bluuebunny/crossref_metadata_2025_split huggingface dataset:
1411. Missed HIV Clinic Visits among Youth Living with HIV in Alabama
Authors: Hao Jiaying 
Published: December 2022

Abstract

Background
Adolescents and young adults with HIV consistently account for about one-fifth of new infections in the United States. YLWH have lower rates of testing, diagnosis, treatment engagement, and viral suppression than adults with HIV. YLWH are particularly challenged with missing medical appointments. Few studies have been published on youth living with HIV (YLWH)’s missed clinic visits and risk factors. Therefore, this study was designed to explore:
1). if the missed visits have significant associations with HIV treatment outcomes (more than 50 counts of CD4 counts drop, viral load increment, and viral suppression) in YLWH; 2). What factors are associated with missed visits for YLWH? 3) Are these factors different from the risk factors of all PLWH?

Methods
A retrospective study using data records from UAB Family Clinic was designed. The study used the records from March 1st 2020 to August 31st, 2021. Patients aged 16-24 were considered as YLWH. The primary outcomes are missed visits and treatment outcomes. CD4 change, Viral suppression and VL change during the study period were investigated for identifying the association between missed visit and treatment outcome. Age, gender, race, HIV transmission mode, insurance type and the viral suppression in index record were used as factors to predict missed visits. Chi-square test and logistic regression have been conducted in SAS 9.4.

Results
YLWH with missed visits had more viral load rebound compared to those without missed visits (p=0.04).
For YLWH, gender and viral suppression in the index record have significant associations with missed visits (Gender: p=0.03, Viral suppression in index record: p=0.04).
In tests among all PLWH, Race (p=0.03), Insurance type (p=0.01) and viral suppression in index record (p=0.001) are associated with missed visits. Table 1.Viral load change by missed visits.Table 2.Risk factors associated with missed visits among YLWH (n=101).Table 3.Risk factors associated with missed visits among PLWY (n=296).

Conclusion
Missed visits are significantly associated with viral load maintenance, and missed visits have adverse effects on treatment outcomes. Also, the risk factors for YLWH of missed visits are not identical with the risk factors for PLWH from the same cohort.

Disclosures
All Authors: No reported disclosures.
1416. The Economic Burden of Adverse Events Requiring Acute Care Services from Outpatient Parenteral Antibiotic Therapy (OPAT) Treatment
Authors: Rodriguez Mauricio , Buscaglia Georgia , Tolle Steven , Michael Darren 
Published: December 2022

Abstract

Background
Antimicrobial resistance (AMR) is a growing threat. ESBL-producing Enterobacterales infections are rising, especially within the community setting. Patients requiring OPAT services will increase based on AMR to oral antibiotic (ABX) options. OPAT adverse events (AEs) are linked to the use of IV catheters, followed by adverse drug events. Complications that arise from OPAT, often necessitate acute care services. We sought to quantify costs associated with OPAT AEs.

Methods
A multicenter retrospective claims analysis from the state of Utah’s (UT) Public IBIS database was performed for 2020. OPAT AEs as described in the literature were used to query charges. All UT hospitals and common OPAT AE principal diagnosis (PDx) codes were included in the analysis. Estimated inpatient (IP) costs associated with common OPAT AEs were calculated from a charge-to-cost ratio (22.5%) using publicly available data from the Centers for Medicare & Medicaid Services. Event counts reported for UT were scaled proportionally to estimate total events for the U.S. population. Emergency department (ED) incidence rates for OPAT AEs from 2016 to 2020 were also examined.

Results
During the study period, 248,843 patients met study inclusion for an OPAT AE PDx. Among IV-related complications, catheter phlebitis accounted for highest median cost per IP event at $14,051. Other PDx, included catheter blockage and central line-associated bloodstream infections at $11,237 and $10,103, respectively, followed by $9,371 for complications post injection. Thrombotic events equated to total of $11,915 for the combined costs of deep venous thrombosis and pulmonary embolism. Lastly, C. difficile infections accounted for a median cost of $5,284 (Figure 1). Age-adjusted rates of ED activity related to AEs rose to 17.6 per 10,000 in 2020; this marked an 18% increase from 2016 (Figure 2). Figure 1.Figure 2.

