bluuebunny/crossref_metadata_2025_split huggingface dataset:
1462. Analysis of Clindamycin and Vancomycin Use and Reported Beta Lactam Allergy in Procedural Antimicrobial Prophylaxis
Authors: Veach Lisa A , Bushman Amanda , Wall Geoff , Hadziric Adela , Olstinke Kayla , Blackmer Sydney 
Published: November 2023

Abstract

Background
Patients with a penicillin (pcn) allergy are less likely to receive cefazolin (cef) and more likely to receive vancomycin (vanco) or clindamycin (clinda) for procedures. Literature reveals a 51% increased risk of surgical site infection in patients with a reported pcn allergy attributed, in multivariable analysis, to use of second line antimicrobial agents.

Methods
We conducted a retrospective review of intravenous vanco and clinda administration in procedural areas during a 6 -month period in 2022.
The aim of our study was to assess the appropriateness of the procedural prophylaxis antibiotic given based on the allergy information available in the medical record.
Documented allergy responses were classified as: severe, cutaneous and other. Multiple documented reactions were classified using the most severe reaction type.

Results
Seven hundred and eighty-eight patient encounters were reviewed: 434 encounters receiving vanco and 354 encounters receiving clinda.
Of the encounters receiving vanco, 237 (55%) had documentation of beta lactam allergy (pcn allergy (212), cef allergy (64), both (39)). Within the pcn allergy group, reaction was cutaneous only in 47% (100). In 79 encounters previous receipt of a cephalosporin was documented in the EHR.
Of the encounters receiving clinda, 330 (93%) had documentation of a beta lactam allergy (pcn allergy (277), cef allergy (98), both (45)). Within the pcn allergy group, reaction was cutaneous only in 60% (167). In 109 encounters previous receipt of a cephalosporin was documented in the EHR. (Figures 1 and 2)
In both groups nursing placed the majority of the vanco (69%) and clinda (70%) orders.

Conclusion
At least 55% (N=267) of pcn allergic patients could have received the optimal agent (cefazolin) for procedural prophylaxis as they had only a cutaneous reaction. EHR review for prior cephalosporin administration in non-cutaneous reaction further increases that number.
In recognition of the role of nursing, our health system has developed guidance documents to aid pre-op nursing staff in selecting the appropriate surgical prophylaxis antimicrobial in patients reporting pcn allergy. This document is readily available and shared with key stakeholders. Process improvement opportunities are ongoing.

Disclosures
All Authors: No reported disclosures
2006. The Impact of Race and Rurality on Healthcare-Associated Infections and Downstream Adverse Outcomes
Authors: Nickel Katelin B , Kinzer Hannah , Fraser Victoria J , Burnham Jason P , Kwon Jennie H 
Published: November 2023

Abstract

Background
There is limited information on racial disparities and healthcare-associated infections (HAIs). The objective of this study was to evaluate the impact of race and rurality on HAIs and outcomes of HAIs including death and intensive care unit (ICU) admission.

Methods
We established a retrospective cohort of adults ≥ 18 years admitted ≥ 48 hours from 1/1/2017–8/31/2020 at three Missouri hospitals. HAIs were defined as positive cultures from urine, blood, or respiratory specimens ≥ 48 hours after admission. The primary exposure was patient race and rurality defined as combinations of race (Black or white) and residence (urban vs. rural based on patient ZIP code and using the National Center for Health Statistics Urban-Rural classification). We used a generalized estimating equations (GEE) model to determine disparity-related (i.e., race/rurality, sex, Medicaid payer, census median income quartile) risk factors for HAI accounting for clustering of admissions at the patient-level and adjusting for other factors (e.g., comorbidities, age, transfer status). Among HAI admissions, similar GEE models examined in-hospital death and ICU admission after HAI.

Results
The cohort included 214,955 admissions (Table 1), with HAIs occurring during 6,699 (3.1%) of admissions (1,572 blood; 3,146 urine; 2,497 respiratory HAIs). HAIs developed during 3.1% of admissions among white urban patients, 3.9% among white rural patients, 2.7% among Black urban patients, and 4.1% among Black rural patients (Figure 1). White rural patients had an increased risk of HAI (adjusted relative risk [aRR] 1.13; 95% confidence interval [CI] 1.06, 1.20) while Black urban patients had a decreased risk of HAI (aRR 0.82; 95% CI 0.76, 0.88) compared to white urban patients. Among HAIs, adverse outcomes were more common in Black rural patients (Figure 2). Specifically, Black rural patients had an increased risk of ICU admission (aRR 1.35; 95% CI 1.15, 1.58) and in-hospital death (aRR 1.85; 95% CI 1.31, 2.60) while white rural and Black urban patients had similar outcomes compared to white urban patients.Table 1.Patient characteristicsFigure 1.Proportion of admissions with an HAI by race and ruralityFigure 2.Among HAIs, proportion of admissions with adverse outcomes by race and rurality

Conclusion
We identified disparities related to race and rurality in HAIs and adverse outcomes from HAIs. Future work to understand the reasons underpinning these differences is critical to identify targets for intervention.

