bluuebunny/crossref_metadata_2025 huggingface dataset:
P-1400. Feasibility, Acceptability and Impact of Self-Sample Collection for Extra-genital STI Testing: Experience from a High Complexity VA Facility
Authors: Waitzman Rachel , Shumaker Amy , Allen Kristen A , Bray Kaylee , Mercurio Michelle , Walker Stephanie , Navas Maria , Musoke Lewis S , Van Epps Puja
Published: January 2025

Background

Routine screening of all exposed extra-genital sites for sexually transmitted infections (STIs), specifically Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT), is recommended for individuals at high risk, including some men who have sex with men (MSM) and individuals receiving Pre-Exposure Prophylaxis (PrEP). However, there are a number of barriers to screening including privacy and provider availability. While self-collected extra-genital STI samples have the potential to mitigate some of these barriers, this approach has not yet achieved widespread use. This study evaluates the implementation of self-collection of extra-genital STI tests at the VA Northeast Ohio Healthcare System (VANEOHS), assesses acceptability and measures impact on testing rates.

Methods

The study included people with HIV (PWH) and patients on PrEP at the VANEOHS’s infectious diseases clinic and covered 10 Ohio counties. Patients chose between self- and provider-collection. We followed GC and CT rectal and pharyngeal testing frequency and test completion rates and characterized reasons for unsuccessful completion. We also compared extra-genital GC/CT testing rates before and after the availability of self-collection. Finally, we deployed an anonymous survey to assess acceptability of self-collection and ease of use. We used descriptive statistics to report completion rates, survey findings and changes in rates of testing over time.

Results

Of the 276 tests ordered for self-collection for 95 unique veterans, 82 pharyngeal and 60 rectal GC/CT rectal tests were successfully completed and interpreted in the first 8 months of the study (Table 1). The testing rate increased from 8 tests/month to 15 tests/month for pharyngeal GC/CT and from 6 tests/month to 10 tests/month for rectal GC/CT (Figure 1). Of the survey respondents who performed self-collection, 11 of 17 were satisfied or very satisfied with self-collection and most found it easy or very easy to swab their own rectum (9/12) and throat (13/14) (Table 2).

Conclusion

Self-sample collection for extra-genital testing is feasible in a large healthcare network. It is highly desired by patients and has the potential to improve access and improve STI screening rates.

Disclosures

All Authors: No reported disclosures
P-1426. Comorbidities and Healthcare Resource Utilization Among People With HIV: Real-World Data From a Large Israeli Healthcare Provider
Authors: Weil Clara , Gazit Sivan , Nugent Arlene , Murrison Liza Bronner , Hoshen Moshe , dos Santos Ana Gabriela Pires , Levy Itzchak
Published: January 2025

Background

Despite recent advances in HIV antiretroviral treatment (ART), unmet needs for people with HIV (PWH) remain. The study compared comorbid disease burden and healthcare resource utilization (HRU) among PWH vs those without HIV diagnosis, as well as by ART patterns.

Methods

A retrospective cross-sectional study used anonymized electronic healthcare data from Israel’s Maccabi Healthcare Services (MHS; >2.7M members) to compare people living with HIV on 31/12/2022 with age-sex-matched controls without HIV diagnosis (1998−2022). PWH had to have ≥1 HIV diagnosis code(s) (1998−2022) and ≥1 dispensed ART prescription (2008−2022). Members enrolled for < 12 months were excluded. Sociodemographic characteristics, lifetime prevalence of comorbidities (exception: anxiety/depression, diagnosed and/or treated in 2022), and HRU (2022) were described. Among PWH dispensed ≥1 ART in 2022, patterns of 12-month percentage of days covered (PDC), discontinuation (≥90-day treatment gap), and interruption (resumed treatment after 6−89-day gap) were described.

Results

Among 1973 PWH and 9865 controls, mean±SD age was 48.2±11.2 and 48.7±11.2 years, respectively, and 74.4% were male. A lower proportion of PWH (39.6%) vs controls (48.0%) had high residential socioeconomic status. Higher prevalence of comorbidities among PWH vs controls included anxiety/depression (26.2% vs 13.5%), liver disease (20.9% vs 12.5%), chronic kidney disease (14.9% vs 7.3%), cancer (7.2% vs 5.3%), hepatitis C virus (5.6% vs 0.1%), and hepatitis B virus (HBV; 3.4% vs 0.4%). PWH (vs controls) had a median of 10 primary-care visits/year (vs 7) and more frequent hospital admissions (≥1: 11.4% vs 6.6%) and emergency room visits (≥1: 26.5% vs 19.0%). Among PWH treated in 2022 (n=1907), 78.1% had PDC ≥90%. Discontinuation and interruption occurred among 7.2% and 69.1% of treated PWH, respectively. PWH with PDC < 90% (vs ≥90%) had younger age, lower socioeconomic status, higher prevalence of HBV diagnosis, and less frequent physician visits in prior 12 months.

Conclusion

Despite high ART coverage, PWH in Israel experience an excess burden of comorbidities and HRU compared to age-sex-matched controls without HIV. Further research is needed to address the excess disease burden and better define treatment/care gaps among PWH.

Disclosures

Sivan Gazit, MD, AbbVie: The relationship is not personal, AbbVie funded the current study, funding to the research institution where I work Arlene Nugent, MSc, Abbvie: Stocks/Bonds (Public Company) Liza Bronner Murrison, PhD, AbbVie: Stocks/Bonds (Public Company) Ana Gabriela Pires dos Santos, PhD, ABBVIE: Stocks/Bonds (Public Company)
P-1428. Risk Factors for Bacterial Infections After Firearm Injury
Authors: Yang Jerry , Tung Chih Chun , Harfouche Melike , Harris Anthony , Baghdadi Jonathan
Published: January 2025

Background

Every day, over 300 Americans sustain firearm injuries, but prevalence estimates for bacterial infection after these injuries vary widely.

