bluuebunny/crossref_metadata_2025 huggingface dataset:
422. Household Economic Burden and Social Consequences of Childhood Severe Pneumonia in India: A Cost of Illness based Pharmacoeconomic Analysis
Authors: Tom Maria , Raju Jomel
Published: January 2025

Background

Childhood pneumonia stands as a leading cause of mortality among young populations. Providing care for pediatric pneumonia poses significant challenges in resource-constrained regions, where caregivers often bear treatment expenses directly. This study aimed to evaluate the burden, social impact, and economic ramifications of childhood pneumonia, as well as to identify associated risk factors.

Methods

An incidence-based Cost of Illness (COI) study was conducted, focusing on one episode of severe childhood pneumonia from a household perspective. The study was carried out across three distinct sites in the South Indian state of Kerala, India. Through face-to-face interviews, data on socioeconomic status, resource utilization, and associated costs were gathered from caregivers of children aged between 1 month and 6 years. Utilizing a micro-costing bottom-up methodology, medical, non-medical, and time-related costs were computed. Multiple regression analysis was employed to examine factors influencing COI, while sensitivity analysis was conducted to assess the robustness of cost estimations.

Results

A total of 436 children with severe pneumonia were enrolled between January 2022 and December 2023. The mean age of participants was 14 months (SD ±9.1), with males constituting 58.7% (256). The average household cost per episode amounted to USD 149 (95% CI; 139.7 - 155.9), with indirect costs serving as the primary cost drivers (65%, USD 98). While household expenses for the poorest income quintile were lower in absolute terms, they represented a higher proportion of monthly income. Notably, COI was significantly higher for treatments sought at urban health facilities compared to rural counterparts (difference USD 54.3, 95% CI 73.3 to 96.3). Additionally, factors such as age, parental education level, and healthcare facility location emerged as significant predictors of household COI.

Conclusion

This study underscores the substantial economic burden imposed on households by severe childhood pneumonia, with cost differentials evident across various socioeconomic strata. In light of these findings, tailored management strategies should be devised for resource-limited settings to enhance treatment affordability and alleviate household economic strain.

Disclosures

All Authors: No reported disclosures
P-1211. Early Infections Predict Weight Gain and Obesity in US Children
Authors: Taylor Zackary W , Lin Jane
Published: January 2025

Background

An unexplained link between early viral infection and later weight gain has been observed in the US and internationally. In our population of children at Kaiser Permanente Southern California, we seek to confirm this association and determine the magnitude of the absolute weight increase.

Methods

In a retrospective cohort of children born 2008 – 2012, frequency of infection in infancy (≤12m), timing of first infection (< 6m vs 6-12m), and antibiotic use, class, timing, and frequency were assessed relative to absolute weight and body mass index (BMI) at age 4-6 and 10 years. Patients with low birthweight and prematurity were excluded. Maternal BMI, breastfeeding, birthweight, delivery type, and race/ethnicity were included in multivariable regression; height was also included when absolute weight was the outcome variable. Weight outcomes were compared in uninfected vs infected without antibiotic treatment in infancy (IWOT); and IWOT vs those infected who received antibiotic treatment (IWAT), using logistic regression analysis for obesity outcomes and linear regression for absolute weight.

Results

We identified N=66,687 children at 4-6y and N= 46,462 at 10y for analysis. Of the latter, 7,918 had been uninfected, 18,144 had IWOT, and 20,400 had IWAT. The IWOT group had higher rates of obesity vs uninfected (24% vs 19% at 10y; see figure 1), reflected in multivariable analysis at 4-6y (OR 1.11 [1.03-1.2]; p=0.004) and 10y (OR 1.14 [1.06-1.22]; p < 0.001), in a "dose-dependent" manner (Figure 2). The corresponding absolute weight increase (+0.55 kg [+0.3-0.8] at 10y; p< 0.001) was also dose-dependent (Figure 3). Compared to untreated infections, the additional contribution of antibiotic use to future obesity was minimal (OR 1.05 [0.99-1.1]; p=0.09) and not dose-dependent. Of the 10 year olds, most had upper respiratory infections (27,562 patients had at least one URI; 59%), ear infections (16,404 patients; 35%), or infections without a specified site (including viral syndromes; 11,822; 25%) in infancy.

Conclusion

A significant (14% at 10y) increase in obesity after early infection is confirmed, with a small (+0.55kg) corresponding increase in average weight. Prospective study in specific subgroups or with specific viruses of interest would be warranted.

Disclosures

All Authors: No reported disclosures
P-1269. Non-Vaccine Group B Streptococcus Serotypes in Clinical Samples
Authors: Taffet Allison A , Job Megan , Haldeman Sydney , Tettelin Hervé , Ratner Adam J
Published: January 2025

Background

Group B Streptococcus (GBS) is a common colonizer of the gastrointestinal and genitourinary tracts and a major cause of neonatal infection. Currently, pregnant individuals are screened for GBS colonization in late pregnancy and given intrapartum antibiotics if positive, but this approach is resource-intensive and incompletely effective. GBS has also emerged as a pathogen in non-pregnant adults. A hexavalent vaccine candidate (GBS6) that protects against 6 of the 10 known GBS serotypes (vaccine-type [VT] serotypes: Ia, Ib, II-V; non-vaccine type [NVT] serotypes: VI-IX) is in phase II/III trials. However, emergence of NVT serotypes could threaten the overall impact of GBS6. Previous studies have estimated that < 2% of GBS isolates are NVT.

