bluuebunny/crossref_metadata_2025 huggingface dataset:
P-909. Molecular Testing Performance for the Diagnosis of Cryptococcal Meningitis in a Tertiary Care Center
Authors: Pinilla Ruth Serrano , Endo Manuel , Dallas Steven
Published: January 2025

Background

Cryptococcus is the most common cause of fungal meningitis worldwide and delayed diagnosis and treatment can be devastating. Diagnostic modalities include culture, antigen detection (CrAg), direct visualization in CSF and PCR. The reported sensitivity of the FilmArray® meningitis/encephalitis (ME) panel for cryptococcal meningitis compared to culture is 92-96%, and compared to CSF CrAg is 52-83%, with reported specificity of 99%. Lower CSF CrAg levels and lower quantitative growth in culture have been associated with false negative ME panel.

Characteristics of samples with false negative ME Panel

Methods

After IRB approval was obtained, a retrospective chart review of all cases of cryptococcal meningitis established by CSF Culture, CSF CrAg or ME panel from June 2017-June 2020 in a tertiary center was performed.

Results

Cryptococcus spp. was detected in 18 specimens, by either ME panel (14), CSF CrAg (12) or culture (18). These specimens were obtained from 16 patients. Their mean age was 46 years (24-73). 75% of patients were male. All the patients in this series were immunocompromised. 10 patients had HIV (PWH), half of them had CD4 counts < 40 cells/mm^3, and the mean CD4 count of the rest was 99 cells/mm^3 (41-163). Three patients had a prior solid organ transplant, one had liver cirrhosis and one had idiopathic CD4 lymphopenia. The mean opening pressure was 28.1 (16- >60 cm CSF). Compared to culture, the ME panel detected Cryptococcus spp. in 14/18 specimens. Of those, a total of 14 patients had a simultaneous CSF CrAG performed, 12 of those samples had a detectable CrAG, and ME panel detected the organism in all those samples. Both false negative CSF CrAG had a false negative ME Panel but were later diagnosed with a culture. There were 4 samples with false negative ME Panel. Their cultures were reported as “very light” qualitative growth. Two of them had a bloody sample and CMV detected in the ME panel, suggesting that contamination with large amount of blood can interfere with the performance of this test. This delayed treatment initiation by an average of 2 days.

Conclusion

Although the ME Panel is an excellent tool to diagnose meningitis, the lack of detection of Cryptococcus sp. in the ME panel in the right clinical context should prompt careful clinical consideration to prevent delays in treatment initiation for patients at risk of this infection.

Disclosures

All Authors: No reported disclosures
P-917. Management of pediatric focal intracranial infections: opportunities to reduce low-value care
Authors: Lu Lydia S , Dalby Allyson , Jaggi Preeti
Published: January 2025

Background

Focal intracranial infections are rare but life-threatening complications of sinusitis, otitis media and mastoiditis in children. Management requires collaboration between multiple specialists and prolonged antimicrobial treatment.

Methods

We retrospectively identified patients hospitalized at our tertiary care children’s hospital with focal intracranial infections from Jan 2022 - April 2024 followed in infectious disease clinic. Patient charts were reviewed to inventory imaging, surgical interventions and antibiotic treatment received. We further identified complications in each case requiring intervention, including surgery, hospitalizations and emergency room visits. MRI imaging was defined as low-value if ordered over 2 weeks prior to the study in a patient without new symptoms, or ordered for a hospitalized patient who was afebrile without neurologic symptoms or parental concerns after 30 days of antibiotic therapy.

Results

Thirty-four patients were followed in pediatric infectious disease clinic for outpatient management of: subdural empyema (13, 38%), epidural empyema (11, 33%) and brain abscess (10, 29%). Patients were most likely male (68%) and Black or African American (74%), with a median age of 12 (range: 2-18). Nearly all (94%) had at least one MRI; 19 (56%) had a repeat MRI during hospitalization, 22 (65%) had a repeat MRI after discharge. About one-third of MRIs (31%) after discharge required sedation. In our cohort 18 patients had a low-value MRI (53%) and 5 of these (28%) had more than one low-value MRI. No low-value MRI led to a finding requiring surgical intervention. The mean duration of antibiotic treatment was 42 days (SD 10.8 days). Four patients (12%) returned to the ED while on antibiotic therapy for PICC line issues, with one patient returning 3 times for PICC concerns.

Conclusion

Some management strategies for pediatric focal intracranial infections may be unnecessary or have unrecognized consequences. Repeat MRI for half our cohort was of low-value, exposed many to risks of sedation, and consumed significant family and system resources. Children on prolonged IV antibiotic therapy were at risk for line complications. Routine management of these infections merits reconsideration to decrease unwarranted costs and risks to patient.

Disclosures

All Authors: No reported disclosures
P-928. The Second Heart Program: A Peer-focused, Multidisciplinary Harm Reduction Intervention to Improve Outcomes for People Who Inject Drugs After Admission for Infective Endocarditis
Authors: Atri Alisha , Lennox Robin , O’Shea Timothy , McIlveen Marcie
Published: January 2025

Background

Infective endocarditis (IE) is a severe and highly prevalent injection-related infection among people who inject drugs (PWID). IE is estimated to account for 5-10% of deaths among PWID. The long-term outcomes among PWID with infective endocarditis are poor, with 5-year mortality rates over 50%. Most long-term complications are related to ongoing drug use (re-infection). However, most PWID with IE are not offered treatment for their underlying substance use disorder while in hospital. The Second Heart (SH) program is the first interdisciplinary team in Canada designed specifically to meet the unique needs of PWID with IE and which transitions with patients from the hospital into the community. The six components of the SH team are: peer support worker, systems navigator, addiction medicine physician, infectious disease physician, cardiologist/cardiac surgeon, and family physician.

