bluuebunny/crossref_metadata_2025 huggingface dataset:
P-2315. Clinical outcome of rifabutin-based treatment for pulmonary tuberculosis in solid organ transplant recipients
Authors: Yang Jinyoung , Ko Jae-Hoon , Cho Sun Young , Kang Cheol-In , Chung Doo Ryeon , Peck Kyong Ran , Rhu Jinsoo , Kim Jong Man , Choi Gyu-Seong , Lee Kyo Won , Park Jae Berm , Huh Woo Seong , Kim Darae , Choi Jin-Oh , Huh Kyungmin
Published: January 2025

Background

Rifabutin (Rfb) is commonly administered instead of rifampicin for the treatment of tuberculosis (TB) in SOTR to avoid substantial drug interaction of rifampin. However, evidence of its efficacy is scarce.

Methods

We conducted a retrospective, case-control study at Samsung Medical Center. The SOTR group included SOTR aged ≥ 18 years who were diagnosed with culture-positive pulmonary TB and treated with anti-TB medications that included both isoniazid (INH) and Rfb for > 80% of the total treatment duration. Patients who discontinued immunosuppressants before TB diagnosis and those with rifampin-resistant TB were excluded. The SOTR group was matched with a 1:3 ratio to the non-SOTRs who were treated with rifampin-based regimens. The primary outcome was survival treatment completion without early relapse. Logistic regression with and without overlap weighting was used to evaluate outcome measures.

Results

A total of 40 SOTRs and 120 non-SOTRs were enrolled. There was no difference between the two groups in the presence of cavitary lesions, smear-positivity, or culture-positivity at two months. However, extrapulmonary TB and INH resistance were significantly more frequent in the SOTR group. Most SOTRs had kidney transplants, followed by liver transplants. The proportions of deceased donors and living donors were 50% each. The primary outcome was achieved in 90% vs. 96.7% in SOTRs and controls, respectively (P=0.108). However, the completion of treatment was more frequent in the non-SOTR group (92.5% vs. 100%, P=0.015). There was no difference in recurrence or all-cause mortality within 1 year of completion of treatment, and there was no TB-attributable mortality in both groups. There was no significant difference in primary outcome after overlap weighting (adjusted odds ratio, 0.31; 95% confidence interval, 0.07–1.30). Grade 3 or higher acute kidney injury or hepatotoxicity was significantly more common in the SOTR group. In the SOTR group, allograft rejection requiring anti-rejection therapy within 6 months of TB diagnosis occurred in 10% and allograft failure in 12.5%.

Conclusion

Treating TB using Rfb in SOTR showed a similar treatment outcome compared to rifampin-based treatment in non-SOTR, suggesting its efficacy in this population.

Disclosures

Kyungmin Huh, M.D., Ph.D., bioMérieux: Grant/Research Support|GSK Korea: Advisor/Consultant|Pfizer Korea: Honoraria|Takeda Korea: Advisor/Consultant
P-2337. Contemporary Epidemiology of Infant Mortality Attributable to Cytomegalovirus Infection in the United States, 2007-2021
Authors: Boasiako Ladonna , Obiefuna Ngozika G , Arthur Abigail , Ononogbu Chidinma S , Dapaah-Siakwan Fredrick
Published: January 2025

Background

Cytomegalovirus (CMV) infections are common in infants in the United States (US) but infant mortality due to CMV has been poorly studied and it is unknown if there have been changes in CMV infant mortality rate (CMV-IMR) over time. We described the characteristics of a contemporary national cohort of infants who died from CMV and whether the CMV-IMR changed from 2007 to 2021.Table 1.Characteristics of the national cohort of infants who died from CMV infections and their corresponding CMV-IMR, 2007-2009.

Methods

This was a retrospective serial cross-sectional analysis of the CDC's linked birth and infant death records from 2007-2021. We used ICD-10 codes to identify infants < 1 year of age who had CMV infection listed as the underlying cause of death.The crude CMV-IMR was calculated per 1,000,000 live births and further stratified by gender, birth weight, gestational age, age at death, race, and census region. The Mann-Whitney U test was used to compare two groups and P < 0 .05 defined statistical significance. Trends were evaluated with Joinpoint regressionand expressed as average annual percentage change (AAPC) with 95% confidence intervals (CI).

Results

Out of 59 million live births, 406 infant deaths were attributed to CMV infections (crude CMV-IMR of 6.9 per 1,000,000). This resulted in at least 30,044 years of potential life lost. Notable characteristics of the study cohort were (Table 1): 78.8% low birth weight, 72.4% preterm, 63.8% of the mothers had at least high school education, 14 states had 64% of the CMV deaths, and 45.3% died within 28 days of birth. The CMV-MR was higher in low birth weight and preterm infants and was inversely related to gestational age (Table 1). The CMV-IMR varied by race [highest in Non-Hispanic Black (9.9)], censusregion [highest in the Midwest (8.5)], and by state [4.3 in Illinoisand 12.3 in Alabama]. There was a non-significant decrease in the CMV-IMR from 9.3 to 4.1 (AAPC -2.9%; CI: -6.7 – 1.0%.)which was insignificant at 95%CI.

Conclusion

The ubiquitous nature of CMV and the higher mortality in preterm and low birth weight infants should prompt serious consideration for early and universal CMV screening in these infants. The racial disparities in CMV-IMR suggest differential public health action toward awareness, prevention, and treatment of CMV. Addressing these disparities must be a top priority.

