bluuebunny/crossref_metadata_2025 huggingface dataset:
P-931. Characterizing Sex-Specific Trends in Opioid Use Disorder-Associated Infective Endocarditis in the United States from 2016-2020
Authors: Kane Cooper D , Smith Stephen W , Schranz Asher J
Published: January 2025

Background

Injection opioid use has emerged as a leading risk factor for infective endocarditis (IE), with incidence of opioid use disorder-associated IE (O-IE) increasing nationwide. Although historically IE has predominantly impacted males, recent studied have shown drug use-associated IE (DUA-IE) may impact males and females to a similar extent. We aimed to characterize sex-specific trends and outcomes in IE across the United States (US).

Demographic Characteristics

Methods

We examined hospitalizations in the unweighted National Inpatient Sample (NIS) from 2016 to 2020. Hospitalizations coded for IE were included and stratified by sex and into O-IE and non-O-IE cohorts based on previously published ICD-10-CM codes. Demographics, clinical factors, and discharge disposition were described. Multivariable logistic regressions assessed the association between 1) sex and O-IE, and 2) sex and inpatient death, among O-IE hospitalizations.

Results

There were 91,377 hospitalizations for IE from 2016 to 2020 comprised of 40,091 (44%) females and 51,286 (56%) males (Table 1). Compared to 2016, hospitalizations for O-IE increased yearly for both sexes, while non-O-IE decreased (Figure 1). There were 14,884 (16%) hospitalizations due to O-IE, 54% of which were females and 46% were males. Among O-IE, females were more commonly White, insured by Medicaid and had concomitant psychiatric diagnoses. Among O-IE hospitalizations, females less commonly underwent valve surgery than males (11% vs 13%), less often died inpatient (5% vs 7%), and more frequently discharged against medical advice (DAMA) (27% vs 22%). In the adjusted models, females demonstrated 43% increased odds of O-IE diagnosis compared to males (aOR: 1.43, 95% CI: 1.32-1.54), while females diagnosed with O-IE demonstrated 21% decreased odds of inpatient mortality compared to males with O-IE (aOR: 0.79, 95% CI: 0.63-0.98).

Conclusion

From 2016 to 2020, most DUA-IE hospitalizations in the US were among females, in stark contrast with IE due to other causes. Females had lower odds of inpatient mortality but higher rates of DAMA. Future work is needed to characterize the social and biological factors driving sex disparities in IE hospitalizations and outcomes, which could serve as vital targets for substance use disorder and harm reduction interventions.

Disclosures

Stephen W. Smith, n/a, Bristol Myers Squibb: Stocks/Bonds (Public Company) Asher J. Schranz, MD, MPH, UpToDate: I receive fees for authorship of an UpToDate article.
P-958. Leveling Up Education Interventions: Antimicrobial Stewardship and Infection Prevention Education Through Gamification
Authors: Hall Nicole M , Ruan Haodi , duncan Mary , Lee Rachael A , Walker Jeremey
Published: January 2025

Background

Kaizen-Education is an app-based, formative question bank infused with gamification for a fun, yet competitive learning environment. This provides an engaging and flexible way to learn new competencies and test retention. Originally developed at University of Alabama at Birmingham (UAB), it has been used in multiple areas of medical education with high learner engagement. Optional participation, team-based competition, leaderboards, and prizes are game elements used to motivate completion of the formative questions. We created two educational games, one for UAB Antimicrobial Stewardship Program (ASP) and another for Infection Prevention (IP), to see if we could engage learners within the hospital system surrounding these topics.

Methods

For the IP game, infection preventionists developed questions for nursing staff. For the ASP game, ID pharmacists developed questions for providers. Both occurred within special weeks: National Nurses Week and U.S. Antibiotic Awareness Week. Recruitment strategies for both games included email invitations and peer-to-peer communication.

Teams for the IP game were nursing units, while the ASP game allowed creation of teams of 4 providers. Winning teams were awarded prizes and were recognized via email, certificate, and highlighted on the institution's website. At the conclusion of the games, participants were invited to provide feedback through a post-game survey.

Participant Survey Results

Results

61 and 156 participants answered at least one question in the ASP and IP games respectively. Retention, defined as completing all questions, was 80% of players in ASP game and 69% in IP game. Across both games, 4,182 questions were answered representing unique teaching moments. Reviewing accuracy based of learning domains (Figure 1), we were able to identify knowledge gaps at our institution. Finally almost all learners who responded to feedback survey agreed the activity increased knowledge in relevant domains (Figure 2).

Conclusion

We found a group of both nurses and providers interested in participating in quality educational activities within Antibiotic Stewardship and Infection Prevention. Retention was high in those that began the activity. Finally, feedback from question performance could be used to identify knowledge gaps for future interventions.

Disclosures

All Authors: No reported disclosures
P-964. Case-Based Learning Outcomes for Pre-Exposure Prophylaxis Education for the Preventative Medicine Plus One Maternal Health Track
Authors: Carr Kristin A , Thomas Alexander , Fleuristal Arshley , Goorhuis Jonathan
Published: January 2025

Background

As HIV prevention methods continue to develop with new agents added for Pre-Exposure Prophylaxis (PrEP). Prep uptake has remained low among US women since its approval in 2012. One major barrier to increasing PrEP uptake remains lack of knowledge of PrEP among patients and providers and lack of access to PrEP care in regions with high HIV prevalence. This study aims to increase PrEP knowledge and medical competence among Maternal Health Track Preventive Medicine residents at a single academic center in Southern California.

