bluuebunny/crossref_metadata_2025_split huggingface dataset:
981. Inducing Antimicrobial Resistance with Long-Term Antibiotics at Stage 2 Revision for Periprosthetic Joint Infection
Authors: Payne Judd , Sutton Jesse , Blackburn Brenna , Imlay Hannah , Spivak Emily S , Anderson Lucas , Gililland Jeremy , Pupaibool Jakrapun , Certain Laura 
Published: December 2022

Abstract

Background
Studies have shown reduced rates of recurrence of periprosthetic joint infection (PJI) with the use of oral antibiotics after stage-two revision. We examined the effects of these antibiotics on the antibiotic susceptibility patterns of subsequent PJI.

Methods
We conducted a retrospective cohort study of patients who underwent two-stage exchange for PJI in the Veterans Affairs system from 1/1/2015 – 6/1/2020. We compared patients who were prescribed oral antibiotic prophylaxis for ³14 days following stage-two revision arthroplasty with those who received &lt; 14 days of antibiotics. The primary outcome was the presence of antibiotic-resistant organisms isolated in cultures from subsequent infections of the same joint. Secondary outcomes included comparisons of rates of recurrent PJI and time-to-subsequent PJI between each group. We used Chi square and Fisher exact tests to compare the two groups.

Results
605 patients met inclusion criteria. Of these, 154 received ³14 days of oral antibiotics following stage 2 surgery. Tetracyclines (48.1%), beta-lactams (27.3%) and trimethoprim-sulfamethoxazole, TMP-SMX (18.8%) were the most common antibiotics used. There was decreased susceptibility to tetracyclines (58 vs 73%, p 0.24), TMP-SMX (48 vs 70%, p 0.059), and clindamycin (38 vs 57%, p 0.22) in organisms isolated from subsequent PJI in the antibiotic prophylaxis group compared to the control group. Subsequent PJI was diagnosed in 29 out of 154 (18.8%) in those who received antibiotic prophylaxis, compared with 80 of 451 (17.7%) who did not. Days to subsequent infection was higher for those who received antibiotics compared to those who did not (101 vs 65 days, respectively).

Conclusion
Prophylactic antibiotics following stage 2 revision for PJI may increase the risk for drug-resistant organisms in subsequent index joint infections, most notably against tetracyclines and TMP-SMX. Based on our data, antibiotics given after stage 2 revision postponed, rather than prevented, subsequent infection.

Disclosures
All Authors: No reported disclosures.
987. Retrospective Evaluation of Calcaneal Osteomyelitis Outcomes and Factors for Treatment
Authors: Fong Rebecca , Moenster Ryan P , McDonald Jay 
Published: December 2022

Abstract

Background
Calcaneal osteomyelitis (OM) accounts for 3-10% of all cases; however, there is limited data comparing clinical outcomes between patients with calcaneal OM and non-calcaneal OM of the foot.

Methods
This was a retrospective, observational cohort study of patients treated with at least 4 weeks of antibiotic therapy or surgical intervention for calcaneal or non-calcaneal OM at the VA St. Louis Health Care System between 1 January 2010 and 30 June 2021.
The primary outcome was treatment failure, defined as a follow-up encounter for new surgical intervention or re-initiation of antibiotics within 6 months of completion of initial surgical intervention or antibiotic therapy. Secondary outcomes included individual components of the primary outcome and antibiotic adverse events. The variables of calcaneal OM, poorly controlled diabetes, severe peripheral vascular disease, treatment for ≥2 weeks at a skilled nursing facility, and amputation as part of treatment were included in a univariate analysis and any variables with a p&lt; 0.2 were subsequently placed into a multivariate regression model to determine if any stated variables were independently associated with treatment failure.

