bluuebunny/crossref_metadata_2025 huggingface dataset:
P-2244. Prevalence of Antifungal Allergies in the General Population
Authors: Shiferaw Meron , Donnelley Monica , Thompson George R
Published: January 2025

Background

The use of antifungal agents continues to increase yearly and coincides with the growing immunocompromised patient population. Therapy may be prescribed as prophylaxis or treatment in fungal disease care. The emergence of novel fungal pathogens, antifungal resistant species, and infection control concerns pose challenges to antifungal agents' use. However patient tolerability remains a significant issue and documented allergic reactions to antifungal agents have not previously been reported.

Primary Outcome

1.7 million patients assessed for reported antifungal allergy

Methods

A multi-site, population health, retrospective cohort review was conducted including all healthcare sites within the University of California system. All inpatient and outpatients with an antifungal allergy reported in 2023 were included. Specifically, patients reporting an allergy to a systemic antifungal agent or with a general antifungal allergy ICD-10 T36.7. The following systemic antifungals were included: fluconazole, voriconazole, isavuconazole, posaconazole, itraconazole, amphotericin B formulations, micafungin, caspofungin, anidulafungin, and/or flucytosine. The primary outcome of this study was the rate of reported antifungal allergy among a general population. Secondary outcome, the incidence of antifungal allergies among patients with documented administration of antifungal agent.

Baseline Characteristics

Results

During the study period 1,704,176 patients were screened for reported antifungal allergy, and 2598 patients exhibited a documented antifungal allergy. An allergy to a specific antifungal agent was reported in 2203 patients, while 395 patients reported an unspecified antifungal allergy. From greatest to least reported: fluconazole 1,591 (0.093%), general antifungal allergy 395 (0.023%), triazole 361 (0.021%), itraconazole 145 (0.009%), amphotericin 110 (0.006%), flucytosine less than 10 (0.001%) (Table 1). Secondary outcome 9,976 patients received an antifungal agent and 496 reported an antifungal allergy.

Table 1

Conclusion

This is the first study to report antifungal allergy rates in the general population. It assessed over 1.7 million patients and found the allergy rate to be low at 0.15%. Future work evaluating the utility of skin testing, cross-allergenicity, and desensitization strategies should be performed.

Secondary Outcome

Disclosures

George R. Thompson, III, MD, Astellas: Advisor/Consultant|Cidara: Advisor/Consultant|Cidara: Grant/Research Support|F2G: Advisor/Consultant|F2G: Grant/Research Support|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Pfizer: Advisor/Consultant
P-2250. Metagenomic Next Generation Sequencing Enhances Rickettsial Infection Diagnosis in Patients with Acute Undifferentiated Fever
Authors: Weiss Sonja , Phoompoung Pakpoom , Yamaguchi Julie , Berg Michael G , Averhoff Francisco , Cloherty Gavin , Suputtamongkol Yupin
Published: January 2025

Background

Murine and scrub typhus are common causes of acute undifferentiated fever (AUF) in tropical regions, after malaria, dengue fever, and typhoid fever have been ruled out. While indirect immunofluorescence assay (IFA) can diagnose both diseases, accuracy depends on when the sample is collected. To improve detection, we used unbiased metagenomic Next Generation Sequencing (mNGS) on 969 AUF patient samples with negative IFA results from Siriraj Hospital, Bangkok, Thailand collected between 2015 and 2021.

Methods

Plasma was pre-treated with benzonase before extraction on an Abbott m2000 instrument. mNGS libraries were prepared from double-stranded cDNA with Illumina Nextera XT reagents then sequenced on a NextSeq. Reads were taxonomically classified by Abbott pipelines SURPI or DiVir and mapped in CLC Bio Genomics Workbench (Qiagen, Inc).

Results

During the study period, a total of 2,465 samples were analyzed by IFA, identifying 58 (2.4%) cases of murine typhus and 26 (1.2%) cases of scrub typhus. Among IFA negative samples, mNGS identified Rickettsia spp. in 27 cases (2.8%), including R. typhi (murine typhus) (n=19), R. felis (n=5), and R. rickettsii, R. prowazaki, and R. australis (n=1 each). Notably, mNGS identified Orientia tsutsugamushi (scrub typhus) in one sample missed by IFA.

For patients with mNGS-detected R. typhi, serological confirmation was achieved in 2 cases. Another 13 were classified as probable based on clinical presentation, while 4 cases lacked conclusive clinical correlation. For patients with R. felis identified by mNGS, 4/5 had confirmed or probable diagnoses based on clinical symptoms. The inconclusive case was a 65-year-old man with a urinary tract infection who died from sepsis for which mNGS revealed a co-infection with R. felis and Serratia marcescens. Interestingly, none of the mNGS positives for R. rickettsii, R. australis, and R. prowazaki had clinical presentations that supported the diagnoses.

Conclusion

mNGS significantly enhances the diagnosis of rickettsial infections, particularly for murine typhus. This improved diagnostic capability provided by mNGS holds promise for improved management of AUF patients, potentially reducing unnecessary testing and inappropriate antibiotic use.

