total Knee Arthroplasty Patients.
Authors: Simon Samantha , Aziz Alya , Goden Gloria , Hollenbeck Brian L 
Published: November 2023

Abstract

Background
Guidelines no longer recommend use of prophylactic antibiotics for dental procedures after total hip and total knee arthroplasty (THA/TKA), yet many surgeons continue to routinely prescribe antibiotics for this purpose. In a setting where one must consider the cost of antibiotics and consequences of antibiotic resistance, there may be reason to rethink the practice of prescribing antibiotics prior to dental procedures.

Methods
We conducted a retrospective cohort study of 10,899 patients who underwent THA/TKA between 1/1/19 and 12/31/20 with one of the 13 surgeons at a single institution. Patients were excluded if they had prior infection in the same joint. The primary outcome was late-presenting PJI, defined as PJI diagnosis &gt; 90 days after surgery. Patients were designated in the antibiotic group or non-antibiotic group based on their surgeon’s prophylaxis protocol. Dental-associated PJIs were considered if the patient had evidence of dental infection, poor dentition and/or a dental procedure within a few weeks prior to onset of PJI symptoms.

Results
There were 2,872 (26.4%) patients in the no antibiotics group and 8,027 (73.6%) patients in the antibiotics group (prescribed 2000mg of Amoxicillin 30 minutes prior to dental procedures) (Table 1). We identified 27 (0.3%) late presenting PJIs and 4 (0.03%) dental-associated PJIs (Table 2). 3 of the 4 dental-associated PJI were in people who had dental infections, rather than routine dental cleanings. In the multivariable analysis, BMI ≥ 30 (OR 2.7, CI 1.1-6.5) and revision surgery (OR 7.7, CI 3.1-19.4) were the only variables that increased late-presenting PJI risk (Table 3). Age, gender, American Society of Anesthesiology Score, occlusive silver dressing, and prescription of antibiotics were not shown to affect risk of late-presenting PJI.Table 1.Overview of Patient and Surgical Variables.Table 2.Description of dental-associated prosthetic joint infections.Table 3.Multivariable Analysis. Adjusted for sex, age, American Society of Anesthesiology Score, body mass index, revision vs primary surgery, and dressing type. Showing odds of developing a late presenting prosthetic joint infection.

Conclusion
In this retrospective cohort study, we found a low rate of late-presenting PJI. Routine prescriptions of antibiotics prior to dental procedures did not alter the risk of late-presenting PJI. In addition, all 4 dental-associated PJIs occurred in patients prescribed antibiotics. These findings demonstrate that antibiotic prophylaxis before dental procedures may not be necessary, but good oral hygiene should be emphasized.

Disclosures
All Authors: No reported disclosures
1479. Analysis of Depression in People Living with Human Immunodeficiency Virus (HIV) During the Coronavirus Disease 2019 Pandemic in 4 African Countries
Authors: Adjei Paul , Dear Nicole , Esber Allahna , Kibuuka Hannah , Maswai Jonah , Owuoth John , Sing’oei Valentine , Bahemana Emmanuel , Crowell Trevor A , Ake Julie A 
Published: November 2023

Abstract

Background
We previously demonstrated higher odds of depression in PLWH during COVID-19 pandemic in our African Cohort Study (AFRICOS) between 07May2020 and 01Dec2021.1
This analysis updates the previous and estimates odds of depressive symptoms through 01Dec2022.
Hypothesis: If the pandemic was truly associated with depressive symptoms in PLWH then odds of depressive symptoms will continue the downward trend identified in later timepoints of our first analysis.

Methods
AFRICOS: Ongoing prospective cohort study enrolling PLWH at 12 clinics in Kenya, Uganda, Tanzania, Nigeria.2
Longitudinal evaluations every 6 months include physical evaluation, medical record abstraction, extensive questionnaires including CES-D; depression defined by score &gt;16.3
We compared odds of depression in preCOVID-19 period (1 Jan 2019 to 19 Mar 2020) with five timepoints in COVID-19 era (7 May 2020 to 1 Dec 2022).
Logistic regression with generalized estimating equations for OR and 95% CI comparing depression before and during pandemic.
Models a priori adjusted for sex, age, and site.

