bluuebunny/crossref_metadata_2025 huggingface dataset:
P-900. Demonstrating Your Expertise: Advanced Leadership Certification in Infection Prevention
Authors: Dangles Jessica , Al Mohajer Mayar
Published: January 2025

Background

The Certification Board of Infection Control and Epidemiology (CBIC) developed the Advanced Leadership Certification in Infection Prevention (AD-CIP). This portfolio-based assessment indicates professional expertise and leadership in infection prevention and control and healthcare epidemiology. This longitudinal perspective provides valuable insights into an applicant’s achievement beyond a single snapshot assessment.

Methods

A group of ten IPC subject matter experts (SMEs), along with a psychometric consultant, applied principles of measurement theory and assessment design to ensure the reliability, validity, fairness, and practicality of the assessment. The SMEs met via focus groups to conduct a job task analysis (JTA) of advanced IPC professionals' job roles and responsibilities. The JTA determined the competency areas essential to advanced leadership within IPC.

Results

The resulting framework targeted specific learning outcomes guided by an existing competency model developed by the Association for Professionals in Infection Control and Epidemiology. Clear guidelines for collecting, organizing, and evaluating portfolio submissions within the scoring rubric were required to establish scoring procedures. Inter-rater reliability analysis was used to assess scoring consistency among multiple raters. A pilot test of the assessment was conducted to identify any issues with the assessment design, instructions, or scoring procedures. The final assessment measures two domains within IPC: leadership and professionalism. Within each domain are subdomains of practice and innovation, change management, quality improvement, and advocacy. Applicants are required to submit supporting evidence indicating how the criteria for each domain and subdomain are met.

Conclusion

IPC leaders use their skills to establish a clear vision and strategic direction, facilitate change that improves programs and practices, enhance individual and population health, and reduce the risk of infection across the lifespan in all settings. The AD-CIP allows IPC professionals to demonstrate how their leadership has a measurable impact on the profession.

Disclosures

All Authors: No reported disclosures
P-908. Implementation of Film Array Meningitis/Encephalitis Panel on diagnostic stewardship program in Memorial Hermann Health System, Houston, TX
Authors: Aguilera Elizabeth A , Wanger Audrey , Moussa Daniel , Hasbun Rodrigo
Published: January 2025

Background

The use of multiplex polymerase chain reaction (PCR) panel for detecting the most common pathogens that cause meningitis and encephalitis are increasing and are currently available worldwide. This study aims to evaluate the clinical impact of the implementation of the BioFire Film Array ME (FA ME) panel at Memorial Hermann Health System in Houston, TX.

Methods

This preliminary retrospective study included adults and children with community-acquired meningitis, encephalitis, and cerebrospinal fluid (CSF) WBC > 5 cells/mm3. We categorized the patients into two cohorts: The Pre-Implementation FAME panel-control group (PRE-FAME), which was enrolled from June 2018 to October 2021, compared with the Post-implementation BioFire FilmArray -Intervention group (POST-FAME) evaluated from July 2022 to November 2023.

Results

A total of 440 patients were included (300 in the pre-implementation cohort and 140 in the post-implementation cohort). The majority were male (53%), white (40%), adults (87%) with a median age of 43 years, had a meningitis presentation (79%) and were immunocompetent (75%). There was no significant difference between the PRE-FAME and POST-FAME cohorts (P > 0.05) in sex, age, and immune status, but the post-implementation cohort had a higher proportion of subjects with Charlson Comorbidity Index Score > 1 and more cases with encephalitis (P< 0.05). PRE-FAME patients underwent more singleplex PCR for Herpes Simplex Virus (82% vs. 60%, P< 0.05) and for Varicella zoster virus (42% vs. 7%, P< 0.05). There was a decrease in West Nile Virus (WNV) serologies (37% vs. 20%, P< 0.05) in the POST-FAME cohort. The number of lumbar punctures (LP), CSF cultures, use of Computed Tomography (CT), Magnetic resonance imaging (MRI), duration of antiviral, and length of stay did not differ between the cohorts (P > 0.05). However, there was a reduction in the duration of antibiotic therapy by one day in the POST-FAME cohort and an increase in the diagnostic yield by 10% [(42% in PRE-FAME vs 52% in POST-FAME cohorts (P < 0.05)].

Conclusion

The implementation of the FAME panel increased diagnostic yield, decreased duration of antibiotic use, and decreased the use of single-plex PCR testing and WNV testing but did not impact duration of antiviral therapy or length of stay.

Disclosures

Rodrigo Hasbun, MD MPH FIDSA, Biomeriaux: Grant/Research Support|Biomeriaux: Honoraria
369. Antibiotic Stewardship at a New York City Public Hospital NICU using Neonatal Early-Onset Sepsis Calculator in the Presence of Maternal Chorioamnionitis
Authors: Rodas Cedeno Gabriela A , Chamavaliyathil Adila , Verdi Jean-Marco , Flores Jairus , Noble Lawrence , Rousseau-Pierre Thaina , Pintiliano Jennifer , Patil Uday
Published: January 2025

Background

Maternal chorioamnionitis is a major risk factor for neonatal early-onset sepsis (EOS) driving the use of empiric antibiotics in the neonatal intensive care unit (NICU). Utilization of the neonatal EOS calculator can guide the management and decrease antibiotic usage. Our objective is to safely reduce the exposure to empiric antibiotics (Ampicillin and Gentamicin) by 30% in a period of 6 months using the neonatal EOS calculator in full-term infants admitted to NICU in the setting of maternal chorioamnionitis at our public hospital.