Disclosures

Sonja Weiss, BS, Abbott Laboratories: Employee Julie Yamaguchi, BS, Abbott Laboratories: Employee Michael G. Berg, PhD, Abbott Laboratories: employee|Abbott Laboratories: Stocks/Bonds (Public Company) Francisco Averhoff, MD, MPH, Abbott Laboratories: Employee Gavin Cloherty, PhD, Abbott Laboratories: Employee
P-2255. Peri-Transplant Antibiotic Use and Multidrug Resistant Infections in Liver Transplantation
Authors: Contag Caitlin A , Deng YaoWei , Rodriguez-Nava Guillermo , Zimmet Alex , Shen Sa , Nelson Joanna K , Subramanian Aruna , Kwong Allison , Ferguson Jessica
Published: January 2025

Background

Understanding antibiotic use patterns and risk of infection with multi-drug resistant organisms (MDROs) in the peri-transplant period is crucial to successful post-liver transplant care.

Methods

Clinical data from patients who underwent liver transplant after the initiation of ICD-10 coding were obtained using Stanford University’s central database. Data were processed and analyzed in R studio and Excel.

Results

During the study period, 645 patients underwent liver transplantation. The median age at transplantation was 60.8 years (IQR 18.9, 82.4) and 222/645 (34%) were female. In the 30-day pre-transplant period, 21/645 (3%) patients developed bacteremia or fungemia, and in the 30-day post-transplant period, 30/645 (5%) patients developed bacteremia or fungemia. Enterococcus faecium was the most common cause of bacteremia (25/60 positive blood cultures), followed by enteric gram-negative rods (16/60 positive blood cultures). All E. faecium causing bacteremia was vancomycin resistant (25/25, 100%), and 9/16 (56%) gram negative rod isolates from blood were MDROs.

The overall antibiotic days per thousand inpatient days in the 30-day pre- and post-transplant period was 374. The most used group of antimicrobials was anti-Pseudomonal β-lactams, with 255.4 days of use per thousand inpatient days (Figure 1). Vancomycin had 83.8 days of use per thousand inpatient days but was more frequently used in patients who had an MDRO isolated from at least one body site than in patients who did not have an MDRO isolated (104.7 days vs 76.8 days per thousand inpatient days).

Patients with at least one MDRO isolated 30 days pre- or post-transplant had significantly higher 90-day and 1-year mortality compared with patients who had positive cultures but did not have an MDRO isolated (12.1% vs 1.8%, p=0.01; 17.6% vs 7.3%, p=0.02), as well as a longer length of post-transplant hospitalization that did not meet statistical significance (14.3 days vs 10.8 days, Table 1).

Conclusion

Liver transplant patients are at high risk for colonization and infection with MDROs in the peri-transplant period and have high rates of antimicrobial use. For this patient cohort, presence of an MDRO is associated with higher rates of mortality and longer lengths of stay in the post-transplant period.

Disclosures

All Authors: No reported disclosures
P-2298. Daily Single-strength vs. Thrice-weekly Double-strength Trimethoprim/sulfamethoxazole for Pneumocystis jirovecii Prophylaxis in Kidney Transplant Recipients: A Non-inferiority Randomized Controlled trial
Authors: Chantapoh Wittawin , Kantachuvesiri Surasak , Sutharattanapong Napan , Bruminhent Jackrapong
Published: January 2025

Background

Pneumocystis jirovecii pneumonia (PCP) is commonly encountered among kidney transplant (KT) recipients. Either daily or thrice-weekly, single strength (SS) or double strength (DS) trimethoprim/sulfamethoxazole (TMP/SMX) is recommended after KT to prevent PCP. However, a direct comparison between these regimens in terms of PCP prevention is lacking. We assessed the efficacy of SS daily (DSS) versus DS thrice weekly (TDS) TMP/SMX prophylaxis for PCP within the first 6 months post-transplant in KT recipients.

Methods

We conducted a single-center block of 4 randomized, open-label, non-inferiority, randomized controlled trial at a single transplant center between December 2022 and December 2023. All KT recipients 15 years and older were included. The single-strength group received TMP/SMX 80/400 mg daily after KT, while the double-strength group received two tablets of SS doses thrice weekly. PCP occurrence was observed for 6 months, and side effects of TMP/SMX and ease of drug consumption were monitored.

Results

A total of 65 KT recipients were included. The participants had a mean age (SD) of 46 (11) years old, with the following proportion: male gender (58%), deceased donor KT (20%), anti-thymocyte globulin as induction therapy (17%), and CMV seropositivity (95%). There were 32 and 33 KT recipients assigned to the DSS and TDS groups, respectively. Baseline characteristics between the two groups were comparable. At 6 months after transplant, all patients remained free from PCP in both groups. There was a non-significant lower mean (SD) of white blood cell counts in the DSS group compared to the TDS group [6,235 (2,271) vs.7,052 (2,464) cells/mm3, p = 0.23], respectively. In parallel, there was no significant difference in terms of hepatotoxicity or renal dysfunction among those groups. According to per-protocol analysis, 27 (96%) of the DSS group reported having convenient administration of the drug compared to 18 (100%) of the TDS group (p = 0.60).

Conclusion

TMP/SMX appears to efficiently prevent PCP in the early period after KT. Both SS daily and DS thrice-weekly regimens seem to be comparable in terms of effectiveness, tolerability, and compliance. Further studies with larger samples are encouraged to support this result. TCTR20240329004.

Disclosures

All Authors: No reported disclosures
P-42. Systematic review and meta-analysis of recombinant herpes zoster vaccine in immunocompromised populations
Authors: Marra Fawziah , Yip Michael , Cragg Jacquelyn , Vadlamudi Nirma K
Published: January 2025

Background

Herpes zoster infection is common in immunocompromised individuals. Recently, the Advisory Committee on Immunization Practices recommended immunizing with the recombinant zoster vaccine (RZV).