Methods

We studied a retrospective cohort of adults with firearm injuries using administrative data from 233 US hospitals in the Premier database from 1/2019 through 4/2021. Encounters for firearm injury were identified by ICD-10 diagnosis codes. The index encounter for firearm injury and subsequent encounters at the same hospital within 90 days were assessed for bacterial infection, defined by a positive clinical culture and at least 4 days of antibiotic therapy or antibiotics until death. Risk factors, including firearm type, intent of injury, and injury location were identified using diagnosis and procedure codes. Relationships between risk factors and infection were evaluated with multivariable logistic regression.

Results

15,437 patients with a medical encounter for firearm injury were identified, including 2,610 (17%) who required surgery during the index encounter and 912 (6%) who developed bacterial infection. 14% of bacterial infections (125/912) developed during 90-day follow-up after the index encounter (median time to presentation 20 days, IQR 8 – 45), including 1% of patients who had surgery during the index encounter (37/2610). On average, patients who developed bacterial infection were 32.5 years old (sd 15.0), 87% men (790/912), 78% single marital status (708/912), and 54% had unintentional firearm injuries (490/912). In multivariable analysis, injury requiring head, neck, or spine surgery (OR 4.8, 95% CI 3.5 – 6.6), lower abdominal surgery (OR 2.1, 95% CI 1.6 – 2.8), or thoracic surgery (OR 1.8 (95% CI 1.4 – 2.4) were the strongest risk factors for bacterial infection. Mortality was 8.7% (1335/15437), including 7.4% (67/912) of patients with bacterial infections. In multivariable analysis, bacterial infection was not significantly associated mortality (OR 0.8, 95% CI 0.6 - 1.1).

Conclusion

Bacterial infection is an infrequent complication of firearm injury that tends to present during initial hospitalization. Patients undergoing head, neck, spine, large bowel, or chest surgery are at highest risk overall, though new postoperative infection is rare at follow-up.

Disclosures

Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor
P-1443. Experiences with Human Immunodeficiency Virus (HIV), Dialysis, and Kidney Transplantation
Authors: Nagam Meghna , Huml Anne , Modi Anita R
Published: January 2025

Background

People living with HIV and advanced kidney disease face unique challenges in the kidney transplant evaluation process. Retrospective chart reviews concerning this marginalized patient population portray kidney transplant candidates and the transplant evaluation process through the lens of the provider. We directly solicited patient perspectives to better understand their experiences with HIV, dialysis, and kidney transplantation.

Methods

We recruited 20 people living with HIV and advanced kidney disease seen at our center to participate in one-on-one interviews guided by a structured questionnaire, audio-recorded, and professionally transcribed. Two physicians coded and reviewed all responses for common themes. A third physician served as the external thematic auditor. Data was collected on demographics, HIV care, and engagement in the transplant evaluation process for each participant.

Results

All 20 participants (18 Male, 14 Black, Mean Age 54y) were prescribed integrase inhibitor-based regimens and 17 demonstrated suppressed HIV viremia. One was not referred for kidney transplantation, one referred but not yet evaluated, nine undergoing evaluation, three with referrals closed, one listed, and five transplanted. Twenty parent codes were identified, each with 1-10 sub-codes. Seven major themes arose: HIV-associated stigma inside and outside of healthcare; Balance of trust and autonomy in decisions to start therapy for HIV and advanced kidney disease; Effect of health literacy on HIV and advanced kidney disease treatment adherence; Communication failures during the transplant evaluation process; Health and lifestyle changes related to dialysis and transplant listing; Impact of social support on pre- and post-transplantation experiences; and Personal and medical consequences of the perception of the “ideal transplant candidate”.

Conclusion

Patient perspectives offer valuable insight into the experiences of people living with HIV and advanced kidney disease undergoing dialysis and pursuing transplant evaluation. Attention to common attitudes and beliefs associated with this complex process, as well as its influence on life outside of healthcare, may guide future interventions to increase this vulnerable population’s access to kidney transplantation.

Disclosures

All Authors: No reported disclosures
P-1446. Impact of Social Determinants of Health on Infectious Outcomes in Patients Undergoing Amputation
Authors: Passarelli Patrick , Sportiello Mike , Geiger Joshua , Tonozzi Theresa , Newhall Karina , Yamshchikov Alexandra
Published: January 2025

Background

Studies have demonstrated the impact of SDOH on outcomes following vascular surgery, but few have focused on risk factors for infectious complications following major amputation.

Odds Ratios (Confidence Intervals) for Infectious Outcomes Based on Social Determinants of Health

Methods

Local data for the Society Vascular Surgery Vascular Quality Initiative, a multicenter registry of quality improvement, were queried for demographics, clinical, procedure, and outcomes of 371 patients with amputation as index procedure 6/1/2015 to 7/31/2023. Zip codes were used to derive CDC/ATSDR Social Vulnerability Index (SVI). The impact of SDOH and SVI on surgical outcomes with a focus on infection was evaluated by logistical regression with R v4.3.2. Primary outcomes for univariate analysis included surgical site infection (SSI), readmission for infection, composite infection-related outcome, organ system complications during index admission, mortality at 30 days, 1 year, 2 years, and 5 years, and composite surgical adverse outcome inclusive of infectious and non-infectious complications. Significant variables were selected for multivariate regression.