Disclosures
All Authors: No reported disclosures
1474. Getting to Zero: Our Journey to Decrease CABG Deep Sternal Wound Infections
Authors: Gentile Paul M , Roberts Scott , Wilson Erin , Martinello Richard A 
Published: November 2023

Abstract

Background
Deep sternal wound infections (DSWI) are a serious complication of cardiac thoracic surgeries and are associated with a significantly higher mortality risk. Our center experienced increased surgical site infection (SSI) rates prompting an epidemiologic evaluation.

Methods
A retrospective cohort review of 10 cardiac surgery patients with DWSI from 2020-2021 were reviewed. An SSI bundle to decrease DSWI was implemented using a standardized pos-operative wound dressing (prior to this, dressing selection was per the cardiac thoracic surgeon's discretion), glucose optimization in collaboration with our endocrinology team, and chlorhexidine bathing practices.

Results
Starting in September 2020 Yale New Haven Hospital observed a statistically significant increase in DSWI (0.51), which was a 285% increase in DSWI. Of the 10 out of 15 patients with DSWI who underwent review, the majority were inpatient prior to surgery with a mean length of stay of 5 days before undergoing surgery. Following selective implementation of the SSI bundle to urgent cases who were inpatient at the time of surgery, the DSWI rate decreased from 1.97 in 2021 to 1.13 in 2022, which reflected a 43% clinical decrease with 0 DSWI reported.

Conclusion
Implementation of an inpatient pre-operative, SSI bundle, including standardization of post-operative sternal wound dressings, resulted in a significant decrease in DSWI that has persisted post-intervention.

Disclosures
All Authors: No reported disclosures
1477. Do Federal Risk Assessment Criteria Adequately Classify Patients for Surgical Site Infections Following Colon Surgery?
Authors: Yusuf Yasna , Episcopia Briana , Fornek Mary , Abdallah Marie , Quale John 
Published: November 2023

Abstract

Background
Infections related to colon surgery are associated with adverse outcomes. Colon SSIs are reportable to National Healthcare Safety Network (NSHN) and Centers for Medicare and Medicaid Services (CMS). Rates of SSIs are factored into federal reimbursement programs; financial penalty may exist for “low-performing” hospitals. CMS employs a risk assessment tool to calculate the number of expected colon SSIs for each center.

Methods
The NYC H+H consist of hospitals that serve patients of low socioeconomic status. Five of the eleven are designated as level 1 trauma centers. Data regarding patients that underwent colon surgery from 2015-2022, including those that developed SSIs, were obtained from NHSN. Propensity score matching was done to match patients with colon SSIs to those without SSIs. Covariates included the CMS risk factors: gender, diabetes, age, BMI, ASA score, surgical closure type.

Results
A total of 5217 patients underwent colon surgery from 2015-2022. There were 276 patients with a colon SSI. A propensity matched cohort (n=276), using the CMS risk assessment variables, was matched with the 276 patients with SSIs (Table 1).
Other features involving the colon surgery were examined for the two cohorts (Table 2). Compared to the matched controls, there was a disproportionate distribution of wound class groups among the SSI cohort. Significantly more patients had dirty wounds in the SSI group. Surgery was more often emergent, and had a significantly longer duration in the SSI cohort. Of the patients with SSIs, more were trauma cases, and a significantly greater percentage had surgery performed in a trauma center compared to the other hospitals.

Conclusion
Colon SSI preventive measures are not applicable for emergent and trauma cases. The current risk assessment model used by CMS does not fully adjust for the complexity of various colon surgeries. As such, hospital performance as judged by federal SSI assessments does not correlate with the quality of care provided. Financial penalties imposed by CMS may be devastating, particularly for safety net hospitals serving patients primarily of low socioeconomic status. Until appropriate risk assessment models are developed, the use of colon surgery SSIs as a quality measure should be re-evaluated.

