bluuebunny/crossref_metadata_2025_split huggingface dataset:
1386. Prescribing Patterns of Skin and Soft Tissue Infections in Patients Discharged from the Emergency Department
Authors: Feist Jacqueline , Panecaldo Nicholas , Kale-Pradhan Pramodini , Delgado George , Giuliano Christopher , Johnson Leonard B 
Published: December 2022

Abstract

Background
Treatment of skin and soft tissue infections (SSTIs) are a growing reason for Emergency Department (ED) visits. Inadequate treatment of SSTIs has been reported in up to 25% of patients treated in ED. The purpose of this project was to describe prescribing patterns for SSTIs from the ED.

Methods
Single center retrospective cohort study of SSTI patients discharged from ED between July 1- December 31, 2020. The primary outcome was to describe the proportion of patients receiving guideline directed therapy (GDT) for SSTIs. Secondary outcomes include describing the proportion of patients readmitted within 30 days, the reason for readmission, and to compare 30-day readmission rates in patients who received GDT versus non-GDT.

Results
Of 876 patients screened, 576 were excluded primarily for being admitted to the hospital. Of the 300 included patients, 117 (39%) received GDT and 183 (61%) received non-GDT. Fifty-six of 300 patients were readmitted within 30 days, of which 21 (17.9%) had received GDT and 35(19.1%) had received non-GDT (p=0.8). Readmissions related to persistence or progression of SSTI were not significantly different between GDT and non-GDT, 9 patients and 11 patients respectively (p=0.57). The remaining 36 patients (64.3%) were readmitted for reasons unrelated to SSTI.

Conclusion
The majority of prescribed antibiotic therapy for SSTI did not conform to GDT. However, 30-day readmission rates were not significantly different between the groups. Further research on GDT and ED treated SSTI is needed.

Disclosures
All Authors: No reported disclosures.
1656. Impact of Pharmacist Intervention on Antibiotic Prescribing at Hospital Discharge for Community-Acquired Pneumonia, Urinary Tract Infection, and Skin and Soft Tissue Infections
Authors: Liu Elaine , Linder Kristin E , Dempsey Casey J , Kuti Joseph L , Nicolau David P , Bilinskaya Anastasia , O'Sullivan David M , Colmerauer Jessica L 
Published: December 2022

Abstract

Background
The high incidence of suboptimal antibiotic use at transitions of care represents a novel area for antimicrobial stewardship for community-acquired pneumonia (CAP), urinary tract infection (UTI), and skin and soft tissue infections (SSTIs). The objective of this study was to investigate the role of a pharmacist intervention at discharge to improve antibiotic use.

Methods
This was a single-center, retrospective, crossover analysis of patients admitted to general medicine units from 11/1/21 to 3/31/22 with a diagnosis of CAP, UTI, or SSTI. The study was divided into two phases separated by a one-month washout. Each two-month phase included two pre-specified units, an intervention and control. During phase 2, the intervention and control units were switched. Patients on antibiotics identified for discharge were reviewed and interventions were communicated by the pharmacist to the provider. Interventions were made based on predefined guidance for oral step-down therapy and total duration. The primary outcome, discharge antibiotic days of therapy (DOT), was compared between the intervention and control cohorts. Secondary outcomes included total DOT, hospital length of stay (LOS), 30-day readmission, and appropriateness of drug selection, dose, and duration.

Results
Records of 161 patients were included in this study, 85 in the intervention cohort (47 in phase 1, 38 in phase 2) and 76 in the control (41 in phase 1, 35 in phase 2). Overall discharge DOT was 3 (IQR 0–4.5) in the intervention cohort and 3 (IQR 0-5) in the control cohort (P = 0.8), and overall total DOT was 7 (IQR 5-9) and 7 (IQR 5-10) respectively (P = 0.27). Patients in the intervention group were more likely to have appropriate total duration (61.2% vs 44.7%, P = 0.001) and discharge duration of antibiotics (67.1% vs 53.9%, P = 0.013) for all three indications based on predefined guidance. Hospital LOS was 4 (IQR 3-5) vs 5 days (IQR 3-6.3) in the intervention and control cohorts (P = 0.001) respectively, and a lower 30-day readmission (14.1% vs. 23.7%, resp.).

