bluuebunny/crossref_metadata_2025_split huggingface dataset:
1659. Association of Rurality and Identifying as Black with Receipt of Specialty Care among Patients Hospitalized with Diabetic Foot Ulcers: a Medicare cohort study
Authors: Taylor Lindsay , Gangnon Ronald , Powell Ryan , Kramer Joseph , Kind Amy J , Bartels Christine , Brennan Meghan B 
Published: December 2022

Abstract

Background
Among those with diabetic foot ulcers, rural patients identifying as Black face at least 10% greater risk of major amputation or death compared to the US as a whole. As specialty care is associated with lower risk of major amputation, this difference could be driven by specialty care access. We hypothesize that rural patients and, particularly, rural patients identifying as Black, receive less inpatient specialty care compared to the overall cohort.

Methods
We built a cohort of all Medicare patients hospitalized with diabetic foot ulcers (2013–2014). Rurality was measured using Rural Urban Commuting Area codes. Race was categorized using the Research Triangle Institute algorithm. Specialty care was defined as receiving inpatient care from at least 1 of 6 relevant specialties to address diabetes, infection, biomechanics or vascular disease, per National Provider Taxonomy codes: endocrinology, infectious disease, orthopedic surgery, plastic surgery, podiatry, and vascular surgery. We reported observed differences in specialty care, overall and stratified by rurality, identifying as Black, and ulcer severity. Pearson X2 tests were performed on observed frequencies.

Results
Overall, 32.2% of the cohort received inpatient specialty care. This proportion decreased to 29.6% for rural patients (X2 = 36.2, p ≤ 0.001) and 26.2% for rural patients identifying as Black (X2 = 19.5, p ≤ 0.001). Among those with osteomyelitis, 54.3% of the cohort received specialty care, while only 49.5% of rural patients, 50.8% of patients identifying as Black, and 37.6% of rural patients identifying as Black received specialty care; the disparity for rural patients identifying as Black was greater than the sum of rural and racial disparities (4.8% for rural + 3.5% for Blacks = 8.3% versus a 16.7% observed difference for rural Blacks; Figure 1). Notably, only 2.7% of patients presenting with osteomyelitis were seen by an infectious disease specialist. This proportion decreased to 2.5% for rural patients.
Observed Proportions of Patients Receiving Specialty Care Stratified by Rurality, Identifying as Black, and Ulcer Severity

Conclusion
A smaller proportion of rural patients received specialty care, and rural patients identifying as Black were half as likely to receive specialty care than the overall cohort. Improving specialty access for these high-risk patients may reduce disparities in major amputations.

Disclosures
All Authors: No reported disclosures.
1433. Factors Associated with Unsuccessful Treatment Outcomes among Patients with Rifampicin Resistant Tuberculosis - Tajikistan, 2015-2020
Authors: Tilloeva Zulfiya Haybullo , Sijotkhonov Amidkhan S , Zikriyarova Sanam , Pirmahmadzoda Bobochon , Alaverdyan Sevak , Nabirova Dilyara , Horth Roberta , Dzhafarov Navruz 
Published: December 2022

Abstract

Background
Tajikistan has a high burden of multidrug resistant TB, including rifampicin-resistant TB (RR-TB). Treatment options are more limited and include standard treatment (T1), bedaquiline/delamanid contained individual treatment (T2), short treatment (T3), modified short treatment (T4), and bedaquiline/pretomanid/linezolid treatment (T5). To inform national treatment plans, we assessed trends in RR-TB and determined factors associated with unsuccessful treatment.

Methods
We conducted a retrospective cohort study in Dushanbe, Tajikistan, from 2015 to 2020 using patient records. Patients had successful treatment outcomes if they completed treatment or were cured, and unsuccessful if they had treatment failure, were lost-to-follow-up, or died. We report relative risk (RR) and 95% confidence interval from multivariable Poisson regression.

Results
From 2015 to 2020, there was a decrease in incidence of TB (68.6 to 47.2 per 100,000) and RR-TB (10.6 to 7.2) with a 33% drop 2019 to 2020. Proportion of unsuccessful outcomes also decreased (30% to 15% 2015-2020). Of 522 patients, 515 had RR-TB. Of these, 39% received T1, 43% T2, 15% T3, 2% T4, and 0.4% T5 (Table 1). Overall, 23% had unsuccessful treatment outcomes. Patients on T1 had higher unsuccessful outcome compared to those on T2 - T5 (31% vs 19%, 14%, 0% and 0%, respectively). Unsuccessful outcomes were associated with combined isoniazid, rifampin and streptomycin resistance, alcohol and drug use. For patients receiving T1, unsuccessful outcome was associated with unemployment (RR: 2.7; 1.1-6.8), HIV (RR: 2.3, 1.5-3.4), hepatitis C (RR: 2.2, 1.4-3.4), and concomitant disease (RR: 2.1, 1.4-3.1). For patients receiving T2, risk of unsuccessful outcome was lower for females (RR: 0.4, 0.2-0.7) (Table 2).

