bluuebunny/crossref_metadata_2025_split huggingface dataset:
1418. The Relationship Between Modifiable Health Behaviors and Health Literacy in People with HIV is Complicated by Multiple Factors
Authors: Richey Lauren , Schroeder Jonathan , Apolzan John , Mistretta Kyle , Holloway Kaila , Lin Hui-Yi , Arnold Connie , Welsh David 
Published: December 2022

Abstract

Background
People with HIV (PWH) who achieve viral suppression have a normal lifespan, however, they now contend with more cardio-metabolic disease and exaggerated rates of malignancies. The etiology of these disparate rates of comorbidities are multifactorial but likely include modifiable behaviors such as smoking, poor diet, and substance use. We created a multidisciplinary team to study health behaviors in PWH. The team included researchers and HIV clinics in three Louisiana cities; New Orleans, Baton Rouge, and Shreveport, forming the Louisiana Translational Collaborative on Health Behaviors [LATCH] network. We hypothesized that patients with low health literacy would have higher BMIs and higher usage of tobacco and illicit drugs.

Methods
PWH aged ≥ 18 were recruited from three HIV clinics during regular appointments. Participants completed surveys using standardized tools that assessed diet, physical activity, health literacy, tobacco and substance use. Weight and height were also recorded.

Results
100 PWH were enrolled. Most were African American (80%), men (57%), and the mean age was 50.72 (range 21-70). Mean BMI was 30.2 (range 18-51). Limited health literacy was found in 50% (REALM-SF &lt; 7). Past month drug use was reported in 24%. Lifetime tobacco use was reported in 59%, with 31% reporting current use. For BMI, the average BMI for those with low health literacy (REALM-SF &lt; 7) was 29.26 compared to 30.62 for those with adequate health literacy (REALM-SF 7) (p&lt; .001). Among patients with limited literacy (REALM-SF &lt; 7) 27.1% reported current tobacco use, compared with 36.7% of those with adequate literacy (REALM-SF 7) (p=0.68). Among patients with limited literacy (REALM-SF &lt; 7) 25% reported past month drug use, compared with 24.5% of those with adequate literacy (REALM-SF 7) (p=0.59).

Conclusion
We hypothesized that PWH with lower health literacy would have higher BMIs, which was the opposite of what we found. We also found higher rates of smoking among those with higher health literacy although it was not significant. No differences were seen in past month drug use. Health literacy and education to improve health literacy may not directly impact modifiable health behaviors which are likely influenced by many different factors.

Disclosures
All Authors: No reported disclosures.
1690. Assessing the safety of TP-102 bacteriophage treatment in the management of diabetic foot infections
Authors: Nir-Paz Ran , Onallah Hadil , Gellman Yechiel N , Haze Amir , Braunstein Ron , Hazan Ronen , Leandro Clara , Barbosa Raquel , Dordio Helena , Wagner Alexandra , Corte Real Sofia V , Garcia Miguel 
Published: December 2022

Abstract

Background
Diabetic Foot Ulcers (DFU) are a major complication in patients with diabetes and affect globally 170 million patients. Approximately 28% of patients with infected DFU require amputation. Diabetic foot infections (DFI) caused by persistent or multidrug resistant organisms are a threat to the outcome of therapy. Infections are mostly polymicrobial, and major pathogens include Staphylococcus aureus and Pseudomonas aeruginosa. A promising new approach using phages may potentially be a novel modality to increase treatment success. TP-102 is an innovative bacteriophage cocktail for treatment of DFI, a diabetes related unmet need.

Methods
TP-102 comprised of 5 different phages, targeting S. aureus, P. aeruginosa and Acinetobacter baumannii. This study is a Phase I/II clinical trial performed in Israel looking at safety and tolerability. TP-102 bacteriophage cocktail was applied topically at a titer of 109 PFU/mL/cm3 of target ulcer. Two cohorts receive multiple doses of TP-102. In non-infected DFU (cohort 1) for 1 week and for 28 days in DFU with infection grade 2 or 3 (PEDIS classification, cohort 2). Treatment groups were TP-102 with standard of care versus placebo and standard of care. Outcomes include microbiologic data on the 3 target bacteria, ulcer healing characteristics, incidence and severity of TP-102-emergent solicited local and systemic adverse events, and their relationship to the treatment, from the first application of TP-102 until the end of study.