Pre-Test and Post-Test Scores and % Improvement

A pre-test was given at the start of each module. The same questions were made into a post-test after the curriculum was completed. Open and closed book portions were offered, and the % improvement was recorded.

Methods

Three Preventative Medicine Fellows from Family Medicine and Obstetrics and Gynecology backgrounds enrolled in multidisciplinary curriculum involving women’s health. A series of twelve case-based lectures were completed from July 2023 through December 2023. Each four-hour session included a pre-test, lecture, and a problem-based learning module. Simultaneous, they provided direct care for women in a combined clinic for PrEP and HIV care weekly for 3-6 months. In March 2024, the pre-test questions were combined into 47 post-test questions.

Results

Two of the three fellows had improvement in the closed book portion of the exam with a mean improvement of 9.5%. However, all of them had significant improvement for the open book exam with an average improvement of 16.2%. This suggests that although the memory retention of the material can wane with time, the ability to use resources to address clinically challenging questions has been strengthened. Of note, the questions were designed to simulate the American Academy of HIV Medicine (AAHIV) certification exam, which is an open-book test.

Conclusion

The combination of lectures, self-assessments, case-based discussions, and clinical experience has enhanced the fellows’ knowledge of PrEP care for women based on the improvement of exam scores after the curriculum. This will enhance their ability to provide multidisciplinary preventative care for women in underserved areas.

Disclosures

Kristin A. Carr, MD, Preventive Medicine Plus One Maternal Health Track: Grant/Research Support
P-980. Film-Based Infectious Diseases(ID) Elective Course
Authors: Lee Su , Ofstad William , Barrameda Maria Cecilia
Published: January 2025

Background

One of innovative educational approaches in enhancing learning outcomes is the integration of cinematic media into educational curricula, to increase student engagement, and motivate students to understand realistic settings to apply their learning (Stone 2010, Karanfil 2016). This research aims to measure qualitative and quantitative assessment of students’ performances in an elective course using movies to introduce various ID in a pharmacy curriculum.  

Methods

This study is a systematic analysis of students’ experiences in “PHAR 949 ID in Movies” through assignments and post-course surveys over two years (2023-2024). Students reflected on the course via a post-survey via the CANVAS platform, soliciting feedback on the course experience, including enjoyment, potential areas for improvement, and their knowledge and skills across various ID topics. Students were also asked to indicate how the course had influenced their mindset and future application of learning. Student data were de-identified and thematically analyzed, categorized according to four levels of Kirkpatrick Learning Outcomes.  Quantitative performance assessment for learning was measured with assignments on regarding etiology, transmission, clinical presentation, diagnosis, treatment options, and prophylaxis strategies of each infectious disease topic. All personally identifiable information was removed to ensure confidentiality. IRB#: 05022024_lee_tIDwm. 

Results

Ninety-six percent of students were actively engaged in discussions on the films and infectious diseases. Qualitative assessment of post-course survey showed that students had positive responses on Reaction and Learning by 100%, 80% for Behavior, and only 10 % for Results of Kirpatrick Learning Outcomes. In the quantitative assessment, students have achieved the highest average score, 100%, in Cholera (The Painted Veil), followed by COVID-19 (Contagion), 93%, HIV (Philadelphia), 91%, Tuberculosis (Moulin Rouge), 90%, and Syphilis (The English), 89%.

Conclusion

The use of movies to introduce ID in an elective course of a doctoral pharmacy program shows high levels of students’ engagement, reaction, and learning. Students achieved the highest average scores in Cholera (The Painted Veil), followed by COVID-19 (Contagion)

Disclosures

All Authors: No reported disclosures
P-981. Bridging language divides and improving global health education for fellows: Implementation of a real-time closed captioned translation tool for an international case conference
Authors: Peterson Sam , Borgetti Scott , Knodle Ryan D , Roque Yori A , de luna David , Rojas-Fermin Rita A , Mena Lora Alfredo J
Published: January 2025

Background

Delivering a broad curriculum that includes diseases uncommon in the United States (US) such as tropical infections is of interest to program directors. Exposure to global health and tropical medicine is often limited by geographical and language barriers. To address this, our institution established an international case conference within the ID curriculum using Zoom's close-captioned translation technology.

Attitudes and perceptions on automatic caption translation and the educational content of our international case conference

Methods

A monthly conference was established in August 2021 with two US-based academic programs and 4 non-US based academic programs in the Dominican Republic (DR). This conference delivers 30-minute case presentations, with one case from the US and another from a DR site. Cases are chosen to reflect the unique pathologies encountered at respective sites. Conferences are via Zoom with an added automatic close-captioned translation feature. In March, an anonymous online survey was developed and sent to all participants to assess attitudes and perceptions on the educational content of the conference and effectiveness of the translation technology.

Results

A total of 17 individuals participated in the survey, including 11 US faculty, 5 US fellows, and 1 physician assistant. All reported English as their primary language. The translation function showed 65% satisfaction and 77% of participants agreed it improved engagement (Figure 1). Most respondents were very satisfied (53%) or satisfied (41%) with the conference (Figure 2). The diversity of cases was satisfactory (47%) or very satisfactory (29%) by most respondents. Additionally, 94% agreed the conference broadened exposure to cases and management uncommon in the US, 88% agreed it fosters global collaboration, and 82% agreed it improved cultural competency (Figure 1). All participants agreed that the conferences broaden global perspectives.

Conclusion

We report a novel approach to integrating technology into medical education, aiming to enhance the learning by facilitating global collaboration and diversity of case discussions. The conference enables real-time multilingual discussions, enriching the learning experience with a diversity of cases and perspectives. This approach broadens the fellows' exposure and fosters international collaboration.

