bluuebunny/crossref_metadata_2025 huggingface dataset:
P-841. Empiric Antimicrobial Treatment of Sepsis in Canadian Emergency Rooms: Analysis of Pathogens Causing Bacteremia and Their Susceptibility Rates
Authors: Li Jeremy , Baxter Melanie R , Walkty Andrew , Karlowsky James , Zhanel George
Published: January 2025

Background

An alarming increase in the frequency of ESBL-producing organisms has been reported in Canada, raising concerns about whether empiric regimens used for the treatment of sepsis remain sufficient to cover ER patients with potentially undiagnosed bloodstream infections. Using data from the CANWARD study, we report on the epidemiology of bloodstream infections in Canadian emergency rooms and estimate the susceptibility rate of these pathogens to empiric regimens commonly used for the treatment of sepsis.

Rate of ESBL production in blood culture isolates of Escherichia coli (ER patients, CANWARD 2007-2022).

Methods

As part of the CANWARD national surveillance study, sentinel hospitals across Canada submitted the first 10 clinically significant isolates recovered from blood cultures each month. Isolates underwent antimicrobial susceptibility testing using the broth microdilution method and susceptibility to antibiotics was determined whenever MICs and CLSI breakpoints were available. For Streptococcus and Enterococcus, where piperacillin-tazobactam breakpoints were not available, susceptibility was inferred from penicillin and ampicillin MICs as per EUCAST standards.

Rate of ceftriaxone susceptibility in blood culture Escherichia coli isolates (ER patients, CANWARD 2007-2022).

Results

From 2007 to 2022, 9,178 blood culture isolates were collected from patients presenting to Canadian emergency rooms. The most common organisms isolated were:

1. Escherichia coli (31.7%)

2. Staphylococcus aureus (16.8%)

3. Klebsiella pneumoniae (7.8%)

4. Streptococcus pneumoniae (6.8%)

5. Streptococcus pyogenes (2.9%)

There has been a marked increase in the rate of ESBL production in E. coli (Figure 1). This is associated with a decrease in the susceptibility rate of E. coli to ceftriaxone (Figure 2).

Despite these changes, isolates from blood cultures of ER patients remain susceptible to piperacillin-tazobactam more than 90% of the time and remain susceptible to piperacillin-tazobactam plus vancomycin more than 95% of the time (Table 1).

Susceptibility rates of blood culture isolates from ER patients to commonly prescribed empiric antimicrobial regimens.

Conclusion

Isolates causing bloodstream infections in Canadian ER patients remain susceptible to piperacillin-tazobactam more than 90% of the time. The susceptibility rate to ceftriaxone is less than 85% and ceftriaxone should be used with caution in sepsis when the source of infection is unclear. Individual centers should perform their own assessments based on the most common pathogens causing bacteremia and their local susceptibility rates.

Disclosures

All Authors: No reported disclosures
P-849. Characteristics and Outcomes of Patients with Community-acquired and Nosocomial Klebsiella pneumoniae Bacteremia in a Tertiary Hospital in the Philippines
Authors: Abad Cybele Lara R , Carascal Mark , Ong Justin Allister G
Published: January 2025

Background

Klebsiella pneumoniae (KPN) bacteremia is associated with higher morbidity and mortality, but there is paucity of local data. This study describes the clinical, microbiologic profile, capsular types, and outcomes of individuals with community-acquired and nosocomial KPN bacteremia.

Methods

This study prospectively enrolled patients in a private tertiary hospital from January 1, 2023 to December 31, 2023. Hospitalized patients >/= 18 years old with documented KPN bacteremia were included in the study and isolates subjected to capsular typing. The two-tailed t test was used for continuous variables reported as mean and standard deviation whereas chi-square test was used for categorical variables reported as frequencies and percentages. Descriptive statistics were used and univariate analysis using Medcalc Statistical software.

Results

A total of 25 patients developed KPN bacteremia during the study period; 18 were community-acquired (CA) and 7 were nosocomial. More than half of patients were female (16/25, 64%), with median age 70 (+/- 15) years old. The most common comorbidities were hypertension (15/25, 60%), diabetes mellitus 14/25 (56%), and solid tumor (9/25, 36%). The average intensive care unit stay of 3.4 (+/- 5.9) days for CA KPN bacteremia was significantly shorter than the 13.6 (+/- 16.1) days for those with nosocomial KPN bacteremia. There was no difference in the total length of hospital stay for CA KPN bacteremia (36.7 +/- 85 days) and nosocomial KPN bacteremia (38.6 +/- 23.3 days). Wild-type KPN isolates (15/25, 83.3%) were more commonly found in CA KPN bacteremia, whereas multi-drug resistant isolates were more common for nosocomial KPN. Patients with endotracheal intubation (OR=16, 95% CI 2.2 to 118.3), positive qSOFA (OR=6.42, 95% CI 1.1 to 37.7%), identification of rmpA (OR=9.33, 95% CI 1.5 to 59.5%), and K20 capsular serotype (OR=6.0, 95% CI 1.0 to 35.9%) were more likely to have higher mortality.

Conclusion

In this cohort, KPN bacteremia occurred more frequently among women, and in the older age group. CA-KPN was more common than nosocomial KPN bacteremia, but the latter was associated with multi-drug resistance. Endotracheal intubation, positive qSOFA, rmpA, and K20 capsular serotypes were associated with higher mortality.