Driver Diagram

Methods

Using the Model for Improvement framework, we developed a management algorithm with the neonatal EOS calculator along with documentation and workflow changes. A multidisciplinary team implemented PDSA cycles to promote adherence to the algorithm using education, training, and reinforcement. Baseline antibiotics usage rate (AUR) was calculated using chart reviews in the pre-quality improvement (QI) period (January 2023-July 2023).

Antibiotic Usage Rate (AUR) for PDSA 1 and PDSA 2

Results

During the QI period (August 2023-February 2024) a total of 127 at-risk full-term neonates were managed using the neonatal EOS calculator. Of these, only 18 neonates received empiric antibiotics. When compared to the baseline AUR, this was a significant decrease by 85.8%. Additionally, the rates of laboratory investigations (blood culture and complete blood count) also showed significant decrease by 77% in this cohort with no positive blood cultures.

EOS Workflow Algorithm

Conclusion

Our QI study demonstrates that the implementation of neonatal EOS calculator-based management in full-term infants born after maternal chorioamnionitis is safe and can be highly effective in establishing antibiotic stewardship in the NICU at a public hospital.

Disclosures

All Authors: No reported disclosures
P-921. A Decade of Changing Incidence and Microbial Aetiology of Brain Abscesses in England between 2014 and 2023
Authors: Guy Rebecca L , Coelho Juliana , Moganeradj Kartyk , Gil Eliza , Sabtu Nurfarah , Brown Colin S , Mirfenderesky Mariyam , Lamagni Theresa
Published: January 2025

Background

Following international and anecdotal domestic reports of post-pandemic increases in incidence of brain abscesses, including from the United States (US), we investigated trends, patient demographics and microbial aetiology of hospital admissions for brain abscess in England.

Methods

National patient admissions data from NHS England Hospital Episode Statistics with an ICD10 code for brain abscess (G06.0/G06.2) between 2014 and 2023 were extracted. Data were linked to the UKHSA national laboratory surveillance database to identify microbiological specimens (blood, CSF, pus/abscess or selected nasopharyngeal) taken within -1 and 30 days of admission. Incidence and mortality trends were assessed by patient demographic and identified organism.

Results

Between 2014-2023, 11,011 brain abscess admissions were identified from 1775 (16.1%) children and 8553 (77.7%) adults (≥18y). Median age was 54y; 64.4% (n=7088) were men, 84.0% (n=7818) were of white ethnicity, lower in children compared to adults (71.5% vs 87.3% for adults).

Brain abscess incidence in adults increased 42% between 2014 and 2023 (1.6 to 2.2/100,000 population), and for children 23% increase (1.5 to 1.7/100,000) particularly in extradural/subdural abscess (G06.2) since 2020, overtaking the rate in adults (figure 1).

Microbiology data were available for 3545 cases (32.2%), with 316 and 109 different species identified in adults and children respectively. In adults, the most frequently identified species was Staphylococcus aureus (26.1%, n=1303; range 22-36%/year), followed by Streptococcus anginosus group (11.1%; n=590; range 9-16%/year; figure 2). In children, 23.6% cases had S. anginosus group identified (n=178; range 12-32%/year), followed by group A Streptococcus at 9.7% (n=73; range 0-18%/year; figure 3).

Conclusion

This is the first national study on brain abscess incidence and microbial aetiology in England. Brain abscess reports showed a marked increase since 2014, with dramatic increases in children since 2020, a similar picture to the US. The microbial aetiology differed between adults and children, with a greater diversity in adults. Differences between surgical and community acquisition and predisposing conditions need to be assessed to identify opportunities for prevention.

Disclosures

All Authors: No reported disclosures
P-925. Diagnostic value of 18-F-FDG-PET scan in endovascular infections
Authors: Ittaman Ajithkumar , Hadi Hamad Abdel
Published: January 2025

Background

There have been multiple studies evaluating the use of 18-fluorine-fluorodeoxyglucose positron emission tomography (18F-FDG PET) as a diagnostic tool for endovascular infections with mixed results. The aim of this study will be to assess the efficacy of 18F-FDG PET scan in endovascular infections

demographic details of confirmed IE by criteria

Methods

Our study plan to evaluate the accuracy of PET scan in diagnosing VPGI, infective endocarditis and other endovascular infection. We will use MAGIC criteria3 and Modified Dukes criteria 1 regarding comparative diagnosing evaluation of VPGI and Infective endocarditis which has been previously validated. It will be correlated with 18 FDG PET report to calculate sensitivity, specificity, negative and positive predictive value of PET scan in diagnosing endovascular infections.

IE according to location (True positives- as per criteria )

Results

•Referred with suspected IE ,Graft infections, endovascular infections and FUO- 158 cases.Analysed PET scan report – IE ,endovascular infections.

PET scan with positive/negative reports for endovascular infections was analysed with confirmed cases by Modified Dukes and MAGIC criteria to calculate sensitivity, specificity, positive and negative predictive value.53- Confirmed and possible IE.Of 53 , 44 positive in PET scan Sensitivity- 83.01%.PET scan done for 14 suspected cases Vascular graft infections. Sensitivity of 64.28%.Sensitivity is variable: excellent for the diagnosis of PVE and CDRIE-pocket infections, but poor for NVE and CDRIE-lead infections.