Disclosures
All Authors: No reported disclosures
1482. Combined Test and Treat Campaigns for HIV, Hepatitis B and Hepatitis C: A Systematic Review to Provide Evidence to Support WHO Treatment Guidelines
Authors: Beard Natasha , Hill Andrew 
Published: November 2023

Abstract

Background
Over 38 million individuals are living with HIV, 296 million with chronic Hepatitis B (HBV) and 58 million with chronic Hepatitis C (HCV). Globally, despite successful and cost-effective treatments for these blood-borne viruses (BBVs), over 1.7 million people die per annum. HIV testing is common practise in many countries, yet HBV and HCV screening is often neglected. This systematic review aims to identify the prevalence of the aforementioned BBVs and discuss the cost-effectiveness of implementing combined testing and treatment for HIV, HBV and HCV as one package.

Methods
MEDLINE, Embase and Global Health were searched to identify papers published between 1st January 2013 and 24th February 2023. Included studies reported the prevalence of HIV (anti-HIV 1/2 antibodies), HBV (Hepatitis B surface antigen) and HCV (anti-HCV antibody). Results were stratified into risk groups: blood donors, general population, healthcare attendees, homeless individuals, men who have sex with men (MSM), people who use drugs (PWUD), pregnant women, prisoners, and refugees.

Results
175 studies conducted in 56 countries sampling over 14 million individuals met the eligibility criteria and were included. The mean prevalence of HIV, HBV and HCV was 3.12% (± 7.71%), 4.01% (±5.80%) and 6.70% (±14.64%) respectively. The mean number of individuals testing positive for at least one BBV was 11.83% (±16.86%); with the greatest burden of disease being reported in MSM and PWUD. Therefore, if combined testing was implemented on a global scale, for every 3 individuals diagnosed with HIV, another 4 would be diagnosed with HBV and 7 with HCV.Table 1:Prevalence of HIV, HBV and HCV and the total testing positive for at least one blood-borne virus in included risk groupsFigure 1:A Bar Chart demonstrating the prevalence of HIV, HBV and HCV in each included risk group

Conclusion
The cost of manufacturing a triple BBV test is $1. Additionally, HIV can be treated for $60/year using TDF/FTC+DTG, HBV for $32/year using generic TDF and HCV can be cured for $79 via generic Sof/Vel, thus providing a cost-effective package solution that could be implemented in the majority of countries. The results of this paper highlight a potential avenue for healthcare improvement by expanding common place isolated HIV testing to combination test and treat programmes. It is only through global diagnosis of all three BBVs, coupled with successful linkage to care, that the Sustainable Development Goal of elimination of these BBV epidemics by 2030 will be achieved.

Disclosures
All Authors: No reported disclosures
2062. In Vivo Efficacy of CD388, a Novel Drug Fc-Conjugate (DFC), Against Seasonal Subtypes of Influenza in Prophylaxis in Immune Competent Mice, and in a Severe Immunodeficient (SCID) Mouse Model
Authors: Levin James , Döhrmann Simon , Cole Jason N , Amundson Karin , Borchardt Allen , Brady Thomas P , Lam Thanh , Fortier Joanne , Almaguer Amanda , Tari Leslie W 
Published: November 2023

Abstract

Background
Influenza remains a significant public health concern due to the limited efficacy of vaccines. Cidara has developed CD388, a multivalent conjugate of a dimeric neuraminidase inhibitor with a proprietary hIgG1 Fc domain engineered for extended half-life, currently in clinical development. Here we describe the efficacy of CD388 against a panel of geographically and temporally diverse influenza A and B subtypes in mouse prophylactic models, and against H1N1 in a SCID model.

Methods
Efficacy studies were conducted in BALB/c mice lethally challenged with influenza virus. CD388 was administered intramuscularly (IM), seven days prior to challenge. Animals were monitored daily for 21 days or longer for survival (&lt; 20% BW loss). For SCID studies, mice were dosed with CD388 two hours prior to lethal challenge with influenza A H1N1. Oseltamivir and baloxavir were included as comparators.

Results
Across all influenza subtypes, CD388 treatment at ≤1 mg/kg resulted in 100% survival (Table 1). Daily BW measurements of treatment groups supported survival findings and showed a transient BW loss (generally between 5 and 15% of starting weight), before animals recovered weight.
In SCID studies, the median time of death for vehicle treated animals was seven days. Treatment with oseltamivir (5 mg/kg, bid x5d) and baloxavir (15 mg/kg, bid x1d) at their human equivalent doses extended the median survival time to Day 10 and 16, respectively (Figure 1). In contrast, a single dose of CD388 at 1 mg/kg extended the median time of death to beyond Day 21. A dose response was evident at higher CD388 doses with the median time of death extended to Day 30 and 35 for 3 and 10 mg/kg groups, respectively.