Methods

Objective: To evaluate the efficacy, immunogenicity and safety of RZV in immunocompromised individuals, such as transplant recipients, cancer patients undergoing chemotherapy, individuals with preexisting autoimmune diseases and HIV-infected patients.

Data Sources and Study Selection: From January 1984 to October 2023, a systematic search of PubMed, MEDLINE, EMBASE, Scopus, Web of Science, CINAHL, and Cochrane CENTRAL was performed. Randomized clinical trials (RCT) evaluating RZV compared to placebo in immunocompromised adults were selected.

Data Extraction and Synthesis: Study characteristics and estimates on the incidence of herpes zoster, humoral and cellular immune responses, and safety data were extracted from studies. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using subgroup meta-analysis and metaregression.

Results

Seven RCTs were included. Compared to placebo, RZV reduced the incidence of herpes zoster across all ages by 81% (RR: 0.19, 95%CI: 0.09, 0.44), with moderate heterogeneity across the studies (I2 = 60.49%; τ2 = 0.31; P=0.07). RZV significantly increased humoral and cellular immunity one month after the last dose. Transplant and past malignancy were associated with lower immunogenicity. RZV was more reactogenic with more local and systemic adverse events. There was no difference in serious adverse events or death between the vaccine and placebo arms.

Conclusion

This study suggests that RZV reduces the risk of herpes zoster infection in immunocompromised individuals. This vaccine should be routinely offered to immunocompromised individuals, preferably before chemotherapy or treatment.

Disclosures

All Authors: No reported disclosures
P-67. Safety of Omadacycline Versus Standard-of-Care Oral Antibiotic Treatment for Bone and Joint Infections: Interim Results from an Open-Label, Non- Inferiority, Randomized Controlled Trial
Authors: Kang Amy Y , Garcia Delgado Guarina , Phan Tran Donna , Flores Evelyn A , Romo-Kozan Vanessa , Payan Isabel , Miller Loren G
Published: January 2025

Background

The incidence of bone and joint infections (BJIs) continues to increase, and existing oral BJI antibiotics have limitations. Omadacycline may be a potential treatment option for BJI treatment due to activity against doxycycline-resistant S. aureus and ESBL-producing Enterobacterales for which there are often no viable oral options. However, the safety of omadacycline in this setting is poorly defined.

Methods

We performed an open label, randomized, controlled clinical trial of adults with BJIs in the outpatient setting. Participants were randomized to omadacycline-containing regimen (omadacycline 300mg po daily) or Standard-of-Care (SOC) antibiotics. Adjunctive antibiotics were permitted in addition to omadacycline. Safety labs were performed at regular intervals. Herein, we report an interim, descriptive analysis of safety data.

Results

Among the 59 participants enrolled to date, 31 (53%) were randomized to the omadacycline-containing regimen and 28 (47%) to SOC. Median age was 58 years old, 52 (88%) were male, 44 (75%) identified as Hispanic, 8 (14%) as African-American, and 4 (6%) as white. The most common BJIs were diabetic foot infections (52, 88%) and device infections (5, 8%). (Table) Combination therapy was used in 16 (52%) vs. 12 (43%) in the omadacycline-containing vs. SOC arms, and IV only therapy was used in 0 (%) vs. 5 (18%) in the two arms, respectively. Most commonly used SOC regimens included ciprofloxacin (8, 29%), doxycycline (7, 25%), amoxicillin/clavulanate (6, 21%), and levofloxacin (3, 11%). Commonly associated laboratory abnormalities included new or worsening renal insufficiency (2 (6%) in the omadacycline-containing arm vs. 5 (18%) in SOC) and transaminitis (2 (6%) vs. 4 (14%)). Adverse events were similar in the omadacycline-containing vs. SOC arms including nausea (6 (19%) vs. 4 (14%)), vomiting (0 (0%) vs. 4 (14%)), and diarrhea (5 (16%) vs. 2 (7%)). (Table) There was 1 drug-related serious adverse event in the omadacycline-containing arm due to likely hypersensitivity to omadacycline; the event resolved after drug discontinuation.

Conclusion

In this interim analysis of our ongoing trial, the safety of omadacycline for BJI appears to be similar to the SOC. More robust data on long-term safety is warranted.

Disclosures

Amy Y. Kang, Pharm.D., BCIDP, Paratek Pharmaceutical: Grant/Research Support 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
P-84. Microbiologic and histologic concordance of pedal osteomyelitis and association with infection progression
Authors: Maier Marissa , Bajema Kristina L , Madrid-Morales Julieta , Bosch Robert
Published: January 2025

Background

Diabetes-related infections and peripheral artery disease are the leading causes of foot amputation worldwide, resulting in significant morbidity and mortality. Clinical management practices vary widely. We sought to describe the concordance of microbiology and pathology results among persons undergoing forefoot or midfoot bone resection.

Methods

We conducted a retrospective cohort study of adults in Veteran’s Administration (VA) care who underwent forefoot or midfoot bone debridement at VA Portland from January 1, 2017 through December 31, 2019. We used VA’s Corporate Data Warehouse, a centralized database with comprehensive demographic and clinical data, and obtained additional clinical information through chart review. We excluded patients who underwent hindfoot debridement, or intervention on the ipsilateral foot within the preceding year. We defined positive pathology as acute or chronic osteomyelitis and positive microbiology as any bacterial growth from the resection clean margin. Descriptive analyses included calculation of the proportion of individuals with both microbiology and pathology results available versus microbiology or pathology results alone.

Results

From January 1, 2017 – December 31, 2019, there were 379 eligible resections performed among 343 patients, who were 97% male, 82% white, and with median age 69 years. Of the 379 resections, 44% (N=167) had both microbiology and pathology results, 11% (N=44) had microbiology alone, and 45% (N=172) had pathology alone.