Conclusion

PET scan was found to be efficient diagnostic tool in endocarditis and vascular graft infection.Need prospective studies for validation in vascular graft inefctions

Disclosures

All Authors: No reported disclosures
P-926. A Comparative Analysis of Infection-Related Mortality and Relapse Rate: Restarting vs. Continuing Antibiotic Regimens in Endocarditis Patients Post-Cardiac Intervention
Authors: Al Safi Ali , Nichols Courtney , Hebert Courtney , Ma Jianing , Peng Jing , Sobhanie Mohammad Mahdee
Published: January 2025

Background

The duration of antibiotic therapy post cardiac intervention (PCI) for treatment of infective endocarditis (IE) remains controversial despite current clinical guidelines. There is paucity of data on the PCI antibiotic duration relating to pathogens, presence of an infected cardiovascular implantable electronic device (CIED), vegetation size, and duration of bacteremia. Due to these limitations, antibiotic therapy may be extended although the impact in clinical practice remains unknown.

Methods

This was a retrospective study comparing outcomes in patients with IE admitted to The Ohio State Wexner Medical Center who underwent valve replacement and/or CIED extraction from January 2013 to November 2017 based on whether the course of antibiotic therapy was restarted PCI (extended group) or if antibiotics prior to cardiac intervention were included in the total antibiotic duration (continuation group). Patients who completed the full course of antibiotics prior to cardiac intervention were excluded. The primary outcome was a composite of one-year infection-related mortality and IE relapse PCI. The proportional win-fractions regression model was used to compare the composite outcome between the groups.

Results

235 patients met study inclusion criteria, 182 in the extended group and 53 in the continuation group. Patient demographics are shown in table 1. 91.5% of patients had positive blood cultures (n = 215) with a median bacteremia duration of 4 days with the most common pathogen being Staphylococcus aureus as shown in figure 1. 79.6% of patients had OR cultures sent (n = 187) shown in table 2. The average antibiotic duration PCI was 39.7 days. 5 patients had bacteremia at the time of surgery. The study revealed no statistically significant difference between the two groups in the primary outcome (Win Ratio 1.59, CI: 0.80-3.15, p-value 0.18) shown in table 3.

Conclusion

For patients with IE requiring surgical intervention, the outcome of one year mortality and infection relapse was not significantly different between the two groups after adjusting for potential confounders. This study suggests that extending antibiotics may not be associated with improved survival or infection relapse, however prospective studies are needed to confirm these findings.

Disclosures

All Authors: No reported disclosures
P-927. Clinical Outcome of Ampicillin plus Ceftriaxone Compared to Nafcillin or Cefazolin plus Gentamicin as an Empirical Treatment for Infective Endocarditis
Authors: Kang Min Seo , Hwang Ji-won , Park Seung Woo , Peck Kyong Ran , Kim Jihoon , Kim Eun Kyoung , Park Sung-Ji , Yang Jinyoung , Cho Sun Young , Ko Jae-Hoon , Kang Cheol-In , Chung Doo Ryeon , Huh Kyungmin
Published: January 2025

Background

A combination of anti-staphylococcal penicillin or cefazolin and gentamicin has been recommended as an empirical treatment regimen for native valve or late prosthetic valve infective endocarditis (NV/LPVIE), while the recent European Society of Cardiology Guidelines proposed ampicillin plus ceftriaxone (AMP+CRO) as an empirical option. However, clinical data supporting either regimen are scarce.

Risk factors of composite outcome in a Cox proportional hazard model with overlap weighting.

Methods

A retrospective cohort study was conducted in a large tertiary care hospital. Adults aged ≥18 years who were diagnosed with NV/LPVIE by the modified Duke criteria from 2000 through 2022 were included. Patients were grouped by empirical antibiotic regimens including AMP+CRO versus nafcillin or cefazolin plus gentamicin (NAF/CFZ+GEN). Multiple logistic regression with overlap weighting was used to compare outcome between the two groups. Primary outcome was all-cause mortality or relapse within 6 months since diagnosis.

Survival probabilities by empirical treatment regimen. (A) Observed survival without relapse, (B) probability of survival without relapse in the Cox proportional hazard model with overlap weighting.

Results

A total of 172 patients were included and divided into two groups by the empirical antibiotic regimens of AMP+CRO (n=102) or NAF/CFZ+GEN (n=70). Both groups exhibited similar baseline characteristics, including underlying diseases, preexisting valvular conditions, and involved valves. However, diabetes, cardiovascular diseases, and congestive heart failure were more common in the AMP+CRP group. Viridans group Streptococcus was the most frequently identified pathogen (33.3%) who were administered AMP+CRP, while Staphylococcus aureus was the most prevalent pathogen in the NAF/CFZ+GEN group (42.9%). In the AMP+CRO group, 6 (5.9%) met the composite outcome compared with 6 (8.6%) in the NAF/CFZ+GEN group (P = 0.551). There was also no statistically significant difference in the risk of composite outcome between the two groups in a multivariable analysis with overlap weighting (adjusted odds ratio, 0.27; 95% confidence interval, 0.05–1.43; P = 0.125).

Factors associated with initial treatment with ampicillin + ceftriaxone in a logistic regression model

Conclusion

In the patients with NV/LPVIE, AMP+CRO as empirical antibiotic therapy showed no significant difference in the all-cause mortality or relapse within 6 months since diagnosis compared to NAF/CFZ+GEN. Our results suggest that AMP+CRO can be used as a primary empirical regimen for the treatment of NV/LPVIE.