Results
For the evaluation of safety in patients with non-infected ulcers, eight patients were enrolled to the first cohort. Six were treated with TP-102 and 2 with placebo. TP-102-treated patients had no severe adverse events associated with the treatment. In the second cohort a total of 18 patients are currently being treated with TP-102 or placebo for 28 days, three times a week. Recruitment is ongoing and results of the trial will be presented.

Conclusion
TP-102 appeared to be safe when applied to patients with uninfected diabetic foot ulcers. The treatment is a potential new non-traditional antimicrobial for topical application. The efficacy of TP-102 in the treatment of infected diabetic ulcers is being assessed in an ongoing randomized clinical trial.

Disclosures
Ran Nir-Paz, MD, BiomX: Advisor/Consultant|Technophage: Advisor/Consultant Clara Leandro, PhD, Technophage: Employee Raquel Barbosa, PhD, Technophage: Employee Helena Dordio, PhD, Technophage S.A.: Employee Miguel Garcia, n/a, IBV Innovation Bioventures Lda: Board Member|IBV Innovation Bioventures Lda: Ownership Interest|LX Bio Pharmaceuticals SA: Board Member|LX Bio Pharmaceuticals SA: Ownership Interest|TechnoPhage, SA: Board Member|TechnoPhage, SA: Author of several patent applications|TechnoPhage, SA: Ownership Interest.
1720. In Vitro Activity of Aztreonam-Avibactam and Comparator Agents Against Enterobacterales from Patients with Urinary Tract Infections Collected During the ATLAS Global Surveillance Program, 2017-2020
Authors: Estabrook Mark , Arhin Francis , Sahm Daniel F 
Published: December 2022

Abstract

Background
β-lactamase-producing Enterobacterales (Eba) frequently carry resistance mechanisms for multiple drug classes, limiting treatment options. Avibactam (AVI) inhibits class A, class C, and some class D serine β-lactamases, while aztreonam (ATM) is refractory to hydrolysis by class B metallo-β-lactamases (MBLs). ATM-AVI is being developed for use against drug-resistant isolates of Eba, especially those co-producing MBLs and serine β-lactamases. This study evaluated the in vitro activity of ATM-AVI and comparators against Eba collected in 2017-2020 from patients with urinary tract infections (UTI) as part of the ATLAS global surveillance program.

Methods
Non-duplicate clinical isolates were collected from 239 sites in 55 countries in Europe, Latin America, Asia/Pacific (excluding mainland China and India), and Middle East/Africa. Susceptibility testing was performed by CLSI broth microdilution and interpreted using CLSI 2022 and FDA (tigecycline) breakpoints. PCR and sequencing were used to determine the β-lactamase genes present in all isolates with meropenem MIC &gt;1 µg/mL, and Escherichia coli, Klebsiella spp. and Proteus mirabilis with ATM or ceftazidime MIC &gt;1 µg/mL.

Results
Based on MIC90 values, ATM-AVI was at least as active as every comparator agent tested against all 15085 Eba isolates collected from UTI (0.12 µg/ml; table), with only five isolates testing with MIC values &gt;8 µg/ml (not shown). Against resistant subsets of isolates, MIC90 values for ATM-AVI were 0.25-0.5 µg/ml, 4- to 8-fold lower than any comparator tested. Against MBL-positive isolates, ATM-AVI MIC values ranged from ≤0.015-2 µg/ml with the exception of one Escherichia coli isolate testing with an MIC value of 16 µg/ml that carried NDM-5, CMY-145, CTX-M-55 and TEM (not shown).

Conclusion
Based on MIC90 values, ATM-AVI was the most potent agent tested against drug-resistant and MBL-positive subsets of Eba collected from UTI. Based on the potent in vitro activity of ATM-AVI, continued development of this combination for treatment of UTI caused by drug-resistant Eba is warranted.

Disclosures
All Authors: No reported disclosures.
1733. Stability of Imipenem/Cilastatin/Relebactam under Different Temperature and Administration Conditions
Authors: Ghazi Islam , Alramany Diaa , Harb Gehan , Nicolau David 
Published: December 2022

Abstract

Background
Imipenem/Cilastatin/Relebactam is an FDA-approved combination antibiotic indicated for resistant infections. There is a practical need to extend the shelf life of parenterals given to patients with such life-threatening infections in the hospital setting. The reconstituted drug's shelf life can be extended by storing at subzero temperatures to slow the degradation kinetics. Package insert indicate stability is 2 hrs at room temperature and refrigeration up to 24 hr. The study aims to determine the stability of the combination in polyvinyl chloride (PVC) infusion (IV) bags when stored at room temperature, refrigerated in addition to continuous infusion CADD pumps.

