bluuebunny/crossref_metadata_2025 huggingface dataset:
P-847. Duration of Daptomycin and Ceftaroline Dual Therapy in Salvage Methicillin Resistant Staphylococcus aureus (MRSA) Bacteremia Prior to Monotherapy De-escalation
Authors: Lechner Josh , Kinn Patrick M , Ince Dilek , Percival Kelly M
Published: January 2025

Background

Methicillin resistant Staphylococcus aureus (MRSA) bacteremia is a serious medical condition known to cause mortality. Earlier escalation to daptomycin and ceftaroline is associated with improved outcomes compared to monotherapy; however, the optimal duration of dual therapy after bloodstream clearance remains unclear.

Methods

This was a single center retrospective cohort study comparing a composite outcome of clinical failure (90-day mortality, 90-day readmission, and bacteremia recurrence) in adult patients with MRSA bacteremia between June 2018 and June 2023 who received dual therapy. Patients who were treated with combination daptomycin and ceftaroline were divided into two groups: patients treated with dual therapy for less than or equal to ten days (short) and patients treated with dual therapy for greater than ten days (long).

Results

The study population included 14 patients in the short group and 13 patients in the long group with 48% female (n=13), 96% white (n=26), median age of 62 years (IQR 54-70), with additional demographics shown in Table 1. There was no statistically significant difference in the primary composite clinical failure outcome (50% vs 38%, p=0.70) which included 90-day infection-related mortality (36% short vs 23% long, p=0.67), 90-day readmission (29% short vs 23% long, p=1), and bacteremia recurrence (7% short vs 0% long). Culture data and antimicrobial usage is shown in Table 2, with patients in the long group receiving a mean of 15 days more of dual therapy than the short group. Patients in the long dual therapy group had longer duration of positive blood cultures after escalation to daptomycin and ceftaroline when compared to the short group (4 days long vs 2 days short) and had longer median hospital length of stays (22 days short vs 25 day long).

Conclusion

Among patients with persistent MRSA bacteremia, short durations of dual therapy with ceftaroline and daptomycin may be adequate once bloodstream clearance is achieved. This study found no difference in 90-day mortality, recurrence, or readmission among patients who received short vs long durations of dual therapy. Further research is needed to identify the optimal duration of dual therapy.

Disclosures

All Authors: No reported disclosures
P-869. Comparison of β-lactams Antibiotics Resistance of Viridans Streptococci in Bacteremic Children and Adults with Malignancy
Authors: Habuka Rie , Aizawa Yuta , Imamura Masaru , Takizawa Jun , Saitoh Akihiko
Published: January 2025

Background

Viridans streptococcus bacteremia (VSB) is an important complication after receiving chemotherapy in patients with malignancy. The increase in antibiotic resistance treating patients with VSB has been a major concern especially in children.

Methods

This is a retrospective study to evaluate patients with malignancy diagnosed with VSB at Niigata University Hospital in Japan between January 2009 and May 2023. Clinical characteristics of the patients, and antibiotic susceptibility of viridans streptococci were evaluated. We used the Mann-Whitney test for numerical variables and the χ2 test, or Fisher’s exact test for categorical variables.

Results

A total of 85 episodes (29 in children, 56 in adults) of VSB were identified during the study period. Acute myeloid leukemia was the most common diagnosis in both children (41%) and adults (61%). The susceptibility rate was significantly lower in children than adults; penicillin (45% vs. 79%, p =. 001), cefepime (52% vs. 91%, p < .001), and meropenem (55% vs. 89%, p < .001). Vancomycin was 100% susceptible in both groups. Based on the susceptibility results, the rate of appropriate initial antimicrobial coverage by empiric therapy was lower in children (59%) than in adults (91%) (p < .001). Severe complications included 2 meningitis cases in children, and a septic shock case in adults, 2 pediatric cases were treated with non-susceptible antibiotics at the onset of fever. No mortality was observed. The median number of previous febrile neutropenia episodes was higher in children (2, IQR 1-4) than adults (1, IQR 0-2) (p < .001). Additionally, the median duration of neutropenia at the onset was longer in children (6.5 days, IQR 4-11days) than adults (5 days, IQR 3-7days) (p = .03). No difference in β-lactam antibiotics use at the onset (7% vs. 0%, p = .11), or β-lactam exposure within 30 days of onset (41% vs. 41%, p = .98) was observed between child and adults.

Conclusion

We demonstrated a high rate of β-lactam antibiotics resistance to viridans streptococci in patients with malignancy, especially in children. The frequent antimicrobial exposure in children might be related to such high resistance. Vancomycin may need to be included in an empiric therapy in the setting where β-lactam antibiotics resistance of viridans streptococci is high.

Disclosures

All Authors: No reported disclosures
P-870. Daptomycin-Susceptible vs. Daptomycin-Non-susceptible Enterococcus Bloodstream Infections: Rates and Predictors of Treatment Failure and Predictors of Daptomycin Resistance
Authors: Olion Kelsey , Moenster Ryan P , Wallace-Lacey Ashleigh , Remensnyder Blake , Linneman Travis W
Published: January 2025

Background

Daptomycin is a well-tolerated option to treat resistant enterococci; however, updated breakpoints from the Clinical Laboratory and Standards Institute (CLSI) have led to increasing numbers of ‘susceptible, dose-dependent’ (SDD) or daptomycin non-susceptible (DNS) isolates.