Methods

The Second Heart Program was a non-randomized clinical trial enrolling PWID with infective endocarditis at three tertiary care hospitals in Hamilton. It was a mixed methods study utilizing both qualitative and quantitative methods. Five quantitative surveys, two qualitative interviews, and chart review were completed over the 12-month study period.

Results

Participants felt that their involvement with SH supported their physical, mental, and social recovery from IE, improved their trust in the healthcare system, and increased their engagement with their care. Out of 20 enrolled participants, all were consulted with an addictions medicine provider during initial hospitalization, 16/20 were set up with a family doctor post-discharge, 9/20 completed their 1-month follow-up survey, one participant died within 12 months of enrolment, and 12/19 completed their 12-month follow-up survey.

Conclusion

The early success in this pilot project has led to the successful application of funding for an expanded version of the multidisciplinary intervention for people who have any injection-related infection, including Hepatitis and HIV.

Disclosures

All Authors: No reported disclosures
P-940. Diagnostic Workup of Bacteremia Post TAVR, a Single Center Experience Over a Decade
Authors: Villareal Kenneth , Zorn George (Trip) , Almoghrabi Omar , Tadros Peter , Marikanti Goutham , Li Yanming , Baddour Larry M , El Atrouni Wissam
Published: January 2025

Background

Prosthetic valves are considered a risk factor for endocarditis however diagnosing prosthetic valve endocarditis (PVE) is complicated by acoustic shadowing on echocardiography. In 2023, the ISCVID published an update to the Duke Criteria (Duke 2023) which intended to increase the sensitivity in diagnosing PVE. The purpose of this study was to examine how TAVR infective endocarditis (TAVR-IE) was diagnosed at our institution

90 Day Mortality Kaplan Meier Curve

Methods

HERON was utilized to match cases between ACC/STS databases and the EMR at The University of Kansas Health System (TUKHS). Patients with bacteremia occurring after a TAVR were reviewed. Each case was evaluated if they met rejected/possible/definitive endocarditis criteria in the Modified Duke Criteria (Duke 2005) and the Duke 2023 Criteria. To adjudicate the diagnosis, an expert panel reviewed all cases that met definitive endocarditis criteria in any edition of the Duke Criteria.

Results

A total of 2371 TAVRs were conducted at TUKHS from 2012 to 2023. We identified 146 cases of post procedure bacteremia. We excluded 53 cases leaving 93 in the cohort. Transeophageal echocardiography was utilized in about half of the cases (TTE 73, TEE 45). F-FDG positron emission tomography/CT was done in six patients and Cardiac CT in one patient. Cultures returning with Enterococcus spp (16). viridans group streptococci (15), and Staphylococcus spp. (15) had similar incidence. About half had either atypical organisms (40) on 2005 Duke criteria or polymicrobial growth (7). Definitive criteria were met in 18 and 21 patients for the Duke 2005 and Duke 2023 Criteria respectively. Two cases had minor microbiological criteria upgraded to major in Duke 2023. One case was promoted to definitive endocarditis based on Cardiac CT. Upon adjudication the panel agreed with Duke 2023 Criteria classification. Sensitivity was calculated 85%/100% for Duke 2005 and Duke 2023 Criteria respectively. Kaplan Meier curves calculated no significant difference of 3 month mortality between TAVR patients who had met definitive criteria and those who did not. (Figure #1)

Conclusion

The 2023 ISCVID Duke Criteria in this study appeared to have superior sensitivity for TAVR-IE when compared to the older Modified Duke Criteria published in 2005.

Disclosures

Larry M. Baddour, MD, UpToDate, Inc.: Royalty payments (authorship duties). Wissam El Atrouni, MD, ViiV Healthcare: Advisor/Consultant
P-944. Usefulness of PCR and Culture of Specimens Obtained at Surgery in Patients with Infective Endocarditis
Authors: Shrestha Nabin K , Nagam Meghna , Wang Hannah , Gordon Steven M
Published: January 2025

Background

By 2016 it was standard protocol at Cleveland Clinic that patients undergoing surgery for confirmed or suspected infective endocarditis (IE) had cardiac specimens tested by both culture and 16s rRNA PCR and amplicon sequencing (PCR) to verify or accurately identify the causative pathogen. The purpose of this study was to compare the sensitivities and false positive rates, of PCR and culture of cardiac specimens obtained at surgery, among patients with infective endocarditis.

Methods

This was a retrospective cohort study. Episodes of pathologically-proven bacterial endocarditis with a single causative pathogen, among patients who underwent surgery for IE from January 1, 2016, to January 1, 2021 were identified from the Cleveland Clinic Infective Endocarditis Registry. The causative pathogen in the registry is determined by criteria that consider blood culture, histopathological findings, and culture and PCR of surgical specimens. Sensitivities of culture and PCR were compared, as were the false positive rates for PCR and culture among tests that were positive.