Disclosures

All Authors: No reported disclosures
P-2350. Respiratory Virus Detection among Children, Teachers, and Touch Surfaces in Childcare Centres: Preliminary Results from the DISeases TrANsmission in ChildcarE (DISTANCE) Cohort Study (2022–2024)
Authors: Ye Sheng , Deng Shuyu , Cong Bingbing , Guo Ling , Zhang Tiantian , Xu Xiaoyu , Shi Chao , Wang Xin , Li You
Published: January 2025

Background

Childcare centres are commonly regarded as high-risk settings for respiratory virus transmission. To understand transmission risks within childcare centres, we conducted a prospective cohort study that collected data on respiratory infections in children and teaching staff, contact behaviours of children, and detection of respiratory viruses on touch surfaces (Figure 1).Figure 1.Schematic figure showing data collection and follow-up of the study.

Methods

We reported updated preliminary findings based on data collected from two childcare centres in Wuxi and Nanjing, China between September 26th, 2022, and January 22nd, 2024. Weekly throat swabs were collected from 211 children and 21 teachers. 56 touch surfaces, such as desks, door knobs, and faucets, were sampled on the same day from childcare centres (Table 1). Both respiratory and surface swab samples were tested by multiplex PCR for eight respiratory viruses.Table 1.Basic characteristics of the study and Positive cases of virus among children and teachers (estimate per 1000 person-weeks, 95% CI)

Results

6886 respiratory specimens and 1868 touch surface samples were collected and tested over the reporting period. Respiratory viruses were most detected among children (7.41%, 447/6032), followed by teachers (4.10%, 35/854) and touch surfaces (2.09%, 39/1868). The top four viruses detected among all children were rhinovirus, influenza A virus, RSV, and PIV (Figure 2). Specifically, rhinovirus prevailed mostly in the Nanjing site (60.11 per 1000 person-weeks, 95% CI: 48.69–73.41), while influenza A dominated in the Wuxi site (23.00 per 1000 person-weeks, 18.75–27.92). Teachers had lower viral infections than children except for influenza A, where rates were comparable: teachers (16.39 per 1000 person-weeks, 8.96–27.51) and children (18.24 per 1000 person-weeks, 14.99–21.98). For a given week, influenza A detection was correlated between students and teachers (Spearman correlation coefficient r =0.55) at the Wuxi and Nanjing sites (Table 2). However, for SARS-COV-2, there was a higher correlation between touch surfaces and individuals (children: r = 0.67; teacher: r = 0.82), than between children and teachers in Wuxi.Figure 2.Comparison of incidence/detection rate among children, teachers and touch surfaces in two childcare centres.

Conclusion

Children in childcare centres face higher risks of respiratory viral infections than teachers. There is synchrony in detecting respiratory viruses among teachers, students and touch surfaces, indicating the varied contribution of each component to respiratory virus transmission in childcare centres.Table 2.Correlation coefficients of respiratory virus detection in Nanjing

Disclosures

You Li, Pfizer: Advisor/Consultant
P-2367. Qualitative Analysis of Barriers to Outpatient Antiviral Treatment for COVID-19 and Influenza Patients Observed by Infectious Disease Specialists in North America, 2024
Authors: Louis Souci , Wang Dennis , Singleton Jordan , Smith Dallas J , Lambrou Anastasia S , Beekmann Susan E , Polgreen Philip M , Garg Shikha , Ricaldi Jessica , Uyeki Timothy M , Santibanez Scott S , Patel Pragna
Published: January 2025

Background

Antiviral medications for COVID-19 and influenza can mitigate disease severity in high-risk outpatients if taken early in the course of illness yet are underutilized. We sought to understand barriers to providers prescribing these medications.

Table

Thematic summary from infectious disease specialists outlining barriers to outpatient antiviral treatment for COVID-19 and influenza patients, United States, 2024

Methods

We conducted an on-line survey regarding knowledge, attitudes, and practices of prescribing antiviral treatment for outpatients with COVID-19 and influenza. Respondents were asked about perceived barriers among providers treating COVID-19 and influenza outpatients in their institutions. Questions were structured using a Likert scale and were analyzed using a thematic analysis approach in Microsoft Excel.

Results

Of 1,898 infectious disease specialists across the United States and Canada who received the survey between 1/10/24 to 2/5/24, 565 (30%) responded, of whom 93% were infectious disease physicians and 7% were healthcare professionals. Surveyed physicians worked in university (45%), non-university teaching (24%), community (20%), city/county (4%), outpatient (0.4%), and veteran affairs hospital settings (6%) and 144 (25%) provided free text responses. The primary barrier to prescribing antivirals was provider skepticism (47%), due to patient symptoms deemed too mild for treatment and needing more evidence about effectiveness. This was followed by perceptions of limited accessibility (31%) related to high cost, limited hospital access, and difficulty administering some medications. Pharmacologic limitations (18%) were concerns about drug interactions, side effects, and incomplete medical history. Other barriers were timeliness of treatment within a short therapeutic window (15%) and patient skepticism (13%). Additional free text responses described successful hospital protocols and suggestions for encouraging antiviral prescribing.

Conclusion

These themes demonstrate a need for better education of providers about antiviral risks and benefits as well as improved access and coverage of life-saving medications. Infectious disease specialists provided useful insights which can help to shape clinical recommendations, future research for antiviral therapeutics, and public health messaging for improved patient care.

Disclosures

Philip M. Polgreen, MD, Eli Lily: Advisor/Consultant|Pfizer: Grant/Research Support
P-47. Vaccine Effectiveness Against Influenza-Associated Hospitalizations in Adults with Liver Diseases
Authors: Huang Po-Han , Patricia Nowalk Mary , Zimmerman Richard K , Olson Samantha M , Talbot Keipp , Zhu Yuwei , Gaglani Manjusha , Murthy Kempapura , Monto Arnold , Martin Emily T , Silveira Fernanda , Balasubramani G K
Published: January 2025

Background

Influenza causes 100,000-710,000 hospitalizations annually in the U.S. Patients with liver disease are at higher risk of severe outcomes following influenza virus infection. While vaccination has been shown to be effective in preventing morbidity and mortality, patients with liver disease experience immune dysfunction that may attenuate influenza vaccine effectiveness (VE). Limited influenza VE data for this population are available. This study evaluated VE against influenza-associated hospitalization among adults with liver disease.

