bluuebunny/crossref_metadata_2025 huggingface dataset:
P-2359. CLEAR Hepatitis C – Development and impact of a regional collaborative to facilitate identification and treatment of patients with Hepatitis C
Authors: Kessell Andrew , Biritwum Madonna A
Published: January 2025

Background

Despite advancements in therapy, hepatitis C continues to significantly impact public health and individual patients. Untreated hepatitis C can lead to liver failure and death. The introduction of oral therapies provides an opportunity to cure patients’ hepatitis C and limit the spread. However, challenges persist in the identification of patients, access to specialists trained in the treatment of hepatitis C and the medication therapy costs. FirstHealth of the Carolinas (FHC) developed partnerships and care pathways within our regional medication community including employed and non-employed physician practices. The principles of the care pathway were, CLEAR Hepatitis C (Figure 1). The purpose of our study was to evaluate the outcomes associated with a comprehensive regional approach to identification and treatment of patients with hepatitis C.

CLEAR Hepatitis C acronym

Outlines care pathway developed for the treatment of hepatitis C

Methods

A retrospective study was conducted at FHC reviewing outcomes associated with the CLEAR Hepatitis C initiative undertaken from September 2023 through April 2024. Data evaluated included: hepatitis C antibody screens conducted by primary care providers, Infectious Disease clinic referrals for hepatitis C treatment, oral therapies prescribed by Infectious Disease providers, patients assisted with medication therapy by specialty pharmacists and pharmacy technicians and patients receiving a curative diagnosis.

CLEAR Hepatitis Results

Results associated with each step of the care pathway.

Results

Primary care provider education and promotion of CLEAR Hepatitis C initiative commenced in November 2023. Comparing the fourth month periods of September-December of 2023 to January-April 2024: the total hepatitis C antibody screens conducted increased from 1169 to 1514 (p < 0.05); Infectious Disease clinic visits with a primary diagnosis of hepatitis C increased from 7 to 18; Prescriptions from Infectious Disease providers increased from 9 to 19; Patients assisted with medication access increased from 6 to 15. During the study period, 4 patients received a curative diagnosis. An additional 8 patients have completed treatment and are awaiting confirmatory lab testing (Figure 2).

Conclusion

Development of a collaborative, integrated hepatitis C care pathway within our regional medical community successfully increased the number of patients identified and treated for hepatitis C in our region.

Disclosures

All Authors: No reported disclosures
P-2361. Real-World Experience of Letermovir for CMV Prophylaxis in Solid Organ Transplant Recipients
Authors: Perez Emily , Cheezem Alexandra , Cabrera-Rios Pierina , Macek Molly , Cano Ennie , Abbo Lilian M , Vu Christine A
Published: January 2025

Background

Valganciclovir is recommended as first-line for cytomegalovirus (CMV) prophylaxis after solid organ transplant, however, its use may be limited by myelosuppression. In 2023, letermovir was approved for CMV prophylaxis in high-risk kidney transplant recipients. The aim of this study was to describe our real-world experience utilizing letermovir for CMV prophylaxis in select solid organ transplant recipients.

Methods

A single-center, retrospective study was conducted in adult solid organ transplant recipients who received letermovir for CMV prophylaxis between December 2022 and March 2024 at the Miami Transplant Institute. We assessed white blood cell count (WBC) recovery following the switch from valganciclovir to letermovir, growth-colony stimulating factor (G-CSF) use, drug interactions, CMV DNAemia, and outpatient accessibility. Data was analyzed using descriptive statistics.

Results

Of the 54 patients included, 31 (57%) received a lung transplant, 22 (41%) received a kidney transplant, and 1 (2%) received a multivisceral transplant. For patients switched from valganciclovir to letermovir, the median WBC change at day 28 was +2.5 k/uL, 95% of patients achieved WBC recovery. Median number of G-CSF doses prior to letermovir was 1 with an average dose of 5.65 mcg/kg. For patients receiving tacrolimus/cyclosporine, 27 (54%) required a dose reduction after starting letermovir. We had 2 cases of breakthrough CMV disease. Of the patients requiring prophylaxis for herpes simplex virus (HSV), 4 (13%) patients were not prescribed acyclovir/valacyclovir. For outpatient accessibility, 27 (59%) of patients required prior authorizations, four (9%) patients were unable to start letermovir due to lack of insurance approval, and 1 (2%) patient discontinued treatment due to ongoing insurance issues.

Conclusion

This study supports the use of letermovir to prevent CMV infection in high- and intermediate-risk transplant recipients. Most patients who were switched from valganciclovir experienced WBC recovery. Our more notable findings were the challenges faced with prescribing letermovir. Early pharmacy engagement may be necessary to help address barriers related to cost, insurance coverage, drug-drug interactions, and reinforce concomitant prescribing of HSV prophylaxis.

Disclosures

All Authors: No reported disclosures
P-89. Daptomycin Compared to Vancomycin for the Treatment of Osteomyelitis: a national VA cohort study
Authors: Moenster Ryan P , Linneman Travis W , Eaton Daniel
Published: January 2025

Background

Daptomycin (DPT) has been used as an alternative to vancomycin (VCM) for the treatment of osteomyelitis (OM), but few studies have compared their efficacy in this infection.

Methods

This was a retrospective evaluation of all patients within the Veteran’s Affairs (VA) Health Care System between the ages of 18 and 89 who were treated for OM with at least 21-days of either intravenous (IV) VCM or DPT between 1 January 2009 and 1 January 2020. The diagnosis of OM was identified by a primary ICD-9 (730.0-730.99) or ICD-10 (M86.0-M86.9) discharge code around the time of VCM or DPT administration. Additionally, records were verified to ensure no patient had received more than 6 days of the other therapy.

