bluuebunny/crossref_metadata_2025_split huggingface dataset:
1845. Integrating Infectious Diseases and Primary Care Providers in a Syringe Service Program in Chicago to Improve Access to Care for People with Substance Use Disorder
Authors: Knodle Ryan D , Chaisson Lelia H , Cotler Karen F , Huyck Michael , Messmer Sarah , Mayer Stockton 
Published: November 2023

Abstract

Background
People with substance use disorders (SUD) are at elevated risk of infectious diseases (ID) but have low uptake of preventive and primary care (PC) due to structural, social, and behavioral barriers to care. Syringe service programs (SSP) are established, trusted sources of care; expanding health care provided through these programs may result in improved health for this population. We aimed to assess uptake of services from a pilot program in Chicago that offered PC, ID consultation, and harm reduction services.

Methods
PC and ID providers were embedded in the SSP to provide routine PC and preventive health services to patients seeking harm reduction services referred by outreach workers with lived SUD experiences. For this analysis, we reviewed all clinical encounters occurring from 10/19/2018-12/31/2021. We assessed patient demographics and visit types and determined the number of encounters for those with and without SUD. We compared characteristics of encounters for individuals with and without SUD using Chi-squared tests and Wilcoxon rank sum tests.

Results
During the study period, a total of 552 patients had 1720 clinical encounters (median 1 per patient, range 1-44). Overall, 390 (70.7%) patients were male, median age was 43 years (IQR 19-71), and 415 (75.2%) had public insurance (Table 1). A higher proportion of those who had a visit for SUD had public insurance compared to those without SUD (79.6% vs 67.2%, p=0.003).
Of the 1720 encounters, 1227 (71.3%) included care for active SUD, of which 402 (23.4%) addressed infections often associated with SUD (Table 2). Encounters for HIV and hepatitis C virus made up 20% of all encounters. PC services were rendered at 910 (52.9%) encounters and 625 (36.3%) encounters included services for both SUD and PC. Those without active SUD were more likely to have encounters for PC (61.7% vs 49.4%, p&lt; 0.001) and infections (50.7% vs 27.1%, p&lt; 0.001) than those with active SUD.

Conclusion
Incorporating ID and PC services in an established SSP was effective for engaging vulnerable populations in Chicago, including people with SUD, with nearly half of all encounters among people with SUD including PC services. Integration of ID and PC within SSPs should be scaled-up to improve access to care, especially given the burden of infections in this population.

Disclosures
All Authors: No reported disclosures
1857. Why do antibiotic become resistant in hospitalized patients? Evidence from tertiary healthcare facilities in Bangladesh
Authors: Sumon Shariful Amin , Chowdhury A B M Alauddin , Sharmin Sabrina , Harun Md Golam Dostogir 
Published: November 2023

Abstract

Background
Antibiotic resistance among hospitalized patients is a growing concern due to irrational antibiotic consumption. Exploring the dynamics of antibiotic consumption including healthcare-seeking behavior is indispensable to minimizing the antibiotic resistance burden. This study explored the pattern of antibiotic consumption and healthcare-seeking behavior of patients before being admitted to tertiary hospitals in Bangladesh.

Methods
Between August and September 2022, we conducted this cross-sectional study in four tertiary care ( 2 public and 2 private) hospitals. A total of 943 admitted patients were randomly enrolled and face-to-face interviews were conducted to obtain data on antibiotic usage history, healthcare-seeking patterns, and duration of medical consultation. Descriptive statistics were used for the analysis and interpretation.

Results
Prior to hospitalization, 32.8% (95%CI: 30.5, 35.1) of patients had antibiotic consumption history within the previous two months without lab confirmation. About one-quarter (25.6%) of the participants sought antibiotic treatment from unregistered physicians. Patients admitted to private hospitals were found to be higher to seek treatment from unregistered sources compared to public hospitals (37.8% vs. 13.4%, p-value: 0.001). Less than two-thirds (63.8%) of patients completed their entire course of antibiotics before admission to the hospitals. The average duration between symptom onset and medical consultation was 5.6 (SD 1.3) days before hospitalization. In terms of place for healthcare seeking, the majority of participants (52.0%) visited government hospitals, followed by private hospitals (22.6%), and pharmacies (20.1%). Self-medication was found in 5.3% of participants before being admitted to the hospital. However, 72.2% of patients were prescribed antibiotics after admission and only 5.3% had a laboratory diagnosis before receiving antibiotics.