Odds Ratios (Confidence Intervals) Additional Factors and Surgical Outcomes Based on Social Determinants of Health

Results

SDOH correlated with multiple parameters in univariate analysis (Fig 1, 2). Male patients had higher ASA score and uncontrolled infection as indication for amputation but were less likely to incur an SSI, or require above trans-metatarsal amputation. Publicly insured patients were more likely to be wheelchair bound or bedridden, or residing in a facility preoperatively, and had the highest risk of readmission for infection (OR=8.09), along with a higher risk of 2 year mortality. Patients with ongoing tobacco use had increased mortality at 1 (OR=1.9) and 2 years (OR=1.7). In multivariate analysis, male gender was associated with SSI (OR 0.25 CI 0.06-0.96). Composite infectious complication was associated with emergent procedure status (OR 2.96 CI 1.22-6.97). There was no significant difference in survival for SDOH derived subgroups (Fig 1) or composite surgical adverse outcome.

Kaplan-Meier Survival Analysis for subgroups based on SDOH parameters

Conclusion

Association between demographic, clinical, and peri-operative complications, with focus on infection, provides opportunity to identify high-risk patients, and serves as a framework for additional interventions, such as close post-operative follow up, and robust involvement of social work and care management teams.

Disclosures

All Authors: No reported disclosures
P-1447. Does Race or Social Vulnerability Play a Role in Antimicrobial Utilization for Admitted Patients? A Retrospective Analysis in a Large Healthcare System
Authors: Cosimi Reese , Mupanomunda Maria , Garrett-Ray Stacy D , Daragjati Florian , Kimathi Moyo , masoudi frederick , Aloia Thomas , Fogel Richard , Fakih Mohamad G , Bollinger Allison
Published: January 2025

Background

Rising antibiotic resistance is a major public health threat. In 2015 our organization responded by establishing antimicrobial stewardship programs in all acute care facilities. A review of the literature has shown concerning disparities in antibiotic use across different populations, potentially contributing to unequal health outcomes. Our organization has an expansive geographic footprint that encompasses diverse patient populations which precipitates the need to evaluate care across the system.Table 1.Antimicrobial Utilization by Race and SVIDOT - Days of Therapy per 1000 Days Present

Methods

Retrospective analysis of 103 hospitals across a large healthcare system of all admitted patients who received a target antibiotic between January 1, 2023 to December 31, 2023. The primary clinical outcome was antimicrobial utilization defined as duration of therapy (DOT) per 1000 days present for four antibiotic groups (total systemic, 3rd generation cephalosporins, broad-spectrum beta-lactams, vancomycin). Data were stratified across patient race and social vulnerability index (SVI) to identify factors that may be contributing to gaps in equitable care.

Results

A total of 665,312 patients were included in the analysis (70.5% White, 17.6% Black/African American (AA)). A greater proportion of White patients were 65 years and older compared with the Black/AA population which were primarily 18 to 64 years. Infectious disease diagnoses accounted for 14.6% of all encounters. Antibiotic utilization for White patients was 13% higher than Black/AA in Total Systemic antibiotics (p< 0.001), and persisted when examined for infectious and non-infectious disease diagnoses (5% and 11.3% higher in White patients, respectively). Minimal differences were found when stratified by SVI.

Conclusion

Large differences in antibiotic utilization were observed by race but were not as pronounced by SVI. Additional factors such as age, diagnosis, and regional variability may need to be further examined in future analyses. Although these disparities were observed, our internal mortality data for infectious diseases shows no differences by race. Additional investigation is warranted to determine appropriateness of antibiotic use in each population to further elucidate on the disparities identified in this study.

Disclosures

All Authors: No reported disclosures
P-1449. An Educational Initiative to Improve Engagement in HIV Services within Substance Use Disorder Clinics
Authors: Zawitz Chad J , Pillinger Kelly E , Vincent Shaina Y , Simone Laura , Napolitan Chris , Carter Jeffrey D , Meza Jimenez Jenniffer A , Molloy Leah
Published: January 2025

Background

Substance use disorder (SUD) clinics are uniquely positioned to link patients with SUD to HIV services. This project aimed to bridge gaps in HIV care within SUD clinics.

Methods

From 6/2023-10/2023, healthcare professionals (HCPs) led 5 education sessions on HIV testing, prevention, and management at SUD clinics in West Virginia and Delaware. Surveys were administered pre- and post-sessions and again 4-6 weeks later. Results informed a workshop for HCPs and policy makers and an online toolkit for HCPs nationwide.

Results

Surveys were completed by 67 SUD clinic patients (mean age: 48 years; 66% female; 76% Caucasian; 61% previously incarcerated; 78% previously tested for HIV, 7% living with HIV) and 35 HCPs. After the sessions, significant improvements were seen in patient knowledge of “undetectable = untransmittable” (27% vs 63%; P < .001), PrEP awareness (62% vs 88%; P = .001), SUD support resources (73% vs 91%; P = .008) and HIV care resources (43% vs 70%; P = .003). Pre-session, 64% of patients did not perceive the need for HIV testing. Of the patients who did (n = 24), anxiety (63%) was the top barrier, while HCPs perceived it was patients’ lack of HIV awareness (63%). Regarding PrEP, HCPs most frequently perceived keeping up with appointments (54%) and remembering doses (51%) as the greatest challenges their patients face, but patients more frequently identified not knowing enough about the medication (39%) and concerns about side effects (31%). Patients’ self-reported likelihood of getting tested for HIV was 18% before the education and was 28% afterwards (P = .147), and 1 month later participating HCPs reported having helped > 250 patients with SUD get HIV testing. On follow-up, HCPs also described continued use of the education materials with 80% planning to lead another group session. After attending the live workshop, HCPs and policy makers (N = 103) committed to improving HIV services for patients with SUD with 77% identifying single site services for both HIV and SUD care as a high priority. As of 3/2024, the online toolkit was accessed by 1,347 HCPs.

