bluuebunny/crossref_metadata_2025_split huggingface dataset:
2001. IDWeek Oral Abstract Coaching Pilot Program
Authors: Blyth Dana , Cutrell James B , Bonura Erin , Luther Vera , Melia Michael T 
Published: November 2023

Abstract

Background
Oral abstract presentations (OAP) at national meetings are high visibility opportunities. However, there has not been a formal process for coaching presenters and providing feedback at IDWeek. We led a pilot project pairing ID-trained medical educators with OA presenters for feedback prior to and at IDWeek.

Methods
A link in IDWeek 2022 OAP acceptances invited presenters to participate in the OAP coaching pilot program (CPP). The link requested demographics, availability of local mentors to provide feedback, and areas of desired feedback for the OAP. Coaches were primarily solicited from the IDSA Med Ed Community of Practice Workgroups to give feedback pre-IDWeek, attend the IDWeek OAP, and provide feedback after. An anonymous survey was sent to presenters and coaches 8 days post-IDWeek.

Results
38 presenters (median of 1 (IQR 0, 4) prior national OAP) requested to participate, despite 71% already having feedback available (table 1). Due to coaching pool limitations, presenters with no prior national OAPs and/or without local feedback were prioritized for the CPP. 22 (85%) and 18 (69%) of the 26 coaches and presenters responded to the post-IDWeek survey, respectively (table 2). Presenters and coaches largely overlapped regarding the types of feedback requested and delivered before and at IDWeek (table 3). Presenter qualitative comments highlighted the value provided in improving OAP visual display, delivery, clarity for those unfamiliar with the work, and the presenter’s confidence. Coaches described appreciation for the opportunity to practice providing feedback and feelings of pride and fulfillment in the improvements noted following the feedback. Both presenters and coaches commented on the benefit of meeting new colleagues and building networks. 94% of presenters and 91% of coaches reported professional/personal benefit from the CPP.Table 1:Characteristics of presenters requesting and selected to participate in the IDWeek Oral Abstract Coaching Pilot ProgramTable 2:Demographics of presenters and coaches in the IDWeek Oral Abstract Coaching Pilot ProgramTable 3:Results of IDWeek Oral Abstract Coaching Pilot Program evaluation survey

Conclusion
This OAP CPP was highly successful, with &gt; 90% of presenters and coaches reporting professional/personal benefit and interest in participating again. In the future, a coach’s guide will be incorporated to increase feedback effectiveness across the desired OAP topics and to augment expansion of the pool of potential coaches. We hope coaching targeting these early career presenters can enhance engagement and recruitment into ID.

Disclosures
James B. Cutrell, MD, IDSA: stipend as Deputy Editor for Open Forum Infectious Diseases
1446. Multidrug-Resistant Acinetobacter baumannii complex Cluster Outbreak Investigation
Authors: Chandramohan Divya , Ford Delvina , Beck Erica , Carroll Theresa , O’Neil Sean , Cadena Jose 
Published: November 2023

Abstract

Background
Healthcare-associated infections (HAI) have tremendously increased since the coronavirus-19 pandemic. With this increase, various attempts should be made to keep multidrug-resistant organisms in check. In 2021, the Veterans Affairs in San Antonio identified a patient with a multidrug-resistant Acinetobacter baumannii complex (MDR-A). This study was undertaken to determine the temporal and spatial relationship of similarly identified MDR-A from other patients at our facility to help prevent spread. We highlight the role whole-genome sequencing plays in a nosocomial outbreak investigation.

Methods
Since the identification of the first MDR-A, we performed interventions to include closure of the unit for new admissions, terminal cleaning, and collection of nasopharyngeal, peri-rectal, urine and wound swabs for surveillance. 15 positive samples were sent from our facility to Multidrug- Resistant Organism Repository and Surveillance Network (MRSN) for genotyping.