Results
Eighty patients were included, 40 treated for calcaneal OM and 40 treated for non-calcaneal OM. More patients in the calcaneal group had a bone biopsy obtained (62% vs. 35%; p=0.014) and were treated with definitive therapy (77.5% vs. 47.5%; p=0.005). Conversely, more non-calcaneal patients received initial amputations for treatment (12.5% vs. 32.5%; p=0.032). Sixteen (40%) of calcaneal OM patients and 17 (42.5%) of non-calcaneal foot OM patients failed initial therapy (p=0.82). There was no statistically significant difference between the two groups in the re-initiation of antibiotics within 6 months for an infection of the same site (20% vs. 40%; p=0.051) or for unplanned surgery for same site within 6 months (30% vs. 15%; p=0.108). None of the factors in the univariate analysis met criteria to be included in the multivariate logistic regression.

Conclusion
The clinical outcomes of patients treated for calcaneal OM were not different from those treated for non-calcaneal OM of the foot.

Disclosures
All Authors: No reported disclosures.
996. Assessment of First-Dose Antimicrobial Infusion Reactions in Outpatient Parenteral Antimicrobial Therapy (OPAT) Service Patients
Authors: Kovacik Carrie , Shah Megan , Thomas Tania A , Eby Joshua C 
Published: December 2022

Abstract

Background
The 2018 Infectious Diseases Society of America (IDSA) OPAT guidelines recommend that an outpatient-initiated first dose may be administered at home under the supervision of healthcare personnel who are trained to respond to IgE-mediated hypersensitivity reactions. This may involve a home health nurse, but if resources are limited, agencies may require a first-dose infusion to be completed in a monitored healthcare setting. The objective of this study is to assess the incidence of immediate reactions in UVA OPAT patients who received a supervised outpatient first-dose infusion as part of care for long term antimicrobial management.

Methods
This single center, retrospective case series evaluated adult patients enrolled in the UVA OPAT program who received a first-dose antimicrobial infusion for initiation of or change in IV antimicrobial therapy at a UVA-affiliated infusion center between January 2019 and October 2021. The primary endpoint is the percentage of UVA OPAT patients who experienced an immediate reaction, which includes IgE-mediated and infusion-related reactions, after receiving a supervised first-dose infusion outpatient. Secondary endpoints include the percentage of UVA OPAT patients who previously received the same antimicrobial and timing of receipt in patients who experienced an immediate reaction and in those who tolerated the first-dose antimicrobial infusion. Data were analyzed using descriptive statistics.

Results
There were 93 OPAT patients who received 115 first-dose infusions during the study timeframe. Daptomycin, ceftriaxone, and vancomycin accounted for 64% of first-dose infusions. Six patients (6%) experienced an immediate reaction, which included itching, erythema, and nausea. All patients received treatment for their reaction and were able to complete their infusion. Two patients who experienced an immediate reaction had received the same antimicrobial more than 12 months prior.

Conclusion
After receiving a first-dose antimicrobial infusion, few UVA OPAT patients experienced an immediate reaction, none of which were consistent with IgE-mediated reactions. These findings support the IDSA guidelines recommending a monitored first-dose infusion at home, particularly among those who recently tolerated the same agent.

Disclosures
All Authors: No reported disclosures.
999. Clinical Outcomes of Off-label Dalbavancin Use within an Outpatient Parenteral Antibiotic Therapy (OPAT) Program
Authors: Igwilo-Alaneme Rita , Bao Hongkai , Nori Priya 
Published: December 2022

Abstract

Background
Dalbavancin is approved for the treatment of acute bacterial skin and soft structure infections (ABSSSI). There is less data on outcomes of off-label use of dalbavancin for orthopedic and other complex infections. In this case series, we aim to analyze clinical outcomes of deep-seated infections treated with IV dalbavancin instead of long-term IV antibiotics post-discharge.

Methods
We conducted a retrospective review of adult patients treated with off-label IV dalbavancin between January 2020 and February 2022 at an academic center in the Bronx, NY within a long-standing outpatient parenteral antibiotic therapy (OPAT) program. Outcomes of interest included 90-d infection recurrence, prothesis retention, mortality, adverse events, and characteristics of antibiotic regimens.