Disclosures

All Authors: No reported disclosures
P-851. Evaluation of a multifaceted intervention on the management of uncomplicated gram-negative bacteremia
Authors: Shihadeh Katherine C , Deaney Michael , Craig Alex , Cooper Margaret M , Jenkins Timothy C
Published: January 2025

Background

Randomized, controlled trials found 7 days of antibiotics to be as effective as 14 days for the treatment of uncomplicated Gram-negative bacteremia. The routine use of repeat blood cultures for these uncomplicated infections is low yield and not recommended. A review of the management of these infections at Denver Health found the median duration of therapy was 10 days and nearly two-thirds of patients had blood cultures repeated. A multifaceted intervention was implemented to reduce duration of therapy and use of repeat blood cultures. The purpose of this study was to evaluate the impact of the intervention.

Methods

This retrospective cohort study took place from 1/2019 - 12/2019 (pre-intervention) and 10/2022 - 9/2023 (post-intervention). 3 interventions were implemented including a) development and dissemination of a guideline for the management of uncomplicated Gram-negative bacteremia which recommends 7 days of therapy and against repeat blood cultures for most patients b) clinical decision support to discourage repeat blood cultures c) prospective review of positive blood cultures with provider feedback performed by an infectious diseases pharmacist. All patients over 18 years of age with a positive blood culture with a Gram-negative organism were included. The primary outcome was duration of therapy pre-and post-intervention. The secondary outcome was proportion of patients with repeat blood cultures.

Results

Patient demographics were similar between groups. Urinary tract and E. coli were the most common source and pathogen, respectively. Most patients completed therapy with an oral agent; either a fluoroquinolone or cephalosporin. Cefdinir decreased and cephalexin increased based on institutional guidance. The median duration of therapy decreased from 10 to 7 days (p< .01) and fewer patients had repeat blood cultures (60% vs 31%, p< .01). There were fewer cases of C. difficile in the post-intervention group, otherwise no differences in safety outcomes.

Conclusion

Implementation of a guideline for the management of uncomplicated Gram-negative bacteremia, clinical decision support, and review of positive blood cultures with provider feedback performed by an infectious diseases pharmacist reduced duration of therapy and the use of repeat blood cultures.

Disclosures

All Authors: No reported disclosures
P-860. Managing Carbapenem-Resistant Enterobacterales (CRE) Bacteremia: Real World Data and Insights from a Quaternary Care Hospital in the United Arab of Emirates
Authors: Nasef Rama , El Lababidi Rania M , Afif Claude
Published: January 2025

Background

Infections caused by carbapenem-resistant Enterobacterales (CRE) represent significant clinical challenges due to their poor outcomes and high mortality. Real-world data on the treatment of carbapenem-resistant Enterobacterales (CRE) bacteremia in the United Arab of Emirates (UAE) is currently scarce. Our aim was to outline the various treatment approaches for CRE and their respective outcomes

Methods

A retrospective observational study was conducted at our quaternary hospital between July 2021 and March 2024. We included patients with bacteremia caused by CRE infections. Antimicrobial resistance genes were detected using blood culture identification panel (Biofire FilmArray). Our primary outcome was all cause mortality and secondary outcomes were clinical success and 30-days-admission rates. Clinical success was defined as microbiological cure in addition to resolution of symptoms. Data was analyzed through descriptive statistical methods.

Results

A total sample of 40 patients met the inclusion criteria, 23 males, median age of 62 (38-74.2) years and a median Charlson Comorbidity Index of 6 (1.75-8). The New Delhi Metallo-β-lactamase (NDM-1) resistance gene accounted for (32/40, 80%) of patients, of which, (19/32, 59.3%) were treated with the combination of Ceftazidime-avibactam-Aztreonam. All cause mortality was observed in (14/40, 35%) patients. The mortality observed in patients with NDM resistance gene was (12/32, 37.5%). Over all clinical success and 30-days-admission rates were (24/40, 60%) and (3/40, 7.5%) respectively.

Conclusion

In our cohort of patients with CRE bacteremia, we observed high rates of NDM resistance gene. The overall mortality rate was high at 35% which is similar to what is reported in the literature. Data is urgently needed on the management of CREs with NDM resistance gene to improve patient outcomes.

Disclosures

All Authors: No reported disclosures
P-891. Clinical Impact of Central Venous Catheter-Only Positive Cultures in Staphylococcus aureus Bacteremia
Authors: Yoon Choseok , Chang Euijin , Bae Seongman , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Lee Sang-Oh , Choi Sang-Ho , Kim Sung-Han , Kim Yang Soo
Published: January 2025

Background

There is limited data on patients with indwelling central venous catheter (CVC) presenting with Staphylococcus aureus bacteremia (SAB) isolated exclusively from the CVC, without positive results from peripheral venipuncture. The aim of this study was to assess the clinical characteristics and prognoses of SAB patients with cultures positive only from CVC-drawn samples.

Methods

A retrospective cohort study was conducted from 2014 to 2018 on SAB patients with indwelling CVCs. The prevalence of patients with S. aureus isolated only from the CVC (CVC-only positive group) was calculated among SAB patients with indwelling CVCs. The clinical characteristics and 90-day clinical outcomes were compared between CVC-only positive group and those with catheter-related bloodstream infections (CRBSI), where S. aureus was positive in peripheral venipuncture as CVC-drawn culture.

