1409. Infectious Complications in People Who Inject Drugs (PWID): A Retrospective Review and Recommendations for Improved Care

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.

214. Comparison of Clinical and Laboratory Findings of Human Monocytic Ehrlichiosis (HME) and Human Granulocytic Anaplasmosis (HGA) in Long Island, New York

Background

Suffolk County reports to the Department of Health the highest absolute number of cases of tick-borne diseases (TBD) for NY State. While Lyme disease and Babesiosis are the most common TBD in this county with more than 600 and 100 cases reported every year, respectively; two other TBD, HME (due to Ehrlichia chaffeensis) and HGA (due to Anaplasma phagocytophilum) are also commonly reported in this county (63 and 37 every year, respectively). There is limited data directly comparing both diseases on acute presentation; the aim of this study was to compare the clinical features, laboratory findings and complications of HME and HGA in the epicenter of TBD in NY State.

Methods

A retrospective study was designed to collect cases with the diagnosis of HME and HGA by using ICD9 or ICD10 codes from 2013 to 2018 at Stony Brook Medicine. Inclusion criteria were patients 18 years or older who had a positive PCR in blood for E. chaffeensis or A. phagocytophilum. Demographics, clinical features, laboratory results, and complications were extracted from patient charts. We used the chi-square test to compare the proportion of symptoms and a two-tailed unpaired student T-test to compare laboratory values.

Results

A total of 40 cases of HME (mean age 67 ± 13) and 27 with HGA (mean age 63 ± 12) met inclusion criteria. Only approximately 50% of cases had a documented history of tick exposure. Clinical presentations were similar in terms of frequency of fever, headache, arthralgia, and myalgia. In contrast, hypotension, confusion, and rash were more common in HME although only the latter was significantly more common. HME patients had significantly greater degrees of leukopenia and thrombocytopenia and elevated AST levels. The majority of patients with HME and HGA were hospitalized >1 day for management of their acute illness (HME, 30/40 and HGA 17/27). Several patients with HME had gastrointestinal (GI) complications including 3 with acute acalculous cholecystitis, 1 with duodenitis, and 1 with acute colitis; 1 patient with HGA had perforated diverticulitis.

Conclusion

Patients with acute HME tend to be more ill than those with acute HGA; however, a substantial proportion of both groups require hospitalization. GI complications were more commonly seen in HME (12.5%) than HGA (3.7%) which deserves further investigation.

Disclosures

All authors: No reported disclosures.

783. Infectious complications in IV abusers: a detailed review of hospitalized IV abusers

Background

With 337 heroin-related deaths between 2009 and 2013, Suffolk County reported more such deaths than any other county in New York State. Suffolk County’s population of 1.5 million is larger than that of some states. Compared with the rest of New York State, median annual household income is the third highest of New York’s 62 counties and the income gap between socioeconomic classes is smaller.

Methods

Detailed retrospective chart review was performed on admitted patients to Stony Brook University Hospital (SBUH) from November 2015 to October 2018 with active IV drug abuse and infection. Demographics, drug use characteristics, microbiology, co-morbidities, and outcome were assessed.

Results

198 active IV heroin users were admitted with a complicated infection during this time frame. Most patients were Caucasian (94%) and more were male (64%). The median age was 33 (range 17 to 58). Most patients (90%) had health insurance, many lived with others at home and were unemployed. Thirty-three were on methadone and 28 on suboxone. The median length of stay was 4.7 days (ranging from 1 to 140 days) and 29% of admitted patients left against medical advice. 60% of the patients had been admitted to a hospital in the prior 12 months. The majority (58%) presented with cellulitis, 12% were diagnosed with endocarditis, 10% with osteomyelitis, 6.5% with bacteremia/sepsis. Ten were also pregnant. Infectious disease was consulted in 55%, and Psychiatry and social worker in 46% of cases. HIV, HepC and HBV testing were not performed in less than 50% of patients. There was a total of 5 deaths during the hospitalization, 2 patients with endocarditis, 2 with sepsis and one overdose. 45% of patients with endocarditis and 43% of patients with osteomyelitis required surgical intervention. S. aureus was a common pathogen and identified in 61% of the cases, where a pathogen was isolated.

Conclusion

Our data show that even in an affluent community opioid addiction is not properly addressed during hospital admissions. As a consequence, users sign out against medical advice, have frequent hospital admissions, remain out of addiction treatment, and outcome is poor. A systematic multidisciplinary approach will be required to improve the care for this vulnerable patient population

Disclosures

All authors: No reported disclosures.