bluuebunny/crossref_metadata_2025_split huggingface dataset:
1986. Switching to DOR/3TC/TDF Improves Renal Function and Decreases Lipid Levels in People Living With HIV: a Real-Life Multicentric Study
Authors: Micali Cristina , Russotto Ylenia , Doctor Medical , Francesco Pellicanò Giovanni , Panella Letizia , Albanese Antonio , Santoro Laura , Agata Sofia Sonia , Pantò Grazia , Coco Mariagiovanna , Guarneri Alessandro , Iacobello Carmelo , Paternò Raddusa Michele Salvatore , Ceccarelli Manuela , Marino Andrea , Maurizio Celesia Benedetto , Santi Cacopardo Bruno , Montineri Arturo , Frasca Chiara , Colpani Agnese , De Vito Andrea , Madeddu Giordano , Alibrandi Angela , Venanzi Rullo Emmanuele , Nunnari Giuseppe 
Published: November 2023

Abstract

Background
Pivotal studies on Doravirine (DOR) showed its high tolerability and effectiveness, even on resistant strains. Therefore, DOR and its single tablet combination treatment DOR/lamivudine (3TC)/tenofovir disoproxil fumarate (TDF) has been referred to as a cardiovascular-safe drug. However, data from real-life studies on safety and efficacy of DOR are lacking.

Methods
Retrospective multicenter cohort study, including 6 Italian HIV centers, evaluated adult treatment-experienced People Living With HIV (PLWH) who switched to DOR/3TC/TDF from June 2020 to June 2022. PLWH with known resistance mutations to DOR were excluded. Clinical and laboratory data were collected at the time of the switch and after 48 weeks.

Results
A total of 98 PLWH were switched to a DOR/3TC/TDF regimen, 75 (76.5%) male, with a median age of 52.41 years (IQR 42.95-58.79).
The main reason for switching to DOR/FTC/TDF regimens was proactive switch (33.3%). No differences were found between the two timepoints on plasma viral load (pVL) (p = 0.345), lymphocytes T CD4+ (CD4+) percentage (p = 0.994) and count (p = 0.611), and CD4+/lymphocytes T CD8+ (CD8+) ratio (p = 0.899), confirming the effectiveness of the drug combination. We also found a significant reduction in total (p &lt; 0.001) and LDL (p = 0.025) cholesterol and triglycerides (p = 0.002). Importantly, we found that the estimated glomerular filtration rate (eGFR) calculated with CKD-EPI formula significantly improved despite the presence of TDF (p = 0.028).
Adverse events (AEs) were reported in 2 PLWHs and were characterized by the onset of a nodular rash in both arms and legs after 2 weeks of therapy in one PLWH, and by the onset of a progressive paresthesia in both extremities of arms after one week of treatment in the other PLWH. In both cases the treatment with DOR/3TC/TDF was interrupted.

Conclusion
The present real-life study showed that DOR/3TC/TDF significantly reduced lipid levels, surprisingly improving estimated renal function. The virological efficacy of DOR/3TC/TDF along with its immunological, metabolic and safety profile are key elements for a proactive management of the cardiovascular risk.

Disclosures
All Authors: No reported disclosures
1294. A Scientometric Study of the Top 100 Most Influential Papers on Septic Arthritis of Native Joints
Authors: Karaismailoglu Berna , Koroglu Ali Egemen , Celayir Arin , Karaismailoglu Bedri 
Published: November 2023

Abstract

Background
The rising popularity of bibliometric studies stems from their ability to determine the features of articles on particular topics. The objective of this study was to identify and evaluate the characteristics of the top 100 highly cited papers on septic arthritis of the native joints.

Methods
The study involved an analysis of the Web of Science database to identify the 100 most-cited articles related to septic arthritis. The characteristics of these articles, such as publication year, country of origin, journal, study type, and funding availability, were recorded and analyzed to identify any relationships or correlations with total citation count or citation density (i.e., citations per year). Additionally, software was used to create a visualization of the most frequently used keywords in the articles.

