bluuebunny/crossref_metadata_2025_split huggingface dataset:
1384. NSTI Outcomes with and without Hyperbaric Oxygen Therapy
Authors: Shishido Akira A , Vostal Alexander C , Tripathi Ravi , Uehling Megan , Chintalapati Sai Pavan Kumar , Conway Lauren , Kus Nicole J , Schrank Gregory M , Rabinowitz Ronald , DiChiacchio Laura 
Published: December 2022

Abstract

Background
Necrotizing soft tissue infections (NSTI) are characterized by fulminant tissue destruction and high mortality rates. Primary treatment is surgical debridement and antibiotics; hyperbaric oxygen therapy (HBOT) may be considered as adjuvant therapy. HBOT for NSTI remains controversial given the lack of quality evidence. HBOT is frequently used for NSTI at our institution; however, the early COVID-19 pandemic forced a significant decrease in its utilization. This practice change created an unusually high proportion of NSTI patients who did not receive HBOT at our institution and thus provided an opportunity to compare outcomes amongst NSTI patients who received HBOT against those who did not.

Methods
We performed a retrospective cohort study of patients aged 18 years and older admitted with the diagnosis of NSTI between January 2018 and December 2020, a period that included the first 6 months of the pandemic (Figure 1). We collected data on patient demographics, comorbidities, infection location, pathogen, severity of illness (APACHE II score), whether HBOT was provided and number of dives. Outcomes included 90-day mortality, amputations, inpatient antibiotic days, ventilator days, and hospital length of stay. Figure 1Proportion of NSTI patients admitted to R Adams Cowley Shock Trauma Center who received HBOT between January 2018 through December 2020. Proportions were averaged over six month blocks.

Results
253 patients were included of whom 143 (56%) received HBOT and 110 (43.3%) did not. Baseline characteristics were similar between the groups except for Wound Surface Area (WSA) and APACHE II score (Table 1). Length of stay was significantly longer in HBOT patients (15.3 days vs 11.7 days p=0.005, Table 2). Fewer HBOT patients had amputations (7.5% vs 21% p=0.007) and fewer died within 90 days of admission (6.3% vs 14.5% p=0.029). When stratifying patients by APACHE II score, HBOT patients with APACHE II scores &gt; 18 had significantly lower mortality than non-HBOT patients (9.7% vs 32.4% p=0.035).

Conclusion
In this population of NSTI patients who underwent surgical debridement, HBOT was associated with lower incidence of amputation, and lower mortality. Patients with APACHE II scores &gt;18 who received HBOT had lower mortality than those who did not. A prospective study should further evaluate the impact of HBOT on mortality and amputations.

Disclosures
All Authors: No reported disclosures.
1657. Real-life implementation of a machine learning based algorithm for urinary tract infection antibiotic resistance management in the community setting
Authors: Ben David Shirley Shapiro , Romano Roni , Palatshi-Nadler Liron , Greenfeld Shira , Rahamim-Cohen Daniella , Lerner Uri 
Published: December 2022

Abstract

Background
At outpatient visits, one of the most common reasons for antibiotics administration is Urinary Tract Infection (UTI), where selection of the appropriate empiric antibiotic requires consideration of multiple factors. The aim of this study was to assess the implementation and effectiveness of a machine learning based model for UTI antibiotic resistance, embedded in the physician's medical encounter workflow.

Methods
A longitudinal, nationwide prospective study, conducted by Maccabi Healthcare Services, a health organization in Israel serving 2.5 million members, with about 120,000 medical encounters with a UTI diagnosis per year. We adopted a machine-learning algorithm to predict antibiotic susceptibility using personal electronic health record data. Then, a designated order set was incorporated within our electronic health record interface, named 'UTI Smart-set' (UTIS). When a UTI diagnosis code is selected by the physician, a pop up screen emerges with the recommended antibiotics. The recommendation is based on the personal predicted susceptibility model developed, followed by the optimal narrow-spectrum antibiotic as recommended by the organizational clinical guidelines. . We analyzed the antibiotic prescriptions that were recommended by UTIS, the actual prescriptions given, and compared them to the culture results and the pathogen antibiotic resistance profile.