Results

A total of 390 SAB patients with indwelling CVC were identified during 5 years: 39 (10.0%) had cultures positive solely from the CVC, 203 (52.1%) were diagnosed with CRBSI, and the remaining 148 (37.9%) had an infection focus other than the CVC. No significant differences in underlying comorbidities or infection severity of CVC-only positive group compared to the CRBSI group. There were no significant differences in the 90-day outcomes for mortality (33.3% vs. 22.7%), recurrence (10.3% vs. 4.4%), or metastatic infection (10.3% vs. 14.8%) between the CVC-only positive group and the CRBSI group (all P >0.05), except for a significantly lower incidence of persistent bacteremia in the former group (12.8% vs. 36.9%, P=0.006). In multivariable Cox regression analyses adjusted confounders, no significant differences in 90-day mortality (adjusted hazard ratio [aHR] 0.96; 95% confidence interval [CI], 0.50–1.84) or recurrence rates (aHR 1.68; 95% CI, 0.48–5.95) in CVC-only positive group compared to the CRBSI group.

Conclusion

S. aureus bacteremia isolated solely from CVCs demonstrated significant mortality and recurrence rates comparable to those observed in CRBSI. These findings indicate that S. aureus bacteremia, even when isolated solely from CVCs, should not be dismissed as contamination, underscoring the necessity for appropriate antibiotic treatment.

Disclosures

All Authors: No reported disclosures
P-893. Expedited Transition to Oral Antibiotics in Gram Negative Bacteremia Reduces Hospital Length of Stay
Authors: Nelson Zachary , Christensen Alyssa
Published: January 2025

Background

Uncomplicated Gram-negative bloodstream infection (GN-BSI), often originating from the urinary tract, is a common reason for hospitalization in the United States. No high-quality data exist that suggest a specific duration of intravenous treatment is indicated for GN-BSI. As such, we hypothesized that expedited transition to oral antibiotics (at the time of susceptibility testing result availability) may facilitate earlier discharge from the hospital. Efforts to reduce hospital length of stay (LOS) yield benefits to both the patient and the healthcare system and have not been as consistently reported as more traditional stewardship metrics, such as time to optimal treatment. A combination of targeted provider and pharmacist education and formal ASP recommendations documented in the medical record were used to facilitate swift transition to oral antimicrobials.

Methods

Data was collected prior to (January to July 2023) and after (August 2023 to December 2023) the intervention consisting of targeted physician and pharmacist education and formal documentation of ASP recommendations in the medical record was deployed on August 1, 2023. The post-intervention cohort was stratified by whether formal ASP recommendations were documented in the medical record, which may reflect the impact of the targeted education efforts alone. The three groups were compared using an analysis of variance.

Results

The average hospital LOS for the pre-intervention (n = 421), post-intervention without ASP recommendations (n = 260), and post-intervention with ASP recommendations (n = 83) groups were 7.13, 6.84, and 5.84 days, respectively (p = 0.63). While not statistically significant, using a conservative estimate of $1,100 per hospital day yields an estimated cost savings due to reduced LOS alone of approximately $187,200 from August to December 2023 that may be attributable to the aforementioned interventions.

Conclusion

Targeted physician and pharmacist education and documenting formal ASP evidence-based recommendations in the medical record that guide clinicians to transition to oral antibiotics when susceptibility results are available can meaningfully reduce hospital length of stay. The reduction in LOS observed in our study was greatest when the two strategies were combined.

Disclosures

All Authors: No reported disclosures
P-903. Human Parechovirus Central Nervous System (CNS) Infection in Infants: A Multicenter Retrospective Case Series of the 2022 outbreak
Authors: Sheth Avni , Shah Nisha , Fortin Oliver , Gagliardo Christina , Hauger Sarmistha Bhaduri , Calardo Sarah J , Santos-Oren Marina , Souverbielle Cristina Tomatis , Erdem Guliz , Sanchez Pablo J , Solaiman Adil , Harik Nada , Mulkey Sarah B , Downey Rachel , Angelis Dimitrios , Ansusinha Emily , Chalak Lina , Russo Susan , Teran Paul , Katragkou Aspasia
Published: January 2025

Background

Human parechovirus (PeVA) typically causes self-limiting respiratory and gastrointestinal infections. However, in infants, it can cause severe sepsis-like illness and CNS disease. In 2022, a CDC Health Advisory reported severe PeVA infections in young infants in multiple states. Our aim was to describe the clinical features, laboratory characteristics, and outcomes in infants with PeVA CNS infection during the 2022 multistate outbreak.

Methods

A multicenter retrospective chart review was conducted at 7 children’s hospitals (6 states) of infants with PeVA CNS infection. Cases were identified by positive CSF PCR testing using the FilmArray meningitis/encephalitis panel (BioFire Diagnostics, Salt Lake City, UT). Data were entered in REDCap and pertinent demographic and clinical data were analyzed.

Results

103 infants were admitted from March-October 2022 with 30 (29%) of the admissions occurring in July. Patients’ median age was 18 days, 55% were male, and 93% born full term. The median length of hospital stay was 3.3 days. 19% required admission to an intensive care unit, 29% had increased oxygen requirement, and 5% required inotropic support. The most common clinical manifestations were fever (84%), irritability (63%), poor feeding (37%), tachycardia (31%), seizures (23%) and hypothermia (19%). The median peripheral white blood cell count was 5.6 x109/L and median CSF white blood cell count was 3 cells/mm3. The median CRP was 0.3 mg/dL and 54% of the infants had transaminitis. Brain MRIs were obtained in 55 cases; 31 (56%) demonstrated abnormalities with diffusion restriction involving white matter and thalami. EEGs were obtained in 40 cases; 22 (55%) revealed abnormalities. 99% of our infants survived, 13% were discharged with anti-seizure medications, and 10% received developmental follow-up.

