bluuebunny/crossref_metadata_2025 huggingface dataset:
174. Implementation of Methicillin Resistant Staphylococcus Aureus (MRSA) Nasal Polymerase Chain Reaction (PCR) Swabs in Pediatric Patients
Authors: Bischoff Hannah , Hughes Heather , Addington Beth , Withers Sarah , Richardson Katherine , Faulkner-Fennell Carmen
Published: January 2025

Background

Current society guidelines for community-, hospital-, and ventilator-acquired pneumonia in adult patients mention use of polymerase chain reaction (PCR) nasal screening for methicillin-resistant Staphylococcus aureus (MRSA) colonization to aid de-escalation of anti-MRSA antibiotics. MRSA nasal PCR has a 96% negative predictive value when utilized for pneumonia. Most available data is in the adult population with limited application in the pediatric patient population. In a single-center retrospective analysis of 95 pediatric patients, MRSA nasal PCR showed a negative predictive value of 95.5% in multiple types of infections. The objective of this study is to expand on the limited pediatric data, encouraging the use of MRSA nasal PCR as a tool to guide de-escalation of anti-MRSA antibiotics.

Methods

This single-center, pre- and post-interventional, retrospective cohort study compared antibiotic regimens in pediatric patients who were treated empirically with anti-MRSA antibiotics and had a MRSA nasal PCR collected compared to those who did not have a MRSA nasal PCR collected. Use of MRSA nasal PCR in the pediatric hospital was encouraged following an antimicrobial stewardship provider-lead continuing education presentation. The primary outcome was duration of therapy of anti-MRSA antibiotics in days. Secondary outcomes include positive predictive values (PPV) and negative predictive values (NPV) for all infections, pneumonia, and skin and soft tissue infections.

Results

A total of 319 patients were included in the study, 252 in the pre-intervention group and 67 in the post-intervention group. The duration of anti-MRSA antibiotics in the pre-intervention group was 6.66 days compared to the post-intervention group at 2.00 days (p-value = 0.027). Using data from 38 patients with appropriate culture results for the diagnosis, negative predictive value was calculated as 92.1%. Skin and soft tissue infections and pneumonia were found to have negative predictive values of 90.1% (22 patients) and 100% (5 patients), respectively.

Conclusion

Implementation of MRSA nasal PCRs swab in pediatric patients significantly reduced the number of days patients received anti-MRSA coverage promoting their use for antimicrobial stewardship.

Disclosures

All Authors: No reported disclosures
212. Gonorrhea and Chlamydia Opt-Out Screening of Justice-Involved Females During Intake at the Los Angeles County Jail: The Pivotal Role of Correctional Health Systems
Authors: Qureshi Nazia , Herrera Sulma J , Miller Loren G , Judge Stephen , Cardenas Charles M , Henderson Sean O
Published: January 2025

Background

Chlamydia and gonorrhea are two of the most common sexually transmitted infections (STIs) worldwide, presenting major public health challenges and resulting in billions of dollars in direct medical costs in the U.S. Incarcerated females have a particularly elevated risk of these infections, which can result in significant clinical and public/community health-level sequelae if left untreated. On December 13, 2021, the division of Correctional Health Services began offering opt-out urogenital chlamydia and gonorrhea screening to all newly incarcerated females within the Los Angeles County Jail system.

Methods

We retrospectively analyzed electronic health record data for completed urogenital chlamydia/gonorrhea screening among newly incarcerated females between December 13, 2021, and May 31, 2023. We used multivariable logistic regression to examine the association of STIs and treatment non-initiation outcomes with various demographic and self-reported variables.

Results

Of the 13739 women offered STI testing, 10717 (78%) completed screening, with 1151 (11%) having a chlamydial infection, 788 (7%) having a gonococcal infection, and 1626 (15%) having either infection. In a multivariable model, result positivity was associated with age 18-34, reported houselessness, amphetamine use, and history of a positive prior treponemal antibody test. STI treatment non-initiation was associated with shorter length of stay for both chlamydial ([aOR] = 87.4, 95% CI (34.2, 223.2)) and gonococcal ([aOR] = 9.0, 95% CI (5.2, 15.7)) infections.

Conclusion

The STI screening and prevalence among female detainees tested at intake was many-fold higher than that of the general population. The implementation of routine opt-out STI screening and treatment of STI-infected people in carceral settings provides a unique and important opportunity to benefit the health of this high-risk population and has the potential to create a spillover effect that might benefit the surrounding community.

Disclosures

Loren G. Miller, MD MPH, Armata: Grant/Research Support|Contrafect: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Paratek: Grant/Research Support
217. Preliminary Results from a Clinical Trial Comparing the Efficacy of Cefixime Versus Penicillin G for the Treatment of Early Syphilis
Authors: Keith Kori , Wilson Gjermayne , Stafylis Chrysovalantis , Reyes-Diaz Michael , Konda Kelika , Klausner Jeffrey
Published: January 2025

Background

Syphilis has reemerged as a global health concern. The standard treatment for all stages of syphilis is injectable benzathine penicillin G. Cefixime is an FDA-approved, oral antibiotic widely available, low-cost, and safe in pregnancy. A previous pilot study showed cefixime was likely efficacious in treating early syphilis. This study aims to evaluate the efficacy of cefixime in comparison to benzathine penicillin G.

Methods

We are conducting a randomized, multisite, open-label, non-inferiority clinical trial to compare the effectiveness of cefixime (400mg, orally, twice daily for 10 days) to benzathine penicillin G (2.4 million units, intramuscularly) in 400 participants from 12 clinical sites in the United States and Peru, including participants living with and without human immunodeficiency virus (HIV) infection. In the event of a penicillin shortage, participants randomized to penicillin receive doxycycline hyclate (100mg, orally, twice daily for 14 days).

