bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1365. Cefazolin Inoculum Effect in Methicillin Susceptible Staphylococcus aureus Recovered From the Nasal Cavity of Patients in Intensive Care Units in Colombia
Authors: Rincon Sandra , Carvajal Lina Paola , Ibarra Laura , Cadavid Maria José , Uribe Mauricio , Matiz Juan , Ordonez Diaz Karen M , Guevara-Pulido Fredy , Porras Alexandra , Ospina Leonardo , Mendez Yardany , Greenia Haley , de Paula Baptista Rodrigo , Arias Cesar A , Reyes Jinnethe 
Published: January 2025

Abstract

Background
Cefazolin is an alternative for the treatment of MSSA infections and first choice option for surgical prophylaxis. The cefazolin inoculum effect (CzIE), the increase in the MIC at high bacterial inocula is associated to therapeutic failures and increased mortality in deep-seated MSSA infections. The prevalence of the CzIE among nasal colonizing MSSA from ICU patients is currently unknown. The aim of this study was to investigate the CzIE in nasal MSSA recovered from patients admitted to ICUs in Colombia.

Methods
We evaluated 33 MSSA isolates recovered from nasal swabs of 29 patients admitted to ICU at 6 high-complexity Colombian hospitals (2019-2023). CFZ MIC using gold standard broth microdilution at high inoculum was done. The modified nitrocefin-based rapid test to identify the CzIE was performed, and diagnostic performance metrics were calculated. Whole genome sequencing was used to characterize BlaZ types and allotypes, Clonal Complexes CC and Accessory Gene Regulator (Agr) types.

Results
The CzIE was identified in 54.5% of nasal MSSA isolates. A high prevalence of nasal colonization with MSSA exhibiting the CzIE was detected (59%, 17 patients). Among 18 MSSA with the CzIE, type A BlaZ was the predominant β-lactamase (61%) and BlaZ-2 was the most common allotype (50%). Whereas among 15 MSSA lacking the CzIE, BlaZ type C was the most frequent (47%) and BlaZ-1 was the allotype predominant (40%). A high diversity of genetic lineages with eight CC was detected among the 33 MSSA. CC30 was the predominant lineage in MSSA displaying the CzIE (44%), while CC5 and CC30 (27% each one) were the most common in MSSA without the CzIE. Agr-III and Agr-I were predominant Agr types in 56% and 47% of MSSA with the CzIE and lacking the CzIE, respectively. Compared to the gold standard the modified rapid test identified nasal MSSA isolates showing the CzIE with a sensitivity of 100%, specificity of 93% and an overall accuracy of 97%.

Conclusion
We found an unexpected high prevalence (59%) of ICU patients colonized by MSSA exhibiting the CzIE, showing similar genetic features to MSSA with CzIE from invasive infections. Furthermore, our findings suggest that the nasal cavity of ICU patients may represent a reservoir for the dissemination of MSSA showing the CzIE, highlighting the importance of screening and surveillance.

Disclosures
All Authors: No reported disclosures
P-1377. Rates of Screening of Sexually Transmitted Infections in Male Military Trainees who Present with Dysuria
Authors: Malone Catherine Sophia , Osuna Angela , Winkler Erin , Jung Ga O , Yun Heather , Marcus Joseph 
Published: January 2025

Abstract

Background
A high burden of sexually transmitted infections (STIs) exists among trainees entering United States Air Force Basic Military Training (BMT). While women entering training are universally screened for STIs, men, who account for the majority of trainees, are rarely tested. The rates of testing among symptomatic men who present with dysuria during BMT are unknown. Furthermore, rates of follow-up testing among male service members who present with dysuria during BMT are unknown.

Demographics of 82 men diagnosed with dysuria or urinary tract infection during BMT, 2019-2023

Methods
All male basic trainees who received a diagnostic code of dysuria or urinary tract infection between 2019-2023 were retrospectively analyzed to evaluate their diagnostic workup and follow-up over the three years after diagnosis. To assess the impact of presumptive STI therapy on subsequent follow-up, patients who received empiric treatment for STIs were compared to those who did not, with a focus on evaluating future STI testing rates and incidence. Nominal variables were compared using Fisher’s Exact Test while continuous variables were analyzed using the Mann-Whitney U test.