Conclusion
Decrease in incidence is promising. Results highlight the need to transition RR-TB patients to non-standard treatment. Closer follow-up of patients with combined resistance, alcohol or drug use, HIV, hepatitis C, and concomitant diseases may contribute to successful outcome.

Disclosures
All Authors: No reported disclosures.
1446. Quality of life and associating factors in pulmonary tuberculosis patients
Authors: Samuel Richard 
Published: December 2022

Abstract

Background
Quality of life is a significant issue among patients with tuberculosis and is used for evaluating treatment responses and therapeutic outcome. This study aimed to assess the quality of life in tuberculosis patients receiving anti-tuberculosis therapy for a short duration in the Vellore district of Tamil Nadu and its associated variables.

Methods
A cross-sectional study was designed to evaluate pulmonary tuberculosis patients receiving treatment under category -1 registered in the NIKSHAY portal at Vellore. A total of 165 pulmonary tuberculosis patients were recruited from March 2021 to the third week of June 2021. On obtaining informed consent, the data were collected through the telephone interview by administering WHOQOL- BREF structured questionnaire. The data were examined with descriptive and analytical statistics. Multiple regression analysis for independent quality of life variables was done.

Results
The lowest median scores, 31(25,38) & 38(25,44) was, related to psychological and environmental domains, respectively. In addition, the Man-Whitney & Kruskal Wallis showed a statistically significant variation in the mean quality of life for gender, employment status, duration of treatment, persistent symptoms, the location of residence of patients, and the stage of therapy. Age, gender, marital status, and persistent symptoms were the main associating factor.
Associating factors
Multiple linear regression (multi-variate analysis) showing factors associated with Physical, Psychological, Social & Environmental domain scores among pulmonary tuberculosis patients receiving under category -1 receiving treatment in Vellore district of Tamilnadu, South India

Conclusion
Tuberculosis and its treatment influence psychological, physical functioning, and the environmental domain of patient quality of life. Attention is required in the follow-up and treatment of patients by monitoring their quality of life.

Disclosures
All Authors: No reported disclosures.
1451. Tuberculosis among Adults Aged 65 Years and Older—Alameda County, California, 2016–2019
Authors: Wu Iris L , Chen Jennie , Shiau Rita , Chitnis Amit S , Jaganath Devan 
Published: December 2022

Abstract

Background
Adults aged 65 years and older represent an increasing proportion of United States (U.S.) tuberculosis (TB) cases, and their clinical complexity creates unique issues for TB management. In Alameda County, California, we examined clinical characteristics and treatment outcomes among older adults with TB disease.

Methods
We evaluated demographic and clinical surveillance data from all adult TB cases in Alameda County during 2016–2019. We further reviewed public health department charts for TB cases among individuals aged 65 years and older to obtain more detailed information on co-morbidities, adverse effects, and treatment outcomes. Demographics, clinical characteristics, and outcomes were compared in younger adults (15-64) to older adults (≥ 65), who were further stratified by those aged 75 years and older. All comparisons were conducted using Fisher’s exact or Mann-Whitney U tests.

Results
Of 517 adult TB cases, 172 (33%) were older adults, and more likely to be male (68.6%), Asian (89.0%), non-U.S. born (98.3%), and have diabetes (32.6%) compared to younger adults (Table). At time of TB diagnosis, older adults were more likely than younger adults to have a negative interferon-gamma release assay result (24.6% vs. 16.0%, P=0.01), particularly among aged 75 years and older where 32.9% had a negative result. The majority of older adults with pulmonary TB had sputum smear-negative disease (58.9%) and 19.9% were culture- and polymerase chain reaction assay-negative. On anti-TB treatment, 32.5% of older adults experienced at least one adverse event, most commonly elevated liver enzymes (56.6%) and rash (32.1%). Older adults were more likely to be dead at diagnosis (3.5% vs. 0.0%, P=0.001), and were less likely to complete TB treatment (77.7% vs. 88.4% in younger adults, P=0.002), which was lowest among aged 75 years and older (72.9% vs. 84.3% in those 65-74, P=0.04). Death during treatment was higher in older adults, in particular aged 75 and older compared to 65–74 years (22.9% vs. 7.1%, P=0.01).

