bluuebunny/crossref_metadata_2025_split huggingface dataset:
1390. Assessing the Relationship between Community Social Vulnerability and Antibiotic Use in Nursing Homes
Authors: Zipfel Casey M , Paul Prabasaj , Slayton Rachel 
Published: December 2022

Abstract

Background
Health inequities impact healthcare delivery and outcomes, but the impacts of health inequities on antibiotic use and AR infections have been less frequently studied in nursing home residents. Nursing home residents are typically older, often have increased care needs requiring frequent contact with staff, and often have comorbidities or in-dwelling devices that make them vulnerable to infection. The community served by a nursing home may play a role in frequency and variability in antibiotic use, as health inequities may impact healthcare delivery and health status of patients, since both patients and caregivers are likely to be drawn from the surrounding community. We hypothesize that antibiotic use in nursing homes is impacted by the social vulnerability of the surrounding community.

Methods
We collected all reports of the proportion of residents who received antibiotics in the previous 7 days in 2019, which are reported monthly to the CMS Minimum Data Set. We assessed the proportion of facility residents using antibiotics by social vulnerability measures (from CDC Social Vulnerability Index) of the surrounding healthcare-seeking community (Hospital Service Areas from Dartmouth Health Atlas), using a hierarchical model to control for facility factors.

Results
We find considerable variability in antibiotic use across 14,908 US nursing homes (Figure 1A). After controlling for facility characteristics, facilities located in areas of greater community-level social vulnerability were associated with higher antibiotic use (Figure 1B).
Figure 1. Antibiotic use in nursing homes and relationships with community social vulnerability. A) The distribution of the proportion of patients using antibiotics within the previous 7 days by facility.
B) Coefficient estimates of a multilevel regression model. Controlling for facility-level factors (blue), community-level social vulnerability index appears to be related with more antibiotic use.

Conclusion
These findings indicate that community social vulnerability is associated with healthcare delivery within facilities. This association may result from differences in antibiotic prescribing behavior, infection prevention practices, or from disparity-driven differences in the health status of the resident population. This work is important for informing epidemiological models within healthcare facilities: failing to include heterogeneity of the surrounding community could bias transmission models and decrease the accuracy of targeted public health interventions to vulnerable facilities and communities.

Disclosures
All Authors: No reported disclosures.
1404. Factors Associated to Decrease in Quality of Life After Mild-Moderate COVID-19: A Cross-Sectional Study.
Authors: Navarro Alberto Ordinola , Villegas Hector Rivera , Luis Bruno Ali Lopez 
Published: December 2022

Abstract

Background
Post-COVID-19 alterations have been recognized even after mild disease. We aimed to assess which factors are the main contributors to a decrease in quality of life(QOL) of patients with different times elapsed from the COVID-19 diagnosis.

Methods
A cross-sectional study from January 2021 to April 2021 in a Referral Center in Mexico City.
Patients were invited for a follow-up visit in which a structured questionnaire about symptoms, the EQ-5D-5L QOL for QOL, and an objective olfactory evaluation with The Sniffin’ Sticks Screening 12 test.

Results
We included 179 patients, 64% were female with a median age of 33 years. The median time since COVID-19 diagnosis until the evaluation was 219 days (IQR, 94-255). Persistent symptoms were present up to in 158/179 (88%), fatigue, pain/discomfort and cognitive alterations were present in 61%, the median EQ-5D-5L index value preCOVID-19 was 1 (IQR, 0.94-1) and post- COVID-19 was 0.87 (IQR, 0.80-0.94), P&lt; 0.001. There were 101/179 (56%) patients with decreased QOL; In the multivariate analysis, post-COVID-19 pain (aOR, 2.5; P= 0.01), anxiety (aOR, 13; P= 0.03), and the persistence of three or more symptoms (aOR, 2.6; P= 0.05) were factors associated with decreased QOL.

Conclusion
Within the post- COVID-19 alterations, psychological and physical factors such as Pain/discomfort, anxiety, and persistent symptoms explained the decreased QOL in the post-COVID-19 patient. These alterations were present as early as 30 days to more than eight months.