Conclusion
Despite similar antibiotic DOTs, pharmacist intervention at discharge appeared to improve overall antibiotic total duration and discharge duration for CAP, UTI, and SSTI. Opportunities to improve discharge stewardship processes should be further explored.

Disclosures
Joseph L. Kuti, PharmD, Abbvie: Honoraria|bioMeriuex: Advisor/Consultant|bioMeriuex: Grant/Research Support|Contrafect: Grant/Research Support|Entasis: Grant/Research Support|Merck and Co: Grant/Research Support|Roche Diagnostics: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Shionogi: Honoraria|Summit: Grant/Research Support David P. Nicolau, PharmD, Shionogi: Grant/Research Support.
1414. Substance Use Treatment Utilization Among Women with and at Risk for HIV
Authors: Fujita Ayako W , Ramakrishnan Aditi , Mehta Cyra Christina , Yusuf Oyindamola , Wilson Tracey , Shoptaw Steven , Carrico Adam , Adimora Adaora A , Eaton Ellen , Cohen Mardge , Cohen Jennifer , Adedimeji Adebola , Plankey Michael , Jones Deborah L , Chandran Aruna , Sheth Anandi N 
Published: December 2022

Abstract

Background
Substance use (SU) contributes to poor health outcomes , yet limited data exist to inform strategies to optimize SU treatment among people with HIV (PWH). We describe SU and SU treatment utilization among women with and at risk for HIV in the Women’s Interagency HIV Study (WIHS).

Methods
We included data from participants enrolled in 10 WIHS sites from 2013-2020. Current SU was defined as self-reported, non-medical use of drugs in the past year, excluding use of only marijuana. SU treatment utilization was determined by self-reported use of a drug treatment program in the past year. Multivariable regression models were used to determine associations between participant characteristics and SU treatment.

Results
Among 2559 women (1802 HIV+, 757 HIV-), 66% (n= 1690) reported lifetime SU (65% HIV+, 69% HIV-), and 14% (n=367) reported current SU (13% HIV+, 18% HIV-). Among women with current SU, 71% reported crack/cocaine, 40% opioids, 12% any intravenous drug, 6.5% tranquilizers, and 6.5% methamphetamines. Of these women, 77% reported smoking cigarettes, 52% marijuana use, and 27% using &gt;7 drinks/week. Among women with current SU, 42% (n=155) reported any treatment in the past year (40% HIV+, 45% HIV-); the most common treatments were methadone (64%), narcotics anonymous (29%), inpatient (28%), and outpatient programs (16%). Among women with opioid use (n= 147), 67% reported methadone use in the past year compared to only 5% using buprenorphine/naloxone. In multivariable analysis, HIV seropositivity and concurrent alcohol or marijuana use were associated with lower odds of SU treatment, and visit with a psychiatrist/counselor with higher odds of treatment (Table). In a separate model including only women with HIV, SU treatment was not associated with having an HIV care visit or viral suppression. Table- part 1Table - part 2

Conclusion
In the WIHS cohort, SU treatment utilization was higher than expected, especially for methadone use, reflecting the resilience of a population which is known to face stigma and barriers to treatment. Still, our analysis highlights opportunities for accessing SU treatment in the context of HIV care for women with HIV, such as the need to prioritize providing buprenorphine/naloxone in HIV care settings.

Disclosures
Steven Shoptaw, PhD, Alkermes Inc: Grant/Research Support|Gilead Sciences, Inc: Grant/Research Support Adaora A. Adimora, MD, MPH, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support Ellen Eaton, MD, MPH, Gilead HIV Research Scholar: Grant/Research Support|Gilead HIV research scholar: Grant/Research Support.
1421. A 5-year Review of Mycobacterium abscessus Susceptibility in a Tertiary Hospital in Thailand
Authors: Phuensan Pawat , Petsong Suthidee , Suwanpimolkul Gompol 
Published: December 2022

Abstract

Background
Mycobacterium abscessus is a common rapid growing mycobacteria (RGM). It causes chronic nodular or cavitary lung disease in adults with bronchiectasis or cystic fibrosis, skin and soft tissue infection following penetrating injury or an unsterile skin procedure. It was also a pathogen of disseminated infection in patients with anti-interferon-gamma autoantibodies. The 2018 clinical and laboratory standards institute (CLSI) guideline suggested that amikacin, cefoxitin, ciprofloxacin, clarithromycin, doxycycline, imipenem, linezolid, meropenem, moxifloxacin, trimethoprim-sulfamethoxazole, tigecycline and tobramycin should be tested against RGM. We aimed to review the antimicrobial susceptibility of this organism in our hospital.