Methods

We used a test-negative, case-control study to estimate VE among adults ≥18 years admitted at four sites within the U.S. Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN) for acute respiratory illness (ARI) during 3 influenza seasons (2015-2018). Adults with liver disease were identified by ICD-9/ICD-10-CM codes recorded ≤1 year before enrollment. VE was defined as (1-adjusted odds ratio) *100 by comparing the odds of having laboratory-confirmed influenza-associated hospitalization between vaccinated and non-vaccinated adults using multiple logistic regression models that incorporated inverse probability of treatment weighting with propensity score.

Results

In total, 1208 (12.9%) of 9359 adults hospitalized for ARI had ≥1 liver disease(s). Compared with those without liver disease, adults with liver disease were slightly more likely to have received influenza vaccine (65.4% vs 62.4%; p = 0.046) but not different in their likelihood of influenza illness (16.6% vs 18.0%; p = 0.229). Overall, VE against influenza-associated hospitalization was 27% (95% confidence interval [CI], 18-34%); 30% (95% CI, 22-38%) among patients without liver disease; and -11% (95% CI, -54% to 20%) among those with liver disease. Significant effect modification of VE by the presence of liver disease was found (p = 0.01 for interaction term).

Conclusion

We observed no association of influenza vaccination on influenza-associated hospitalizations among adults with liver disease. Further studies are warranted to evaluate VE in patients with different types of liver disease to better understand if effectiveness varies by specific liver diseases and to investigate potential residual confounding.

Disclosures

Po-Han Huang, MD, MSc, Pfizer: Honoraria Mary Patricia Nowalk, PhD, AstraZeneca - Icosavax: Grant/Research Support|GSK: Advisor/Consultant|Merck & Co.: Grant/Research Support|Sanofi: Grant/Research Support Richard K. Zimmerman, MA;MD;MPH;MS, Sanofi Pasteur: Grant/Research Support Arnold Monto, MD, Roche: Advisor/Consultant Fernanda Silveira, MD, Ansun: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Viracor Eurofins: Advisor/Consultant
P-71. Combined Orthopaedic and Infectious Disease Periprosthetic Joint Infection Clinic: A Survey Study
Authors: Dilbone Eric , Leal Justin , Hendershot Edward F , Gettler Erin , Seidelman Jessica , Seyler Thorsten M , Jiranek William A
Published: January 2025

Background

The rising incidence of total joint arthroplasties being performed is leading to an increased number of prosthetic joint infections (PJI). PJI treatment is complex, thus a collaborative approach involving orthopaedic surgeons and infectious disease (ID) providers is growing. This single institution has a weekly combined Ortho-ID (OID) clinic that sees PJI patients and is staffed by joint replacement fellows and ID attendings. This project sought to survey the joint replacement fellow participants from recent years regarding the impact of this experience on their subsequent clinical practice.

Figure 1

Methods

A survey was distributed to fellows who participated in the combined OID clinic during their single year of fellowship from 2020 through 2023 to evaluate the impact of this experience on their development as clinicians and current clinical practice. An anonymous survey included all current and former fellows since the inception of this clinic in 2020. Institutional review board (IRB) approval was obtained prior to the distribution of the survey.

Table 1

Results

A total of 14 current and former fellows received the survey and 12 responded. The majority of the respondents are currently in an academic practice setting (75%), with the rest being hospital employed (17%) or private practice (8%). Taking care of PJI patients makes up anywhere from 0-40% of the respondents’ practices. 92% of former fellows felt that the multi-disciplinary approach to this clinic helped prepare them for managing PJI patients in practice today. 92% also felt that this experience would be beneficial going forward for future fellows and that the current model of ½ day clinic once per month was sufficient.

Conclusion

A combined OID clinic is increasingly a popular approach to the management of PJI patients, but little is known about the utility of this clinic setting for trainees. This survey of participants in this model of clinic shows that once in practice, many orthopedic surgeons found that this experience gave them tools to better manage their PJI patients. Arthroplasty fellowship programs should consider including a combined OID clinic as part of their fellowship.

Disclosures

Jessica Seidelman, MD, MPH, 3M: Expert Testimony
P-74. Can Laboratory Investigations Predict Relapsing Malignant Otitis Externa ?
Authors: Hammami Fatma , Rekik Khaoula , Smaoui Fatma , Chakroun Amal , Marrakchi Chakib , Koubaa Makram , Ben Jemaa Mounir
Published: January 2025

Background

Malignant otitis externa (MOE) is a life-threatening infection of the external auditory canal. Relapse was reported in 9 to 27% of the cases, mainly due to inadequate length of treatment. We aimed to evaluate the predictor value of laboratory investigations in relapsing MOE.

Methods

We conducted a retrospective study including all patients hospitalized in the infectious diseases department for MOE between 2000 and 2022. Receiver operating characteristic curves and areas under the curves (AUC) were calculated to evaluate the predictor value of laboratory investigations in relapsing MOE.

Results

We included 116 cases, among which 64 were males (55.2%). Relapse was noted in 18 cases (15.5%). The white blood cells count was significantly higher among relapsing MOE cases (10220[8400-10770] /mm3 vs 8290[7020-9600] /mm3 ; p=0.022). The optimal cut-off of white blood cells count for predicting relapse among MOE cases was 8860/mm3, with a sensitivity of 72.2% and a speciﬁcity of 64.2%. The AUC was 0.670 and the 95% conﬁdence interval ranged from 0.544 to 0.796. Neutrophil levels were significantly higher among relapsing MOE cases (6730[5320-7562]/mm3 vs 5260[4420-6740]/mm3 ; p=0.024). The optimal cut-off of neutrophil level for predicting relapse among MOE cases was 5975/mm3, with a sensitivity of 70.6% and a speciﬁcity of 68.4%. The AUC was 0.676 and the 95% conﬁdence interval ranged from 0.545 to 0.806. Creatinine levels were significantly lower among relapsing MOE cases (64[52-91] µmol/L vs 91[70-117] µmol/L ; p=0.013).