Results
Nineteen patients received dalbavancin for off-label indications. Dalbavancin was used primarily for hardware, bone and joint, and complicated soft tissue infections (table 1). The predominant pathogen was Staphylococcus aureus. Source control was achieved in 12 (63%) patients via debridement alone (5), debridement with prosthetic device retention (4), or debridement and complete hardware removal (3). The most common dosing regimen was two-doses (1000-mg, 500-mg) one week apart. Two (11%) patients (both with initial prosthesis retention) had infection recurrence within 90 days of dalbavancin and eventually required removal (table 2). One patient experienced recurrence after 90 days and required removal. The remaining patient with prothesis retention has not experienced infection recurrence to date. Concomitant antibiotics while on dalbavancin and suppressive antibiotics following therapy were common. No patient died within 90 days of therapy and no adverse drug effects were reported.

Conclusion
Dalbavancin use for hardware infections, osteomyelitis, complicated soft tissue infections, and spinal infections is associated with favorable cure rates, safety profile, and tolerability. Improved outcomes may be achieved with hardware removal. Dalbavancin off-label use within an OPAT program may facilitate early discharge or prevent admissions in eligible patients, although further study is needed.

Disclosures
All Authors: No reported disclosures.
1003. Curbsiding Twitter: Potential Value and Patient Confidentiality Implications of Infectious Diseases Clinician Peer Consultations via Social Media
Authors: Boyland Ryan , Cortes-Penfield Nicolas W , Marcelin Jasmine R 
Published: December 2022

Abstract

Background
Infectious Disease (ID) clinicians increasingly collaborate via social media and have adopted Twitter and the hashtag #IDTwitter for community-wide conversation. We investigated clinicians’ use of #IDTwitter for peer consultation, examining both the utility of responses and how frequently discussions risked compromising patient privacy.

Methods
We reviewed English-language posts on www.twitter.com with the hashtag #IDTwitter over a 6-week period ending August 31st, 2021. We collected posts that we deemed examples of peer consultation, recording the post’s author, topic, engagement produced, and patient information disclosed. Finally, we recorded whether (by consensus) we judged a question meaningfully answered.

Results
We identified 108 instances of peer consultation; 91 posts (84%) were consultations about a clinical scenario, 17 (16%) included a specific request for medical literature, and seven (6%) included a request for literature interpretation. Twenty-four posts (22%) contained polls, which received a mean 107 (SD 104) votes. We judged 71% of questions meaningfully answered; of these, 68% received responses including explicit justification or reasoning and 35% included citations of supporting literature. Questions were more likely to be meaningfully answered if they included polls (91.7% vs 65.5%; p=0.01). Receipt of a meaningful answer was not predicted by the questioner’s professional role and follower count, the question topic, or the post’s number of likes and shares.
A total 28/108 posts (26%) referenced the care of a specific patient, with details shared including gender (74%), age (26%), radiographic or clinical images (7%), and other potentially identifying data (7%). Patients were stated or implied to be currently under the clinician’s care in 70% of cases, and 61 clinicians (92.4%) had their employer listed in their profile or immediately available via internet search.

Conclusion
ID clinicians’ peer consultations via #IDTwitter appeared frequently useful, particularly when questions were accompanied by polls. However, most participants sharing patient data were readily identifiable, and best practices to limit sharing of nonessential data and safeguard patient privacy are needed.

Disclosures
Jasmine R. Marcelin, MD, Pfizer (Grant reviewer): Honoraria.
1021. The post-sign-off events of Infectious Diseases (ID) consultation and the incidence of non-adherence to ID consultation during the post-sign-off period: A retrospective cohort study
Authors: Honda Hitoshi , Takamatsu Akane 
Published: December 2022

Abstract

Background
Infectious Diseases (ID) consultation has contributed to improving the quality of care in inpatient settings. ID physicians traditionally examine patients and provide the final treatment recommendations (i.e., sign-off ID consultation). However, patients may acquire antimicrobial-associated adverse drug events (AAADE) and healthcare-associated infections (HAI) after the sign-off ID consultation. Moreover, it is unclear how these events that occurred during the post-sign-off period were managed. The study aims to scrutinize the post-sign-off events and the current epidemiology of non-adherence to ID recommendations during the post-sign-off period.