Participants undergo follow-up visits post-treatment at 3-, 6-, and 9-months, involving clinical evaluation and rapid plasma reagin (RPR) testing. The primary outcome is a ≥4-fold decrease in the RPR compared to the initial RPR titer at enrollment, assessed at either 3 or 6 months after treatment.

Results

As of May 1, 2024, 134 participants are enrolled, 67.2% living with HIV. The current cefixime adherence rate is 92.3% (60/65) at the 10 day mark. Evaluable data is available from 104 participants with 3- or 6-month follow-up visits, including 52 cefixime, 45 penicillin, and 7 doxycycline participants. By 3- or 6-month post-treatment, 88.5% (95% CI, 76.5% - 95.6%; 46/52) of cefixime participants, 88.9% (95% CI, 75.6% - 96.3%; 40/45) of penicillin participants, and 100.0% (95% CI, 59.0% - 100%; 7/7) of doxycycline participants achieved a ≥4-fold RPR titer decrease.

Conclusion

Comparable effectiveness was observed among the treatment arms. Enrollment and data collection continue, with study completion expected by June 2026.

Disclosures

Jeffrey Klausner, MD MPH, Direct Diagnostics: Advisor/Consultant
P-812. Not Little Adults: Key Differences in Antimicrobial Resistance in Australian Bloodstream Isolates between Children and Adults, 2020-2021
Authors: Williams Anita , Coombs Geoff W , Bell Jan , Daley Denise A , Mowlaboccus Shakeel , Bryant Penelope A , Campbell Anita Jane , Cooley Louise , Howard-Jones Annaleise , Iredell Jon , Irwin Adam D , McMullan Brendan , Warner Morgyn , Williams Phoebe , Blyth Christopher C
Published: January 2025

Background

The incidence, risks and organisms causing bloodstream infections (BSI) differ between children and adults due to distinct comorbidities, procedures and antibiotic exposures. Age-specific data are required to inform targeted interventions, empiric treatment and guideline development. We aimed to compare the incidence, risk factors and resistance patterns of bacteria causing BSI in children and adults (2020-21).

Methods

The Australian Group on Antimicrobial Resistance (AGAR) is a national hospital-based BSI surveillance program reporting on Staphylococcus aureus, Enterococcus spp. and key gram-negative pathogens.

Results

Data from 25,958 isolates were assessed (children: 1,679; adults: 24,279). The most common organisms in children and adults were Escherichia coli (20.9 vs 39.1%) and S. aureus (36.2 vs 20.9%). E. faecalis and non-typhoidal Salmonella spp. were more frequent in children (7.3% and 4.4% of surveyed organisms in children vs 5.1% and 0.5% in adults). BSI were more often community onset (69.0% children; 76.4% adults). 30-day mortality was significantly lower in children (3.3% vs 9.8%).

Enterobacterales resistance was more common in children: e.g. to gentamicin/tobramycin (11.6% of child isolates; 8.5%, adult isolates; rate ratio [RR]: 1.4 [95%CI: 1.1-1.7]) and piperacillin-tazobactam resistance (11.2%; 8.6%; RR: 1.3 [1.0-1.6]). However, there was no difference observed in Enterobacterales resistance to cephalosporins, ciprofloxacin, meropenem or multi-drug resistance status. AMR prevalence in Pseudomonas and Acinetobacter spp isolates were also similar between children and adults.

Methicillin-resistant S. aureus isolates were less common in children (13.2 vs 17.7%; RR: 0.7 [0.6-0.9]). Rates of clindamycin and cotrimoxazole resistance in S. aureus were similar to adults.

Children had a lower proportion of E. faecium infections (24.1 vs 39.8%) and the rate of vancomycin-resistant E. faecium in children was half that in adults (19.5 vs 37.2%; RR; 0.5, [0.2-1.0]).

Conclusion

Analysis of national AMR data identifies unique trends in children. Ongoing clinical surveillance, targeted prevention, antimicrobial stewardship strategies and research to evaluate AMR drivers in children are required.

Disclosures

All Authors: No reported disclosures
P-821. Invasive Streptococcus pyogenes Infections: Is Anti-toxin Therapy Necessary?
Authors: Kinsey Daniel , Jagannathan Megha , Jordan Tamara , Kenney Rachel M , Veve Michael , Shallal Anita , Suleyman Geehan
Published: January 2025

Background

Invasive Streptococcus pyogenes or group A Streptococcus (GAS) carries a high morbidity and mortality rate. In addition to penicillin, adjunct anti-toxin therapy (AT) with linezolid or clindamycin is the standard of care. Although the use of AT is supported by in vitro data and observational studies, there are limited conclusive data supporting its efficacy in reducing GAS mortality. Our study aimed to compare clinical outcomes of patients receiving AT versus those who did not.

Methods

This was a retrospective cohort study of hospitalized patients with positive blood cultures for GAS at our five-hospital system from June 2013 to August 2023. Patients were identified through Microsoft SQL Server. Patients who received AT therapy for > 48 hours were defined as the AT group; the control group did not receive AT therapy. Patients who received AT for < 48 hours were excluded. Collected variables included demographics, infection & microbiological characteristics, and clinical outcomes. Data was analyzed using SPSS.

Results

265 patients were included in the study of whom 179 (68%) received AT (Table 1). About half were female, and the median age was 58 years. Comorbidities were overall similar between the two groups. Persons who inject drugs or with chronic hepatitis C were more common in the control group. Abscess/cellulitis was the most common clinical syndrome in both groups. Shock requiring vasopressors, need for dialysis and mechanical ventilation, and toxic shock syndrome were prevalent in the AT group. There was no difference in the duration of bacteremia, clindamycin resistance, and management between the two groups except for receipt of intravenous immunoglobulin (IVIG), which was more common in the AT group (Table 2). Outcomes, including length of stay, readmission for infection-related complications, and 30-day mortality, were similar between the two groups.