Conclusion
Hospitalized patients were found to consume antibiotics more frequently before and after admission. Furthermore, healthcare seeking from unregistered sources, including delayed and incomplete treatment could hindrance to combating against antibiotic resistance among admitted patients.

Disclosures
All Authors: No reported disclosures
1859. Median Income by Location of Residence and Clinical Outcomes of Hospitalized Persons with COVID-19 in an Urban Veterans Affairs Medical Center
Authors: Tuck Matthew , Rivasplata Heather , Towers Steven , Liappis Angelike P , Arundel Cherinne , Dinescu Anca , Hamidi Zachariah , Alaithan Haitham , Uppal Surabhi , Patel Pratish C , Khosla Shikha , Simmens Samuel , Benator Debra A 
Published: November 2023

Abstract

Background
The COVID-19 pandemic has disproportionately affected racial and ethnic minorities and those of low socioeconomic status, including higher rates of illness severity and death. This has been attributed in part to decreased healthcare access. We sought to determine whether place of residence as a marker of socioeconomic status, healthcare access, and median income were predictive of disease severity in a large integrated healthcare system.

Methods
We conducted a prospective observational cohort study of ­348 patients admitted to the hospital with a diagnosis of COVID-19 between March 1, 2020 through June 30, 2021. Using univariate and multivariable logistic regression, we evaluated associations of disease severity outcomes with demographic characteristics of veterans, age-adjusted Charlson Comorbidity Index (CCI), and median income by place of residence.

Results
&lt; The mean age of our cohort was 68 and 90% were male. The racial and ethnic makeup was 83% black, 14% white, 5% Hispanic or Latino, and 3% other. In unadjusted models, only median income and the CCI predicted need for high-flow oxygen (p = 0.009 and p &lt; 0.0001, respectfully) and death (p = 0.04 and p = 0.0005, respectively), while the CCI also predicted the need for intubation (p = 0.02). In multivariable models, CCI was strongly associated with the need for high-flow oxygen, intubation, and death (p = 0.0001, 0.01, and 0.02, respectively); age alone remained the most powerful predictor of death. Race and ethnicity were not associated with the need for high-flow oxygen, intubation, or death. Place of residence was not associated with worse outcomes.

Conclusion
This cohort study of hospitalized patients in an urban Veterans Affairs Medical Center found that race, ethnicity, and location of residence were not associated with COVID-19 disease severity and death, but median income and higher scores on the CCI predicted worse outcomes.

Disclosures
Pratish C. Patel, PharmD, BCIDP, AAHIVP, VBI Vaccines: Stocks/Bonds
1867. Clinical Presentation and Outcome of Tuberculosis in Patients with Chronic Kidney Disease Stage 4 and 5: A Retrospective Cohort Study from a TB Endemic Country
Authors: Babar Zaheer Udin , Dodani Sunil Kumar , Nasim Asma , Badlani Sanjay Kumar 
Published: November 2023

Abstract

Background
Patients with chronic kidney disease (CKD) have high risk of developing TB and numerous studies have been done on presentation and outcome of both conditions. However there is a lack of data on regional burden of TB in this group of population. We set out to study on clinical presentation and treatment outcome of TB in patients with moderate to severe renal impairment from a large renal and dialysis center.
Demographics and microbiological characteristics of Tuberculosis in patients with CKD
Risk factors of mortality in patients with TB and CKD

Methods
This is a retrospective cohort study included all patients with CKD stage 4 and 5 and diagnosed active TB from May 2016 till June 2020. Transplant recipients were excluded. TB diagnosis was made as pulmonary tuberculosis (PTB), extra pulmonary TB (EPTB) and disseminated TB (DTB). Primary outcome was measured as treatment successfully completed, lost to follow up, all-cause mortality. Our secondary outcome was to evaluate microbiological characteristics and drug resistant pattern in PTB and EPTB.
Microbiology of mycobacterium TB in CKD patients
Characteristics of EPTB

Results
A total of 259 patients with stage 4-5 CKD of all age groups were identified. Mean age of study population was 34.68 +16.7 and a higher proportion of EPTB than PTBTB (61% and 37.1% respectively). Diagnosis of TB in majority of patients 118 (45.51%) were microbiological based and 46 (17.8%) isolates found to have culture positive among those, 16 (34.78%) were resistant to either single (26.08%) or multiple TB drugs (8.69%). Out of 259, 38 (14.7%) patients died during treatment and 12 (4.6%) patients lost to follow up. Our treatment success rate (treatment completed and cured) was 80.7%.

Conclusion
We have made few important observations such as diagnosis EPTB as predominant from in CKD. We have made microbiological based diagnosis in around half of our patients. Drug resistance and mortality was found to be high.