The primary outcome was clinical failure, which was a composite of retreating with antibiotics for at least 14 days within the 6-months after initial treatment was completed, surgical procedures related to OM in the 6-months after treatment was completed, or all cause 30-day readmission while on antibiotic therapy for the incident case of OM.

Two additional, nested cohorts were analyzed. A cohort matched based on age, race, sex, body mass index, and Charlson Comorbidly Index, and a cohort analyzed using average effect on treatment (ATT).

Results

Five thousand, four hundred twenty-six patients were included (4777 VCM, 649 DPT). The primary outcome of composite clinical failure occurred in 63.4% (412) of DPT patients and 57.2% (2731) of VCM patients (p < 0.001). In the adjusted cohort, DPT was not associated with failure (OR 1.173, 95% CI 0.978-1.407), but overall retreatment (1-180 days after completion of initial therapy) and early retreatment (1-25 days after completion of initial therapy) were more likely in DPT treated patients (OR 1.23 (95% CI 1.026-1.475) and OR 1.242 (95% CI 1.092-1.414), respectively). In the ATT analysis composite failure was not associated with DPT, but overall retreatment and early retreatment were (OR 1.263 (95% CI 1.014-1.574) and OR 1.247 (95% CI 1.068-1.455), respectively).

Conclusion

In this large, retrospective cohort of veteran’s receiving treatment for OM more patients receiving DPT experienced composite failure compared to those treated with VCM. The difference appears driven by DPT failure within the first 25 days after treatment completion.

Disclosures

All Authors: No reported disclosures
P-109. A Phase I First-in-Human Study to Evaluate the Safety and Pharmacokinetic (PK) Properties of the Intravenously (IV) Administered OMN6, A Novel Antimicrobial Peptide Targeting Acinetobacter baumannii (AB), in Adults including Older Healthy Volunteers (HVs) Subjects
Authors: Shusterman Muratov Bella , Maximov Shelly , Stark Yafit , Zazoun Jonathan , Michaeli Janna , Dogterom Peter , Abd-Elaziz Khalid , Shorr Andrew , Cohen Kutner Moshik , Bachnoff Niv
Published: January 2025

Background

Acinetobacter baumannii (AB) is an opportunistic Gram-negative pathogen ranked 1st on the World Health Organization (WHO) Priority Pathogen list, that causes severe infections among elderly patients in intensive care units. Given the accelerating pace of global population aging, the burden of diseases including multi-drug resistant AB (MDRAB) infections is increasingly falling on elderly adults. Due to both elevated mortality rates associated with AB and the lack of effective treatments in older adults, there is a critical unmet need to develop new effective and safe anti-infectives. OMN6 is a novel, biochemically-engineered antimicrobial peptide, with a unique mechanism of action, which is being developed for the treatment of severe AB infections including carbapenem-resistant AB and MDRAB.

Methods

The First in Human Phase 1 OMN6 clinical trial was a single center, double-blind, placebo-controlled, randomized, single ascending total daily dose study, conducted in healthy volunteers. 5 single ascending total daily doses were tested; 5 cohorts in adults aged 18-59 years, and 1 cohort of older adults aged ≥ 60 years. Adults aged 18-59 years received doses ranging from 7.5 to 100 mg OMN6 as a 3-hour single IV infusion, while 50 mg was administered to both age groups (N=8/cohort). Safety and tolerability assessments, and pharmacokinetic (PK) blood sampling occurred at pre-defined timepoints. All blood samples for PK evaluation were analyzed with a validated LC/MS/MS assay. PK parameters of 50 mg OMN6 in both age groups were compared.

Results

No serious adverse events (SAEs) were reported in either adults or older adults and all dose levels were considered safe and well tolerated.

Upon a single infusion administration, mean PK results demonstrated dose-proportionality for Cmax and near dose-proportionality for AUCinf. The OMN6 PK profiles in adults and older adults at the 50 mg dose indicated a similar pattern. The mean AUCinf and Cmax for adults and older adults, were 1289 and 1211 h*ng/mL; and 502 and 470 ng/mL, respectively.

Conclusion

OMN6 had a favorable safety, tolerability, and PK profile that was similar in adults across all age groups. These positive results support advancing OMN6 to Phase 2 clinical trials, including subjects aged ≥ 60 years.

Disclosures

Andrew Shorr, MD, MPH, MBA, Basilea: Advisor/Consultant|Basilea: Grant/Research Support
P-128. Evaluating dopamine agonists to confer colonization resistance against bacterial enteric infection: population-based propensity-matched cohort study
Authors: Birabaharan Morgan , Kaelber David C , Mehta Sanjay R
Published: January 2025

Background

Uncovering gut microbiota mechanisms can afford new preventive therapies against enteric infection amidst the antimicrobial resistance crisis. Recent groundbreaking work in mice models suggest microbial-mediated metabolism of diet-derived tryptophan helps confer colonization resistance against enteric pathogens via agonism of dopamine receptors. This study aims to assess the risk of bacterial enteric infection in restless leg syndrome patients using a dopamine agonist (ropinirole) compared to a voltage-gated calcium channel modulator (gabapentin).Table 1:Characteristics of the ropinirole and gabapentin cohorts before and after propensity score matching

Methods

The TriNetX Analytics Platform containing 89 million unique patients from 63 health care organizations was used. These data represent 27% of the US population from all 50 states, and includes persons from diverse geographic, age, race, ethnicity, income, and insurance groups. Persons >18 years of age diagnosed with restless leg syndrome and prescribed ropinirole or gabapentin between Jan 2018- Jan 2023 were included as the study and control cohort, respectively. Individuals who received both ropinirole and gabapentin were excluded. The two cohorts were propensity score matched for age, sex, race, ethnicity, social determinants of health, obesity, ischemic heart disease, type 2 diabetes mellitus, hypertension, hyperlipidemia, human immunodeficiency virus and organ transplant status. Using the matched cohorts, we calculated the relative risk of first-ever and recurrent bacterial enteric infection 1-year after index events in the respective cohorts.