Covariate balance before and after overlap weighting

Disclosures

All Authors: No reported disclosures
P-932. Re-classification of Endocarditis Diagnoses in Patients who Inject Drugs using the 2023 Duke-ISCVD Microbiologic Criteria
Authors: Henson David M , Alnabelsi Talal , Collis Bennett , Hall Evan , Stoner Bobbi Jo , El-Dalati Sami
Published: January 2025

Background

In 2023, the Duke Criteria for infectious endocarditis (IE) were modified for a second time. Many criteria were adjusted with significant changes to the microbiologic criteria, introduction of new imaging criteria, and greater clarity of predisposing conditions contributing to the IE diagnosis. The changes to the microbiological criteria included expanding the list of typical organisms and adding cultures from a sterile site as a possible minor criterion. Other studies have assessed the impact of the updated criteria on the diagnosis of IE in large patient subsets. However, none have evaluated the effect of the criteria on diagnosis specifically in patients who inject drugs.

Methods

Patients were identified through pre-existing data from a previous study and from the records of the institutional multidisciplinary endocarditis team. Charts of 237 patients with a preliminary classification as possible or rejected IE were reviewed by study investigators in the electronic medical record based on the 2000 modified Duke Criteria, the 2023 Duke-ISCVD Criteria, and for a history of intravenous drug use (IVDU).

Results

Between January 1st, 2017 and November 1st, 2023, 51 patients with possible or rejected IE by the modified Duke Criteria and a history of IVDU were identified. Seven (13.7%) were re-classified from possible IE to definite IE based on the 2023 Duke-ISCVD criteria. All upgraded diagnoses were secondary to the new microbiologic criteria. Three patients were re-classified due to Streptococcus agalactiae bacteremia. An additional patient was re-classified due to Staphylococcus epidermidis bacteremia in the context of intra-cardiac material. The remaining three patients were re-classified due to positive cultures from sterile sites other than blood. All three patients received antibiotics prior to blood culture collection.

Conclusion

Compared to the modified Duke Criteria, applying the 2023 Duke-ISCVD criteria for IE resulted in the re-classification in 13.7% of patients with a history of IVDU from possible or rejected IE to definite IE. All upgraded diagnoses were secondary to changes in the microbiologic criteria. The 2023 Duke-ISCVD criteria may lead to increased diagnosis of definite IE in patients who inject drugs.

Disclosures

All Authors: No reported disclosures
P-937. Clinicomicrobiological Risk Factors for Infective Endocarditis in Viridans Group Streptococci Bacteremia
Authors: Bae Jiyeon , Park Jae Hyeon , Lee Minkyeong , Jo Hyeon Jae , Lee Chan Mi , Kang Chang Kyung , Choe Pyoeng Gyun , Park Wan Beom , Kim Nam Joong , Kim Inho , Oh Myoung-don
Published: January 2025

Background

Viridans group streptococci (VGS) persist as the dominant cause of community-acquired native-valve endocarditis, contributing to 20% of cases. The incidence of streptococcal infective endocarditis (IE) exceeds that of Staphylococcus aureus IE, notably in Asia. However, the risk factors that guide the decision to conduct echocardiography to rule out IE in patients with VGS bloodstream infections (BSIs) remain unclear. Therefore, our study aimed to identify independent risk factors for IE in patients with VGS BSIs.

Methods

This retrospective study conducted at Seoul National University Hospital from January 2013 to December 2022 involved patients with VGS and nutritionally variant streptococcal BSIs, excluding single positive blood cultures and polymicrobial BSI cases. Independent risk factors were identified by multivariate logistic regression and sensitivity analyses according to echocardiography results, VGS species, or the inclusion of possible IE cases.

Proportions of infective endocarditis by viridans group streptococci species.

VGS species belonging to the mitis group are represented by the orange-coloured dots, and those in the non-mitis group are represented by the green-coloured dots. Circle size correlates with the number of IE cases attributed to each VGS species.

Results

Of 845 VGS BSI cases, 349 were analyzed and 86 IE cases were identified (24.6%). In the multivariate analysis, heart valve disease (adjusted odds ratio [aOR], 14.14, 95% confidence interval [CI], 6.14–32.58; P < 0.001), persistent bacteremia (aOR, 5.12, 95% CI, 2.03–12.94; P = 0.001), age (per year, aOR, 0.98; 95% CI, 0.96–1.00; P = 0.015), solid cancer (aOR, 0.26, 95% CI, 0.13–0.53; P < 0.001), and hematologic malignancy (aOR, 0.04; 95% CI, 0.01–0.41; P = 0.006) were independently associated with IE. Sensitivity analyses yielded consistent results; also, infection by a member of the mitis group was independent risk factor for IE (aOR, 6.50; 95% CI, 2.87–14.68, P < 0.001).

Conclusion

Younger age, heart valve disease, persistent bacteremia, absence of underlying hematologic malignancy or solid cancer, and BSI by a member of the mitis group were the independent risk factors for IE in VGS BSI patients. In conclusion, regular echocardiographic evaluation could be prudently considered based on these clinicomicrobiological risk factors.

Disclosures

All Authors: No reported disclosures
372. Impact of Updated 2020 Public Health Service Guidelines on Deceased Organ Donors and Transplant Recipients
Authors: Handarova Dzhuliyana , Howell Jesse , Danziger-Isakov Lara A , Pouch Stephanie M
Published: January 2025

Background

New guidelines for assessing solid organ donors and recipients for Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), and Hepatitis C (HCV) infection were published by the US Public Health Service (PHS) in 2020 and implemented into Organ Procurement and Transplantation Network (OPTN) policy on 3/1/21. Changes included a shorter risk criteria inclusionary timeframe and the removal of 4 risk criteria.