Conclusion

White blood cells count and neutrophil levels are a simple blood test that can predict relapsing MOE cases. Such patients require a regular follow-up in order to promptly diagnosis relapse.

Disclosures

All Authors: No reported disclosures
P-75. Factors Predicting Sequelae After Treatment Of Spondylodiscitis
Authors: Hammami Fatma , Rekik Khaoula , Smaoui Fatma , Chakroun Amal , Marrakchi Chakib , Koubaa Makram , Ben Jemaa Mounir
Published: January 2025

Background

The outcome of spondylodiscitis, a serious infection of the intervertebral disc(s) and/or adjacent vertebrae, might be invalidating with the occurrence of sequelae. We aimed to study factors predicting sequelae after treatment of spondylodiscitis.

Methods

We conducted a retrospective study including all patients hospitalized in the infectious diseases department for spondylodiscitis between 2000 and 2022. Tubercular, brucellar and pyogenic spondylodiscitis were included in the study.

Results

We encountered 173 cases, among whom 78 had sequelae (45.1%). No significant difference was noted concerning the age of patients with (54[37-62] years) or without (57[41-67] years) sequelae (p=0.155). Tubercular spondylodiscitis was significantly associated with sequelae (52.6% vs 36.8% ; p=0.038). Anorexia (49.4% vs 31.2% ; p=0.016) and night sweats (57.9% vs 41.9% ; p=0.039) were significantly noted among patients with sequelae. Fever (53.8% vs 64.2% ; p=0.167), back pain (97.4% vs 93.5% ; p=0.295) and asthenia (53.2% vs 44.1% ; p=0.234) were the revealing symptoms among cases with or without sequelae. An accelerated erythrocyte sedimentation rate was noted more frequently among patients with sequelae (90.5% vs 76.5% ; p=0.018). Elevated C-reactive protein level (21.7% vs 20.7% ; p=0.873) and leukocytosis (23.1% vs 24.2% ; p=0.861) were noted among cases with or without sequelae. Treatment duration was significantly longer among patients with sequelae (11[6-15] months vs 7[4-12] months ; p=0.021). Percutaneous abscess drainage was significantly more frequent among patients with sequelae (17.1% vs 6.5% ; p=0.029). Surgery was indicated among patients with or without sequelae (14.3% vs 7.4%), with no significant difference (p=0.141).

Conclusion

The presence of anorexia, night sweats and an accelerated erythrocyte sedimentation rate, especially among tubercular spondylodiscitis cases, were predictor factors of sequelae after treatment. Such patients require a regular follow-up and an adequate treatment duration in order to reduce sequelae.

Disclosures

All Authors: No reported disclosures
P-80. The microbiology of periprosthetic joint infections as revealed by sonicate cultures in Korea: Routine use of fungal and mycobacterial cultures is necessary?
Authors: Park Kyung-Hwa , Sung Jeong Hae , un Shin Sung , Jin Kim Uh , Eun Kim Seong , Kang Seung-ji , In Jung Sook
Published: January 2025

Background

Although sonication is a valuable diagnostic tool for periprosthetic joint infections (PJI), it is not commonly utilized. We analyzed sonicate and intraoperative tissue culture results obtained from three hospitals to define the microbial etiology of PJIs in Korea. Furthermore, we investigated necessity of conducting regular fungal and mycobacterial cultures.

Methods

We retrospectively analyzed data for patients with suspected orthopedic-related infections between 2017 and 2022, who had undergone prostheses removal surgery. We included 193 patients with suspected PJIs, and bacterial (n = 193), fungal (n = 193), and mycobacterial (n = 186) cultures were conducted on both sonicate and intraoperative tissue samples. The diagnosis of PJI was based on the European Bone and Joint Infection Society (EBJIS) criteria.

Results

Out of 193 patients, 121 (62.7%) had positive sonicate cultures, while 112 (58.0%) had positive periprosthetic tissue cultures. According to EBJIS criteria, a total of 181 patients were diagnosed with PJI, and 141 patients received microbiological confirmation through sonicate fluid culture or tissue culture. Of the 181 patients, 28 were classified with acute PJI (within 3 months of implantation) and 153 with chronic PJI. Among 141 patients, staphylococci were the most common organisms, accounting for 51.8% of cases, followed by Gram-negative organisms (15.6%), fungus (8.5%), and mycobacteria (3.5%). Nearly 91.7% of fungal isolates were Candida species, which also grew in bacterial cultures. In total, 11 cases cultured positive only in tissue culture, whereas 20 cases cultured positive only in sonicate culture. The antibiotic treatment plans were adjusted according to culture results.

Conclusion

Utilizing sonicate culture has greatly assisted in identifying pathogens responsible for chronic indolent PJIs, allowing suitable antimicrobial treatment. Based on few cases involving non-Candida and mycobacterial infections, it appears that routine fungal and mycobacterial cultures may not be necessary.

Disclosures

All Authors: No reported disclosures
P-91. Clinical characteristics and analysis of predictors of the outcome of septic arthritis of the shoulder : a 16-year experience
Authors: Eun Seong Jae , Ahn Sangmin , Han Min , Lee Yongseop , Ah Lee Jung , Ho Kim Jung , Young Ahn Jin , Jin Jeong Su , Su Ku Nam , Yong Choi Jun , Yeom Joon-sup
Published: January 2025

Background

The number of septic arthritis cases is increasing due to the increasing number of joint surgeries and lengthened life expectancy. There are few data about the characteristics and risk factors of septic arthritis of the shoulder. As timely diagnosis and treatment are essential, we aim to describe the clinical characteristics and analyze predictors of the outcome of Septic arthritis of the shoulder.