Conclusion

Utilization of AT for invasive GAS infections correlated with severity of illness, but clinical outcomes did not significantly differ between patients receiving AT and those who did not, suggesting a potential opportunity for antimicrobial stewardship. Further research is needed to determine whether AT should be reserved for patients with select infectious syndromes

Disclosures

Rachel M. Kenney, PharmD, BCIDP, Medtronic Inc: Spouse is an employee, stockholder
P-839. Clinical Diagnostic Performance of Droplet Digital PCR for Pathogen Detection in Patients with Escherichia coli Bloodstream Infections
Authors: Kitagawa Hiroki , Kojima Masato , Tadera Kayoko , Omori Keitaro , Nomura Toshihito , Shigemoto Norifumi , Ohge Hiroki
Published: January 2025

Background

Rapid diagnosis and early administration of appropriate antimicrobials are crucial to improve the prognosis and decrease the mortality of patients with bacterial bloodstream infections (BSIs). Droplet digital PCR (ddPCR) is a new tool for pathogen detection in BSIs. This study aimed to examine the sensitivity of ddPCR and explore the association between bacterial DNA load in whole blood and time-to-positivity (TTP) of blood cultures (BCs) in patients with Escherichia coli BSIs.

Relationship between E. coli DNA load in whole blood and time-to-positivity of blood cultures

Methods

This prospective study included 59 patients with E. coli BSIs confirmed using BCs enrolled at the Hiroshima University Hospital between June, 2023 and April, 2024. The E. coli DNA load in whole blood, which was simultaneously obtained from two sets of BCs, was evaluated using ddPCR. For each patient, only the TTP of the first positive BC obtained using the BacT/ALERT Virtuo System was used for analysis.

Results

The median TTP was 9.0 (IQR: 8.3–10.2) h, and 15.2% (9/59) of the patients exhibited septic shock during BC sampling. In 83.1% (49/59) of the whole blood samples, E. coli DNA was detected via ddPCR. Patients with positive ddPCR results exhibited significantly shorter TTP than those with negative ddPCR results (median TTP: 8.8 vs. 10.5 h; p < 0.001). The rate of positive results for both sets of BCs was significantly higher in patients with positive ddPCR results than in those with negative ddPCR results (87.8 vs. 40.0%, p = 0.003). The E. coli DNA load was 75–200,475 copies/mL. Moreover, ddPCR revealed a significant correlation between the E. coli DNA load in whole blood and TTP (r: –0.58; 95% confidence interval: –0.74 to –0.36; p < 0.001). All patients with septic shock exhibited positive ddPCR results and significantly higher E. coli DNA loads in whole blood than those without septic shock (median E. coli DNA load: 6,375 vs. 113 copies/mL; p < 0.001).

Conclusion

Overall, ddPCR effectively detected E. coli DNA in the whole blood of patients with septic shock with a relatively short TTP. Notably, E. coli DNA load was associated with the infection severity of the patient. Further optimization of the bacterial DNA extraction protocol from blood and reaction systems and conditions can enhance the sensitivity of ddPCR.

Disclosures

All Authors: No reported disclosures
P-842. Community-onset vs. Hospital-onset Staphylococcus aureus Bacteremia: Implications for Patients and Healthcare Systems
Authors: Rico Crescencio Juan Carlos , Dare Ryan K , Myers Jordan
Published: January 2025

Background

Staphylococcus aureus is a leading cause of bacteremia, associated with high rates of morbidity and mortality. It poses a tremendous burden to the healthcare system in terms of cost and resource utilization. This study's objective is to evaluate the incidence and clinical outcomes of both community and hospital-onset S. aureus bacteremia (SAB).

Methods

This study is a retrospective analysis of adult patients with SAB at an academic medical center in Arkansas from May 2016 to January 2024. Subjects were identified as hospital-onset SAB (HO-SAB) if positive blood cultures were collected ≥ 48 hours after admission or community-onset SAB (CO-SAB) if blood cultures were collected < 48 hours after admission.

Results

A total of 1,179 patients had SAB during the study period of which 230 (19.5%) died or transitioned to hospice care. In-house mortality varied by age(11%< 35y vs 48%≥ 85 y). There were similar rates of mortality between patients with MRSA (21%) and MSSA (19%) bacteremia. Infectious disease (ID) consultation was common (N=1,013; 86%) and resulted in a lower mortality rate compared to patients without ID consultation (16.2% vs 39.8%; P< 0.001). There were 254 (21%) HO-SAB cases with an incidence of 0.22 episodes per 1,000 patient days. HO-SAB incidence increased following the onset of the COVID-19 pandemic (0.17 vs 0.28 cases per 1,000 patient days). In addition, in-house mortality of patients with HO-SAB also increased following the onset of the COVID-19 pandemic (20.8% vs 32.8%). Patients with HO-SAB had a longer median length of stay (20.8 days vs 8.9 days; P< 0.001) and a higher rate of in-hospital mortality (27.2% vs 17.4%; P< 0.001) compared to patients with CO-SAB.

Conclusion

This study highlights the tremendous impact of SAB for patients and the healthcare system. SAB mortality remained high however, ID consultation resulted in significantly lower mortality rates. HO-SAB is unfortunately common and patients with HO-SAB had longer LOS and a higher rate of in-house mortality compared to patients with CO-SAB. Following the onset of the pandemic, HO-SAB incidence and in-hospital mortality increased. Further studies are necessary to understand the risk factors and prevention of HO-SAB.