Disclosures
All Authors: No reported disclosures.
1405. High risk or unstable substance use may predict OPAT nonadherence among people who use drugs (PWUD) admitted with invasive infections
Authors: Ching Patrick R , George Nivya , Kottilil Shyam , Narayanan Shivakumar 
Published: December 2022

Abstract

Background
Patients with substance use disorder (SUD) are frequently admitted to hospitals for invasive infections and may have poor infection outcomes including non-adherence and lack of completion of therapy.

Methods
In this retrospective cohort of 263 hospital encounters among 201 patients for invasive infections due to SUD to an urban tertiary care facility, we looked at characteristics of SUD to assess whether there were differences in infections, their management, SUD interventions and parenteral antibiotic outcomes between groups.

Results
Among people with SUD, 79% of antibiotic courses were completed in skilled nursing facilities. Most common infectious syndromes were osteoarticular infections (123, 47%), infective endocarditis (IE) (54, 20%) and non-IE endovascular infection (23, 9%). Among SUD specific interventions, 64% of episodes had documentation of a consultation by substance use services and 68% episodes had documentation of medication for opioid use disorder (MOUD) being prescribed at discharge. Overall, completion of therapy was documented in 163 (62%) of encounters. Overall, treatment non-adherence was seen in 63 encounters (24%). Non-adherence was documented 32% of episodes with documentation of injection drug use (IDU), 28% of encounters where active substance use was documented in the prior year and 33% of encounters where use of more than one substance was documented (P&lt; 0.05 for all 3 groups). Drug or catheter related adverse events seemed to be significantly higher in the IDU group (3.64/1000 OPAT days) and catheter abuse was documented in 7 encounters of which 6 were with IDU or active SUD active documented. Cumulatively an unfavorable outcome (including failure, 30-day readmission, drug or PICC related adverse event, non-adherence or death) seemed to occur in 58% of IDU encounters as compared to non-IDU encounters (42.5%, P=0.011). Medication for opioid use disorder (MOUD) was prescribed at discharge in 68% of overall cohort and was not associated with improved outcomes for any of the above groups.
Demographics, infection details and outcomes by type of SUD

Conclusion
In patients hospitalized with SUD-related infections, interventions need to be focused on those with high risk, unstable SUD through MOUD optimization along transitions of care and linkage to care to improve OPAT outcomes and overall health events

Disclosures
Shyam Kottilil, MD, PhD, Arbutus Pharmaceuticals: Grant/Research Support|Gilead: Grant/Research Support|Merck: Grant/Research Support|Regeneron Pharmaceuticals: Advisor/Consultant|Silverback Therapeutics: Advisor/Consultant|The Liver Company: Advisor/Consultant|Yufan Biotechnologies: Advisor/Consultant.
1658. Using remote Infectious Disease physician expertise to support inpatient antibiotic stewardship activities at three VA medical centers an implementation-effectiveness trial
Authors: Livorsi Daniel J , Sherlock Stacey Hockett , Goedken Cassie Cunningham , Clarke Kim , Goodman David , Pratt Sandra , Cho Hyunkeun , Reisinger Heather , Perencevich Eli N 
Published: December 2022

Abstract

Background
Remote Infectious Disease (ID) physicians can provide stewardship support through telehealth. Using the RE-AIM framework, we assessed the implementation of telehealth-supported prospective-audit-and-feedback (tele-PAF) across 3 rural Veterans Administration medical centers (VAMC).

Methods
All 3 invited sites agreed to participate and lacked ID support for stewardship at baseline. During 2021, an ID physician met virtually 3 times/week with the stewardship pharmacist champion at each participating VAMC to review patients on antibiotics in acute-care (mean daily census 3/site) and nursing-homes (NHs; mean census 71/site); real-time feedback on antibiotic use was given to clinicians. The primary outcome of effectiveness was monthly antibiotic days of therapy (DOT) per 1,000 days-present aggregated across all sites; the secondary outcome was days of antibiotic spectrum coverage (DASC) per 1,000 days-present. An interrupted time-series analysis was performed to asses these outcomes during the 1-year intervention period vs. the 2-year prior baseline. Semi-structured interviews with 20 clinicians and pharmacists were conducted to assess implementation.