A. Serotype distribution for all isolates, from both colonization and sterile sites. B. Distribution of NVT isolates.

Methods

We conducted laboratory-based surveillance for GBS isolates from sterile sites and rectovaginal colonization samples from May 2021 – December 2023. Urinary samples were not included. GBS whole genome sequencing was used to determine serotype, multilocus sequence type (ST), and clonal complex (CC). We performed retrospective chart review to gather demographic and clinical data.

Results

For this interim analysis, 873 isolates were successfully sequenced, of which 868 had a detectable serotype (Figure). 5.3% of isolates were NVT. NVT isolates were present among both colonization (6.8%) and sterile-site isolates (4.1%). The majority of NVT isolates (40/46; 87%) were serotype VI. Serotypes VII – IX were rarely observed. Of the serotype VI isolates, almost all (37/40; 92.5%) were CC1. 34 serotype VI isolates had antibiotic susceptibility data available from the microbiology lab. 79% of these were susceptible to tetracycline, compared to the all-serotype average of 18%. 79% were susceptible to clindamycin, higher than the all-serotype average of 49%. All isolates from neonatal invasive disease (N=15) were VT.

Conclusion

The majority of clinical colonization and sterile-site GBS isolates have serotypes contained in GBS6. However, NVT rates are higher than previously estimated, primarily driven by serotype VI. Serotype VI merits further study and consideration for addition to future GBS vaccine candidates.

Disclosures

Hervé Tettelin, PhD, Merck, Sharpe & Dohme: Advisor/Consultant
P-1285. Particularities Of Non-Osteoarticular Brucellosis In Comparaison With Osteoarticular Cases
Authors: Hammami Fatma , Rekik Khaoula , Smaoui Fatma , Chakroun Amal , Marrakchi Chakib , Koubaa Makram , Jemaa Mounir Ben
Published: January 2025

Background

Osteoarticular (OA) brucellosis represent the most frequently described form of the sub-acute brucellosis. We aimed to study the clinical, laboratory and evolutionary features of non-osteoarticular (NOA) brucellosis in comparaison with OA cases.

Methods

We conducted a retrospective study including all patients hospitalized in the infectious disease department for sub-acute brucellosis between 1995 and 2022. Standard agglutination test titer > 1/160 and/or positive blood cultures to Brucella spp confirmed the diagnosis of brucellosis.

Results

We encountered 108 cases among which 30 cases had NOA brucellosis (27.8%). In total, NOA cases included neurobrucellosis (60%), Brucella endocarditis (23.3%) and genitourinary brucellosis (16.7%). Patients with NOA were significantly younger (30[21-44] years vs 52[37-60] years; p< 0.001). Vomiting (30% vs 2.6% ; p< 0.001) and nausea (16.7% vs 3.8%; p=0.036) were significantly more frequent among NOA cases, while night sweats (46.7% vs 70.5%; p=0.021) was significantly less frequent among NOA cases. Fever (86.7% vs 80.8%; p =0.471), weight loss (24.1% vs 38.5%; p= 0.166), myalgia (13.3% vs 23.1%; p=0.26) and asthenia (53.3% vs 44.9%; p=0.43) were noted among NOA and OA cases. Hepatomegaly was significantly more frequent among NOA cases (13.3% vs 2.6% ; p=0.049). A negative C-reactive protein (67.9% vs 24.2%; p< 0.001) and a normal erythrocyte sedimentation rate (75% vs 50.7%; p=0.027) were significantly more frequent among NOA cases. Leucopenia (6.7% vs 7.8%; p=1), thrombopenia (13.3% vs 6.4%; p=0.244) and hepatic cytolysis (6.7% vs 10.3%; p=0.723) were noted among NOA and OA cases. Treatment duration was significantly shorter among NOA cases (4[3-6] months vs 6[4-9] months; p< 0.001). Sequelae were significantly less frequent among NOA cases (3.3% vs 20.8%; p=0.37). A favorable disease evolution (83.3% vs 90.9%; p=0.311) and relapse (3.3% vs 9.1%; p=0.437) were noted among NOA and OA cases.

Conclusion

Clinical presentation of NOA brucellosis included vomiting and nausea more frequently, the presence of hepatomegaly and the absence of inflammatory markers, among younger patients. The treatment duration was significantly shorter in comparaison with OA brucellosis cases.

Disclosures

All Authors: No reported disclosures
P-1304. Public Health Impact of Changes to Meningococcal Vaccination Platform in the United States
Authors: Schley Katharina , Presa Jessica , Snow Vincenza , Dooling Kathleen , Cane Alejandro D , Peyrani Paula , Farkouh Raymond , Sullivan Shannon M , Jaime Caro J
Published: January 2025

Background

In the US, vaccination recommendations for the prevention of Invasive meningococcal disease (IMD) include routine MenACWY vaccination at 11-12 years (y) of age and a booster at 16 y and two doses of MenB vaccine as shared clinical decision making from 16-23 y. Recently a MenABCWY vaccine became available and was recommended when both MenACWY and MenB are to be given at the same visit. The aim of this study is to assess the public health impact of various alternative vaccine strategies compared to current ACIP vaccine recommendations.

Methods

A static longitudinal cohort model was developed to estimate the impact of various vaccination strategies on IMD cases and deaths. A cohort of 11-y-olds was simulated for 50 y after vaccination. Vaccine uptake differed according to age and vaccination strategy.