Disclosures

All Authors: No reported disclosures
P-845. HECK-Yes This is The Remix!! Ceftriaxone vs Cefepime or Carbapenems for Definitive Treatment of Low-Risk AmpC-Harboring Enterobacterales Bloodstream Infections
Authors: Kenney Rachel M , Veve Michael , Shallal Anita , Tibbetts Robert , Mulbah Jessica L
Published: January 2025

Background

Recent literature suggests ceftriaxone as a viable treatment of low-risk AmpC-producing organisms, allowing for the preservation of AmpC-stable therapies for moderate to high-risk organisms. This study aimed to determine whether ceftriaxone is effective in patients with bloodstream infections (BSI) caused by low-risk AmpC harboring Enterobacterales compared to AmpC-stable therapies.

Methods

This was an IRB-approved, retrospective cohort of hospitalized patients ≥18 years old with a BSI due to Serratia marcescens, Morganella morganii, or Providencia spp. from 1/1/2017-2/28/2024. Patients were compared according to definitive therapy with ceftriaxone vs AmpC stable therapy (cefepime or carbapenem). The primary endpoint was 30-day all-cause mortality; secondary endpoints were clinical failure, development of ceftriaxone resistance, and hospital length of stay (LOS) after index culture. Clinical failure was defined as persistent signs and symptoms of infection, repeat positive blood cultures on days 3-5 of therapy, antibiotic escalation, or death.

Results

163 patients were included: 54 (33.1%) received ceftriaxone vs 109 (66.9%) AmpC stable therapies. Baseline, infection, and treatment characteristics are found in Table 1. 30-day all-cause mortality was observed in 5 (9.3%) ceftriaxone vs 11 (10.1%) AmpC stable patients (P=0.87). There were no differences in clinical success (49 [90.7%] vs 86 [78.9%], P=0.059), relapsing infection (3 [5.6%] vs 10 [9.3%], P=0.55), or rehospitalization (11 [20.4%] vs 38 [34.9%], P=0.06) between ceftriaxone and AmpC stable patients, respectively. Ceftriaxone resistance was only observed in AmpC stable patients (0 vs. 4 [3.7%], P=0.302), and median (IQR) LOS was similar between groups (5 [4-8] vs 6 [3-13] days, P=0.39). After adjustment for vasopressor use (adjOR 4.2; 95%CI, 1.3-13.1), ceftriaxone definitive therapy (adjOR, 0.79; 95%CI, 0.23-2.3) was not independently associated with 30-day all-cause mortality

Conclusion

Patients treated with definitive ceftriaxone for low-risk AmpC Enterobacterales BSI achieved comparable outcomes to those treated with AmpC stable therapies. These findings support ceftriaxone as a treatment option for low-risk AmpC producers.

Disclosures

Rachel M. Kenney, PharmD, BCIDP, Medtronic Inc: Spouse is an employee, stockholder
P-846. A Single-Institution Retrospective Analysis on the Administration of Beta-lactam Antibiotics Prior to Vancomycin in Bacteremic Patients
Authors: Cravero John C , Telchik Collin M , Yakubik Taylor , Woods Lewis , Sisco Lauren
Published: January 2025

Background

According to the 2021 IDSA Surviving Sepsis Guidelines, prompt administration of antibiotics is an essential recommendation for patients with bacteremia. Similarly to a recent study published by Amoah et al., we sought to determine if the sequence of antibiotic administration impacted 30-day mortality.

Methods

We conducted a single-institution retrospective study at Baylor Scott & White Medical Center in Temple, Texas, on patients greater than 18 years of age admitted with sepsis and confirmed bacteremia from January 1st, 2021, to July 1st, 2023 who received sequential antibiotic administration with a Beta-lactam and vancomycin within the first 6 hours of admission time. Our primary endpoint was odds ratio for 30-day mortality.

Results

Of 6143 patients generated from electronic search, 222 patients were included in the Beta-lactam first group and 16 were included in the vancomycin first group. Of these 238 patients, 132 patients were admitted to the ICU upon admission. The most common Beta-lactam antibiotic administered was piperacillin-tazobactam (58.40%) followed by Cefepime (25.47%), then Ceftriaxone (13.03%). For patients with monomicrobial bacteremia, the most common organisms isolated were Escherichia coli (25.21%), Methicillin resistant Staphylococcus aureus (MRSA) (13.45%), Methicillin sensitive Staphylococcus aureus (MSSA) (11.34%), and Proteus mirabilis (7.56%). The calculated odds ratio for 30-day mortality was 0.40 (95% CI 0.089-1.831), indicating a decreased occurrence of mortality within 30 days for patients who received Beta-lactam antibiotics first, though this result was not statistically significant due to limited sample size, particularly within the vancomycin first group.

Conclusion

Although not statistically significant, our results suggest that prompt administration of Beta-lactam antibiotics prior to vancomycin may have mortality benefit in patients with bacteremia. Further confirmatory studies will be required to investigate this principle.

Disclosures

All Authors: No reported disclosures
P-854. Determining whether presence of Lower Urinary Tract Infection Symptoms is Associated with Better Graft Outcomes in Kidney Transplant Recipients with Bacteremia from a Urinary Source
Authors: Donzo Maja Wichhart , Anderson Rebecca , Eichenberger Emily
Published: January 2025

Background

Bloodstream infection is a feared complication of bacteriuria in kidney transplant recipients (KTR). We recently found that among KTR with blood stream infection from a urinary source (BSIU), only 28.9% had experienced lower urinary tract infection (UTI) symptoms prior to or upon presentation for their bacteremia. We hypothesized that presence of lower UTI symptoms may lead to earlier recognition of BSIU and therefore better outcomes.