Conclusion
Give that viable oral ABX treatment options in the community setting are limited, patients will require additional OPAT services as AMR rates continue to escalate. OPAT services are not without added risks of complications, as the average median cost for an OPAT AE was $8,852. These costs may be minimized by the addition of new oral ABXs that overcome AMR, thus improving patient outcomes.

Disclosures
Mauricio Rodriguez, PharmD, MS-HEOR, BCPS, BCCCP, BCIDP, Spero Therapeutics: Employee Georgia Buscaglia, PhD, Spero Therapeutics: Advisor/Consultant Steven Tolle, BFA, Spero Therapeutics: Advisor/Consultant Darren Michael, PhD, CC, SC, Spero Therapeutics: Advisor/Consultant|Spero Therapeutics: Grant/Research Support.
1417. The Impact of Psychosocial Factors on ART Adherence is Mediated by Poverty in Older Adults Living With HIV
Authors: Mazonson Peter J , Karris Maile Y , Huang Emily , Berko Jeff , Spinelli Frank , Zolopa Andrew 
Published: December 2022

Abstract

Background
Despite decades of work evaluating multiple interventions to improve ART adherence, viral load suppression in the U.S. remains far below Ending the HIV Epidemic goals. Previous research demonstrates that income and other factors, including social well-being (SWB), resilience, and exercise, are correlated with ART adherence. However, it is unclear how these factors interact with income to impact adherence in older adults living with HIV (OALWH).

Methods
Self-reported outcome measures from the Aging with Dignity, Health, Optimism, and Community (ADHOC) cohort were collected from November 2017 to June 2019. Adherence was measured using the Brief Adherence Self-Report Questionnaire, depression using the Patient Health Questionnaire-2, SWB using the Functional Assessment of HIV Infection, and resilience using the Connor-Davidson Resilience Scale. Face-valid questions provided data on household income, race, sexual orientation, # of ART pills daily, and exercise. Linear regressions assessed the associations between these variables and adherence. Mediation analysis using bootstrapping assessed the significance of the mediation effects of income on these variables.

Results
For 1,039 ADHOC participants, average age was 59 years, 86% were male, 69% were White, and mean adherence was 96.2% (SD=11.2). In bivariate analyses, depression, SWB, exercise, resilience, White race, # ART pills daily, and sexual orientation were each significantly correlated with both ART adherence and income. Interestingly, depression, SWB, resilience, and exercise became non-significant predictors of adherence after adjusting for the effects of income. Mediation analysis with bootstrapping demonstrated significant causal mediation effects of income on depression and adherence (B=-0.14, 95% CI (-0.25 – -0.04)), SWB and adherence (B=0.03, 95% CI (0.01 – 0.05)), resilience and adherence (B=0.15, 95% CI (0.04 – 0.27)), and exercise and adherence (B=0.002, 95% CI (0.0007-0.003)).

Conclusion
In OALWH, household income mediates the relationship between ART adherence and depression, SWB, resilience, and exercise. Therefore, interventions to improve adherence must address the causal role of income and focus on providing low-income patients with economic support to help lift them out of poverty.

Disclosures
Peter J. Mazonson, MD, MBA, ViiV Healthcare: Grant/Research Support Maile Y. Karris, MD, Gilead Sciences: Grant/Research Support|Gilead Sciences: I have received honorarium to speak at conferences|ViiV Healthcare: Grant/Research Support Emily Huang, MPH, ViiV Healthcare: Grant/Research Support Jeff Berko, MPH, ViiV Healthcare: Grant/Research Support Frank Spinelli, MD, Gilead Sciences: Employee|ViiV Healthcare: former employee Andrew Zolopa, MD, ViiV Healthcare: full time employee|ViiV Healthcare: Stocks/Bonds.
1419. Matters of the Heart: A Scoping Review Toward Better Management‌ ‌of‌ Nontuberculous‌ ‌Mycobacterial‌ ‌Infections of‌ Cardiac ‌Devices‌
Authors: Mahatanan Rattanaporn , Ovalle Anais , Lee Devin , Alkozah Maria , Talbot Elizabeth 
Published: December 2022

Abstract

Background
Medical device infections caused by nontuberculous mycobacteria (NTM) are increasingly reported in the literature. Management is complex and often guided by expert opinion, in the absence of evidence-based guidelines.