Methods

We analyzed OPTN deceased donor and transplant data 2 years pre-(3/1/19-2/28/21) and post-(3/1/21-3/1/23) implementation of the updated guidelines. For Kaplan-Meier survival analyses, the post- cohort included recipients transplanted before 1/1/23 to ensure recipients had at least 1 year follow-up plus a 3-month data lag. Utilization rates, defined as number of organs transplanted divided by number of available organs from donors with at least 1 organ recovered for the purpose of transplant, are shown for thoracic organs. Non-use rates, defined as number of organs recovered for the purpose of transplant but not transplanted divided by the total number of organs recovered for the purpose of transplant, are shown for abdominal organs.

Results

The proportion of donors considered to have PHS risk factors decreased by approximately 10% post-policy, both overall and by organ type (Fig. 1). There were no major differences pre- to post- in reported donor HIV, HCV or HBV NAT test results (Fig2. ). Post-policy, utilization rates for heart and lung for donors with risk factors were 34.9% and 17.5% respectively, compared to 34.3% and 20.0% pre-policy; while kidney and liver non-use rates for donors with risk factors were 20.3% and 8.2% respectively, compared to 17.2% and 7.9% pre-policy. There was no significant change in 1-year post-transplant patient survival for recipients who received organs from donors with PHS risk factors (Fig. 3).

Conclusion

Less restrictive PHS guidelines led to fewer donors being classified as having risk factors for disease transmission. Updated guidelines did not significantly affect donor infectious disease test results or post-transplant survival for recipients. Changes in donor organ utilization and non-use may be due to donor pool changes and/or overlapping policy implementations, and further investigation is warranted.

Disclosures

Lara A. Danziger-Isakov, MD, MPH, Aicuris: clinical research contract, paid to institutio|Ansun BioPharma: clinical research contract, paid to institution|Astellas: Advisor/Consultant|Astellas: clinical research contract, paid to institutio|Merck: clinical research contract, paid to institutio|Pfizer: Grant/Research Support|Takeda: clinical research contract, paid to institutio
P-956. Perception of the Fellows/Faculty on Inpatient Expectations and Academic Half-Day
Authors: Osorio Georgina , Vargas Geraldine , Yancovitz Stanley
Published: January 2025

Background

Increased volume of Infectious Diseases (ID) inpatient consults has spear-headed training programs to launch efforts to mitigate burnout for optimal quality patient care and physician well-being including well-structured interventions such as academic half-day (AHD) to protect education time for fellows. This project describes inpatient strategies, electronic medical record (EMR) utilization, and perspectives on implementation of AHD by ID inpatient faculty and fellows at a large academic institution.

Methods

An anonymous survey on daily inpatient schedules, EMR utilization, and AHD feedback was distributed to the ID Section at a NYC urban hospital system in 3/2024.

Results

21 members of the ID section completed the survey (14 fac­ulty, 7 fellows). Daily inpatient schedules: When asked what time fellows should start workday, median response was 8AM-8:30 AM from both fellows (range, 8AM-9AM) and faculty (range, 7AM–9AM). When asked what time fellows should end work day, median response was 4:30PM-5PM from fellows (range, 4:30PM-5:30PM) and 5:30PM-6PM from faculty (range, 4:30PM-6:30PM). Fellows reported starting workday 7:30AM-8AM (range, 7AM-8:30AM) and ending 5:30PM-6PM (range, 4:30PM-6:30PM), while faculty reported starting 8:30AM-9AM (range, 6AM-9AM) and ending 6PM-6:30PM (range, 4:30PM-7PM). EMR utilization: fellows reported taking 4-6 hours to write notes (range, 2-6) and “about half the time” changing secure chat to “offline” when not on call versus faculty reported taking 2-4 hours (range, 1-6) to write notes and “never” setting EPIC secure chat to “offline.” AHD: Both groups reported AHD advantages were protected time for education, ability for fellows to focus on continuity clinic, in-person, and amplification of teamwork/mentorship. Fellows reported no disadvantages with AHD while faculty noted concerns of lost of continuity of care and not preparing fellows for clinical expectations as they transition to faculty.

Conclusion

Both fellows and faculty report different strategies with EMR utilization. AHD feedback was overall positive by both groups, but faculty expressed concerns regarding impact to continuity of care. AHD evaluation and strategies to mitigate burnout are ongoing including leveraging EMR.

Disclosures

All Authors: No reported disclosures
P-962. Designing ID Elective Goal and Learning Objectives Based On Need Assessment From Learners
Authors: Yoon Jungwon , Hatem David S
Published: January 2025

Background

Comprehensive Infectious disease (ID) education is indispensable for clinicians, given challenges posed by antimicrobial resistance, pandemics, expanding immunocompromised population, and the effect of climate change. ID fellowship applications have failed to match the demand for training programs. While numerous factors contribute to the prevailing challenges in ID workforce, enhancing clinical education in ID holds promise for bridging this gap.

Need Assessment Survey Results

Methods

An anonymous survey was conducted to understand the reasons learners in undergraduate (UME) and graduate medical education (GME) choose ID electives, what and how they want to learn during the rotation. In the academic year 2023, there were 59 GME and 10 UME learners enrolled in ID elective at our institution. 38 responded to the survey (55% response rate).

Results

The survey showed 93% of respondents opted for electives to augment their knowledge. 24% sought networking and mentorship from faculty members, and 21% wanted to explore career options in ID. However, only 8% plan to apply to ID fellowship programs. Learners expressed interest in exploring outpatient ID clinics (63%), antimicrobial stewardship initiatives (81%), and infection control activities (42%), alongside inpatient consultation services. Moreover, a majority (87%) expressed a desire for structured didactics.