Conclusion

PeVA should be considered in young infants presenting with fever or hypothermia, sepsis-like symptoms, or meningitis even with no laboratory findings of significant inflammatory responses. PeVA CNS infection in young infants can cause neurologic injury requiring long term neurodevelopmental follow up. Nationwide epidemiological studies are necessary to elucidate the dynamics of this infection.

Disclosures

Cristina Tomatis Souverbielle, MD, Merck, inc: Grant/Research Support
P-904. Spinal Arachnoiditis and Syringomyelia in Coccidioidomycosis: A Case Series of 53 Adult Patients
Authors: Torres Bianca , Khalid Danish , Dunn Chelsea , Sharma Rupam , Kooner Lovedip , Valdez Michael , Mishra Shikha , D’Assumpcao Carlos M , Johnson Royce H , Kuran Rasha
Published: January 2025

Background

Central nervous system (CNS) involvement with coccidioidomycosis (cocci) is a serious infection that is universally fatal if not treated. Prior to the advent of magnetic resonance imaging (MRI), very few reports describe spinal cord involvement and autopsies often omitted spinal cord examination. Accurate and anatomic localization of areas affected by CNS cocci can be challenging due to mental status changes and the presence of brain abnormalities. Here, we describe radiologic and clinical characteristics of 53 cases of CNS cocci who had spinal MRI imaging performed.

Methods

This retrospective case series reviewed 53 adult patients at the Valley Fever Institute in Bakersfield, California. Patients had confirmed CNS cocci and MRI of at least one segment of the spinal image with and without contrast. A waiver of consent was submitted, and approval was obtained by Kern Medical’s Institutional Review Board. ICD 9 and ICD 10 codes were used to query electronic health record and cross referenced with imaging. Each record reviewed required inclusion criteria of age above 18 years, cerebrospinal fluid (CSF) abnormalities compatible with chronic meningitis and one of the following: positive CSF IgG antibody, CSF complement fixation (CF) or growth of Coccidioides on CSF culture. MRI Imaging with and without contrast of at least one of the following: cervical, thoracic or lumbar spine.

Results

77% of the patients were Latinx, 13% African American, 4% Asian and 6% Caucasian. Males make up the majority at 72%. 37% had intrathecal (IT) amphotericin (ABD) injections. Spinal cord abnormalities can be asymptomatic with the most common symptom of back pain followed by radiculopathy. Abnormal findings included leptomeningeal enhancement, arachnoid cysts, masses or adhesions, syringomyelia, myelitis, cord edema, myelomalcia, flattened cord, nerve root "clumping" or solid cauda equina.

Conclusion

This study suggests the benefit of obtaining neuro axis imaging with and without contrast on all new cases of Coccidioidal meningitis. Spinal cord involvement with CNS cocci is common and contributes to significant morbidity. Contrary to common belief, our study shows that spinal arachnoiditis occurs in patients who were never treated with IT ABD. This may suggest that IT ABD may not cause arachnoiditis.

Disclosures

All Authors: No reported disclosures
P-910. Enhancing Awareness: Early Detection of Varicella-Zoster in CNS Among Immunocompromised Patients
Authors: Sienra-Iracheta Estefania , Rodea Bianca Paola Aguilar , Lopez Angela Michelle Arias , Ramos Melissa Mariana Lopez , Ramírez-Hinojosa Juan Pablo , Castellanos Juan Pablo Venzor , Rodriguez-Zulueta Patricia , Godinez Xochitl Yadira Sanchez , Julio David Medina
Published: January 2025

Background

Varicella zoster virus (VZV) reactivation typically presents as herpes zoster, but central nervous system (CNS) involvement is more prevalent in immunocompromised individuals.

Methods

This retrospective study, conducted from January 2023 to March 2024 at two hospitals, aimed to characterize VZV CNS infections in this population. Twenty-seven immunocompromised patients with active herpes zoster were included. Clinical data, cerebrospinal fluid (CSF) analysis, and treatment outcomes were analyzed.

Results

The mean age was 45 years, with a predominance of males (60%). Most patients had HIV (16) with a mean CD4 count of 126, while others had cancer (5), autoimmune diseases (2), or diabetes mellitus (1). Headache was the most common symptom (64%), followed by fever (19%), altered consciousness, and behavioural changes (7%). Facial palsy was observed in 3 patients, but no seizures were reported. CSF analysis revealed hyperproteinorrachia (mean 75 mg/dL) and pleocytosis (mean 39 cells). All patients received intravenous acyclovir for an average of 14 days, with a 100% survival rate at 30 days.

Conclusion

This study highlights the importance of early suspicion and diagnosis of VZV CNS infections in immunocompromised individuals, even in the absence of classical neurological symptoms. Prompt initiation of intravenous acyclovir therapy is crucial for favourable outcomes.

Disclosures

Estefania Sienra-Iracheta, MD, PFIZER: Advisor/Consultant|STENDHAL: Advisor/Consultant Juan Pablo Ramírez-Hinojosa, MD, Abott: Honoraria|Jansen: Honoraria|Silanes: Honoraria Patricia Rodriguez-Zulueta, MD, PFIZER: Advisor/Consultant|STENDHAL: Advisor/Consultant
P-916. Use of BCID2 on CSF in nosocomial CNS surgical site infections
Authors: Walters Laura , Weber Devin , Nassur Jamie , Pettengill Matthew
Published: January 2025

Background

Nosocomial intracranial infections, arising from surgical procedures or neuroinvasive devices like ventricular drains or shunts, present distinct risk factors and microbiologic etiologies compared to community-acquired meningitides. Pathogens typically include Staphylococcus spp., Gram-negative bacilli, and multidrug-resistant bacteria. The current diagnostic standard for nosocomial central nervous system (CNS) infections is cerebrospinal fluid (CSF) Gram stain and culture, but rapid molecular diagnostics could improve diagnosis and treatment, enhancing patient outcomes. This pilot study aimed to assess the validity of the BioFire® Blood Culture Identification Panel 2 (BCID2) panel used for blood culture positivity detection on CSF samples in patients presenting with nosocomial meningitis/ ventriculitis. Sensitivity and specificity were calculated, and patient characteristics and co-morbidities were reviewed.