Methods
We performed a retrospective descriptive review of the minimal inhibitory concentration (MIC) of clinical isolates of M. abscessus from 2013 to 2018.

Results
We found 267 isolates of M. abscessus. Eighty-four isolates were tested for MICs. Of these, 4 isolates were excluded due to duplication. The remaining 80 isolates were included for analysis. The susceptibility results were as follows.

Conclusion
To our knowledge, this is the largest report of susceptibility pattern of M. abscessus in Thailand. MICs of cefoxitin and imipenem, which are the recommended intravenous antimicrobials, were high. Most isolates also demonstrated high MICs of doxycycline, linezolid, trimethoprim-sulfamethoxazole, tobramycin, ciprofloxacin and moxifloxacin. In contrast, most of MICs of amikacin and clarithromycin were in susceptible range. These findings may be used to guide the treatment regimen although clinical outcomes of each drug are still to be investigated.

Disclosures
All Authors: No reported disclosures.
1422. A Multi-Center Evaluation of Omadacycline for Multi-Drug Resistant Infections
Authors: Ghali Amer El , Ghali Amer El , Allosaimy Sara , Morrisette Taylor , Molina Kyle C , Frens Jeremy J , Stevens Ryan W , Bouchard Jeannette , Brandon Bookstaver P , Veve Michael P , Vemula Raaga , Philley Julie , Rebold Nicholas S , Holger Dana , Kunz Coyne Ashlan J , Lagnf Abdalhamid M , Lucas Kristen , Witucki Paige , Rybak Michael J 
Published: December 2022

Abstract

Background
Multi-drug resistant (MDR) pathogens are a continuously evolving threat for which there are limited effective treatment modalities. Omadacycline (OMC) is a novel oral and intravenously administered aminomethylcycline with potent in-vitro activity against MDR gram-negative and gram-positive pathogens. Post-marketing data investigating its potential place in the antibiotic armamentarium is limited. This study aimed at describing the clinical success and tolerability of patients receiving OMC for various infections.

Methods
This was a multicenter, retrospective, observational study conducted from January 2020 to March 30, 2022. We included all patients ≥ 18 years of age that received OMC for any infection not related to Mycobacterium spp. for ≥72 hours. The primary outcome was clinical success at 30 days, defined as survival, the absence of persistence or re-emergence of infection during or after therapy, and the absence of escalation or alteration of OMC. Incidence of adverse effects while on OMC and reasons for OMC utilization were also analyzed.

Results
This analysis included 19 patients from 10 distinct academic centers. The median age was 50 years (IQR, 37-63), 58% were male, 63% were Caucasian, and the median APACHE II, Charlson and SOFA scores were 10 (IQR 5-12.5), 4 (IQR 2-6.3), and 1 (IQR 0 – 2.25), respectively. Most patients had a bone and joint (8/19, 42.1%) or intra-abdominal infections (4/19, 21.1%), all with positive cultures. Eight patients (44.1%) had a polymicrobial infection and 4 (22.2%) had bacteremia. The most common pathogens encountered were Carbapenem-resistant A. baumannii (5/19, 27.8%), E. coli (5/19, 27.8%), Vancomycin-resistant Enterococcus spp. (4/19, 22.2%), and K. pneumoniae (3/19, 16.7%). Clinical success was observed in 14 patients (74%) and 7 (36.8%) received combination therapy. Adverse drug reactions were reported in 3 patients (15.8%) and of those patients, none discontinued therapy. Reasons for prescribing OMC were mostly attributed to oral availability (12/14, 85.7%) and resistance to other agents (7/14, 50%).