Conclusion

Patient knowledge of HIV testing, prevention, and management increased following the program which also offered insights into community-level awareness and barriers to engaging in HIV services.

Disclosures

Chad J. Zawitz, MD, Gilead Sciences: Honoraria Kelly E. Pillinger, PharmD, AHFS: Contractor
P-1461. Influenza Vaccine Amongst Persons Experiencing Homelessness: Evaluating Attitudes, Barriers, and Trust
Authors: Mann Yasmeen , Ishak Angela , Ogbenna Ugonna K , Kasmikha Lauren , Cherabuddi Medha R , Joyce Katherine , Harris Charlalynn , Numi Mariia , Santana-Garcés Maria , Rehman Najibah K , Bryce Richard , Joshi Seema , Zervos Marcus
Published: January 2025

Background

In Detroit, persons experiencing homelessness (PEH) have been a vulnerable part of society due to their comorbidities and unique barriers in access to care. Despite PEH experiencing higher rates of vaccine-preventable diseases, there is a lack of information on strategies to improve vaccine rates. The objective of this project is to obtain an understanding of enablers and barriers in influenza vaccine uptake amongst PEH, to inform future work to increase vaccine uptake.

Methods

This is a cross-sectional study of survey data from adult PEH encountered during Street Medicine (SM) outreach in Detroit to assess enablers and barriers in influenza vaccination. Respondents were provided a complimentary bus pass for participation. Descriptive statistics were conducted on sociodemographic variables with analysis of variables related to level of homelessness, vaccine concerns, vaccination status, and underlying health problems.

Results

43 participants' surveys were analyzed. Participant vaccine status and level of homelessness varied with majority (35%) reporting spending at least 1 night in a tent or other dwelling. Regarding participant demographics, 86% (n=37) were male and 81% (n=35) were Black or African American (AA) (Table 1). Amongst survey respondents, the highest sources of trust for information regarding influenza vaccine was found amongst: ‘Social Services Agencies or Other Services’ 95.2% (n=20) and ‘Experts and Scientists’ 93.8% (n=15) (Figures 1 and 2). Variables regarding sources of information trusted were analyzed via chi-square analysis to evaluate for statistical significance (p-value < 0.05) amongst demographic variables (Figure 3).

Conclusion

Previous literature regarding attitudes towards vaccines amongst PEH has demonstrated distrust in healthcare. Results of this study are unique in identifying healthcare members as resources trusted by most participants in providing information on vaccines. This emphasizes the importance of SM outreach in Detroit in building trusting relationships with PEH in addition to decreasing barriers in access to care, to help target future vaccination initiatives.Table 1:Participant Demographics and Influenza Vaccination Status

Disclosures

Seema Joshi, MD, AbbVie: Grant/Research Support Marcus Zervos, MD, Johnson and johnson: Grant/Research Support|Moderna: Grant/Research Support
P-1471. Mortality Analysis of Antimicrobial Regimens Selection in Acinetobacter baumannii Ventilator-Associated Pneumonia
Authors: Lozano Axel , Rondan Paola L , Martínez Jaime T , Taype-Rondan Alvaro
Published: January 2025

Background

Ventilator-associated pneumonia from Acinetobacter baumannii is one of the most severe healthcare-associated infections. Its increased antimicrobial resistance presents challenges in treatment and is associated with high mortality rates. The objective of this study was to determine the association between high dose ampicillin-sulbactam and mortality in patients with ventilator-associated pneumonia from Acinetobacter baumannii (AB-VAP).

Clinical epidemiological characterization of patients with AB-VAP

*Median

**Interquartile range

Methods

We performed a retrospective cross-sectional study reviewing electronic medical records of patients from the Intensive Care Unit of a referral hospital for COVID-19 between April 2020 and May 2021.

Characterization according to antibiotic therapy in patients with AB-VAP

Results

We reviewed a total of 311 medical records. 48 patients with AB-VAP were selected according to inclusion and exclusion criteria. The study population was 81.25% male and the median age was 54.9 years [IQR: 22-74]. The most common comorbidities were obesity (43.75%) and hypertension (10.4%). Patients requiring mechanical ventilation for more than 30 days had higher mortality rates compared to patients requiring less than or equal to 30 days (73.68% vs. 44.83%, p=0.049). The most commonly used antibiotic regimens were meropenem plus colistin (41.67%) and colistin plus ampicillin-sulbactam (25.0%). The non-sulbactam antibiotic regimens had a higher 14-day mortality than the sulbactam regimens (60.71% vs 20%, p=0.005). The mortality risk was 2.99 (CI: 1.19 - 7.49, p=0.019) times higher when using regimens without sulbactam, adjusted for sex, SAPS II score and days in the ICU.

Bivariate analysis of antibiotic regimens and mortality in patients with AB-VAP

Conclusion

The mortality risk with non-sulbactam antibiotic regimens was 3 times higher compared to sulbactam antibiotic regimens in patients with AB-VAP.