Results
From July 1st 2021 to April 1st 2022, among 73,148 medical encounters with a UTI diagnosis, 34,659 antibiotic prescriptions were provided. In 21,924 (63.2%) encounters the UTIS recommendation was accepted whereas in 12,736 (36.7%) it was declined. Use of the UTIS recommendation resulted in a 31.8% reduction of the measured resistance to antibiotics prescribed to patients, 10.9% (2,224) of cases who followed the UTIS recommendation for antibiotics versus 16.0% (1,879) case who did not. A 47% cumulative improvement in adherence to clinical guidelines was also observed using the tool.

Conclusion
This unique, point of care, antibiotic stewardship tool, based on a combination of clinical guidelines and personalized medicine, led to a major improvement in the selection of appropriate antibiotics.

Disclosures
Shirley Shapiro Ben David, MD, pfizer: Grant/Research Support.
1407. Increasing access to COVID-19 testing in underserved Black American neighborhoods
Authors: Avery Elizabeth , Olinger Tamara , Suzuki Sumihiro , Cartwright Yolanda , Jenkins LaDawne , Chaisson Lelia H , Moss Angela , Davis Elizabeth , Logan Latania K , Epting Steve , Lynch Elizabeth 
Published: December 2022

Abstract

Background
Black Americans have been disproportionately impacted by COVID-19, with systemic inequities contributing to increased incidence and mortality. In Chicago, access to COVID-19 testing was scarce in many predominantly Black neighborhoods early in the pandemic, exacerbating inequities. We aimed to assess uptake and yield of a COVID-19 testing campaign to increase access in high-risk, underserved Chicago communities.

Methods
The Alive Church Network (ACN) is a community-driven coalition of Black pastors and public health researchers developed to address health inequities in Chicago. For this initiative, ACN implemented two strategies to improve access to COVID-19 testing in underserved neighborhoods: 1) church-based testing, with nurses and community health workers (CHWs) stationed in churches to perform PCR testing for community members and church staff (Dec 2020-Dec 2021) and 2) community site testing, with nurses and CHWs deployed to 8 local sites (e.g., Salvation Army) to conduct weekly PCR testing for employees and clients (May 2021-Mar 2022). We assessed characteristics of individuals undergoing testing; symptom and exposure history; and COVID-19 positivity. In addition, we compared positivity for ACN sites with Chicago citywide positivity over time.

Results
A total of 3420 tests were performed for 1703 individuals. Of those tested, 931 (54.7%) were tested at churches and 772 (45.3%) were tested at community partner sites. Those presenting to churches were older (mean 44.8 vs. 39.1 years), more likely to be female (56.5% vs. 48.5%), and more likely to have a chronic medical condition (37.1% vs. 22.5%, Table). Prevalence of COVID-19 symptoms and exposure history were similar for those presenting to church and community sites (Table). Overall, ACN test positivity was similar to Chicago citywide positivity; however, ACN test positivity was much higher during the Omicron surge (24% vs. 11%, Figure).
Characteristics of individuals tested for COVID-19 at church and community sites
COVID-19 test positivity, ACN sites vs. Chicago citywide

Conclusion
The ACN testing campaign increased access to COVID-19 testing in underserved neighborhoods in Chicago and had high yield during the Omicron surge. Church-based testing was successful for reaching older, medically vulnerable individuals. Ensuring widespread access to testing is essential for health equity and to reduce COVID-19 morbidity and mortality.

Disclosures
All Authors: No reported disclosures.
1409. Infectious Complications in People Who Inject Drugs (PWID): A Retrospective Review and Recommendations for Improved Care
Authors: Martin Elena K , Wang Caroline , Lier Audun J , Azab Nancy , Fries Bettina F 
Published: December 2022

Abstract

Background
Suffolk County, NY is home to 1.5. million people and has a higher drug related deaths per capita rate compared to NY state average (19.9 vs 14.9/100,000). Injection drug use (IDU) is associated with complicated infections and inadequate treatment of substance use disorder (SUD) leads to relapse of infection and treatment failure. Unfortunately, access to SUD treatment services is not optimized in Suffolk County. We aimed to characterize the incidence and outcome of admissions for PWID and identify modifiable risk factors which can contribute to suboptimal care for PWID.

Methods
A retrospective review of SBUH electronic medical record was conducted from Jan 1, 2015 to June 1, 2021. Length of stay, discharge disposition, 6-month hospital readmission, insurance, employment and housing status, SUD history plus infection type and antimicrobial receipt were assessed.