Results
Genotyping results confirmed that there were only one to four Single Nucleotide Polymorphism (SNP) variations between three of the patient isolates indicating that these were genetically related with likely nosocomial transmission. All isolates carried an OXA-23 carbapenemase and a 16S rRNA methyltransferase which conferred resistance to all clinically relevant aminoglycosides. Overall, twelve isolates were identified from our facility with &lt; =4 SNP variations interlinking them with prior isolates sent to MRSN. MRSN identified 2-45 SNP variations between 87 isolates from seven different hospitals in South Texas (Figure 1). Environmental sampling in our hospital revealed an Acinetobacter baumannii isolated from shower trolleys. Since the organism isolated was identical, spread was presumed secondary to the contaminated shower trolley.
MDR-A cluster indicating interrelation between various isolates from seven different facilities in South Texas.
This figure depicts four common isolates pictured in the center, which resulted in SNP variations and spread across seven facilities in South Texas. The SNP variations between isolates are noted here. Several inter-facility spread of MDR-A took place as can be seen here. Abbreviations: SNP, Single Nucleotide Polymorphisms; MDR-A, Multidrug Resistant Acinetobacter baumannii complex

Conclusion
Spread of MDR-A from our index case was linked to transmission from shower trolleys. These were disinfected, and focused disinfection of all high-touch surfaces was undertaken in addition. Further spread was successfully prevented and no other cases with MDR-A identified thereafter. This case highlights the critical steps in outbreak investigation and highlights the importance of whole-genome sequencing in this process.

Disclosures
All Authors: No reported disclosures
1464. β-lactam versus Non-β-lactam Alternatives for Colorectal Surgical Prophylaxis: Does Recommended Dosing and Timing Matter?
Authors: Collins Curtis D , Hartsfield Eric , Cleary Robert K , Brockhaus Kara K 
Published: November 2023

Abstract

Background
Previous studies have shown reduced surgical site infections (SSIs) with β-lactam prophylaxis compared with non-β-lactam alternatives; however, variations in timing and dosing have been reported. Few studies have investigated the impact of preoperative antibiotic timing or dosing on reported SSI differences between regimens.

Methods
A multi-center, retrospective cohort study was performed utilizing available data from elective colorectal surgeries in Michigan. Adult patients receiving surgical prophylaxis between July 2012 and June 2021 were included. Exclusions included emergent or urgent surgeries and missing follow-up and antibiotic information. The primary objective was to evaluate the incidence of SSIs between patients receiving surgical prophylaxis with β-lactam antibiotics with those who received non-β-lactam alternatives. A multivariable logistic regression model tested the association of SSIs and covariates including antibiotic dosing and timing.

Results
A total of 28,899 procedures were included. Of these, 25,875 received β-lactam prophylaxis and 3,024 received non-β-lactam alternatives. Patients in the β-lactam cohort received higher recommended dosing (83.7% vs. 54.2%; p &lt; 0.001), timing (93.6% vs. 83.9%; p &lt; 0.001), combined recommended dose and timing (78.7% vs. 38.1%; p &lt; 0.001), and had a lower unadjusted incidence of SSIs (6.7% vs 8.9%, p &lt; 0.001). Multivariable logistic regression showed β-lactam prophylaxis was associated with a reduction in SSIs (adjusted odds ratio (aOR) 0.79; 95% CI 0.64 to 0.98; p =0.033) (Table 1). Recommended dosing (aOR 1.09; 95% CI 0.91 to 1.32; p = 0.359) and timing (aOR 1.07; 95% CI 0.83 to 1.39; p = 0.601) were not associated with any change in SSIs. Older age clean/contaminated procedures, and colectomies were associated with a decreased SSI risk. Higher body mass index, corticosteroid use, contaminated and dirty procedures, ASA scores 3-5, and open procedures were associated with an increased risk.

Conclusion
The use of β-lactams for surgical prophylaxis in elective colorectal surgery procedures was associated with decreased SSIs. Significant differences in compliance with recommended prophylaxis dosing and timing between cohorts was not associated with changes in SSIs.