Multivariate Poisson Regression Analysis of antibiotic therapy and mortality in patients with AB-VAP

Disclosures

All Authors: No reported disclosures
P-1477. In vitro efficacy of Minocycline on Skin, Soft Tissue and Musculoskeletal Gram Negative bacterial isolates
Authors: Crowley Patrick , Streck Nicholas , Challener Douglas , Abu Saleh Omar M
Published: January 2025

Background

Minocycline is a second-generation tetracycline with a broad antimicrobial spectrum. It is often used in chronic suppression of musculoskeletal infections, given activity against gram positive organisms. Efficacy of Minocycline against gram negative skin and soft tissue infection has not previously been defined. In this study, we review in vitro minocycline efficacy against isolates from skin, muscle, and bone sources.Fig 1.Organisms isolated

Methods

We conducted a retrospective review of all minocycline susceptibility testing performed on musculoskeletal GNB isolates performed at the Mayo Clinic reference lab between 2013-2022. We describe the isolates broken down by site of culture and organism isolated. Then, we calculated the overall susceptibility of these isolates to Minocycline and susceptibility of the most common 6 organisms isolated.Fig 2.Sites of gram negative isolation

Results

During the study timeframe, we identified 13,567 gram negative isolates from musculoskeletal sites. Of 330 species identified, 19 were identified in at least 100 isolates (fig 1). Of 36 unique sites, 19 sites were each identified in at least 100 isolates (fig 2). 1920 isolates were tested for susceptibility to minocycline. Of these, 1584 (82.5%) were susceptible to minocycline. Of the most common organisms identified and tested for minocycline susceptibility, 99% of Stenotrophomonas maltophilia, 83% of Enterobacter cloacae, 80% of Escherichia coli, 68% of Acinetobacter baumanii, 1% of Proteus mirabilis, 53% of Klebsiella pneumoniae, 65% of Serratia marcescens isolates were susceptible to minocycline (fig 3). Pseudomonas aeruginosa isolates were not tested, due to innate resistance.Fig 3.Minocycline susceptibility compared to key organisms

Conclusion

A majority of skin and soft tissue cultures positive for Gram negative isolates were below the waist line. Of these, we reported organisms most commonly found. Minocycline showed in vitro activity against some commonly isolated gram negative organisms, especially E.coli, Acinetobacter, and Stenotrophomonas. Further research is needed into the efficacy of minocycline in gram negative skin and soft tissue infections, but it may represent a viable oral option, especially in the end of life.

Disclosures

All Authors: No reported disclosures
P-1485. Comparison of Eravacycline and Cefiderocol in the Treatment of Multidrug-resistant Acinetobacter baumannii Infections
Authors: Halim Justin , King Madeline , Nikolic Dejan , Palacios Carlo Foppiano
Published: January 2025

Background

A. baumannii is a common cause of drug-resistant hospital-associated infections. Eravacycline and cefiderocol were recently introduced as agents against drug-resistant A. baumannii. Data comparing these drugs against multi-drug resistant (MDR) A. baumannii is lacking. We compared clinical outcomes of patients with multi-drug resistant A. baumannii infections treated with either eravacycline or cefiderocol.

Methods

A retrospective chart review of patients with MDR A. baumannii infections from 2019-2023 at Cooper University Hospital who received either eravacycline or cefiderocol was performed. MDR infections were defined as isolates resistant or intermediate to meropenem or ampicillin-sulbactam. Patients were excluded if A. baumannii was deemed a colonizer rather than infection per infectious diseases evaluation, or non-MDR infections. We collected data on demographics, risk factors for MDR infection, and infection characteristics. Primary outcome was hospital mortality rate. Secondary outcomes assessed were mortality and readmission at 30 and 90 days, ICU admission, shock requiring vasopressors, mechanical intubation, and drug-related adverse events. Descriptive statistics and Fisher’s exact test were used.

Results

44 patients were included, median age was 61 years old, 80% were male, 59% identified as White, and 13.6% were Latino. Most common site of infection was pulmonary (59%). 31 patients received cefiderocol, 11 received eravacycline, and 2 received combination therapy with both agents. Higher hospital mortality rates were observed in the cefiderocol group (52% vs 18%), approaching significance (P=0.08). Hospital mortality, and 30 and 90-day mortality were not significant between both groups. Patients on cefiderocol were more likely to require mechanical intubation (74% vs 27%, P=0.01). ICU admission and use of vasopressors did not differ significantly between both groups. Liver function elevations more common among patients on cefiderocol compared to eravacycline (61% vs 9%, P=0.004).

Conclusion

In this retrospective study comparing eravacycline and cefiderocol for the treatment of MDR A. baumannii infections, mortality and readmission outcomes were comparable between both groups.

Disclosures

Madeline King, PharmD, Innoviva: Advisor/Consultant
P-1486. Comprehensive Approach to Vibrio Vulnificus: Integrating Drug Therapy, Diagnostic Modalities, and Targeted Care for At-Risk Populations
Authors: Ebrahimi Hashem Haj , Ghneim Hiyam , Farid Tahsin
Published: January 2025

Background

Vibrio vulnificus (VV), is endemic to warm coastal waters where it causes significant foodborne and aquatic illnesses resulting in high mortality and morbidity. There are no FDA-approved treatments or standard management strategies. Here we explore the landscape of VV infections, their characteristics and treatment outcomes.Figure 1:Outcome of Vibrio Vulnificus Infections

Methods

Cases of VV from 2014 to 2024 were identified from PubMed and Embase databases, employing pertinent keywords, MeSH terms, and Emtree terms. Articles underwent screening using Rayyan.ai using PRISMA protocol. 72 cases that met inclusion criteria were entered to CURE ID and aggregated data was analyzed.Figure 2:Age Distribution of Vibrio Cases

Results

The outcome distribution of cases are in Figure 1. 46/72 patients recovered while 21 died. Age and gender of patients with VV infections are displayed in Figure 2 and 3 respectively. Most cases occurred in middle aged individuals while there was a male prevalence in cases. Figure 4 displays the countries where most infections occurred. China and the United States had the highest incidence of cases.Figure 3:Sex of Patients