Methods
Drug vials (Merck & Co) were reconstituted to 5mg/mL (imipenem) in a 100mL normal saline. To avoid further degradation, samples were collected and mixed 1:1 with stabilizing buffer, then frozen at -80 °C within 5 minutes. For room temperature stability, 6 bags were prepared and stored at (24°C). 0.5ml samples were collected at 0, 2, 4, 6, 8, 12, 24 h from each bag at each time point. For refrigeration stability, 6 bags were prepared and refrigerated at 4 °C. At each time point (24, 36, 48, 60, 72, 84, 96,108, 120h), a sample of 0.5-mL is taken from each bag and frozen at −80 °C. For continuous ambulatory drug delivery (CADD) infusion devices stability, the reconstituted drug is loaded to 2g/200 mL cassettes (for 24-hr infusion) continuous infusion and 1g/100mL (for 12-hr infusion). The cassettes are immediately attached to the infusion pump and placed in a cold pouch with gel packs. After the initial 0.5 mL, 0-h samples from each pump, the pumps are sampled at 4, 8,12, 16, 20, and 24 hours for 2g/ 200mL cassettes and 2, 4, 8, 12 h for 1g/100 mL. Cut off for stability was set at 90% of the original concentration. Chemical assay was performed by a validated HPLC method.

Results
See tables Table 1:CADD pumps, concentrations are in mg/mL. Imi; imipenem, Rel; relebactam, Cil; Cilastatin, CADD; continuous ambulatory delivery device, SD; standard deviationTable 2:PCV bags, concentrations are in mg/mL. Imi; imipenem, Rel; relebactam, Cil; Cilastatin, PVC; polyvinyl chloride, SD; standard deviation

Conclusion
Imipenem/relebactam/cilastatin drug product was stable for 12 hrs in CADD pumps 100mL, 16 hrs in 200 mL, 108 hours in refrigerated PVC bags and 12 hrs at room temperature. The extended stability data will assistant pharmacy departments in optimizing drug preparation and storage, nursing time and minimize drug waste improving overall cost and efficiency of drug administration.

Disclosures
Islam Ghazi, PharmD, Merck And Co Inc: Grant/Research Support David Nicolau, PharmD, Marck and Co Inc: Advisor/Consultant|Marck and Co Inc: Grant/Research Support.
1756. Prescriber Adherence to System-Wide Urinary Tract Infection Guidelines in Ambulatory Care Clinics
Authors: Revolinski Sara , Michels Samuel , Olexia Deanna , Fermanich Katherine , Fermanich Katherine 
Published: December 2022

Abstract

Background
Antimicrobial stewardship (AMS) practices are well established in acute care, only recently expanding into ambulatory care settings. It has been estimated that 80-90% of antibiotic use occurs in the ambulatory setting with up to 52% of that use being unnecessary. Urinary tract infections (UTIs) are commonly treated in ambulatory settings, and drug selection and duration of therapy vary among different practices. Our study evaluated the impact of a system-wide guideline and prescriber education, two recommended AMS strategies, on antibiotic utilization for UTIs in the ambulatory setting.

Methods
This retrospective study evaluated female adult patients prescribed an antibiotic for acute uncomplicated cystitis by a primary care provider at a clinic within our organization between January and March 2021. System-wide UTI treatment guidelines were implemented in November 2020, with live education delivered to primary care prescribers in December 2020. The primary objective of this study was to assess prescriber adherence to system-wide guidelines. The secondary objective was to evaluate utilization of antibiotic regimens for treatment of acute uncomplicated cystitis.

Results
A total of 100 patients were evaluated. Guideline adherence was met in 49% of patients. The primary reason for guideline non-adherence was duration of therapy, which was inappropriate (too long) in 42% of patients. Nitrofurantoin, the first-line antibiotic recommendation on the system-wide guideline, was the antibiotic prescribed most frequently (48%), but was the antibiotic of choice in 90% of patients. Sulfamethoxazole/trimethoprim was prescribed in 35% of patients and was most often prescribed correctly with respect to appropriate dose and duration of therapy (60%), followed by nitrofurantoin (54%). Recurrent cystitis within 30 days occurred in 11% of patients.