Results

Microbiological testing was done on 1326 fresh tissue specimens from 731 episodes of IE among 706 unique patients during the 5-year study period. PCR was significantly more sensitive than culture in detecting the pathogen (79.6% vs. 31.6%, p-value < 0.001). After adjusting for the number of specimens tested per IE episode, the odds of detecting the pathogen were significantly higher for PCR than for culture (OR 10.60, 95% C.I. 8.23 – 13.74, p-value < 0.001). Specimens that tested positive were false positives 1.6% and 10.1% of the time, for PCR and culture, respectively. Among specimens that tested positive, the odds of a positive test result being a false positive were significantly lower for PCR than for culture (13/795 vs 35/313, OR 0.15, 95% C.I. 0.07 – 0.27, p-value < 0.001).

Conclusion

The causative pathogen for IE is much more likely to be identified by PCR of surgical specimens than by culture. Conversely, a positive culture from a surgical specimen is much more likely to be a contaminant than a positive PCR.

Disclosures

Hannah Wang, MD, Hologic: Advisor/Consultant
P-948. Three Drugs, Two Pills, One Algorithm: HIV PrEP, PEP, and Treatment Initiation Consolidated Guidelines for Resource Limited and Non-Specialty Settings
Authors: Boney Colton P , Park Erin G , Hill Samantha V , Parker Robert W , Jergel Andrew , Davis Nicholas S , Yap Austin
Published: January 2025

Background

Accessing HIV prevention and treatment remains difficult throughout the United States (US). With the shortage of infectious disease physicians and other providers offering HIV prevention and treatment services, increasing the number of clinicians offering HIV Pre-Exposure Prophylaxis (PrEP), HIV Post-Exposure Prophylaxis (PEP), and Test & Treat (T&T) (where individuals testing positive for HIV are rapidly engaged in HIV treatment) is imperative. This project’s goal is to create a consolidated algorithm for HIV treatment and prevention that simplifies care for providers with few resources or limited experience.

The 3-2-1 Algorithm

The algorithm includes the necessary steps, testing, and result interpretation to provide PrEP, PEP, and T&T services. Guidelines referenced in the making of this algorithm include those published the International Antiviral Society (IAS), the National Institutes of Health (NIH), and The New York State Department of Health AIDS Institute (NYSDOH AI).

Methods

The algorithm was designed using published HIV care guidelines from multiple clinical bodies and includes PrEP, PEP, and T&T. Only three medications are offered in the algorithm to reduce cost of implementation. The combination of tenofovir disoproxil fumarate with emtricitabine provides low-cost, generic PrEP regardless of gender, pregnancy, or intravenous drug use while also providing the backbone needed for PEP and T&T. Dolutegravir, the third medicine, was chosen for PEP and T&T because of its once daily dosing and approval in pregnancy. The algorithm was tested with US medical students. Students completed an eight-question test unassisted then immediately repeated those questions with the algorithm. Questions included clinical scenarios related to HIV testing, PrEP, PEP, and T&T. Students were recruited by email for the online test. Pearson’s chi-squared compared pre vs post test scores; total score (number of items correct) used Paired Wilcoxon signed rank test.

Results

76 students from 13 medical schools completed pre and posttest questions. Correctness increased from 3 of 8 (pretest) to 6 of 8 (posttest) (p=< 0.001). All questions increased in percentage correct with the algorithm. Change in correct responses on PEP, PrEP lab work, need for quantitative RNA with prior injectable PrEP use, and selecting a T&T regimen were all statistically significant. (p=< 0.001)

Conclusion

This algorithm significantly improved medical students’ ability to accurately answer HIV clinical care questions and has the potential to expand access to HIV prevention and treatment. Further studies are needed to understand the algorithms’ effect in a clinical setting.

Disclosures

All Authors: No reported disclosures
P-950. Pre-Exposure Prophylaxis Education for Internal Medicine Residents (PRIMER)
Authors: Nash Brenton , Abrantes-Figueiredo Jessica , Godshall Casey
Published: January 2025

Background

Pre-exposure prophylaxis (PrEP) for HIV is a safe and effective strategy for HIV prevention among high-risk patient groups. Despite consistent experimental and real-world data showing benefit, PrEP is underutilized. There is a dearth of non-specialized providers engaging in PrEP services. The purpose of this project is to increase knowledge and prescribing of PrEP among a cohort of internal medicine (IM) residents.

Methods

A 3 hour interactive education session was provided to the IM residents of the University of Connecticut Categorical Internal Medicine Residency. Baseline knowledge was assessed with a pre-training survey. This survey was repeated up within six months to assess for a change in PrEP knowledge and prescribing.