Methods
The retrospective cohort study was performed at a Japanese tertiary care center. Among all ID consultation cases from January to December 2019, those with general ID consultation with treatment recommendations given for the definitive or suspected infectious diseases were included for analysis. The instances of post-sign-off events included AAADE, HAI, and treatment failure of established infections. Non-adherence to ID consultation was defined as the failure of the primary care team to complete ID final recommendations. The incidence of the post-sign-off events and outcomes associated with nonadherence to ID consultations were investigated.

Results
Among 762 ID consultations that occurred, 367 cases were included for analysis. The incidence of the post-sign-off events was 10.9% (40/367), and AAADEs accounted for 62.5% (25/40) of cases. Non-adherence to ID consultation occurred in 105 (28.6%) cases, and prolonged antimicrobial therapy beyond ID consultation was the most common reason for non-adherence. The primary care team modified antimicrobial therapy in approximately two-thirds of cases (71/105) without ID re-consultation. The length of hospital stay was longer in patients with non-adherence to ID consultation than in those with adherence (36 versus 29 days; p=0.002).

Conclusion
The post-sign-off events of ID consultation commonly occur, leading to nonadherence to ID consultation during the post-sign-off period. Because nonadherence may be associated with worse clinical outcomes, attention after the sign-off ID consultation is needed to ensure patient safety.

Disclosures
All Authors: No reported disclosures.
1026. What Proportion of Infectious Diseases Physicians Have Buprenorphine Waivers to Treat Opioid Use Disorder in the United States?
Authors: Fujita Ayako W , Loughry Nora , Moore DeLante , Colasanti Jonathan , Sheth Anandi N 
Published: December 2022

Abstract

Background
Since the onset of the COVID-19 pandemic, opioid-related overdose deaths have increased. Buprenorphine, a medication for opioid use disorder (OUD), is safe and effective but is underutilized and requires qualifying physicians to obtain a waiver. Infectious diseases (ID) physicians are uniquely positioned to treat OUD, as persons with OUD may present with infectious complications from injection drug use. We sought to understand the proportion and distribution of ID physicians with waivers in the United States (US).

Methods
This was a cross-sectional study merging data from the Centers for Medicare & Medicaid Services and the Drug Enforcement Agency Substance Abuse and Mental Health Services Agency. Our primary outcome was proportion of ID physicians who possess buprenorphine waivers. We used multivariable regression models to identify individual and county-level characteristics associated with buprenorphine waiver possession. We used geospatial analysis to describe county-level distribution of buprenorphine-waivered ID physicians.

Results
Among 6439 ID physicians in the US, 170 (2.6%) possessed buprenorphine waivers. Overall, 57.2% of ID physicians were male with a median 23 (IQR 15-33) years since medical school. Most (97.3%) practiced in metropolitan counties. In multivariable analysis, medical school graduation beyond 20 years was associated with lower odds of waiver possession compared to those graduating within 20 years (OR 0.59, 95% CI 0.43-0.80). ID physicians practicing in counties with median income &gt; 50,000/year and in counties with higher proportion of uninsured residents also had lower odds of having a waiver (OR 0.58, 95% CI 0.35-0.97; OR 0.93, 95% CI 0.90-0.97). Among counties with at least one ID physician (n=519), 86.6% had no buprenorphine-waivered ID physicians (Figure 1). Figure 1County-Level Distribution of Infectious Diseases Physicians with Buprenorphine Waivers

Conclusion
Fewer than 3% of ID physicians in the US have obtained waivers to prescribe buprenorphine, highlighting missed opportunities to treat individuals with OUD, especially in rural America. Education on OUD management should be integrated into ID continuing medical education, and policies are urgently needed to expand buprenorphine access to persons without insurance.

Disclosures
All Authors: No reported disclosures.
1032. Janus Kinase Inhibition for Refractory Post-infectious Inflammatory Response in Previously Healthy Patients with Cryptococcal Meningoencephalitis
Authors: Anjum Seher , Williamson Peter , Hargarten Jessica 
Published: December 2022

Abstract

Background
Post-infectious inflammatory response syndrome(PIIRS) is a previously reported complication of non-HIV cryptococcal meningitis (CM) involving a pathological T cell-mediated neuroinflammatory response once the fungus has been cleared. Although corticosteroids have been successfully used as therapy, side effects preclude prolonged use. Additionally, alternative targeted agents may be required as adjunctive therapy in steroid-refractory PIIRS. We report the clinical course in 3 patients in whom Janus kinase (JAK) inhibitor use led to favorable outcomes when used along with corticosteroids.