Results
Of 425 patients (pts) admitted between Jan 1, 2015 to June 1, 2021, the median age was 34 years, 93% were white, and 59% male. Most pts. (89%) reported stable housing and had government insurance. The average length of stay was 13.6 days with 1/3 of pts. requiring ICU admission. Notably, 34% of pts left prematurely against medical advice and 34% were readmitted within 6 months. Formal ID (63%) and Psychiatry (62.5%) consults were not requested on all pts. Only 18% and 25% of pts. were treated with methadone or suboxone. 60% of screened pts. had HCV but 50% were not screened for co-infections. Complicated skin and soft tissue represented 70%, sepsis/bacteremia 11%, osteomyelitis/arthritis 10% and endocarditis 12% of the cases. 14.8% of pts. with endocarditis died, 48% had recurrent endocarditis, 52% needed surgery including 12% of repeat valve replacements. Staphylococcus species caused 42% of infections. About 2/3 of pts required continued antibiotic therapy at time of discharge, leading to delayed discharge for IV catheter placement.

Conclusion
Managing infectious complications in PWID is a multi-faceted endeavor extending beyond inpatient care. This study highlights the need for standardized treatment plans involving specialized case managers to reduce LOS and AMA discharges, improve screening for infections and integrate SUD treatment for PWID.

Disclosures
All Authors: No reported disclosures.
1410. Methamphetamines and Serious Injection Related Infections: Epidemiology and Outcomes of Alabama’s Drug Crisis
Authors: Prados Myles D , Eaton Ellen , Levy Sera , Bassler John R , Gagnon Kelly , Jeziorski Madison M , Bradford Davis , Leisch Leah J , Li Li 
Published: December 2022

Abstract

Background
The U.S. is facing a steep increase in infectious consequences of intravenous drug use due to the ongoing opioid crisis, surging methamphetamine use, and health care disruptions caused by COVID-19. We hypothesize that the sociodemographic and clinical outcomes of persons who inject drugs (PWID) differ based on their drug of choice (opioids, methamphetamines). Further, we hypothesize that the OUD (opioid use disorder) continuum, including linkage and retention in OUD treatment, will vary depending on co-occurring methamphetamine use. By elucidating differences in these groups, we aim to identify opportunities for interventions along the care continuum.

Methods
This is a retrospective study of hospitalized PWID receiving care at the University of Alabama at Birmingham Hospital for a serious injection related infection (SIRI) between 1/11/2016 and 4/24/2021. We queried the EMR for clinical data and health outcomes. We extracted data on substance use disorder(s), treatments, and linkage to care through review of primary and addiction medicine consultation notes. Using statistical measures of association, we compared demographic factors and clinical outcomes among groups; delineating between those with and without methamphetamine use, and without OUD. When appropriate, additional comparisons were made to detect statistical differences between factors and those with and without methamphetamine use.

Results
Of 370 PWID, 286 had OUD, 94 had OUD and methamphetamine use, and 84 had another substance use disorder. There were significant differences according to drug use disorder with patients with OUD and meth use being mostly White (99%), 42% female, and younger relative to those who use opioids only. Patient directed discharge was most common among those with OUD plus meth use, but death was highest for those with OUD only. The OUD care continuum was similar and alarming for both groups with many gaps in care. Figure 1.OUD Care continuum for PWID with SIRI for those with and without comorbid meth use disorder

Conclusion
PWID with SIRI are a diverse group with significant differences based on substance of choice, but all experience suboptimal hospital outcomes. There are opportunities to improve linkage and retention across the care continuum, most noticeably outpatient linkage.

Disclosures
Ellen Eaton, MD, MPH, Gilead HIV Research Scholar: Grant/Research Support|Gilead HIV research scholar: Grant/Research Support.
1415. Successful Model for Pharmacy Driven Harm Reduction Services to Link Veterans Who Inject Drugs Into Care
Authors: Silva Deanna Cordero Da , Byrd Jacqueline , Slazinski Karen , Ho Minh 
Published: December 2022

Abstract

Background
Substance abuse continues to be on the rise in the U.S. driven by the proliferation of fentanyl laced street drugs. Per the CDC, during May 2020 - April 2021, a 29% increase in over dose deaths was observed compared to the previous year. Harm reduction services play a major role in reducing overdose deaths, life-threatening infections and chronic diseases. Syringe service programs (SSPs) have proven to be an essential component of a broader focus on harm reduction; however, gaps remain in engaging Veterans into these programs. Figure 1.Contents of Standard SSP Kit Distributed to Veterans at the Orlando VA