Results
The article with the highest citation count and density had 309 and 21.6, respectively. Out of the 100 selected papers, the majority (44 articles) were contributed by the United States. Case series studies were the most common type of research with 26 articles. Annals of the Rheumatic Diseases published the highest number of articles (8 in total). 15 studies were funded. The analysis revealed that the citation density of review articles was significantly higher than that of clinical and basic science studies (p&lt; 0.001). The citation density was positively correlated with the publication year and number of contributing institutions, but negatively correlated with the level of evidence.
Figure 1
The map of keyword co-occurrence obtained by VOSviewer Version 1.6.16.
Figure 2
The correlation analysis between citation density and the publication year. A positive correlation was found indicating increased citation density in more recent papers. (Spearman’s Rho =0.655, p&lt;0.001)
Figure 3
The correlation analysis between level of evidence and publication year. A negative correlation was found indicating that the recent papers have higher level of evidence. (Spearman’s Rho=-350, p=0.003)

Conclusion
The study found that the majority of highly cited papers related to septic arthritis have a low level of evidence, highlighting the need for higher quality research in this area. Furthermore, the analysis revealed a positive correlation between citation density and both publication year and number of institutions involved, indicating better citation performance for more recent articles and those with contributions from multiple institutions. There was a negative correlation between level of evidence and publication year, suggesting that study designs have improved over time.

Disclosures
All Authors: No reported disclosures
1297. Implementation of a Prosthetic Joint Infection Clinic in a Rural Setting
Authors: Lindsay John D , Lastinger Allison 
Published: November 2023

Abstract

Background
Nearly one million patients undergo hip or knee replacements in the United States every year This number is expected to double by 2030. The rate of prosthetic joint infection (PJI) ranges from 0.5 to 2% which translates to between 50,000 to 200,000 PJIs annually. Prosthetic joint infections have high rates of morbidity and mortality. These complex patients are best managed in a multidisciplinary clinic. In 2018, we implemented a specialized Ortho ID clinic where PJI patients are seen by their joint surgeon and ID physician in a single coordinated visit. In this study, we compared no-show rate, miles traveled to clinic, C diff rates, and other complication rates for PJI patients before and after the implementation of our Ortho ID clinic.

Methods
We performed a chart review of PJI patients treated at our institution, comparing a group of patients who were treated prior 2018 in the General ID clinic to a group of patients who were treated after 2018 in the Ortho ID clinic. We assessed no-show rates, cumulative distance driven and time spent driving (calculated using Google Maps), C. diff rate, and rates of side effects between the 2 groups.

Results
The combination clinic improved ID follow-up. Prior to the clinic, only 70% of PJI patients were followed by ID after hospital discharge compared to 100% after the clinic was founded. The no-show rate for PJI patients decreased from 18.2% pre-clinic to 6.9% post-clinic. The mean distance traveled pre-clinic was 226 miles compared to 192 miles post-clinic. The C diff rate decreased from 9.09% pre-clinic to 5.22% post-clinic. Rate of acute kidney injury decreased from 11.1% pre-clinic to 3.45% post-clinic.

Conclusion
Our Ortho ID Clinic’s biggest impact was improving ID follow-up for these complicated patients. Prior to the Clinic’s implementation, approximately 30% of PJI patients never followed up with ID after being discharged from the hospital. We saw positive outcomes with regards to reducing C diff rates and rates of acute kidney injury.