Diagnostic Workup and follow-up for male basic trainees diagnosed with dysuria or urinary tract infection compared by receipt of empiric antibiotics for sexually transmitted infections

Results
Of the 102,382 men who entered BMT during the study period, 82 (0.08%) were diagnosed with dysuria or a urinary tract infection during training. Dysuria accounted for the majority of diagnoses (79%) (Table 1). 70% of symptomatic men were tested for gonorrhea and chlamydia (GC/CT). Among those tested, 23% had a positive GC/CT test. Only 25 (30%) received any additional follow-up STI testing in their next 3 years in the military, with a positivity rate of 12%. Those who were empirically treated for STIs were more likely to have a documented sexual history (80% vs. 45%, p=0.004), receive a GC/CT test (96% vs. 57%, p=0.002), and have additional STI testing in the 3 years after diagnosis (46% vs. 23%, p=0.04) (Table 2).

Conclusion
There is limited data on the diagnostic workup and follow-up of men presenting with symptoms of dysuria during BMT. This study found that despite a high positivity rate for STIs in symptomatic men, sexual history documentation and STI screening were inconsistent in this population. As males account for the vast majority of basic trainees, efforts to accurately capture the burden of STIs are imperative to limit the impact on military populations.

Disclosures
All Authors: No reported disclosures
P-1382. Utilization of Doxycycline Post-Exposure Prophylaxis at a Midwestern United States HIV/PrEP Clinic
Authors: Codling Gabriel , Havens Josh , Lyden Elizabeth , Bares Sara H , Scarsi Kimberly , Sunagawa Shawnalyn 
Published: January 2025

Abstract

Background
Limited real-world data exist regarding usage of doxycline post-exposure prophylaxis (doxyPEP). We evaluated appropriate doxyPEP prescribing and monitoring following implementation of a doxyPEP protocol at the University of Nebraska Medical Center (UNMC) Specialty Care Clinic.

Methods
We retrospectively evaluated patients receiving doxyPEP between 3/1/2023-2/29/2024. Patients receiving doxycycline for other indications were excluded. The primary outcome was adherence to the UNMC doxyPEP protocol. Secondary outcomes included total doxyPEP doses prescribed, sexually transmitted infection (STI) incidence in the doxyPEP cohort compared to 2023 UNMC STI incidence, and factors associated with protocol adherence or STIs while prescribed doxyPEP. We performed descriptive statistics for cohort characteristics and outcomes. Fisher’s exact test or student t-test was used to assess associations of patient characteristics with protocol adherence or STIs while on doxyPEP.

Results
Characteristics of the cohort and prescriptions are listed in Table 1. Primary and secondary outcomes are reported in Tables 2 and 3. Of 90 patients receiving doxyPEP prescriptions, 30% were not prescribed in concordance with UNMC protocol; the most common reason was missed STI screenings (89%). There were 145 chlamydia/gonorrhea (CT/GC) and 163 syphilis screenings obtained from 90 patients; 13% of the patients on doxyPEP were diagnosed with an STI. Between patients prescribed doxyPEP and 2023 UNMC STI incidence, there was no difference in incidence of GC/CT (p &gt; 0.05); however, syphilis incidence was lower (p=0.01) in patients on doxyPEP. There were no characteristics associated with doxyPEP protocol adherence. Age, reason for care, and number of STIs within 12 months of first doxyPEP prescription were significantly associated with an STI diagnosis while on doxyPEP.

Conclusion
Appropriate doxyPEP prescribing patterns occurred for 70% of prescriptions; missed STI screenings was the most common reason for protocol non-adherence. Patients with HIV and with &gt; 1 STI in the past 12 months were more likely to be diagnosed with an STI while on doxyPEP. As utilization expands, it is necessary to ensure appropriate follow-up and monitoring.

