bluuebunny/crossref_metadata_2025_split huggingface dataset:
1258. Consulting Colleagues: Increasing Role of Advanced Practice Providers in Inpatient ID Consultation
Authors: Perez Reinaldo , Yarrington Michael E , Deri Connor R , Smith Michael J , Hayes Jillian E , Wrenn Rebekah , Moehring Rebekah W 
Published: November 2023

Abstract

Background
Advanced practice providers (APPs) have taken on increasing roles as primary team members in acute care hospitals. Little is known about variable consulting practices across provider types. Here we describe longitudinal trends in infectious diseases (ID) consultation by attributed provider type in 3 hospitals.

Methods
We performed a retrospective time series analysis of ID consultation from July 2015 to June 2022 to investigate the changes in requesting provider type at 3 hospitals: a major university hospital and 2 community hospitals. ID consultation rates were based upon new consult orders placed into the electronic health record (EHR). Provider type was categorized by type of ordering clinician: physicians, trainees (residents, fellows and medical students), and APPs (nurse practitioners, physician assistants, and nurse anesthetists). We evaluated the number of ID consult orders over time to assess quarterly rate trends. Then, we calculated the percent of ID consults attributed to each provider group. We used multinomial logistic regression to measure changes in ID consults across the clinician groups over time using physicians as the referent.

Results
We observed an overall increase in rate of ID consultation per 1000 days present by 35% (Table 1, Figure 1). Each hospital had a distinct baseline care model, though all 3 showed increased consultation by APPs (Figure 2, Table 2). This shift was largest at the university hospital, and was a statistically significant increase relative to attending physicians. Trainee proportion of consultation was stable at community hospitals and decreased at the university hospital.
Figure 2. Percent of ID Consults Ordered by Provider Type and Hospital, July 2015 – June 2022

Conclusion
Hospitals had differing baseline patterns of ID consultation attributed to provider groups, but all experienced increases in consults attributed to APPs and increased ID consultation rates over time. Hospital staffing models aiming to increase use of APPs must consider consultation rates as a potential effect and support infectious diseases services accordingly. As research showing the benefits of ID consultations expands and consultation increases, ID providers will need to continue to optimize their interprofessional collaboration.

Disclosures
Michael J. Smith, M.D., M.S.C.E, Merck: Grant/Research Support|Pfizer: Grant/Research Support Rebekah W. Moehring, MD, MPH, FIDSA, FSHEA, UpToDate, Inc.: Author Royalties
1983. Clinical outcomes of people living with HIV and cirrhosis: a clinical cohort study
Authors: Arant Elizabeth C , Gay Cynthia L , Davy-Mendez Thibaut , Moon Andrew M 
Published: November 2023

Abstract

Background
People with HIV (PWH) are aging, with an increasing prevalence of cirrhosis from causes such as viral hepatitis, non-alcoholic fatty liver disease (NAFLD) and alcohol-associated liver disease (ALD). It is hypothesized that HIV could accelerate the progress of liver disease, but the characteristics and outcomes of PWH with cirrhosis are not well-known. We characterized patient characteristics and longitudinal outcomes of PWH with cirrhosis in a clinical setting.

Methods
This was a retrospective cohort study including PWH ≥18 years old with cirrhosis in HIV care in the UNC Center for AIDS Research HIV Clinical Cohort between 2014 and 2022. We estimated incidence rates (IR) of hospitalization, hepatocellular carcinoma (HCC), and death. In a subgroup of PWH with incident cirrhosis, we estimated 3-year cumulative incidence (CI) of first decompensation event and death from Kaplan Meier curves.

Results
The 114 PWH with cirrhosis were mostly male (78%), Black (53%), aged 50-59 (44%), and 38% had Medicare. A third (32%) had injection drug use (IDU) as the mode of HIV transmission, and almost all were virally suppressed (91%). Hepatitis C virus infection was the most common cirrhosis etiology (62%), followed by ALD (24%). Unadjusted IR per 100 person-years was 27.0% (95% CI 20.2-36.1) for hospitalization, 1.8% (95% CI 1.1-3.1) for HCC, and 3.8% (95% CI 2.6-5.6) for death. Among 69 PWH with incident cirrhosis, the 3-year CI was 38.0 (95% CI 32.0-44.0) for decompensation and 10.9 (95% CI 7.0-14.9) for death (Fig. 1). Three participants (2.6%) were referred for liver transplantation during the study period, however none received a transplant.
Figure 1

Conclusion
PWH with cirrhosis in this cohort had high rates of adverse health outcomes, with hospitalization and death rates that are higher than those reported among PWH overall. Despite being engaged in HIV care, over a third of PWH experienced decompensation within 3 years, indicating a need for earlier consideration for liver transplantation. Analyses are ongoing to compare clinical outcomes by cirrhosis etiology and severity at diagnosis.