Results
RE-AIM elements are summarized in Table 1. Tele-PAF reviewed 502 unique patients and made 681 recommendations to 23 clinicians; 77% of recommendations were accepted. The most common recommendations were to stop antibiotics (28%) and change duration (20%). After the start of tele-PAF, antibiotic DOT and DASC immediately decreased in acute-care (-20%, p=0.01; -22%, p&lt; 0.01) and NHs (-28%, p=0.03; -37%, p&lt; 0.01). Both metrics began to rise again in acute-care (DOT: +2.5%/month, p=0.02; DASC: +2.7%/month, p=0.02) but were stable in NHs (Figure 1). Clinicians generally appreciated feedback, found it compatible with their workflow and responded favorably to collaborative discussions. Barriers included difficulty establishing rapport with some providers.

Conclusion
The implementation of tele-PAF was associated with sustained reductions in antibiotic use across 3 NHs but not in the studied small acute-care units. Overall, clinicians perceived the intervention as acceptable and appropriate. Wider implementation of telehealth-supported stewardship activities may achieve reductions in antibiotic use.

Disclosures
Daniel J. Livorsi, MD, Merck & Co.: Grant/Research Support.
1424. Central Nervous System Tuberculosis in a Large Healthcare System
Authors: Jacobs Annie , Leonard Michael 
Published: December 2022

Abstract

Background
Central nervous system tuberculosis (CNS-TB) accounts for 5-10% of extrapulmonary TB cases. It takes 3 clinical forms: meningitis, tuberculoma, and arachnoiditis. Modern case descriptions of the presentation of CNS-TB are rare. The goal of this study is to examine the presentation, diagnostic studies, and associated comorbidities of CNS-TB.

Methods
In our academic healthcare system, cases of culture confirmed CNS-TB were identified in a database maintained by the infection control group. This is a retrospective case series of the 11 adults with confirmed CNS-TB.

Results
273 patients were identified with TB infection from 2008 to 2022. 104 (38%) had extra pulmonary disease. 11 (4%) had CNS infection. Patient characteristics are described in Table 1. 5 (45%) of the patients with CNS disease also had pulmonary disease. Mean age of diagnosis was 42. 5 (45%) were male and 9 (82%) were African American. 5 (45%) had HIV; mean CD4 count was 100 (8-255). Diagnostics are shown in Table 2. CSF studies revealed a mean WBC of 295/mm3 (4-808), protein of 605 mg/dL (27-4476), and Glucose of 31 (12-64) mg/dL. 4 (36%) patients presented with British Research Medical Council (BMRC) clinical stage I disease and 7 (64%) with stage II disease. 8 (73%) patients had an abnormal CT or MRI scan of the head, with representative images seen in Figure 1. 5 patients (45%) had lesions consistent with tuberculomas. 1 (9%) had arachnoiditis identified on imaging. 1 (9%) patient died.

Conclusion
38% of patients diagnosed with TB at our center had extrapulmonary disease compared to 17.5% reported in the literature. The 4% rate of CNS-TB was similar to previously reported. Our series describes abnormal imaging as well as CSF studies showing leukocytosis, pleocytosis, and hypoglycorrhachia consistent with previously described findings. Though numbers were small, no significant difference was found between HIV positive and negative patients. Although mortality was rare in our series, the patient who died had advanced AIDS and multidrug resistant meningitis. Given the significant global mortality of this disease, this series highlights the need for more current studies describing the presentation and diagnostic characteristics of modern CNS-TB so clinicians can better recognize and treat the condition without delay.

Disclosures
All Authors: No reported disclosures.
1430. Eravacycline associated hypofibrinogenemia during treatment of M.abscessus
Authors: Rausch Ethan , van Duin David , Bartelt Luther A , Daniels Lindsay M 
Published: December 2022

Abstract

Background
Eravacycline, a novel synthetic fluorocycline, is structurally similar to tigecycline. Cases of tigecycline associated hyperfibrinogenemia have been reported in the literature, however the mechanism is not currently well described. At this time it is unknown if this is a class effect.

Methods
Two cases of patients on eravacycline for treatment of Mycobacterium abscessus (M.abscessus) who received regular fibrinogen monitoring are described.