Results

The current strategy results in 364 cases (82 cases due to MenB and 282 cases due to MenCWY) in one cohort of 11-y-olds. Keeping the dose of MenACWY vaccine at 11 y and switching to two doses of MenABCWY vaccine at 16 and 17 y would additionally prevent 15 MenB and 6 MenCWY cases over 50 y compared to the current strategy. Removing the dose of MenACWY vaccine at 11 y and using two doses of MenABCWY vaccine at 16 and 17 y would prevent 22 additional MenB cases but lead to 73 additional MenCWY cases compared to the current strategy. In contrast, offering one dose of MenABCWY at 11 y and one dose at 16 would prevent 26 additional MenB cases and 4 additional MenCWY cases compared to the current strategy. Offering two doses of MenABCWY at 13 y (instead of 11) and 17 y would prevent 14 MenB cases while leading to 22 additional MenCWY cases.

Conclusion

Our model suggests adding protection against serogroup B at 11 y would prevent additional cases of disease, while delaying adolescent protection against all serogroups of meningococcal disease will result in additional cases in the unprotected populations.

Funding: This study was funded by Pfizer Inc.

Disclosures

Katharina Schley, Dr. rer pol., Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Jessica Presa, MD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Vincenza Snow, MD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Kathleen Dooling, MD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Alejandro D. Cane, MD, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company)|Pfizer: Stocks/Bonds (Public Company) Paula Peyrani, MD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Raymond Farkouh, PhD, Pfizer: Stocks/Bonds (Public Company) Shannon M. Sullivan, PhD, Evidera: Employee|Pfizer: Advisor/Consultant J. Jaime Caro, MDCM, FRCPC, FACP, Evidera: Employee|Pfizer: Advisor/Consultant
P-1342. LiaX Decreases Killing By β-Lactam Antibiotics: Enterococcal Tolerance Revisited
Authors: Streling Ana , Panesso Diana , Singh Kavindra , Gomez Villegas Sara I , Malikzad Husna , Miller William R , Arias Cesar A
Published: January 2025

Background

Compared to other Firmicutes, enterococci are often tolerant to many antibiotics; combination therapy is used for severe, deep-seated infections. We have previously reported the LiaFSR system, a three-component cell-envelop stress regulatory system, mediates resistance and tolerance to daptomycin (DAP). The main effector, LiaX, harbors distinct N- and C-terminal domains. The N-terminal portion of LiaX is released into the extracellular milieu where it recognizes DAP and other antimicrobial peptides functioning as a sentinel and signal transduction protein to decrease DAP-mediated killing. LiaX likely acts through LiaF, a transmembrane protein necessary for the LiaX effect. We postulated that the LiaX-LiaF relay system may be involved in the β-lactam tolerance shown by E. faecalis (Efs).Figure 1.N-terminal domain of LiaX protects E. faecalis from ampicillin and ceftriaxone.

Methods

We used wild type (WT) Efs OG117 and derivatives: OG117liaF*11-14 (liaF deletion) and OG117 liaF*11-14::liaF (liaF complemented). Ampicillin (AMP) and ceftriaxone (CRO) broth-microdilution MICs were performed. N-terminal LiaX1-275 was expressed in E. coli and purified. Killing assays (5 replicates) with 0.5 X MICs of AMP and CRO were done, with and without LiaX1-275 (80 nM). Bacteria were diluted (∼1x105 CFU/mL) and used to inoculate test media containing antibiotic alone, antibiotic+LiaX1-275, and no antibiotic. After 2-hours of incubation at 37°C, samples were plated on BHI agar for enumeration.

Results

The CRO MICs for WT and complemented strains were 64 μg/mL, whereas it was 2-fold higher (128 μg/mL) for OG117liaF*11-14. All strains showed AMP MICs of 1 μg/mL. In the AMP killing assay, OG117 survival increased with the addition of LiaX1-275 (p < .005). The addition of LiaX1-275 failed to increase survival of OG117liaF*11-14 in the presence of AMP compared to WT (p = 0.4). The survival advantage was restored in the complemented strain (p < .0001). CRO showed a similar trend, i.e., increased survival in OG117 (p < .01) and complemented strain (p < .001), but not in OG117liaF*11-14 (p = 0.29).

Conclusion

We have discovered a novel pathway in Efs for antibiotic tolerance. The LiaF-LiaX signal relay, part of the enterococcal response to antibiotics, boosts organism survival, contributing to tolerance to multiple anti-enterococcal drugs.

Disclosures

William R. Miller, M.D., Merck: Grant/Research Support|UptoDate: Royalties
P-1360. Activity of Cefiderocol against Carbapenem Non-susceptible Enterobacterales, Including Molecularly Characterized Multidrug-resistant Clinical Isolates, Causing Infections in United States Hospitals (2020–2023)
Authors: Mendes Rodrigo E , Hubler Cory , Beekman Danielle , Maher Joshua , Sader Helio S , Castanheira Mariana
Published: January 2025

Background

Cefiderocol (FDC) is a siderophore cephalosporin that hijacks the iron transport system of Gram-negative bacteria to facilitate cell entry. FDC remains stable to hydrolysis in the presence of serine β-lactamases (BL) (e.g. ESBLs, KPC, and OXA-type carbapenemases) and metallo-BL (MBL). FDC and comparator activities were analyzed against carbapenem-nonsusceptible (nonS) Enterobacterales (ENT), including molecularly characterized isolates, collected as part of the SENTRY Antimicrobial Surveillance Program for the US.

Methods

15,147 ENT were collected from 35 sites in 2020–2023. Susceptibility (S) testing was performed by broth microdilution with cation-adjusted Mueller-Hinton broth (CAMHB) for comparators and iron-depleted CAMHB for FDC. CLSI criteria (same as the FDA) were used for FDC; whereas CLSI were applied for comparators, except for colistin (EUCAST). ENT with MIC ≥2 mg/L (nonS by CLSI) for imipenem or meropenem (MER) were screened for BL genes.