Disclosures
Robert K. Cleary, MD, FASCRS, FACS, Intuitive Surgical Inc: Honoraria
1472. Development of an Interactive Provider Dashboard for Enhanced Recovery After Surgery to Monitor Compliance with Perioperative Surgical Site Infection Measures
Authors: Patel Pratish C , Raymond Britany L , Cherry Brandi , Jayaram Jennifer , McEvoy Matthew D 
Published: November 2023

Abstract

Background
Enhanced Recovery After Surgery (ERAS) protocols are patient-centered, evidence-based pathways aimed at improving patient outcomes through multidisciplinary interventions in the perioperative period. Among other outcomes, these bundled protocols have been associated with improvement in postoperative immune function, decrease in perioperative inflammatory markers, and a reduction in surgical site infections and hospital readmission.

Methods
ERAS for colorectal surgery was launched at Vanderbilt University Medical Center in 2014. A working group of surgeons, anesthesiologists, infection preventionists, pharmacists, nurses, data analysts, and other staff reviewed the literature to provide evidence and guideline-based recommendations regarding various elements of perioperative care. Following a successful trial period, ERAS principles were sequentially introduced to multiple other surgical services.

Results
To track compliance to protocols and outcome variables associated with ERAS components, we required a method that would allow us to analyze data in real time, as well as customize the reports to align with specific goals of different surgical services. An adaptable data visualization dashboard was developed in Tableau® to meet this need. ERAS components were listed by phase of care and defined by the data source and specific data element. Surgical services could customize their dashboard by selecting data elements to review for informational use only or to include within a scoring system to track performance. An aggregate ERAS protocol view displayed mutual components of at least three service lines to suggest areas for improvement, as well as those of the highest compliance. Monthly and annual compliance trends assist in assessing each metric over time.
ERAS Metric Definitions and Scoring Grid
Aggregate ERAS Protocol Opportunities and Wins Summary
Monthly Compliance by Phase of Care and ERAS Component

Conclusion
The ERAS component dashboard allowed service line leaders and perioperative administrators to view various key performance indicators such as appropriate perioperative antimicrobial prophylaxis, avoidance of intraoperative hyperglycemia, and preoperative skin disinfection. The data from this dashboard seeks to standardize perioperative care, improve patient recovery, and reduce hospital readmission.

Disclosures
Pratish C. Patel, PharmD, BCIDP, AAHIVP, VBI Vaccines: Stocks/Bonds
1475. A Retrospective Study Analyzing Recurrent LVAD Driveline Infections
Authors: Tin Kathy , Malik Muhammad K , Santarossa Maressa , Yu Mingxi , Liebo Max , Clark Nina M , Reid Gail 
Published: November 2023

Abstract

Background
Left ventricular assist devices (LVADs) are an advanced form of heart failure therapy for patients who failed conventional medical therapy. LVAD patients are at increased risk for developing infections due to the presence of foreign hardware. Infection of the LVAD driveline (DL), the connection between the electrical cable and air vent to an external site, is the most common type of LVAD infection. Due to limited data available, this study sought to investigate outcomes of recurrent LVAD driveline infections (DLI).

Methods
This was a retrospective chart review study at Loyola University Medical Center of patients with LVAD driveline infections over 14 years. The primary outcome was days to recurrent DLI. Recurrent DLI was defined as any antibiotic alteration due to infection by a new organism, relapse with the same organism, and/or clinical signs or symptoms of worsening infection. Secondary endpoints included recurrent infection after surgical management, abscess development, and post-heart transplant (HT) infection.

Results
35 of 49 patients (71.4%) developed a recurrent DLI with a mean of 173 days (range 14-820 days) to recurrent infection. The most common organisms were methicillin sensitive Staphylococcus aureus, Pseudomonas aeruginosa, coagulase negative Staphylococcus, and Corynebacterium species. 4 patients with recurrent DLI developed local abscesses. 7 patients with recurrent DLI (20.0%) underwent DL debridement and/or revision, and 4 of these patients (57.1%) developed recurrent DLI afterward. 1 of the remaining 3 patients underwent HT 198 days after the DL procedure. 10 of the 35 patients with recurrent DLI underwent HT and 4 developed infections within 90 days of transplant; 2 were due to the same organism that caused the DLI. One of these had a retained portion of the DL and the other had a retained ICD lead. There were also 2 sternal wound infections of unknown cause.

Conclusion
Most patients with DLI developed recurrent infection. Additionally, DL debridement/revision was not successful in curing infection in most patients. In some cases, recurrent DLI may have been due to antibiotic non-adherence. Other than patients with retained device components, those who underwent a heart transplant did not have infections 90 days post-transplant caused by the DLI organism.