Of resections with both microbiology and pathology results, 87% (146/167) had bacterial growth and 58% (97/167) had osteomyelitis on pathology; bacterial growth was present in 90.7% and 82.6% of specimens with and without osteomyelitis on pathology, respectively. Of those with microbiology alone, 93% (41/44) had bacterial growth. Of those with pathology alone, 50% (87/172) had osteomyelitis on pathology.

Conclusion

Similar proportions of bacterial growth were observed whether pathology evidence of osteomyelitis was present. The utility of microbiology results alone to inform antibiotic treatment decisions requires further study.

Disclosures

All Authors: No reported disclosures
P-96. Efficacy and Safety of Lactobacillus reuteri Supplementation Combined with Triple Therapy for Eradicating Helicobacter pylori: An Updated Meta-Analysis of Randomized Controlled Trials
Authors: Elkoumi Omar , Elkoumi Ahmed , Khaled Elbairy Mariam , Khaled Elnegiry Amr , Ghanem Ahmed
Published: January 2025

Background

The efficacy of Helicobacter pylori (H. pylori) triple therapy is declining over time. Lactobacillus reuteri (L. reuteri) is a probiotic that has shown promising results for eradicating H. pylori and decreasing adverse events. We aim to assess the efficacy of adding L. reuteri to the standard triple therapy for H. pylori eradication.

Methods

We systematically searched PubMed, Embase, Cochrane Central, Web of Science (WOS), and Scopus databases from inception until May 2nd, 2024. We included any randomized controlled trial comparing individuals receiving viable L. reuteri or a placebo preceding, during, or after the standard triple therapy for H. pylori eradication. We used Review Manager 5.4 for all statistical analyses.

Results

Seven randomized controlled trials with a total of 518 patients were included in the meta-analysis. We found that patients who received L. reuteri added to their triple therapy showed a higher eradication rate than those with triple therapy alone (HR: 1.16, 95% CI [1.03, 1.31], p = 0.01). The pooled results showed that the addition of L. reuteri to the triple therapy resulted in a significantly lower risk of taste distortion (RR: 0.59, 95% CI [0.39, 0.90], p = 0.01), diarrhea (HR: 0.44, 95% CI [0.28, 0.71], p = 0.0007), and constipation (HR: 0.52, 95% CI [0.31, 0.87], p = 0.01). There was no difference between both groups in experiencing epigastric pain (HR: 0.62, 95% CI [0.29, 1.33], p = 0.22), or nausea/vomiting (HR: 0.61, 95% CI [0.16, 2.40], p = 0.48).

Conclusion

In contrast to a previous meta-analysis, L. reutri supplementation improved the H. pylori eradication rate. Adding L. reuteri to the triple therapy decreased diarrhea, constipation, and taste distortion compared to the standard triple therapy alone. To reinforce our conclusions, further clinical trials with larger sample sizes are required.

Disclosures

All Authors: No reported disclosures
P-104. Impact of Sepsis-Induced Cardiomyopathy on Clinical Outcomes in Sepsis Patients
Authors: Wan Kim Tae , Ko Ryoung-Eun
Published: January 2025

Background

Despite the known impact of cardiac function on sepsis outcomes, there is limited understanding of how ejection fraction (EF) influences hospital mortality in patients with sepsis-induced cardiomyopathy. This study assesses the severity of cardiac dysfunction determined by echocardiography within the first 24 hours of sepsis diagnosis on hospital mortality.

Methods

In this retrospective cohort study, 2,504 patients diagnosed with sepsis and who underwent echocardiography within 24 hours were analyzed. Based on EF, patients were classified into normal (EF ≥ 50%), moderate dysfunction (30% ≤ EF < 50%), and severe dysfunction (EF < 30%). The primary outcome was hospital mortality. Multivariable logistic regression was employed to identify factors associated with increased mortality, adjusting for clinically and statistically significant variables.

Results

Among the study patients, 1,803 (72%) had a normal EF, 356 (14.2%) had moderate dysfunction, and 115 (4.6%) had severe dysfunction. The hospital mortality was significantly higher in the severe dysfunction group at 40.0%, compared to 29.5% in moderate and 25.7% in normal EF groups (P=0.023). In multivariable analysis, severe cardiac dysfunction, inappropriate initial antibiotic therapy, and certain sites of infection were significantly associated with increased hospital mortality.

Conclusion

The decreased EF among sepsis patients is correlated with increased organ failure and higher mortality rates compared to patients with normal cardiac function.

Disclosures

All Authors: No reported disclosures
P-145. Parasitological characterization of stool samples from indigenous Wayuu children from La Guajira, Colombia
Authors: Carolina Hernandez Derly , Judith Benavides Clara , Tatiana Saenz Angie , Sanchez Gil Maria Valentina , Ariza Marín Diego Sebastian , Hernandez Diaz Tatiana Alejandra
Published: January 2025

Background

La Guajira, 396,511 children and most of them recognized as Wayuu indigenous population. They have many public health problems in primary services. This children are at high risk of suffering from intestinal parasitosis. The most common are Entamoeba histolytica (EH) and Giardia duodenalis (GD) in their infectious forms. The common source is contaminated food and water. Geohelminth (GH) infections can be complicated by pulmonary compromise and worsening health of children with nutritional problems. In Colombia, primary care for intestinal parasitosis is albendazole. As part of the social interest we want to know the main species that we can find in the feces of a group of these children to know if primary treatment with albendazole is sufficient.