Conclusion
Older adults with TB disease faced several challenges, including negative diagnostic testing and poor treatment outcomes. A greater understanding of the presentation, adverse events and outcomes can guide interventions to improve TB care in this population.

Disclosures
All Authors: No reported disclosures.
1457. Epidemiology of Human Herpesvirus-6 Meningoencephalitis in Los Angeles County, 2016-2020
Authors: Ranson Elizabeth L , Ngo Van , Kuguru Karen , Halai Umme-Aiman 
Published: December 2022

Abstract

Background
Human herpesvirus 6 (HHV-6) is ubiquitous and a known central nervous system (CNS) pathogen. However, HHV-6 in cerebrospinal fluid (CSF) without clinical findings of meningoencephalitis (ME) may not represent true infection, but rather, asymptomatic viral reactivation, chromosomal integration, or latent activation. With the introduction in 2015 of a rapid polymerase chain reaction (PCR) multiplex panel that simultaneously tests for 14 CNS pathogens, reports of HHV-6 PCR positive ME have increased. We sought to understand the epidemiology of HHV-6 ME by evaluating reported cases in Los Angeles County (LAC) between 2016-2020.

Methods
ME is a reportable condition in LAC. We reviewed clinical, laboratory, and radiologic data for all HHV-6 PCR positive cases reported in LAC between 2016-2020. We developed case classification categories, “unlikely,” “possible,” and “likely”, based on symptoms, CSF profile, and alternative diagnoses (see Table 1).

Results
A total of 67 HHV-6 ME cases were reported (see Table 2). Reports increased over time, with one in 2016, 12 in 2017, 17 in 2018, 20 in 2019, and 17 in 2020. Median age was 9 months (range 0d-78y), and 47 (70%) were &lt; three years old. Forty-four (66%) were male. Six (9%) were immunocompromised, including one hematopoietic stem cell transplant recipient. Nineteen (28%) had abnormal CSF, and eight (12%) received therapy for HHV-6.
Five cases (7%) were classified as “likely” HHV-6 ME, 12 (18%) “possible,” and 50 (75%) “unlikely”. The “likely” cases ranged in age from 7 months to 12 years old, and none were immunocompromised. One received antiviral therapy and was discharged to a rehabilitation facility, the other four were discharged home with full recovery.

Conclusion
The significance of HHV-6 in CSF remains challenging to determine both clinically and epidemiologically. In the setting of increased testing, increasing detection of HHV-6 in CSF may not reflect increasing rates of HHV-6 ME. The majority of reported HHV-6 ME cases were “unlikely” based on our classification. Classifying cases with alternative diagnoses as ‘unlikely” may miss cases with multiple true infections, particularly in the immunocompromised. It is important to consider clinical presentation, CSF profile and other diagnoses to understand the true burden of HHV-6 ME.

Disclosures
All Authors: No reported disclosures.
1463. Association between Herpes Simplex Virus Type 1 and the Risk of Alzheimer’s Disease
Authors: Liu Luke , Jarousse Nadine , Johnston Christine , Fletcher Simon P , Iqbal Shahed 
Published: December 2022

Abstract

Background
There is significant unmet need of novel therapeutics for Alzheimer’s Disease (AD). A growing body of evidence suggests a role for herpesviruses in the development of AD and reduced risk of AD among patients receiving antivirals. We investigated the association between herpes simplex virus type 1 (HSV-1) diagnoses, antiviral use, and AD using real-world data.

Methods
In a matched case-control study, AD patients aged ≥ 50 years diagnosed between 2006 and 2021 were identified from IQVIA PharMetrics Plus® claims database using International Classification of Disease (ICD) codes (ICD 9 331.0; ICD 10 G30.x). Controls without any history of neurological disorders were matched in a 1:1 ratio with AD subjects on age, sex, region, database entry year, and healthcare visit numbers. HSV-1 diagnoses were identified using relevant ICD codes. Conditional logistic regression was used to evaluate the association between HSV-1 and AD. The association between antiviral use (e.g., acyclovir, famciclovir, valacyclovir) and AD was assessed by multivariate Cox proportional hazards model in patients with HSV-1 diagnosis.