Results

1.4% (207/15,147) isolates were carbapenems-nonS, and among these 57.5% (119/207) carried carbapenemases. Class A blaKPC (72.3%; 86/119) prevailed, followed by class B MBL genes (17.6%; 21/119) and class D blaOXA-48 variants (5.9%; 7/119). FDC (96.6–98.3%S) had MIC50 of 0.5 mg/L and MIC90 of 4 mg/L against carbapenem-nonS and carbapenemase-carrying isolates; other agents had S of 6.7–86.5% (Table). FDC (100%S) and β-lactam-β-lactamase inhibitor (BL/BLI) combinations (96.6–100%S) were active against ENT carrying class A carbapenemases, whereas only FDC (MIC50/90, 2/4 mg/L; 95.2%S) had activity against those carrying class B genes. FDC and ceftazidime-avibactam (CAZ-AVI) were active (100%S for both) against ENT carrying class D genes. FDC (MIC50/90, 0.25/4 mg/L; 92.1%S), MER-vaborbactam (MIC50/90, 0.25/4 mg/L; 92.1%S) and CAZ-AVI (MIC50/90, 0.5/8 mg/L; 94.7%S) were most active against carbapenem-nonS, but carbapenemase-negative ENT.

Conclusion

FDC activity against carbapenem-nonS ENT collected in the US. FDC activity was consistent across different genotypes, including against isolates carrying carbapenemase genes, where approved BL/BLI combinations showed limited activity. These data demonstrate FDC as an important option for the treatment of infections caused by carbapenem-nonS ENT.

Disclosures

Rodrigo E. Mendes, PhD, GSK: Grant/Research Support
P-1380. Congenital Syphilis at Los Angeles General Medical Center, 2022-2023
Authors: Villarreal Diana , Lewis Katherine , Cielo Mikhaela , Klausner Jeffrey
Published: January 2025

Background

Congenital syphilis cases in the United States have increased 10-fold in the last decade. At Los Angeles General Medical Center (LAGMC), a large public hospital in Los Angeles, infants born to mothers with untreated syphilis during pregnancy continue to rise. We reviewed all the cases of neonatal congenital syphilis in 2022 and 2023 to describe sociodemographic and clinical characteristics and management history.

Methods

A search of the LAGMC Electronic Health Records uncovered all infant RPR test results in 2022 and 2023. Once case-patients were identified, we abstracted relevant information related to maternal health and infection history along with the infant medical history into a Redcap database. Statistical analysis was performed.

Results

Thirty-six infants were born to mothers with a history of inadequately treated syphilis in pregnancy. Compared to women who were adequately treated before or during pregnancy (n=62), women that were not adequately treated were more likely to have methamphetamine use (72% vs. 41%, p=0.004), cocaine use (19% vs. 2%, p=0.005), opiate use (34% vs. 9%, p=0.002), or no prenatal care (41% vs. 8%, p ≤ 0.001). Of the 12 infants with probable congenital syphilis, two infants had an abnormal physical exam. One infant had an RPR > 4-fold the mother’s RPR. Four infants had bony changes on long bone radiography. Of the 36 exposed infants, 20 had successful lumbar punctures. Five met criteria for probable congenital syphilis from elevated CSF protein alone, with normal cell counts and non-reactive VDRL. Two infants had positive CSF VDRL.

Conclusion

Overall, 2 infants out of 12 with probable congenital syphilis were symptomatic at the time of birth, and the other 10 were identified from laboratory and radiographic evaluation. Sixteen infants did not have a successful lumbar puncture, but results of the lumbar puncture did not change treatment choice. Our review also identified maternal substance use and no prenatal care as risk factors for inadequate treatment of syphilis before or during pregnancy.

Disclosures

Jeffrey Klausner, MD MPH, Direct Diagnostics: Advisor/Consultant
P-1381. Gender-based Testing Differences for Chlamydia trachomatis and Neisseria gonorrhoeae in Military Service Members
Authors: Aleman-Reyes David Manuel , Aden James , Arroyo Cazurro Miguel A , Marcus Joseph
Published: January 2025

Background

Chlamydia trachomatis and Neisseria gonorrhoeae infections impose a significant burden to the military, due to its young, sexually active population. In previous studies, female service members had 3-5 times the rate of both these infections as compared to men for unclear reasons. The purpose of this study was to investigate if gender-based differences in infection rates for chlamydia and gonorrhea may be due to gender-based differences in testing practices.

Demographic Information of 1620 Military Service Members Tested for Chlamydia trachomatis and Neisseria gonorrhoeae at Brooke Army Medical Center and Wilford Hall Ambulatory Surgical Center June-September 2023

Methods

A retrospective chart review was conducted on military service members who underwent testing for chlamydia and gonorrhea at Joint Base San Antonio between June and September 2023. The local electronic health record database was queried to determine patient demographics (age, gender, race, ethnicity, rank, military branch), clinical setting and indications for testing.

Results

A total of 3768 patients were identified. 2148 female basic trainees who underwent mandatory entry screening were excluded, leaving 1620 (43%) patients for analysis. The cohort was predominantly female (67.5%) and enlisted (84.2%) with a median age of 27. Male patients were more likely to be tested for patient driven factors, such as symptoms (41.2%) or patient request (24.5%). Female patients were most frequently tested due to clinical algorithm (53.0%). Tested male patients were more likely to have a positive result than female patients for both chlamydia (8.7% vs 3.9%, p=< 0.001) and gonorrhea (2.8% vs 0.4%, p=< 0.001) (Table).