Disclosures
All Authors: No reported disclosures
1872. Risk factors associated with gaps in screening and testing for latent TB infection in children
Authors: Fink Julia , Burrough William , Hsieh Charlotte , Tamerat Mariamawit , Noor Zarin , Chitnis Amit S , Lewis Gena , Jaganath Devan 
Published: November 2023

Abstract

Background
Children should be treated for latent TB infection (LTBI) to prevent progression to TB disease, but there are gaps in screening and testing for LTBI. We evaluated demographic and clinical factors associated with LTBI screening and testing at a Federally Qualified Health Center in Oakland, California.

Methods
We extracted demographic, clinical and note data from the electronic health records of all well-patient visits of children and adolescents 1-19 years old without a history of LTBI or TB disease from 2014 – 2020. Screening was defined as documenting the presence/absence of new TB risk factors, and testing was defined as ordering/completing a tuberculin skin test (TST) or QuantiFERON-TB Gold blood test (Quantiferon Gold). We performed multivariable logistic regression to determine the factors associated with conducting a TB risk assessment, ordering LTBI testing, and completing LTBI testing.

Results
We evaluated 18,681 visits, of which 38% were age 1 – 4, 50% were female, and 19% preferred a language other than English. Overall, 90% of visits documented a TB risk assessment, of which 8% had a risk factor for TB infection. Only 26% visits with a documented TB risk had a TB test subsequently ordered. 82% of ordered tests were completed. We found that children 1 – 4 years old were more likely to be screened for TB risk factors than adolescents ≥12 years (aOR 7.87, 95% CI 6.77 – 9.13, p &lt; 0.01), but adolescents were more likely to be tested (aOR 1.74, 95% CI 1.12-2.66, p &lt; 0.05). Non-English-speaking patients were more likely to be assessed for TB risk factors and were more likely to have an LTBI test ordered (Table 1). LTBI testing was more likely to be completed in females (aOR 5.08, 95% CI 1.75 – 14.70, p &lt; 0.01) as well as when TST was ordered compared to Quantiferon Gold (aOR 24.15, 95% CI 8.17 – 71.42, p &lt; 0.01).

Conclusion
Gaps in the LTBI care cascade for children were associated with age, sex and language preference, and interventions are needed to improve LTBI care in these groups. Further efforts are needed to address barriers to Quantiferon Gold completion in children.

Disclosures
All Authors: No reported disclosures
1875. Factors associated with unfavorable tuberculosis treatment outcomes, Almaty, Kazakhstan, 2018-2021
Authors: Gabdullina Malika , Gazezova Saya , Ayapova Gulzhan , Smagul Manar , Horth Roberta , Nabirova Dilyara 
Published: November 2023

Abstract

Background
The COVID-19 pandemic negatively influenced the availability of TB related services around the world, including detection, diagnosis and treatment. The purpose of this research is to assess the impact of the COVID-19 pandemic on TB treatment outcomes in Almaty, and to determine risk factors associated with said outcomes by examining data from before (2018-2019) and during the pandemic (2020-2021).

Methods
We conducted a retrospective cohort study among all people newly diagnosed with drug-sensitive tuberculosis over 18 years old who initiated treatment from 2018-2021 in Almaty. We abstracted data from the national tuberculosis electronic database. Unfavorable treatment outcomes were sorted as follows: ineffective treatment, death, loss for follow-up, results not evaluated, and transferred for treatment with second-line anti-TB drugs. We used multivariate Poisson regression to calculate adjusted relative risk [aRR] and 95% confidence intervals [95%CI].
Risk factors associated with TB treatment outcomes among people newly diagnosed with drug-susceptible TB, Almaty, Kazakhstan, 2018-2022

Results
Among 1548 people newly diagnosed with TB during the study period, average age of was 43 years (range 18-93) and 52% were male. A higher proportion of people had unfavorable outcomes during the pandemic (2020-21) than before the pandemic (2018-19) (20% vs 11%, respectively, and aRR=1.8; CI: 1.4-2.2). Among those with unsuccessful outcomes, 1% were lost to follow-up, 3% had treatment failures, and 9% died. Risk factors for unfavorable TB treatment outcomes were: being male (aRR=1.4, 95%CI=1.1-1.8), having HIV (aRR=2.4, 95%CI=1.8-3.3), having drinking disorder (aRR=2.3, 95%CI=1.6-3.3) and experiencing homelessness (aRR=2.6, 95%CI=1.5-4.3) (Table 1). Protective factors for unfavorable TB treatment outcomes were: being 18-39 years old (aRR=0.4, 95%CI=0.3-0.6), 40-59 years old (aRR=0.6, 95%CI=0.4-0.8), and being student (aRR=0.1, 95%CI=0.02-0.9).