Microorganisms causing septic arthritis of the shoulder

Methods

We performed a retrospective cohort study of patients diagnosed with septic arthritis of the shoulder between June 2007 and June 2023 at a tertiary hospital in Korea, Aged over 19. We excluded patients who did not undergo treatment in this hospital and had tuberculosis isolated from synovial culture.

We analyzed demographic data, comorbidities and underlying conditions, shoulder trauma history, operation history, acupuncture history, previous steroid injection history, rotator cuff tear, clinical presentation, MRI finding, synovial findings, laboratory findings, and culture findings. We analyzed whether each characteristic was associated with unfavorable outcome.

Results

Among 99 patients enrolled in this study, 49 patients showed unfavorable prognosis.

The most frequently identified microorganisms were Staphylococcus aureus (39 cases), 11 of which were Methicillin-resistant S. aureus (MRSA), Streptococcus, and beta-haemolytic (7 cases).

The univariate analysis revealed that elevated blood WBC count at 2 weeks and CRP/Albumin ratio at 2 weeks were significant factors. Additionally, findings of positive culture, blood stream infection and MRSA isolation were statistically significant.

In multivariate analysis, we identified positive culture findings (OR 3.34; 95% CI, 1.01 – 11.12; P = 0.049), the CRP/albumin ratio at 2 weeks (OR 1.07; 95% CI, 1.01 – 1.12; P = 0.012), and the Charlson calculator score (OR 0.32; 95% CI, 0.69 – 0.99; P = 0.037) as risk factors for unfavorable outcomes.

Conclusion

The significance of our study is that we analyzed characteristics of multiple cases for the long term and identified new predictors of the outcome for septic arthritis of the shoulder. In case of identified positive culture findings, elevated CRP/albumin ratio at 2 weeks and high Charlson calculator score, unfavorable outcome can be considered.

Disclosures

All Authors: No reported disclosures
P-107. Serious Injection-Related Infections in Hospitalized Adults with Opioid Use Disorder Enrolled in an Ongoing Randomized Clinical Trial: A Focus on Staphylococcus aureus
Authors: Fanucchi Laura , Thornton Alice C , Villacorta Cari Evelyn , Mynatt Ryan P , VanMeter Connor , Nuzzo Paul , Walsh Sharon , Chang Loui , Kunzelman Wyatt , Kapadia Shashi , Lofwall Michelle
Published: January 2025

Background

Staphylococcus aureus (SA) causes the majority of serious injection-related infections (SIRI) in persons with opioid use disorder (OUD). Invasive SA infections are typically treated with prolonged IV antibiotic courses; increasingly oral transitions are considered though prospective clinical trial data are limited. Outpatient parenteral antibiotic therapy (OPAT) may be denied to persons with OUD and SIRI despite increasing evidence that it may be feasible and safe. Our ongoing study evaluates the efficacy and cost-effectiveness of an integrated outpatient care model combining Buprenorphine for OUD with OPAT (B-OPAT; NCT04677114) compared to Treatment As Usual (TAU) in persons hospitalized with OUD and SIRI. Here we present preliminary data on the prevalence of SA infections, treatment outcomes, and adverse events (AE) in the ongoing B-OPAT study.

Methods

This study is a randomized, 2-arm superiority trial enrolling hospitalized adults with OUD and SIRI. Participants are randomized 1:1 to discharge with B-OPAT or TAU. SIRI details, planned and completed days of IV antibiotic therapy, and AEs are collected at baseline and through the 12-week post-discharge intervention.

Results

From March 2021 – March 2024, 58 persons were randomized (B-OPAT: 29; TAU: 29), with 39 (67%) having SA infections (B-OPAT: 18; TAU: 21), and of those 24 (61%) due to Methicillin-resistant SA (MRSA). Baseline characteristics stratified by SA are shown in Table 1. In patients with SA, average hospital length of stay was longer and fewer days of IV antibiotics were missed in both BOPAT and TAU (Figure 1). In BOPAT 1 person received oral antibiotic transition, and 8 in TAU, all with SA. Over 12-weeks post-discharge, B-OPAT had 13 serious adverse events (SAE) including 1 death in non-SA; 8 SAE were in those with SA. TAU had 17 SAE, 13 in those with SA including 3 deaths (Table 2).

Conclusion

Our ongoing clinical trial enrolling hospitalized persons with OUD and SIRI shows that SA accounts for the majority of infections overall, and that SA may be associated with longer hospitalizations and higher morbidity. Importantly, our study may contribute prospective safety and other clinical trial data to inform the practice of oral transitions for invasive SA infections.

Disclosures

Sharon Walsh, PhD, Astra Zeneca: Advisor/Consultant|Braeburn Pharmaceuticals: Advisor/Consultant|Cerevel Therapeutics: Advisor/Consultant|Lundbeck: Advisor/Consultant|Opiant Pharmaceuticals: Advisor/Consultant Michelle Lofwall, MD, Berkshire Biomedical: Advisor/Consultant|Braeburn Pharmaceuticals: Advisor/Consultant|Journey Colab: Advisor/Consultant
P-129. Evaluation of the Mannheim Peritonitis Index, the Neutrophil/Lymphocyte Ratio, and the Platelet/Lymphocyte Ratio as Predictive Parameters of Clinical Outcomes of Patients with Intra-Abdominal Infection in a Teaching Hospital in Nicaragua
Authors: Alvarado-Malueño Freda L , Porras-Cortés Guillermo D
Published: January 2025