Disclosures
Josh Havens, PharmD, Gilead Sciences: Grant/Research Support|Medscape: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant Sara H. Bares, MD, Gilead Sciences: Expert Testimony|Janssen: Grant/Research Support|ViiV Healthcare: Grant/Research Support Kimberly Scarsi, PharmD, Organon, Inc.: Grant/Research Support|Viiv Healthcare: Grant/Research Support
P-1398. Implementation of a Doxycycline for Post-Exposure Prophylaxis Protocol at a Large Academic HIV Clinic
Authors: Pellegrino Rachael , Lokant Matthew , Patel Nishant , Vojtek Christina , Jagadeesan Priya , Ito Andrea , Merkhofer Richard M , Moore Emily , Reasoner Kaitlyn , Zou Michael , Katona Austin , Turner Megan , Zhang Jim , Terndrup Christopher , Kelly Sean , Smiley Casey 
Published: January 2025

Abstract

Background
The use of doxycycline post-exposure prophylaxis (DoxyPEP) lowers the incidence of gonorrhea, chlamydia, and syphilis in men who have sex with men and transgender women living with HIV or taking pre-exposure prophylaxis (PrEP) for HIV. We aimed to implement a standardized protocol to increase the number of appropriate DoxyPEP prescriptions and decrease bacterial sexually transmitted infections (STI) in our clinic population.

Methods
Based on existing evidence, a DoxyPEP clinic protocol and flowchart (Figure 1) were developed and implemented in November 2023 at an academic clinic providing HIV and PrEP services. Interventions included provider education and display of the flowchart in clinical workspaces. The number of new DoxyPEP prescriptions was collected by chart review for the 10 months prior to and 5 months after implementation and compared by t-test. Baseline patient characteristics and STI diagnoses for the clinic population living with HIV were described. Pre- and post-implementation surveys were used to assess provider practices and comfort with DoxyPEP prescribing.

Results
Of persons with HIV prescribed DoxyPEP in the pre-implementation period, 72.1% had at least 1 bacterial STI and 34.4% had &gt;1 bacterial STI in the preceding 10 months (Table 1). There were significantly more DoxyPEP prescriptions (p&lt; 0.001) in the 5-month post-implementation period [148 new prescriptions, 29.6/month] compared to the 10-month pre-implementation period [70 new prescriptions, 7/month] (Figure 2).
Post-implementation, there was an increase in providers who felt comfortable or very comfortable counseling a patient on DoxyPEP (86% vs 60%) and assessing a patient’s eligibility for DoxyPEP (85% vs 60%). Most respondents (86%) reported use of the protocol, and of these providers, all reported it easy or very easy to use. Nine of the fourteen DoxyPEP prescribers (64.3%) in the post-implementation period had not prescribed DoxyPEP prior to the intervention.

Conclusion
Implementation of a standardized DoxyPEP protocol using education and updated policy increased providers’ comfort with and prescribing of DoxyPEP and can help inform future implementation efforts. Further assessment of post-implementation STI rates and patient characteristics are planned.

Disclosures
Sean Kelly, MD, ViiV: Advisor/Consultant
P-1400. Feasibility, Acceptability and Impact of Self-Sample Collection for Extra-genital STI Testing: Experience from a High Complexity VA Facility
Authors: Waitzman Rachel , Shumaker Amy , Allen Kristen A , Bray Kaylee , Mercurio Michelle , Walker Stephanie , Navas Maria , Musoke Lewis S , Van Epps Puja 
Published: January 2025

Abstract

Background
Routine screening of all exposed extra-genital sites for sexually transmitted infections (STIs), specifically Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT), is recommended for individuals at high risk, including some men who have sex with men (MSM) and individuals receiving Pre-Exposure Prophylaxis (PrEP). However, there are a number of barriers to screening including privacy and provider availability. While self-collected extra-genital STI samples have the potential to mitigate some of these barriers, this approach has not yet achieved widespread use. This study evaluates the implementation of self-collection of extra-genital STI tests at the VA Northeast Ohio Healthcare System (VANEOHS), assesses acceptability and measures impact on testing rates.

Methods
The study included people with HIV (PWH) and patients on PrEP at the VANEOHS’s infectious diseases clinic and covered 10 Ohio counties. Patients chose between self- and provider-collection. We followed GC and CT rectal and pharyngeal testing frequency and test completion rates and characterized reasons for unsuccessful completion. We also compared extra-genital GC/CT testing rates before and after the availability of self-collection. Finally, we deployed an anonymous survey to assess acceptability of self-collection and ease of use. We used descriptive statistics to report completion rates, survey findings and changes in rates of testing over time.