Conclusion
Implementation of a system-wide guideline and prescriber education for treatment of UTIs in the ambulatory setting identified areas for future optimization of antibiotic use, namely first line antibiotic selection and duration of therapy. This data will be shared with our prescribers to continue to encourage guideline-adherent antibiotic use.

Disclosures
All Authors: No reported disclosures.
1770. Effects of Acculturation and Social Norms on Intention to use Antibiotics without a Prescription among Hispanic or Latino individuals
Authors: Alquicira Osvaldo , Trautner Barbara , Raphael Jean , Salinas Juanita , Barning Kenneth , Mahmood Hammad , Porter Thomas , Street Richard , Lopez-Alonso Moramay , Paasche-Orlow Michael K , Grigoryan Larissa 
Published: December 2022

Abstract

Background
The use of antibiotics obtained without a prescription (non-prescription use) in the United States (U.S.) may contribute to antimicrobial resistance. We hypothesized that among Hispanic/Latino patients, the intention to use non-prescription antibiotics would be associated with: [1] lower acculturation (preference to socialize with Hispanic/Latinos) and [2] having friends or relatives who use antibiotics without contacting a doctor (social norms).

Methods
We conducted a survey on the factors that impact Hispanic/Latino patients’ decisions to use non-prescription antibiotics in safety-net primary care clinics and private emergency departments in the greater Houston, Texas area between January 2020 and June 2021. Surveys were read to patients in English or Spanish and queried patient, health system, and clinical encounter factors.

Results
Of 263 Hispanic/Latino patients, 59% completed the survey in Spanish and 41% in English (Table 1). Overall, 47% reported previous non-prescription antibiotic use, and 36% professed intention to hypothetically obtain and use non-prescription antibiotics, if feeling sick, from one or more of three sources (bought without a prescription in the U. S., from another country, and from friends or relatives).
Lack of health insurance, being surveyed in Spanish, having friends or relatives who use antibiotics without consulting a doctor, and high cost of doctor visits were predictors of intent to use antibiotics bought without a prescription in the U.S. (Table 2). Predictors of intent to use non-prescription antibiotics from other countries included lower acculturation scores (preferring to socialize with Hispanics/Latinos), younger age, having friends or relatives who use antibiotics without consulting a doctor, and reported language barriers to medical appointments. Predictors of intent to use antibiotics from friends and relatives included having friends or relatives who use antibiotics without consulting a doctor, and high cost of doctor visits.

Conclusion
Interventions aimed at reducing non-prescription use in the Hispanic/Latino community should focus on ensuring affordable language concordant healthcare and promoting antibiotic stewardship as a social norm.

Disclosures
Barbara Trautner, MD, PhD, Genetech: Advisor/Consultant Michael K. Paasche-Orlow, MD, MPH, GlaxoSmithKline: Advisor/Consultant Larissa Grigoryan, MD, PhD, Rebiotix Inc: Grant/Research Support.
1777. Shorter Versus Longer Antibiotic Durations for Coagulase-Negative Staphylococcus Catheter-Related Bloodstream Infections and Potential Impact on Antimicrobial Stewardship in a County Hospital
Authors: Arab Niki , Gallardo Huizar Oscar E , Aquije Elizabeth , Cheng Marsha R , Kim Brian , Wong Joseph Isaac S , Jeng Arthur 
Published: December 2022

Abstract

Background
Coagulase negative Staphylococcus (CoNS) is a common cause of catheter-related bloodstream infection (CRBSI). Current guidelines are to provide 10-14 days (d) of antibiotics (abx) plus lock abx in the absence of catheter removal, and if the catheter has been removed, 5-7 d after removal. Olive View UCLA-Medical Center (Sylmar, CA) is an academic county hospital, serving the medical needs of the underserved community. The purpose of this study was to evaluate differences in treatment (tx) durations for CoNS CRBSI on clinical outcomes and evaluate the potential impact on antimicrobial stewardship.