Conclusion

While most pursue ID electives to address knowledge gaps, 21% of learners seem to be in an exploratory phase, seeking mentorship and contemplating a career in ID. ID electives have potential to serve as a platform for early trainees and students to explore their interests in the field. To optimize their experience, we could provide interactive didactics and diversifying clinical activities such as antimicrobial stewardship initiatives, and subspecialty clinics. Such initiatives not only provide learners with comprehensive insights into the field but also foster a deeper appreciation for the multifaceted nature of infectious diseases. Limitations from this study include small sample size and low response rate which impact generalizability of this finding. Conducting longitudinal surveys and evaluations with elective learners could provide further insights into how to improve the curriculum and better meet the needs of participants.

Disclosures

All Authors: No reported disclosures
P-963. Development, Delivery, and Evaluation of the Texas Epidemic Public Health Institute (TEPHI) Infection Control Lecture Series
Authors: Ruch Kayla , Rodriguez Anabel , Rios Janelle , Ostrosky-Zeichner Luis , Brown Eric L
Published: January 2025

Background

The Texas Epidemic Public Health Institute (TEPHI) is a state agency of higher education headquartered at UTHealth Houston School of Public Health. With a mission to keep Texans healthy and the economy strong by preparing for the next infectious disease outbreak, TEPHI’s Small Rural Healthcare Preparedness working group developed, delivered, and evaluated a pilot infection prevention and control webinar series called Infection Control for rural-serving health organizations.Table 1:Modular Registration, Attendance, and YouTube Views

Methods

Pilot data was collected from year one of the Infection Control series. Data sources included series attendee registration forms and attendance records (stored in WebEx Webinar Platform) and from post-lecture evaluation surveys using Qualtrics. These data were analyzed using Qualtrics software.Table 2:Infection Control series attendee demographic and occupational characteristics

Results

A total of 1105 individuals attended or viewed the Infection Control series. Overall, response rate to the evaluation surveys, in general, was low. Even so, feedback was consistently very positive, noting a “high likelihood of future TEPHI infection prevention and control lecture attendance”. Additionally participant feedback was used to guide the active improvements for year two of the series.Table 3:Infection Preventionist Module Registration Demographics

Conclusion

Infection Control series attendees obtained a deeper understanding of relevant policies, procedures, components, and practices. By offering essential, accessible education on infection prevention and control at no cost to healthcare systems, administrators and healthcare providers working in these systems have gained the knowledge necessary to establish and sustain a safe environment for patients and staff in healthcare settings.Table 4:Modular Post-Survey Evaluations

Disclosures

Luis Ostrosky-Zeichner, MD, FACP, FIDSA, FSHEA, FECMM, CMQ, Cidara: Advisor/Consultant|Enanta: Advisor/Consultant|F2G: Advisor/Consultant|Gilead: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Octapharma: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pulmocide: Grant/Research Support|Scynexis: Grant/Research Support|Viracor: Advisor/Consultant
P-975. Comprehensive Survey of Current Transplant Infectious Disease Fellowship Programs
Authors: Scolarici Michael J , Tischendorf Jessica S , Filipiak Rachel , Saddler Christopher
Published: January 2025

Background

Adult Transplant Infectious Disease (TID) training is not ACGME accredited, and there is heterogeneity in training offered at transplant centers.

Methods

The American Society of Transplantation ID Community of Practice surveyed current adult TID fellowship programs and tracks regarding required clinical experiences, non-clinical work, fellowship recruitment/funding, and outcomes of TID fellowship training. Respondents could skip questions, and R was used for statistical analysis.

Results

From 149 adult ID fellowship websites, we identified 37 TID tracks and 25 TID fellowships. After soliciting online forums, we had 24 respondents representing 20 active TID training programs and 16 TID fellowships of which 7/16, 44% have existed for at least 10 years.

In these 16 TID fellowships, fellows averaged 50% of their time with solid organ (SOT) and 41% with hematopoietic stem cell transplantation. The SOT centers were comprehensive (95% offering liver, 95% kidney, 90% heart, 75% lung transplantation). TID fellowships required more inpatient TID consult service compared to TID tracks (28 vs 21 weeks, p=0.1), and TID fellows average 392 (sd=202.8) inpatient TID consults per year. All TID fellowships require TID specific clinic, 93% pre-transplant evaluations, 67% attending selection committees, and 88% scholarship.

All 12 TID fellowships who actively recruit rely on both word of mouth and their program’s website, 11/12, 92% use in-person meetings (e.g. IDWeek), and only 7/12, 58% use social media.

To fund TID fellowships, 11/15, 73% use more than one mechanism (e.g. internal ID division funding, grants), and only 4/15, 27% rely on billable services by TID fellows. Six of 15, 40% hire TID fellows as a clinical instructor/lecturer, the other 9/15, 60% hire the TID fellow as a research/advanced fellow. At 12/14, 86% TID fellowships, more than 50% of the graduates sought TID focused clinical careers. At 6/14, 43% and 11/14, 79% of fellowships none of the graduates sought research focused or industry careers respectively.

Conclusion

TID fellowships require significantly more inpatient consult weeks than tracks, all have non-patient care requirements, the funding for these programs is variable, and most graduates seek a clinically focused career. The heterogeneity of TID fellowships is high.