Methods

This study was to determine if isolation of daptomycin-sensitive enterococcal (DSE) or daptomycin-non-susceptible enterococcal (DNSE) isolates from the blood impacts patient outcomes. A retrospective, observational, cohort of patients within the Veteran’s Affairs (VA) Healthcare System from 1 January 2017 to 31 December 2021 with at least 1 blood culture positive for Enterococcus faecalis or E. faecium was identified. Patients were analyzed in 3 cohorts: 1) all included patients, 2) only patients with minimum inhibitory concentration (MIC) data available, and 3) E. faecium isolates and DSE isolates only. The primary outcome of treatment failure was a composite of 30-day mortality and microbiological failure. Two multivariate regressions were conducted - one to establish predictors of treatment failure and one to establish predictors for daptomycin non-susceptibility.

Results

Two hundred four patients were included (90 DSE, 114 DNSE). In cohort 1, 63.3% (57) DSE patients experienced failure vs. 58.8% (67) in the DNSE group (p = 0.56). Sixty-nine percent (40/58) of DSE patients failed in cohort 2 vs. 56.4% (35/62) of DNSE patients (p = 0.157), and 69% (40/58) of DSE and 64.4% (56/87) of DNSE failed in cohort 3 (p = 0.56). Multivariate regression revealed infectious diseases (ID) consultation (OR 0.402; 95% CI, 0.176-0.918; p = 0.030) was associated with reduced risk of failure, while infection with vancomycin-resistant enterococcus (OR 2.04; 95% CI 1.028-4.049; p = 0.04) and endocarditis/endovascular source of infection (OR 4.33; 95% CI 1.34 – 13.99; p = 0.01) were associated with increased risk of failure. Previous beta-lactam and vancomycin exposure were associated with increased risk of DNSE.

Conclusion

No significant difference in failure between patients with DSE and DNSE bacteremias was observed; however, ID consultation was found to be protective, and previous antibiotic exposure was associated with increased DNSE risk.

Disclosures

All Authors: No reported disclosures
P-887. Evaluation of ceftriaxone and cefotaxime as surrogate markers for oral second and third generation cephalosporins in Escherichia coli strains from blood
Authors: Pham Tho H , Molina Kyle , Huang Vanthida
Published: January 2025

Background

Oral second- and third-generation cephalosporins are increasingly being utilized as oral transitional therapy for Escherichia coli bloodstream infections due to resistance or intolerance to other classes. However, most automated susceptibility systems only include cefazolin (CFZ), ceftriaxone (CRO), or cefotaxime (CTX). We aimed to evaluate the susceptibility correlation of CFZ, CRO, or CTX compared to oral second- and third-generation cephalosporins to determine a potential surrogate breakpoints.

Antimicrobial susceptibility and categorical agreements of intravenous and oral cephalosporins against 100 E. coli strains

Methods

We obtained 100 E. coli blood isolates from HonorHealth and Abrazo Health Systems in Phoenix, AZ from September 2021 to 2023. Broth microdilution was performed according to CLSI using commercially purchased CFZ, CRO, CTX, cefuroxime (CXM), cefaclor (CEC), cefprozil (CPR), cefdinir (CDR), and cefixime (CFM). E. coli ATCC 25922 was utilized as quality control. Categorical agreement and error rates were calculated for drug-drug combinations using CFZ, CRO, or CTX as the surrogate antibiotic for oral cephalosporins.

Results

MIC50/90 values were reported in Table 1. With the recommended CFZ surrogate breakpoint of ≤ 16 µg/mL for oral cephalosporins, the categorical agreement rates were 86% for CEC and 93% for CPR. When applying CRO and CDR breakpoint of ≤ 1 µg/mL, highest categorical agreement rates of 99% were seen with CDR, followed by those of 86% with CPR. Compared to CFZ, CRO, and CXM resulted in higher false susceptible rates with CEC and CPR. However, if CRO and CTX MIC ≤0.06 µg/mL had been used, the categorical rates would have been above 95% with CEC and CPR. CFM susceptibility could not be predicted with CFZ, CRO, or CTX due to high major error rates.

Conclusion

This study suggests potential utility of parenteral first- and third-generation cephalosporins as surrogates for oral counterparts within their respective second- and third- generations. Use of a lower breakpoint for third generation cephalosporins strengthens their role as surrogates. Future investigation is warranted to clinically corroborate these findings.

Disclosures

Kyle Molina, PharmD, Innoviva Speciality Therapeutics: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Merck: Grant/Research Support|Shionogi: Advisor/Consultant
367. Enhancing antimicrobial stewardship capacity building and communication across multidisciplinary departments in Chinese hospitals: a national qualitative study
Authors: Wang Xiaomin , Zhou Xudong
Published: January 2025

Background

Antimicrobial stewardship (AMS) programs have been widely adopted and proven to be effective to optimize antibiotic use. After a decade of efforts in mandatory AMS implementation, inappropriate prescribing and antimicrobial resistance are still disproportionately prevalent in China. We aim to investigated the underlying barriers to the mandatory AMS programs from a multidisciplinary health system perspective in the Chinese context.

Example of quotes from interview transcripts that illustrate and validate the themes

Methods

Face-to-face, in-depth qualitative interviews were conducted in 16 public hospitals in eastern, central, and western China. Hospitals were purposely selected with full consideration to represent both economically developing and developed areas and both secondary and tertiary care hospitals. A total of 111 respondents were interviewed, including 38 doctors, 28 clinical pharmacists, 15 microbiologists, 14 infection prevention and control (IPC) specialists, 10 experts from medical service departments, and 6 quality improvement experts. A thematic framework analysis was conducted aided by NVIVO 11 software.