Results
2,038 AFRICOS participants with complete cases and visits before and during COVID-19 periods included.
Median age at first visit included: 43 years (IQR 36-51)
1,181 (57.9%) were female
Depression varied significantly by: sex, participants by site, marital status, ART adherence at first timepoint included (Table 1).
60 (2.9%) participants had CES-D score suggestive of depression at first visit included.
Compared with pre-pandemic:
PLWH had higher odds of reporting depressive symptoms throughout pandemic. After adjusting for age, sex, and site, PLWH had higher odds of reporting depressive symptoms only in second, third, fourth parts of pandemic period, aORs: 1.62 (95% CI 1.13 – 2.31), 1.72 (95% CI 1.27-2.31), 1.41 (1.01 – 1.96) respectively (Table 2, Figure).

Conclusion
COVID-19 pandemic is associated with higher odds of depressive symptoms in PLWH in AFRICOS.
Odds of depression increased as pandemic progressed, peaking in third period and decreasing sequentially in fourth, fifth periods to confirm our hypothesis.
Given the strong association between depression and HIV outcomes, aggressive public health mental health response to pandemics may improve HIV clinical outcomes.

Disclosures
All Authors: No reported disclosures
1486. The Association of Aging-related Comorbidity Burden and Quality of Life Among Women with and without HIV in the U.S.
Authors: Collins Lauren F , Ofotokun Igho , Greene Quincy , Palella Frank J , Naggie Susanna , Topper Elizabeth F , Anastos Kathryn , French Audrey L , Kassaye Seble , Taylor Tonya , Fischl Margaret A , Adimora Adaora A , Kempf Mirjam-Colette , Tien Phyllis C , Sheth Anandi N , Mehta Cyra Christina 
Published: November 2023

Abstract

Background
Women with HIV (WWH) are at higher and earlier risk of developing aging-related non-AIDS comorbidities (NACM) compared to those without HIV; however, the impact on health-related quality of life (QoL) is largely unknown.

Methods
We analyzed data from the Women’s Interagency HIV Study to evaluate the effect of comorbidity burden (total NACM of 10 assessed) on nine QoL domains and a summary QoL index (QoLI; measured by the MOS-HIV instrument). We included women followed on/after 2009 (when &gt;80% of WWH reported antiretroviral therapy use) and ascertained covariates, NACM, and QoL through the last study visit by 03/2018. Unadjusted (HIV, age, NACM burden or prevalence separately), partially adjusted (unadjusted + all possible interaction terms) and adjusted (partially adjusted + covariates) linear regression assessed impact on QoL.

Results
Among 3036 women (2173 HIV+, 863 HIV-), median age was 50 (Q1-Q3 43-56) yrs, 66% were Black, 51% had annual income &lt; $12K, and mean (sd) NACM burden was 3.4 (2.2). In unadjusted models, each additional NACM decreased the mean QoLI by -4.4 (95%CI -4.7,-4.1; p&lt; 0.0001). Mean QoLI did not differ in WWH vs without HIV (68 vs 69, p=0.40) but decreased with older age (&lt; 40, 40-49, 50-59, 60-69 yrs): 75 (95%CI 73,77), 71 (70,73), 65 (63,66), 63 (61,65), respectively (p&lt; 0.0001). Unadjusted QoLI was negatively associated with each prevalent NACM (Table). NACM burden was associated with all nine QoL domains in unadjusted models: physical function, role function, energy/fatigue, social function, cognitive function, emotional well-being, health perception, pain, and perceived health index. In the partially adjusted model, the impact of NACM burden on QoLI was modified by age (p=0.02) but not HIV serostatus (p=0.40) (Figure). In covariate-adjusted models (race, BMI, cigarette, alcohol or crack use, menopausal status, socioeconomic status), NACM burden was associated with QoLI (p&lt; 0.0001) but age and HIV did not modify this effect (age*HIV*NACM burden, p=0.83).
Summary quality of life index and aging-related comorbidity burden by HIV serostatus and age

Conclusion
Among women with a high prevalence of multimorbidity, HIV, and health disparities, total comorbidity burden was associated with QoL, independent of age or HIV serostatus. Research is needed to optimize multimorbidity screening and prevention strategies in this population.