Results
Patient 1 received a kidney transplant (2010) and was admitted for acute hypoxic respiratory failure secondary to COVID-19. Their course was complicated by multiple infections including disseminated M.abscessus with positive cultures from the lung and blood. Eravacycline 1 mg/kg BID (80 mg) was started on D1 and continued through D24. Fibrinogen levels on D1 was 448 mg/dl and on D23 were 120 mg/dl. Eravacycline was stopped and fibrinogen returned to normal range (228 mg/dl) in 5 days. Eravacycline was re-trialed at 80 mg BID and fibrinogen level on D1 was 310 mg/dl and 147 mg/dl on D8. No repeat fibrinogen levels were obtained. Patient 2 was a lung transplant recipient (2019) admitted for treatment of M.abscessus skin and soft tissue infection. The patient was started on eravacycline 1 mg/kg BID (90 mg) due to concerns of hypofibrinogenemia from tigecycline. On D1 of eravacycline fibrinogen was 167 mg/dl , on D19 of therapy fibrinogen was 64 mg/dl and eravacycline was stopped. Fibrinogen level returned to normal 3 days after eravacycline discontinuation (212 mg/dl).

Conclusion
Similar to tigecycline, we observed eravacycline related hypofibrinogenemia. Time to onset was variable in the two cases presented. Hypofibrinogenemia was readily reversible, within 3-5 days, with drug withdrawal and reproducible in one patient with re-challenge of eravacycline. Further analysis into eravacycline related hypofibrinogenemia and its impact on coagulation outcomes are warranted based on these reports.

Disclosures
David van Duin, MD, PhD, Achaogen: Advisor/Consultant|Allergan: Advisor/Consultant|Astellas: Advisor/Consultant|MedImmune: Advisor/Consultant|Melinta: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|NeuMedicine: Advisor/Consultant|Pfizer: Advisor/Consultant|Qpex: Advisor/Consultant|Roche: Advisor/Consultant|Sanofi-Pasteur: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|T2 Biosystems: Advisor/Consultant|Tetraphase: Advisor/Consultant.
1443. Nontuberculous Mycobacterial Cervicofacial Lymphadenitis Therapy: Experience from a Tertiary Care Pediatric Center
Authors: Vo Anh N , Singh Prachi , Karandikar Manjiree , Rosbe Kristina 
Published: December 2022

Abstract

Background
Nontuberculous mycobacterial (NTM) infections commonly present as a unilateral, subacute cervical lymphadenitis in immunocompetent children under the age of 5 years. The natural history of NTM lymphadenitis without intervention is slow resolution, and there is a high risk of spontaneous drainage through the skin, often result in a scar. For NTM lymphadenitis, the gold standard is complete surgical excision as it is often curative and limits scar formation. However, surgical intervention, especially complete surgical excision, carries the risk of damage to the facial nerve in the parotid and submandibular region. Antibiotic therapy is thought to interrupt the natural progression of the disease.

Methods
We conducted a retrospective chart review and reviewed &gt;700 patients, who had a diagnosis of cervical lymphadenopathy and/or atypical mycobacterial based on ICD codes. Patients received a diagnosis of NTM if they had clinical adenitis with NTM detected on culture and/or PCR, acid-fast bacilli identified, or histological findings consistent with mycobacterial infection.

Results
A total of 17 cases of NTM were identified. The median age was 27 months; 52% were male and 47% were female. The median time of adenopathy prior to presentation to ENT or ID specialist was 2 months. The average size of the involved lymph node was 2.05 cm. Two patients were treated with only medical management, 6 with surgical management, 8 with both, and 1 had observation alone as patient was near resolution. Of the patients on antibiotics, a total of 4 patients had adverse effects (abdominal discomfort, diarrhea, vomiting, and/or rash). Surgical interventions include FNA, incision and drainage, curettage, and complete excision. Four patients required 2nd intervention. One patient had concerns for sinus formation but resolved in &lt; 1 month. No patients had facial nerve palsy or hypertrophic scarring.

Conclusion
Regardless of management strategy, all children in this study had resolution of NTM. Though there is a consensus that complete surgical resection is the gold standard, we demonstrate that medical management alone (anti-microbial therapy or “wait-and-see” method) can be an alternative first-line treatment. Limitations include retrospective nature of study which is limited by data available in the EMR.

Disclosures
All Authors: No reported disclosures.
1447. Retrospective Study Comparing the Characteristics of NTM Vertebral Osteomyelitis and Tuberculous Vertebral Osteomyelitis
Authors: Park Sunghee , Kim Tark , Ryu Byung-Han , Hong Hyo-Lim , Kwak Yee Gyung , Kim Min Jae 
Published: December 2022

Abstract

Background
Nontuberculous mycobacteria (NTM) species rarely cause vertebral osteomyelitis (VO). The clinical characteristics and radiological findings of NTM VO are not well described since the number of cases are limited. Here we present the clinical characteristics of culture positive NTM VO, compared to those of tuberculous (TB) VO.