Example of quotes from interview transcripts that illustrate and validate the themes (continue)

Results

Our research identified two key barriers to AMS implementation. 1) Inadequate AMS-related capacities among doctors and nurses. Doctors, especially surgeons, had inadequate knowledge and poor practices on appropriate antibiotic use and had insufficient knowledge and skills in antimicrobial susceptibility testing (AST) and its interpretation. The continuing education in a few hospitals was reported to be crammed with large class sizes and showed little effect on capacity improvement. 2) Poor communication and cooperation between the AMS team and doctors. Compared with AMS team members, doctors had a dominant and powerful position in hospitals. Clinical pharmacists admitted that they were subjected to high pressure and not well respected while conducting routine prescription audit and feedback works. Most (87%) of the interviewed microbiologists were not able to access the electronic health records.

Conclusion

We propose a multi-disciplinary training program covering microbiology, clinical pharmacy, and IPC for newly-recruited health workers (i.e., doctors and nurses), and a communication mechanism among clinical departments and AMS members to facilitate AMS implementation.

Disclosures

All Authors: No reported disclosures
P-894. MRSA bacteremia with high MIC to Vancomycin: A comparison study of Daptomycin, Ceftaroline, and Both
Authors: Al khouri Zaid , Al Qura'an Anood , VanNatta Mollie , Alam Mohammad , Munshi Ruhul , Malek Alexandre
Published: January 2025

Background

Daptomycin (DAP) and/or ceftaroline (CPT) have been used in pts with MRSA bacteremia (MRSAB) with minimum inhibitory concentration (MIC) 2 ug/ml to vancomycin (Vanc). However, head-to-head studies comparing DAP versus CPT or DAP-CPT combination are lacking. In this study, we sought to describe the outcomes and characteristics of pts with MRSAB who received DAP, CPT, or both.

Methods

We performed a retrospective cohort study of adult pts admitted to Ochsner LSU Health Shreveport– Academic Medical Center who were diagnosed with MRSAB MIC 2 ug/ml to Vanc and received DAP, CPT, or both for at least >=72 hours. Pts’ demographics, comorbidities, source of infection, and mortality data were all collected.

Results

We identified 82 pts with MRSAB MIC 2 ug/ml to Vanc. We divided them into 3 groups: DAP (n = 39, 47.6%), CPT (n = 12, 14.6%), and DAP-CPT (n = 31, 37.8%). The mean age was 53 vs 55 vs 63 y, respectively (p-value=0.013). Males were more prevalent than females in the 3 groups. Pts’ demographics at baseline were comparable between the three groups, and there were no statistically significant differences between the three groups in terms of comorbidities. Prior MRSA bacteremia was reported in 5 pts in the DAP-CPT group and DAP group (p-value=0.34). IV drug use was only reported in 5 pts who received DAP(p-value=0.05). SSTI (33.3%) was the leading cause of bacteremia in DAP group followed by osteoarticular and CVC-related infections in 25.6% each. The lung was the most source of infection in 58.3% of Pts in CPT group. In the DAP-CPT arm, IE was the main source of infection (48.4%), followed by endovascular and lung in 38.7% each. IE was statistically significant in DAP-CPT group (p-value=0.002). The mean of MRSA bacteremia was 4 vs 5 vs 9 days in DAP, CPT, and DAP-CPT, respectively while the clearance of MRSA bacteremia after the initiation of each regimen was faster and in favor of Pts who received DAP-CPT (2.3 d), p-value< 0.009. However, the 30-day mortality was higher in patients of the DAP-CPT group (25.8%), p-value=0.02.

Conclusion

Our data demonstrated that pts who received DAP-CPT combination therapy cleared MRSA bacteremia faster than those who received DAP or CPT as monotherapy. Further studies are needed to elucidate if early initiation of the DAP-CPT combination could reduce the mortality rate.

Disclosures

All Authors: No reported disclosures
P-896. Artificial Intelligence Performs Well in Assessing the Clarity of Definitions of Variables in Periprosthetic Joint Infection Studies
Authors: Tenorio Bettina Gabrielle V , Yu Melody Hope Lee , Deslate Angelica Bernadette , Tai Don Bambino Geno
Published: January 2025

Background

Artificial intelligence (AI) has the potential to improve healthcare research methodologies, particularly in addressing the need for consistency and clarity in defining variables in observational studies. However, concerns exist regarding the accuracy and reliability of AI in this context.

Performance of Artificial Intelligence in Assessing Clarity of Definition of Variables

Methods

We reviewed observational studies on prosthetic joint infection studies from 2017-2023, focusing on 13 categories of variables. We used ClaudeAI 2 (Anthropic, San Francisco, CA), a large language model, in analyzing definitions from full texts, instructing it to classify them as objective, subjective, or undefined. Some examples of a highly objective definition are the presence of time element, severity, staging, frequencies, laboratory cut-off, and medication dependence. A simple chart review was deemed subjective.

Results

We included 75 studies with a total of 369 variables in the analysis. AI detected 88% of variables (n=324). Of those detected, 74% (241/324) were correctly classified. It accurately identified antibiotic use and infection type as the variables that are most frequently defined objectively (94%). For the 9/13 categories, it appropriately assessed that most studies lacked definitions. Smoking (20%) and alcohol use (33%) were least frequently defined. Notably, 5 detected variables did not exist in the manuscripts.