Conclusion

The high mortality of VV underscores the importance of finding treatment options for this often-forgotten disease. The age and sex distribution in middle aged males is indicative of the correlation between aquatic activity such as fishing and VV. Males who engage in these activities are at highest risk of contracting VV infections. The geographic distribution of cases underscores countries with warm oceans is where most cases occur. In our data we noticed a prevalence of chronic liver diseases amongst VV patience. We aim to explore this correlation and most effective antimicrobials in a full manuscript.Figure 4:Geographic Distribution of Vibrio Vulnificus

Disclosures

All Authors: No reported disclosures
P-1490. Evaluating the Impact of Inadequate Empiric Gram-Negative Antibiotic Therapy on Clinical Outcomes
Authors: Baghdadi Jonathan , Goodman Katherine E , Magder Laurence S , Claeys Kimberly C , Sutherland Mark , Harris Anthony
Published: January 2025

Background

Many clinicians select broad-spectrum antibiotic therapy based on the concern that inadequate empiric coverage will be associated with a worse outcome. To explore this concern, we compared outcomes between patients started on empiric narrow-spectrum antibiotics and later escalated to broad-spectrum antibiotics v. patients started empirically on broad-spectrum antibiotics and then continued on broad-spectrum antibiotics.Figure 1.Antibiotic Classification

Methods

We conducted a retrospective observational cohort study of adult patients discharged in 2019 from 120 hospitals in the Premier Healthcare Database. Encounters for adult patients were included if associated with (1) initiation of narrow- or broad-spectrum Gram-negative antibiotics on hospital day 0-2 and (2) administration of a broad-spectrum Gram-negative antibiotic as definitive therapy (see Fig. 1 for classification of antibiotics as narrow v. broad). Patients who received empiric narrow-spectrum antibiotics were matched to patients who received empiric broad-spectrum antibiotics using propensity scores. A win ratio was estimated to compare a ranked composite outcome including mortality, readmission, and adverse drug events between the two groups (see Fig. 2 for outcome structure).Figure 2.Components of Overall Clinical Outcome including Desirability of Outcome Ranking (DOOR)

Results

81,826 patients who received empiric narrow-spectrum antibiotics were matched to 81,826 patients who received empiric broad-spectrum antibiotics (see Table 1 for patient characteristics). Mortality was lower (8.9% v. 9.2%, p = 0.022), readmission was less frequent (11.1% v. 12.7%, p < 0.0001), and adverse events were more frequent (10.5% v. 9.0%, p < 0.0001) after empiric narrow-spectrum antibiotics than empiric broad-spectrum antibiotics (see Table 2 for outcomes). Head-to-head comparison of ranked outcomes between the two groups suggested better clinical outcomes associated with empiric narrow-spectrum antibiotics (win ratio 1.04, p = 0.0007).Table 1.Characteristics of Patients in the Overall and Matched Cohorts

Conclusion

In a large propensity score-matched analysis of observational clinical data, starting empiric narrow-spectrum antibiotic therapy and needing to escalate to broad-spectrum antibiotic therapy later was not associated with worse clinical outcomes. Our findings challenge traditional guidance on how to select empiric antibiotic coverage.Table 2.Distribution of DOOR by Empiric Treatment Group in the Matched Cohort

Disclosures

Kimberly C. Claeys, PharmD, PhD, bioMérieux: Advisor/Consultant|bioMérieux: Honoraria Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor
P-1491. Practice variations and clinical outcomes of Intravenous Aminoglycosides in Nontuberculous Mycobacterium infections at three tertiary hospitals in London, Ontario, Canada
Authors: Babaeer Esraa , Minuk Jeffrey , McCormack David , Mura Marco , Dhaliwal Inderdeep , Elsayed Sameer , Bondy Lise , Devlin Megan K , Shalhoub Sarah , Mohammadi Mahshid , Saeed Huma , Silverman Michael , Fuller Jeffrey , Almutawa Fatimah , Shahmirzadi Reza Rahimi
Published: January 2025

Background

The worldwide occurrence of nontuberculous Mycobacterium (NTM) infections is rising. In Canada, there is a continuing surge in infections caused by Mycobacterium avium complex (MAC). Treating NTM infections is challenging and requires multidrug regimens with antimicrobial susceptibilities to guide therapy.

Generally, aminoglycosides have moderate in-vitro activity against NTM isolates. However, the synergistic effect with other antimicrobials makes it an attractive choice for clinicians, especially in the management of severe or refractory cases. The recommended duration of intravenous aminoglycosides is debatable due to side effects and the need for therapeutic monitoring. Moreover, NTMs are becoming more resistant to aminoglycosides.

This study aims to assess clinical practice variations in aminoglycoside use among NTM infections in terms of duration and monitoring in London, Canada.

Patient Characteristics and Clinical Presentation

Methods

Retrospective study reviewing the characteristics of 30 patients diagnosed with NTM infection between January 1, 2019 and December 31, 2023 in three tertiary care hospitals in London, Ontario, Canada.Table 2:NTM Susceptibility Report

Results

Mean age at diagnosis was 60.8 years. Seventeen (57%) were male and 13 (43%) were female. The presentations included pulmonary NTM infections in 19 (63%) and skin and soft tissue infections in four (13%). Among all identified species, MAC was the most common.

Fifteen (50%) patients received IV aminoglycosides, with 7 (32%) having documented susceptibility to aminoglycosides. Duration of aminoglycoside use varied among patients, ranging from 2 to 24 weeks. Of the patients started on an IV aminoglycoside, 3 (20%) developed ototoxicity and 2 (13%) had acute kidney injury. Serum aminoglycoside levels were checked in 12 (80%), but only 7 patients (47%) had at least one audiology screen.

In terms of outcomes, 7 (23%) achieved clinical cure while 9 (30%) had refractory disease, 7 (78%) of which were pulmonary. Two (57%) of the cured patients and 2 (22%) of the refractory patients had received an aminoglycoside.