Disclosures
Andrew M. Moon, MD, MPH, TARGET RWE: Advisor/Consultant
1261. Prospective Audit and Feedback Approach Differs between Antimicrobial Stewardship Professions
Authors: Ausman Sara , Mara Kristin , Brown Caitlin , Epps Kevin L , Kooda Kirstin , Mendez Julio C , Rivera (O'Connor) Christina G 
Published: November 2023

Abstract

Background
Implementing effective antimicrobial stewardship interventions is an important component of antimicrobial stewardship programs. Recently, stewardship research has shown that clinician characteristics may have an impact on antimicrobial stewardship intervention methods and acceptance rates.

Methods
A multisite health system antimicrobial stewardship prospective audit and feedback program interventions performed by stewardship staff using a standardized electronic medical record (EMR) tool were compared by stewardship clinician profession (pharmacist, physician, or advanced practice provider, APP) from 7/1/2017 to 6/30/2022. Outcomes assessed were intervention rates, communication methods, and intervention acceptance by patient age and intensive care unit (ICU) status of patient. Generalized estimating equations utilizing logistic regression were used to assess for associations between staff. Associations were assessed both univariately and after adjusting for other factors.

Results
Of 69,503 prospective audit and feedback EMR based rules, there were 14,699 rules associated with an intervention. The majority of rules were reviewed by pharmacists (90.7%) followed by physician (9.2%) and APP (&lt; 1%). Of 9,034 interventions with an outcome documented, 7326 (85.5%) pharmacist interventions were accepted and 360 (77.3%) physician interventions were accepted (adjusted p=0.047).  Pharmacists intervened by direct action (ie, adjust a medication order) in 6.6% of interventions; whereas, physicians did so rarely (0.4%). Pharmacists were more likely to use synchronous communication than physicians in the adjusted model (pharmacist vs. physician: 63.8% vs 52.5%; p=0.004). Patients in the ICU had a significantly lower intervention acceptance rate (non-ICU vs. ICU: 86.6% vs. 78.0%; adjusted OR 0.57 [95% CI 0.46-0.70], p&lt; 0.001).Table 1.Intervention Rate by Baseline Demographics of Stewardship Clinicians and Patients.
*% are reported as row % **Multivariable model was also adjusted for day of week and time of day APP-Advanced practice provider; ICU-intensive care unitTable 2.Intervention Acceptance.
*% are reported as row % **Multivariable model was also adjusted for day of week and time of day APP-Advanced practice provider; ICU-intensive care unit

Conclusion
Antimicrobial stewardship pharmacists and physicians are both effective at prospective audit and feedback but used different intervention styles. Advanced practice providers were vastly underrepresented. Patients in the ICU may benefit from tailored ASP efforts.

Disclosures
Sara Ausman, PharmD, Gilead: Honoraria Caitlin Brown, PharmD, Alexion: Grant/Research Support|Trevena: Advisor/Consultant Christina G. Rivera (O'Connor), Pharm.D, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Board Member|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria
1263. The Experience of an Antimicrobial Stewardship Program at a Tertiary Referral Hospital in a Low/Middle Income Country
Authors: Abdallah Tamara , Haddad Nisrine , Rizk Nesrine , Zeenny Rony , Kanj Souha S 
Published: November 2023

Abstract

Background
Antimicrobial Stewardship Programs (ASP) play a crucial role in optimizing antimicrobial utilization and limiting the use of broad-spectrum antibiotics, to reduce antimicrobial resistance. During the COVID-19 pandemic, there was a noticeable increase in antimicrobial consumption globally. The ASP at the American University of Beirut Medical Center (AUBMC) began formal operations in January 2019. In this study, our aim is to evaluate the activities of the ASP -since implementation and during the pandemic- at our institution, a tertiary referral hospital in Beirut.