Conclusion
This data demonstrated a single IM administration of CD388 fully protected animals from lethal challenge against seasonal influenza A and B. Importantly, CD388 was found to be efficacious in a severe model of immune deficiency. This data supports the prophylactic use of CD388 to prevent seasonal influenza in individuals.

Disclosures
James Levin, PhD, Cidara Therapeutics: Stocks/Bonds Simon Döhrmann, PhD, Cidara Therapeutics: Stocks/Bonds Jason N. Cole, Ph.D., Cidara Therapeutics: Stocks/Bonds Karin Amundson, BSc, Cidara Therapeutics: Stocks/Bonds Allen Borchardt, PhD, Cidara Therapeutics: Stocks/Bonds Thomas P. Brady, Ph.D., Cidara Therapeutics: Stocks/Bonds Thanh Lam, PhD, Cidara Therapeutics: Stocks/Bonds Joanne Fortier, BSc, Cidara Therapeutics: Stocks/Bonds Amanda Almaguer, Bachelors, Cidara Therapeutics: Stocks/Bonds Leslie W. Tari, Ph.D., Cidara Therapeutics: Stocks/Bonds
1493. Targets for Primary Prevention in Newly Diagnosed People Living with HIV: Applying Life's Simple 7 to Assess Cardiovascular Health Needs in ART-Naive People Living with HIV in Tanzania
Authors: Khan Safah , Manyangu Gloria J , Peck Robert N 
Published: November 2023

Abstract

Background
People living with HIV (PLWH) are at elevated cardiovascular disease risk by virtue of their infection, even before initiation of antiretroviral therapy (ART). There is a need to characterize cardiovascular health (CVH) during the early infection phase to appropriately direct primary prevention efforts. Therefore, we applied American Heart Association's Life's Simple 7 (LS7) scale to compare CVH between ART-Naive PLWH and HIV-uninfected adults in Tanzania.

Methods
A cross-sectional analysis was conducted on a cohort of ART-Naive PLWH and HIV-uninfected adults recruited from HIV clinics between June 2016 and August 2019 in Mwanza, Tanzania (HIV&HTN cohort). We applied modified Life's Simple 7 (LS7) definitions (Table 1), categorizing each metric as ideal (2 points), intermediate (1 point) and poor (0 point). We compared distribution of these categories for each LS7 metric between study groups. Ordinal regressions were employed to investigate associations between HIV status and each individual LS7 metric adjusting for age, sex, education, income.

Results
Our study included 997 participants (493 PLWH, 504 controls). The distribution of LS7 metrics differed between PLWH and HIV-uninfected controls, as displayed in figures 1a and 1b. PLWH had higher prevalence of ideal BMI (75.6% vs 65.4%) and ideal blood pressure (56.1% vs 35.1%) than HIV-uninfected counterparts. By contrast, PLWH had lower prevalence of ideal smoking (83.5% vs 89.6%), physical activity (38.9% vs 45.0%), blood glucose (93.9% vs 97.8%) compared with controls. These associations were validated by multivariate ordinal regression wherein PLWH were found to be more likely to have ideal BMI (aOR= 1.59 [95%CI= 1.20-2.12], p=0.001), ideal blood pressure (aOR =2.50 [1.95-2.31], p&lt; 0.001) but less likely to have ideal smoking (aOR =0.63 [0.49-0.97], p=0.04), ideal physical activity (aOR= 0.63 [0.49-0.81], p&lt; 0.001), ideal blood glucose (aOR=0.34 [0.16-0.68], p=0.003).

Conclusion
Cardiovascular health profiles differ between PLWH and uninfected counterparts, even in the early pre-ART phase. Although PLWH had lower rates of traditional risk factors, there is room for improvement with regards to smoking cessation, improving physical activity and diabetes screening in newly diagnosed PLWH.

Disclosures
All Authors: No reported disclosures
1509. Clinical Features and Outcomes of COVID-19 in People Living with HIV in South Korea: a Nationwide Population-based Cohort Study
Authors: Yoon Young Kyung , Kim Jeong Yeon , Jeong Yujin , Ahn Hyong Gin , Suh Jin Woong , Kim Sun Bean , Sohn Jang Wook 
Published: November 2023

Abstract

Background
The aim of this study was to assess whether people living with HIV were at increased risk of severe or critical COVID-19, compared with HIV-negative individuals with COVID-19.

Methods
This nationwide descriptive epidemiological study was performed in South Korea between January 2020 and February 2022. Demographic and clinical characteristics were analyzed using National Health Insurance claims data collected through the Health Insurance Review and Assessment service (HIRA). We performed descriptive statistics and Cox proportional hazards regression analysis using the inverse probability weighting (IPW) to compare clinical features and outcomes between the HIV-positive and the HIV-negative COVID-19 patients.