Results

The pre-intervention (pre) survey was completed by 39 IM residents. The post-intervention (post) survey was completed by 25 IM residents from the same cohort. 4 participants from the post group were excluded as they had not completed a pre survey. Similar proportions indicated PrEP awareness pre- and post-intervention 97.4% and 100%, respectively. There was a numeric increase in the proportion of respondents reporting knowledge of PrEP indications from 69.2% pre to 85.7% post. Similar proportions reported prescribing PrEP 15.4% pre and 14.3% post. Those who had prescribed PrEP reported providing it to only 1-5 patients. When assessing for paired differences among a sub-set of participants who had both pre- and post scores, general knowledge of PrEP significantly improved. General knowledge scores averaged 8.6% pre and 22.6% post (p-value 0.001). Of the five general knowledge questions – testing individual domains -- the mean differences between pre and post scores were: 0.6 (95% CI 0.3-1.0), 0.2 (0.04-0.4), 0.05 (-0.1-0.2), 0.2 (0.007-0.4), 0.05 (-0.05-0.1), and 0.3 (0.08-0.5), respectively. Indicating that in all but 2 domains the 95% confidence interval did not include 0.

Conclusion

Among a cohort of IM residents from a mid-sized, university-based program, general PrEP knowledge was low despite widespread awareness. Knowledge was improved following an educational session; however, prescribing did not increase. Other barriers besides knowledge likely impact the likelihood of generalists, and in particular learners, to prescribe PrEP.

Disclosures

All Authors: No reported disclosures
P-951. Delphi Study of a Fungal Curriculum for Infectious Diseases Fellows
Authors: Bryan Karen , Linder Kathleen A , Miceli Marisa H , Abdoler Emily
Published: January 2025

Background

Infectious Diseases (ID) clinicians must be proficient in diagnosis and management of fungal diseases. Though certain fungal diseases have geographic distributions, those distributions are shifting, and ID fellows need to be prepared to practice in diverse environments. We aimed to reach consensus from experts on the critical topics to include in fungal diseases curricula for ID fellows, focusing on North and South America.Figure 1:Delphi Methodology

Methods

We conducted a modified Delphi survey (See Figure 1) of ID faculty in North and South America who are members of the Mycoses Study Group Education and Research Consortium (MSGERC). Authors selected the initial list of 78 topics based on a previous single institution modified Delphi, as well as fellow and expert faculty member input. Respondents rated each topic’s importance from 1 (Do Not Include) to 5 (Very Important to Include), over two survey rounds. Consensus to prioritize a topic in the curricular list was defined as ≥80% of participants rating the topic ≥ 4 (Important to Include).Table 1:List of Topics that Met Consensus Criteria

Results

Of eligible MSGERC members, 24% (33/139) responded to the first round survey and 73% of initial respondents (24/33) completed the second round. Six new topics were proposed after round 1 and were included in round 2. Fifty topics (50/84, 60%) met consensus criteria after round 2. Topics that met consensus criteria included endemic fungi and highly morbid fungal diseases, as well as specific topics regarding diagnostics and therapeutics for fungal diseases (Table 1). Some common but often less serious fungal diseases did not meet consensus, along with several rare conditions (Table 2).Table 2:List of Topics that Did Not Meet Consensus Criteria

Conclusion

The scope of fungal diseases is broad and varies geographically, which necessitates intentional prioritization of certain topics in designing curricula for ID fellows. Our survey identifies topics of particular importance in the North and South American regions. These findings, along with additional input from broad representation of ID fellowship program leaders and educational experts, can be used in the development of a standardized fungal diseases curriculum for ID fellows, regardless of the location of training.

Disclosures

Marisa H. Miceli, MD, AN2: PI in clinical trial|F2G: PI in clinical trial|Pulmocide: PI in clinical trial|Scynexis: Advisor/Consultant|Scynexis: PI in clinical trial
P-955. Single vs. Multiple-Fellow Triaging Systems in a Large Academic Infectious Disease Service – A Quality Improvement Project
Authors: Machiavello Roman Francisco J , Azar Marwan M
Published: January 2025

Background

The Yale New Haven Hospital (YNHH) is a large academic center with 3 Infectious Diseases (ID) consult services (General, Heme-Onc, and Transplant ID), each staffed by 1 fellow and attending physician. In the traditional consult triaging system, one fellow receives all the consults, often ≥15/day, and assigns them to each ID service. Fellows alternate the triaging duty during the week, resulting in 2-3 triaging days/week/fellow. Our program review identified that this system was a significant source of burnout and contributed to prolonged work hours, which prompted a QI project to address these concerns.

Traditional and New Proposed Triaging Systems at YNHH

Methods

We designed an 8-question survey to assess the effect of triaging on the fellows’ workload, performance and mental health (anxiety and burnout). 2 interventions changed the consult triage workflow: i) The ID consult order on the electronic medical record was reformatted to require that primary providers select an ID subspecialty service, and ii) We eliminated the traditional triage role by asking the YNHH call center to route service-specific consults to the appropriate ID fellow (Figure 1). We conducted the pre-intervention survey in November 2023. The interventions took place in December 2023. The survey was repeated in February 2024.

Pre and post-intervention surveys

Results

7 (100%) and 6 fellows (86%) completed the pre and post-intervention surveys (Figure 2). In the pre-intervention survey, 57% reported frequently experiencing interruptions, and 57% reported an average of 15-25 interruptions/day. 86% stated that the traditional system contributed to a little or some anxiety, and 100% that it caused some or a lot of burnout. 57% replied that it contributed to some or a lot of impaired patient care.

In the post-intervention survey, 17% reported frequently experiencing interruptions, and 67% reported an average of < 5 interruptions/day. 50% stated that the new system contributed to a little or some anxiety, and 50% said that it caused some or a lot of burnout. 17% replied that it contributed to some or a lot of impaired patient care.