Results
Of the 276 tests ordered for self-collection for 95 unique veterans, 82 pharyngeal and 60 rectal GC/CT rectal tests were successfully completed and interpreted in the first 8 months of the study (Table 1). The testing rate increased from 8 tests/month to 15 tests/month for pharyngeal GC/CT and from 6 tests/month to 10 tests/month for rectal GC/CT (Figure 1). Of the survey respondents who performed self-collection, 11 of 17 were satisfied or very satisfied with self-collection and most found it easy or very easy to swab their own rectum (9/12) and throat (13/14) (Table 2).

Conclusion
Self-sample collection for extra-genital testing is feasible in a large healthcare network. It is highly desired by patients and has the potential to improve access and improve STI screening rates.

Disclosures
All Authors: No reported disclosures
P-1426. Comorbidities and Healthcare Resource Utilization Among People With HIV: Real-World Data From a Large Israeli Healthcare Provider
Authors: Weil Clara , Gazit Sivan , Nugent Arlene , Murrison Liza Bronner , Hoshen Moshe , dos Santos Ana Gabriela Pires , Levy Itzchak 
Published: January 2025

Abstract

Background
Despite recent advances in HIV antiretroviral treatment (ART), unmet needs for people with HIV (PWH) remain. The study compared comorbid disease burden and healthcare resource utilization (HRU) among PWH vs those without HIV diagnosis, as well as by ART patterns.

Methods
A retrospective cross-sectional study used anonymized electronic healthcare data from Israel’s Maccabi Healthcare Services (MHS; &gt;2.7M members) to compare people living with HIV on 31/12/2022 with age-sex-matched controls without HIV diagnosis (1998−2022). PWH had to have ≥1 HIV diagnosis code(s) (1998−2022) and ≥1 dispensed ART prescription (2008−2022). Members enrolled for &lt; 12 months were excluded. Sociodemographic characteristics, lifetime prevalence of comorbidities (exception: anxiety/depression, diagnosed and/or treated in 2022), and HRU (2022) were described. Among PWH dispensed ≥1 ART in 2022, patterns of 12-month percentage of days covered (PDC), discontinuation (≥90-day treatment gap), and interruption (resumed treatment after 6−89-day gap) were described.

Results
Among 1973 PWH and 9865 controls, mean±SD age was 48.2±11.2 and 48.7±11.2 years, respectively, and 74.4% were male. A lower proportion of PWH (39.6%) vs controls (48.0%) had high residential socioeconomic status. Higher prevalence of comorbidities among PWH vs controls included anxiety/depression (26.2% vs 13.5%), liver disease (20.9% vs 12.5%), chronic kidney disease (14.9% vs 7.3%), cancer (7.2% vs 5.3%), hepatitis C virus (5.6% vs 0.1%), and hepatitis B virus (HBV; 3.4% vs 0.4%). PWH (vs controls) had a median of 10 primary-care visits/year (vs 7) and more frequent hospital admissions (≥1: 11.4% vs 6.6%) and emergency room visits (≥1: 26.5% vs 19.0%). Among PWH treated in 2022 (n=1907), 78.1% had PDC ≥90%. Discontinuation and interruption occurred among 7.2% and 69.1% of treated PWH, respectively. PWH with PDC &lt; 90% (vs ≥90%) had younger age, lower socioeconomic status, higher prevalence of HBV diagnosis, and less frequent physician visits in prior 12 months.

Conclusion
Despite high ART coverage, PWH in Israel experience an excess burden of comorbidities and HRU compared to age-sex-matched controls without HIV. Further research is needed to address the excess disease burden and better define treatment/care gaps among PWH.

Disclosures
Sivan Gazit, MD, AbbVie: The relationship is not personal, AbbVie funded the current study, funding to the research institution where I work Arlene Nugent, MSc, Abbvie: Stocks/Bonds (Public Company) Liza Bronner Murrison, PhD, AbbVie: Stocks/Bonds (Public Company) Ana Gabriela Pires dos Santos, PhD, ABBVIE: Stocks/Bonds (Public Company)
P-1428. Risk Factors for Bacterial Infections After Firearm Injury
Authors: Yang Jerry , Tung Chih Chun , Harfouche Melike , Harris Anthony , Baghdadi Jonathan 
Published: January 2025

Abstract

Background
Every day, over 300 Americans sustain firearm injuries, but prevalence estimates for bacterial infection after these injuries vary widely.