Disclosures
Kathy Tin, D.O., Merck: Stocks/Bonds|Novavax: Stocks/Bonds|Pfizer: Stocks/Bonds
1484. Hepatitis C Virus Infection and Cure by Priority Population Among New York City Ryan White HIV/AIDS Program Part A Clients
Authors: Cheek Jelani , Avoundjian Tigran , McPherson Tristan D , Irvine Mary 
Published: November 2023

Abstract

Background
Hepatitis C virus (HCV) infection is a common comorbidity among people with HIV (PWH). HCV-related liver disease is the second leading cause of death among PWH. To identify opportunities to improve service integration and health equity, we examined HCV infection and cure among priority populations identified for New York City (NYC) Ryan White HIV/AIDS Program Part A (RWPA) service delivery.

Methods
Using a merge of NYC HIV and HCV surveillance data with RWPA program data, we identified RWPA clients receiving services from 01/2019–12/2022. We categorized clients into priority populations: Black or Latina cisgender women; Black or Latino men who have sex with men (MSM); transgender, intersex, gender non-conforming, or non-binary (TIGNCNB) people; people who inject drugs (PWID); and people aging (age &gt;50) with HIV (PAWH). We measured active HCV infections (any positive RNA test during analysis period), and HCV cure­ (negative RNA result on the most recent HCV test &gt;12 weeks after most recent positive RNA result obtained during the analysis period). Using logistic regression, we compared HCV prevalence and HCV cure by population, adjusting for potential confounders.

Results
Among 15,702 RWPA clients, 15% (n=2,278) had active HCV infection, with 70% (n=1,596) achieving cure. 53% of clients were PAWH, 36% were Black/Latino MSM, 26% were Black/Latina cisgender women, 5% were TIGNCNB people, and 2% were PWID. PWID had the highest proportion of HCV infection (38%), and PAWH had the highest cure proportion (73%) (Table 1). After adjusting for potential confounders, PWID and PAWH had higher odds of HCV infection compared to other clients [adjusted odds ratio (aOR): 4.37, 95% CI: 3.41, 5.59 for PWID; aOR: 4.05, 95% CI: 3.61, 4.54 for PAWH]. Black/Latino MSM and Black/Latina cisgender women had lower odds of infection (aOR: 0.79, 95% CI: 0.71, 0.88 and aOR: 0.60, 95% CI: 0.53, 0.68, respectively) compared to other clients. Among clients with HCV, PWID had lower odds of cure compared to non-PWID (aOR: 0.58, 95% CI: 0.39, 0.85; Table 2).
Table 1, Part 1
Table 1, Part 2

Conclusion
These findings – particularly the low odds of HCV cure among PWID, who had the highest odds of infection – highlight gaps that can inform resource allocation and targeted integration of HIV/HCV care.

Disclosures
All Authors: No reported disclosures
1489. CD4+ T Cell Count and Associated Mortality in PLWHIV and Cancer at an Oncologic Center in Mexico over a 10-year Period.
Authors: Olmedo-Reneaum Alejandro , VOLKOW-FERNÁNDEZ P A T R I C I A , MARTÍNEZ-RIVERA N A N C Y , MENDOZA-PALACIOS M A R ÍA J O S É , ISLAS-MUÑOZ B E D A 
Published: November 2023

Abstract

Background
PLWHIV and cancer have an increased risk of mortality. Previous studies show that a 100 cells/mm3 drop in CD4+ T cells following chemotherapy increases the risk of mortality by up to 30%. In Mexico almost 40% of patients have a late diagnosis. The aim of this study is to measure the mortality association between the CD4+ T cell count nadir in PLWHIV and cancer.

Methods
We conducted a retrospective study involving PLWHIV and cancer ≥18 yo treated at the cancer and AIDS clinic of the Instituto Nacional de Cancerología in México City from January 01, 2005, to December 31, 2015, that received chemotherapy, immunotherapy, radiotherapy and/or oncologic surgery. The baseline CD4+ T cell count, nadir during treatment, first CD4+ T cell count after treatment, one year and five years after the end of oncologic treatment were evaluated. A logistic regression (LR) model was performed considering CD4+ T cell count at baseline, nadir during oncologic treatment and the association with all-cause mortality. Institutional Review Board (IRB) of INCan approved the study (Ref/INCAN/CI/0049/2022).