Disclosures
All Authors: No reported disclosures
1298. High Prescription Rate of Medications with Significant Rifampin Drug Interactions in Patients with Diabetic Foot Osteomyelitis: Should Rifabutin be Included in Clinical Trials for Adjunctive Therapy?
Authors: Mallarino-Haeger Christina , Watson Allison , Mahgoub Umnia , Francis Lily , Heydari Maryam , Choudhary Muaaz , Kempker Russell R , Schechter Marcos 
Published: November 2023

Abstract

Background
Diabetic foot osteomyelitis (DFO) is a leading cause of amputations. Rifamycins can penetrate osteoblasts and disrupt biofilm, making them ideal adjunctive antibiotics for DFO. A recent retrospective DFO study found that rifampin adjuvant therapy was associated with significantly higher amputation-free survival rate and randomized clinical trials to establish whether adjunctive rifampin therapy improves DFO outcomes are ongoing. Rifamycin use is complicated by drug-drug interactions (DDIs), primarily due to cytochrome P450 induction. However, rifabutin is a less potent and broad cytochrome P450 inducer versus rifampin. We evaluated DDI predicted rates of rifampin and rifabutin in a DFO cohort.

Methods
We conducted a retrospective cohort study of all patients hospitalized with DFO between 2017 and 2019 at Grady Memorial Hospital (Atlanta, GA). We queried discharge billing records using ICD-10 codes for DFO and performed a chart review to confirm the diagnosis. We used the Lexicomp DDI tool to determine the number of potential DDIs between all medications prescribed upon discharge and rifampin or rifabutin.

Results
There were a total of 530 hospital admissions among 330 unique patients for DFO of which 70% were male and 80% were Black. The mean hemoglobin A1c was 9.4%. Chronic kidney disease was present in 69% of patients. Among 239 DFO cases with a culture, S. aureus was identified in 79 (33%). Eighty-nine (27%) patients were prescribed medications with a class X (“avoid combination”) rifampin interaction versus 4 (1%) patients who were prescribed drugs with a rifabutin class X interaction. Two-hundred-and-forty (73%) patients had prescriptions for medications with a class D (“avoid combination”) rifampin interaction versus 15 (5%) with a class D rifabutin interaction. The most common medications with class X rifampin DDIs were proton pump inhibitors (20%) and directly acting oral anticoagulants (5.7%), while those for class D rifampin DDIs were atorvastatin (35%) and clopidogrel (12%).

Conclusion
A high percentage of patients with DFO were prescribed medications with significant rifampin DDIs compared with rifabutin, supporting the need to investigate rifabutin for adjunctive DFO therapy.

Disclosures
All Authors: No reported disclosures
1301. Assessing Safety and Clinical Outcomes of Outpatient Parenteral Antimicrobial Program in Veterans
Authors: Rich William , Epstein Lauren H , Oliver Nora T 
Published: November 2023

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) is administering intravenous antibiotics in the outpatient setting. Herein we wish to understand the Atlanta VAMC (AVAMC) home OPAT population, infection details, and risk factors for hospital readmission, adverse drug events (ADEs), and clinical failure.

Methods
Medical records of AVAMC veterans receiving home OPAT (not hemodialysis or infusion center) January 1, 2019 and June 30, 2022 were reviewed. Data collected included: demographic and co-morbidity data, OPAT indication/infection type, microbiological information, presence of surgical debridement, and antimicrobial selection and duration of therapy.
Outcomes included ADEs such as venous access events, laboratory abnormalities, and Clostridioides difficile infection. Other information include modification of OPAT plan (drug or duration), patient follow-up visit occurrence, re-hospitalization, and clinical resolution of infection. Univariate regression analyses were conducted on a subset of patients with musculoskeletal (MSK) infections (e.g. osteomyelitis, prosthetic joint infection).