Microbiologic data comparing gold standard Gram stain and culture of CSF to BCID2 result.

Methods

Patients over 18, admitted to Thomas Jefferson University Health System hospitals between 4/1/2017 to 4/1/2024, were included if meeting Centers for Disease Control (CDC) criteria for intracranial infection or meningitis/ventriculitis.

Positive CSF samples (n=30) from 28 patients with nosocomial infections included Gram-positive bacteria (13), Gram-negative bacteria (13), and fungi (4). Positive CSF samples included those positive on culture, while control samples (n=26) had negative cultures or cultures positive for Cutibacterium acnes, an organism not detected by the BCID2 panel.

Results

Across all positive CSF specimens, sensitivity for organism detection was 76.7%. When culture-positive samples were classified based on Gram Stain, samples with organisms detected on Gram Stain had a sensitivity of 94.7% compared to 45.5% for samples with no organisms seen. For samples with organisms detected on Gram Stain, sensitivity for Gram-negative organisms was 100% and 88.9% for Gram-positive organisms. Among all control specimens, specificity was 100%.

Conclusion

The ability to rapidly identify a pathogen is crucial for managing nosocomial CNS infections effectively. Our study found that the BCID2 panel offers a promising utility in the detection of nosocomial CNS infections through CSF analysis.

Disclosures

Matthew Pettengill, PhD, Cepheid: Grant/Research Support
P-929. Identification and Treatment Outcomes of Patients with Infective Endocarditis Coinfected with Hepatitis C Virus
Authors: McQuaide Lauren C , El-Dalati Sami , Walston Bobbi Jo
Published: January 2025

Background

Patients with infective endocarditis (IE) often have co-morbid injection substance use and are at risk for infection with hepatitis C virus (HCV). As of 2023, only 10% of patients who inject drugs have been treated for HCV in the United States. Low rates of treatment may reflect the logistical challenges associated with HCV therapy. To improve access to treatment for patients with IE and HCV, we developed an interdisciplinary collaboration between pharmacy and clinical infectious diseases (ID) providers.

Methods

The University of Kentucky (UK) implemented a cardiovascular ID consult service in September 2021. The service including physicians, advanced practice providers, a pharmacist and nurse. The consult team worked with UK Healthcare specialty pharmacy to create a pathway connecting patients with IE and HCV to treatment and outpatient follow-up. Regimens included either glecaprevir/pibrentasvir for 8 weeks or sofosbuvir/velpatasvir for 12 weeks. IRB approval was obtained from UK. Study investigators then retrospectively reviewed the endocarditis team registry to identify patients referred for HCV treatment and collect demographic and outcomes related data.

Results

Between September 2021 and April 2024, 64 patients with IE and HCV who were referred for expedited treatment were identified. The mean age was 37.9 years and 40.6% were female. Sixty-two patients had recent injection drug use. Only 1 was treatment experienced and 51.6% had HCV genotype 1A. Seventy-five percent (48) started treatment and 57.8% were prescribed sofosbuvir/velpatasvir. Thirty-three of 48 (68.8%) patients who started treatment completed therapy. Of the 15 patients who did not complete treatment,10 were lost to follow-up and 3 had adverse drug reactions. Twenty-two of 48 had viral loads collected for SVR12 and 20 were negative.

Conclusion

Using a standardized, interdisciplinary approach, 31.3% of patients with IE and HCV completed treatment with documented evidence of SVR12. An additional 17% of patients completed therapy but were unable to complete testing for SVR12. Loss to follow-up remains the primary barrier to starting therapy and accurately recording treatment outcomes. Future efforts should focus on ease of access to treatment and follow-up.

Disclosures

All Authors: No reported disclosures
P-930. Infective Endocarditis and the Role of Oral Pathogens
Authors: Lauriente Tanna J , Leis Benjamin , Takaya Satchan , Wong Chantelle Y G , Spence Cara , Teekasingh Mohan
Published: January 2025

Background

Studies suggest poor oral health increases the risk of infective endocarditis (IE) as 20-53% of cases stem from organisms linked with oral flora. Despite intravenous drug use being a known risk factor for IE, our local data reveals nearly 33% of IE pathogens in individuals who inject drugs (PWID) come from oral microflora. Shockingly, only 9.1% of IE patients received dental consultation during admission.Table 1.Classification of isolated infective endocarditis pathogens by site of origin and injection drug use status.77 participants underwent retrospective chart review with 36.4% identifying as people who inject drugs (PWID). A heat map was used with blue indicating 0 and red indicating higher number of pathogens up to 12. This demonstrates that the majority of pathogens identified from positive blood cultures were from skin, oral cavity, and GI sources. However, among the PWID group, environmental pathogens were more prevalent.