Background

Intra-abdominal infections are associated worldwide with relatively high mortality. Decisions in patient management and clinical outcomes may be determined by specific risk factors that can be assessed in the form of scores or indices, and ratios. The objective of this study was to evaluate the Mannheim Peritonitis Index (MPI), the Neutrophil/Lymphocyte Ratio (NLR), and the Platelet/Lymphocyte Ratio (PLR) as predictors of mortality and other clinical outcomes in this type of patients at a teaching and referral hospital (Dr. Fernando Vélez Paiz Hospital) in Managua, Nicaragua.Table 1.Mannheim Peritonitis Index and Surgical Reintervention, Admission to ICU, and Mortality

Methods

This is a retrospective, cross-sectional, analytical study. Patients hospitalized for complicated intra-abdominal infection (cIAI)an between November 2021 and November 2023 were included. The relationship of MPI, NLR, and PLR with mortality and other clinical outcomes as need for reoperation, requiring admission to intensive care unit, and length of hospital stay was analyzed. The cut-off points of previous reference studies for MPI (≥ 26 points), NLR (≥ 11), and PLR (≥ 222) were used. Sensitivity, specificity and a ROC curve (AUC) were calculated for each of the predictive instruments evaluatedTable 2.Neutrophiles/Lymphocytes Ratio and Surgical Reintervention, Admission to ICU, and Mortality

Results

102 patients with cIAI were included in the study. The mean age was 56.05 ± 21.25 years-old. The most common etiology was acute appendicitis (39.2%). Overall mortality was 34.3%. The need for surgical reintervention was observed in 72.7% of patients with MPI ≥ 26 points, 31.3% of patients with NLR ≥ 11, and 45.0% of patients with PLR ≥ 222. Regarding requiring admission to the intensive care unit, it was observed in 84.0% of patients with MPI ≥ 26 points, 57.8% of patients with NLR ≥ 11, and 27.5% of patients with PLR ≥ 222. Mortality in patients with MPI ≥ 26 points was 75.0%, and 46.9% in patients with NLR ≥ 11 (Table 1 and 2). Theand specificity of MPI for mortality was 94.3% and 47.9% respectively, with an AUC of 0.95. The sensitivity and specificity of NLR for mortality were 85.7% and 49.3% respectively (Table 3).Table 3.Sensitivity and Specificity of MPI and NLR for Mortality Prediction.

Conclusion

The MPI ≥ 26 points predicts mortality, a higher probability of surgical reoperation, ICU admission, and prolonged hospital stay. In the population of this study, the cut-off point with the best diagnostic reliability was MPI ≥ 25 points. The NLR ≥ 11 points is also a significant predictor of mortality.

Disclosures

All Authors: No reported disclosures
P-133. Klebsiella pneumoniae liver abscess as the herald of underlying colon neoplasm
Authors: Lin Yi-Tsung , Chuang Chien , Liao Tsen-En , Chou Sheng-Hua , Ho Yu-Chien , Liu Szu-Yu , Juan Chih-Han
Published: January 2025

Background

Klebsiella pneumoniae liver abscess (KPLA) is an endemic disease in Eastern Asia, especially Taiwan. Hypervirulent K. pneumoniae strain in the gut is able to translocate across the colonic mucosal defects to the portal system, resulting in subsequent liver abscess. Occult colon cancer in patients with KPLA has been described in several case series. However, data regarding colonoscopic findings in patients with KPLA in Taiwan have not been investigated. We aimed to investigate whether the diagnosis of KPLA serves as a marker of underlying colorectal neoplasm.

Methods

Consecutive patients with KPLA in Taipei Veterans General Hospital from April 2011 to January 2024 were included in this retrospective study. Clinical data were collected and colonscopy was recommended within 6 months of diagnosis of KPLA according to the patient’s will. Hypervirulent strains were defined as those with rmpA or rmpA2. In patients receiving colonoscopy, we determined the risk factors of underlying colon adenoma/adenocarcinoma using a logistic regression analysis.

Results

A total of 491 unique KPLA episode was collected during the study period. Most of the available strains (401 of 422, 95%) were hypervirulent strains, and most of them (339 of 422) belonged to capsular type K1 or K2. One hundred and thirteen patients (23%) had undergone colonoscopy within six months of diagnosis of KPLA. Clinical characteristics were similar between patients who had undergone colonoscopy or not. The findings of colonoscopy showed that 48 patients had adenomas (42.5%) and 12 patients had adenocarcinoma (10.6%). Patients with colon adenoma/adenocarcinoma had a higher proportion of age over 50 years (90% versus 62.3%, P< 0.001) and female (45% versus 26.4%, P=0.04), compared with patients without colon adenoma/adenocarcinoma. The proportion of hypervirulent strains and the distribution of capsular types were similar between the 2 groups. In multivariate analysis, age over 50 years was the only independent risk factor for colon adenoma/adenocarcinoma (P=0.002, OR=5.14, 95% CI=1.84-14.36).

Conclusion

Colon adenoma and adenocarcinoma were notably common in patients with KPLA. We recommended colonoscopy be routinely performed in patients with KPLA in the endemic area, especially for those older than 50 years old.