Conclusion

Although women were more frequently tested for chlamydia and gonorrhea infections, male service members had significantly higher positivity rates, with more patient-driven indications for testing. This study implies the higher positivity rates in female patients compared to the male patients that has been previously reported is at least partially due to a testing bias.

Disclosures

All Authors: No reported disclosures
P-1395. Safety and Effectiveness of LC16m8 for Pre-Exposure Prophylaxis Against mpox in High-Risk Population: An Open-Label Randomized Trial
Authors: Okumura Nobumasa , Morino Eriko , Nomoto Hidetoshi , Yanagi Mashiho , Takahashi Kozue , Iwasaki Haruka , Uemura Yukari , Shimizu Yosuke , Mizushima Daisuke , Fukushima Kazuaki , Kinai Ei , Shiojiri Daisuke , Itoda Ichiro , Onoue Yasuhiko , Kobori Yoshitomo , Nakamura Fukumi , Tokita Daisuke , Sugiura Wataru , Ohmagari Norio , Ujiie Mugen
Published: January 2025

Background

Since May 2022, the incidence of mpox cases has surged outside endemic regions. Although vaccination remains pivotal in mpox prevention, data on LC16m8, a third-generation smallpox vaccine, are scant. We provided LC16m8 pre-exposure prophylaxis opportunities to high-risk individuals, including those with HIV, and conducted a randomized controlled trial to assess LC16m8’s effectiveness in mpox prevention and safety.

Methods

Our multicenter randomized open-label trial enrolled men and women aged ≥18 years at high mpox risk who provided written consent. Participants were randomly assigned 1:1 to early or late vaccination groups, receiving vaccinations approximately 70 days apart. Primary endpoint: vaccine effectiveness (VE) against mpox development between early and late vaccinations. VE against severe mpox, symptoms, “take” incidence, and adverse events were secondary endpoints.

Results

A total of 1,135 participants were recruited; 570 and 565 were assigned to early and late vaccination groups, respectively; 530 and 476 were vaccinated. Median age: 41 years; 99.7% were male; 89.7% Japanese; and 34.4% HIV-infected. No mpox cases occurred during the observation period, precluding VE calculation. “Take” rates: 90.3% (HIV-infected), 94.6% (uninfected). Adverse events related to the study were observed in 96.6% and 98.0% of the HIV-infected and uninfected participants, respectively. No fatal adverse events were observed; serious adverse events (SAE): 0.6% (HIV-infected), 0.5% (uninfected). One HIV-uninfected participant reported pulmonary embolism and deep vein thrombosis as a causally undeniable SAE. Local skin reactions: 96.6% (HIV-infected), 97.9% (uninfected); systemic reactions: 63.6% (HIV-infected), 64.2% (uninfected).

Conclusion

LC16m8’s effectiveness in mpox prevention remains inconclusive. Yet, its use in well-controlled HIV-infected and -uninfected individuals showed no significant safety concerns, suggesting potential for targeted vaccination strategies in at-risk groups.

Disclosures

All Authors: No reported disclosures
P-1396. Compliance Rates to Updated CDC Guidelines and an Automatic Communication Intervention Following Positive Sexually Transmitted Infection Results in the Emergency Department
Authors: Taweh Noor , Cahill Patrick , Chhabra Jyoti
Published: January 2025

Background

The emergency department (ED) remains at the forefront of the growing sexually transmitted infection (STI) epidemic. Despite being a critical leverage point for STI management, current practices can be incongruent with recent 2021 CDC STI Guidelines. The transitory role of the ED poses challenges to establishing follow-up. We sought to assess the degree of deviation from CDC STI guidelines in the Hartford Hospital ED and optimize management by having positive STI tests automatically routed to the outpatient infectious disease (ID) clinic for follow-up.

Methods

This was a retrospective, observational study of 342 patients from October 31st, 2021 to August 18th, 2023. Pre-intervention, ED providers were solely responsible for reviewing results and contacting patients to return for treatment. An intervention was initiated on October 31st, 2022, whereby positive STI test results from the ED were automatically rerouted to the ID clinic EPIC inbox, eliminating the modulatory role of ED providers. Manual chart review was conducted to evaluate compliance to CDC guidelines and parameters before and after the intervention, including the rate of referral to and follow-up with ID.

Results

Significant deviations from CDC guidelines were observed: 78.8% of practitioners took inadequate sexual history, 95.0% did not order comprehensive STI screening (gonorrhea, chlamydia, HIV, and syphilis), and only 60.8% initiated empiric antibiotic therapy. Of those, only 71.6% were guideline-based therapies. This intervention was successful in decreasing the proportion of patients lost to follow-up; Prior to intervention, 3.9% of patients were seen in the ID clinic for follow-up which increased to 15.3% after intervention (p < 0.001).

Conclusion

Although guidelines were updated almost 3 years ago, current practices remain incongruent with recommendations. Automatically rerouting positive STI results resulted in a higher rate of follow-up. We propose other hospital systems utilize a similar automatized system to minimize gaps in care and reduce burden on strained ED systems.