Conclusion
OMC demonstrated clinical effectiveness and safety against a large number of MDR pathogens. More robust, prospective, comparative studies are needed to confirm our preliminary findings.

Disclosures
P. Brandon Bookstaver, PharmD, Spero Therapeutics: Advisor/Consultant.
1425. Changes in Clinical Presentation of TB due to the COVID-19 pandemic
Authors: Khan Nazia , Sirichand Surksha , Xie Xianhong , Achkar Jacqueline M 
Published: December 2022

Abstract

Background
In 2020/21, deaths due to active tuberculosis (TB) increased globally for the first time in decades with concomitant global decline in TB detection rates, suggesting that delay in TB diagnosis during the COVID-19 pandemic is associated with increased mortality. In the US and New York City, 20% decline in TB cases was reported in 2020/21. We aimed to compare symptom duration, sputum microscopy and radiographic findings in patients with newly diagnosed TB at Montefiore Medical Center (MMC) in the Bronx, New York, before and during the COVID-19 pandemic. We hypothesized that patients during the COVID-19 pandemic present with signs of more advanced TB than before.

Methods
Using a cross-sectional study design, we retrospectively reviewed medical records of TB patients identified through microbiology lab records from 11/1/2018 to 3/11/2022 and stratified by admission before (11/1/2018–2/29/2020) and during (3/1/2020–3/11/2022) the COVID-19 pandemic. Inclusion criteria were age ≥18 years, admission to an MMC hospital, and new diagnosis of culture-confirmed TB.

Results
We identified 24 TB patients who presented before and 24 during the pandemic. About 1.7 new TB cases were diagnosed monthly before vs 1.0 during the pandemic, an &gt;40% decline. Patients had both pulmonary and/or extrapulmonary manifestations without differences between groups. There were no significant differences in demographics and comorbidities between the two groups aside from diabetes, which was higher in the pre-COVID group (p = 0.03). Two TB patients had a prior history of COVID and one developed nosocomial COVID during the admission. There was no difference in mortality between groups. Patients with pulmonary manifestations had higher sputum AFB smear positivity (p=0.14) and significantly higher occurrence of multilobar or miliary infiltrates on chest X-ray during compared to before COVID (p = 0.01; Table 1). Table 1.Symptoms and diagnostics on initial presentation of patients with pulmonary TB before and during the COVID-19 pandemic
Depending on distribution, t-tests or Mann Whitney U tests were used for continuous and Chi-square tests or Fisher’s exact tests for categorical variables. Sputum AFB smears results are reported for the initial 3 smears.

Conclusion
Our findings show &gt;40% decline in patients presenting with TB in the Bronx during vs before the COVID-19 pandemic and suggests patients presented with more advanced disease than before the pandemic. Whether COVID-19 could have contributed to this remains to be investigated. Our results have implications for public health and emphasizes the need for earlier identification of TB.

Disclosures
All Authors: No reported disclosures.
1427. Correlation of Dermoscopic and Histopathologic Patterns in Leprosy-a Pilot Study
Authors: Mitra Debdeep , Chopra Ajay 
Published: December 2022

Abstract

Background
Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. It is diagnosed based on clinical features and confirmed on the histological findings and peripheral slit skin smear staining. Dermoscopy is a handy easily accessible tool to diagnose this granulomatous disease and classify patients based on the immunological and clinical response.

Methods
A total of 50 patients in different poles of leprosy were evaluated as a single spot observational analysis. The clinical and histological findings were correlated with the characteristic dermoscopy findings.
A Lepromatous leprosy showing xerosis and scaling along leg as part of glove and stocking distribution of lesions
Dermoscopic pattern in lepromatous leprosy showing partial loss of hair follicles, dry xerotic skin, and white characteristic scaling (Heine Delta® 20 T dermatoscope; 16×; polarizing)