Results
The study included 344,628 AD patient-control pairs. Most patients were female (65%) with a mean age of 73 (± 5) years. AD patients had more comorbidities (50% vs. 45% with ≥ 2 comorbidities) and shorter follow up time (median of 33 vs. 48 months) when compared to controls. History of HSV-1 diagnosis was present in 1507 (0.44%) AD patients vs. 823 (0.24%) controls. HSV-1 diagnosis was associated with AD (adjusted odds ratio [OR] 1.80; 95% confidence interval [CI] 1.65-1.96). In a stratified analysis, this association was more pronounced in the older age group (75+ years: OR 2.10, 95% CI 1.88-2.35; 71-74 years: OR 1.51, 95% CI 1.27-1.80; 50-70 years: OR 1.14, 95% CI 0.91-1.44). Patients with HSV-1 who used antivirals were less likely to have AD compared to those who did not use antivirals (adjusted hazard ratio 0.83, 95% CI 0.74-0.92). Similar results were observed when the analysis was extended to include all patients with AD-related dementia and matched controls.
The association between herpes simplex virus type 1 (HSV-1) and Alzheimer’s Disease (AD)/AD-related Dementia(ADRD)

Conclusion
Findings from this large real-world data study is consistent with emerging literature on HSV-1 and risk of AD and the possible protective role of antiviral drugs.

Disclosures
Luke Liu, PhD, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds Christine Johnston, MD, MPH, AbbVie: Advisor/Consultant|Gilead: Grant/Research Support|GSK: Advisor/Consultant Simon P. Fletcher, PhD, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds Shahed Iqbal, PhD, MBBS, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds.
1466. Antiretroviral (ART) Virologic Suppression (VS) and Patient Reported Outcomes (PROs) at 6 Months in the Clinical Opportunities and Management to Exploit Bictegravir/Emtricitabine/Tenofovir Alafenamide (B/F/TAF) an Asynchronous Connection Key (COMEBACK) Study
Authors: Roden Lindsey , Huhn Gregory , DeMarco Camille E , Keckler Kody , Valadez Patricia Cortes , Burke Kerianne 
Published: December 2022

Abstract

Background
Effectively interrupting the source of transmission is a critical step in ending the HIV epidemic. COMEBACK (NCT04519970) is a 48-week single-center study in Chicago implemented in September 2020, with its main objectives to reengage lost-to-care patients and rapidly reinitiate ART to promote VS and favorable PROs.

Methods
Adults off ART ≥2 weeks, without history of significant B/F/TAF resistance or renal impairment, were rapidly started on B/F/TAF upon reengagement after same day collection of baseline labs and PROs. A retention screening assessment was used to stratify participants into case management (CM) tiers: Minimal, Moderate, or Advanced. An acuity assessment tool was adapted to determine whether participants needed additional support based on retention and VS. Currently, 80 of the expected 100 subjects are enrolled and 55 have reached the 24-week timepoint. Baseline and 6-month endpoints were analyzed for these participants.

Results
At baseline (N=55), median age was 34 years (range, 24–62), with 92.6% Black and 72.2% cisgender male. Median CD4+ was 338 cells/mm3, with a median viral load 7,402copies/mL, (range, &lt; 40–333,350, 16.3% VS). Median time off ART was 2.6 months (range, 0.5-243). For CM, participants were stratified into Minimal (71%) and Moderate (29%) tiers; none were identified as Advanced.
Table 1 reflects tier shifts through 24 weeks.
Shifts in CM intensity differs from the HIV adherence self-efficacy PRO completed within 24 weeks, indicating that at least 50% underestimated their need to integrate and maintain adherence to ART treatment. Forty of 55 participants (72.7%) were retained-in-care at 6 months, with VS in 61.8% (N=34/55) by intention-to-treat and 85% (N=34/40) by observed analysis. No resistance to B/F/TAF was detected through 6 months.
Note: The table reflects patients retained on study at their week 24 endpoint.

Conclusion
VS was high for participants retained-in-care, but lapses in retention and shifts toward more intense CM were likely due to social determinants of health challenges, including incarceration, housing insecurity, and COVID-19-related disruptions in healthcare.

Disclosures
Gregory Huhn, MD, MPHTM, Eli Lilly: Advisor/Consultant|Eli Lilly: Grant/Research Support|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Jannsen: Advisor/Consultant|Jannsen: Grant/Research Support|Merck: Advisor/Consultant|Viiv: Advisor/Consultant|Viiv: Grant/Research Support.
1682. An Exciting New Approach: Isolation and characterisation of bacteriophages against MDR Acinetobacter baumannii
Authors: Chowdhury Souradeep , Rathor Nisha , Chaudhry Rama 
Published: December 2022

Abstract

Background
The modern advances in the fields of Medicine and Surgery depend entirely on our ability to treat and prevent infections. However, the rising incidence of antimicrobial resitance in both community and hospital settings has proved to be increasingly challenging. In 2017, WHO published a list of ‘priority pathogens’; antibiotic-resistant bacteria which posed the greatest threat to human health. Among them, A. baumannii was recognized as a critical priority pathogen due to its significant role in nosocomial infections. There was a growing call for new avenues in antimicrobial therapy. One such endeavour was to revisit an old therapeutic option against MDRO, viz. bacteriophage therapy. Numerous instances of successful phage therapy have already been published, with many more becoming available each day.