Conclusion

A switch from a single-fellow to a multiple-fellow triaging system in our ID division led to decreased interruptions, decreased feelings of anxiety and burnout, and reduced perceptions of impaired patient care.

Disclosures

All Authors: No reported disclosures
P-970. Impressions of the Pediatric Infectious Diseases Subspecialty by Pediatric Resident Physicians and Medical Students Following a Peds ID Elective Rotation
Authors: Watson Michael E
Published: January 2025

Background

The subspecialty of Pediatric Infectious Diseases continues to struggle with a low number of applicants seeking training relative to the number of fellowship programs and open training positions. We explored the impressions that medical students and pediatric residents gathered about the subspecialty after completion of a Peds ID elective as a Quality Improvement initiative.

Methods

Resident physicians and medical students at the University of Michigan, from July 2022 to present, were surveyed after their Peds ID elective experience. Participation was voluntary and only anonymous responses in aggregate form were reported.

Results

The survey response rate was 56.3% (27 of 48 learners invited; 79% resident physicians and 21% medical students). 100% of learners reported a high educational value in participating in a Peds ID elective. Despite only 7.4% of learners considering Peds ID as a career before the elective, 18.5% of learners reported considering Peds ID fellowship training after their elective experience. Respondents indicated that 1) expertise in the subject matter of infectious diseases, 2) a mixture of inpatient and outpatient clinical experiences, and 3) opportunities to participate in Infection Prevention and Public/Global Health, were the top three most attractive aspects of the Peds ID subspecialty. In contrast, respondents indicated that 1) salary and compensation, 2) antimicrobial stewardship responsibilities, and 3) patient volume and workload, were the three least attractive aspects of the Peds ID subspecialty.

Conclusion

Peds ID remains a popular elective among learners who praise the educational content and teaching. Relatively low compensation, a heavy workload, and displeasure with antimicrobial stewardship duties were some of the main negative impressions by learners. Despite these impressions, participation in a Peds ID elective did lead to over twice as many learners considering Peds ID for their future careers. A mandatory Peds ID experience should be considered for the educational benefit of all learners and may improve fellowship recruitment. We identified issues for our subspecialty to address through advocacy to improve working conditions and compensation, thereby helping train and sustain an appropriate Peds ID workforce for the future.

Disclosures

All Authors: No reported disclosures
P-971. Chogoria Rounds: A Novel Clinical Reasoning Tool for Residents
Authors: Leonard Michael , Kooken Banks , Barrier Charles , smith Will
Published: January 2025

Background

Teaching clinical reasoning requires a clinician being able to demonstrate their thought process when approaching a case, and a large volume of case exposure during residency to gain a basis of understanding. Training programs have observed improved application of clinical reasoning skills by internal medicine (IM) residents when a case-based reasoning curriculum is introduced. We present a novel educational tool for IM residents involving a series of case presentations (Chogoria Rounds, CR) from a physician partner in Kenya to general IM and Infectious Disease attendings, along with IM residents at different stages of training.

Methods

Over an 18-month period, 30 cases were presented virtually, de novo, allowing attendings to discuss their clinical assessment of these cases in real time with the residents in attendance. A survey with Likert scale response (1 strongly disagree, 5 strongly agree) was distributed to residents to assess CR as an effective clinical reasoning teaching tool

Results

Of the 30 presented cases, 11 were related to tuberculosis (pulmonary, miliary, meningitis), 10 to other infections (severe malaria, leishmaniasis) and other interesting cases such as African night shade ingestion. Thirteen residents were surveyed with 10 respondents. All 10 strongly agreed or agreed that CR was a useful clinical reasoning teaching tool (50% strongly agreed, 50% agreed), and 90% felt it impacted patient care. 80% reported CR drove them to read more about a particular disease process that was discussed. 50% of residents did not feel CR impacted their practice regarding high value care, but 90% felt it generated meaningful discussion surrounding resource utilization. All residents expressed interest in participating in a global medicine experience in the future, and 90% became more interested in global medicine.

Conclusion

CR showed to be an effective clinical teaching tool for IM residents by giving them insight into clinical reasoning from expert attendings as well as rapid fire case conferences to provide increased volume of exposure.This virtual case conference model can easily be replicated for the benefit of residents and other learners at the US-based institution while at the same time benefiting those at the partnering international institution.

Disclosures

All Authors: No reported disclosures
P-973. Pediatric Infectious Diseases rotation for general pediatric residents in Washington DC: impact, benefits and pitfalls
Authors: Shieb Mohamad , Stern Eric J , Gaviria Susana , AlSayeb Badr , Ristagno Elizabeth H , Li Guyu
Published: January 2025

Background

Although infectious diseases present significant challenges in pediatric care, formal training in pediatric infectious diseases is not mandated in categorical pediatric residency training. This research seeks to examine the self-assessed confidence levels of general pediatric residents in Washington DC in managing common infectious diseases. The study specifically compares the confidence levels of residents who have undergone elective infectious diseases training with those who have not.

Subjective Confidence in the Management of Common Infectious Diseases Encounters

Methods

A cross-sectional study was conducted using voluntary surveys distributed among pediatric residents from various programs in Washington DC. The surveys aimed to assess subjective confidence levels in managing common infectious disease conditions and to explore motivation to pursue infectious disease training.