Disclosures

Scott Borgetti, MD, GSK: Grant/Research Support Rita A. Rojas-Fermin, MD,FIDSA, Gilead: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria
P-983. Online CME Improves Knowledge, Competence and Confidence in the Management of Hepatitis B among Primary Care Physicians
Authors: Thorpe Sara , Gardner Lindsey , Uravich Maria B
Published: January 2025

Background

Viral hepatitis, affecting diverse populations, is a significant public health concern with 850,000 patients living with hepatitis B virus (HBV). Public policy initiatives, such as the CDC's Division of Viral Hepatitis 2025 Strategic Plan, aim to globally eliminate viral hepatitis through culturally relevant prevention, testing, and treatment services. Healthcare providers need professional education to increase awareness, enhance capacity for reducing infection rates, improve identification and linkage to treatment, and address healthcare disparities. This study examined whether online continuing medical education (CME) could improve the knowledge and competence of primary care physicians in hepatitis B virus (HBV) screening, testing, and vaccination into clinical management.

Methods

The CME intervention comprised of a 30- minute online video-based, three-faculty panel discussion. Response to 3 multiple choice, knowledge questions 1 self-efficacy, 5-point Likert scale confidence question were analyzed using a repeated pairs pre-/post-assessment study design. Pre- to post responses were compared using a McNemar’s test to assess statistical significance (P < .001 level). The activity posted on 6/12/2023; data were collected through 8/24/2023.

Results

The analysis set consisted of responses of primary care physicians (n=193). Analysis demonstrated a significant improvement in knowledge, competence, and confidence.

• 65% relative increase in knowledge regarding ACIP Vaccine guidelines (34% pre vs. 56% post, P< .001)

• 18% relative increase in knowledge of CDC Hepatitis B guidelines (66% pre vs. 78% post, P< .001)

• 17% relative increase in competence related to overcoming barriers to Hepatitis B vaccination (65% pre vs. 76% post, P< .001)

• 35% improved confidence related to recommending HBV screening in primary care settings (P< .001)

Conclusion

This study demonstrated the success of online, video-based round table discussion CME on improving knowledge, competence and confidence related to HBV management in primary care. Education enhanced primary care physicians integration of updated Centers for Disease Control and Prevention (CDC) guidelines for hepatitis B virus (HBV) screening, testing, and vaccination into clinical management.

Disclosures

All Authors: No reported disclosures
P-984. Assessment of Clinical Practice Gaps Negatively Impacting Vaccination Rates for Hepatitis B
Authors: Thorpe Sara , Larkin Amy
Published: January 2025

Background

The World Health Organization (WHO) and the US Department of Health and Human Services (HHS) have set goals for the elimination of viral hepatitis infection as a public health threat by 2030[HHS 2021; WHO 2016]. Barriers to achieving viral hepatitis elimination exist and progress toward hepatitis B (HepB) elimination has stalled. Understanding clinician gaps related to knowledge is critical to improve education and training to improve vaccination rates for HepB.

Methods

A survey instrument of 25 multiple choice, knowledge- and case-based questions allowed participants to assess their clinical knowledge related to HepB vaccination. Respondent confidentiality was maintained and responses were de-identified and aggregated prior to analyses. Data collection occurred from June 23, 2023 to August 31, 2023.

Results

Topic Gaps Measured with Incorrect Responses to Knowledge and Clinical Decision-Making Questions (%) PCPs (N=158) Pharmacists (N=98) Public Health Specialists (N=36) Knowledge Prevalence of chronic HepB in the US 56% 45% 53% Prevalence of US population vaccinated against HepB 51% 38% 47% Healthy People 2020 goal related to HepB 61% 72% 50% HepB vaccine safety 62% 35% 39% Continuity of care for HepB vaccines series 46% 39% 36% Completion rates for HepB vaccine series 57% 54% 56% Differences in completion rates for different HepB vaccines 74% 78% 64% Seroprotection rates with HepB vaccines 56% 54% 50% Clinical Decision-Making HepB vaccination recommendation in a patient case 42% 50% 31% HepB vaccine selection in a patient case 66% 57% 56% Contraindication for HepB vaccine 54% 59% 50% Most common rationale for not discussing HepB vaccination 82% 84% 94% Assessment of practice HepB vaccine coverage 59% 48% 44% Confidence Self-reported confidence in ability to discuss HepB vaccines with your patients 75% not confident 81% not confident 64% not confident

Conclusion

This assessment yielded important insights into gaps related to HepB vaccination rates. PCPs have lower knowledge related to HepB vaccines in many areas which may be contributing to lower HepB vaccination rates. Pharmacists are the least confident in recommending HepB vaccines to their patients, followed closely by PCPs. Additional education is needed to increase knowledge and confidence to meet elimination goals.

Disclosures

All Authors: No reported disclosures
383. VA SHIELD: Building an Interactive Dashboard for Surveillance of Infectious Diseases across the Veterans Health Administration, 2000 – 2023
Authors: Epstein Lauren , Paredes-Vincent Ariana , Ogston Christopher , Rodriguez-Barradas Maria C , Bonomo Robert A , Woods Christopher , Brown Sheldon T
Published: January 2025

Background

The Veterans Health Administration (VA) utilizes a comprehensive data system that can be updated in real time to help detect emerging diseases across the United States. We describe a novel interactive dashboard that was developed to track emerging infections across the VA system.Figure 1.Comparison of trends of selected Infectious Diseases, VA system vs. U.S. population (2000 – 2023).