Disclosures

Jessica S. Tischendorf, MD, MS, Merck: Grant/Research Support
P-976. The Effectiveness of Augmented Reality Handouts for Learning Microbiology in Medical Students
Authors: Suwantarat Nuntra , Vanichcharoenchai Vorawan , Vichitvejpaisal Pongsagon , Raksamani Kasana
Published: January 2025

Background

Augmented reality (AR) is a novel technology-enabled active learning for medical education. The goal of this study was to determine effectiveness of self-directed learning AR handouts as a learning material for teaching medical microbiology in the 3rd year medical students, Doctor of Medicine (English Program), Thammasat University.

Example of the traditional handouts and the AR handouts in this study

Methods

A randomized controlled trial study was conducted by comparing academic performances (MCQs scores), the motivation level (Motivation Scores Learning Questionnaire, MSLQ) and satisfaction survey scores in the students after studied AR handouts (intervention group) and traditional handouts (control group). The content of AR handout was similar to the traditional handout (topic: common Gram-positive bacteria).

Study Procedures and Methods

Results

Twenty-four students were enrolled in this study (n = 02 each group). The both groups had no differences on age, gender, total GPA, pre-test scores (means of 5.08). The both groups also had similar increases in the post-test scores means of 11.25 (intervention group) and 10.58 (control group). MSLQ (topic of intrinsic goal orientation) was significantly higher in the intervention group than the control group (5.73 vs 4.81, p = 0.002). Satisfaction survey scores (topic of "Handouts are stimulating" and "Handouts are exciting") were significantly higher in the intervention group than the control group (4.58 vs 3.50, p = 0.025 and 4.42 vs 3.17, p = 0.019).

Conclusion

AR handouts for learning medical microbiology and infectious diseases was effective to improve the knowledge in medical students. Based on cognitive information theory, the AR handouts help learning process by increased students' motivation, and satisfaction.

Disclosures

All Authors: No reported disclosures
P-978. Internal Medicine Resident Perceptions of the Barriers to and Facilitators of Optimal Inpatient Care of Persons who Inject Drugs: A Mixed Methods Study
Authors: Bailey Rosemary C , Tischendorf Jessica S
Published: January 2025

Background

Harm reduction counseling and HIV pre- and post-exposure prophylaxis (PrEP and PEP) can prevent infectious complications among persons who inject drugs (PWID). Hospitalizations are opportunities to provide these services, though these interventions occur infrequently for PWID admitted to our hospital. Little is known about internal medicine resident (IMR) perceptions of these interventions in the inpatient setting despite their frontline role in patient care in our institution.

Methods

In our mixed methods study we describe IMR perceptions of HIV prevention interventions and harm reduction counseling among PWID admitted to the University of Wisconsin Hospital. We conducted a survey examining current practices and perceptions. We explored the barriers and facilitators to optimizing these practices through semi-structured interviews. Transcripts were analyzed via consensus coding using the Systems Engineering Initiative for Patient Safety (SEIPS) model as a guiding conceptual framework. This framework describes the interactions of five components of complex work systems and their individual and overlapping influence on patient outcomes: 1) organization, 2) person, 3) physical environment, 4) task, and 5) technology and tools.

Results

59 IMRs responded to the survey (58% response rate). Residents report offering HIV-PrEP or HIV-PEP to PWID at low frequency; 56% never offer PrEP and 64% never offer PEP. 20% or fewer IMRs report offering PrEP or PEP at least some of the time. IMRs report a high degree of importance and appropriateness of HIV prevention interventions; however, the majority lack comfort, familiarity, or competence in how to counsel patients or prescribe PrEP or PEP (Table 1). 15 residents participated in interviews, all of whom identified barriers and facilitators to these interventions relevant to each component of the work system (Figure 1).

Conclusion

Despite recognizing the importance of HIV prevention services, including PrEP, PEP and harm reduction counseling, IMRs lack knowledge and comfort to do so. Barriers to optimal care span all components of the work system. Facilitators to optimal care and next steps include educational initiatives and EMR-based interventions with assessment of impact.

Disclosures

Jessica S. Tischendorf, MD, MS, Merck: Grant/Research Support
P-982. Online CME Improves Knowledge, Competence and Confidence of Infectious Disease Specialist in the Management of Patients who are Heavily Treatment Experienced
Authors: Thorpe Sara , Blatherwick Donald , Uravich Maria B
Published: January 2025

Background

Heavily Treatment Experience-People Living with HIV (HTE-PLWH) encompass older individuals and perinatally infected adolescents facing challenges with medication adherence. This demographic, dealing with increased lifespans, often struggles with medication adherence, posing a significant challenge. In comparison to PLWH outside the HTE category, HTE individuals typically experience higher rates of comorbidities, AIDS-defining conditions, and elevated healthcare costs. These multifaceted factors collectively limit the available HIV therapies for HTE PLWH, making treatment decisions more complex. Addressing the challenges posed by HTE PLWH requires clinicians to stay informed about advances in antiretroviral therapy, ensuring they can provide optimal, patient-centered care.

Methods

The CME intervention comprised of a 30- minute online text-based article authored by 1 faculty expert faculty. Response to 3 multiple choice, knowledge questions 1 self-efficacy, 5-point Likert scale confidence question were analyzed using a repeated pairs pre-/post-assessment study design. Pre- to post responses were compared using a McNemar’s test to assess statistical significance (P < .001 level). The activity posted on 9/27/2023; data were collected through 11/6/2023.