Results

We identified 38,122 and 82,961 persons with restless leg syndrome receiving ropinirole or gabapentin, respectively. After 1:1 propensity matching, demographic and clinical characteristics were balanced (SD < 0.1) (Table 1). Ropinirole compared to gabapentin use among persons with restless leg syndrome was associated with decreased 1-year risk of both recurrent (RR 0.85, 95% CI 0.74-0.98) and new-onset bacterial enteric infection (RR 0.77, 95% CI 0.65-0.92).

Conclusion

This study found that persons with restless leg syndrome receiving dopamine-agonist (ropinirole) compared to voltage-gated calcium channel modulator therapy (gabapentin) was associated with reduced risk of recurrent and new-onset bacterial enteric infection.

Disclosures

David C. Kaelber, MD, PhD, MPH, FAAP, FACP, FACMI, FAMIA, Dynavax Technologies Corporation: Advisor/Consultant
P-132. Retrospective Comparison of Short and Prolonged Treatment Strategies for Patients with Neutropenic Enterocolitis
Authors: Pravato Tori , Yassin Arsheena , Narayanan Navaneeth , Mohayya Sana M , Abdul Azim Ahmed , Awad David A , Cho Junhee , Schwartz-Orbach Lianna , Bhatt Pinki
Published: January 2025

Background

Neutropenic enterocolitis (NE) is a severe necrotizing condition affecting the small and/or large intestines in neutropenic patients. With a lack of high-quality studies looking at antimicrobial duration and outcomes for patients with NE, this study aims to evaluate the impact of short versus prolonged antimicrobial treatment durations on clinical outcomes in patients with NE.

Methods

This was a single-center, retrospective, cohort study conducted at a tertiary care academic medical center in New Jersey. Medical records of adult patients with hematologic malignancies admitted between January 2015 to September 2023, with diagnosis of NE and receipt of treatment with broad-spectrum antimicrobials, were reviewed. This study compared patients who received short versus prolonged antimicrobial treatment courses for NE. Patients in the short treatment group included those who received broad antimicrobials for NE treatment, that were stopped or switched to prophylaxis while the patient’s absolute neutrophil count (ANC) was less than 0.5 x 103/uL. The prolonged treatment group included patients who received broad antimicrobials at least until ANC was over 0.5 x 103/uL. The primary endpoint was the time to clinical improvement of symptoms between the two groups. Secondary endpoints included hospital length of stay (LOS), intensive care unit (ICU) admission, incidence of NE complications, and 30-day mortality. 

Results

A total of 17 patients were included, with 5 (21.7%) patients who underwent hematopoietic stem cell transplantation. Time to clinical improvement, defined as improvement in symptoms (including resolution of abdominal pain, abdominal distension and/or cramps, diarrhea, nausea, vomiting, lower GI bleed), and 30-day mortality were similar in both treatment groups. However, hospital LOS, ICU admission, and incidence of NE complications were higher in the prolonged treatment group.

Conclusion

Between short and prolonged treatment groups in patients with NE, time to clinical improvement was similar. Larger, randomized controlled trials are needed in this patient population to assess the appropriate duration of therapy for patients with NE.

Disclosures

Navaneeth Narayanan, PharmD, MPH, BCIDP, Astellas: Honoraria|Beckman Coulter: Honoraria|Merck: Grant/Research Support|Shionogi: Grant/Research Support Pinki Bhatt, MD, Sanofi: Grant/Research Support
P-158. Knowledge of Rabies Prevention Measures for Dog Bite Incidents in the Peruvian Population: Findings from a National Survey in 2022
Authors: Perez-Castilla Jesus , De-Los-Rios-Pinto Abraham , Benito-Vargas Raysa M , Soriano-Moreno David , Fernandez-Guzman Daniel , Gonzales-Zamora Jose A
Published: January 2025

Background

Rabies continues to be a significant global zoonotic threat. In the last two decades, Peru has reported nine dog-transmitted rabies cases, including a preventable death in 2023. This study aimed to assess public knowledge of rabies prevention post-dog bites, focusing on sociodemographic disparities to better tailor future interventions.Figure 1.Factors associated with knowledge of the Rabies Preventive Triad of the Peruvian population, ENAPRESS 2022.

Methods

Utilizing data from the 2022 National Survey of Budget Programs, targeting Peruvians aged 14 and older through a stratified two-stage sampling across both urban and rural areas, this cross-sectional study included 89,655 adults who completed interviews on the rabies prevention triad (wound washing, biting animal identification, and medical consultation). The "Survey" package in R facilitated data analysis, acknowledging the complex design. Poisson regression was employed to explore sociodemographic disparities in knowledge.

Results

Out of 89,655 participants, the majority were women (53.7%), aged 30-59 (52.2%), and lived in urban areas (81.6%). The 6.5% displayed adequate knowledge of the rabies preventive triad, 45.7% indicated they would clean their wounds, 20.9% would identify the dog involved, and 86.7% would seek medical attention at a health facility. Regression models revealed better knowledge among older adults and the elderly (adjusted prevalence ratio (aPR): 1.04; 95% confidence interval (95%CI): 1.03-1.05), females (aPR: 1.01; 95% CI: 1.00-1.02), and those with higher educational levels. Highland residents showed greater knowledge than coastal ones (aPR: 1.02; 95% CI: 1.01-1.03). Conversely, Quechua ethnicity and rural residency were negatively associated with knowledge (aPR: 0.97; 95% CI: 0.96-0.98 and aPR: 0.98; 95% CI: 0.97-0.99, respectively) (Figure 1).