Disclosures

All Authors: No reported disclosures
P-1437. Racial Disparities in Inpatient Antibiotic Prescribing for Community-Acquired Pneumonia
Authors: Rock Matthew , Hamilton Keith W , Momplaisir Florence , Cressman Leigh , Lautenbach Ebbing , Dutcher Lauren
Published: January 2025

Background

Racial disparities have been reported in antibiotic prescribing for certain inpatient and outpatient conditions, but it remains unknown if antibiotic prescribing for inpatients with community-acquired pneumonia (CAP) have similar patterns despite long-standing guidelines for CAP treatment regimens. We evaluated racial disparities in antibiotic prescribing for inpatients with CAP at three hospitals within a health system.

Methods

We conducted a retrospective cohort study with data from the electronic health record using two binary metrics to evaluate differences in the appropriateness of antibiotic selection and duration by race. The cohort included non-ICU inpatients from 1/1/2019-12/31/2021 with a diagnosis of CAP based on ICD-10-CM code who received a systemic antibiotic within 48 hours of admission. We used multivariable logistic regression to determine the association of race with prescribing (selection and duration in separate models), adjusting for variables such as hospital, admitting service, age, sex, Charlson Comorbidity Index (CCI), and area deprivation index.

Results

Patient demographics are described in Table 1. Of 2,524 CAP episodes, subjects were prescribed an appropriate empiric antibiotic for an appropriate duration in 42.6% of cases. The rate of appropriate selection was 83%, while the rate of prescribing for the appropriate duration was 53% (Table 2). In the multivariable model, the following were associated with appropriate selection: hospital, lower CCI, and admitting service; race was not associated with antibiotic selection. Black race, hospital, lower CCI, and admitting service were associated with appropriateness of antibiotic duration. (Table 3).

Conclusion

While patient race was not independently associated with the likelihood of appropriate antibiotic selection, it was associated with a higher likelihood of appropriate duration. Importantly, the distribution of patient race differed significantly between hospitals and in both models we found that hospital site was associated with antibiotic prescribing appropriateness. Future research is required to explore the systems-level mechanisms creating these differences in order to ameliorate disparities.

Disclosures

All Authors: No reported disclosures
P-1438. Health-Related Social Needs and Guardian Adversity in Outpatient Pediatric Infectious Diseases
Authors: Day Melissa E , Choony Chitravati , Duan Qing , Burkhardt Mary Carol , Klein Melissa , Beck Andrew F , Schlaudecker Elizabeth P
Published: January 2025

Background

Infectious Diseases (ID) outpatient settings do not routinely screen for psychosocial needs of patients and families that may exacerbate infectious processes or challenge traditional treatment. We assessed the prevalence of health-related social needs (HRSN), guardian adverse childhood experiences (ACEs), and neighborhood-level socioeconomic deprivation in two pediatric outpatient ID clinics.

Methods

Using a cross-sectional study design, we approached English- and Spanish-speaking guardians of outpatient ID patients at two campuses. Guardians completed a HRSN screen (evaluating food/housing insecurity, transportation access, and mental health concerns) and the 10-question ACEs questionnaire (evaluating traumatic childhood experiences of guardians). Responses were entered into REDCap. We geocoded street addresses to identify census tract-level socioeconomic deprivation index (SDI) scores, with higher scores indicating more deprivation. We quantified individual HRSN items, total ACE scores, and SDI measures. We extracted clinical/demographic information from patient charts. Descriptive analyses were pursued. ANOVA analyses explored associations with psychosocial needs and SDI scores.Figure 1.Association of SDI score and Food Insecurity Over the Past 12 Months.

Results

To date, 221 caregivers have been surveyed, and results are described in Table 1. Most children identified as White, non-Hispanic, and English-speaking. Many families reported any food insecurity (15%), regular caregiver depressive symptoms (20%), and recent anxiety (70%). Four percent lived in an unsteady place, and 5% had transportation issues that affected access to medical care. Firearms were present in 35% of homes. Nineteen percent of guardians had high ACEs (≥4). The mean SDI score was 0.32 (range 0.11-0.71), similar to our institution’s primary service area. Higher SDI scores were associated with more food insecurity over the past 12 months (Figure 1, p< 0.001) and the past week (Figure 2, p=0.01).Figure 2.Association of SDI Score and Food Insecurity Over the Past Week.

Conclusion

Guardians of children receiving ID outpatient care reported HRSNs and ACEs. SDI score may be a useful adjuvant to screening to identify more efficiently those at risk for challenges like food insecurity. Outpatient ID settings can identify and help mitigate these concerns in clinical encounters.

Disclosures

Elizabeth P. Schlaudecker, MD, MPH, Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant
P-1445. Evaluation of Achievement of Metabolic Goals in People with Human Immunodeficiency Virus (HIV) in the Illinois Department of Corrections (IDOC)
Authors: Khair Nivan , Vu Amber , Ruiz Jonathan M , Drwiega Emily N , Patel Mahesh C , Borgetti Scott , Badowski Melissa E
Published: January 2025

Background

The UIC-IDOC clinic is an interdisciplinary telemedicine clinic addressing HIV care needs of individuals in custody. The UIC-IDOC care team makes recommendations to medical providers regarding disease states outside of HIV. HIV contributes to increases in cardiovascular (CV) risk, along with diabetes (DM), hypertension (HTN), and hyperlipidemia (HLD). Managing comorbidities in patients with HIV (PWH) can lead to an overall reduction in CV risk. The goal of this study was to provide evidence that follow-up with IDOC telemedicine clinic had positive outcomes on achieving metabolic goals in individuals in custody.

Methods

This was a pilot retrospective cohort study evaluating the effectiveness of an interdisciplinary approach in achieving A1C, blood pressure, or lipid panels among PWH in custody. Adults diagnosed with HIV, on antiretroviral therapy (ART), and with a diagnosis of DM, HTN, and HLD were included between 1/1/2021 and 6/30/2022. The primary outcome evaluated the achievement of metabolic goals within 1 year compared to baseline, while the secondary outcome assessed medication optimization to guideline-recommended therapy for any diagnoses above.