Methods

Patients who underwent a kidney transplant at our institution between 01/2010-09/2022 with BSIU were eligible for inclusion. BSIU was defined as KTR with concordant organisms growing in blood and urine cultures. For subjects with >1 episode of BSIU, only the first episode was included for analysis. KTR with BSIU were classified into one of two groups: presence of lower UTI symptoms or absence of lower UTI symptoms. Lower UTI symptoms were defined as presence of urinary frequency, urgency, dysuria, or suprapubic pain.

Continuous and categorical variables were compared using Wilcoxon-rank sum and fisher exact tests as appropriate. Time to graft failure and acute cellular rejection were analyzed with Kaplan Meier curves and compared using log rank tests.

Results

Among 142 patients who presented with BSIU, 41 (28.9%) presented with lower UTI symptoms. Relative to BSIU without UTI symptoms, BSIU with lower UTI symptoms were less likely to have a history of diabetes induced renal failure (20% vs 43%, P=0.012), and less likely to have a had acute cellular rejection preceding infection (7.3% vs 27%, P=0.012). Race, gender, recipient age at transplant, donor type, and immunosuppression regimen did not differ between the two groups. 90-day mortality among BSIU was 0% for those with lower UTI symptoms versus 4% for those without symptoms (P=0.324). Time from BSIU to acute cellular rejection did not differ by symptom status (P = 0.99). Overall time to graft failure was longer in BSIU with UTI symptoms (P=0.041).

Conclusion

Longer time to graft failure was noted among BSIU who presented with lower UTI symptoms. Larger studies are needed to validate these findings and investigate how we can use clinical data and symptomatology to predict outcomes for KTR with BSIU.

Disclosures

All Authors: No reported disclosures
P-858. Impact of Infectious Diseases Consultation on the Management of Staphylococcus Aureus Bacteremia in a Large, Predominately Rural, Health System
Authors: Murtaza Muhammad , Howard Catessa A , Thompson Jesse , Edmond Michael B , Stevens Michael
Published: January 2025

Background

Staphylococcus Aureus Bacteremia(SAB) is associated with high morbidity and mortality. Infectious Diseases (ID)consultation has been associated with a decrease in mortality. The WVU Medicine Health System (WVUM) serves as a predominantly rural population and includes 24 hospitals (9 of which are critical access hospitals). Access to ID consultations is limited across the system and region.

Methods

We generated a list of patients with SAB who presented to WVUM hospitals between 6/1/22 to 5/30/2023. A subset of patient charts were selected for review. We manually reviewed patient records and recorded key information and assessed whether patients met IDSA guidelines criteria for complicated versus uncomplicated SAB.

Results

Please see Table 1 Table 1.Management of SAB for Patients With and Without ID ConsultationVariablePatients with ID Consult (143)Patients without ID Consult (93)P-valueDiagnostic ImagingMRI C-spine: 27/143 (19%)MRI C-spine: 2/93 (2%)< 0.001MRI T-spine: 32/143 (22%)MRI T-spine: 4/93 (4%)< 0.001MRI LS spine: 41/143 (29%)MRI LS spine: 3/93 (3%)< 0.001TTE: 129/143 (90%)TTE: 38/93 (41%)< 0.001TEE: 62/143 (43%)TEE: 3/93 (3%)< 0.001Metastatic Infection48/143 (34%)5/93 (5%)< 0.001Complicated139/143 (97%)93/93 (100%)0.1557Antibiotic duration< 2 weeks: 0/143 (0%)< 2 weeks: 52/93 (56%)< 0.0012 weeks 10/143 (7%)2 weeks 16/93 (17%)0.0254 weeks 24/143 (17%)4 weeks 2/93 (2%)< 0.0016 weeks 95/143 (66%)6 weeks 10/93 (11%)< 0.001Died within 72 hours of presentation0/143 (0%)16/93 (17%)< 0.00130 Day re-admission*30/143 (21%)26/77 (34%)0.30130-Day mortality*10/143 (7%)11/77 (14%)< 0.001*Excluding people who died within 72 hours of presentation 

Conclusion

We found major differences in the work up of SAB and in clinical outcomes for patients receiving ID consultation and those who did not. Patients who received ID consultation were more likely to receive guidelines compliant evaluation and treatment, and were less likely to be re-admitted and die. When patients who died within 72 hours of presentation were excluded from analysis , patients without ID consults were still significantly more likely to die. These data will inform efforts to expand access to ID consultation for patients with SAB across our health system.

Disclosures

All Authors: No reported disclosures
P-865. Clinical Characteristics, Risk Factors and Outcome of Critically Ill Immunocompromised Patients with Bloodstream Infections and Sepsis
Authors: Vonineng Nirusdee , Sutherasan Yuda , Bruminhent Jackrapong
Published: January 2025

Background

Immunocompromised patients with sepsis have greater odds of in-hospital mortality compared to immunocompetent patients. A study focused on bloodstream infection (BSI) and sepsis in critically ill immunocompromised (CII) patients has not been extensively explored. We investigated the epidemiology of pathogens, risk factors, outcome, mortality associated with BSI and sepsis among CII patients.

Methods

A retrospective cohort study was conducted at the Medical Intensive Care Unit between January 2022 and December 2023. The participants included patients with immunocompromised status who had suspected sepsis and septic shock and developed documented BSI confirmed by positive blood cultures. A 1:1 propensity score matching without replacement was performed for creating comparable groups and used in Cox proportional hazards modeling to estimate the risk of all-cause mortality within 30 days.