Methods

This project was developed as part of VA Science and Health Initiative to Combat Infectious and Life-Threatening Diseases (VA SHIELD), a comprehensive biorepository of specimens and clinical data that was developed in 2020 to address national health threats across the VA system to improve diagnostic and therapeutic capabilities.

We compiled a list of rare and emerging infectious diseases and identified appropriate ICD-9 and ICD-10 codes for each infectious disease based on expert opinion. All unique persons that received care at any type of VA facility (inpatient, outpatient) were eligible to be included in the analysis. We calculated incidence rates (per 100,000 VA population) based on the number of unique patients that received care at VA facilities annually from 2000 – 2023. We compared VA rates of selected infectious diseases with national rates using publicly available data from CDC’s WONDER database, where available.Figure 2.Incidence of rare Infectious Diseases detected across the VA system (no CDC comparison), 2000 – 2023.Rate per 100,000 VA patients.

Results

We included 47 unique infectious diseases in our assessment; 16 (34%) were also included in CDC’s WONDER database. Compared to CDC’s WONDER database, incidence rates and geographic trends of Coccidioides, Babesiosis, Dengue, Lyme disease and West Nile in VA population were similar to trends across the U.S. population (Figure 1). Among diseases that are not reported in CDC’s WONDER database, the incidence of Leishmaniasis increased in 2005 across the VA population while Bartonellosis, Q fever, and Tick-borne relapsing fever incidence increased in 2015 (Figure 2).

Conclusion

We illustrate how a VA dashboard demonstrates infectious disease trends across the U.S. Although some infections may be Veteran specific and related to deployment by military Reservists, others reflect overall population trends. Linkage of the dashboard to a structured surveillance program can serve as a powerful investigational tool to evaluate emerging outbreaks and trends due to environmental exposures across the U.S.

Disclosures

All Authors: No reported disclosures
P-1002. Congenital Syphilis: Are We Doing Too Much?
Authors: Palaganas Haley Anne , Iacob Alexandra , Batra Jagmohan S , Tay Ching Ching , Soliman Antoine , Guajardo Leonel F
Published: January 2025

Background

The resurgence of syphilis and its risks to neonates has been reported nationally. Sixty to ninety percent of infected infants can be asymptomatic at birth. Effective early identification and treatment of congenital syphilis is paramount. The American Academy of Pediatrics (AAP) offers guidelines for categorizing risk of congenital syphilis and outlines recommended and optional testing for completed workup. Literature on adherence to these guidelines is limited. We hypothesized that unnecessary imaging and labs were obtained on infants without an impact in their management.

Number of congenital syphilis cases per year and divided by diagnostic category.

Methods

We conducted a retrospective study of all infants with a diagnosis of congenital syphilis admitted at MemorialCare Miller Children’s and Women’s Hospital, an urban tertiary referral center, from Jan 2017 – Dec 2023 (IRB # MHS 361-23). Infants were subdivided by congenital syphilis diagnostic category. Data collected for infants included completion of long bone X-ray, head ultrasound, MRI brain, ophthalmologic exams, and lumbar puncture with CSF analysis, as well as if management changes were made based off study results and if any of the studies were abnormal.

Number of ophthalmology exams ordered for each congenital syphilis diagnostic category. The black checkmark indicates if this study was recommended by the AAP.

Results

81 infants were identified in this period. 11 (13.6%) had proven or highly likely, 50 (61.7%) had possible, 14 (17.3%) had likely, and 6 (7.4%) had less likely congenital syphilis. 46 (56.8%) received ophthalmologic exams, all of which did not lead to changes in management. 36 of the 46 ophthalmologic exams (78.3%) were conducted without recommendations from the AAP. 10 out of 19 (52.6%) brain MRIs were ordered without AAP recommendations and did not result in changes in management. 4 out of 62 (7%) long bone x-rays were performed without either AAP recommendation or subsequent changes in management. Similarly, 5 out of 66 (7.6%) lumbar punctures were carried out without adherence to AAP recommendations and did not result in changes in management. 12 out of 15 (80%) head ultrasounds were conducted without AAP recommendation.

Number of brain MRIs ordered for each congenital syphilis diagnostic category. The black checkmark indicates if this study was recommended by the AAP.

Conclusion

Unnecessary labs and imaging were frequently ordered for congenital syphilis work up. Our unit has now undertaken a multi-disciplinary quality improvement project to ensure timely and proper categorization of congenital syphilis risk to ensure appropriate imaging and labs are obtained.

Disclosures

All Authors: No reported disclosures
P-1026. Predictors of Consolidations, Such as Non-Round Image Pattern, in CT Findings in Patients with Invasive Mold Pneumonia
Authors: Jang Hyeon Mu , Chang Euijin , Bae Seongman , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Kim Sung-Han
Published: January 2025

Background

CT is important to diagnose pulmonary invasive mold infection (PIMI). According to 2008 European Organization for Research and Treatment of Cancer (EORTC) criteria, dense, well-circumscribed lesion(s) was listed, but the recent 2020 EORTC criteria further categorized into wedge-shaped and segmental or lobar consolidation in addition to the dense, well-circumscribed lesion(s). However, there are limited data on the different clinical characteristics between these two CT findings. We thus evaluated the frequency of the newly added criterion (consolidation) depending on the underlying diseases.

Methods

We reviewed all adult patients, at a 2700-bed tertiary hospital, Seoul, South Korea, between June 2007 and December 2023, who were diagnosed with proven PIMI, based on 2020 EORTC criteria. CT findings were classified as “round lesion” if those had well-circumscribed lesions such as nodule, mass or cavity and “consolidation” if those had wedge-shaped and segmental or lobar consolidation.