Results

102 patients were included. Baseline characteristics are presented in Table 1. Notably, most PWH reported ART adherence and achieved viral suppression. For the primary outcome, there was no difference in the achievement of metabolic goals 1-year post-follow-up for all disease states, DM (p=0.347), HTN (p=0.833), and HLD (p=0.935). For our secondary outcome, there was a significant difference in the optimization of hypertensive medications by the last visit, Table 2.

Conclusion

Findings from this study offer insights into optimizing HIV care delivery within correctional settings and enhancing outcomes for this patient population. Based on this data, recommendations being made by the UIC-IDOC telemedicine clinic may not be consistently implemented. However, our study shows an interdisciplinary clinic's role in the medication management of individuals in custody and the potential to assist in reducing cardiovascular risk in PWH, especially in people with HTN. Furthermore, a high degree of viral suppression was demonstrated for this study which may predict adherence to medications for metabolic diagnoses.

Disclosures

Scott Borgetti, MD, GSK: Grant/Research Support
P-1454. Characterizing the Prevalence of Recurrent Antimicrobial Resistant Infections in an Urban County
Authors: Ingle Tanvi A , Beauchamp Alaina M , Cooper Lauren N , Wakene Abdi , Diaz Marlon I , Hanna John J , Lehmann Christoph U , Medford Richard J
Published: January 2025

Background

Individuals treated for antimicrobial resistant organism (AMRO) infections are exposed to broader antibiotics, which can contribute to an increased likelihood of future resistant infections. Given that community transmission and AMRO recurrence remains underexplored, we conducted spatiotemporal analyses of recurrent AMRO infections in an urban county.

Figure 1

Map of spatiotemporal hotspots and recurrent infection counts per 1,000 population (CP1K) for five patterns of antimicrobial resistance at a census block group level.

Methods

We mapped the spatial prevalence of recurrent AMRO infections for census block groups using electronic health records from two major health systems in Tarrant County (Texas) from 2010-2019. We delineated recurrence across five different patterns: AmpC beta-lactamase producing bacteria (AmpC), Carbapenem-Resistant Enterobacterales (CRE), Extended spectrum beta lactamase (ESBL), Methicillin-Resistant Staphylococcus aureus (MRSA), and Vancomycin-resistant Enterococcus (VRE). We compared recurrent AMRO rates against space-time permutation model identified hotspots. We used spatial lag regressions to explore the relationship between recurrent AMRO rates and Area Deprivation Index (ADI), a measure of neighborhood inequity.

Results

Of 105,291 patients, 19,161 (18.2%) had at least one AMRO infection. There were 10,611 (10.1%) patients with multiple AMRO infections: AmpC = 202, CRE = 136, ESBL = 741, MRSA = 1255, and VRE = 205. We observed that AmpC, ESBL, and MRSA recurrence had the greatest co-location with spatiotemporal hotspots (Figure 1). In spatial regressions, increasing neighborhood ADI rank (increasing deprivation) was significantly associated with an increase in block group-rates of recurrent AmpC (β = 0.02), ESBL (β = 0.03), MRSA (β = 0.04) and VRE (β = 0.01) (p-value < 0.05).

Conclusion

We geographically and temporally identified patterns of recurrent AMROs in a large urban county and demonstrated a significant relationship between inequity and AMRO recurrence. This work can enhance our understanding of local infection dynamics and inform antibiotic stewardship.

Disclosures

John J. Hanna, MD, Pieces Technologies: Advisor/Consultant
P-1457. Association of Food Insecurity Risk with HIV Viral Non-suppression among People with HIV, Accessing Care in an Urban Infectious Disease Clinic in Baltimore, MD
Authors: Verinumbe Tarfa I , Lee Ye Eun , Agee Tracy , Hutton Heidi , Kelly Sharon , Hsu Jeffrey H , Jones Joyce L , Schwartz Sheree R , Falade-Nwulia Oluwaseun
Published: January 2025

Background

Food insecurity disproportionately affects people with HIV (PWH) and is associated with increased HIV transmission, interruptions in HIV care, and poor medication adherence. The intersection of depression, anxiety, substance use, and food insecurity among PWH may further exacerbate adverse HIV outcomes. This study assesses the association of food insecurity risk with viral load (VL) non-suppression among PWH, with or at risk for comorbid mental health (MHD) or substance use disorder (SUD), in HIV care.

Methods

PWH in care at The Johns Hopkins Bartlett Infectious Disease Clinic who screened positive for depression (PHQ-2), anxiety (GAD-2), or substance use (NIDA Quick Screen), were enrolled in an interventional trial evaluating optimal strategies for engaging PWH in MHD and SUD treatment. Food insecurity risk was assessed at baseline using a 2-item validated tool: The Hunger Vital Sign. Patients were considered at risk if they reported a response other than “never” to either question on the tool: 1) worry about running out of food or 2) having insufficient food in the prior 12 months. HIV VL assay performed as part of routine care within 6 months of study enrollment were used to evaluate for VL non-suppression. The association of food insecurity risk with VL non-suppression (HIV RNA > 200 copies/ml) was assessed using log-binomial regression adjusting for age, sex, race, education, employment, homelessness, and social support.