Results
A total of 149 veterans were reviewed, with median age 66 years, 92% male, and 44% white race. Median CCI score was 5, and 80/149 (54%) patients had diabetes. The majority of infections were bone infections (30%), followed by diabetic foot osteomyelitis (24%). Methicillin-sensitive S. aureas was the predominant bacteria isolated (20%). See included table for full details.
In the full cohort, 100/149(68%) had clinical resolution at 6 months and 20/149 (13%) had ADE during therapy. Rehospitalization occurred in 29 (20%) pts. Diabetes was associated with increased risk of failure -- Risk Ratio (RR) 1.68 (95% CI 1.01-2.77). Patients with clinic follow-up had a RR of 0.39 (95% CI: 0.21-0.73) for rehospitalization versus pts without follow-up.
For pts with diabetes in the MSK group (N=97), risk of failure was 1.50x higher than those without diabetes (95% CI: 0.67-3.34).The RR for rehospitalization was 0.23 (95% CI: 0.06-0.82) for patients who received follow-up compared to patients who did not receive follow-up.
AVAMC OPAT population demographic data, N = 149

Conclusion
The AVAMC OPAT cohort is an older group with largely MSK-related infections and MSSA. Few ADEs occurred, and clinical failure remained high.

Disclosures
All Authors: No reported disclosures
1306. Lower Treatment Failure Rates in Patients with Non-Staphylococcal Prosthetic Joint Infections (PJI) Treated with Debridement and Implant Retention (DAIR) Receiving Chronic Antibiotic Suppression (CAS)
Authors: Sekar Poorani , Merchant James , Alexander Bruce , Miell Kelly , Beck Brice , Nair Rajeshwari , Suh Daniel , Richards Christopher , Puig-Asensio Mireia , Pugely Andrew , Walhof Julia , Dukes Kimberly , Schweizer Marin 
Published: November 2023

Abstract

Background
PJI occurs in 0.5-2% of Joint Arthroplasty. Patients with acute non-Staphylococcal PJI who undergo DAIR are treated with 6 weeks of antimicrobials after which CAS may be considered. We aimed to compare the incidence of treatment failure between people who received CAS and those who did not.

Methods
This is a retrospective cohort study of patients admitted to Veterans Affairs (VA) hospitals from 2003-2017 with a non-Staphylococcal PJI, underwent DAIR and received 6 weeks of antimicrobial treatment (Table 1). CAS was defined as at least 30 days of oral antibiotics after 6 weeks of antimicrobial treatment. Duration of CAS was categorized as short (1-3 months), moderate (3-6 months) and long ( &gt;6 months) (Fig 1). Patients were followed for 5 years. Treatment failure was defined as microbiologically confirmed recurrent PJI, additional debridement or re-operation at the same site. Cause-specific Kaplan-Meier curves were used to compare treatment failure rates between those who did and did not receive CAS, censoring on death.

Results
Among 468 patients with non-staphylococcal PJI who underwent DAIR, 208 (44.4%) received CAS. Patients with Enterococcus PJI were statistically more likely to receive CAS. K-M curves showed patients on CAS had a higher estimated failure free survival probability at 5 years when compared to those who did not get CAS (66% vs. 55%, p&lt; 0.01) (Fig 2). When antibiotic use was considered as a time-dependent covariate, CAS was associated with a decreased hazard of treatment failure (hazard ratio (HR): .47 (95% confidence interval [CI]: 0.29, 0.76). After statistically adjusting for surgical site, severity of illness, and alcohol abuse, a short duration of CAS was significantly associated with decreased treatment failure (HR=0.24; 95% CI: 0.11, 0.52). There was no significant association between moderate or long duration of CAS and treatment failure (Table 2)

Table 2

Conclusion
A short duration of CAS may be beneficial among patients with non-Staphylococcal PJI who underwent DAIR. However, there was not a statistically significant association between longer duration of CAS use and treatment failure. Thus, the risks and benefits of long-term antibiotics should be weighed when aiming to prevent recurrence of PJI.