Methods
The ASP team performed handshake stewardship rounds and daily reviews of antimicrobial use. It provided educational activities in a multi-disciplinary approach in addition to implementing a carbapenem sparing strategy and ongoing monitoring of antibiotic consumption. This study is a retrospective review of those activities. We compiled the ASP recommendations from January 2019 until December 2021. Data collected included the number of ASP recommendations and their sub-categories in addition to acceptance rates.

Results
We recorded a total of 9922 recommendations during this three-year period. Recommendations aiming at reducing antimicrobial consumption were the most common (42%), and included: duration of therapy, de-escalation, and duplicate coverage (Figure 1). Rates of acceptance of these recommendations were 88%, 92% and 95% in 2019, 2020 and 2021 respectively. The number of recommendations increased during the pandemic and coincided with COVID-19 surges in Lebanon (figure 2). There was also an increase in the acceptance rate of recommendations to reduce antibiotic consumption (Figure 3) over this period.Figure 1.Distribution of ASP Interventions per sub-CategoryFigure 2.Number of ASP Recommendations pre- and During COVID-19Figure 3.ASP recommendations to Reduce Antibiotic Consumption and Acceptance Rate

Conclusion
Despite the challenges imposed by the pandemic and the involvement of the ASP in the COVID-19 response, the team maintained its efforts and involvement to mitigate antibiotic misuse. The results are encouraging and attest to the important role of ASP in driving culture change regarding the judicious use of antimicrobials even during a pandemic.

Disclosures
Souha S Kanj, MD, Gilead: Advisor/Consultant|Menarini: Advisor/Consultant|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant
1276. Mechanical, Microbiological, and Inflammatory Factors May Impact 1-Year Revision Rates after Arthroplasty Resection for Periprosthetic Joint Infection
Authors: Aljadani Rawabi , Kremers Hilal Maradit , Carvour Martha 
Published: November 2023

Abstract

Background
Periprosthetic joint infection (PJI) is often managed using a combination of medical and surgical treatments, including irrigation and debridement or joint resection, spacer placement, and then revision to reimplant the arthroplasty components. The timing between surgical stages may vary, and little information exists about the clinical and microbiological factors impacting these temporal relationships.

Methods
A single center cohort study was conducted. The cohort included all cases of PJI for which resection was performed at the University of Iowa Health Care (UIHCs) between January 1, 2009, and December 31, 2016. Using a 1-year follow-up period, we constructed Kaplan-Meier estimates of the time to revision after resection—overall and then stratified by joint location (knee vs. hip), organism identification (known vs unknown), and C-reactive protein level (CRP &gt;10 mg/L vs. CRP ≤10 mg/L). We then used Cox proportional hazard modeling to identify factors associated with revision within 1 year.

Results
Among a total of 109 cases of prosthetic joint resections (n = 67 knee, n = 42 hip), 56.9% underwent revision surgery during the follow-up period (n = 46 knee, n= 16 hip). Most revisions occurred between 2.5 and 3.0 months after resection. Knee arthroplasties were significantly more likely to undergo revision during the study period (hazard ratio, HR = 2.53, 95% confidence interval, CI: 1.38, 4.94) compared to hip arthroplasties. Identification of one or more organism involved in the PJI was also associated with revision during the study window (HR = 3.56, 95% CI: 1.94, 6.47), whereas elevated CRP was associated with lower rates of revision during the study period (HR = 0.21, 95% CI: 0.09, 0.46 for CRP &gt;10 mg/L compared to CRP ≤10 mg/L).
Figure 1. Kaplan-Meier curves for revision within 1-year after resection for the (A) cohort overall and then stratified by (B) joint location (hip vs knee), (C) organism identification (known vs unknown), and (D) C-reactive protein level (CRP &gt;10 mg/L vs. CRP ≤10 mg/L).

Conclusion
For patients with surgically managed PJIs, joint location, organism identification, and lower CRP level were all associated with revision procedures within 1-year after resection. These findings may reflect mechanical and microbiological factors influencing the decision to proceed with revision. The variable length between stages—and thus, the variable time during which a spacer is retained—may be important to measure in future observational and clinical studies examining PJI outcomes.