Methods
We studied a retrospective cohort of adults with firearm injuries using administrative data from 233 US hospitals in the Premier database from 1/2019 through 4/2021. Encounters for firearm injury were identified by ICD-10 diagnosis codes. The index encounter for firearm injury and subsequent encounters at the same hospital within 90 days were assessed for bacterial infection, defined by a positive clinical culture and at least 4 days of antibiotic therapy or antibiotics until death. Risk factors, including firearm type, intent of injury, and injury location were identified using diagnosis and procedure codes. Relationships between risk factors and infection were evaluated with multivariable logistic regression.

Results
15,437 patients with a medical encounter for firearm injury were identified, including 2,610 (17%) who required surgery during the index encounter and 912 (6%) who developed bacterial infection. 14% of bacterial infections (125/912) developed during 90-day follow-up after the index encounter (median time to presentation 20 days, IQR 8 – 45), including 1% of patients who had surgery during the index encounter (37/2610). On average, patients who developed bacterial infection were 32.5 years old (sd 15.0), 87% men (790/912), 78% single marital status (708/912), and 54% had unintentional firearm injuries (490/912). In multivariable analysis, injury requiring head, neck, or spine surgery (OR 4.8, 95% CI 3.5 – 6.6), lower abdominal surgery (OR 2.1, 95% CI 1.6 – 2.8), or thoracic surgery (OR 1.8 (95% CI 1.4 – 2.4) were the strongest risk factors for bacterial infection. Mortality was 8.7% (1335/15437), including 7.4% (67/912) of patients with bacterial infections. In multivariable analysis, bacterial infection was not significantly associated mortality (OR 0.8, 95% CI 0.6 - 1.1).

Conclusion
Bacterial infection is an infrequent complication of firearm injury that tends to present during initial hospitalization. Patients undergoing head, neck, spine, large bowel, or chest surgery are at highest risk overall, though new postoperative infection is rare at follow-up.

Disclosures
Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor
P-1443. Experiences with Human Immunodeficiency Virus (HIV), Dialysis, and Kidney Transplantation
Authors: Nagam Meghna , Huml Anne , Modi Anita R 
Published: January 2025

Abstract

Background
People living with HIV and advanced kidney disease face unique challenges in the kidney transplant evaluation process. Retrospective chart reviews concerning this marginalized patient population portray kidney transplant candidates and the transplant evaluation process through the lens of the provider. We directly solicited patient perspectives to better understand their experiences with HIV, dialysis, and kidney transplantation.

Methods
We recruited 20 people living with HIV and advanced kidney disease seen at our center to participate in one-on-one interviews guided by a structured questionnaire, audio-recorded, and professionally transcribed. Two physicians coded and reviewed all responses for common themes. A third physician served as the external thematic auditor. Data was collected on demographics, HIV care, and engagement in the transplant evaluation process for each participant.

Results
All 20 participants (18 Male, 14 Black, Mean Age 54y) were prescribed integrase inhibitor-based regimens and 17 demonstrated suppressed HIV viremia. One was not referred for kidney transplantation, one referred but not yet evaluated, nine undergoing evaluation, three with referrals closed, one listed, and five transplanted. Twenty parent codes were identified, each with 1-10 sub-codes. Seven major themes arose: HIV-associated stigma inside and outside of healthcare; Balance of trust and autonomy in decisions to start therapy for HIV and advanced kidney disease; Effect of health literacy on HIV and advanced kidney disease treatment adherence; Communication failures during the transplant evaluation process; Health and lifestyle changes related to dialysis and transplant listing; Impact of social support on pre- and post-transplantation experiences; and Personal and medical consequences of the perception of the “ideal transplant candidate”.

Conclusion
Patient perspectives offer valuable insight into the experiences of people living with HIV and advanced kidney disease undergoing dialysis and pursuing transplant evaluation. Attention to common attitudes and beliefs associated with this complex process, as well as its influence on life outside of healthcare, may guide future interventions to increase this vulnerable population’s access to kidney transplantation.

Disclosures
All Authors: No reported disclosures