Results
The database contains claim records for 3,653,808 individuals who were diagnosed with COVID-19 and for whom hospitals issued claims to the HIRA. Of them, 1,311 subjects (0.04%) were people living with HIV. The proportion of male patients in the HIV-positive group was significantly higher than that in the HIV-negative group (88.6% vs. 46.3%, P&lt; 0.001). The most common age groups were less than 20 years old in the HIV-positive group and 30 years old in the HIV-negative group, respectively. There was no significant difference in the mean Charlson's comorbidity index between the two groups. The mortality and morbidity rates in all COVID-19 patients were 0.24% and 15.7%, respectively. The hazard ratios (HRs) of hospitalization and in-hospital mortality in the HIV-positive group were 1.07 (95% CI 0.99-1.17; P=0.10) and 2.16 (95% CI 0.82-5.70; P=0.12) respectively, compared to those in the HIV-negative group. However, the odds ratios (ORs) of oxygen therapy (OR 2.82; 95% CI 2.26-3.52; P&lt; 0.001), use of vasopressors or inotropes (OR 4.74; 95% CI 3.07-7.32; P&lt; 0.001), and renal replacement therapy (OR 15.35; 95% CI 5.94-39.68; P&lt; 0.001) were higher in the HIV-positive group, compared to those in the HIV-negative group.

Conclusion
In conclusion, people living with HIV were not found to be at higher risk for mortality of COVID-19. However, they had a significantly higher risk of severe or critical COVID-19 than HIV-negative individuals. Our findings suggest the need for an immunization policy that prioritizes vaccination with the COVID-19 vaccine for people living with HIV.

Disclosures
All Authors: No reported disclosures
1510. Evaluation of Quantitative (1,3)-β-D-glucan in Prediction of Pneumocystis jirovecii Pneumonia in Patients Living with HIV in New York
Authors: Yune Philip , Felson Uriel , Fazzari Melissa , Orner Erika , Grossberg Robert 
Published: November 2023

Abstract

Background
(1,3)-β-D-glucan (BDG) has been utilized as an indirect marker for Pneumocystis jirovecii pneumonia (PJP). The clinical utility of BDG, however, is limited because of uncertainty in interpreting quantitative values. A correlation was drawn between quantitative BDG and the diagnosis of PJP in hospitalized patients living with human immunodeficiency virus (HIV) at four affiliate campuses of the Montefiore Health System in the Bronx, NY.

Methods
All Pneumocystis direct fluorescent assays (DFA), polymerase chain reactions (PCR) either from bronchoalveolar lavage (BAL) fluid or sputum, and quantitative BDG assays either from serum or BAL fluid were retrieved from the Montefiore microbiology laboratory (date range: 8/1/18 - 8/31/22). Results from hospitalized patients with HIV whose CD4 count within 3 months were available, with either PJP DFA or PCR result within 7 days of serum BDG and lactate dehydrogenase (LDH) test were selected (n = 146). CD4 count was grouped into &lt; 50 (n = 106), 50-100 (n = 15), 100-200 (n = 16), and &gt;200 (n = 9). BDG, LDH, and CD4 were considered as input variables in a logistic regression model for true PJP status. The area under the curve (AUC) of the empirical receiver operating characteristic (ROC) curve with 95% confidence intervals (CI) was estimated based on trapezoidal area. Comparisons between ROC curve areas were performed via contrast matrix to take differences of the AUC of the empirical ROC curves and chi-square testing.

Results
Of the 146, 29 had PJP detected and 117 did not. When BDG only was considered, the AUC of the ROC curve was 0.78. When LDH quartiles (cutoffs: 232, 334, and 480 U/L) were considered with BDG, there was a statistically significant increase in AUC (0.84 vs. 0.78; p = 0.025). Adding CD4 group did not influence AUC.
Figure 1
ROC curves for BDG only, BDG with CD4 count, BDG with LDH quartile, and BDG with CD4 group and LDH quartile combined
Table 1
Area under the curve calculated for the ROC curves for BDG only, BDG with CD4 count, BDG with LDH quartile, and BDG with CD4 group and LDH quartile combined

Conclusion
The test characteristics (AUC) improved when LDH quartiles were used in conjunction with BDG, suggesting a better prediction of PJP diagnosis when BDG and LDH were considered together. This result supports further investigation of clinical markers of PJP given the limitations of establishing a microbiologic diagnosis. Further steps of the investigation will involve analyzing if other clinical factors including HIV viral load, oxygen saturation, and radiographical reading, influence predictability of PJP.

Disclosures
All Authors: No reported disclosures