Results

A total of 211 CII patients were included. The mean age (SD) was 61 (16) years, and 57% were male, with a median SOFA score (IQR) of 7 (4-11) and a median APACHE score (IQR) of 16 (14-20). The immunodeficiency profile included hematologic malignancy (37.4%), solid organ malignancy (27.0%), autoimmune disease (19.0%), solid organ transplantation (5.7%), others (10.4%). There were 85 cases (40.28%) had positive blood cultures, predominately showing gram negative rod bacteria (65.9%) focusing of P. aeruginosa (17%), E.coli (17%) and K.pneumoniae (14%). There were 103 (48.82%) patients died within 30 days (p=0.73). There were 85 well balanced matches paired to positive and negative hemoculture groups, respectively. In a propensity score–matched cohort, factors associated with 30-day mortality included a higher SOFA score and lactate level above 4 mmol/L, showing a trend towards increased risk with [HR 1.12 (95%CI, 1.04-1.20, P = 0.003] and [HR 1.91 (95%CI, 1.06-3.42, P=0.031), respectively. Additionally, underlying COPD/asthma appeared to be a protective factor [HR 0.20(95% CI, 0.06-0.66, P = 0.009)].

Conclusion

Among CII patients, BSI, especially those derived from gram-negative bacteria, are not uncommon. Severe conditions characterized by higher SOFA scores and persistently high lactate level from inadequate resuscitation are risk factors for mortality within 30 days.

Disclosures

All Authors: No reported disclosures
P-872. Clinical and Microbiological Trends in Citrobacter Bacteremia: A Study from South India
Authors: Mulla Rukhsar Abdur Rahim , Ananthanarayanan Rajalakshmi , Niyas Vettakkara Kandy Muhammed , Hussain Febeena
Published: January 2025

Background

Citrobacter spp are anaerobic Gram-negative bacilli, accounting for approximately 0.8% of all Gram-negative infections. This study aims to elucidate the clinical manifestations and drug susceptibility in Citrobacter infections.

Clinical features of patients with Citrobacter bacteremia and comparison between Citrobacter koseri and other Citrobacter spp

Methods

We conducted a retrospective analysis of Citrobacter spp. bacteremia cases from 2016 to 2022. We assessed clinical profile, species, antimicrobial susceptibility and 28-day outcome.

Blood cultures were processed using the BacT/ALERT, Vitek 2 system was employed for bacterial identification and antimicrobial susceptibility testing and reported as per CLSI criteria. Isolates with intermediate susceptibility were classified as non-susceptible.

Comparison of antibiotic susceptibility between C Koseri and other Citrobacter spp

Results

Over the 7 year study period, 25 cases of Citrobacter bacteremia were identified, 60% were males. The median age was 52.5 years (IQR: 46 – 75), with 2 pediatric cases.

The annual incidence of Citrobacter bacteremia displayed an upward trend, from 12% in 2016 to 24% in 2022. C. koseri emerged as the predominant species (72%), followed by C. freundii (24%) and C. farmeri (4%).

The majority of patients (72%) had diabetes, 16% had chronic liver disease, 12% had malignancy. Risk factors for Citrobacter bacteremia included the presence of an indwelling bladder catheter (76%) and a central venous catheter (44%). Urinary tract was the most frequent source (56%), followed by abdominal (20%) and soft tissue (8%); a newborn had meningitis with brain abscess. The mean for Pitt’s bacteremia score was 1.52±2.6. The mean Charlson’s co-morbidity index was 2.76±2.3. Clinical features for the entire cohort and comparative results between C Koseri and other Citrobacter spp (grouped as non-koseri) is depicted in figure 1.

Ciprofloxacin susceptibility was higher among C koseri (94%) as compared to other spp (71%). Antibiotic susceptibility for ceftriaxone was almost similar between the 2 groups. Susceptibility rates for other antibiotics and comparison between C Koseri and other spp are shown in figure 2. All isolates were susceptible to ertapenem, imipenem and amikacin. The overall 28-day mortality rate was 12%.

Conclusion

We found C. koseri more commonly, urinary source as the most common source and device presence as a significant risk factor. Antibiotic susceptibility was better for C. koseri compared to others.

Disclosures

All Authors: No reported disclosures
P-874. Clinical Characteristics and Outcomes Associated with Enterococcal Bloodstream Infections at an Integrated Healthcare Network
Authors: Rothman Ryan , BCHECH G E O R G E , Saleh Saleh , Bhanot Nitin , Abdulmassih Rasha
Published: January 2025

Background

Enterococcus spp. represent a frequent cause of blood stream infections in the United States. We wanted to gather data on clinical characteristics and outcomes associated with enterococcal bloodstream infections encountered at our quaternary care integrated health network.Table 1:Patient demographics and comorbiditiesBaseline characteristics of patients reviewed in the study, including their demographic data and underlying medical history

Methods

We conducted a multicenter retrospective chart review from 2022 to 2023 of patients hospitalized (community or healthcare acquired) with enterococcal bacteremia. Information on demographics, comorbidities, duration of treatment, readmission rates, and mortality were obtained.Figure 1:Prescribed treatmet duration

Treatment duration in patients who completed their prescribed antimicrobial therapy course

Results

146 patients (mean age 67.5 years) were identified with enterococcal bacteremia. Demographics and comorbidities are shown in Table 1. Prescribed treatment duration varied based on the underlying clinical presentation, and is outlined in Figure 1, which only includes patients who were able to complete the prescribed course. 30-day all-cause readmission was 34/146 (23.3%), with only 1 readmission due to recurrence of bacteremia. 30-day all-cause mortality was 51/146 (35%). Most of these patients (48/51; 94%) died prior to completing the antimicrobial therapy; 3/48 (6%) patients died following completion of an 11-14 day treatment course.