Methods
A multimodal strategy was implemented to engage Veterans and VA staff into harm reduction services. A harm reduction short video series was developed and posted on social media channels. ICD-10 codes were utilized to identify Veterans with polysubstance use and harm reduction letters were mailed. A pre and post survey was developed to assess provider’s familiarity and level of comfort with SSPs before and after in-service education was provided by ID physicians. An ID pharmacy consult was developed for providers to request patient education or harm reduction kit dispensing. Upon completion of the quality improvement project, we expect to see an increase in the number of Veterans utilizing SSP. Figure 2.Orlando VA SSP Process MapFigure 3.Harm Reduction Letter

Results
Upon implementation of outreach strategies total SSP visits increased by 72%. A total of 2040 syringes and 24 Naloxone kits have been dispensed through the SSP. Survey data shows that employees' knowledge on SSPs have increased by 48%, their comfort on working with Veterans who inject drugs increased by 6%, providers confidence in the tools available to them to successfully help veterans with alcohol and substance use recovery increased by 17%, misconception that SSPs increase drug use decreased by 6%, and support of placing consults for medication assisted therapy increased by 4%. Data is notable given limitations like post survey participation. Figure 4.Pre and Post Education Survey Data Collection ComparisonFigure 5.Pre and Post Education Survey Data Collection ComparisonFigure 6.Pre and Post Education Survey Data Collection Comparison

Conclusion
The implementation of multimodal strategies to engage Veterans and VA staff has resulted in an increase of SSP utilization. Sustained efforts to continue to identify target patients and bring them into care will be undertaken in an effort to increase and normalize SSP utilization. The steps already taken can serve as a model for programs currently in development and moves us closer to ending the HIV epidemic by 2030. Figure 7.Outreach Strategies Summary

Disclosures
All Authors: No reported disclosures.
1426. Characterization of Patients with Iatrogenic Mycobacterial Infections: A Hospital-Based Survey
Authors: Mitra Debdeep 
Published: December 2022

Abstract

Background
Tuberculosis (TB) is a chronic granulomatous inflammation usually involving the lung parenchyma and hilar lymph nodes. Extra-pulmonary involvement is seen in ∼20% of all TB cases. Developing tuberculosis following treatment for another primary medical condition is a rare occurrence. Iatrogenic literally means illness caused by medical examination or treatment.
Mycobacteria have been used to treat a few medical conditions and the therapeutic use has been validated extensively in literature. The mycobacteria used for therapeutic purposes are supposed to be either attenuated or non pathogenic strains. Growth and dissemination of this mycobacterium is a rare but serious possibility. Reactivation of latent mycobacterial infection following therapy is also a part of iatrogenic mycobacterial infection.

Methods
We report a retrospective study investigating adverse events manifesting with development of iatrogenic tuberculosis. The data was obtained from a tertiary care centre over a period of 2 years. Diagnosis of tuberculosis was established based on clinical, radiological(chest X-Ray and High resolution CT scan), sputum smear microscopy and skin/tissue biopsy and Xpert MTB/RIF. Tuberculin skin test(TST) and Interferon gamma release assay (IGRA) were used as additional diagnostic tests.

Results
The search yielded 26 cases of iatrogenic tuberculosis, with a median age of 56.5 years. Most common cause was reactivation of latent tuberculosis due to use of anti-TNF alpha biologic agents(53.8%). Development of Tuberculosis verrucosa cutis following BCG inoculation for verruca vulgaris was noted in about 19.2% of cases and Tubercular abscess due to Mycobacterium w or BCG inoculation for Covid-19 was noted in 11.5% cases. Bacillus Calmette Guérin(BCG) induced balanitis secondary to therapy for Carcinoma urinary bladder was noted in 7.69%of cases.
Bacillus Calmette-Guerin or BCG induced balanitis following use of intravesical immunotherapy for treating early-stage urinary bladder cancer and successful clearance of lesions post therapy
Tuberculosis Verrucosa Cutis following Immunotherapy for plantar warts

Conclusion
All patients were managed successfully with anti tubercular therapy. These observations indicate that tuberculosis infection can develop in previously healthy individuals in endemic zones following biologic therapy of use of mycobacterial agents for other therapeutic indications.