Methods
A total of fifty (50) multidrug resistant isolates of A. baumannii were collected. We attempted to isolate bacteriophages from hospital sewage water, against these collected strains, using standard procedure. Then the host range of the isolated phages were analysed against those 50 collected isolates. The lytic activity was confirmed using spot and plaque assays, following the techniques used by Newase et al, with some modifications. The isolated phages were then purified and stained following methods of Ellis et al, with some modifications, and visualised by a ThermoScientific Talos L120C transmission electron microscope (TEM).
Graphical Workflow
This depicts the workflow of the study. Created with BioRender.com

Results
A total of three (3) bacteriophages were isolated from the hospital sewage, and their lytic activity against A. baumannii strains were confirmed by the spot assay which showed clear zones on bacterial lawns. The phages, named vB_AbaS_SRNAIIMS002, vB_AbaS_SRNAIIMS008 and vB_AbaP_SRNAIIMS010, showed central clear zones surrounded by halos, in the plaque assay. Finally, all 3 bacteriophages were visualised by TEM, and two of them had morphology suggestive of siphoviridae family, with long tails, while the third had a short stubby tail, characteristic of the podoviridae family.

Conclusion
The study concludes that 3 novel bacteriophages were isolated from sewage water, all of which were active against MDR A. baumannii strains. This provides impetus to further research towards phage therapy as a novel therapeutic option against MDROs.

Disclosures
All Authors: No reported disclosures.
1702. Platelet Counts in Contezolid Complicated Skin and Soft Tissue Infection Phase 2 and Phase 3 Clinical Trials
Authors: Fang Edward , Yang Huahui , Yuan Hong 
Published: December 2022

Abstract

Background
Contezolid (CZD; MRX-I) is a novel oral (PO) oxazolidinone with potent activity against Gram-positive pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococccus (VRE). Nonclinical and Phase 1 (Ph1) clinical data indicate CZD may cause less myelosuppression, particularly with longer duration therapy, and with reduced risk of monoamine oxidase inhibition compared with linezolid (LZD). In Phase 2 (Ph2) and Phase 3 (Ph3) complicated skin and soft tissue infections (cSSTI) clinical trials, CZD was compared with LZD with dosing for 7-14 days, and noninferiority was demonstrated in the Ph3 study. Overall safety was comparable to LZD, and the most common treatment emergent adverse events (TEAEs) in both the CZD and LZD groups were gastrointestinal; however, hematologic laboratory abnormalities and TEAEs were less common with CZD. In June 2021, CZD was approved in China for cSSTI. Sequential therapy with intravenous contezolid acefosamil (CZA; double prodrug of CZD) followed by CZD PO is being evaluated in global Ph3 diabetic foot infection (DFI) and acute bacterial skin and skin structure infection (ABSSSI) clinical trials. Because DFI requires longer treatment (14-28 days), changes in platelet counts with therapy ≥11 days were evaluated in completed Ph2 and Ph3 CZD cSSTI studies.

Methods
In Ph2 and Ph3 cSSTI studies, mean percent changes in platelet counts from baseline (BSL) to the end of therapy (EOT) visit were compared for all subjects in the safety analysis sets (SS) who received CZD 800 mg and LZD, and also the subjects who received ≥11 days of therapy.

Results
In the Ph2 and Ph3 cSSTI studies, the mean platelet count values for LZD subjects decreased compared with CZD subjects, and the difference was greater in subjects who received ≥11 days of therapy.

Conclusion
In Ph2 and Ph3 cSSTI clinical trials with treatment durations of 7-14 days, mean platelet counts did not decrease for CZD subjects while mean values for LZD subjects did decline, consistent with nonclinical and Ph1 clinical data. Differences were more significant in subjects who received ≥11 days of therapy. In the current Ph3 global DFI study which compares 14-28 days of CZA/CZD to LZD, evaluation of hematological safety is an important outcome measure.

Disclosures
Edward Fang, MD, MicuRx Pharmaceuticals Inc: Employee Huahui Yang, MS, MicuRx Pharmaceuticals Inc: Employee.