Disclosures
Mireia Puig-Asensio, MD, GILEAD: Honoraria Andrew Pugely, MD, MBA, Globus Medical: Advisor/Consultant|Globus Medical: Grant/Research Support|Globus Medical: IP royalties|Medtronic: Advisor/Consultant|Medtronic: Grant/Research Support|RDB Bioinformatics: Grant/Research Support|United Healthcare: Advisor/Consultant
1307. Vaso-occlusive Crisis is Associated with Subsequent Osteomyelitis in Pediatric Sickle Cell Disease
Authors: Shapiro Kate , Wolf Joshua , Jesudas Rohith , Winer Jeffrey C , Arnold Sandra 
Published: November 2023

Abstract

Background
Children with sickle cell disease (SCD) commonly develop microvascular infarcts of bone known as vaso-occlusive crisis (VOC) and are also at high risk of osteomyelitis (OM). VOC and OM can be challenging to distinguish due to overlapping clinical features. VOC might predispose to OM, or an initial misdiagnosis of OM as VOC might lead to delayed diagnosis of OM. This study aimed to test whether VOC was associated with subsequent development of OM in children with SCD.

Methods
A retrospective Pediatric Health Information System (PHIS) database study (2010-2021) was performed. ICD-code data related to common diagnoses in pediatric patients with SCD were extracted. The rate of VOC within 30 and 180 days preceding episodes of OM was compared to the rate preceding acute chest syndrome (ACS), another common diagnosis in children with SCD but unlikely to be anatomically related to OM. Odds ratios (OR) were used to evaluate the association between these diagnoses.

Results
Of 22,818 PHIS participants with SCD, 13,699; 450; and 7,327 had ≥ 1 episode of VOC, OM and ACS, respectively. The distribution of OM diagnoses was similar across pre-specified age groups (0-4, 5-12, and 13-18 years). The odds ratio of VOC preceding a diagnosis of OM vs. ACS was 2.15 within 30 days (95% CI: 1.82-2.54; p= 3.68 x 10-18), and within 180 days was 1.39 (95% CI: 1.20-1.62; p=2.04 x 10-5).
VOC Preceding Osteomyelitis vs. Acute Chest Syndrome

Conclusion
VOC was significantly more common in the days preceding a diagnosis of OM than of ACS. The strength of association was stronger within 30 days prior to OM than 180 days. These results suggest possible misdiagnosis of OM since VOC might delay OM diagnosis in some cases, that recurrent VOC might be misdiagnosed as OM, or that VOC can directly contribute to risk of OM in some cases. Limitations of this study include possible incomplete adjustment for unmeasured variables which could confound the analysis. More research is needed to confirm and evaluate the mechanism behind this association. Understanding the relationship could lead to improved screening and treatment of both VOC and OM.

Disclosures
Joshua Wolf, MBBS, PhD, Karius Inc.: Grant/Research Support|Merck Inc.: Participation in industry-sponsored research Sandra Arnold, MD, Contrafect: Grant/Research Support|Enanta: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support
1318. Clinical Characteristics of Patients with Patent Foramen Ovale and Pyogenic Brain Abscess
Authors: Chesdachai Supavit , Tabaja Hussam , Yetmar Zachary A , Enzler Mark , Reeder Guy S , DeSimone Daniel C , Baddour Larry M , Abu Saleh Omar M , Corsini Campioli Cristina G 
Published: November 2023

Abstract

Background
Patent foramen ovale (PFO) can be identified in about 20-25% of the adult population and may result in variable degrees of left-to-right and right-to-left intracardiac shunting. The association between PFO and pyogenic brain abscess remains poorly understood. The current study aimed to compare the clinical characteristics and outcomes of pyogenic brain abscess in patients with and without PFO.

Methods
All adults with pyogenic brain abscess seen at Mayo Clinic from 1/1/2009-12/31/2021 who underwent either transesophageal echocardiography (TEE) or transthoracic echocardiography (TTE) with agitated saline shunt (bubble) study were included.