Coccidial structures by Ziehl-Neelsen (ZN)

Methods

Descriptive cross-sectional study. On December 2023 was assessing 44 coprological samples. Containers were labelled, consent and informed assent were signed. They were preserved in MIF reagent and stored at 4°C, processed by Formalin-Gasoline (F-G) with the addition of parasitological lugol for microscopic evaluation under 10x and 40x objectives. Coccidial structures were observed by Ziehl-Neelsen (ZN) staining with a 100x objective, both calibrated with a micrometer. The variables was analized by frequencies and measures of central tendency.

Trophozoite of Entamoeba histolytica

Results

44 samples were included. Abnormal results were found in 42/44 (95.5%) by ZN technique; 44 (95.5%) Microsporidium and 23 (52.3%) Cryptosporidium. In the F-G and addition of parasitological lugol, abnormal results were found in 38/44 (86.4%). Regarding Protozoa, 18 (40.9%) were found GD cysts, 36 (81.8%) B. hominis, 8 (18.2%) E. nana, 12 (27.3%) EH trophozoites and 2 (4.5%) C. Mesnili. Regarding GH, 2 (4.5%) were found with S. stercoralis and A. lumbricoides and 1 (2.3%) H. nana. Both ZN staining and parasitological lugol staining showed 19 (43.2%)C. cayetanensis and 14 (31.9%) C. belli.

Cysts of Giardia Duodenalis

Conclusion

The frequency of PI was 95.5%, 42 (95.5%) protozoan and 5 (11.4%) GH. The most frequent isolates were Microsporidium, B. hominis and GD. Perhaps we could offer another deworming treatment in this population. This description could be the basis for other studies in this population to offer better alternatives and make the public health situation in this scenario more visible to the government.

Egg of Hymenolepis nana

Disclosures

All Authors: No reported disclosures
P-151. Cutaneous Larva Migrans Within the United States Military Health System and Association with International Travel
Authors: Crecelius Elena , Hickey Patrick , Helfrich Alison
Published: January 2025

Background

Cutaneous larva migrans (CLM) is a parasitic dermatitis which occurs after zoonotic hookworm larva from the soil penetrate the skin. CLM is most common in tropical and sub-tropical regions of the world and in returning travelers from those regions. Within the United States (U.S.) autochthonous cases of CLM have been reported, however the epidemiology is not well-described. We seek to describe the epidemiology of CLM and association with geographic location and international travel within the U.S. military health system.

Methods

We performed a retrospective cohort study of active duty service members and their family members who had a diagnosis code of hookworm between October 2012 and September 2018. Of the initial cohort (n = 272), 61 (22.4%) were diagnosed with CLM.

Results

Most patients in this study were male (65.5%), active duty (55.7%), and white (45.9%) [Table 1]. Patients’ ages ranged from 1 to 56 years (mean 24.6) with 80.3% of patients 18 years of age or older. All the patients were born within the United States. Most were diagnosed by their primary care manager, however 19.7% were diagnosed via emergency or urgent care. Patients reported preceding travel to tropical and subtropical world regions in 32.8% of cases: Caribbean (13.1%), Africa (6.6%), Mexico and Central America (6.6%), South America (3.3%) and Japan (3.3%) [Figure 1]. After excluding those with preceding international travel, 67.2% of patients had autochthonous CLM. Of the autochthonous cases, more patients were diagnosed or had preceding travel in the southeast U.S. (68.3%) compared with the western U.S. (19.5%), southwest U.S. (9.8%), or northeast U.S. (2.4%) [Figure 2]. States with the highest number of cases were Florida (26.7%), Georgia (14.6%), North Carolina (9.8%), Texas (9.8%), Washington (7.3%) and Hawaii (7.3%). Based on the reported literature, we found a lower number of cases with preceding international travel than expected. Most autochthonous cases within the U.S. were from the southeast and coastal regions.

Conclusion

CLM should be considered in the U.S. even in patients without recent international travel. These findings are useful in providing nationwide data on the epidemiology of CLM and allowing for informed preventative counseling to travelers and non-travelers within the U.S.

Disclosures

Alison Helfrich, DO, MPH, Moderna: Stocks/Bonds (Public Company)|Sanofi: Stocks/Bonds (Public Company)
P-170. Efficacy and Safety of Intermittent Preventive Treatment with Dihydroartemisinin-Piperaquine for Prevention of Malaria in Pregnant Women with HIV: A Meta-analysis of Randomized Controlled Trials
Authors: Joseph Meghna , Murali Krishna Mrinal , Ezenna Chidubem , Sadasivan Sreemathy Lal
Published: January 2025

Background

WHO recommends intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (S-P) in malaria-endemic areas. In pregnant women with HIV taking cotrimoxazole prophylaxis, IPTp with S-P is contraindicated due to the risk of adverse effects from combining two antifolate and sulfonamide drugs. The growing resistance of the malarial parasite to sulfa-based drugs adds to the problem. We performed a meta-analysis comparing IPTp with dihydroartemisinin-piperaquine (D-P) vs. placebo for malaria prevention in pregnant women with HIV.

Methods

We searched PubMed, Scopus, Cochrane Central, LILACS, and Malaria in Pregnancy Consortium Library databases for trials comparing IPTp with D-P vs. placebo in pregnant women with HIV. Outcomes of interest included placental malaria, maternal malaria, and adverse pregnancy outcomes. Statistical analysis was performed using R software. Heterogeneity was assessed using I2 statistics. The analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline.