Methods
Medical records of three previously healthy CM-PIIRS patients admitted to the NIH between January 2021 to December 2021 were used to prepare this report. All were transferred from another facility due to worsening neurological status. Neurological exam and radiological findings were compared at baseline and one month after ruxolitinib initiation. CSF parameters including cellular markers of T-cell inflammation (HLA-DR+ CD4+ and HLA-DR+ CD8 cells and monocytes) and soluble CSF cytokines, including IL-6 and sCD25, were also included in the comparison.

Results
One patient was on 1mg/kg oral prednisone for 8 months with no improvement in symptoms despite VP shunt placement. The other two had also been on moderate-dose oral steroids for approximately 6 weeks for a recent diagnosis of PIIRS. All three were started on ruxolitinib (5-10 mg PO BID) as an adjunct to prednisone with a significant improvement in their neurological status, CSF inflammatory markers, and radiological findings. CSF fungal cultures remained negative with no occurrence of adverse events 3 months after ruxolitinib initiation. Therapy with ruxolitinib allowed continued corticosteroid taper without clinical flairs of disease in each patient.

Conclusion
The selective JAK1/2 inhibitor, ruxolitinib, was safe in a small group of HIV-negative patients with CM. This agent may offer promise in conjunction with corticosteroids in the treatment of non-HIV CM patients with refractory PIIRS who are at risk for adverse side effects related to prolonged steroid use. Further study will be required to determine efficacy, tolerability and ability to reduce corticosteroid use.

Disclosures
All Authors: No reported disclosures.
1040. Comparative Surge Data on SARS CoV-2 Variants in a Rural Community – A Virtual Hospital Experience
Authors: Costello William A , Frank Anthony , Rhodes Regina , Loomis Gandhari , Sampath Rahul 
Published: December 2022

Abstract

Background
UNC Health Blue Ridge is a nonprofit community teaching hospital with 145 staffed beds. The COVID-19 pandemic has challenged rural hospitals like ours with high occupancy and periodic surges. UNC Health Blue Ridge COVID Virtual Hospital (CVH) created a home monitoring program for enrolled patients with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection utilizing disease risk stratification and pulse oximeter readings to dictate nurse and clinician follow-up. We report raw data that compare surge levels in our community for the Alpha (B.1.1.7), Delta (B.1.617.2) and Omicron (B.1.1.529) surges.

Methods
From April 2020 to present, the CVH enrolled patients diagnosed with COVID-19 based on FDA approved PCR tests. For this abstract, we defined any surge as an outpatient CVH census of greater than 50 patients or an inpatient census of &gt;10 patients. We defined the maximum intensity of the surge as &gt;20% outpatient SARS CoV-2 positivity and a CVH census &gt;100 patients or &gt;20 inpatients with SARS CoV-2 infection.

Results
For the outpatient setting, days of surge and maximum intensity were 144 / 98 days for Alpha, 92 / 71 days for Delta, 74 / 47 days for Omicron, respectively. Average daily CVH admissions during surges were 17.7 for Alpha, 26.15 for Delta, and 27.15 for Omicron. Total emergency department (ED) and urgent care visits were 12,765 and 23,696 for Delta, and 9701 and 16102 for Omicron. In the inpatient setting, days of surge and maximum intensity days were 102/76 days for Delta and 78/48 days for Omicron. Our peak inpatient COVID-19 daily census was 51 and 50 patients for Delta and Omicron.

Conclusion
Our CVH has enrolled over 8700 patients, and our hospital has not been on diversion during the COVID-19 pandemic, unlike many surrounding hospital systems of similar size. More importantly, the CVH has helped create a sustainable model that gathers local data to aid predictive algorithms and facilitate proactive rather than reactive resource allocations. This virtual model can be adapted for multiple other health conditions in the outpatient setting to improve patient safety and quality care.

Disclosures
All Authors: No reported disclosures.