Methods

This is a pre-and-post intervention cohort study. Through retrospective chart review, we established baseline PWID status, pathogen identified in positive blood cultures, dentistry details, and determined origin site of the microorganism. We reviewed all adult IE admissions to our tertiary care hospital in Saskatoon, SK from January 1, 2022 to May 31, 2023 who met the Modified Duke Criteria. Using this data, we designed a Multi-Disciplinary Endocarditis (MENDO) Clinical Pathway to address gaps in dentistry review and intervention at our hospital. This intervention, which began September 25, 2023, has enrolled 35 patients so far.

Results

Among the 77 retrospective participants meeting inclusion criteria, 36.4% were PWID and 31.2% of all IE pathogens were from oral sources. Commonly isolated oral pathogens included Viridans Group Streptococci and Streptococcus anginosis. Notably, 32.1% of IE organisms in PWID were oral pathogens which was similar to non-PWID (p = 1.0). In the retrospective cohort, the baseline rates of dentistry consultation and dental intervention were 9.1% and 7.8% respectively. Since September 2023, 35 patients have been enrolled in the MENDO pathway, 72.1% of which are PWID. Through care standardization and case worker support, our dentistry consultation rate and intervention rates are now 35.5% (p = 0.0115) and 9.7% (p = 0.714) respectively.

Conclusion

In our study, approximately 1 in 3 PWID had IE due to oral pathogens. This was comparable to non-PWID, suggesting equal prevalence of IE due to dental sources in both populations. Our intervention enhanced dentistry access for PWID, and we hypothesize that our longitudinal data will show reduced infection relapse. Integrating oral health assessments and interventions into the care of individuals at risk for IE, including those with PWID, could potentially reduce the burden of this serious condition.

Disclosures

Satchan Takaya, MD FRCPC, Moderna: Advisor/Consultant
P-939. 2-year Follow-up on Patients Who Inject Drugs (PWID) Diagnosed with Infective Endocarditis (IE)
Authors: Patel Kaya , Duffield Olivia , Schultz Sara K , Spivack Stephanie
Published: January 2025

Background

IE is a serious infectious complication of intravenous drug use (IVDU). Treatments include prolonged courses of IV antibiotics, surgical valve repair or replacement, and vacuum-assisted thrombectomy. Herein, we describe a 2-year follow up of outcomes of PWID who presented with IE.

Treatment modalities for IE

Methods

The IRB approved this study. We queried our EMR for patients with documented opioid use disorder (OUD) with injection behavior and positive blood cultures from September 2021 to March 2022. For patients identified to have IE in this time frame, we conducted a retrospective chart review from March 2022- March 2024 to evaluate outcomes.

Outcomes in all treatment groups

Results

We identified 37 patients with definite IE by modified Duke’s criteria. The treatment modalities these patients received are described in Figure 1. Of the 11 patients meeting criteria to receive surgical intervention, only 7 (63%) of these patients received intervention. All 7 (100%) of the patients that received intervention completed their antibiotic course for treatment. None were readmitted for sequela of undertreated endocarditis, but 2 (28%) patients were readmitted within 2 years for repeat endocarditis due to continued injection drug use. The 2-year all-cause mortality in this group was 0%. Of the 4 (37%) patients who required intervention but did not receive it, 1 (25%) was offered intervention but declined, 1 (25%) had an in-hospital death, and 2 (50%) left with a patient directed discharge but received intervention when readmitted within 3 months. The 2-year all-cause mortality rate in this group was 50%.

In the remaining 26 patients who did not require intervention, 7 (27%) completed an antibiotic treatment course, 17 (65%) did not complete antibiotics, and 2 (8%) had an unknown treatment course. Eleven (42%) were readmitted for bacteremia within 2 years. Four (15%) were readmitted with endocarditis (3 within 60 days from untreated endocarditis with worsening vegetation on TTE and 1 with endocarditis from continued injection drug use). The 2-year all-cause mortality in this group was 3 (11%). Table 1.

Conclusion

In a 2-year follow-up of PWID presenting with definite endocarditis, high survival was noted in patients who underwent intervention. In patients receiving antibiotic therapy alone, high rates of incomplete treatment and readmissions occurred.

Disclosures

Sara K. Schultz, MD FACP FIDSA, AbbVie: Advisor/Consultant
P-941. Short- and Long-term Mortality of Infective Endocarditis in the Veteran Population
Authors: Davis Matthew , Mergenhagen Kari A , Chan Arthur , Xu Jiachen , Wattengel Bethany A , O’Leary Ashley
Published: January 2025

Background

The aim of this study was to evaluate the short- and long-term mortality of infective endocarditis within the veteran population.

Methods

This study was a retrospective, national study of veterans > 18 years old between 1/1/2010-3/1/2023 diagnosed with endocarditis. Endocarditis was defined by ICD coding, patients having at least one positive blood culture and having an echocardiogram performed. during admission. The primary objective was to evaluate the rate of 30-day and one-year mortality of the study population.

Secondary endpoints looked at correlation between mortality and other factors such as comorbidities, causative organism, drug/alcohol disorders, smoking status, septic emboli, fever, and the use cardio-protective medications.

Charlson Comorbidity Scores

Results

4,241 hospitalized patients who received care at a Veterans Affairs Hospital and were diagnosed with bacterial endocarditis during the study timeframe were included. The primary outcome of short- and long-term mortality was seen in 658/4,241 patients (15.5%) and 1775/4,241 patients (41.9%) respectively.

Enterococcus faecalis endocarditis was the most prevalent organism (17.2% of infections). MRSA endocarditis was associated with a clinically significant increase in mortality at both 30-days and one-year (p < 0.001). The diagnosis of septic emboli showed a statistically significant increase in short-term mortality with 106/427 patients diagnosed experiencing mortality within 30-days (p < 0.001) Fever during admission showed a statistically significant increase in mortality for both short- and long-term mortality rates (p < 0.001).