Conclusion

The model demonstrated high performance in detecting variables from study text and evaluating the clarity of variable definitions. The false positive detections serve as an important reminder that human oversight remains crucial to ensuring accuracy when integrating AI into the research process. Looking ahead, AI may assist researchers in objectively defining study variables from the outset and verifying the correct application of definitions. More studies are needed on how to optimally integrate its capabilities into the research process.

Disclosures

All Authors: No reported disclosures
P-912. A 10-Year Retrospective, Single-Center Analysis of Nocardiosis in Immunocompetent and Immunocompromised Hosts: Clinical and Microbiological Features, Treatment Outcomes, and Determinants of Central Nervous System Involvement
Authors: Machiavello Roman Francisco J , Grubman Allison , Azar Marwan M , Farhadian Shelli F
Published: January 2025

Background

Nocardia species are organisms with the potential to affect numerous organ systems, including the brain. However, it is unknown whether specific host or microbe factors are associated with central nervous system (CNS) nocardiosis and whether outcomes for CNS nocardiosis differ according to host immune status.

Demographics and clinical characteristics by immune status. SOTr: solid organ transplant recipient. SCTr: stem cell transplant recipient. MSK: musculoskeletal structure, such as bone or joint. COPD: chronic obstructive pulmonary disease. WBC: white blood cell count. *The isolation of Nocardia in 2 or more non-contiguous body sites constituted disseminated disease

Methods

We performed a retrospective review of all adults admitted to Yale New Haven Hospital with laboratory-confirmed nocardiosis from 2013 to 2023. CNS involvement was defined as the identification of Nocardia spp on brain tissue or new radiological brain lesions in a patient with extra-neural nocardiosis. We performed multivariate logistic regression analyses of clinical and microbiological variables related to CNS involvement.

Nocardia species distribution by CNS involvement

Results

94 patients were included, of which 63 (67%) were immunocompromised (Table 1). The most common immunocompromising conditions were recipients of solid organ transplants (32%) and stem cell transplants (22%). Sixteen (17%) patients had CNS involvement of their nocardiosis; this included 22% of immunocompromised and 6% of immunocompetent patients (p=.056). The most common species isolated was the Nocardia nova complex (Table 2). Table 3 summarizes the univariate analysis of factors associated with CNS involvement. Black race [OR 3.7 (1.2-11.7), p=.03] and N. farcinica infection [OR 5.9 (1.8-19.3), p=.005] were associated with increased risk of CNS involvement. In a multivariate analysis, infection by N. farcinica was an independent risk factor for CNS involvement [OR 5.3 (1.5-18.7), p=.009]. There were no significant survival differences in immunocompromised hosts, with or without CNS disease, compared to immunocompetent hosts.

Univariate analysis of demographic, host immune status and organism features associated with CNS involvement.

Conclusion

N. farcinica infection was identified as an independent risk factor of CNS involvement in patients with nocardiosis. Other factors related to the net state of immunosuppression were not associated with an increased risk for CNS involvement.

Disclosures

All Authors: No reported disclosures
P-936. Incidence and Risk Factors for Ventricular Assist Device Infections: A Retrospective Review from the Middle East Gulf Region
Authors: Hisham Mohamed , Salmeh Noor , Shah Hajra , El Lababidi Rania M , Atallah Bassam , Abidi Emna , Afif Claude
Published: January 2025

Background

A ventricular assist device (VAD) is either a destination therapy or a bridge to heart transplant for patients with end-stage heart failure. Unfortunately, VAD infections are a major complication postimplant. We aimed to evaluate the incidence, risk factors, and outcomes for patients with VAD infections.

Baseline characteristics and risk factors for patients implanted with ventricular assist device.

Methods

We performed the single-center, observational, retrospective study on all patients who underwent VAD implantation between May 2016 and August 2022 with a minimum of 12-month follow-up post-placement. We defined VAD infections according to the International Society of Heart and Lung Transplantation (ISHLT) criteria, classifying infections into VAD-specific and VAD-related. We included all patients above 18 years of age with VAD and excluded patients who underwent VAD implantation outside our facility.

Results

We included 29 VAD patients, of which 16 were HeartMate 3 left ventricular assist devices (LVADs), 12 were HeartWare ventricular assist devices (HVADs), and one was a biventricular assist device (BiVAD). We reported an overall incidence of 41.3% (n=12/29) of VAD infections during the study period. Within one year post-implantation, we had two VAD-specific driveline infections, which isolated Pseudomonas aeruginosa and methicillin-sensitiveStaphylococcus aureus from the pus culture, and seven VAD-related infections (mediastinitis and bloodstream infections). Bloodstream infections included coagulase-negative staphylococci (n=4), Klebsiella pneumonia (n=1), andCandida tropicalis (n=1). We also had three patients with driveline infections one year after implantation. There were 15 patients requiring extracorporeal membrane oxygenation (ECMO) and one on Impella®. The mean (SD) length of stay during VAD infection was 56.5 (±37.6) days, all-cause mortality for patients with VAD infections was 41.6% (n=5/12), and the overall all-cause mortality in our study was 44.8% (n=13/29).

Conclusion

The VAD infections for patients on additional cardiac implantable electronic devices, multiple device reinterventions, or requiring temporary mechanical support complicate the overall outcome. Further studies with a larger population from the region are necessary to make better decisions about preventing and treating VAD infections.