Conclusion

Despite the high frequency of dog bites in Peru, knowledge of rabies prevention is very low. Although limited by potential recall bias and its non-causal inference capacity, the study's strengths lie in its national scope and reliable data collection. The results underscore the urgency of targeted educational campaigns and policy enhancement in high-risk areas to boost community health and rabies prevention.

Disclosures

All Authors: No reported disclosures
P-221. Ribotype Ecology and 90-day Mortality Changes after a CDI Diagnostic Change from a PCR-based to a 2-step Diagnostic Algorithm
Authors: Huynh-Phan Ricky , Eubank Taryn A , Le Thanh , Gonzales-Luna Anne J , Jo Jinhee , Begum Khurshida , Alam M Jahangir , Lasco Todd M , Al Mohajer Mayar , Garey Kevin W
Published: January 2025

Background

Due to detection of Clostridioides difficile colonization, many hospitals changed from a PCR-based CDI diagnostic to a two-step diagnostic using a GDH/EIA assay. How this change affected the ecology of diagnostic C. difficile strains or patient outcomes is unknown. The purpose of this study was to assess differences in strain ecology and patient outcomes after a CDI-diagnostic change from a PCR-based to a GDH/EIA diagnostic assay.

Methods

Stool samples considered CDI positive by institutional policy were collected from a university-affiliated quaternary care hospital and associated community hospitals from 2016-21. Stool samples were cultured for C. difficile and ribotyped by fluorescent PCR. Patient’s health records were reviewed for 30- and 90-day mortality and CDI recurrence. Ribotype distribution and clinical outcomes were compared after the diagnostic change.

Results

The cohort included 418 patients (PCR+: n=315; GDH+/EIA+: n=103). An increased proportion of ribotype (RT) 027 was noted after the change to GDH/EIA and a decreased likelihood of RT014-020 and RT255. An increased likelihood of singletons (PCR ribotypes observed only once) was shown during use of the PCR diagnostic. CDI treatment failures and mortality was higher after implementation of the GDH/EIA diagnostic. Ninety-day mortality was 19.4% using the GDH/EIA diagnostic and 11.1% using the PCR (p=0.030). No differences in CDI recurrence were noted.

Conclusion

C. difficile ecology and clinical outcomes changed after implementation of a GDH/EIA diagnostic, likely due to PCR detection of colonization.

Disclosures

Anne J. Gonzales-Luna, PharmD, BCIDP, Ferring Pharmaceuticals: Advisor/Consultant|Innoviva Specialty Therapeutics: Advisor/Consultant|Merck and Co: Grant/Research Support|Paratek Pharmaceuticals: Grant/Research Support|Seres Therapeutics: Grant/Research Support Kevin W. Garey, PharmD, MS, Acurx: Grant/Research Support
P-306. Characterization of a Rare Hospital-Associated MRSA Lineage
Authors: Felton Emily , Kennedy Sarah , Jackson Jessica , Virgillio Ariana , Cella Eleonora , Becker Deanna , Lima Amorce , Silbert Suzane , Azarian Taj , Kim Kami , Shaw Lindsey
Published: January 2025

Background

The adaptive power of Staphylococcus aureus enables it to cause a wide variety of infections and readily develop resistance to antibiotics. It does this through extensive variability in its genomic repertoire, not only via laterally acquired elements but also through core genome evolution.

Methods

Herein we use whole genome sequencing to study the genomic epidemiology of S. aureus strains circulating within Tampa General Hospital (TGH).

Results

While characterizing the genetics of mupirocin resistance, we identified a rare ST belonging to hospital-associated clonal complex 5. The elevated rate of mupirocin resistance in this ST, ST3390 (83.2% total, high-level resistance 55.5% and low-level resistance 27.7%), was particularly striking. To date, there have only been 6 recorded instances of this lineage globally, whilst this work identified 36 individual strains from TGH alone. Genome analysis of our strains identified numerous completely conserved non-synonymous mutations in genes relating to DNA damage response, metabolism, adhesion/biofilm formation, iron acquisition and peptidoglycan biosynthesis compared to CC5 isolates. Additionally, exploration of AMR genes detected the presence of a unique dual SCCmec type, with two-thirds of strains possessing components of both SCCmecIa and SCCmecIIa. Phenotypically, all ST3390 strains lack the characteristic staphyloxanthin pigment that gives S. aureus its name. Additionally, ST3390 isolates display high levels of cytotoxicity towards human neutrophils compared to other CC5 strains.

Conclusion

Collectively, this work provides a deeper understanding of the genetic variability of S. aureus in clinical settings, leading to a better comprehension of in-hospital bacterial population dynamics and the evolution and spread of contemporary isolates.