Conclusion

Mortality within one-year was found to be 41.9% amongst our patient population. Identifying possible risk factors for increased mortality in this population may assist in decreasing both the short- and long-term mortality of those with infective endocarditis. Future directions for research could include assessing cardio-protective medications in this population on a larger scale to assess potential benefit.

Disclosures

All Authors: No reported disclosures
P-945. “Bug Of The Day”: An Infectious Disease Interest Group Initiative to Provide Weekly Doses of Infectious Education
Authors: Palacios Alfredo A , Pavia Jonathan E , Le Rose , Nicolas Marissa , Roa Kyra , Hornak Joseph Patrik
Published: January 2025

Background

Medical education continues to accommodate advancements in technology. Currently within the social media era students can access vast amounts of information through various platforms. As education evolves with technology, educators must understand social media platforms in order to maximize their impact. The Infectious Disease Interest Group (IDIG) has initiated “Bug of The Day”, a social media initiative to increase medical student exposure to the field of Infectious Disease.

Methods

IDIG formed a committee of 7-10 medical students who collaborate to produce informative posts about microorganisms. These posts include a compelling question, detailed explanations, and facts to assist medical students in solidifying their knowledge of important organisms. Metrics obtained through the study consist of user interaction with posts including likes, comments, shares, amount of votes, and profile interaction. An online survey will be administered assessing student satisfaction of the posts, and to what degree these posts benefit their knowledge of ID.

Results

Sixten “Bug of The Day (BOTD)” posts have been shared on our instagram with posts being published twice a week. The average number of accounts reached by a BOTD post is 148.6, with an average of 76% selecting the right answer. The highest number of profile visits from a BOTD story post was 62 accounts. A survey distributed via instagram revealed that 95% of respondents enjoyed the content (n = 19), while 100% reported that the content not only proved helpful but also increased their appreciation for microbiology (n = 18).

Conclusion

The use of social media in education has been slowly adopted as we’ve delved deeper into the technology era. The field of Infectious Disease spans into many different specialities, making medical students' knowledge of microorganisms essential regardless of their desired career path. BOTD demonstrates that students engage with online Infectious Disease educational material through the use of social media. The survey to be administered will assess student satisfaction with the initiative, and could demonstrate the benefit of utilizing such a platform to build upon student knowledge.

Disclosures

Joseph Patrik Hornak, MD, Innoviva Specialty Therapeutics: Advisor/Consultant|Innoviva Specialty Therapeutics: Advisor/Consultant
P-947. Evaluation of Priorities and Inclusion in Coaching Opportunities for Infectious Disease Advanced Practice Providers (APPs)
Authors: Beieler Alison M , Yoke Leah H , Zimmer Andrea J , Strnad Luke , Riedel David J
Published: January 2025

Background

In line with the Infectious Diseases Society of America (IDSA) mission statement, the IDSA Medical Education of Community Practice launched in 2019 establishing several sub-groups, including a mentoring workgroup. This group successfully started a Clinician Educator Coaching Program for Infectious Disease (ID) in which junior faculty are paired with experienced faculty to meet around IDWeek. Advanced practice providers (APPs) are a growing workforce within ID but have limited access to formal mentoring programs despite expressed desire for mentorship. In response, the IDSA APP interest group developed a survey to identify APP priorities and then developed a pilot coaching program to address some of the mentoring needs identified.Figure 1.Anonymous survey of six APP priorities ranked by score (n = 41)

Methods

An anonymous survey was distributed via email and the IDSA IDea exchange in 2022 to evaluate APP priorities on topics including education, mentorship, inclusion, and IDSA membership. Following that survey, an APP coach/advisee pilot program was created and advertised via email and the IDSA IDea exchange from 8/16/23 – 9/1/23. APP coaches were defined as those with > 6 years ID experience while APP advisees were those in practice < 3 years. Coaches and advisees were paired and encouraged to meet virtually over several sessions.Table 1.Matches for APP Advisee/Coach by area of ID practice. (n=6)BMT: bone marrow transplant, HIV: human immunodeficiency virus, PrEP: Pre-exposure prophylaxis

Results

41 survey responses were returned from APPs in ID with six ranked priorities using calculated scoring (Figure 1). Overall, “mentorship” was the 3rd most common item scored as a number one priority, and 44% of the respondents ranked it as one of their top three priorities. Six APP coach/advisee pairs were matched, based on specialty of ID practice (Table 1). An advisee survey identified individual needs assessment pre-meeting (Table 2). Feedback from participants was limited mostly to coaches by response rates post-meeting (5 coaches, 1 advisee), but suggested the coaching program was beneficial overall (Table 3).Table 2.APP Advisee Pre-Meeting Needs Assessment (n = 6)

Conclusion

APP priorities included IDSA membership, education, inclusion, and mentorship. While formal APP mentorship has not yet been established in ID, a pilot APP ID coaching program launched successfully with six pairs. Additional APP coaching or mentoring opportunities alongside other educational curriculum could be offered within IDSA to meet needs and optimally support APPs in ID.Table 3.APP Coaching Pilot Post-Meeting Survey Results

Disclosures

All Authors: No reported disclosures
P-967. Impact of simulated ID rounds for third year pharmacy students (P3s) in an infectious diseases (ID) elective
Authors: Lee Yuman , Bradley Nicole
Published: January 2025

Background

ID Rounds simulate real-world multidisciplinary ID rounds for P3s enrolled in the ID elective. Two faculty play the ID attending and 4th year pharmacy students on their Advanced Pharmacy Practice Experiences play the roles of the ICU fellow, nurse, microbiologist, and radiologist. An ID consult for a patient with post-influenza pneumonia along with the patient’s general information and basic labs are presented. P3s are guided to navigate the patient care process, collecting and assessing information, and formulating, implementing, and evaluating therapeutic recommendations. Challenges incorporated include a weight discrepancy, altering antimicrobials, monitoring drug levels, following cultures, and discharge planning. The purpose of this study was to assess the impact of ID Rounds on achieving Doctor of Pharmacy educational outcomes and professional activities.