Disclosures

All Authors: No reported disclosures
373. Closing Care Gaps: Optimizing Pre-Transplant Trypanosoma cruzi Testing
Authors: Newstead Sabrina E , Swaminathan Neeraja , Imlay Hannah
Published: January 2025

Background

Chronic Trypanosoma cruzi infection can be asymptomatic, but T.cruzi can reactivate and cause disease among transplant recipients following immunosuppression. Prior to transplant it is recommended to perform 2-step testing among candidates at high risk of exposure, defined as patients who were born or had prolonged residence in Mexico, Central, or South America. We reviewed transplant recipients at our institution to identify the frequency of testing, percentage with positive testing, and whether testing was being performed in the appropriate high-risk population.Figure 1:Percentage of transplant patients tested by organ type.

Methods

We identified patients who underwent organ transplant from January 1, 2018 – April 18 2024 and determined how many patients underwent T.cruzi testing. Among those with positive tests, we identified the proportion with epidemiologic risk factors; we also determined whether appropriate confirmatory testing was obtained. We identified 40 randomly selected patients registered as Spanish-speaking in our electronic medical record (EMR), reviewed their charts to determine whether they were at high risk of exposure, and identified if they received screening.Figure 2:Number of patients with high epidemiologic risk who were tested vs not tested for T.cruzi, among 40 patients reviewed.

Results

Among 1399 patients who underwent transplant (104 lung, 101 heart, 212 liver, 918 kidney, 62 multiorgan, 2 pancreas), 180 (12.9%) were tested for T.cruzi (Figure 1). Twelve of 180 tests (6.7%) were initially positive; only 8/12 (75%) positive tests were among patients with high risk for T.cruzi. Ten of 12 positive tests were sent for confirmatory testing and 2 tests were not sent or followed up. Only one patient had a positive confirmatory test and underwent post-transplant monitoring. Of 40 patients identified as Spanish-speaking in the EMR, all 40 had high epidemiologic risk but only 18 (45%) underwent appropriate pre-transplant T.cruzi testing (Figure 2).

Conclusion

We identified several care gaps in our pre-transplant T.cruzi testing, including over-testing among patients without epidemiologic risk, under-testing among patients with risk for prior T.cruzi exposure, and incomplete confirmatory testing. Our data highlight an opportunity for specific testing guidance and education to optimize patient care.

Disclosures

All Authors: No reported disclosures
P-977. Design and Implementation of a State-Wide Infection Prevention and Control (IPC) Curriculum; Delivering Comprehensive, Engaging, Accessible Content Promotes Sustained Learner Engagement
Authors: Ching Patrick R , Rittmann Barry , Cooper Kaila , Armstrong-Novak Jo Dee , Stevens Michael , Spleen Angela , Lineberger Sarah , Vanhoozer Ginger , Pryor Rachel , Sastry Sangeeta , Wooten Ryan , Doll Michelle
Published: January 2025

Background

In the wake of COVID-19, the Virginia Department of Health (VDH) partnered with Virginia Commonwealth University Health System to produce a comprehensive IPC curriculum to address known gaps in education among healthcare providers. A 2021 needs assessment conducted by VDH found needs for comprehensive IPC education that was more accessible, engaging, and interactive.

Core Content Attendee Work Settings

Methods

A tiered curriculum was developed to address the identified needs from a variety of healthcare provider types: Foundational, Intermediate, and Advanced, targeting respectively concepts critical for anyone in the healthcare environment, concepts for HCP actively engaged in IPC activities in their facility, and concepts for those leading IPC programs or healthcare facilities. The education was delivered in a hybrid model with virtual-synchronous and virtual-asynchronous offerings in addition to in-person conferences. To rapidly build engaging content, expertise to create content was contracted from experts in IP across the United States. Evaluations and content created from 7/2021-4/2024 were reviewed and summarized.

Total Attendees by Learning Experience

Results

Eighty individual modules organized into 3 core courses, a webinar series, and specialty site series were created by 62 individual IPC experts in less than 3 years. The program conducted 4 in-person conferences and 2 additional synchronous virtual conferences, and 13 live webinars. Materials remain accessible for on-demand learning. Content has been consumed by 4152 attendees (by total # registrations, not unique participants) across 43 states and 19 different countries. The breakdown of learner types is shown in Figure 1. Learners were more likely to access live virtual content (3472) than on-demand virtual content (509) or in-person events (171). Total attendees by event type over time are shown in Figure 2.

Conclusion

By leveraging existing expertise within the Infection Prevention community of professionals, a comprehensive IP program was rapidly implemented and provided sustained educational opportunities to HCP. HCPs preferred live virtual events to other delivery models to access the content.

Disclosures

All Authors: No reported disclosures
P-990. Inequities in Testing for Infants Perinatally Exposed to Hepatitis C Viral Infections — Tennessee, 2018–2023
Authors: Thomas Christine M , Wingate Heather , Roberts Shamia , Sizemore Lindsey , Fill Mary-Margaret A , Jones Timothy F , Schaffner William , Dunn John R
Published: January 2025

Background

National guidelines recommend testing infants perinatally exposed to hepatitis C virus (HCV). We sought to examine sociodemographic factors associated with HCV testing and infection among Tennessee infants.