Aminoglycoside Use and Monitoring

Conclusion

Aminoglycoside use for the treatment of NTMs is variable among clinicians, mostly due to concerns for side effects and the need for consistent drug monitoring, which limits its implementation in outpatient settings.

Clinical Outcomes

Disclosures

Lise Bondy, Assistant Professor, Pfizer: Honoraria|Viiv: Advisor/Consultant Michael Silverman, MD, FRCP, FACP, AAHIVMed, Pfizer: Grant/Research Support
P-1494. Factors Associated with Intravenous Sodium Stibogluconate Treatment Failure in Mucocutaneous Leishmaniasis: A Case-Control Study in Cusco, Peru, 2012-2022
Authors: Arando-Torres Katherin , Perez-Castilla Jesus , Concha-Velasco Fátima
Published: January 2025

Background

Mucocutaneous leishmaniasis is a neglected infectious disease primarily affecting impoverished individuals across various regions worldwide. Untimely diagnosis and treatment often result in lasting physical and psychological consequences for patients, significantly impacting their quality of life. Currently, first-line pharmacotherapy consists of pentavalent antimonials, with a treatment failure rate of over 30%. We explored factors associated with intravenous sodium stibogluconate (Sb) treatment failure in mucocutaneous leishmaniasis.

Methods

This retrospective case-control study was conducted at Antonio Lorena Hospital in Cusco, Peru, from 2012 to 2022. Clinical records meeting the criteria of confirmed mucocutaneous leishmaniasis through smear, culture, PCR, or histopathology, with completion of a 30-day intravenous Sb treatment regimen, were analyzed. To calculate the sample size, proportions for independent cases and controls were used, with an Odds Ratio of 2. Moderate to severe disease was defined as more than two mucosal areas compromised with dyspnea. Cases were defined as individuals experiencing treatment failure after the initial 30-day antimonial cycle; whereas controls were those successfully cured after one 30-day antimonial cycle. Adjusted odds ratios were calculated using a logistic regression model. Ethics approval was obtained for the study.

Results

A total of 124 clinical records were included, with a 49.6% intravenous Sb treatment failure rate in mucocutaneous leishmaniasis after the 30-day treatment. Of these, 75.8% (94/124) were male, 53.2% (66/124) were farmers, 17.7% (22/124) had comorbidities, 69.4% (86/124) had more than 12 months of disease, and 66.1% (82/124) had moderate to severe disease. The intravenous Sb treatment failure was associated with disease duration over 12 months (OR: 5.77, 95% CI: 2.01-16.52, p=0.001), comorbidities (OR: 21.12, 95% CI: 3.89–114.89, p< 0.001), and moderate-severe disease (OR: 2.63, 95% CI: 1.05–8.72, p=0.048).

Conclusion

Our case-control study suggests that intravenous Sb treatment failure is associated with disease duration over 12 months, comorbidities, and moderate to severe disease. However, further studies are needed to elucidate this association.

Disclosures

All Authors: No reported disclosures
P-1499. Patient Characteristics and Clinical Outcomes Associated with Meropenem/Vaborbactam Treatment in Carbapenem-Resistant Enterobacterales Pneumonia
Authors: Caniff Kaylee E , Judd Chloe , Eubank Taryn A , Garey Kevin W , Krekel Tamara , Kufel Wesley D , Andrade Justin A , Cerenzio John , Veve Michael , Rybak Michael J
Published: January 2025

Background

Carbapenem-resistant Enterobacterales (CRE) are a major public health threat due to increasing prevalence and limited effective treatment options. Meropenem/vaborbactam (M/V) is a beta-lactam/beta-lactamase inhibitor agent designed to treat CRE. There is a paucity of data related to patient characteristics and associated outcomes with the utilization of M/V in pneumonia due to CRE. The objective of this study was to describe real-world experience with M/V in this setting.

Methods

This is a retrospective, observational, multicenter, cross-sectional study of patients ≥ 18 years old who received M/V for ≥ 72 hours for clinically-diagnosed hospital-acquired (HAP) or ventilator-associated pneumonia (VAP) due to CRE between 6/2020-2/2024. The primary outcome was clinical success, defined as resolution or improvement in signs/symptoms of infection and without the need for additional therapy. The secondary outcomes included 30-day mortality, 30-day microbiologic recurrence, 30-day symptomatic recurrence and adverse drug reaction(s).

Results

Sixty-two patients were included from six U.S. medical centers. The mean age (standard deviation [SD]) was 58.2 (15.4) years; patients were predominantly male (71.0%) and Caucasian (58.1%). At time of culture collection, the mean (SD) APACHE II score was 22.1 (7.8) and most patients (78.0%) were admitted to the intensive care unit. Klebsiella pneumoniae was the predominant species isolated in culture (43.5%). Notably, 65.6% were diagnosed with VAP, 32.3% had a COVID-19-related hospitalization and 29.0% developed secondary bacteremia. Patients received a median (interquartile range [IQR]) of 7.2 (6.1-12.0) days of M/V, with 21.0% receiving systemic combination therapy. Clinical success was achieved in 69.4% of patients and 30-day mortality occurred in 33.9%. Microbiologic and symptomatic recurrence occurred in 11.2% and 8.1% of cases, respectively. One patient experienced Clostridioides difficile infection attributed to the use of M/V.

Conclusion

Our study demonstrates promising clinical success with the use of M/V for treatment of pneumonia. Larger, comparative studies are needed in this population to identify patient factors associated with clinical success and assess M/V’s efficacy compared to other available therapies.