Results
The dermoscopy findings correlated with the clinical and histological findings. Tuberculoid poles of leprosy classically showed loss of hair and skin pigment along with absence of white dots as sweat glands in dermoscopy. Lack of blood vessel changes ruled out any lepra reaction. Lepromatous pole of leprosy on the other hand showed characteristic xerosis and white scaling on dermoscopy in the background of hypotrichosis and hypopigmentation. leprosy reactions were characterized by blood vessel changes and arborizing blood vessels were characteristic in erythema nodosum leprosum and a diffuse erythema was a clue towards diagnosing type I lepra reaction. Interestingly clofazimine induced pigmentation was picked up characteristically on dermoscopy as a ‘honey comb pattern’.
Borderline tuberculoid leprosy with a hypoaesthetic patch on the left side of face with a thickened greater auricular nerve
Dermoscopic pattern in borderline tuberculoid leprosy showing white areas with loss of hair follicles. In between yellow globules can be seen which was the hallmark apart from white areas demonstrating hypopigmentation. Absence of blood vessels rules out lepra reaction (Heine Delta® 20 T dermatoscope; 16×; polarizing)

Conclusion
Dermoscopy is certainly a handy tool in aiding the diagnosis of leprosy, lepra reactions and course of therapy. Characteristic patterns during the course of leprosy would certainly facilitate a quick and definitive diagnosis of patients suffering from leprosy. Also patient drug compliance particularly to Clofazimine can also be picked up objectively on Clofazimine.
Multiple erythematous plaques on the back depicting type 1 lepra reaction
Dermoscopic features of type I lepra reaction showing characteristic diffuse erythematous background and branching telangiectatic vessels along with sparse hair follicles and scaling (Heine Delta®20 T dermatoscope; 16×; polarizing)

Disclosures
All Authors: No reported disclosures.
1428. Clinical Characteristics and Management of Nontuberculous Mycobacterial Infections in the Finger Lakes Region of New York
Authors: Croix Michael , Dumyati Ghinwa , Adams Alexandra , Hardy Dwight , Levy Paul , Lesho Emil , Munsiff Sonal 
Published: December 2022

Abstract

Background
Nontuberculous Mycobacteria (NTM) are ubiquitous in the environment and associated with pulmonary and extra-pulmonary infections. Evaluation and treatment of these infections is complex and prolonged, involving oral, intravenous and inhaled therapies, although not all patients with NTM need treatment. We reviewed the clinical characteristics and referral patterns of NTM patients in our institutions to evaluate resource needs.

Methods
We retrospectively identified all patients who had NTM isolated from 2 referral labs servicing the Finger Lakes Region of NYS, from April 1, 2018 thru March 31, 2020. Demographic, comorbidities, culture, and treatment data were collected from medical records. We compared comorbidities, clinical symptoms, and species among patients with pulmonary and extra-pulmonary NTM. Pearson’s chi-squared and student t-test were performed where appropriate for statistical analysis.

Results
155 NTMs were isolated from 149 patients, 128 from pulmonary and 27 from extra-pulmonary sites. Patients with pulmonary NTM were more likely to be older, female, and have underlying lung disease (Table 1). Patients with extra-pulmonary NTM were more likely to have immunodeficiency. Mycobacterium avium complex (MAC) was isolated more frequently in pulmonary samples and rapidly growing mycobacteria more frequently from extra-pulmonary samples (Table 2). Disease site specific symptoms were more common than constitutional symptoms in both groups. 36% of patients with pulmonary NTM were treated compared with 70% of patients with extra-pulmonary NTM (Table 3). 69% were referred to Pulmonologists, and 43% to infectious diseases for evaluation and management. Table 1Demographics
Demographic data for patients with pulmonary and extrapulmonary NTM Table 2Mycobacterium species
Mycobacterium species isolated from patients with pulmonary and extrapulmonary NTM Table 3Clinical characteristics
Clinical characteristics of patients with pulmonary and extrapulmonary NTM including symptoms, referral to specialists, whether patients were diagnosed with disease by a clinician, and how many were treated.

Conclusion
Though not all patients with NTM isolated from culture require treatment, most of the patients in our cohort had extensive evaluation, those on treatment required multidisciplinary care, and many not on treatment require ongoing monitoring. Knowing the volume and clinical characteristics of NTM patients in our region has helped to identify the needed resources for developing a comprehensive regional NTM center of Excellence. Other institutions can similarly assess their volume to plan for the increasing incidence of these infections.

Disclosures
Ghinwa Dumyati, MD, Pfizer: Grant/Research Support.