Effect of infectious diseases elective rotation on interest in infectious diseases as a career.

Are you more or less likely to pursue infectious diseases fellowship?

Results

Analysis of 20 completed surveys revealed that residents who completed infectious diseases rotations demonstrated significantly higher confidence levels in managing infectious disease conditions compared to their counterparts (P: < 0.001). Notably, residents with specialized training showed increased confidence in antibiotic selection and in their diagnostic abilities. Additionally, they exhibited enhanced confidence in managing specific presentations such as sexually transmitted diseases, fever of unknown origin, and central nervous system infections (all with P < 0.05). Finally, 22% of respondents expressed an increased likelihood of pursuing a career in infectious diseases following their rotation.

Effect of infectious diseases rotation on the confidence in the management of inpatient and outpatient infectious diseases encounters

Conclusion

These findings underscore the potential benefits of incorporating infectious diseases rotations into pediatric residency programs, as evidenced by improved skills in antibiotic selection, diagnosis, and management of specific infectious disease scenarios. Additionally, the observed increased interest in pursuing a career in infectious diseases among a subset of residents highlights the positive impact of such training on career trajectory and specialty choice. Investigators plan to distribute the questionnaire more broadly across the US to see if these results are more widespread.

Disclosures

All Authors: No reported disclosures
P-974. An Embedded Transplant Infectious Diseases Fellowship Track Is Appealing to Clinical and Research-Focused Fellows
Authors: Fung Monica , Schwartz Brian S , Babik Jennifer M
Published: January 2025

Background

Transplant Infectious Diseases (TID) training is commonly completed as a separate fellowship following ACGME ID fellowship. There is limited evidence on the impact of an embedded TID training track within ID fellowship.

Fellow Interest and Preferences for Transplant Infectious Disease Training by Career Focus

Methods

Our TID track, created in 2016, aligns with existing standards for TID training. Fellows may complete the track within a 2-year ACGME fellowship or as part of a longer research track. Current and prior fellows of our TID track were anonymously surveyed about TID track interest/impact and career goals.

Results

All 11 prior and current track fellows completed the survey. 64% of fellows (n=7) have or plan to pursue careers in clinical medicine, with a secondary focus on medical education (73%, n=8) and/or research (73%, n=8). 36% (n=4) have or plan to pursue primary careers in basic/translational research with a secondary focus in clinical medicine (Figure 1). Only 3 (26%) fellows were committed to TID prior to fellowship, with most (73%) developing an interest in TID during fellowship. Trainees cited interesting clinical cases (100%), mentorship/role models (73%), and research opportunities (55%) as reasons for their interest in TID training.

If an embedded TID fellowship were not offered, 18% (n=2, both with primary clinical focus) of fellows would have pursued a discrete TID year. All fellows cited the ability to stay at the same institution and patient population as factors for participating in our track, with 91% selecting quality of mentors and 73% level of clinical training. 55% of all fellows, and 100% of fellows pursuing careers in basic/translational science, specified the ability to tailor training path as a reason for participating in our track.

Since 2022, we have had 41% (7/17) of the fellows in our ID fellowship participate in the TID track. All track graduates (n=6) are currently in academic positions specializing in TID.

Conclusion

Among ID training programs with adequate patient population and clinical expertise/mentors to provide specialized training in TID, an embedded TID Track within ID fellowship may increase recruitment into TID, particularly among fellows pursuing a career in basic/translational research and not initially interested in TID prior to fellowship. Results are limited by our single-center experience.

Disclosures

All Authors: No reported disclosures
P-1003. Group B Streptococcus Colonization in Pregnant Women and Their Infants: Prevalence of Colonization, Vertical Transmission, and Serotype Dynamics
Authors: Kwak Byung Ok , Kim Dong Hyun
Published: January 2025

Background

Group B Streptococcus (GBS) is a leading cause of neonatal mortality and morbidity worldwide. Despite historically lower colonization rates among pregnant Korean women compared to those in Western countries, recent studies indicate a rising trend in GBS colonization rates and serotype changes. This study aimed to investigate GBS colonization rates, vertical transmission, and serotype distribution among pregnant women and their infants in Korea.

Methods

A prospective, mother-infant paired cohort study was conducted from January 2020 to November 2023. Vaginal and rectal swabs were obtained from pregnant women, while gastric aspirate and nasopharyngeal swabs were collected from infants immediately after birth, and nasopharyngeal and rectal swabs were obtained at one and two months of age. Serotyping and multilocus sequence typing (MLST) of GBS isolates were performed.

Results

Among 427 pregnant women, 67 (15.7%) tested positive for GBS colonization. Serotype III (24%), followed by V (22.4%), VIII (19.0%), and Ib (17.2%), were the predominant serotypes, with the most common sequence types (ST) being ST2, ST19, and ST10. Vertical transmission was observed in one infant at birth, presenting with serotype V. GBS colonization was identified in four infants at one month of age, with serotypes Ia and VIII. Of these, serotype Ia persisted in two infants, while serotype III was newly detected in one infant at two months of age.