Methods
We performed a retrospective, multicenter study at 5 hospitals. Patients with radiologic findings consistent with VO, and positive NTM or TB cultures on biopsy were included. Demographic characteristics and symptoms were collected, along with laboratory, radiologic, and pathologic findings.

Results
Nineteen patients with NTM VO and 105 patients with TB VO were included. M. intracellulare (52.6%) and M. abscessus (26.3%) were the most common NTM pathogens. The mean age of patients was significantly older in the NTM VO group (68.0 vs. 58.5 years, P = .01). Previous steroid or immunosuppressant use was more frequent in the NTM VO group (21.1% vs. 2.9%, P = .01; 15.8% vs. 2.9%, P = .046, respectively), as was a history of vertebral surgery (47.4% vs. 13.3%, P &lt; .001). Symptoms and laboratory findings were similar between the 2 groups, although the proportion of patients with positive interferon-gamma release assays (IGRA) was significantly higher in the TB VO group (14.3% vs. 86.4%, P &lt; .001). Radiologic findings were also similar, with lumbar involvement being the most common (57.9% and 44.8%, respectively). Chronic granulomatous inflammation was more frequently seen in TB VO patients (33.3% vs. 64.0%, P = .04), while inflammation alone was more common in NTM VO. Although there was no significant difference in survival after 1 year, survival at last follow-up (median, 24 months) was significantly lower in the NTM VO group (75.0% vs. 98.8%, P = .02).

Conclusion
NTM VO should be considered in older patients with a history of immunosuppression or previous vertebral surgery. The pathologic findings and radiologic findings of NTM VO were similar to that of TB VO. Granulomatous inflammation and positive IGRA tests were more common in TB than NTM VO.

Disclosures
All Authors: No reported disclosures.
1453. Clinical Manifestation and Risk Factors Associated with Mortality of Cytomegalovirus Infection in Immunocompetent Patients in King Chulalongkorn Memorial Hospital, Bangkok, Thailand: a 3-year experience
Authors: Kiatsuranon Phimkamon , Vanichanan Jakapat , Jutivorakool Kamonwan 
Published: December 2022

Abstract

Background
Cytomegalovirus (CMV) infection usually occurs in organ transplant or HIV-infected patients. Recently, we found CMV infection was increased in non-transplant and non-HIV infected patients. Our study aimed to determine the epidemiology, clinical manifestation, clinical outcome, and risk factors associated mortality of CMV infection in this population.

Methods
The retrospective study was conducted in King Chulalongkorn Memorial Hospital. Patients aged above 18 years with diagnosis of CMV infection from January 2017 to September 2019 were collected and identified by ICD-10 code. Patients with HIV infection, solid organ transplant and hematopoietic stem cell transplant were excluded.

Results
A total of 51 patients, including 28 males (54.9%) were identified. The median age was 61 years (range 48-73 years). 46 patients (90.2%) had underlying disease which were 19 cases (37.3%) of autoimmune disease, 13 cases (25.5%) of hematologic disease (mostly hematologic malignancy), 4 cases (7.8%) of chronic kidney disease, and 10 cases (21.6%) of others. CMV viremia was found in 31.4%. Regarding CMV end-organ disease, there were 20 cases of gastrointestinal tract CMV infection, 10 cases were CMV retinitis, 5 cases were CMV pneumonitis and 1 case was CMV hepatitis and CMV transverse myelitis. The all-cause mortality was 25.5% and significantly in age over 70-year-old (p=0.037). The end-organ disease and CMV viral load were not different in survived and death group (p=0.445 and p=0.838, respectively).
Factors associated with mortality of CMV infection

Conclusion
CMV infection was an emerging problem in non-transplant and non-HIV infected adult patients, especially in age over 70-year-old in our Institute. The study showed infections predominated in rheumatologic and hematologic malignant patients who were received chemotherapy or immunosuppressive agent. Viremia and gastrointestinal tract were organs that mainly involved. CMV infection will become an important complication in the era of treatment with immuno-chemotherapy. Clinician should be aware of this potentially life-threatening infection.

Disclosures
All Authors: No reported disclosures.