Results

Among 241 participants, mean age was 51 years (SD 13.7), 85% were Black, 65% were male, 74% had a clinical diagnosis of MHD and 44% a diagnosis of SUD. Most participants were employed (41%) or retired/on disability (44%). Homelessness in the prior 6 months was reported by 15%. Overall, 61% had food insecurity risk and 13% were virally non-suppressed. PWH at risk of food insecurity were more likely to be virally non-suppressed compared to food secure individuals (adjusted PR: 3.16; 95% CI: 1.26 – 7.91).

Conclusion

Food insecurity risk was high in this study of PWH with or at risk for MHD/SUD, and was significantly associated with VL non-suppression. In populations of PWH with or at risk for MHD/SUD, screening for food insecurity as part of routine HIV care and subsequent linkage of individuals at risk to food intervention programs may support improved VL suppression.

Disclosures

Oluwaseun Falade-Nwulia, MBBS ,MPH, Abbvie Inc: Grant/Research Support|Gilead Sciences: Advisor/Consultant
P-1458. The Implementation Science Coordination Initiative (ISCI) for evidence-based HIV services: supporting implementation in practice
Authors: McKay Virginia , Zamantakis Alithia , Pachicano Ana , Merle James , Purrier Morgan , Brewer Russel , Li Dennis , Smith Justin , Benbow Nanette , Mustanski Brian
Published: January 2025

Background

The Ending the HIV Epidemic (EHE) Initiative was launched in 2019 to address implementation problems related to HIV interventions. In alignment with EHE, the National Institutes of Health supported research projects focusing on implementation science (IS), or the scientific examination of strategies to overcome barriers to and improve effective implementation of HIV-related interventions. The result is a growing IS knowledge base. The Implementation Science Coordination Initiative (ISCI) at Northwestern University has developed a suite of tools and resources for providers for practice communities to improve implementation and uptake of HIV prevention, testing, and treatment using IS.

Methods

We will describe tools, projects, and programs available to clinicians to support implementation of evidence-based HIV interventions in practice including that have been developed over from 2020-2024.

Results

ISCI maintains a literature review dashboard for that summarizes ongoing systematic reviews of the HIV implementation science literature. It includes common barriers and facilitators to evidence-based HIV interventions, interventions to support patients, and implementation strategies for practitioners and clinics. Literature is filterable along various dimensions so that users can quickly review literature relevant to their setting and patient population. See Figure 1. ISCI provides two training opportunities for practitioners interested in learning about IS and innovative tools that can be applied to real-world practice. The IS Navigation Practitioner Page is an online, freely available self-paced curriculum. The Practitioner-Oriented Implementation Science Education (POISE) Training Program is a mix of in-person and remote training over a 5-month period leveraging IS to support implementation in one’s practice setting. The Best Practices Project identifies and disseminates implementation strategies for evidence-based HIV interventions with the best evidence. We accomplish this through a review process and then develop a mix of resources to support use of implementation strategies in practice, which are freely accessible on the ISCI webpage

Conclusion

There are a number of resources available to support evidence-based HIV services.

Disclosures

Brian Mustanski, PhD, Hologic: Grant/Research Support
P-1460. Judicious Use of Benzathine Penicillin G in Response to a Medication Shortage Alert
Authors: Terrazas William Campillo , Kenney Rachel M , Argyris Amy , Shallal Anita , Veve Michael
Published: January 2025

Background

The national shortage of benzathine penicillin G (BPG) poses challenges in the treatment of syphilis. In response to this critical BPG shortage, our health system implemented a medication shortage alert within the electronic health record (EHR). The alert provides recommendations to optimize BPG utilization. This study investigates the impact of the BPG drug shortage on clinical practice.

Methods

This was an IRB-approved, retrospective cohort study focusing on patients >3 months who received BPG between 5/9/23–2/28/24. The study included inpatient and outpatient visits after implementing the medication shortage alert. Exclusions were applied for severe penicillin allergy, neurosyphilis, or congenital syphilis. Two cohorts were analyzed: the judicious BPG group (patients with primary, secondary, or latent syphilis receiving BPG), and the non-judicious group (patients receiving BPG for alternative diagnoses). The study assessed social determinants of health (SDOH) as primary outcomes and compared a separate cohort of syphilis patients receiving BPG or alternative therapy (e.g., doxycycline).

Results

453 patients were included. Majority of patients were non-Hispanic Black (273, 60%) men (272, 60%), with a median age of 32 years (IQR: 22-44). Of these patients, 318 (70%) received judicious BPG, while 135 (30%) received non-judicious BPG. The most common non-judicious diagnosis was streptococcal pharyngitis (128, 95%). In multivariable logistic regression (Table 1), variables associated with judicious use included: age >32 years (adjOR: 2.273; 95% CI: 1.488-3.472), male sex at birth (adjOR: 1.835; 95% CI: 1.206-2.792), and black race (adjOR: 1.847; 95% CI: 1.212-2.815). Among a cohort of 128 syphilis patients who received either BPG (64, 50%) or doxycycline (64, 50%) treatment, those who received doxycycline were more likely to lack health insurance (35 [54.7%] vs. 43 [67.2%], p=0.15) and receive outpatient treatment (3 [4.7%] vs. 12 [18.7%], p=0.13) (Table 2). SDOH data were reported in < 50% of patient charts.

Conclusion

Despite implementing an EHR drug shortage alert, 30% of BPG use was suboptimal and mostly for pharyngitis. Optimizing SDOH documentation represents an opportunity to assess health inequities and the impacts on patient outcomes for syphilis management.

Disclosures

Rachel M. Kenney, PharmD, BCIDP, Medtronic Inc: Spouse is an employee, stockholder