Results

The systematic review identified 3 randomized controlled trials including 1,770 participants. Placental malaria (RR 0.65; 95%CI 0.48-0.87; p=0.004; I2=2%) at delivery was significantly lower in the D-P group compared with the placebo group. Maternal malaria (RR 0.63; 95%CI 0.29-1.40; p=0.258; I2=22%) at delivery showed no significant difference between the groups. However, a leave-one-out analysis excluding one study conducted during a low-transmission period found a significantly lower risk of maternal malaria (RR 0.47; 95%CI 0.23-0.96; p=0.039; I2=0%) in the D-P group. Adverse pregnancy outcomes like mother-to-child transmission of HIV (RR 1.53; 95%CI 0.25-9.35; p=0.646; I2=0%), spontaneous abortion (RR 1.80; 95%CI 0.60-5.42; p=0.296; I2=0%), stillbirth (RR 1.02; 95%CI 0.56-1.85; p=0.952; I2=0%), congenital anomaly (RR 0.90; 95%CI 0.33-2.43; p=0.830; I2=31%), preterm delivery (RR 1.05; 95%CI 0.56-1.94; p=0.885; I2=42%), and low birth weight (RR 1.13; 95%CI 0.87-1.48; p=0.352; I2=0%) were similar in both groups.

Conclusion

IPTp with D-P reduced the risk of placental malaria and maternal malaria at delivery in pregnant women with HIV. Adverse pregnancy outcomes were similar in both groups.

Disclosures

All Authors: No reported disclosures
P-191. Outcomes of Clostridioides difficile Infection in Patients Treated with a Partial versus Complete Course of Fidaxomicin
Authors: Rosario Caroline , Rausch Ethan P , Soman Rohit , Beckman Kaitlin , Lefemine Amanda
Published: January 2025

Background

Current guidelines recommend fidaxomicin as the preferred treatment for initial and recurrent non-fulminant Clostridioides difficile infection (CDI). However, widespread use of fidaxomicin in practice is limited by high cost and inconsistent insurance coverages which may necessitate partial completion of a fidaxomicin course with an alternative antibiotic. Currently, to our knowledge, there is no published literature to describe how this impacts CDI treatment outcomes.

Methods

This was a retrospective, multicenter cohort study of hospitalized patients with CDI treated with fidaxomicin from May 2022 through August 2023. Patients treated with a full course of fidaxomicin (≥20 doses) were compared to those treated with a partial course of fidaxomicin (< 20 doses). Included patients were age ≥18 years, received ≥6 inpatient doses of fidaxomicin, and had a stool sample positive for C.difficile. Demographic and clinical data were collected via electronic medical record review. The primary outcome was 90-day CDI recurrence. Secondary outcomes were 30-day CDI recurrence, 90-day hospital readmissions, 90-day all-cause mortality, and hospital length of stay.

Results

The study included 39 patients in the full fidaxomicin group and 11 patients in the partial fidaxomicin group. The population was predominately female (56%) with a mean age of 67.2 years. Among all patients who completed treatment after discharge (62%), a gap in therapy of greater than four days was more frequently observed in the full fidaxomicin group (2/22 vs. 0/9; p=1.000). The partial fidaxomicin group observed a numerically higher rate of 90-day recurrence (18.2% vs. 12.8%; p=0.641). Similar patterns were observed for all secondary outcomes (Figure 1). The mean hospital length of stay was 23.9 in the full fidaxomicin group compared to 9.8 days in the partial fidaxomicin group (p=0.301).

Conclusion

Partial completion of a fidaxomicin course with an alternative antibiotic was associated with a numerically higher rate of CDI recurrence, readmission, and all-cause mortality. Due to small sample size, the study was underpowered to detect statistically significant differences in these findings. Larger comparative effectiveness studies are needed.

Disclosures

All Authors: No reported disclosures
P-234. Clinical Factors Associated with Central Line Associated Blood Stream Infections (CLABSI) in Hospitalized Dialysis Patients
Authors: Morton Jackson , Neelakanta Anupama , Betts Wendy , Kester Shelley , Passaretti Catherine
Published: January 2025

Background

We sought to understand factors associated with Central Line Associated Blood Stream Infections (CLABSI) in hospitalized patients receiving dialysis.

Methods

7353 patients hospitalized between 2019 and 2021 with an ICD-10 code for dialysis and who had a central line accessed during their stay were identified. Demographics, comorbidities, central line characteristics, and length of stay data were collated from the electronic health record and linked to infection prevention CLABSI data. 38 cases on dialysis at the time of CLABSI were identified and matched to controls who did not have a CLABSI. Controls were matched to cases (2:1) by age (+/- 10 years), race, facility, admission date (+/-6 months) and intensive care unit admission during their stay. 2 cases were excluded due to inability to match.

Descriptive statistics were performed. Univariate and multivariable logistic regression models were used to assess for factors associated with increased odds of CLABSI.

Results

Dialysis patients with CLABSI were predominantly Black and male. 76% of cases were admitted to the ICU during their stay and 33% died within 30 days of CLABSI. Tunneled catheters, non-tunneled catheters and arteriovenous fistula/graft (AVF/G) were present in 50%, 31% and 14% of patients respectively at time of CLABSI. Cases were more likely than controls to have a non-tunneled catheter for hemodialysis access, longer length of stay, longer central line duration, and have had a transplant. (Table 1) Patients with non-tunneled catheters were 13 times more likely to have a CLABSI than those with AVF/G (p 0.02). Patients who received dialysis prior to admission had lower odds of CLABSI compared to acute dialysis patients (OR 0.5, p 0.08). (Table 2) After adjustment for age, sex, history of transplant, and being on dialysis prior to admission, increased length of stay (OR 1.03, p 0.01) and use of non-tunneled catheter for dialysis (OR 10.2, p 0.03) remained associated with increased odds of CLABSI. (Table 3)

Conclusion

The use of non-tunneled catheters and longer length of stay were identified as key predictors of CLABSI in patients on dialysis. These findings emphasize the need for strict infection control measures and careful monitoring of catheter types in this vulnerable population.