Results
A total of 222 patients developed pyogenic brain abscess during the study period; 148 (66.7%) patients were excluded due to unknown PFO status. Among 74 remaining patients, PFO was detected in 30 (40.5%) patients; 25 by TEE and 5 by TTE with bubble study (Figure 1). The prevalence of cryptogenic brain abscess (unable to identify the source of abscess) was significantly higher in patients with PFO as compared to those without PFO (53.3% versus 18.2%, p=0.002). Patients with PFO had a larger abscess size (25 mm [IQR 15.8-37.5] versus 15.5 mm [IQR 10.0-28.0], p=0.038). However, multiple abscesses were more common in the group without PFO (43.2% versus 20.0%, p=0.038). Additionally, patients with PFO had less documented bloodstream infection. There were no differences between other clinical characteristics and one-year, all-cause mortality between two groups.

Conclusion
These findings provide critical insights into the likely association between PFO and cryptogenic brain abscess; additional investigation is warranted.

Disclosures
Larry M. Baddour, MD, Boston Scientific: Advisor/Consultant|Roivant Sciences: Advisor/Consultant
1326. Comparison of Positive BioFire® FilmArray® Meningitis Encephalitis (ME) Panels, CSF cultures, CSF Parameters and Inpatient Mortality Among Patients with Bacterial and Fungal Meningitis
Authors: Myint Thein , Castillo Marice Ruiz Conejo , Soria Jaime , Arora Vaneet , Ribes Julie 
Published: November 2023

Abstract

Background
The aim of this study was to evaluate the performance of the BioFire® FilmArray® Meningitis Encephalitis panel (MEP) for the detection of bacterial and fungal pathogens compared with cerebrospinal fluid (CSF) cultures and other parameters to determine the predicted value of a positive result (PPV).

Methods
This study is a retrospective chart review of patients with positive MEP from 10/2016–9/2022 at the University of Kentucky. Results of the MEP, culture, cellularity, protein, and glucose were collected using an electronic medical record search. Chart review was performed to collect demographic data, presentation, and test indication if a bacteria or fungus was identified. MEP was considered true positive (TP) if it was confirmed by CSF culture. It was classified a likely TP based on a positive CSF Gram stain, blood culture, other CSF findings consistent with clinical meningitis. It was considered false positive (FP) if the MEP was discordant with CSF and clinical findings. Statistical analysis was performed.

Results
Of the 11,969 panels tested, 132 (1.1%) were positive for bacterial or fungal pathogens. Seventeen positive repeats were excluded. Clinical characteristics, outcomes, and CSF findings for 115 patients with positive MEP for bacterial and fungal organisms are shown in Table 1. Results were summarized as TP, likely TP or FP by the pathogen detected (Table 2). The majority of results [106(92.2%)] were classified as TP or likely TP whereas 9 (7.8%) were classified as FP. 28/37 (75.7%) of patients with negative CSF cultures received at least one day of antibiotics prior to lumbar puncture. One third of the FP results were S. agalactiae. FP were statistically different from those classified as positive for cellularity, glucose and protein (Table 3).Table 1.Clinical Characteristics, Outcomes, and CSF Findings of Patients with BioFire® FilmArray® ME panels Positive for Bacterial and Fungal OrganismsTable 2:Clinical Correlation of Positive BioFire® FilmArray® Meningitis Encephalitis Panel (MEP) for Bacterial and Fungal Organisms and CSF Parameters

Conclusion
The PPV of MEP ranged from 78.6-100% based on an organism. Three-quarters of negative CSF cultures were likely from a prior antibiotic exposure. FP MEP were most common for S. agalactiae. Interestingly, 27.4% (29/106) cases (excluding the FP) would not have had a pathogen definitively identified if MEP was not used. The positive CSF and blood culture rates were higher for cryptococcal meningitis. The median CSF cell count and protein were the highest among patients with S. pneumoniae meningitis. Inpatient mortality was uncommon.
Table 4. Clinical Characteristics and Outcome of Patients with False Positive Biofire® ME Panel with Negative CSF Gram Stain and Cultures

Disclosures
All Authors: No reported disclosures