Conclusion
COVID-19 pandemic was associated with unfavorable treatment outcomes for people newly diagnosed with drug-sensitive tuberculosis in Almaty, Kazakhstan. People with lower social stability were at increased risk. Results point to the need for improved continuity of care for TB treatment for people at increased risk of unfavorable outcomes, especially during disease outbreaks and pandemics.

Disclosures
All Authors: No reported disclosures
1885. Resultados clínicos del tratamiento antituberculoso en pacientes oncológicos entre 2011-2022 en Cali Colombia
Authors: Montes-Tello Sofía Alexandra , García-Goez José Fernando 
Published: November 2023

Abstract

Background
Tuberculosis infection represents a clinical challenge despite the fact that treatment can cure 85% of cases because successful outcomes can vary due to other comorbidities such as cancer, during which pharmacological interactions, adverse effects and decreased adherence to treatments are common. This study aims to describe the characteristics and outcomes of patients with active tuberculosis and cancer from a referral hospital.

Methods
A retrospective observational study was conducted, which included patients who were diagnosed with cancer requiring oncological treatment during tuberculosis treatment management, as well as patients who were undergoing oncological management and were diagnosed with active tuberculosis during this process at a referral hospital in southwestern Colombia between 2011-2021.

Results
Fifty-eight patients with tuberculosis and cancer were included. The median age of the patients was 60 years (IQR: 42 – 67), 31% were women and 75% of the cases were pulmonary tuberculosis. Hematological neoplasms accounted for 62% of cases and the intention of oncological therapy was curative in 89% of cases. The most common clinical decision was to administer antituberculous and oncological therapy simultaneously in 46% of cases and the antituberculous regimen was modified in 34% of cases. The success rate of antituberculous treatment was 60% and 28% of cases died.

Conclusion
It is necessary to consider screening for active and latent tuberculosis as a priority in patients with neoplasia diagnoses and ensure prophylactic management.

Disclosures
All Authors: No reported disclosures
1886. Prevalence Of Latent TB Infection Among Critically Ill COVID-19 Population In a Tertiary Teaching Hospital In Mexico
Authors: Montiel Santiago , Valente-Acosta Benjamin 
Published: November 2023

Abstract

Background
Tuberculosis (TB) is the leading cause of death from a single infectious agent. Latent tuberculosis infection (LTBI) is defined as TB infection without clinical symptoms or microbiological evidence. LTBI is a risk factor to later development of active TB. COVID-19 pandemic represents an emerging infectious disease. Immunosuppressants as corticoids and tocilizumab are the standard of care of critically ill COVID-19 patients. Those drugs have previously been shown to increase the risk of developing active TB, especially in patients with latent TB.

Methods
We conduct a cross-sectional study to determine the prevalence of latent tuberculosis infection, through QuantiFERON, in patients who have been hospitalized with severe or critical COVID-19 at the ABC Medical Center in Mexico City-Mexico, from March 2020 to March 2021.

Results
From 1174 records reviewed, a total of 503 patients who have a QuantiFERON® test were included. The prevalence of LTBI in hospitalized patients with severe or critical COVID-19 in our hospital was 10.1% (n=51). Of the total of patients with a diagnosis of LTBI, 82.3% had severe disease and 17.6% had critical illness requiring invasive mechanical ventilation (IMV) and 42 (82%) received corticosteroids and 29 (57%) received tocilizumab.

Conclusion
To the best of our knowledge this is the first report that depict the LTBI prevalence in a cohort of severe and critical COVID-19 patients in a Lower-Middle Income Country. Our prevalence was lower than previously reported global prevalence of LTBI.