Methods

An anonymous, electronic survey was distributed to P3s to assess the impact of ID Rounds. Survey questions were designed in accordance with the standards set by the American Association of Colleges of Pharmacy Curriculum Outcomes and Entrustable Professional Activities, using a Likert scale. Student perceptions were also collected.

Results

36 P3s responded and all strongly agreed or agreed that ID Rounds helped them learn foundational knowledge of inpatient rounds and enhanced their professional skills by building and maintaining trust among their colleagues. Majority strongly agreed or agreed that ID Rounds helped them understand the role of a pharmacist in optimizing antimicrobial use (94.5%, 34/26), become better communicators (94.5%, 34/36), and support the achievement of shared goals on a team (97.2%, 35/26). Majority rated ID Rounds a 4 out of 5 in difficulty, found the activity as an engaging way of learning about inpatient rounds, and enjoyed participating.

Conclusion

ID Rounds allowed pharmacy students to achieve key standards in Doctor of Pharmacy educational outcomes and professional activities. Students responded positively to ID Rounds, which actively involved them in a real-world scenario, enabling the application of critical skills such as collaborative practice, critical thinking, and effective communication. These competencies are fundamental to the practice of pharmacy.

Disclosures

All Authors: No reported disclosures
375. Back to School Unequal: Neighborhood Disadvantage and Asthma-related Emergency Department Visits in School-Aged Children
Authors: Dunphy Peter , Matsui Elizabeth , Rathouz Paul , Chambliss Sarah , Zárate Rebecca , Balcer-Whaley Susan , Bhavnani Darlene
Published: January 2025

Background

Asthma-related emergency department (ED) visit rates among children in a typical year closely follow the school calendar, with a sharp increase in rates when students return to school. The well-known increase in asthma exacerbations at the start of the school year is largely attributable to increases in respiratory viral infection. Because neighborhood disadvantage is strongly tied to asthma exacerbations, we hypothesized that greater neighborhood disadvantage would be associated with a greater increase in the rate of asthma exacerbations after the start of school.

Methods

We summarized Texas Health Care Information Collective data (2016-2019) on asthma-related ED visits among children (ages 5-17) in four Texas metropolitan statistical areas (Houston, Dallas, Austin, and San Antonio) by week and census tract. Neighborhood disadvantage was characterized at the census-tract level using tertiles of Social Vulnerability Index (SVI), percent uninsured, and percent living below the federal poverty line. Within each tertile, we described population-based incidence rates of asthma-related ED visits per 100,000 person-years in the 6 weeks before and after the week that school started. We also modeled weekly incidence rates and pointwise 95% confidence intervals by week using a locally weighted smoothing model.

Results

Comparing the 6-week periods before and after the week that school started, the incidence rate of asthma-related ED visits in high-, medium-, and low-SVI census tracts increased by 60, 39, and 20 cases per 100,000 person-years, respectively, representing a 3-fold difference between high- and low-SVI census tracts. Census tracts with high SVI had the greatest modeled increase in weekly rates of asthma-related ED visits after the start of school (Figure 1). Results were qualitatively similar for the percent of the population uninsured and below the federal poverty line (Figures 2-3).

Conclusion

Greater neighborhood disadvantage was associated with a greater increase in the rate of asthma related ED visits after the start of school, suggesting that neighborhood disadvantage may contribute to exacerbation risk by increasing the risk of respiratory virus infection.

Disclosures

Paul Rathouz, PhD, Sunovion Pharmaceuticals: DSMB Member
P-1005. Seroepidemiology of Cytomegalovirus, Rubella and Toxoplasma in Women of Childbearing Age in Korea
Authors: Cho Youngmin , Moon Hyejeong , Cho Eun Young , Park Jaemin , Lee Anna , Lee Hyunju
Published: January 2025

Background

This study aimed to assess the seroprevalence of Korean women of childbearing age to define the population susceptible to cytomegalovirus (CMV), rubella, and toxoplasmosis.

Methods

The results of cytomegalovirus, rubella, and toxoplasma antibody tests performed by chemiluminescent microparticle immunoassay in women 15-50 years of age at Seoul Clinical Laboratories from 2012 to 2022 were analyzed based on age, year, and region.

Results

The average positive seroprevalence rate was 92% (256/3,114) for CMV, 91% (405,207/442,998) for rubella, and 5% (819/15,712) for toxoplasma. In the age-group analysis, seroprevalence of CMV increased from 69% in women 15-19 years to ≥98% in 35-50 years of age, whereas seroprevalence of rubella was higher in women 15-39 years (90-93%) than in women 40-50 years (80-89%) of age. There was no change between age groups in seroprevalence of toxoplasma.

Conclusion

During the past 10 years, there was no significant difference of seroprevalence for CMV, rubella, and toxoplasma according to year or region age in reproductive women in Korea. To prevent and manage congenital infections, monitoring for the changes in seroprevalence of women with childbearing age should be continued.

Disclosures

All Authors: No reported disclosures