Disclosures
All Authors: No reported disclosures
1288. Rapidly evolving Lyme epidemiology in central Ohio creates challenges in prompt diagnosis and management of Lyme arthritis
Authors: Erdem Guliz , Watson Joshua R , Barson William J 
Published: November 2023

Abstract

Background
Institutional practices regarding care for septic arthritis (SA) patients varies. To streamline the care of SA patients we established a clinical pathway with two care delivery expectations: % of patients on appropriate antibiotics and % of patients with time to diagnostic joint fluid aspiration &lt; 24 hours after admission.
Key driver diagram
Lyme and non-Lyme bacterial arthritis patients since 2020

Methods
Quality improvement initiative aimed to streamline the care and key drivers were established (Figure 1). Interventions included development management algorithm, consensus building among infectious diseases physicians. The pre-study baseline period was January 1, 2020 to May 31, 2021, and the study period was from June 1, 2021, to March 1, 2023. Control charts were used to assess the interventions.

Results
Of the 97 patients admitted during the baseline and study period 42 patients were diagnosed with non-Lyme associated SA, 39 had Lyme arthritis, 16 had reactive arthritis. Significant increase in Lyme arthritis patients were observed since 2021 (Figure2) coinciding with reported geographic expansion of ticks in Ohio attributed to climate change. Length of hospitalization for Lyme arthritis (median: 2.35 days, IQR 1.29) was shorter than non-Lyme associated SA (median: 3 days, IQ 1.48). 18 (42.9%) of non-Lyme SA patients and 10 (25.6%) of Lyme arthritis patients underwent surgical washouts. 27 (69 %) of Lyme arthritis patients were initially treated with anti-staphylococcal antimicrobial agents. Lyme serologies took 1-3 days to result causing delays in diagnosis and management. 7 (18%) of patients were discharged home on no antibiotics or with antibiotics not appropriate for Lyme arthritis.

Conclusion
Our streamlined approach led to timely and appropriate diagnostic and therapeutic approach in non-Lyme associated SA patients. Rapidly evolving Lyme epidemiology in central Ohio created challenges in prompt diagnosis and management of Lyme arthritis patients.

Disclosures
All Authors: No reported disclosures
1299. Clinical Characteristics of Native Vertebral Osteomyelitis in Patients with a History of Acupuncture
Authors: Moon Soo-youn , Lim Kyoung Ree , Son Jun Seong 
Published: November 2023

Abstract

Background
Considering that vertebral osteomyelitis (VO) can occur via various routes. It can be predicted that clinical characteristics may vary depending on the way of infection or risk factors of the disease. In this study, the clinical characteristics, causative pathogens, clinical features, and prognosis of the native VO in patients with a history of acupuncture were compared with those without a history of acupuncture.

Methods
This retrospective study was conducted at a university-affiliated hospital in Seoul, from May 2006 to February 2021. The patients of age 18 or older with native VO were enrolled. Data on demography, clinical presentation, treatment, causative organisms, and clinical outcomes were collected via electronic medical records.

Results
A total of 100 patients with VO were reviewed, among which 34 patients had a history of acupuncture before the diagnosis of VO. The frequency of Gram-positive cocci (GPC) was significantly higher in the acupuncture group than in the non-acupuncture group (p=0.016). Abscess was observed more frequently in the acupuncture group than in the non-acupuncture group (p=0.01). Patients with abscesses underwent surgical treatment more often than those without (p=0.021). There was no difference in clinical outcomes between the two groups, including mortality, neurologic sequelae, and recurrent after one year.

Conclusion
This study suggests that confirming a history of acupuncture may help predict the pathogen or clinical characteristics of the disease. If the patient has a history of acupuncture, GPC can be considered the causative organism. The presence of abscesses may lead to surgical treatment more frequently.

Disclosures
All Authors: No reported disclosures
1305. Current Management of Osteoarticular Infections by Infectious Diseases Physicians: Results of an Emerging Infections Network (EIN) Survey
Authors: Cortes-Penfield Nicolas W , Beekmann Susan E , Polgreen Philip M , Ryan Keenan L , Sekar Poorani 
Published: November 2023

Abstract

Background
Osteoarticular infections (OAI) have been commonly treated with prolonged intravenous (IV) antimicrobials. The Oral versus Intravenous Antibiotics for Bone and Joint Infection (OVIVA) trial demonstrated that oral (PO) antibiotic therapy was noninferior to IV antibiotics in the treatment of OAIs. We surveyed Infectious disease (ID) physicians to see how often they used PO antibiotics in the treatment of OAIs and the barriers to using PO antibiotics.

