Background Increasingly, injection opioid use and opioid use disorder (OUD) are complicated by methamphetamine use, but the impact of stimulant use on the care of people who inject drugs (PWID) with serious injection related infections (SIRI) is unknown. The objective of this study is to explore hospital outcomes as well as post-discharge trends for a cohort of hospitalized PWID to identify opportunities for intervention. Methods We queried the electronic medical record for patients hospitalized at the University of Alabama at Birmingham with injection drug-use related infections between 1/11/2016 and 4/24/2021. Patients were categorized as having OUD only (OUD), OUD plus methamphetamine use (OUD/meth), or injection of other substance(s) (other). We utilized statistical analyses to assess group differences across hospital outcomes and post-discharge trends. We determined the OUD continuum of care for those with OUD, with and without methamphetamine use. Results A total of 370 patients met inclusion criteria- many with readmissions (98%) and high mortality (8%). The majority were White, male, and uninsured, with a median age of 38. One in four resided outside of a metropolitan area. There were significant differences according to substance use in terms of sociodemographics and hospital outcomes: patients with OUD/meth were more likely to leave via patient directed discharge, but those with OUD only had the greatest mortality. Comorbid methamphetamine use did not significantly impact the OUD care continuum. Conclusions The current drug crisis in AL will require targeted interventions to engage a young, uninsured population with SIRI in evidence-based addiction and infection services.

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.

7041 Background: The most concerning complications following port placement are infection and thrombosis. Early infections in patients with hematological malignancies are reported at 2-5% post-placement. However, data specific to patients with Acute Myeloid Leukemia (AML) is sparse. Here, we report infection rates within 30 days of placement and factors associated with increased risk of infection in patients with AML. Methods: We retrospectively reviewed charts of patients ≥ 18 years with AML who had ports placed between January 2019 to September 2022 at our institution. Baseline and peri-placement characteristics were collected. Port infection was defined as at least one of the following: 1) site infection, 2) gram-positive bacteremia, or 3) bacteremia that was documented by Infectious Disease consultants as a port source. Infections were classified as very early ( < 7 days) and early (7-30 days). Variables were compared in each group by using Pearson’s chi-square test. Results: A total of 101 ports were placed in 98 patients with AML. The median age at placement was 64 years and 58% of patients were female. A total of 14 (13.9%) port infections were identified; 5 (35.7%) were very early and 9 (64.2%) were early infections. The median time to infection was 15 days (range 1-25 days). 5 (35.7%) patients had site-only infections, 6 (42.8%) had isolated bacteremia, and 3 (21.4%) had both. 13 (93%) patients were hospitalized, and 1 patient died from infectious complications. 8 (57%) of infected ports were removed. 57 patients were on regimen-specific prophylactic antibiotics at the time of placement, of whom 12 developed an infection (21%). The infection rate was 10% vs 23% (p = 0.1) in patients with ANC ≥ 500 /µL and ANC < 500/µL respectively at 1 week after port placement, with no difference based on ANC at the time of placement. The infection rate was 21.9% vs. 6.5% in patients with platelets < 100 x103/µL and ≥ 100 x103/µL (p = 0.01) at the time of placement; 28% vs. 8.6% in patients with albumin < 3.5 g/L and ≥ 3.5 g/L (p = 0.02). The infection rate was numerically higher in Venetoclax-based regimens (19%) compared with cytarabine-based regimens (8%) (p = 0.06). Rates of infection were similar among inpatient and outpatient placements (14%). 5/53 patients (9.4%) were in complete remission (CR), 3/29 (10.3%) of newly diagnosed, and 6/19 (31.5%) relapsed/refractory (R/R) AML patients developed an infection (p = 0.02). Conclusions: In our single-institution study, a higher-than-expected port infection rate of 14% was seen in patients with AML. Platelets ≤100 x103/µL and albumin < 3.5 g/L at the time of placement, Venetoclax-based regimens, and R/R state were associated with significantly higher rates of infection. Interestingly ANC at the time of placement was not associated with an increased infection rate. Strategies to prevent early infections in these high-risk patients are much needed.