Results

A total of 63 patients with proven PIMIs: 38 (60.3%) aspergillosis and 25 (39.7%) mucormycosis. Of these 63 patients, 19 (30.2%) had a solid malignancy (SM), 18 (28.6%) underwent solid organ transplant and 23 (36.5%) had a hematologic malignancy (HM) including 10 hematopoietic stem cell transplant recipients. Of these, 27 (43%) patients had consolidations in CT findings, and the remaining had “round lesion”. Consolidation was significantly more frequent in patients with neutropenia (< 1500 neutrophils/mm3) (33.3% [5/15] vs 66.7% [10/15]; p 0.03). It was also significantly more common in HM (34.8% [8/23] vs 65.2% [15/23]; p 0.0007) but less in SM (89.5% [17/19] vs 10.5% [2/19]; p 0.006).

Conclusion

More than 40% of proven PIMI showed lung consolidation, which is more frequent in neutropenia and HM but less common in SM.

Disclosures

All Authors: No reported disclosures
P-1028. A Shifting Baseline: Epidemiology and Mortality of Invasive Candidiasis caused by Candida Species Recovered at a Single Tertiary Care Center
Authors: Dickey James , Fowler Michael , Toth Eszter , Raposa Jesse , Vazquez Jose A
Published: January 2025

Background

Invasive candidiasis (IC) refers to a range of infections caused by the fungus Candida. Mortality rates from IC are as high as 40% despite antifungal therapy. Candidemia is the most common manifestation and ranks within the top 4 hospital-associated bloodstream infections in the US. In the past, most cases of IC were historically caused by Candida albicans. Recently there have been corresponding increases in non-albicans Candida species (NAC). This trend is concerning given the observed increases in antifungal resistance among the NAC, such as C. glabrata, C. parapsilosis, and C. auris. Given the high rate of mortality due to IC and increasing rates of antifungal-resistance among the NAC spp., it is critical to provide up-to-date information describing the shift in Candida spp.

Non-albicans Candida comprised the majority of cases of candidemia, with C. glabrata accounting for the majority of these infections. There was no discernable shift in species distribution across the study period.

Methods

A registry of all Candida clinical specimens recovered from anatomically sterile sites at our tertiary care center in Augusta, GA, was developed. Data over a 27-month period was evaluated through a retrospective chart review of all patients with IC. In addition to patient demographics, risk factors, and treatment courses, we analyzed the incidence and the 30 day all-cause mortality of subjects with either C. albicans or NAC causing IC.

Candida albicans comprised the majority of deep-tissue infections with no discernable shift in species distribution across the study period.

Results

184 cases of IC were identified during this period. NAC spp. comprised the majority of cases of candidemia (64.8%, n=84) while the majority of the deep-tissue infections were caused by C. albicans (60%, n=110; Chi-squared, p < 0.001). We identified a notable, non-statistically significant difference in 30-day all-cause mortality between C. albicans and all NAC infections. When compared directly, we found a higher 30-day all-cause mortality in infections caused by C. glabrata (30.6%, n=49) than C. albicans (14.6%, n=89; Chi-squared, p=0.026).

Conclusion

We describe a significant increase in candidemia due to NAC (65%), especially due to C. glabrata. Moreover, there was a slightly higher 30-day mortality due to C. glabrata when compared to C. albicans across all cases of IC. This study establishes a framework to maintain detailed and current, longitudinal evaluations of the epidemiological trends of IC. In addition, knowledge of the shifting epidemiology of IC would also help with the appropriate selection of empiric antifungals and adequate antifungal stewardship.

Disclosures

All Authors: No reported disclosures
P-1041. Contemporary Increase in Candidemia Mortality Is Associated with Antifungal Resistance and Patient Demographics
Authors: Adelman Max W , Nigo Masayuki , Connor Ashton , Casarin Stefano , Hsu Enshuo , Arias Cesar A
Published: January 2025

Background

Candida spp. commonly cause bloodstream infections (BSI) in chronically ill patients, and Candida BSI is increasingly due to antifungal-resistant species. This retrospective cohort study examined temporal trends in candidemia epidemiology and associations between epidemiologic changes and mortality.Table 1.Characteristics of patients with different bloodstream infection types.

Methods

We included patients in a large healthcare system with a first BSI due to Escherichia coli or Klebsiella pneumonia (gram-negative bacteremia [GNB]), Staphylococcus aureus (SAB), or Candida spp. (candidemia) from 6/2016-6/2023. We compared 30-day mortality and demographics between BSI types. We examined changes in candidemia demographics, mortality, and causative species, both by individual year and by period (period 1, 2016-2019 vs. period 2, 2020-2023).Figure 1.Changes in mortality due to bloodstream infection types examined.

Results

Of 12057 patients, 7801 (64.7%) had GNB, 3602 (29.9%) SAB, and 654 (5.4%) candidemia (baseline characteristics in Table 1). Thirty-day mortality was highest for candidemia (30.9% vs. 13.4% for SAB and 8.0% for GNB, p< .01 by χ2). There was a trend toward increased mortality for patients with candidemia (p=0.06 by Mann-Kendall test, Figure 1). Candidemia mortality was significantly higher in period 2 vs. 1 (36.8% vs. 22.7%, p< .01 by χ2). Candidemia patients in period 2 tended to be older (mean age 66.3±14.3 vs. 63.8±16.2, p=0.04 by t-test); age was associated with mortality among patients with candidemia (OR 1.02, 95% CI 1.01-1.04 per year increase). Of species examined, only the incidence of C. auris increased (p< 0.01 by Mann-Kendall test, Figure 2). C. glabrata was associated with the highest 30-day mortality (36.3%) among common species; C. auris mortality was 17.4%. While the proportion of candidemia cases due to antifungal-resistant species (C. auris, glabrata, krusei, lusitaniae, parapsilosis) did not change between periods (p=0.79), mortality from these species was significantly higher in period 2 vs. 1 (36.1% vs. 21.5%, p< 0.01).Figure 2.Increasing prevalence of candidemia due to C. auris, 2016-2023.