Comparison of Testing Practices for Infants Perinatally Exposed to HCV by Sociodemographic Characteristics — Tennessee, January 2018–July 2020

1 Percentages might not add up to 100% because of missing data.

2 This analysis excludes 177 infants with HCV testing that did not adhere with guidelines.

Methods

The Tennessee Department of Health conducts active perinatal HCV surveillance by requesting that clinicians report all HCV test results for perinatally exposed infants. For infants born during January 2018–July 2020, we linked birth certificate sociodemographic information with HCV test results as of July 31, 2023. We defined HCV RNA testing at 2–36 months or antibody testing at 18–36 months of age as guideline-adherent; testing conducted outside these ages as not guideline adherent. In Tennessee, perinatal hepatitis C is considered confirmed if positive RNA testing at 2–36 months, probable if positive antibody testing only at 18–36 months, and excluded if negative RNA testing at 2–36 months or negative antibody testing at ≤ 36 months of age. We calculated odds ratios (OR) to identify sociodemographic factors associated with guideline-adherent testing.

Results

Among 3,020 infants perinatally exposed to hepatitis C, 776 (26%) had guideline-adherent HCV testing, 177 (6%) had testing that was not guideline adherent, and 2,067 (68%) did not have any testing reported. Infants born to Black or Hispanic persons had lower odds of guideline-adherent testing, compared with White (OR = 0.33 [95% CI: 0.20–0.53]) or non-Hispanic (OR = 0.27 [95% CI: 0.11–0.68]) persons. Infants had higher odds of guideline-adherent testing if born to a person residing in a medium or small, compared with large metropolitan areas (OR = 2.94 [95% CI: 2.32-3.72]), or if public insurance was used at birth, compared with private insurance (OR = 1.64 [95% CI: 1.23–2.18]) (Table). Of 798 infants with hepatitis C status determined by 36 months of age, 51 (6.4%) had either confirmed (n = 45) or probable (n = 6) hepatitis C.

Conclusion

Most perinatally exposed infants in Tennessee were not tested for hepatitis C. Black and Hispanic infants were less often tested and residents of medium or small areas more often tested. Equitable implementation of testing practices for perinatally exposed infants is necessary to avoid compounding disparities in hepatitis C treatment.

Disclosures

All Authors: No reported disclosures
P-994. Cellular and humoral immunological profile of Human T-Lymphotropic Virus type I (HTLV-1) in a pediatric case series
Authors: Rojas Juan P , Donneys Diana , James Ingara
Published: January 2025

Background

Human T- lymphotropic Virus type 1 (HTLV-1) is a powerful oncovirus. In South America there is a high incidence of cases in countries such as Brazil, Peru and Colombia, mainly affecting the indigenous and Afro-descendant population. In children, the main clinical findings are dermatological manifestations followed by lung disease, opportunistic coinfections, and autoinflammatory disorders. The main target of HTLV-1 is CD4+ T lymphocytes, which are the regulators of the acquired immune response, but It’s also capable of infecting CD8+ T lymphocytes, B cells, dendritic cells and synovial cells.

The purpose of this study is to describe the humoral and cellular immunological profile in pediatric patients diagnosed with HTLV-1 in a reference center in Cali, Colombia.Table 1.Characterization of cellular immunity in pediatric patients diagnosed with HTLV1 (n = 6)BL: B lymphocyte, TL: T lymphocyte Source: Self elaboration

Methods

This is an observational, descriptive, retrospective cross-sectional study carried out between January 2017 and March 2021.Table 2.Characterization of humoral immunity in pediatric patients diagnosed with HTLV1 (n = 16)

Results

Nineteen patients were included in this study with a median age at diagnosis of 94 months, most of them were schoolchildren (52.6%), 50% of patients had elevated B lymphocytes (CD19), and 50% of them had normal range cytotoxic T lymphocytes (CD8+) and helper T lymphocytes (CD4) (Table 1 and graph 1). None of the patients had decreases in serum immunoglobulins (IgM, IgG, IgE and IgA) (Table 2 and graph 2)Graph 1.Cellular immunological profile (n=6)

Conclusion

HTLV-1 immunosuppression is not mediated by low levels of lymphocyte subpopulations in the pediatric population.Graph 2.Humoral immunological profile (n=16)

Disclosures

All Authors: No reported disclosures
P-998. A multi-center observational study in Northern Italy to evaluate the impact of Sepsis bundle in Obstetric Settings: the SOS study
Authors: Colaneri Marta , Biscarini Simona , Tiranini Lara , Pesare Rebecca , Valsecchi Pietro , Seminari Elena Maria , Spinillo Arsenio , Bandera Alessandra , Ferrazzi Enrico Maria , Gori Andrea , Carenzi Laura , Pusterla Luigi , D’Amico Federico , Raimondi Alessandro , Puoti Massimo , Vallicella Elisa , Grisolia Gianpaolo , Zavatta Alice , Cetin Irene , Bonetti Alice , Baldanti Fausto , Cambieri Patrizia , Pan Angelo , Seminari Elena Maria , Torriani Camilla , Monti Cristina Maria , Bruno Raffaele
Published: January 2025

Background

Maternal sepsis presents challenges in early detection and treatment. A pregnancy-specific sepsis scoring system (MEOWS) and management bundles for pregnant septic patients were recently introduced, but there is a lack of data on their effectiveness. Our study aims to assess the impact of implementing a Lombardy sepsis bundle for septic pregnant and puerperal patients.Table 1:Demographic and clinical data of the patients included

Methods

The SOS, a retrospective multicenter study across 7 Lombardy Hospitals, focuses on adult pregnant and puerperal women diagnosed with sepsis according to SCC [1]. Medical records from 2 periods were analyzed: pre-bundle implementation (May 2015 - May 2018) and post-bundle implementation (Jan 2019 - Jan 2022). The primary outcome was to describe clinical and microbiological data, while the secondary outcome was to evaluate the impact of the Sepsis bundle on the length of stay (LOS), the timing of antibiotic treatment, and the rate of positive blood cultures (BCs).