Disclosures

All Authors: No reported disclosures
P-255. Evaluation of automated disinfectant dispenser systems in 6 hospitals demonstrates a need for improved monitoring to ensure that correct disinfectant concentrations are delivered
Authors: Cadnum Jennifer , Kaple Claire , Saade Elie , Ray Amy , Donskey Curtis
Published: January 2025

Background

Automated dispensers that dilute concentrated disinfectants with water are commonly used in healthcare facilities. However, most facilities do not perform routine monitoring to ensure that the dispensers are functioning correctly and being used as recommended by the manufacturer.Table 1.Concentrations of disinfectant measured in samples obtained from automated dispensers and from in-use buckets on environmental services carts in 6 hospitalsQA, quaternary ammonium disinfectant; PA, peracetic acid-based disinfectant.a. Expected concentrations, ∼1,300 parts per million (PPM) for PA and ∼800 PPM for QA; higher-than-expected concentration of peracetic acid, >1,800 ppm; b. Lower than expected concentration, 300-900 PPM for PA and 200-400 PPM for QA; cNo disinfectant detected, limit of detection (∼300 PPM for PA and ∼150 PPM for QA); d. Wrong product, the in-use product that was supposed to be PA or QA was a detergent intended for floors.

Methods

In 6 acute care hospitals in Northeast Ohio, we tested disinfectant concentrations and pH of products obtained from automated dispensers and in-use containers from environmental services (EVS) personnel carts. The disinfectants included quaternary ammonium (800 parts per million [ppm]; pH 8) and peracetic acid-based products (∼1300 ppm; pH 3).

Results

All 6 hospitals had 1 or more malfunctioning dispensers (Table 1). Of 57 systems assessed, 14 (25%) dispensed products with lower-than-expected concentrations, including 8 (14%) with no detectable disinfectant (i.e., water). Nine of 62 (15%) in-use products had no detectable disinfectant, and 4 (7%) were the wrong product (i.e., a detergent for floors used for high-touch surfaces). Reasons for dispenser malfunction included incorrect connection of the concentrate container, dysfunction of a low-product indicator, and failure to change the concentrate container when indicated. pH measurements identified disinfectants with lower-than-expected concentrations, and an intervention that included monitoring was effective in ensuring that the dispensers were operating correctly.

Conclusion

Improved monitoring of automated disinfectant dispenser systems in healthcare facilities is needed to ensure patient safety. pH measurements could provide a simple means to ensure that dispensers are functioning correctly.

Disclosures

Elie Saade, MD, MPH, FIDSA, Janssen Global Services: Advisor/Consultant|Janssen Global Services: Advisor/Consultant|Janssen Research and Development: Advisor/Consultant|Janssen Research and Development: Advisor/Consultant Curtis Donskey, MD, Clorox: Grant/Research Support|Pfizer: Grant/Research Support
P-260. Antibiotic residues in hospital sink p-trap water in Kilifi, Kenya
Authors: Hookham Lauren , Tigoi Caroline , Amulele Anne , Rodger Gillian , Chau Kevin , Musyimi Robert , Berkley James A , Stoesser Nicole
Published: January 2025

Background

The hospital environment, including sink drains, may act as reservoirs for bacteria and antimicrobial resistance (AMR) gene amplification and spread. Selective pressures in sink environments, such as from disposal of antibiotics, may promote AMR. This pilot study at Kilifi County Hospital, Kenya, aimed to describe the prevalence of common antimicrobials in wastewater.

Presence of antibiotics in sinks by ward type

Presence of antibiotics (beta-lactam, sulpha, quinolone or tetracycline) detected in p-trap water of sinks in in-patient wards at Kilifi County Hospital, Kenya.

Methods

Data were collected on the number of beds/patients/sinks per bay and ward, distance from sink to patient bed, and sink design. We aimed to obtain 50ml of p-trap water from different sink types (i.e. bay, sluice, toilet) across all hospital wards.

Dipstick testing was performed using the QuaTest BTSQ 4-1 kit, which was previously validated using serial dilutions of ampicillin, doxycycline, sulfamethoxazole and ciprofloxacin (1). All samples were processed at Kenya Medical Research Institute Wellcome Trust Research Programme on the day of collection.

Results

34 sinks were targeted across nine wards. Two sinks on the neonatal birth unit (NBU) were broken or blocked and not sampled. One sink p-trap on NBU could not be aspirated despite running water to fill the p-trap. 1 sample from ICU was lost in transit from hospital to laboratory. In total, p-trap aspirates from 30 sinks were available for analysis.

Antibiotic testing failed in 1/30 (3%) samples, with absent control lines. Antibiotics were detected in 6/30 (20%) samples (complex triage, adult ICU, maternity, NBU, paediatric HDU). Most positive samples (67%, 4/6) were from patient bays, and the remainder from sluices (33% 2/6). No association was found between the presence of any antibiotic in p-trap water and building or sink type. The proportion of sinks in wards caring for pregnant women (50%, 2/4) and neonates (67%, 2/3) with detectable beta-lactam antibiotics was higher than wards caring for adults or children (p=0.03).