Conclusion

Candidemia mortality increased significantly starting in 2020, at least in part due to increasing patient age and increased mortality associated with antifungal-resistant candidemia. Urgent efforts are needed to combat candidemia in an ageing population prone to antifungal-resistant Candida infections.

Disclosures

All Authors: No reported disclosures
P-1052. Identifying Facility and Specimen Type Associated with Screening-to-Clinical Candida auris Patients in the United States, 2013–2022
Authors: Baker Anna D , Jones Sophie , Rajeev Malavika , Lyman Meghan
Published: January 2025

Background

Candida auris (C. auris) is an emerging healthcare-associated fungal pathogen associated with high mortality and antifungal resistance. Targeted screening based on patient risk factors and facility type is important for identifying colonized patients and implementing recommended infection prevention and control (IPC) precautions. Understanding the epidemiology of C. auris colonized patients who subsequently have positive clinical specimens (screening-to-clinical patients (STC)) can help us understand the clinical course and impact of colonization.

Methods

Using national case surveillance data from 34 states and Washington DC, we described C. auris adult patients, as defined by Council of State and Territorial Epidemiologists, during 2013–2022. We analyzed facility and specimen source for STC patients and compared with screening or clinical only patients using chi-squared tests.

Results

Among 13,341 screening patients, 1,151 (9%) were STC. STC patients were more likely than screening only patients to be screened at long-term acute-care hospitals (LTACH) (48% vs 40%; p< 0.001) and were more likely than clinical only patients to have positive clinical specimens taken at LTACHs (35% vs 10%; p< 0.001). While blood was the most frequent clinical specimen source for STC and clinical only patients (39% and 35% respectively), respiratory specimens were more likely to be taken from STC patients than clinical only patients (12% vs 8%; p< 0.001). The median time between STC specimen collection was 47 days [interquartile range (IQR) 19-111] and was shorter for patients in LTACHs (median 37 days [IQR 17–78]) than ACHs (median 53 days [IQR 21–116]).

Conclusion

About half of STC patients were screened at LTACHs and over half of STC clinical specimens were collected at LTACHs. While blood specimens were most frequent clinical specimen source among STC, respiratory sources were more likely to be taken from STC patients than clinical only patients. As high-risk respiratory devices (e.g., mechanical ventilation) are associated with invasive infections, our findings emphasize the importance of timely diagnosis and monitoring STC patients with clinical respiratory sources in LTACHs to reduce risk of invasive infection.

Disclosures

All Authors: No reported disclosures
P-1070. Safety and Efficacy of Replacement with Contezolid-Containing Regimens in Patients with Multidrug-Resistant/Rifampicin-Resistant Tuberculosis Who are Intolerant to Linezolid-Containing Regimens: a Retrospective Case Analysis
Authors: Chang Tingting , Zhang Yuxia , Sun Yanming , Zhao Zhiyuan , Liu Fengxia , Xiong Yu
Published: January 2025

Background

Linezolid, commonly used in the treatment of multidrug-resistant tuberculosis (MDR-TB), has limitations due to adverse effects such as myelosuppression, optic neuropathy. Contezolid, a new oxazolidinone, was developed to reduce toxicity. This preliminary study focused on the potential utility of contezolid in the treatment of MDR-TB.

Methods

This is a retrospective case analysis, thirteen MDR/rifampicin-resistant(RR) TB patients who were switched to contezolid-containing regimens due to adverse reactions during treatment with linezolid-containing regimens were included. Linezolid was administered 600mg once daily for 6-24 weeks, contezolid was given 400mg twice daily for 4 months to 1 year. The results of drug sensitivity test (DST), regimens containing linezolid or contezolid and treatment duration, occurrence of adverse reactions, timing of treatment adjustment, adverse reactions and efficacy are described.

Results

The basic information and treatment related results were shown in Table 1. All of 13 patients experienced adverse reactions during the treatment of linezolid-containing regimens, of which 9 (69.2%) were severe. The time to myelosuppression after linezolid initiation was approximately 8 weeks, and 16 weeks for neurotoxicity. After at least 4 weeks of switching to regimens containing contezolid, 95% of patients with linezolid-related adverse reactions were alleviated or improved. At the end of the third month after treatment adjustment, the WBC, PLT and hemoglobin level of 13 patients returned to pre-treatment level, and the lower limb numbness of 2 patients were improved. Sputum mycobacterium tuberculosis culture and sputum smears acid fast stain of 13 patients turned negative or continued negative, and no case of positive recurrence. Follow-up chest computed tomography showed no evidence of disease progression.

Conclusion

This study showed that contezolid were not only safer than linezolid but also demonstrated clinical improvement in all included patients with MDR-TB. This study supports the hypothesis that contezolid may provide an effective and safe alternative to linezolid in the management of MDR-TB in the future.