Results

Eighty patients (24 in the pre-bundle and 56 in the post bundle period) were found (Table 1). Overall, median age was 31 years, they had few underlying comorbidities and mostly were pregnant (rather than puerperal) in the moment of sepsis occurrence (Table 2).

More than half of the post-bundle patients had a high MEOWS score (62%) and an mSOFA score of more than 1 (70%) (tablee 2). Microbiological data are detailed in Table 3, while outcome data in Table 4. No significant differences were found in the rate of positive BCs (p=1) between the 2 periods. Similarly, the rate of antibiotic treatment started before BCs collection, and the LOS did not significantly differ (p=0.40). However, in the post-bundle period there were both a marked increase in infectious disease (ID) consultations (p=0.003), and a reduction of neonatal Intensive Care Unit admission (p=0.013).

Conclusion

While the bundle did not significantly improve maternal outcomes, it led to an increased number of ID consultations, providing a more comprehensive understanding of sepsis severity, and a consequent reduction of neonatal severity conditions.

Disclosures

All Authors: No reported disclosures
P-1006. If You Build It Will They Come?: Lessons Learned from a Dedicated Congenital Syphilis Clinic
Authors: Rochat Ryan H
Published: January 2025

Background

Cases of congenital syphilis (CS) have been rising for the past decade, with 3755 infants affected in 2022 alone. Texas accounted for nearly 25% of these children, with 922 cases reported in 2022, up 35% from the year prior. A review of the management of these children across our system of over 2000 medical professionals suggested that a clinic dedicated to CS, may be warranted to ensure that these children receive evaluations as recommended by the CDC. Here we report on the logistics of this clinic with insights into its success and failures, and the implication of these findings for the general pediatric population and its providers.

Methods

Laboratory and encounter specific data for children diagnosed with CS from 1/1/2010 to 12/31/2021 was obtained from our Epic® electronic health record (EHR). Additionally, we requested scheduling and appointment information for patients evaluated in our CS clinic at Texas Children’s Hospital which started in 2022.

Results

Prior to the establishment of our dedicated CS clinic in 2022, we identified 458 children born into our hospital system and had been evaluated for CS from 2010-2021. Of these 458 infants, 233(51%) had a subsequent encounter within our system at ≥2months of age, with only 66(28%) of them having a repeat RPR. From 4/2022-12/2023 there were a total of 367 outpatient encounters in our CS clinic (239 completed, 128 no show/cancelled). All children seen in our CS clinic had repeat RPR testing, in addition to age-appropriate developmental screening, according to CDC recommendations.

Conclusion

The rising rate of CS in the US should concern all pediatricians. Our findings call attention to the reality that follow up is not guaranteed and recommendations are not universally followed. Given that CS cases were at lifetime lows a decade ago, there is a concern that providers may be unaware of current management recommendations for these children. Integrated healthcare systems, coupled with clinical informatics, give us the opportunity to address these problems in real-time and make sure no child falls through the cracks. Our results and experiences from this unique clinic will be invaluable in providing timely feedback for tailoring education to providers and families to make sure that these children get the care they deserve.

Disclosures

Ryan H. Rochat, MD, PhD, MS, Merck Sharpe Dohme: Grant/Research Support
P-1007. Cytomegalovirus reinfections and viral shedding in seropositive pregnant women
Authors: Ross Shannon , Boppana Suresh , Vinson Anslee , Fowler Karen
Published: January 2025

Background

Congenital Cytomegalovirus (CMV) is a common cause of hearing loss and other sequelae in children. Rates of congenital CMV are higher in maternal populations seropositive before pregnancy, often due to the acquisition of a new strain of CMV. The objective of this study is to document CMV reinfections in CMV seropositive pregnant women and correlate them with CMV shedding.

Methods

Pregnant women positive for CMV IgG were enrolled after their first prenatal visit but before 20 weeks gestation and followed prospectively. Maternal demographics were obtained, and blood, urine, saliva, and vaginal samples were obtained at enrollment and regular intervals during pregnancy and immediately post-partum. Maternal sera were analyzed for strain-specific anti-CMV antibody reactivity to four CMV epitopes, and when a new strain-specific antibody reactivity occurred during pregnancy, they were considered reinfected. All specimens were tested for CMV DNA by Real-time PCR.

Results

Among 165 pregnant women, the mean age at enrollment was 26.6 years (±5.4). 80% of the women were non-Hispanic Black and never married. At study enrollment, 52 women (31.5%) had antibody reactivity to one CMV strain while 83 (50%) had 2 or more strain-specific antibodies. There was no difference in viral shedding at study enrollment between the women with one strain-specific antibody (4/52, 7.7%) compared with women with two or morestrain specific antibodies (11/83, 13.3%, p=0.34). Ten of 165 women (6%) acquired antibodies reactive with a new strain of CMV during the study period (reinfection). Among the 10 women with CMV reinfection, 3 (33.3%) had CMV shedding, with 2 shedding in the visit before documented serological reinfection and one with viral shedding after reinfection. The majority of women with reinfection provided direct care of young children (9/10), lived in a household with 3 or more people (8/10), and lived with children < 6 years of age (8/10).