Disclosures

All Authors: No reported disclosures
P-308. Impactful Implementation of “HAPPI MRSA” - Hospital Onset Pneumonia Prevention and Reduction of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections at a Large U.S. Health System
Authors: Rosello Gemma , Ruiz Maribel , Jones Dr LaShonda , Rosa Rossana , Villamil Dr Susana Flores , Biggs Dr Carol , Abbo Lilian M
Published: January 2025

Background

Hospital onset (HO) Methicillin-Resistant Staphylococcus aureus (MRSA) bloodstream infection is one of the key performance metrics for the CMS Hospital-Acquired Condition (HAC) reduction payment program. MRSA bacteremia is a serious preventable infection associated with increased morbidity and mortality. The goal of our intervention was to implement process changes to reduce MRSA bacteremia and HO pneumonia, improve patient safety, quality of care and decrease healthcare costs associated with treatment.Figure 1:Most Common Sources of All Cases HO MRSA Bacteremia at JHS (Baseline Period: January 2019- September 2021)

Methods

Jackson Health System (JHS) is a 2,289-bed nonprofit academic health system located in Florida, USA. Utilizing a PDSA cycle for process improvement, we implemented a bundle of interventions focused on Hospital Onset Pneumonia Prevention (HAPPI) as the leading cause of MRSA bacteremia across JHS (Figure 1). Planning included focus groups and process mapping to assess barriers to an ideal oral care universal practice (Figure 2). Policies were updated; education and compliance monitoring were incorporated at each hospital. Managers were empowered by hospital leadership to hold staff accountable for each of the metrics within the bundle: universal oral care with kits tailored to independent, dependent, and ventilated patients, universal skin bathing with chlorhexidine gluconate (CHG), nasal decolonization, early mobility, and aspiration precautions.Figure 2:Barriers to Universal Oral Care in Hospitalized Patients at JHS (Focus Groups with Frontline Staff and Infection Prevention Leadership)

Results

During the pre-intervention period Jul 2021-Jun 2022, we identified 46 HO MRSA bacteremias that were secondary to HO pneumonia. System wide education occurred Jul-Dec 2022. During our post-intervention period Jan-Dec 2023, 20 HO MRSA bacteremias were identified that were secondary to HO pneumonia, a 57% reduction (Figure 3). Estimating $60,000 to treat MRSA bacteremia secondary to pneumonia, we identified a $1.5 million dollars in cost savings by preventing 26 infections.Figure 3:Most Common Sources of All Cases HO MRSA Bacteremia at JHS (Post-Intervention Period: January-December 2023)

Conclusion

We reduced HO MRSA bacteremias and subsequently HO pneumonia after implementing and actively monitoring compliance with a bundle of interventions. Facilities considering pneumonia and MRSA prevention should include strategies that reduce organism bioburden with bathing, nasal decolonization, and oral care along with early mobility and aspiration precautions.

Disclosures

All Authors: No reported disclosures
P-314. A Retrospective Review of Long-Acting Lipoglycopeptide Utilization at a VA Tertiary Teaching Medical Center
Authors: Maree Megan B , Chan Bonnie , Goolsby Tiffany , Oliver Nora T
Published: January 2025

Background

Dalbavancin and oritavancin are long-acting lipoglycopeptides (LA-LGPs) approved by the Food and Drug Administration (FDA) for acute skin and soft tissue infections (ASSTIs). With their long-acting pharmacokinetics and broad activity against gram-positive bacteria, LA-LGPs are ideal options for patients with serious infections, such as bone, joint, and bloodstream, who (1) require prolonged antimicrobial therapy, (2) are not candidates for long-term intravascular catheter access, (3) prefer to avoid hospital admission, and/or (4) need early discharge.

Methods

A retrospective chart review was conducted on patients ages older than 18 with a medication order of dalbavancin or oritavancin from September 2020- August 2023 at the Atlanta VA Medical Center. Patients were excluded if the patient did not have an active infection or a LA-LGP was ordered but not administered. Pertinent demographic, clinical, and microbiological data were collected from the patient’s medical record.

Results

Resolution of infection in 3 months with LA-LGPs was found to be 76% (35/46) effective in lower extremity osteomyelitis and 74% (72/98) effective for all indications. The mean total length of stay (inpatient) after LA-LGP infusion was 3.9 days. The most common adverse events were nausea and vomiting, which occurred at a rate of 6.1% (6/98).

Conclusion

The utilization of LA-LGPs showed to be effective in infection resolution in a 3-month period in majority of patients. Specifically, lower extremity osteomyelitis, a non-FDA approved use, showed promising results in resolution of infection. The use of LA-LGPs can be beneficial in shortening hospital length of stay and prevention of hospitalizations with minimal adverse events. This can possibly lead to decreased health care cost and hospital acquired infections. In all, the use of LA-LGPs has significant potential use in other serious infections other than ASSTIs with a variety of benefits from the patient and healthcare perspective.

Disclosures

All Authors: No reported disclosures
P-358. Infection Prevention and Control Practice in Tertiary Care Military Hospitals in Bangladesh during COVID-19 Pandemic: Results from WHO IPCAF Assessment Tools
Authors: Abdullah Syed Abul Hassan Md , Harun Md Golam Dostogir , Amin Sumon Md Shariful , Jahan Ishrat , Ul Anwar Md Mahabub , Siddiquee Taufiq H
Published: January 2025

Background

WHO estimates a high burden of the MDR organism in hospital settings in South Asian countries, especially in Bangladesh. Infection prevention and control (IPC) in healthcare settings is critical to limit the healthcare-associated infections, especially during pandemics like COVID-19. Military hospitals in Bangladesh are known for better compliance of health system practice. To measure current IPC level, activities, resources, and gaps, WHO developed the IPC Assessment Framework (IPCAF) assessment tools. We aimed to assess the IPC practices level in Military hospitals of Bangladesh to reduce the gaps.Table of WHO IPCAF score of Dhaka and Jashore CMH

Methods

From Oct to Dec 2019, using IPCAF tools, we conducted a cross-sectional survey at two tertiary level Combined Military hospitals (CMH) in Bangladesh to collect the information. The hospital administrator, IPC focal person, or relevant person who had better knowledge about the overall IPC situation was interviewed. The tool comprises eight sections assessing the eight IPC core components. Based on the scores ranging from 0 to 100, the hospital was categorized into four distinct IPC levels - Advanced, Intermediate, Basic and Inadequate. Descriptive statistics were used to summarize and describe the key findings.