Disclosures
All Authors: No reported disclosures
1897. Therapeutic Drug Monitoring in CSF and Plasma in Tuberculous Meningitis:Correlation with Disease Outcome
Authors: Singh Urvashi , Aayilliath Adarsh 
Published: November 2023

Abstract

Background
Tuberculous meningitis (TBM) is a serious form of extra-pulmonary tuberculosis with significant morbidity and mortality. TBM patients are treated with pulmonary tuberculosis regimen, often requiring extension for 1 year or longer. Current study was designed to find any association of CSF and blood levels of anti-tubercular drugs with treatment response in patients with tuberculous meningitis using therapeutic drug monitoring.
Pharmacokinetic Parameters of Rifampicin and Isoniazid in CSF and Plasma

Methods
A prospective observational study was conducted in a tertiary care institute in North India among clinic-radiologically and/or microbiologically diagnosed TBM patients. Plasma and CSF levels of anti TB drugs (rifampicin, isoniazid, pyrazinamide and ethambutol) were determined using Liquid Chromatography Mass Spectrometry technology at 1 week and 1 month (follow up) after initiating treatment. The primary outcome assessed was association of drug levels with treatment response. The secondary outcomes assessed were association of drug levels with treatment duration/alteration, patient demographic profile, comorbidities and adverse effects. Patients were followed-up till treatment completion.

Results
A total of 40 patients with TBM were recruited. All received daily weight-based doses of anti TB drugs. Low Cmax of INH and rifampicin in plasma were observed in 60.5% & 42.1% of observations respectively. In CSF, low Cmax of INH and rifampicin were observed in 77.6% & 82.9% of observations respectively. The concentrations of INH (4 hours after drug intake) during follow up were significantly lower among patients with poor response, at 1 month (p=0.008) & 6 months (p=0.009). Similarly, low Cmax & CSF levels of INH at follow up sampling were significantly associated with poor response at 6 months of therapy (p= 0.022 & 0.042 respectively).

Conclusion
Low plasma and CSF concentrations of isoniazid were associated with a poor response to treatment in patients with TBM. Therapeutic drug monitoring can guide dose modification of ATT to achieve target concentrations in patients with TBM and facilitate optimal treatment outcomes. Higher dose INH can be considered in TBM treatment regimen for better outcome.

Disclosures
All Authors: No reported disclosures
2106. Desirability of Outcome Ranking (DOOR): Application to a Phase 3 Registrational Trial Evaluating Sulopenem for Patients with Complicated Intra-abdominal Infection (cIAI)
Authors: Aronin Steven I , Dunne Michael W , Gupta Jayanti , Puttagunta Sailaja 
Published: November 2023

Abstract

Background
The DOOR approach has been proposed as an improved way to evaluate novel anti-infective agents by focusing on benefits and harms and providing an assessment of the patient experience. We conducted a Phase 3 cIAI trial comparing IV ertapenem (stepped down to either oral ciprofloxacin and metronidazole or amoxicillin-clavulanate) to IV sulopenem (stepped down to oral sulopenem etzadroxil/probenecid). Using the FDA’s current definition of a successful response (clinical response at Day 28 / Test-Of-Cure (TOC) in the microbiological intent-to-treat (micro-ITT) population using a non-inferiority margin of 10%, sulopenem’s overall success rate was 85.5% while ertapenem’s was 90.2% (treatment difference -4.7%, 95% CI: -10.3, 1.0). In all other study populations including the intent-to-treat (ITT), modified ITT, clinically evaluable (CE), and microbiologically evaluable (ME) populations the lower limit of confidence interval was above -10.0. To further understand these trial results, an analysis using the DOOR methodology was performed post hoc.Table 1Desirability of Outcome Rankings by Treatment Arm

Methods
The DOOR analysis strategy, developed by the Antibacterial Resistance Leadership group (ARLG), was retrospectively applied to our registrational drug trial for cIAI (SURE-3) to estimate the probability of a more desirable outcome for sulopenem.

Results
The DOOR probability of a more desirable outcome is 47.4% [95% CI (44.1%, 50.8%)], indicating no significant difference between the sulopenem and ertapenem treatment arms for patients with cIAI. The probabilities for the analyses prioritizing efficacy and safety were identical to the original outcome ranking, and those for the individual components were very similar.

Conclusion
Traditional endpoints used in registrational trials for cIAI may be inadequate. They evaluate safety and efficacy separately, and they fail to evaluate the cumulative impact of multiple clinical events. DOOR combines clinical efficacy and safety into a single endpoint that may be more reflective of an individual patient’s overall outcome. Applying DOOR to SURE-3 data showed no significant difference between the sulopenem and ertapenem treatment arms for patients with cIAI.

Disclosures
Steven I. Aronin, MD, Iterum Therapeutics Limited: Stocks/Bonds Michael W. Dunne, MD, Iterum Therapeutics: Board Member|Iterum Therapeutics: Stocks/Bonds Jayanti Gupta, PhD, Iterum Therapeutics: Advisor/Consultant Sailaja Puttagunta, MD, Iterum Therapeutics Limited: Full time employee|Iterum Therapeutics Limited: Stocks/Bonds