Methods
We searched available databases for reports of‌ implantable‌ cardiac device-related‌ (ICDR) infections with NTM. We collected patient-level characteristics, microbiological, and treatment data, and used univariate analysis to correlate with reported outcome, which we defined as death, treatment failure, relapse after treatment completion, cure, and treatment completion.

Results
Of 2573 potential eligible articles, 68 articles were included, representing 112 patients. The average patient age was 61 years, and 6% of patients were immunocompromised. Of 12 species reported, 65% were rapid growers, with M. fortuitum most common. Prosthetic heart valves and pacemaker/automatic implantable cardiac devices (AICD) were the most commonly reported infected devices (45% and 37%, respectively). Diagnosis was often delayed, and confirmed with culture (62%, 41% blood cultures) and 16s ribosomal RNA gene sequencing data (14%) of cases. Antimicrobial susceptibility was available in 55% of cases. 70% of patients received &gt;2 antibiotics and, of these, 41% included a macrolide. Devices were removed for 65% of patients, more commonly if the infected deice was a pacemaker or AICD than another type of cardiac device (86% vs 56%, p=0.02). 67% of patients with prosthetic valves underwent valve replacement. Compared with those who did not have their device removed, patients who underwent device removal were less likely to die (23% vs 48%, p=0.02) and more likely to have favorable outcomes (68% vs 28%, p=0.002).

Conclusion
Reports of ICRD NTM infections were common, and suspicion should be high even for those without immunocompromising condition. Determining outcome was challenging and should be standardized to provide an evidence base for better management. In our analysis, patients who underwent device removal had improved survival, suggesting either that comorbidity precluded device removal and/or that removal may be an essential part of the management.

Disclosures
All Authors: No reported disclosures.
1420. 99mTc-Ethambutol scintigraphy with SPECT/CT in skeletal tuberculosis: A Prospective Study
Authors: Sikdar Sunit , Damle Nishikant , Ranjan Piyush , Tripathi Varsha , Tyagi Apoorva , Arora Geetanjali , Bal Chandrasekhar , Nischal Neeraj , Bala Kiran 
Published: December 2022

Abstract

Background
Tuberculosis (TB) is the most common infectious disease in poor and underdeveloped countries, with extra-pulmonary TB (EPTB) infections accounting for 10-15 percent of all cases in developing and underdeveloped countries. Apart from 18F-FDG PET/CT, which cannot discriminate between metastatic and infective lesions, Nuclear Medicine methods do not play a significant role in clinical practice. We have attempted to address this constraint by our study involving radiolabelled Ethambutol.

Methods
The study was conducted over a period of 20 months at the Department of Nuclear Medicine of our institution and included a prospective cohort of 16 adult patients diagnosed as skeletal TB (clinico-radiologically, histopathologically, or microbiologically) who were treatment naive or within 14 days of treatment initiation. 10-15 mCi of Tracer was administered to the patients. Dynamic phase imaging was performed for 10 minutes, followed by minimum 3 planar anterior and posterior views whole-body scans with over 4 hours. SPECT/CT was performed between 60-120mins after injection. Patients were followed up by a clinical assessment/telephonic review with a follow up period of 2 months to 21 months (mean follow up period of 10.2 months).

Results
SPECT-CT and 99mTc-Ethambutol scintigraphy were performed on 16 patients at the time of diagnosis or treatment initiation. The average age of individuals with positive scans was 33.75, whereas those with negative scans was 36.25 +/- 19.80. The most common symptom was bone pain (93.75%), followed by fever (81.25%) and weight loss (13 of 16 cases) (81.25 percent ). 3/12 (25%) of the 12 positive patients had multiple site involvement, whereas 8/12 (75%) had single site involvement. We found considerable tracer uptake in 75% of the patients in the trial. When ATT was given to 11/12 (92%) of the people who had a positive scan, the clinical result was decreased discomfort and greater mobility in the affected joints.