Results

The analysis consisted of responses of infectious disease specialist (n=122) who answered all pre/post questions. Analysis demonstrated a significant improvement in knowledge and confidence related to managing HTE PLWH

• 91% relative change from 33% to 63% pre vs. post regarding knowledge of issues that can arise with the long-term use of antiretroviral therapy (P< .001)

• 60% relative change from 42% to 67% pre vs. post regarding the competence in applying best practices for managing HIV in aging patients (P< .001)

• 42% improved their confidence in their ability to manage HIV in aging patients- 23% v. 44% pre to post (P< .001)

Conclusion

This study demonstrated the success of online, text-based CME on improving knowledge and confidence related to best practices in caring for people with HIV (PWH) and the subset who are heavily treatment experienced. These findings suggest the benefits of education that addresses clinicians’ individual needs across the continuum of their professional development.

Disclosures

All Authors: No reported disclosures
P-992. Global Estimated CMV Seroprevalence by Age and Sex
Authors: Lally Cathy , Flanders W Dana , Dilley Anne , Diaz-Decaro John D
Published: January 2025

Background

Cytomegalovirus (CMV) infection, while typically subclinical, is a lifelong latent infection that has been implicated in various adverse outcomes, including accelerated immunosenescence, increased cardiovascular risk, and cognitive decline. However, during pregnancy, CMV infection can cause severe complications in neonates infected in utero (congenital CMV [cCMV]). We present modeled age-, sex-, and country-specific CMV seroprevalence estimates.Figure 1.Modeled CMV Seroprevalence Estimates by Country, Age, and Sex

Methods

PubMed and EMBASE searches were conducted in August 2022 to identify English-language literature, published 2005-2022, on CMV seroprevalence. Sex-specific seroprevalence by age category was extracted and smoothed using weighted regression; when ≥ 2 studies were identified, a random-effect meta-regression was used.

Results

Overall, 25 studies were included. Estimated CMV seroprevalence increased with age and varied widely by sex and geographic location (Figure 1). Canada had the lowest seroprevalence estimates: 23.7% for females and 13.7% for males at age 18 years, and 33.5% and 23.5%, respectively, at age 40 years. The highest estimates at age 18 years were in China, with 93.0% for females and 95.3% for males, and at age 39 years in South Korea, with 99.1% and 98.8%, respectively. In Canada, France, Italy, Japan, UK, and USA, estimated seroprevalence was higher in females than in males across all age groups. In Australia, Germany, and Spain, estimated seroprevalence in younger age groups was higher among males than females, but in older age groups was higher among females than males. CMV seroprevalence was > 50% for both sexes in China at age 2 years, Japan at 4 years, and South Korea at 17 years, and for females at 14 years and males at 18 years in Spain.

Conclusion

Modeled CMV seroprevalence estimates increased with age and were higher among females than males in most countries. The highest modeled CMV burden was observed among the Asian countries. This study highlights the seroprevalence of CMV among females during their reproductive years, with potential risk of cCMV in their unborn children. The findings underscore the urgent need for targeted strategies to mitigate the global burden of CMV, particularly among reproductive-age females.

Disclosures

Cathy Lally, MSPH, Epidemiologic Research & Methods, LLC: Ownership Interest W. Dana Flanders, MD, DSc, MPH, MA, Epidemiologic Research & Methods, LLC: Ownership Interest Anne Dilley, PhD, Epidemiologic Research & Methods, LLC: Ownership Interest John D. Diaz-Decaro, PhD, MS, Moderna, Inc.: Employee|Moderna, Inc.: Stocks/Bonds (Public Company)
P-996. Antibiotic Selection for Group B Streptococcus Prophylaxis in Penicillin Allergic Pregnant Patients
Authors: Lam Jenny , Ham YoungYoon , Yu Diana
Published: January 2025

Background

Penicillin (PCN) is preferred by American College of Obstetricians and Gynecologists (ACOG) for the prevention of early-onset Group B Streptococcus (GBS infections in newborns, but 10% of patients report a PCN allergy. Clindamycin and vancomycin are second-line for GBS prophylaxis because they are less effective; thus ACOG recommends PCN testing in pregnant patients who report an allergy. Cefazolin has limited cross-reactivity in IgE-mediated PCN reactions and has excellent activity against GBS. This study aims to determine how PCN allergy testing is utilized in GBS positive, PCN allergic pregnant patients and its effect on antibiotic selection.

Methods

This is a single-institution, IRB approved, retrospective cohort of patients that gave birth with an EHR documented PCN allergy from January 1, 2022-July 30, 2023. Pregnant patients over the age of 18 with a penicillin allergy and received antibiotics with an indication for GBS prophylaxis were included. Patients were excluded if they received antibiotics for indications other than GBS prophylaxis. The primary outcome was the rate of PCN used compared to cefazolin in skin-tested and non-skin-tested pregnant patients with indications for GBS prophylaxis. The secondary outcomes were rate of PCN allergy testing, adverse effects due to the antibiotic, the rate of neonatal early-onset sepsis, and frequency of PCN use compared to other antibiotics.

Results

Of 4,780 births, 57 patients met inclusion criteria. Of those 57 patients, only 2 patients received PCN allergy testing referrals. Only 1 of the 2 PCN skin-tested patients had a negative result; however, both patients received cefazolin. The 55 patients without skin testing consults received penicillin (3.9%), cefazolin (51%), clindamycin (22%) and vancomycin (27.5%). Of the 25 patients who received clindamycin or vancomycin, all could have received cefazolin based on allergy cross reactivity data. There were no antibiotic-related adverse effects or neonatal early-onset sepsis.

Conclusion

PCN allergy testing was found to be used very infrequently in this population; providers should be educated about the availability of this service. Additionally, providers should be educated regarding cross-sensitivity with PCN allergy and encouraged to use cefazolin for GBS prophylaxis.

Disclosures

YoungYoon Ham, PharmD, Gilead: Honoraria