Results

The mean IPCAF score was 421.75 out of 800.The Dhaka CMH (1100 bedded) was categorized as ‘intermediate’ with the score of 497.5 and Jashore CMH (500 bedded) scored 346 which was characterized ‘basic’ level. Both the hospitals scored very high in adherence of IPC guideline 87.5 and 77.5 respectively. Scoring of Dhaka CMH in IPC program (77.5), Workload, staffing & bed occupancy (75) and Built environment, materials and equipment (82.5) is higher than the same components of Jashore CMH. IPC education & training score of both hospitals (50 and 25 respectively) was not satisfactory. None of the hospitals had an IPC surveillance system with standard surveillance case definitions to track HAIs.

Conclusion

Military hospitals needs to attain advanced level IPC practice. To achieve that organized quality improvement programs and feedback mechanisms is required. To strengthen all IPC core components, particularly IPC surveillance, monitoring, education & training is needed to improve for healthcare safety and resilience.

Disclosures

All Authors: No reported disclosures
P-382. Evaluation of Antibiotic Prophylaxis for Patients Undergoing Whipple Procedure
Authors: Crawford Garrett , Soto Caitlin , Tsai Y Vivian , Cosgrove Sara E , Klein Eili , Dzintars Kate
Published: January 2025

Background

Pancreatoduodenectomy (PD) or the Whipple is a complex surgical intervention with high complication rates. The purpose of this study is to evaluate the efficacy of standard of care (SOC) perioperative antibiotics, cefazolin plus metronidazole, as prophylaxis for surgical site infection (SSI) in patients undergoing PD at The Johns Hopkins Hospital (JHH).

Methods

A retrospective study was performed of adult patients undergoing PD at JHH between January 1, 2022 and October 31, 2023. The following information was collected on all patients: peri-operative antibiotics administered, placement of operative drains, pre-operative biliary stent, prior endoscopic retrograde cholangiopancreatography, SSI, pancreatic fistula, and microbiological data. Criteria for SSIs were adapted from the CDC’s National Healthcare Safety Network definitions. SOC prophylaxis included cefazolin plus metronidazole. The primary outcome was the proportion of patients who developed an SSI within 30 days of PD. Secondary outcomes included identification of the causative pathogens of SSI in patients after PD and the proportion of organisms susceptible to SOC antibiotics. Descriptive statistics was used to summarize demographic data and the primary and secondary outcomes.

Results

A total of 333 patients met inclusion criteria and were documented as having PD during our study period. Of these patients, 106 (31.2%) had post-operative complications including infection or fistula. Overall, 81 patients (24.3%) had a SSI after PD. Seventy-one SSIs occurred in 295 patients (24.1%) receiving SOC antibiotic prophylaxis compared to 10 SSIs in 38 patients (26.3%) receiving non-SOC antibiotics (p=0.761). Of the 81 patients with a SSI, pathogens were identified through post-operative culture data in 33 patients. Thirty-two of the 55 (58%) clinically relevant pathogens were susceptible to SOC antibiotics.

Conclusion

The incidence of surgical complications associated with PD at our institution is comparable to rates reported in the available literature. While the incidence of clinically relevant organisms not covered by SOC prophylaxis is low, a targeted approach for prophylaxis may be required for select patients.

Disclosures

All Authors: No reported disclosures
P-385. A Change of Heart: Limitations of National Healthcare Safety Network (NHSN) and Society of Thoracic Surgeons (STS) Surveillance Systems in Identifying SSI After Heart Transplant Surgery
Authors: Seidelman Jessica , Smith Becky A , Arif Sana , Lewis Sarah , Gettler Erin , Padgette Polly W , Wood Brittain A , Williams Melissa , Fleming Peter , Schroder Jacob , Milano Carmelo , Miller Rachel , Alexander Barbara D , Carugati Manuela
Published: January 2025

Background

Surgical site infections (SSI) complicate 4.8-12.4% of orthotopic heart transplants (OHT) and result in increased length of hospital stay, mortality, and health care costs. As such, the need for accurate SSI surveillance systems for OHT is critical. This study aimed to evaluate the diagnostic accuracy of the National Healthcare Safety Network (NHSN) and Society of Thoracic Surgeons (STS) surveillance systems for SSI against the gold standard of a detailed manual adjudication process performed by Transplant ID physicians (TXID).

Methods

We retrospectively reviewed single-organ OHT performed at an academic medical center between 1/1/19 and 12/31/20 among adult patients (≥18 years). Each OHT was adjudicated for SSI by NHSN, STS, and TXID SSI definitions. The TXID definition was the same as the NHSN classification. The surveillance window was 90 days for NHSN and TXID. STS adopted a 90-day surveillance window for deep sternal wound infections from 7/1/20 onward.

Results

TXID identified 17 (10.5%) SSI among 162 OHT surgeries during the study period. NHSN identified only 7 (4.3%) SSI, including 3 false positive SSI, which were not considered SSI by TXID. STS identified only 4 (2.5%) SSI during the study period and no false positive SSI(Fig 1). The sensitivity, specificity, positive-predicted-value, and negative-predicted-value for NHSN were 23.5%, 97.9%, 57.1%, and 91.6% and for STS 23.5%, 100%, 100%, and 91.8%, respectively. The suboptimal sensitivity of NHSN was mostly explained by intervening surgeries (such as chest closures or washouts) that prevented a subsequent SSI from being attributed to the OHT, and by STS’s prior 30-day surveillance window.