Disclosures

Kaylee E. Caniff, PharmD, BCIDP, T2Biosystems: Honoraria Kevin W. Garey, PharmD, MS, Acurx: Grant/Research Support Tamara Krekel, PharmD, BCPS, BCIDP, Merck Inc: Honoraria Wesley D. Kufel, Pharm.D., BCPS, BCIDP, Merck & Co.: Grant/Research Support|Shionogi, Inc: Grant/Research Support Michael J. Rybak, PharmD, PhD, MPH, Abbvie, Melinta, Sionogi, Merck, T2Biosystems: Advisor/Consultant|Abbvie, Melinta, Sionogi, Merck, T2Biosystems: Grant/Research Support|Abbvie, Melinta, Sionogi, Merck, T2Biosystems: Speaker
515. Neurological Complications in Children Hospitalized for Influenza, 2010 to 2022, the Canadian Immunization Monitoring Program Active (IMPACT)
Authors: Vaugon Esther , Morris Shaun , Bettinger Julie A , Burton Catherine , Halperin Scott , Jadavji Taj , Kazmi Kescha , Modler Jacqueline , Sadarangani Manish , Papenburg Jesse
Published: January 2025

Background

Influenza-associated neurological complications are rare, but can cause significant morbidity and mortality. We aimed to estimate the proportion of children with neurological complications among those hospitalized for influenza and to identify associated risk factors. The secondary objective was to compare the risk of severe outcomes among children with neurological complications to that of those without.

Methods

Prospective active surveillance was conducted in 12 pediatric hospitals from the Immunization Monitoring Program, ACTive (IMPACT), representing >90% of all tertiary pediatric beds in Canada. We included patients aged ≤ 16 years hospitalized for microbiologically confirmed influenza during the 2010-11 to 2021-22 influenza seasons. Regression analyses were used to calculate adjusted odds ratios (aORs) for factors associated with neurological complications (seizure, meningitis, encephalitis, myelitis, encephalopathy, radiculopathy, cerebral edema, hydrocephalus, or stroke). The risk of severe outcomes (intensive care unit admission, mechanical ventilation, or death) in children with neurological complications was compared to that of children without these complications using the Chi-square and Wilcoxon tests.

Results

Among the 9533 children hospitalized for influenza, 1228 (12.9%) had neurological complications. Children with neurological complications had longer hospitalization (6.3 days vs 4.5 days, p < 0.001) and were at higher risk of intensive care unit admission (31.8% vs 14.1%, p < 0.001), mechanical ventilation (20.5% vs 4.4%, p < 0.001), and death (2.2% vs 0.3%, p < 0.001). In a multivariable model adjusting for IMPACT site and influenza type, factors associated with neurological complications were: pre-existing neurological condition (aOR 4.19, 95% CI 3.61-4.86); age between 6 and 24 months (aOR 1.62, 95% CI 1.29-2.03) and age between 2 and 4 years (aOR 1.36, 95% CI 1.09-1.71).

Conclusion

More than one in ten children hospitalized for influenza developed neurological complications and these were associated with higher risk of severe outcomes. Risk factors identified for neurological complications were age between 6 months and 4 years and the presence of a pre-existing neurological condition.

Disclosures

Shaun Morris, MD, MPH, DTM&H, FRCPC, FAAP, GSK Canada: Advisor/Consultant|GSK Canada: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Sanofi Canada: Advisor/Consultant|Sanofi Canada: Honoraria Jesse Papenburg, MD, MSc, Merck: Honoraria|Merck: Site investigator, RCT
P-1506. In Vitro Activity of Ceftazidime-Avibactam and Comparator Agents against Pseudomonas aeruginosa Collected from Patients with Presumed Hospital- and Community-acquired Respiratory Tract Infections as a Part of the ATLAS Global Surveillance Program 2018-2022
Authors: Li Henry , Estabrook Mark , Stone Gregory , Sahm Daniel F
Published: January 2025

Background

The β-lactamase inhibitor, avibactam, has potent inhibitory activity against Class A, Class C, and some Class D serine β-lactamases. This study evaluated the in vitro activity of ceftazidime-avibactam and comparators against respiratory tract infection (RTI)-associated Pseudomonas aeruginosa isolated from presumed community-acquired (CA; culture started < 48 hours after hospital admission) and hospital-acquired (HA; culture started ≥48 hours post-admission) infections collected from 2018-2022.

Methods

13,186 isolates were collected from the lower respiratory tract of patients from 224 medical centers in 57 countries (excluding China and North America). Of these, 8,880 were HA and 4,306 were CA. MICs were determined using CLSI broth microdilution and interpreted using CLSI 2024 breakpoints. Isolates testing nonsusceptible (NS) to meropenem (MEM) were screened by PCR and Sanger sequencing for β-lactamase genes.

Results

Ceftazidime-avibactam was the most active agent tested against the CA population (92.3% susceptible, MIC90 of 8 µg/mL; Table). Against HA isolates, ceftazidime-avibactam was active against 88.6% (MIC90 of 16 µg/mL). Only amikacin was active against more HA isolates (89.4% susceptible; MIC90 32 µg/mL). Of isolates that were MEM-NS and metallo-β-lactamase (MBL)-negative, 81.0% of HA isolates and 79.5% of the CA isolates were susceptible.

Conclusion

The in vitro activity of ceftazidime-avibactam against CA and HA organisms infecting the lower respiratory tract indicates that it remains an important option for treating infections including those caused by MEM-NS organisms that do not carry an MBL.

Disclosures

Henry Li, MS in Biotechnology, Pfizer, Inc.: Advisor/Consultant Mark Estabrook, MS, Pfizer, Inc.: Advisor/Consultant Daniel F. Sahm, PhD, Pfizer, Inc.: Advisor/Consultant