Conclusion
99mTc-ethambutol scintigraphy with SPECT/CT was accurately able to show bony lesions in 75% of the patients. Also 92% of those with positive scan eventually responded to Anti-Tubercular Treatment thus showing that this rarely used technique may have a role in prognosticating skeletal tuberculosis.

Disclosures
All Authors: No reported disclosures.
1429. Epidemiology, Clinical Characteristics, and Outcomes of Extra-Pulmonary Non-Tuberculous Mycobacterial Infections from a Single Center over a 10-Year Period
Authors: Ford Mary B , Okulicz Jason , Salinas Jesse , Kiley John L 
Published: December 2022

Abstract

Background
Non-tuberculous mycobacteria (NTM) cause a wide variety of clinical syndromes, including extra-pulmonary infections. Skin and soft tissue infections (SSTI) and bone infections caused by NTM are often associated with traumatic inoculation and data to guide diagnosis and treatment is limited. We sought to better understand skin and soft tissue infections (SSTI) and bone infections caused by NTM.

Methods
All NTM clinical isolates recovered at Brooke Army Medical Center from 2012-2022 were initially screened and SSTI and bone isolates were included. Corresponding electronic health records were reviewed for epidemiologic, microbiologic, and clinical data. Infections were defined as recovery of ≥ 1 NTM isolate from skin, soft tissue, or bone cultures with a corresponding clinical syndrome.

Results
Forty isolates from 27 corresponding patients were analyzed with a median of 1 isolate [IQR 1-1] per patient. Two-thirds (18, N = 27) were female with a median age of 51 years (IQR 33-66, Table 1). A total of 21 (78%) patients had infecting isolates, most commonly secondary to surgery (28.6%) or trauma (33%). Six of 21 (29%) had bone infections, 5 (83%, N = 6) were secondary to trauma, and 2 (33%, N=6) had both bone and SSTI isolates recovered. The majority were rapid growers (81%), most frequently M. abscessus. In infected patients, 8 (38%) had combined medical/surgical therapy, 8 (38%) had surgery alone, 4 (19%) had medical therapy alone, and 1 (5%) patient received no treatment. No infectious disease consultation was sought for 7 (87.5%) patients who received only surgery nor for the patient who received no treatment. Time from symptom onset to isolate recovery was a median of 64 days (IQR 48-108), with a median of 33 days (IQR 6-60) from isolate recovery to directed medical therapy. At the end of the study period 2 of 21 patients had died.

Conclusion
Data supporting diagnosis and treatment decisions in SSTI and bone NTM infections is sparse. In this study the majority of NTM isolated were determined to be the cause of true infections. We confirm that surgery and trauma are the most common mechanisms of exposure. The delay between symptom onset and directed therapy demonstrates a need for additional studies delineating specific criteria for diagnosis and treatment.

Disclosures
All Authors: No reported disclosures.
1437. Investigation of Increased Latent Tuberculosis Infection Rates During the COVID-19 Pandemic Among International Students at a U.S. University Campus
Authors: Askar Wajih , Nandyal Lauri E , Hardig RaeJean , Coberley Tina , Doner Amanda , Haglund Lisa , Forrester Jennifer W , Wang Shu-Hua , Holliday Michael B , Huaman Moises A 
Published: December 2022

Abstract

Background
The COVID-19 pandemic has caused dramatic changes in the epidemiology of many diseases globally due to various changes in exposure to different pathogens, social restrictions, and demographic shifts. A university student health center located in the U.S. Midwest detected an increase in latent tuberculosis infection (LTBI) rate among its incoming international students (INTS) from 5.7% to 8.1% in the fall semesters of 2019 and 2021, respectively. We describe our approach to investigating the increase in LTBI rate at a university campus in a low-endemicity area.

Methods
Factors that may affect LTBI rates were evaluated. LTBI testing policy and methods were reviewed. Medical and lab staff were interviewed regarding the consistency of specimen collection, transport, and processing. LTBI risks in the general population such as older age, male gender, and country of origin (COO) were also considered. Factors that were expected to be uncommon in the INTS (homelessness, incarceration, and illicit drug abuse) were not evaluated.