Disclosures

All Authors: No reported disclosures
P-140. A Quality Improvement (QI) Project to Increase Chagas Disease Screening Rates in an At-Risk, Underserved Patient Population Living in Houston, Texas
Authors: Centeno Fernando H , Wetterman-Capo Renatta , Rueda Jaime , Clark Eva
Published: January 2025

Background

Chagas disease (CD), caused by Trypanosoma cruzi, is a neglected disease of poverty affecting >6 million people in the Americas, including >200,000 in the US. While many are asymptomatic, 20-30% develop end-organ damage like Chagas cardiomyopathy. Early diagnosis and treatment are essential to reduce this risk; however, US clinicians generally are unaware of for whom CD screening is recommended (Table 1) and how to order it. >1.5 million people born in continental Latin America live in Harris County, TX, making this an important region in which to establish systematic CD screening. This QI project seeks to improve CD screening rates using electronic medical record (EMR) tools.Figure 1A:HHS Chagas disease testing protocol, Figure 1B: Outpatient clinic visit flow diagram incorporating PDSA Cycle Phase 1 and Phase 2

Methods

This project is set in the Harris Health System (HHS), a public safety-net healthcare system serving >1 million outpatients annually; 52.9% are Hispanic and 45.9% are uninsured. Previous studies support a CD prevalence of ∼1%, suggesting that >5,000 outpatients/year present to HHS with undiagnosed CD. Our HHS CD screening protocol (Figure 1A) is based on US screening recommendations. We assembled a team of stakeholders and identified a HHS primary care clinic (MLK Clinic) as the pilot location. We used Epic Systems EMR tools to evaluate the patient population presenting to MLK Clinic over a 9 month period and develop corresponding QI interventions. The primary outcome is CD screening rate; see Table 2 for secondary outcomes.Figure 2:Plan, Do, Study, Act (PDSA) cycle structure

Results

1,443 patients presented to MLK Clinic between 7/1/2023-4/30/2024, average age 26 years (range 0-95). A sample of 158 showed that 40% were eligible for CD screening based on birth country. Of those, only 12 T. cruzi IgG tests were ordered (2% of eligible patients). Together with stakeholders, we developed 2 interventions to improve CD screening rates (Figure 1B): 1) single-question Epic SmartPhrase used by nursing staff during patient triage and 2) physician CD educational session and Epic SmartPhrase. These will be applied in 2 PDSA cycle phases (Figure 2). We trained nursing staff on 4/2024 and began PDSA Phase 1 on 5/1/24.

Conclusion

Early CD diagnosis and treatment reduce the risk of progression to devastating end-organ damage. This QI project will contribute to improved identification of at-risk patients through use of EMR tools for systematic screening.

Disclosures

All Authors: No reported disclosures
P-142. Clinical and epidemiological profile of patients with malaria hospitalized at a tertiary level hospital of Central America
Authors: Rodriguez Cristel M , Cárdenas Rosa , Tulloch Felicia , Pachar Flores Monica , Suarez Jose , Arauz Rodriguez Ana Belen
Published: January 2025

Background

During the last two years Panama has found itself in the midst of a malaria epidemic, with cases spiking by 65% from 4181 in 2021 to 7083 in 2022. As of October 2023, reported cases reached 8301. This situation is thought to be related with human movements of indigenous groups, and the unprecedented number of migrating people crossing Central America through the Darién Gap, a dense rainforest between Colombia and Panama. The increasing incidence of malaria is reflected in hospital admissions in a tertiary level hospital of the city, a non-endemic region of malaria in the country.

Methods

Retrospective study of malaria diagnosed at Hospital Santo Tomás, Panama City, Panama, between 2017 and 2024. Charts from patients hospitalized and confirmed to have malaria were collected. Demographic, clinical and biochemical variables were analyzed using Excell v.2403.

Results

A total of 46 cases were found from 2017 to 2024. The year with more admissions was 2023. Mean age was 34.52 years. Men and women were affected equally. Migrants represented 30% of the cohort and the most common origin was Venezuela. Admissions were more frequent in the months of February and March which coincides with the dry season of the country. The most frequent region to acquire malaria was Darién, in people crossing the Darien Gap or natives from the region. Mean time to onset of symptoms was 11 days and the most common clinical features were fever in 91%, malaise (80%) , and headache (60%). There were 9 cases of severe malaria and one case of cerebral malaria. Only one patient died. In the biochemical profile, the most common findings were thrombocytopenia in 87% and anemia in 76.5%. The diagnosis was made mostly by rapid diagnostic test of malaria (RDT) and thin smear in 52%. The most common Plasmodium species was vivax, with 43 cases, 2 cases of falciparum and 1 case of falciparum and vivax coinfection. The treatment used for vivax malaria was chloroquine and primaquine, and artemether lumefantrine for falciparum malaria. The most common coinfection was dengue fever.

Conclusion

Malaria admissions have been raising in Panama City. The latter raises concern and calls to action to strengthen community networks to diagnose and treat malaria with more laboratory professionals and vector technicians, as well as diagnostic supplies and treatment.

Disclosures

All Authors: No reported disclosures
P-172. Assessment of the HIV Case Epidemiological Surveillance System in Sughd Region, Tajikistan, 2024 year
Authors: Shamsudinov Muhiddin , Sharifov Rajabali , Horth Roberta , Nabirova Dilyara , Tilloeva Zulfiya H , Mergenova Gaukhar
Published: January 2025

Background

In recent times, the HIV epidemic has emerged as a major challenge in contemporary healthcare, leading to the demise of 40.4 million individuals globally. Across the timeline of the ailment, fatalities have been recorded, and the spread of the virus persists worldwide, Tajikistan included, where over 10.5 thousand cases have been documented. This study aimed to evaluate the efficiency of the HIV surveillance system, which stands as a pivotal strategy in combating HIV/AIDS.

Methods

Between February and March 2024, we conducted a descriptive evaluation study of the existing surveillance system using the CDC's methodology. The analysis covered data from the AIDS Centre and three health centers in Khujand, including a survey of 33 health workers to assess aspects of surveillance such as flexibility, timeliness, sensitivity, predictive positive value, cost, and overall effectiveness.