Disclosures
Lauren F. Collins, MD, MSc, Curio Science: Honoraria Igho Ofotokun, MD, MSc, FIDSA, Merck: Grant/Research Support Phyllis C. Tien, MD, MSc, Merck: Grant/Research Support Cyra Christina Mehta, PhD, MSPH, Merck: Grant/Research Support
1496. Utility of Urinary Lipoarabinomannan (LAM) for Diagnosis of Tuberculosis in HIV-infected Hospitalized Patients – A Prospective Observational Study.
Authors: Kumar Deepak , Sharma Shivang , Bohra Gopal Krishana , Garg M K , Midha Naresh Kumar , Meena Durga Shankar 
Published: November 2023

Abstract

Background
Lipoarabinomannan (LAM) is an essential component of the cell wall of mycobacterium tuberculosis. LAM causes anti-inflammatory effects on the human immune system by reducing innate and acquired cellular activity and increasing IL-10 production. Increased LAM in body fluid is a marker of active infection, with maximum concentration in sputum followed by urine. WHO has endorsed the urine LAM for diagnosis of tuberculosis in HIV infection. The study aimed to find the utility of urinary LAM assay in diagnosing tuberculosis in hospitalized patients with HIV Infection.

Methods
All Adult (≥18-year-old) patients with HIV infection and hospitalised and regardless of their presenting symptoms or CD4 count, were included for urinary LAM assay (Alere) for diagnosis of tuberculosis. Patients who had taken antituberculosis drugs (first or second line) the month prior were excluded. With molecular and culture methods, best practices were done to find opportunistic infections, including tuberculosis.

Results
A total of 60 patients were enrolled, and urinary LAM was positive in 18 (30%) cases. Among culture or GeneXpert-confirmed tuberculosis, urinary LAM was positive in 55.6% of cases. None of the patients who were not eligible for the LAM test as per 2019 WHO guidelines were found positive (Table 1). The sensitivity, specificity, and negative and positive predictive values of urinary LAM were 62.5%, 91.8%, 76.3% and 85.1%, respectively. In-hospital mortality was significantly high in LAM-positive cases (38.8% vs 16.7%; p-value=0.03).

Conclusion
Urinary LAM may greatly help diagnose tuberculosis in Patients with HIV-TB co-infection with critically ill, with low CD4, or presented by multiple system affection with high specificity. LAM positivity was also associated with increased mortality in HIV infection.

Disclosures
All Authors: No reported disclosures
1501. Characterizing Engagement in Care and STI Screenings among DC Cohort Participants with HIV and Mpox
Authors: O’Connor Lauren , Byrne Morgan , Anderson Elisabeth , Benator Debra A , Lucar Jose , Horberg Michael A , Denyer Rachel V , Lee Rachel , Castel Amanda Derryck , Monroe Anne K 
Published: November 2023

Abstract

Background
A high proportion of people with HIV (PWH) in the 2022-2023 mpox outbreak (approx. 40% of US cases) has raised questions about the association between HIV and mpox. Increased encounters with the healthcare system may be contributing to this association. This study sought to elucidate whether detection bias drives the relationship between mpox and HIV by determining whether engagement in care and STI screening are associated with having an mpox diagnosis.

Methods
We conducted a 5:1 matched case-control study among DC Cohort participants, a longitudinal cohort of PWH receiving care in Washington, DC. Cases were matched on age (+/-5 years), gender, race/ethnicity, HIV transmission risk factor, time since HIV diagnosis (+/-5 years), years enrolled (+/-3 years), and HIV care site (community or hospital) with up to 5 controls. Engagement in care was defined as two or more CD4 or HIV RNA tests at least 90 days apart during the last year. STI screening was any test for gonorrhea, chlamydia, or syphilis in the past year. Cases were participants with an mpox diagnosis identified by providers or an ICD10 code in the EHR. We used unadjusted conditional logistic regression to assess the relationship between engagement in care, STI screening, and mpox diagnosis.

Results
We identified 68 cases of mpox in the DC Cohort and 65 could be matched to 300 controls (n = 365). Participants were majority male (98.9%), Black (70.7%), MSM (89.3%), and 51.5% of participants had an STI diagnosis since cohort enrollment. Cases were significantly more likely to be engaged in care (50.8% vs. 26.3%; OR: 3.24), receive an STI screening (69.2% vs. 41.3%; OR: 3.45), have a historical STI (72.3% vs. 47.0%; OR: 3.58), and have a CD4 count &lt; 500 (40.4% vs. 21.9%; OR: 2.51).

Conclusion
Among a cohort of PWH, those with an mpox diagnosis were significantly more likely to be engaged in care and received an STI screening in the year prior, suggesting increased encounters for HIV care may account for a higher rate of PWH among mpox cases. The high proportion of CD4 &lt; 500 among mpox cases suggests more clinically evident manifestations in this population. Future analyses should examine unmeasured behavioral factors to explain the association between mpox diagnosis, increased engagement in care and STI screening.

Disclosures
All Authors: No reported disclosures