Conclusion

The increasing trend in GBS colonization among pregnant Korean women highlights the need for continuous monitoring. GBS colonization was observed in infants at birth and up to two months of age, emphasizing the importance of ongoing surveillance of GBS colonization rates and serotype distribution to establish guidelines and preventive strategies in Korea.

Disclosures

All Authors: No reported disclosures
P-1004. The Ascendance of Serotype VIII in Group B Streptococcus among Korean Women: A Detailed Examination of Serotype Distribution and Multilocus Sequence Typing
Authors: Kwak Byung Ok , Kim Dong Hyun
Published: January 2025

Background

Group B Streptococcus (GBS) remains a formidable agent in neonatal sepsis and meningitis, often transmitted from mothers to neonates. Despite traditionally lower colonization rates in pregnant Korean women compared to their Western peers, emerging evidence suggests an uptick in both colonization rates and serotype variability. This study endeavors to elucidate the patterns of serotype distribution and sequence types among both pregnant and non-pregnant Korean women.

Methods

We analyzed 115 specimens, comprising 72 vaginal and 43 anorectal swabs, collected from 85 pregnant and 10 non-pregnant women. Serotyping was executed via multiplex PCR, complemented by multilocus sequence typing (MLST) of the GBS isolates.

Results

In our cohort of pregnant women, the leading serotypes were VIII (24.7%), followed by V (21.2%), III (20%), Ib (12.9%), and Ia (10.6%). Lesser prevalent serotypes included II (4.7%), IV (2.4%), and VI (2.4%). The sequence types most frequently encountered were ST2 (22.4%) and ST19 (14.1%), with ST2 predominantly associated with serotype VIII, and ST19 with serotypes III and V. Among non-pregnant women, the distribution was serotype VIII and Ia (20% each), followed by Ib (20%), III, IV, and V (10% each).

Conclusion

Contrary to earlier observations, serotype VIII has now emerged as the primary serotype among Korean women, succeeded by serotypes V, III, Ib, and Ia. Our findings underscore the imperative for continued and extensive surveillance to refine our understanding of the epidemiological and serological dynamics of GBS within this population.

Disclosures

All Authors: No reported disclosures
386. Pathogen-Harboring Ticks are Prevalent in Suburban Green Spaces in Central North Carolina
Authors: Schulz Abigail , Dalton Jack , Abernathy Haley , Evans Lanya , Hicks Johnathan , Diouf Adjaratou , Giandomenico Dana , Boyce Ross M
Published: January 2025

Background

North Carolina (NC) reports high numbers of ehrlichiosis and spotted fever group rickettsioses. However, the prevalence of pathogens in ticks has historically been relatively low, with a < 10% prevalence of Ehrlichia spp. and < 1% prevalence of Rickettsia rickettsii in field-collected Amblyomma americanum and Dermacentor variabilis ticks. Most entomological surveys have focused on woodlands and rural sites, while less is known about the risk of human-tick interactions in suburban green spaces such as parks.Table 1.Pathogens identified in ticks in central North Carolina from surveillance in suburban green spaces and animal shelters.

Methods

The objective of the study, which was supported by an IDSA GERM Award, was to describe the prevalence and distribution of pathogen-harboring ticks in a suburban area of central NC with a focus on green spaces. Tick surveillance was performed by dragging vegetation in 16 suburban green spaces, primarily city and county parks, in Orange and Chatham Counties from June - August 2022. Ticks were also collected from stray dogs presenting to two county animal shelters. Polymerase chain reaction (PCR) was used to detect pathogens in the ticks.

Results

A total of 107 ticks were collected and underwent PCR testing (Table 1), including 40 collected via dragging and 67 from animal shelters. A. americanum were the most frequently encountered ticks, accounting for more than two-thirds of ticks collected in green spaces and half of ticks from shelters. A total of 26% were positive for E. chaffeensis or E. ewingii, with substantially higher infection rates among ticks from shelters. A. maculatum accounted for 25% of ticks in green spaces, half of which were positive for R. parkeri. The vast majority (90%) of D. variabilis ticks were collected from shelters, but all three ticks from green spaces were positive for R. rickettsii. While of uncertain pathogenicity, R. amblyommatis was the most frequently encountered bacterium among all ticks collected.

Conclusion

Our findings demonstrate that pathogen-infected ticks are present in suburban green spaces. Given that exposure risk of tick-borne disease is commonly associated with rural activities such as hiking, camping, and hunting, further education and public campaigns are warranted, and vector control efforts may need to be considered. Our findings also suggest that A. maculatum may be moving further inland than previously reported.

Disclosures

All Authors: No reported disclosures
P-1025. Outcome Analysis of Breakthrough Invasive Aspergillosis on Anti-Mold Azole Prophylaxis: Thirty Year Experience in Hematologic Malignancy Patients
Authors: Dagher Hiba , Chaftari Anne-Marie , Haddad Andrea , Jiang Ying , Shrestha Jishna , Sherchan Robin , Lamie Peter , Makhoul Jennifer , Chaftari Patrick , Hachem Ray Y , Raad Issam I
Published: January 2025

Background

In patients with haematologic malignancy (HM) and stem cell transplant recipients, Invasive Aspergillosis (IA) remains associated with a poor prognosis. Anti-mold azoles have improved the outcome of IA when used therapeutically but are extensively used as prophylaxis. There is limited data regarding the outcomes of HM patients with IA breakthroughs on anti-mold azoles. We aimed to determine whether breakthrough IA patients on anti-mold azole prophylaxis are associated with a worse outcome.