Conclusion

There was a significant burden of enterococcal bacteremia at our institution during the study period. Although 30-day readmission was seen in about 23% of patients, there was only 1 patient who was readmitted for recurrent bacteremia, notably in a patient who had not yet finished his prescribed course of antibiotics. Additionally, we encountered a high all-cause mortality rate of 35%, with the majority dying while on active antimicrobial therapy. These findings are congruent with other studies measuring the mortality rate of enterococcal bacteremia. This study highlights the importance of identifying high-risk comorbidities in patients that might portend a poor prognosis, and helps to educate both providers and patients on the overall prognosis of enterococcal bacteremia.

Disclosures

All Authors: No reported disclosures
P-889. Therapeutic Failures of High Inoculum Infections with Cefazolin: Role of A Rapid Test and Prevalence of the Cefazolin Inoculum Effect in Methicillin-Susceptible Staphylococcus aureus (MSSA) Bloodstream Infections
Authors: Flores Erika , Dziadula Jacob , Panesso Diana , Singh Kavindra , Carvajal Lina Paola , Rincon Sandra , Reyes Jinnethe , Ghosh Asmita , Wesley Long S , Cernoch Patricia L , Howden Benjamin , Tong Steven , Munita José M , Miller William R , Tran Truc Cecilia , Arias Cesar A
Published: January 2025

Background

Cefazolin (CFZ) remains a key therapy for MSSA bloodstream infections (BSIs), yet some studies suggest poorer outcomes when CFZ is used in the presence of cefazolin inoculum effect (CzIE). We developed a rapid colorimetric test with nitrocefin to detect CzIE in MSSA. Here, we report the performance of the rapid test in four recurrent BSIs caused by MSSA exhibiting the CzIE. Furthermore, we assess the local prevalence of CzIE using both standard broth microdilution (BMD) and the rapid test.

Methods

A chart review collected clinical data from four patients, including demographics, microbiologic features, antibiotic therapies, and clinical outcome. Patients were selected based on positive MSSA BSI after initial clearance, and availability of their index isolate. The nitrocefin-based rapid test was performed according to a published protocol. For the surveillance step, MSSA were collected from initial cultures of adult patients diagnosed with BSIs between July 2023 and April 2024 from 8 hospitals. The CzIE was assessed using BMD at standard (105) and high (107) inocula, with a cutoff CFZ MIC ≥ 16 μg/ml. The rapid test was performed in all isolates.

Results

All four patients had deep-seated infections, including endocarditis, osteomyelitis, or device-related infections, with two patients undergoing surgical interventions. While receiving CFZ therapy, all patients successfully cleared their MSSA BSI. After initial clearance, these patients received prolonged antibiotic therapy lasting ≥ 6 weeks, with 3 of 4 patients continuing with CFZ, as part of their initial therapy. Despite this, MSSA BSI recurred between 34 and 155 days after initial hospitalization. Notably, all index isolates tested positive for CzIE via the rapid test. During the surveillance period, we collected 196 isolates, with a 40% (79/196) prevalence of the CzIE based on BMD. The rapid nitrocefin test correctly identified 72 of 79 strains exhibiting the CzIE, with 91% sensitivity and 80.3% specificity.

Conclusion

These findings underscore a high prevalence of MSSA isolates exhibiting CzIE in BSIs. Patients infected with MSSA displaying CzIE may face an increased risk for recurrence when treated with CFZ. Further validation of these observations is warranted to better understand their clinical implications.

Disclosures

José M Munita, MD, MSD: Grant/Research Support|Pfizer: Grant/Research Support William R. Miller, M.D., Merck: Grant/Research Support|UptoDate: Royalties
P-892. Impact of early continuous renal replacement therapy in patients with septic acute kidney injury: an analysis of the MIMIC-IV database
Authors: Lee Yongseop , Seo Jun Hye , Seong Jaeeun , Ahn Sangmin , Han Min , Lee Jung Ah , Kim Jung Ho , Ahn Jin Young , Jeong Su Jin , Choi Jun Yong , Yeom Joon-sup , Oh Hyung Jung , Ku Nam Su
Published: January 2025

Background

Renal replacement therapy (RRT) is an important treatment option for septic acute kidney injury (AKI); however, the optimal timing for its initiation remains controversial. Here, we aimed to investigate the clinical outcomes of early continuous renal replacement therapy (CRRT), which was defined as CRRT initiation within 6 hours of the onset of septic AKI, which is earlier than the time of initiation defined in previous studies.Figure 1.Study flowchart.

Methods

We used clinical data sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. This study included patients aged ≥18 years who met the sepsis diagnostic criteria and received CRRT because of stage 2 or 3 AKI. Early and late CRRT were defined as CRRT initiation within 6 hours and after 6 hours of the development of septic AKI, respectively.Table 1.Clinical characteristics of patients with sepsis after propensity matching

Results

Of the 33,236 patients diagnosed with sepsis, 553 underwent CRRT for septic AKI. After excluding cases of early mortality and patients with a history of dialysis, 45 and 334 patients were included in the early and late CRRT groups, respectively. After propensity score matching, the 28-day mortality rate was significantly lower in the early CRRT group than that in the late CRRT group (26.7% vs. 43.9%, P=0.035). The early CRRT group also had a significantly greater number of days free of mechanical ventilation (median days, 19; interquartile range [IQR] 3–25) and vasopressor administration (median days, 21, IQR 5–26) than did the late CRRT group (median days, 10.5; IQR, 0–23; P=0.037 and median days, 13.5; IQR, 0–25; P=0.028, respectively). The Kaplan–Meier curve also showed that early CRRT initiation was associated with an improved 28-day mortality rate (log-rank test, P=0.040). In contrast, there was no significant difference in the 28-day mortality between patients who started CRRT within 12 h and those who did not (log-rank test, P=0.237).Table 2.Clinical outcomes of patients with sepsis after propensity score matching

Conclusion

Early CRRT initiation can improve the survival of patients with septic AKI. CRRT must be initiated as early as possible after the onset of septic AKI, preferably within 6 hours.Figure 2.Kaplan-Meier survival curves of patients with septic acute kidney injury after propensity score matching.A. Comparison of 28-day survival and B. 90-day mortality among patients with sepsis between continuous renal replacement therapy initiation < 6 hours and ≥ 6 hours. C. Comparison of 28-day survival and D. 90-day mortality among patients with sepsis between continuous renal replacement therapy initiation < 12 hours and ≥ 12 hours.