Conclusion

In this urban, young cohort of seropositive pregnant women, CMV reinfections occur. However, viral shedding was documented in only a third of women with new CMV antibody reactivity. Most women with reinfection had close contact with young children.

Disclosures

Suresh Boppana, MD, GSK: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support Karen Fowler, DrPH, Moderna: Advisor/Consultant
P-1008. Congenital Cytomegalovirus Infection Screening in the Newborn Nursery: Areas for Improvement in the Absence of Standardized Guidelines
Authors: Abraham Tanya , Desai Ankita P , Minich Nori M
Published: January 2025

Background

Cytomegalovirus (CMV) is the most common viral cause of congenital defects in the U.S. Early identification of congenital CMV (cCMV) infection allows for optimal antiviral treatment which reduces progression of sensorineural hearing loss and improves neurodevelopmental outcomes. There is varying guidance from expert consensus groups ranging from universal screening to selective screening based on clinical features. With conflicting data, many hospitals have no standardized protocol for cCMV screening. This study aims to detail clinical characteristics and outcomes of infants with cCMV in a tertiary medical center prior to implementation of standardized guidelines.

Methods

This was a retrospective case study of newborns who screened positive for CMV between June 2017-July 2022 at Rainbow Babies & Children’s Hospital in Cleveland, Ohio. 1900 newborns less than 21 days old were tested for CMV during this period, and newborns who screened positive for CMV were included (n=18). Clinical characteristics of the patients were described using median and interquartile range for continuous variables and frequency and percentages for categorical variables.

Results

The prevalence rate of cCMV at our center is 9.5 per 1000 live births. The most common associated clinical features were small for gestational age (SGA; n=12), microcephaly (n=9), abnormal neuroimaging findings (n=6), and failed newborn hearing screen (n=4). Two patients had isolated SGA, and neither received treatment nor had clinical sequelae. Saliva PCR tests were used for screening with no confirmatory urine testing. 11 patients received oral valganciclovir with documented side effects of transient neutropenia and transaminitis. 33% of newborns had no infectious disease or audiology follow-up.

Conclusion

Targeted screening practices for cCMV infection in our institution varies between providers. Our center has a prevalence rate slightly above the national average; however, the yield of screening isolated SGA is shown to be low. This study highlights gaps in current cCMV screening including lack of confirmatory urine CMV testing, and infants lost to follow up. System-level interventions including creation of standardized guidelines and provider education are necessary to improve follow-up and outcomes.

Disclosures

All Authors: No reported disclosures
P-1009. Invasive Fungal Disease is Rare in Multiple Myeloma Patients Treated with BCMA CAR-T Therapy
Authors: Pena Angelica Medina , Bridget Kim E , Cirstea Diana , Hammond Sarah P , Little Jessica S
Published: January 2025

Background

B-cell maturation antigen (BCMA) chimeric antigen receptor T-cell (CAR-T) therapy has transformed treatment of relapsed/refractory multiple myeloma (MM). While this innovative therapy may introduce increased risks for infections, little is known about the characteristics and incidence of invasive fungal disease (IFD).Table 1.Institutional protocols for antifungal prophylaxis following immune effector cell therapy.

Methods

We evaluated MM patients treated with first BCMA CAR-T therapy at 2 institutions November 2016 through October 2023. Table 1 summarizes institutional protocols for antifungal prophylaxis for immune effector cell (IEC) therapy. We documented IEC toxicities graded according to ASTCT and Lee Criteria. Proven or probable IFD was recorded from Day 0 through last follow-up, Day 365, or death according to the EORTC/MSGERC consensus criteria.Table 2.Baseline characteristics & immune effector cell toxicity

Results

Among 234 patients in the cohort, median age was 66 years, and 56% were male. Patients had a median of 6 prior therapy lines, and 68% had undergone autologous stem cell transplant (Table 2). The most common IEC toxicity was cytokine release syndrome (CRS), observed in 84.6% of patients, primarily Grade 1-2 (Table 2). Four patients (1.7%) developed proven/probable IFD, including 1 with Candida albicans peritonitis and 3 with invasive aspergillosis. Among these 4 cases, the timing of diagnosis ranged from 6 to 104 days post-CAR-T infusion. All four had CRS/ICANS and received corticosteroids. Outcomes were mixed, with 3 cases reported as severe and 2 deaths within 30 days. One death occurred from Stenotrophomonas sepsis, and isolated cardiac Aspergillus was found incidentally on autopsy. On the second case, pulmonary Aspergillosis was found shortly before transitioning to comfort care due to hemophagocytic lymphohistiocytosis and Staphylococcus aureus pneumonia (Table 3).Table 3.Characteristics of invasive fungal disease

Conclusion

This is the largest study to date to provide details on the incidence and characteristics of IFD in BCMA CAR-T recipients. Here we demonstrate a low incidence of IFD despite a lack of routine antifungal prophylaxis. Nonetheless, these infections may be severe and appear to affect the most vulnerable with IEC toxicities with 50% of affected patients dying with active infection. Larger studies are needed to define underlying risk factors in this population.

Disclosures

Diana Cirstea, MD, Sanofi: Advisor/Consultant Sarah P. Hammond, MD, Cidara: Grant/Research Support|F2G: Grant/Research Support|GSK: Grant/Research Support|Melinta: Advisor/Consultant|Pfizer: Advisor/Consultant|Roche: Advisor/Consultant|Scynexis: Grant/Research Support|Seres Therapeutics: Advisor/Consultant