Conclusion

We describe prevalence of antibiotic residue in hospital wards at Kilifi County Hospital, Kenya. Antibiotics were predominantly found in patient bays in wards caring for pregnant women and neonates. This finding may reflect differences in antibiotic usage and waste disposal practices. Targeted interventions with healthcare staff and hospital governance are necessary to promote responsible antibiotic and patient waste management.

Disclosures

All Authors: No reported disclosures
P-275. Risk Factors for Community Colonization with Extended-Spectrum Cephalosporin-Resistant Enterobacterales (ESCrE) among People with HIV in Botswana
Authors: Loabile Bogadi , Lautenbach Ebbing , Mannathoko Naledi B , Mosepele Mosepele , Mosepele Mosepele , Styczynski Ashley R , Mann Smith Rachel , Cressman Leigh , Jaskowiak Anne , Bilker Warren B , Alby Kevin , Glaser Laurel , Richard-Greenblatt Melissa , Cowden Laura , Sewawa Kgotlaetsile , Otukile Dimpho , Paganotti Giacomo , Mokomane Margaret , Gross Robert
Published: January 2025

Background

Extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) are a major global threat, and there is a significant gap in research on the burden and associated risk factors for ESCrE in low-and middle income countries(LMICs). This is particularly true for people with HIV (PWH), who make up a significant proportion of the population in sub-Saharan Africa. In Botswana, 20% of individuals aged 15-49 are PWH. The risk factors associated with ESCrE colonization, typically a precursor to infection, are important to understand as such infections can result in increased healthcare costs as well as high morbidity and mortality.

Methods

Within a larger regional surveillance study, 546 adults with HIV were recruited from clinics and communities in 3 districts and underwent interviews and rectal sampling. ESCrE was defined as Enterobacterales demonstrating non-susceptibility to ceftriaxone or ceftazidime.

Results

27% of participants screened positive for ESCrE colonization. The mean CD4 count was 635 cells/mm3 (SD± 267). Table 1 describes the demographics of the participants with and without ESCrE colonization. Escherichia coli was the most commonly isolated ESCrE (146/174; 84%). Bivariate and multivariate analysis was used to determine risk factors associated with ESCrE colonization (Table 2). Recent hospitalization and certain geographic locations were independent risk factors for ESCrE colonization. Recent antibiotic use had an elevated OR for ESCrE colonization that did not achieve statistical significance in adjusted analysis.

Conclusion

These results add to the limited data on risk factors associated with ESCrE colonization in PWH. Hospitalization is an independent risk factor for colonization despite controlling for antibiotic use, which suggests the need for further investigation into hospital-specific factors that contribute to ESCrE colonization. Further research is needed to understand the geographic differences in ESCrE colonization in this setting. As LMICs with high HIV burdens build capacity for antimicrobial stewardship and infection prevention infrastructure in healthcare, research on unique potential mechanisms that result in multi-drug resistant colonization in PWH may impact strategies and priorities to combat antimicrobial resistance.

Disclosures

Robert Gross, MD, MSCE, Pfizer Inc: DSMB member for drug unrelated to study
P-281. Risk Factors for Treatment Failure in Infections Caused by Carbapenem-Resistant Enterobacterales (CRE)
Authors: Ting Michelle , Martens Mycah , Albazzaz Haya , Wolesensky Christine , Kobic Emir
Published: January 2025

Background

Multi-drug resistant organisms (MDROs) are a rising global public health threat. During the COVID-19 pandemic, there was a surge in New Delhi Metallo-Beta-Lactamases (NDM) amidst increasing prevalence of Carbapenem-Resistant Enterobacterales (CRE) infections in Maricopa County, Arizona. The objective of this study was to investigate risk factors associated with CRE treatment failure by measuring the composite of 30-day mortality and 30-day microbiologic recurrence.Table 1.Patient Characteristics

Methods

A multicenter observational retrospective chart review of a large health system’s 31 acute care facilities was performed for adult patients with infections caused by an organism in the Enterobacterales group with resistance to at least one carbapenem between January 1st, 2023 and July 31st, 2023. Key exclusion criteria were pregnancy and any patients with prior positive cultures with CRE within 60 days (only the first instance was included). Data was obtained via reports provided by pharmacy analytics.Table 1.Multivariable Logistic Regression, Predictors of Clinical Failure

Results

Of 169 included patients, 21% faced 30-day mortality, while 18% encountered microbiologic recurrence within 30 days. The majority (53%) of patients were admitted from assisted living facilities. The most common organism was Klebsiella pneumoniae occurring in 82% of cases and NDMs were the most prevalent carbapenemase, occurring in 76% of patients; urine was the source of infection in 60% of patients. Our multivariable logistic regression identified several significant risk factors associated with CRE treatment failure, including receipt of renal replacement therapy (RRT), prior diagnosis of peripheral vascular disease (PVD), and prior hospitalization within 90 days of index culture. Patients infected with an MBL producer and those not being seen by ID consult also trended towards worse outcomes.

Conclusion

Our study highlights the concerning prevalence of Klebsiella pneumoniae infections with metallo-beta lactamases in Maricopa County Arizona, along with clinically significant risk factors contributing to treatment failure against CREs. Notably, the majority of patients arrived from a healthcare related facility, underscoring the importance of implementing best infection prevention and antimicrobial stewardship practices in these settings.

Disclosures

Emir Kobic, BCIDP, Shionogi: Grant/Research Support|Shionogi: Speaker Bureau