Disclosures

All Authors: No reported disclosures
P-1071. In Vitro Susceptibility of the syphilis spirochete, Treponema pallidum, to Linezolid
Authors: Stafylis Chrysovalantis , De Lay Bridget D , Norris Steven , Nguyen Ryan M , Konda Kelika , Reyes-Diaz Michael , Klausner Jeffrey , Edmondson Diane
Published: January 2025

Background

Benzathine penicillin is the antimicrobial treatment of choice for syphilis, but worldwide shortages have caused disruptions in patient care. Therefore, the is a need for new antimicrobial compounds that are effective at curing Treponema pallidum subsp. pallidum (Tp) infections that are not subject to the same supply chain issues currently effecting benzathine penicillin availability. To this end, we tested the in vitro susceptibility of four different strains of Tp (Nichols, Mexico A, UW231B, and UW249B) to linezolid.

Methods

There are two genetically distinct subgroups of Tp: the Nichols group and the SS14 group. The SS14 group is currently predominant worldwide, so we tested three different strains from this group (Mexico A, UW231B, and UW249B). Tp cultured in TpCM2 medium were exposed to linezolid concentrations ranging from 0 to 4 µg/mL for 1 week, then the number of Tp per culture and motility were assessed by darkfield microscopy.

Results

Multiplication was completely inhibited (fold increase ≤1) in cultures treated with 0.5 - 4 µg/mL linezolid and motility was significantly decreased. In vitro MICs for linezolid ranged from 0.32 to 0.36 µg/mL in the four strains tested, with no difference between the Nichols strain (0.32 µg/mL) and the SS14 subgroup strains (0.34 - 0.36 µg/mL). The MIC range determined in vitro is compatible with the blood serum ranges reported in patients given therapeutic doses of linezolid.

Conclusion

Further studies are ongoing to determine if linezolid is an effective antimicrobial compound for the treatment of syphilis.

Disclosures

Jeffrey Klausner, MD MPH, Direct Diagnostics: Advisor/Consultant
P-1090. Rifaquizinone for the Treatment of Acute Bacterial Skin and Skin Structure Infections: A Multicenter, Double-Blind, Randomized, Active-Controlled, Phase 2 Trial
Authors: Scott Overcash J , Waters Michael , Wang Huan , Geng Guozhu , Ai Changlin , Ma Zhenkun , Chen Jing
Published: January 2025

Background

Rifaquizinone (RFQ, TNP-2092) is under development for the treatment of serious or life-threatening bacterial infections including those caused by gram-positive pathogens that have developed resistance to commonly used antibiotics. This study compared the safety, tolerability and efficacy of RFQ and vancomycin in patients with acute bacterial skin and skin structure infections (ABSSSIs).

Methods

A multi-center, randomized, double blind, positive controlled phase 2 clinical trial (NCT03964493) was conducted in adults with ABSSSIs in the USA. Eligible patients were randomized 2:1 to receive RFQ (300 mg) or vancomycin (1 g) IV q12h for 3 to 14 days. Patients who met the switching criteria may switch to commercially available oral antibiotics judged by the investigators. The total duration of the treatment was 7 to 14 days. The primary endpoint was safety and tolerability. The key secondary endpoint was the clinical response at early assessment (EA) visit.

Results

A total of 117 patients received at least 1 dose of study drugs. The incidences of adverse events (AEs) in RFQ and vancomycin groups were 46.2% (36/78) and 48.7% (19/39), respectively. The most of AEs were mild in severity. No drug-related serious AE was reported. The clinical response rate of RFQ at EA visit was higher than vancomycin in the ITT, modified ITT and Micro-ITT populations (Table 1). In patients infected with MRSA and fluoroquinolone-resistance (RF-Q) S. aureus, the clinical response rate of RFQ and vancomycin group were 78.1% (25/51) vs 57.9% (11/29), and 75.9% (22/51) vs 55.6% (10/29), respectively. Pharmacokinetic-pharmacodynamic (PK-PD) analysis indicated that more than 95% of patients achieved the systemic exposures required (AUC0-24h > 50 µg·h/mL) for the treatment of medical device associated biofilm infections.

Conclusion

RFQ was safe and well tolerated in patients with ABSSSIs. The early clinical response rates of RFQ in ITT, mITT and micro-ITT populations were all higher than that of vancomycin. More importantly, RFQ demonstrated higher early clinical response rates than vancomycin in patients infected with MRSA and FQ-R S. aureus. The PK-PD analysis indicated that sufficient drug exposures were achieved for medical device associated biofilm infections.

Disclosures

Huan Wang, PhD, TenNor Therapeutics (Suzhou) Ltd: Employee Guozhu Geng, MD, TenNor Therapeutics (Suzhou) Ltd: Employee Changlin Ai, Master of Medicine, TenNor Therapeutics (Suzhou) Ltd: Employee Zhenkun Ma, PhD, TenNor Therapeutics (Suzhou) Ltd: Employee Jing Chen, Master of Science, TenNor Therapeutics (Suzhou) Ltd: Employee
P-1093. In Vitro Activity of Eravacycline against Carbapenem-Resistant Acinetobacter baumannii as Evaluated by Broth Microdilution, MIC Test Strip and Disc Diffusion
Authors: Liu Qihui , Li Shirong , Jiang Haoqin , Wang Xuan , Li Ning
Published: January 2025

Background

Eravacycline is a new type of fully synthetic fluorocycline antibiotic. The Chinese Committee on Antimicrobial Susceptibility Testing (ChinaCAST) published the clinical breakpoints of eravacycline, including MIC breakpoints and their inhibition zone diameter correlates. MIC test strip (MTS) is a gradient diffusion method that represents a simple alternative to the broth microdilution (BMD) method for performing antimicrobial susceptibility testing (AST). The aim of this study was to compare the susceptible rate of carbapenem-resistant Acinetobacter baumannii (CRAB) to eravacycline by three different testing methods.