Methods
An EIN survey was sent to 1475 ID physicians. The survey had 9 questions pertaining to antibiotic prescribing patterns in the treatment of OAIs. The questions were mostly multiple choice, Yes/No questions with an area provided for free text. Definitive oral antibiotic therapy was defined as switching to PO antibiotics within 2 weeks of starting antibiotics.

Results
There were 413 respondents who treated OAIs and responded to the survey. A plurality of respondents 150/413 (36%) switched from IV to PO antibiotics after 4 weeks of IV therapy. 129/413 (31%) switched to oral antibiotics as definitive treatment (Fig 1). PO antibiotics were used as definitive therapy most often for diabetic foot osteomyelitis and native joint septic arthritis (Fig 2). Trimethoprim-sulfamethoxazole was most often used as definitive therapy for Staphylococcus aureus infections followed by doxycycline/minocycline. Amoxicillin/ cefadroxil/ cephalexin was used for treatment of streptococcal infections and fluoroquinolones were used as definitive treatment for infections caused by Gram-negative organisms. The most common reasons for not transitioning to PO antibiotics included non-susceptible pathogen, comorbidities preventing therapeutic drug levels and concern about adherence

For the following infections, how often do you use oral antibiotics as definitive therapy?

Conclusion
A sizeable portion of ID physicians utilize PO antibiotics for the management of OAIs, although significant practice variation exists regarding the timing of IV to PO switch.

Disclosures
Philip M. Polgreen, MD, Eli Lilly: Case adjudication for a clinical trial Keenan L. Ryan, PharmD, PhC, PharmCon: Honoraria
1308. Exploration of Infectious Disease Specialist Attitudes on Utilizing Oral Antimicrobials for the Treatment of Bone and Joint Infections
Authors: Wolfe Katy , Funaro Jason , Seidelman Jessica , Dicks Kristen , Yarrington Michael E , Shroba Jenny 
Published: November 2023

Abstract

Background
Despite recent literature supporting non-inferiority of oral therapy, many patients are treated with traditional extended intravenous (IV) antimicrobial courses. The objective of this study was to evaluate the attitudes of infectious disease (ID) specialists on utilizing oral antimicrobials (PO-A) for the treatment of bone and joint infections (BJI).

Methods
This was a multicenter clinician survey study of ID specialists from 1/10/23 – 1/31/23, regarding their attitude towards using PO-A for the treatment of BJIs. Survey respondents were presented with statements and rank order questions and asked to indicate their level of agreeance using a 5-point Likert scale. The primary outcome was agreement with the phrase ‘I am willing to prescribe PO-A for treatment of BJIs’. Secondary outcomes included patient case and ID specialist characteristics associated with willingness to prescribe PO-A. Study utilized descriptive statistics and univariate tests.

Results
A total of 216 surveys were distributed to ID specialists of which 65 recorded responses with 50 complete responses (30% overall response rate and 23% completion rate). Of the 50 complete surveys, the majority of respondents (60%) indicated they prescribe PO-A in ≤25% of their patient-case load as definitive treatment of BJIs. A total of 41/50 respondents (82%) indicated strong agreement with comfortability prescribing and dosing PO-A for BJIs (Table 1) and were most willing to prescribe PO-A ( &gt;70%) in patients with diabetic foot infection (Table 2). ID specialists’ willingness to prescribe PO-A for treatment of BJIs significantly correlated with their current clinical practice. Respondents who disagreed with the statement ‘I am willing to prescribe PO-A’ currently prescribe PO-A in less than 25% of their BJI patients compared to respondents who agreed (37% prescribe PO-A 26-50% of their patients with 35% of those who strongly agree prescribe PO-A it in &gt;50% of their BJI patients (p=0.004). The most common concern (62%) when prescribing PO-A for BJIs is the identified pathogen may not be susceptible to the preferred antibiotic (Table 3).

Conclusion
The findings of this survey suggest that most ID specialists in this sample are comfortable prescribing PO-A for treatment of BJIs and was significantly related to current practice.

Disclosures
Jessica Seidelman, MD, MPH, Uptodate: content editor for pelvic osteomyelitis page Kristen Dicks, MD, UpToDate: Advisor/Consultant