Methods

We compared baseline characteristics, antifungal therapies, and outcomes in patients with breakthrough IA between July 1993 and July 2023 who received anti-mold azole prophylaxis (group 1) versus anti-mold non-azole prophylaxis (echinocandins) (group 2) versus no anti-mold prophylaxis (group 3). We compared mortality and clinical response at 6 and 12 weeks after diagnosis.

Results

614 patients with IA were analyzed, 163 in group 1, 62 in group 2 and 389 in group 3. 42-Day all-cause mortality (45%) and IA-associated mortality (35%) were significantly higher in group 1 as compared to group 3 (33% p=0.032 & 24% p=0.02 respectively). Breakthrough IA patients in group 1 were treated with Ampho B based (AMB) primary therapy at a significantly higher rate (64%) as compared to group 3 (44% p< 0.001). By multivariate analysis, AMB primary therapy was independently associated with worse response at EOT (OR= 0.64 p=0.041) and all-cause 84-day mortality (OR=1.85 p=0.002). Interestingly, anti-mold azole prophylaxis was independently associated with IA-associated and all-cause 42-day mortality (OR=1.85 p=0.009 and OR=1.70 p=0.013, respectively). Anti-mold azole primary therapy was independently associated with a successful response at EOT, protective against IA-associated and all-cause 42-day mortality, and IA- associated and all-cause 84-day mortality (p= < 0.01).

Conclusion

Breakthrough IA patients receiving anti-mold azole prophylaxis are associated with a worse prognosis possibly because they are more likely switched to AMB primary therapy which is associated with a poor outcome compared to anti-mold azole therapy.

Disclosures

All Authors: No reported disclosures
P-1027. Socioeconomic Factors Associated with Adverse Outcomes in Patients with Candidemia
Authors: Iqbal Hamail , Dalkilic Ahmet , Nikolic Dejan , Palacios Carlo Foppiano
Published: January 2025

Background

Candidemia can be a life-threatening disease associated with multiple infectious complications, such as endocarditis and endophthalmitis. With the rise of the opioid epidemic and intravenous drug use, candidemia incidence has increased, particularly among young adult patients. While treatment standards are well-established, data on the impact of socioeconomic factors on patient outcomes is lacking. Here, we aimed to evaluate if candidemia outcomes were associated with various socioeconomic factors.

Methods

A single-center, retrospective chart review was conducted including all patients with candidemia from 2017 to 2022 at an academic medical center. We collected demographic data, culture results, treatment measures, discharge outcomes, and outcomes at 30 and 90 days. Patient census tract codes were used to evaluate socioeconomic markers from the American Community Survey (2020). Descriptive statistics, Chi-square, and Kruskal-Wallis tests were performed.

Results

237 candidemia episodes among 199 patients were included. The mean age was 54 years, 55% were male, 58% were White, and 15% were Latino. Most cases were due to C. albicans (37%), and most patients were treated with micafungin (51%). Patients who did not speak English had a higher hospital mortality (P=0.003), 30-day mortality (P=0.01), and 90-day mortality (P=0.03). Interestingly, patients with a history of substance use disorder (P=0.006) and housing insecurity (P=0.006) were less likely to die inpatient; similar trends were found for 30 and 90-day mortality. Census tract data demonstrated that patients living in areas with more people who do not speak English well were more likely to be readmitted to the hospital within 30 (P=0.02) and 90 (P=0.001) days from discharge

Conclusion

Non-English-speaking patients and those residing in census tracts with higher unemployment had higher mortality. These findings underscore the importance of considering socioeconomic and demographic factors in clinical management and public health strategies aimed at improving outcomes in Candidemia patients. Further research should explore underlying mechanisms driving such disparities.

Disclosures

All Authors: No reported disclosures
P-1031. Frequency and resistance patterns of Candida auris causing candidemia in 3 teaching hospitals in Illinois: a routine data analysis
Authors: Paredes Jose Luis , LaChance Erik , Saad Peguy
Published: January 2025

Background

Despite a reported increase in the prevalence of Candida auris in the US, a potential emergent multidrug-resistant health care associated pathogen, data on its prevalence and drug resistance patterns is still scarce.

Methods

Sub-analysis or routinely collected data from 3 teaching hospitals in Chicago, Illinois. Isolates from patients with positive blood cultures for any species of Candida between April 2022 and April 2024 were included. The percentage of samples positive for Candida auris, considering one isolate per patient, and the prevalence or resistance to several antifungals (echinocandins, azoles, and amphotericin B) was reported.

Results

Among 422 candidemia isolates, 210 (49.8%) were Candida auris, isolated from 64 patients: 23 (36.5%), 34 (54.0%) and 6 (9.5%) from 2022, 2023 and 2024 respectively. Four isolates (6%) were resistant to echinocandins, nine (14%) isolates were resistant to fluconazole and one (2%) was resistant to amphotericin B.

Conclusion

A large proportion of candidemia isolates were caused by Candida auris. An important percentage was resistant to fluconazole and to echinocandins, supporting amphotericin B or high dose echinocandins as first line therapy.

Disclosures

All Authors: No reported disclosures