Methods

587 strains of CRAB were collected from the Huashan Hospital affiliated to Fudan University from 2019 to 2023. According to the antimicrobial susceptibility test recommended by the American Society for Clinical and Laboratory Standards 2023, the activity of eravacycline was determined. In this study, the BMD was used as the reference standard, and the clinical breakpoints standard published by ChinaCAST ( Acinetobacter baumannii susceptible MIC, ≤ 1 μg / mL or inhibition zone diameter , ≥ 15 mm ) was used to detect the susceptible rate of eravacycline to CRAB.

Results

The MIC50/90s were as follows: BMD, 0.5/1 mg/L; MTS, 0.38/0.75 mg/L. Based on the BMD method, the susceptible rate of CRAB to eravacycline was 98.13% (576/587) according to the ChinaCAST breakpoints, while 97.96% (575/587) was observed in MTS method. The results of DD method showed that the sensitivity rate was 97.61% (573/587). Compared with the results of BMD, the essential agreement (EA) rate of MTS was 94.55%. The categorical agreement (CA) rates of MTS and DD were 99.83% and 99.49%, respectively. The total major error (ME) rate and total very major error (VME) rate of MTS were 0.17% and 0%, respectively. The total ME rate and total VME rate of DD were 0.51% and 0%, respectively.

Conclusion

The susceptible rate of eravacycline to CRAB is high. CA, ME or VME all met the methodological evaluation indicators. The results of the sensitivity of CRAB to eravacycline determined by MTS and DD methods were similar, and the consistency with the BMD method was good. Both of them can be used as reliable AST methods for the determination of eravacycline antibacterial activity in clinical microbiology laboratories.

Disclosures

All Authors: No reported disclosures
P-1110. The Impact of Xeruborbactam on in vitro Activity of Cefiderocol against a Panel of Enterobacterales Enriched with Isolates with Reduced Cefiderocol Susceptibility
Authors: Hara Takafumi , Ishibashi Naoki , Miyagawa Dai , Onishi Motoyasu , Lomovskaya Olga , Yamano Yoshinori
Published: January 2025

Background

Cefiderocol (CFDC) is a siderophore cephalosporin with potent activity against resistant gram-negative bacteria. According to recent SIDERO-WT surveillance studies that involved testing of > 30,000 Enterobacterales (ENT) isolates collected in North America and Europe, 99.8% of ENT were susceptible (S) to CFDC (by CLSI breakpoint) (MIC90=1 µg/mL). For carbapenem-resistant Enterobacterales (CRE), S to CFDC was as high as 96.5% (MIC90=4 µg/mL). In ENT, resistance to CFDC is multifactorial and seems to require production of either a serine (SBL) or metallo (MBL) carbapenemase. Xeruborbactam (XER) is a novel beta-lactamase inhibitor that inhibits multiple SBL and MBL enzymes. In this study, we evaluated the impact of XER on activity of CFDC against a challenge panel of β-lactamase-producing ENT (BL-ENT) enriched in CFDC-resistant isolates.

MIC50/90 of cefiderocol (CFDC) alone and with xeruborbactam (XER) against Enterobacterales

Methods

A challenge panel of 165 BL-ENT isolates that included 139 CRE was used for this study. 79 (56.8%) and 41 (24.8%) of isolates had CFDC MIC values > 1 µg/mL and > 4 µg/mL (non-S by CLSI/FDA breakpoint), respectively. The β-lactamase profile for each isolate was determined by PCR or whole genome sequencing. MICs were determined for CFDC alone and in combination with 1, 2 or 4 μg/mL of XER according to CLSI guidelines for CFDC using iron-depleted CAMHB.

Results

MIC50/MIC90 of CDFC alone and XER alone against 165 ENT were 2/16 and 16/ > 16 μg/mL, respectively. Dose-dependent shifts of CFDC MICs to the more susceptible range in the presence of increasing concentrations of XER were observed. XER at ≥ 1 μg/mL reduced the MIC90 of CFDC to ≤ 1 μg/mL, which is below the MIC90 for CFDC alone for all ENT in surveillance studies. XER at ≥ 2 μg/mL reduced CFDC MIC90 of MBL producers to ≤ 1 μg/mL For isolates with CFDC MIC > 4 μg/mL, 4 μg/mL of XER reduced the CFDC MIC90 from 32 to 1 μg/mL; the MIC50 for this subset of isolates were reduced from 16 to 0.25 µg/mL, the same MIC50 that were observed for all surveillance isolates.

Conclusion

XER significantly improved the activity of CFDC against rarely encountered isolates of Enterobacterales with elevated CFDC MICs. The potency of CFDC/XER against these isolates was as high as potency of CFDC alone against CFDC susceptible strains.

Disclosures

Takafumi Hara, MSc, SHIONOGI & CO., LTD.: Employee Naoki Ishibashi, MD, SHIONOGI & CO., LTD.: Employee Dai Miyagawa, n/a, SHIONOGI & CO., LTD.: Employee Motoyasu Onishi, PhD, Shionogi & Co., Ltd.: Employee Olga Lomovskaya, PhD, Qpex Biopharma Inc.: Board Member|SHIONOGI & CO., LTD.: Employee Yoshinori Yamano, PhD, Shionogi & Co., Ltd.: Employee