Disclosures
All Authors: No reported disclosures.
1436. Interventions to Address the Global Underreporting of Pediatric and Adolescent Tuberculosis: A Systematic Review
Authors: Linn Alexandra R , Steenhoff Andrew 
Published: December 2022

Abstract

Background
The WHO currently estimates that at least a third of pediatric and adolescent tuberculosis cases go untreated or incompletely treated each year. Many cases are detected but lost to follow-up due to underreporting to national or private surveillance systems.

Methods
We conducted a systematic literature review to better understand the global reporting gap of pediatric tuberculosis as well as current interventions. Following PRISMA guidelines, the review included articles published in English within the past 30 years. Studies were included if they discussed underreporting of tuberculosis in pediatric and adolescent patients. Studies were excluded if they did not include these populations or if they focused on challenges with initial diagnosis or general loss to follow-up rather than underreporting. In May and June 2021, we searched PubMed and Ovid databases along with reference lists of included works. Multiple reviewers and further assessments of heterogeneity and bias will be implemented in the next steps of the project.

Results
Of 458 records identified, 420 were screened for inclusion and 19 studies met inclusion criteria in the preliminary search. Of included studies, 14 described the gap in reporting of pediatric tuberculosis and 5 described potential interventions to close this gap. The estimated gap in reporting ranged from 16% to 98% and was described in 23 countries. Larger gaps were described in rural areas, in areas with higher disease burden, in patients with disseminated disease, and in those under age 5 years. Effective interventions are limited and include strengthening linkage systems between hospitals and clinics, increasing communication between patients and healthcare workers following initial diagnosis, utilizing electronic systems to optimize ongoing monitoring, improving death registration, and using implementation science for continued quality improvement. Table 1
Characteristics of studies included in the review

Conclusion
Underreporting of pediatric and adolescent tuberculosis is a significant global problem. Few evidence-based effective strategies exist to close this gap. Future research should assess the ability of creative, pragmatic solutions to mitigate this with an emphasis on pediatric populations in high-TB burden countries.

Disclosures
All Authors: No reported disclosures.
1449. Therapeutic Drug Monitoring of Isoniazid and Rifampicin and Clinical Outcomes in Adults with Tuberculosis.
Authors: Espiricueta-Zavala Luz A , Sanchez-Durán Diego , Ortiz-Álvarez Arturo , Huerta-García Ana P , Rodríguez-Pinal Cristian J , Milán-Segovia Rosa C , Romano-Moreno Silvia , Medellín-Garibay Susanna 
Published: December 2022

Abstract

Background
Directly Observed Treatment Short Course for Tuberculosis (TB) (DOTS) treatment currently produces a cure rate of 80%. Rifampicin (RMP) and isoniazid (INH) are the main bactericides; both show wide inter-individual pharmacokinetics and narrow therapeutic range. Therapeutic drug monitoring (TDM) of antiTB drugs is a strategy to improve the response to treatment.
The aim of this work was to optimize and individualize antiTB treatment based on plasma concentrations of RMP and INH, NAT2 genotyping and the Bayesian estimation of PK parameters.

Methods
A prospective and analytical study including TB patients under DOTS scheme was performed. Venous blood samples were drawn 2 and 4 hours after last dose; INH and RMP were quantified by liquid chromatography coupled to tandem mass spectrometry. Anthropometric and clinical information was retrieved from medical records. Acetylator phenotype was determined based on NAT2 genotyping by real-time PCR.
Bayesian estimation of the PK parameters was performed using NONMEM and dosing scheme was proposed to achieve therapeutic concentrations of RIF and INH.

Results
A total 62 patients were included from 18 to 80 years and 35 to 117 kg of total body weight. The most frequent was pulmonary infection (40%), 25% of patients had type 2 diabetes mellitus and 58.5% were slow acetylators for the NAT2 gene. Lower INH and RMP plasma concentrations were related to adverse clinical outcome, compared to those patients classified with early clinical success [1.9 vs 3.7 mg/L and 16.9 vs 10.0 mg/L (p&lt; 0.05)]. Results indicate the need to adjust anti-TB drugs dose to more than 50% of the patients who show plasma concentrations outside the range for both drugs. Bayesian dosing performed was validated after individualization by quantification and interpretation of INH and RMP plasma concentrations followed by a narrow medical follow up.

Conclusion
Even with standard anti-TB treatment, great proportion of patients show subtherapeutic concentrations of RMP and INH which is associated with overall therapeutic failure. TDM is a useful tool to individualize antimicrobials dose and improve clinical outcomes at early stages of active TB.

Disclosures
All Authors: No reported disclosures.