Results
No changes in the INTS screening policy were noted. All incoming INTS were screened for LTBI during initial health screening, regardless of COO. The same manufacturer's QuantiFERON®-TB Plus test was utilized. Compared to previous years, no inconsistencies in the testing logistics were reported. A total of 1,016 INTS were screened in 2019 and 1,179 in 2021. There were no significant differences in average age in years (23.1 vs. 23.3) or male gender (59.6% vs. 56.8%) between 2019 and 2021, respectively. Most INTS came from two countries (A and B). Country A was COO of 21.6% of INTS in 2019, which dropped to 8.4% in 2021. Country B was COO of 44.8% of INTS in 2019, which increased to 57.6% in 2021 (p&lt; 0.001; Figure 1). Although LTBI rates within each country (A and B) remained similar before and during the COVID-19 pandemic (Figure 2), country B had consistently higher rates than country A (p&lt; 0.001), which contributed to the overall increased rate of LTBI in 2021. Figure 1.Numbers and percentages of international students from countries A and B.Figure 2.LTBI positivity rates for countries A and B before and during COVID-19 pandemic.

Conclusion
Evaluating changes in COO of INTS is essential in investigating trends in LTBI rates at otherwise low-endemicity universities. In our investigation, demographic changes in university admissions over two years relative to COVID-19 pandemic restrictions contributed to an increase in the overall LTBI rate.

Disclosures
Moises A. Huaman, MD, MSc, Gilead: Grant/Research Support|Insmed: Grant/Research Support.
1438. Latent tuberculosis infection (LTBI) in hematopoietic stem cell transplantation (HSCT) recipients: a retrospective Italian cohort study in Tor Vergata University Hospital, Rome.
Authors: Compagno Mirko , Navarra Assunta , Campogiani Laura , Coppola Luigi , Benedetta Rossi , Marco Iannetta , Goletti Delia , Sarmati Loredana 
Published: December 2022

Abstract

Background
Patients undergoing haematopoietic stem cell transplantation (HSCT) have severe and prolonged immunodeficiency and the incidence of tuberculosis (TB) disease in those patients is 10 to 40 times higher than the general population

Methods
This retrospective study performed at Tor Vergata University Hospital in Rome (Italy) included all adult patients who underwent a HSCT in the Hematologic Transplant Unit from January 2015 to December 2019. Data on TB screening, performed through interferon-γ release assay (IGRA), were collected; patients were observed for TB reactivation in a follow up period of at least 3 years

Results
323 HSCT recipients were enrolled in this study. Patients’ characteristics are summarized in table 1. 63 patients (19.5%) were not screened for TB, of which 6.3% were born overseas. 260 HSCT recipients (80.5%) were screened: 228 patients (87.7%) had a negative IGRA result, 21 (8.1%) tested positive, and 11 (4.2%) had an indeterminate result. 98.5% were screened before the HSCT. Of the 21 patients with a positive pre-HSCT IGRA test, 14 (66.7%) were males and significantly (p&lt; 0.001) older (median age 60 [IQR] 58-65 years) than those with negative or indeterminate results. Almost all patients (95.2%) were Italian. Patients with a positive IGRA showed a higher monocyte count compared to the other groups (p=0.044), while those with indeterminate IGRA showed a tendence to lower lymphocyte absolute counts, compared to the other groups (p=0.060) (Table 2).
All the 21 patients with a pre-HSCT positive IGRA test were radiologically and clinically screened for active TB and, once it was ruled out, treated for latent TB (LTBI) with isoniazid (INH) for 6 months. No events of toxicity or treatment interruption were reported. None of the patients was treated with rifampin. None of the 21 patients with pre-HSCT positive IGRA test developed active TB during the follow up period. Table 1.Characteristics of the study population, overall and divided according to IGRA testingTable 2.Characteristics of the IGRA tested patients, overall and divided by IGRA test results

Conclusion
To our knowledge, this is the first Italian study on the prevalence of LTBI in patients undergoing HSCT. 8.1% of the 260 patients screened with an IGRA tested positive. The great majority (95.2%) of LTBI patients were Italian and significantly older than IGRA-negative patients. All LTBI HSCT patients received INH treatment and no drug toxicity, nor TB reactivation was observed during the follow-up period

Disclosures
All Authors: No reported disclosures.