Methods
Single center retrospective chart review from January 2018 to December 2021 on all central line-obtained blood cultures (Bcx) positive for CoNS. Exclusion criteria included suspected contamination or no abx tx, invasive CoNS infection, and concomitant infection treated with abx that have activity against CoNS. Duration of abx tx was divided into two groups: &gt;10 d vs ≤10 d with or without catheter removal and &gt;7 d vs ≤7 d post catheter removal. Primary outcomes assessed were recurrence of CoNS CRBSI within 90 d and 30 d hospital readmission. Secondary outcomes included hospital length of stay (LOS), 30 d all-cause mortality, and days of Bcx positivity. Groups were compared using Wilcoxon rank-sum for continuous variables and Fisher’s exact for categorical variables using Stata (Version 15).

Results
153 positive CoNS central line Bcx were screened, 40 met study inclusion. 37 received vancomycin as initial abx with a median total tx duration of 13.5 d [IQR 8-14] and 9 d [IQR 6-13.5] after line removal. 22 (55%) received total abx duration of &gt;10 d and 18 (45%) received total abx duration of ≤10 d. Baseline characteristics were similar between &gt;10 d and ≤10 d (table 1). There was no significant difference in primary and secondary outcomes, respectively, between &gt;10 d and ≤10 d (table 2). After catheter removal, there were no significant differences in outcomes whether antibiotics were continued for &gt;7 d (n=18) vs ≤7 d (n=15) (table 3). Table 1:Baseline CharacteristicsTable 2:Outcomes according to days of therapyTable 3:Outcomes post catheter removal days of therapy

Conclusion
Abx tx duration of ≤10 d compared with &gt;10 d for CoNS CRBSI did not result in differences in 90 d recurrence and 30 d readmission. Shorter courses of tx for CoNS CRBSI should be considered as a target for antimicrobial stewardship to minimize antibiotic exposure.

Disclosures
All Authors: No reported disclosures.
1779. An Assessment of Antibiotic Treatment Guideline Adherence for Common Infections in a Tertiary Care Hospital with an Established Antimicrobial Stewardship Program in Kathmandu, Nepal
Authors: Adhikari Prabhat , Director Medical , Bhumiratana Adisak , Acharya Subhash , Acharya Upasana , Pant Suman , Silwal Sashi , Dawadi Pratima , Koirala Janak , Gyanwali Pradip , Shrestha Suman 
Published: December 2022

Abstract

Background
Antibiotic treatment guidelines have been increasingly recognized as an effective tool to guide appropriate prescriptions and help curtail antibiotic resistance. We aimed to assess the quality of inpatient antibiotic prescribing practices for common infections in a tertiary centre in Kathmandu.

Methods
We conducted a retrospective monocentric review of medical records of adult inpatients diagnosed with Urinary Tract Infection; Pneumonia; and Skin and soft tissue infection between January 2018 till December 2019. Adherence was defined as the prescription of antibiotics for mentioned infection fulfilling the correct choice, correct dose, and correct duration of therapy.
Flow diagram 1
Medical Records Review to assess adherence to guideline

Results
Clinical records of 354 inpatients were included in the analysis. Overall, 37.9% of antibiotic prescriptions were adherent to guideline recommendations. The non-adherent groups also had a higher proportion of patients in the age group between 45 and 60 years (66%, OR: 1.87, 95% CI: 1.09-3.21, p=0.2) and with the presence of co-morbidities (58%, OR: 0.44, 95% CI: 0.26-0.75, p&lt; 0.1). The department categories, gender, number of comorbidities, infectious disease diagnosis, and history of antibiotic drug allergy had no significant effect reported on adherence. Incorrect selection (20%, or: 0.24, 95% CI: 0.07-0.79, p=0.19) and incorrect antibiotic dosage (21%, OR: 0.26, 95% CI: 0.08-0.82, p=0.02) were prescribed among patients diagnosed with urinary tract infection. Likewise, an incorrect dosage of antibiotics (40%, OR: 0.27, 95% CI: 0.07-0.97, p=0.05) was prescribed for patients with pneumonia. Pneumonia (52%) and urinary tract infection (32%, p&lt; 0.01) had more de-escalations, while the antibiotic spectrum prescribed was significantly broad (81%, p&lt; 0.001).
Study Schema

Conclusion
Our study revealed low adherence despite the availability of the updated guideline for an antibiotic prescription. These data demand an urgent need to confront the antibiotic prescription pattern in the tertiary care centres for tailored interventions to improve adherence to guidelines, particularly focusing on prescriptions of antibiotic types and in the elderly population. It is also an imperative to reduce the broad-spectrum antibiotic exposure to the patients with acute infections guided by the culture reports.

Disclosures
All Authors: No reported disclosures.