Results
A total of 445 patients were included, median of nadir CD4+ T cell count was 122 cells/µL (IQR 48-232), 147 (32.89%) had baseline CD4+ T cell ≤100 cells/µL. Kaposi Sarcoma (46%) and non-Hodgkin lymphoma (27%) were the most frequent diagnosis. One-year mortality occurred in 72 patients (16%), from them, the cause of death was cancer in 54 (75%). Descriptive analysis by mean difference showed significant difference in CD4+ T cell count between patients who died vs. those who survived 117.7 vs 175.4 (p=0.01). In the LR model, a significant association was found between stage IV of cancer and higher mortality at 1 year (OR 2.39; CI 1.27- 4.52) and at 5 years (OR 2.21; CI 1.21-4.02). At five years, mortality was higher in patients with a second AIDS defining event (OR 2.17; CI 1.12-4.17). At one year after completed cancer treatment having a CD4+ T cell nadir &gt;200 cells/ µL was associated with lower mortality (OR 0.29; CI 0.08 – 0.92).

Conclusion
This study found that having other AIDS defining events and advanced neoplastic disease was associated with higher mortality; while having a nadir ≥200 cd4+ cells/ml showed lower mortality after one year of treatment.

Disclosures
All Authors: No reported disclosures
1492. Gender-Specific Targets for Primary Prevention in People Living with HIV : Applying Life's Simple 7 to a Gender-Stratified Population of ART-Naive People Living with HIV in Tanzania
Authors: Khan Safah , Manyangu Gloria J , Peck Robert N 
Published: November 2023

Abstract

Background
Cardiovascular disease (CVD) represents a major cause of premature mortality in people living with HIV (PLWH). However, morbidity is not equal between males and females. There is a need to better understand how gender influences cardiovascular health (CVH) in PLWH in order to identify targets for intervention. Therefore, we applied the Life's Simple Seven (LS7) scale to a gender-stratified cohort of ART-Naive PLWH and HIV-uninfected controls in adults.

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 Seven (LS7) definitions (Table 1) and compared the distribution of Ideal LS7 metrics between males and females of both study groups. Each LS7 metric was categorized as ideal (2 points), intermediate (1 point) and poor (0 point) and ordinal regressions were employed to investigate associations between gender and each individual LS7 metric. Regressions were adjusted for HIV status, age, income, education level.

Results
Our study included 997 participants, with 493 PLWH (68.7% female) and 504 HIV-uninfected (66.4% female). As displayed in Figure 1, the distribution of Ideal LS7 metrics differed between the males and females in both study groups. Males had a higher prevalence of ideal physical activity (aOR=4.12 [95%CI=3.11 to 5.44], p&lt; 0.001) and ideal BMI (aOR=5.10 [3.47 to 7.49], p&lt; 0.001) but lower prevalence of ideal smoking (aOR=0.037 [0.021 to 0.065], p&lt; 0.001) and ideal blood pressure (aOR= 0.65 [0.50 to 0.85], p=0.002). The magnitude of these differences also varied by HIV status such that they were larger in PLWH than HIV-uninfected group for smoking (41.3% vs 26.4%), physical activity (41.6% vs 24.8%) and blood pressure (12.7% vs 9.2%) metrics. By contrast, these differences were less pronounced in PLWH vs HIV-uninfected group for the BMI metric (23.1% vs 29.7%).
Figure 1: Distribution of Ideal Life's Simple 7 metrics, stratified by gender for both PLWH and HIV-uninfected controls

Conclusion
Cardiovascular health profiles vary by gender and HIV status, with stark differences between male and female PLWH for most metrics. Gender-specific interventions targeting smoking cessation, blood pressure control in male PLWH and physical activity, weight loss in female PLWH are warranted to mitigate CVD risk.

Disclosures
All Authors: No reported disclosures