Disclosures

All Authors: No reported disclosures
P-895. Perceptions of Bias and Discrimination Among Antimicrobial Stewardship Providers
Authors: Giuffre Allison M , Taylor Lindsay , Cinnamon Katie , Osman Fauzia , Tischendorf Jessica S
Published: January 2025

Background

Bias and discrimination influence the experience of many in healthcare, and antimicrobial stewardship providers are no exception as demonstrated by work documenting differential uptake of recommendations made by men and women stewards. In this mixed method study, we explored the perceptions and experiences of bias and discrimination among antimicrobial stewards.

Methods

We conducted a nationwide survey of stewardship providers including physicians, pharmacists, advanced practice providers and trainees. Participants were recruited via convenience sampling using X and professional listservs during May and June 2023. We solicited steward and program demographics and responses to statements exploring bias and discrimination in the execution of stewardship duties through a 67-item electronic survey (Qualtrics). Statistical analysis using chi-squared were performed in STATA. We further explored these experiences through semi-structured interviews.

Results

Stewards identifying as females and those with < =5 years were more likely to report their identities negatively influenced interactions with primary teams than male and more experienced stewards, respectively (table 1). Similarly, female stewards and those with the least experience reported these identities negatively influenced their interactions with health system representatives compared to male and more experienced stewards, respectively (table 2). Although there was no difference in the reported negative influence of race/ethnicity on interactions with primary teams, more non-white stewards reported their race/ethnicity negatively influenced interactions with health system representatives (tables 1 & 2). Themes from our 16 interviews illuminated sources of perceived bias, the impact they had, and strategies to mitigate the influence of these biases.

Conclusion

Bias and discrimination are felt disproportionately by women and junior antimicrobial stewardship providers and can lead to poor job satisfaction and lack of perceived effectiveness. Acknowledging these experiences and equipping stewards with strategies to mitigate the harmful personal, professional and programmatic effects of bias and discrimination should be a priority of institutions and professional societies.

Disclosures

Jessica S. Tischendorf, MD, MS, Merck: Grant/Research Support
368. Impact of Social Determinants of Health (SDOH) on Outcomes of OPAT (Outpatient Parenteral Antimicrobial Therapy)
Authors: Sportiello Mike , Burgoyne Colleen , Yamshchikov Alexandra
Published: January 2025

Background

Complex infections may warrant extended antibiotics traditionally reserved for inpatient settings. OPAT is safe and cost effective, allowing return to regular activities and decreased risk of hospitalization. Understanding of SDOH-sensitive risk parameters and impact on adverse events is needed to guide safety and adherence interventions.Figure 1.Most Common OPAT Antibiotics and Indications in Study Cohort

Methods

Records of patients treated 7/15-10/31/2023 by URMC OPAT program, exclusive of concurrent Transitions of Care Program, were retrospectively reviewed for race, social vulnerability index, insurance type, substance use, needs insecurity, household composition, and outcomes such as OPAT-related orders errors, intravascular device (IVAD) complications, emergency utilization, organ system adverse events, and clinical outcome. A composite Undesirable OPAT Outcome was derived. The impact of SDOH was assessed by chi-square, univariate and multivariate logistic regression using R v4.3 3, rstatix v0.7.2, and sjPlotv2.8.15.Table 1.Proportion and Rates of Errors, Complications, and OPAT Treatment Outcomes in Study Cohort

Results

Total 116 patients received 3573 OPAT days for varying indications (Fig 1). High rates of discharge order errors, ED utilization, IVAD complications, adverse events, and composite Undesirable Outcomes were noted (Table 1). Those with public insurance (OR=13.6, CI: 1.95-322) or who used cannabis (OR=5.23 CI: 1.1- 27.2) were more likely to incur a laboratory order error on discharge. Patients of color were more likely to experience IVAD complications (OR=3.61, CI: 1.1-12.6) and multiple organ system adverse events (OR= 6.55, CI: 1.45-34.9). High-risk tobacco use was associated with shortened OPAT duration due to adverse event (OR=28.47, CI: 1.72-1299) (Fig 2). OPAT patients with public insurance were least likely to follow up with the ID clinic (OR=7.65, CI: 1.27-152). Time to ID follow-up correlated with multiple SDOH parameters, with publicly insured and persons of color experiencing significantly longer time to follow-up appointments (Fig 3). Incurring a non-IVAD adverse event correlated to composite undesirable outcome in multivariate analysis.Figure 2.Odds Ratios in Univariate Analysis of OPAT Complications Based on Social Determinants of Health

Conclusion

Social determinants may be predictors in OPAT-related unwanted events. A dedicated focus of evaluating SDOH as contributing drivers of adverse OPAT outcomes may assist creating interventions to support marginalized patient groups.Figure 3:Time-to-event probability analysis for timing of post-discharge ID clinic follow up among OPAT patients by Insurance Type (3A), Race (3B), and All Patients (3C)

Disclosures

All Authors: No reported disclosures