Conclusion

Accuracy of SSI surveillance is essential for SSI prevention. Current SSI surveillance systems have low sensitivity in detecting OHT SSI, which is likely due to the complex nature of the hospital courses following OHT surgeries. While a manual adjudication performed by Transplant ID physicians is time- and resource-intensive, it likely provides a more accurate depiction of SSI rates compared to automated surveillance systems. Future studies are needed to determine how NHSN and STS surveillance systems can be adjusted to more accurately identify OHT SSI.

Disclosures

Jessica Seidelman, MD, MPH, 3M: Expert Testimony Becky A. Smith, MD, UpToDate: royalties Jacob Schroder, MD, Abbott: Advisor/Consultant|Abiomed: Advisor/Consultant Barbara D. Alexander, MD, Basilea: Advisor/Consultant|F2G: Advisor/Consultant|F2G: Grant/Research Support|HealthTrackRx: Advisor/Consultant|HealthTrackRx: Board Member|Scynexis: Grant/Research Support|TFF Pharmaceuticals: Advisor/Consultant
P-386. Assessing Implementation of Evidence-Based Practice Recommendations for Prevention of Surgical Site Infections Through a Statewide Survey of Nebraska Hospitals
Authors: Pavlovsky Lacey , Kanishka Fnu , Preusker Jenna , Baker Mikayla , Hill Tammy , Hoogestraat Laura A , Kinyoun Mary W , Nelson Emily , Martinez Rebecca , Penn Robert G , Plueger Angel , Scebold Jody , Tyner Kate , Van Schooneveld Trevor C , Vivekanandan Renuga , Ashraf Muhammad Salman
Published: January 2025

Background

Almost half of surgical site infections (SSIs) are preventable by application of evidence-based strategies. An online survey of Nebraska hospitals was conducted by the Nebraska Healthcare-Associated Infections/Antimicrobial Resistance Advisory Council’s SSI Subcommittee between March and May 2023 to assess implementation of evidence-based practice recommendations (EBPR) from national guidelines.

Methods

Infection preventionists completed the survey in collaboration with their perioperative teams. In addition to facility demographics, data was collected on general SSI prevention practices along with those specific to colon procedures, hysterectomies, and cesarean sections. Implementation frequencies were calculated for each EBPR after excluding missing responses.Figure 2:Routine Audits Conducted by Facilities

Results

Response rates for acute care and critical access hospitals were 72% (21/29) and 47% (30/64), respectively. Most EBPR (19/30) assessed were reported to be implemented by majority ( >50%) of the hospitals. The least implemented EBPR was vaginal cleansing prior to all cesarean sections (16%, 5/31) (Figure 1). Audits to monitor operating room traffic and skin antisepsis were conducted by approximately a third of hospitals (31%, 15/49 and 33%, 16/48, respectively) (Figure 2). Among hospitals that performed hysterectomies (n=23), less than half reported performing vaginal cleansing prior to all hysterectomies (43%), presence of policies/protocols for pre- and intraoperative antibiotic use for hysterectomies (39%) and monitoring of antimicrobial prophylaxis practices for hysterectomies (43%). Least implemented colon procedure specific EBPR in hospitals performing these procedures (n=26) included having standardized policies/procedures for mechanical bowel preparation (35%), presence of policies/protocols for pre- and intraoperative antibiotic use for colon procedures (50%,) and monitoring of antimicrobial prophylaxis practices for colon procedures (54%).

Conclusion

Several EBPR for SSI prevention are not routinely implemented highlighting the need for educational efforts to raise awareness among hospitals. Future studies should focus on identifying practice barriers and mitigation strategies to increase implementation.

Disclosures

Trevor C. Van Schooneveld, MD, FSHEA, FIDSA, AN2 Therapeutics: Grant/Research Support|BioMerieux: Grant/Research Support|BioMerieux: Honoraria|Thermo-Fisher: Honoraria Renuga Vivekanandan, MD, MDconsult: Ownership Interest Muhammad Salman Ashraf, MBBS, Merck & Co. Inc: Grant/Research Support
P-389. Review of Post Cesarian Section Surgical Site Infections in a Tertiary Care Hospital
Authors: Alvi Rija B R , Shanahan Clare , Ruby Abigail , Chami Eman , Lanfranco Odaliz Abreu , Suleyman Geehan
Published: January 2025

Background

Surgical site infection (SSI) is one of the most common complications following cesarean section (CSEC), variably ranging from 3% to 18%, and adds a significant burden to the healthcare system. Given its substantial implications, developing strategies to prevent SSIs are essential. We aimed to explore factors associated with an increased risk of these infections.  

Methods

Retrospective observational study of post-CSEC SSIs from Jan 2021-Dec 2023 at Henry Ford Hospital in Detroit. SSIs were defined according to the National Healthcare Safety Network (NHSN) criteria. Cases were categorized as superficial incisional (SI), deep incisional (DI) and organ space (OS). Demographics, risk factors, clinical features, treatment, and outcomes were evaluated. 

Results

70 (3%) of 2,230 CSECs performed during the study period met criteria for post-CSEC SSI, of which 42 (60%) were SI, 4 (6%) DI, and 24 (34%) OS; 42 (60%) were emergency cases. The majority of patients were Black with mean age of 30.3 years (Table 1). Obesity (BMI >30), anemia (hemoglobin < 11), hypertension, prior abdominal surgery, Group B Strep colonization, and ruptured membranes at presentation were common. Most (86%) received perioperative antibiotics, and 69% were administered within 1 hour of incision; cefazolin was frequently used. Infection was diagnosed after a median of 11.5 days. Wound pain and drainage were the most prevalent symptoms. Manual chart review revealed 21% of cases did not have clinical symptoms or signs of infection. Cultures were obtained in 33% of patients, of which 91% were positive; common skin commensals were frequently isolated (Figure 1). Readmission was common, a quarter of patients required surgical intervention, and most cases were treated with antibiotics (Table 2). Complications included uterine dehiscence (9%) and half of these required hysterectomy.   