Results

According to the decision of the Government of the Republic of Tajikistan, from 2012 to 2022, 12 AIDS centers were organized in the cities and districts of the region. However, to date, the infrastructure of these centres has not yet been fully developed. Also, 30% of commission blood samples are collected with a delay. The sensitivity of the system has reached 91%, which means that 91% of the estimated number of people living with HIV are detected by surveillance. The positive predictive value is 78%, indicating the probability that the reported case is indeed consistent with a real case of HIV. The cost of confirming an HIV diagnosis per person was $19.94. Also, the cost of antiretroviral therapy per month ranges from US$3.78 to US$23.94, which remains cost-effective, while HIV prevention costs US$3.06. In the region, HIV testing coverage increased by 1.2 times and reached 13.9% in 2023 compared to previous years, which led to a decrease in the mortality rate by 1% and indicates the effectiveness of the system.

Conclusion

The system shows potential for further improvement and adaptation. Improved strategies need to be implemented to increase timeliness and flexibility in responses to epidemiological changes. Particular attention should be paid to optimizing logistics processes and expanding infrastructure to achieve higher standards in HIV diagnosis and treatment.

Disclosures

All Authors: No reported disclosures
P-175. Assessing the Dynamics of Fecal Colonization with Antibiotic-Resistant Bacteria in a Chilean Cohort: A Longitudinal Study
Authors: Rafael Araos , Jara Alejandro , Sanchez Felipe , Adell Aiko , Olivares Jorge , Ferreccio Catterina , Huidobro Laura , Garrido Macarena , Rivas Lina M , Peters Anne S , Munita Jose M , D’Agata Erika M C
Published: January 2025

Background

In low- and middle-income countries, the community burden of antibiotic-resistant Gram-negative bacteria (AR-GNB) colonization is high. Understanding factors influencing AR-GNB colonization is crucial for controlling antimicrobial resistance.

Methods

We conducted a cohort study from December 2019 to November 2020 with community-dwelling adults in Molina, an agricultural town in Central Chile. We collected questionnaires and fecal samples every two weeks for six months to identify colonization by extended-spectrum cephalosporin-resistant Enterobacterales (ESCRE). ESCRE detection involved selective media screening, MALDI-TOF identification, and disk-diffusion antibiotic-susceptibility testing. We assessed the impact of epidemiological and clinical features and exposure to various water sources, foods, and animals on i) baseline ESCRE fecal colonization, ii) ESCRE acquisition during follow-up, and iii) ESCRE clearance. The study included 198 subjects, using multiple imputations for missing predictor values. We used two hidden Markov models for each dataset, with Model 1 assuming perfect sensitivity and specificity and Model 2 estimating sensitivity. A Bayesian approach with Markov chain Monte Carlo algorithms estimated odds ratios (OR) and credible intervals (CI).

Results

The sample consisted of 198 residents with a mean age of 60.9 and a predominance of women (75%). Model 1 showed that treating drinking water before consumption reduced the risk of baseline ESCRE colonization (OR: 0.38; 95% CI: 0.02 – 0.89). No significant associations were found for ESCRE acquisition during follow-up. Males and individuals with comorbidities had a lower risk of clearing ESCRE (ORs: 0.58, 0.54; CIs: 0.24 – 0.97, 0.258 – 0.88, respectively). Model 2, with imperfect sensitivity, showed similar results.

Conclusion

This study highlights the significance of environmental and individual health factors in ESCRE colonization. Interventions like treating drinking water could reduce baseline ESCRE colonization risk. The varied impacts of gender and comorbidities on ESCRE clearance provide insights for targeted AR-GNB management strategies. Further research is needed to understand these associations and develop effective community-level interventions against AMR.

Disclosures

All Authors: No reported disclosures
P-179. A Retrospective Review of Plasmodium falciparum Malaria at a Pediatric Hospital in the United States
Authors: Doshi Shreya M , Ansusinha Emily , Dassner Aimee , Yonts Alexandra B , Jantausch Barbara A
Published: January 2025

Background

Malaria infects millions globally, and recently is also reported to have endemic transmission in the US. CDC definition of severe malaria applies to patients with at least one of the following : High percent parasitemia (≥5%), impaired consciousness, seizures or acute respiratory distress syndrome (ARDS), acidosis, acute kidney injury (AKI), DIC, jaundice, (Hb < 7 g/dL ). Artesunate was recently approved in 2020 for treatment of severe malaria. Our goal was to describe demographic features, insurance status, clinical characteristics, and hospital course of children with severe malaria admitted to our hospital from 01/2018-11/2023 and assess any differences in outcomes between those receiving quinidine versus artesunate.

Methods

After IRB approval medical records of children with severe malaria due to P. falciparum were reviewed for demographic and clinical characteristics of patients. Time to reduction in parasitemia (less than 1%) after drug administration patients who received artesunate (n=30) & patients who received quinidine (n=11) was calculated. Readmission to the hospital for relapsed of malaria or side effects, including post-artesunate delayed hemolysis was noted.

Results

In an analysis of 41 patients with severe malaria 27 % were uninsured, 24 % were recent immigrants to the US. Peak parasitemia was mean was 11.2 %. Time to reduction in parasitemia on artesunate (n=30) was 24.2 hours and time to reduction in parasitemia on quinidine (n=5) was 23.8 hours (comparable). See Tables 1-3, and Figure 1 for results.

Table 3

Conclusion

Severe malaria presentation in children is unique to travelers and immigrants. Clinical presentation and features are important to know as it could have fatality. Time to reduction in parasitemia was comparable for the two drugs. Artesunate was well tolerated with low incidence of post-artesunate delayed hemolysis (n=1) leading to readmission. No deaths were attributable to malaria. Research and advocacy are important as 27 % were uninsured, 24 % were recent immigrants to the US highlighting the need for systemic changes. Future studies could include time to drug administration and time to reduction in parasitemia for children in the US vs children in developing countries highlighting access and equity issues globally.

Figure 1

Disclosures

Alexandra B. Yonts, MD, Pfizer: Grant/Research Support