Organisms Identified on cultures in patients with post-CSEC SSI

Conclusion

In our cohort of patients with post-CSEC SSI, obesity and ruptured membranes were common, and more than half of the cases were performed emergently. Implementing evidence-based practices and recommendations are critical to reduce the burden of SSIs. Additionally, proper documentation and diagnostic stewardship are critical to accurately capture SSI cases and avoid unnecessary antibiotics.

Disclosures

All Authors: No reported disclosures
P-414. From Anecdotal to Analytical: Correlating Self-Reported Norovirus-Like Illness with Epidemiological Data
Authors: Quade Patrick , Jaykus Lee-Ann , Chapman Benjamin , Faircloth Jeremy , Goulter Rebecca
Published: January 2025

Background

Human norovirus is a leading cause of foodborne illness globally, with hallmark symptoms of vomiting and diarrhea. The Norovirus Sentinel Testing and Tracking (NoroSTAT) network is a collaborative network of select U.S. state public health departments and the U.S. CDC, designed to collect epidemiologic and laboratory data on suspected or confirmed norovirus outbreaks. The global crowdsourcing website Iwaspoisoned.com (IWP), established in 2009, provides a means by which the public can self-report foodborne disease-like symptoms in real-time, world-wide. The value of crowdsourced data in relation, or complementary, to classic epidemiologic approaches, is largely unknown.

This study aims to investigate correlations between self-reported norovirus-like illness from IWP and norovirus epidemiological data from NoroSTAT.

Methods

The analysis was limited to reports between August, 2018 and May, 2022. NoroSTAT data were obtained from their website and internet archives. Data was extracted directly from the IWP database, with the following inclusion criteria: (i) symptoms of both vomiting and diarrhea reported together (used as a proxy for norovirus-like illness); and (ii) reports originating from a NoroSTAT-participating state. Reports were excluded if spam or duplicate. Associations were investigated using Pearson Correlation and Granger Causality tests using the Minitab (State College, PA) software package.

Results

The Pearson Correlation value of 0.669 was highly significant (p< 0.001), indicating a strong linear relationship between IWP and NoroSTAT dataset outcomes (those being time and number of reports/cases). The Granger Causality analysis indicated a highly significant directional correlation between the two datasets (p=0.003).

Conclusion

There was a strong positive correlation between self-reported norovirus-like illness trends reported to the IWP crowdsourcing website, and NoroSTAT-reported outbreaks over the same timeframe. The alignment of the crowdsourced symptom data with public health surveillance lends credibility to the value of curated self-reporting as a complementary signal for detecting and perhaps predicting emerging norovirus epidemiological reports over time.

Disclosures

All Authors: No reported disclosures
P-420. Epidemiology of Patients with Laboratory-confirmed Aspergillus species in a Singaporean Hospital
Authors: Arora Shalvi , Myat Oo Aung , Kyawt Aung May , Chan Darius Y W , Foo Mabel Z Q , Yang Yong , En Wee Liang , Ying Sim Jean Xiang , Ling Moi Lin , Venkatachalam Indumathi
Published: January 2025

Background

Aspergillus species is an opportunistic mould associated with serious complications, healthcare costs and mortality, especially in immunocompromised patients. WHO has declared Aspergillus fumigatus as a “critical pathogen”. This study aims to report clinical epidemiology of patients with Aspergillus species in Singapore General Hospital (SGH), an acute-care hospital.Table 1:Demographic and clinical characteristics of patients

Methods

Inpatients with laboratory-confirmed Aspergillus species were included in this retrospective, observational study between January 2018 and April 2024. For patients with > 1 positive cultures, first positive culture was used to describe clinical characteristics. Comorbidities were identified using ICD-10AM codes. Immunocompromised patients were those under haematology-oncology at time of specimen collection, received immunosuppressants within preceding 90 days and/or were neutropenic (count < 1x109/L) within 30 days preceding specimen collection. Trends were reported as monthly incident rates (IR) per 10,000 patient-days.Table 2:Breakdown of microbiology cultures

Results

The mean IR was 1.2 per 10,000 patient days (n=399). Median patient age was 67 years. 151 of 399 (38%) patients tested positive on a specimen taken ≥ 7 days after admission. 172 (43%) patients were immunocompromised. 213 (53%) patients had non-pneumonia respiratory illnesses, 211 (53%) had pneumonia and 201 (50%) had acute/chronic kidney disease. 79 (20%) patients were admitted under haematology-oncology and 53 (14%) had haematological malignancies. 151 (38%) patients received Aspergillus targeted anti-fungal treatment within ±7 days of positive result (surrogate for infections). Crude mortality was 29% (n=115) of whom 98 (85%) patients died within 30 days and 112 (97%) patients died within 90 days of positive specimen. Median duration between specimen collection and mortality was 11.7 days. Pneumonia was the most common cause of death (51%). 187 (47%) patients had positive Aspergillus species cultured from lower respiratory specimens. The common species was Aspergillus fumigatus complex (45%). No outbreaks were identified during this period.Table 3:Breakdown by Aspergillus species isolated

Conclusion

Aspergillus species causes significant morbidity and mortality in hospitalized patients, including non-immunocompromised. Hence hospital-wide surveillance should be implemented.

Trend of monthly incidence rates of laboratory-confirmed healthcare-associated Aspergillus patients

Disclosures

Moi Lin Ling, FRCPA, Solventum: Honoraria|Solventum: Educational grant for APSIC projects