bluuebunny/crossref_metadata_2025 huggingface dataset:
732. Increase in the Proportion of Hospitalizations in the Setting of Methicillin-Susceptible vs. Resistant Staphylococcus aureus in New York City (NYC)
Authors: Bromberg Maria , Huang Chaorui C , Doucette John T , Altman Deena
Published: November 2023

Background

Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible SA (MSSA) infections are a public health threat; MSSA is a growing problem requiring targeted attention. Socioeconomically disadvantaged patients face disparate outcomes. We analyzed SA infection trends in NYC.

Methods

Hospitalization data for NYC residents were obtained from the NY SPARCS database for 2009-19. Trends in hospitalization rate by resistance (MSSA vs MRSA), clinical syndrome (bacteremia (BAC), pneumonia (PNA), all other infections (OTH)) and setting (community-associated (CA) vs healthcare-associated (HA)) were assessed with Poisson regression. Associations between baseline variables and death were assessed with multivariable logistic regression. CA SA cases were defined as those: 1) with no prior hospitalization in the past year; 2) with a SA diagnosis present on admission; 3) not admitted for complications from a surgery; 4) with no comorbid chronic conditions.

Results

The overall rate of hospitalization with SA infection declined by 7.8% from 2009 to 2019. The hospitalization rate for all MSSA infections increased significantly (+21.8% BAC, +65.5% PNA, +18.1% OTH MSSA; p < 0.001 all groups) (F1). The rate of MRSA PNA increased significantly (+11%; p < 0.001) but MRSA BAC and OTH MRSA hospitalizations significantly declined (-25% and -30.4%, respectively; p < 0.001) (F1). CA cases declined as a proportion of all SA hospitalizations, from 18.4% in 2009 to 12.4% in 2019 (F2).

Age, living in a high-poverty area (HPA), and Medicaid or Medicare insurance were significantly associated with higher odds of in-hospital death for CA cases. Non-Hispanic Black and Hispanic Black patients had lower odds of death for HA but not CA cases; the effect of living in a HPA appeared to attenuate the association between race/ethnicity and death. A logistic regression model with demographic predictors (age, sex, race/ethnicity, HPA, insurance, and borough) was discriminative in predicting in-hospital death for CA cases (area under the curve: 0.87).

Crude Hospitalization Rates

Crude Hospitalization Rates by Pathogen (MSSA, MRSA, and Unspecified SA infection) and Clinical Syndrome (Pneumonia, Bacteremia, and all other infections)

Total counts of hospitalizations by resistance (methicillin-resistant, methicillin-susceptionble, or unknown) and setting (hospital-associated or community-associated)

Conclusion

While hospitalization with SA is declining overall, the relative burden of MSSA has increased compared to MRSA. Further studies and interventions are needed to understand this and baseline risk factors for SA mortality in vulnerable populations.

Mandatory disclaimer for publications using NYS Department of Health data and/or produced under auspices of NYC Department of Health and Mental Hygeine

Disclosures

All Authors: No reported disclosures
733. The attributable mortality, length of stay, and healthcare costs of methicillin-resistant Staphylococcus aureus infections in Singapore
Authors: Cai Yiying , Philip Edwin , Arora Shalvi , Sim Jean X Y , Whiteley Sean , Chow Weien , Tiang Daniel , Neo Siow Leng , Hong Wei Wei , Venkatachalam Indumathi , Graves Nicholas
Published: November 2023

Background

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are known to compromise patient outcomes and increase healthcare costs. Previous evidence on the prolongation of length of stay due to MRSA infections in Singapore is limited by methodology, including time-dependent bias. We used a multistate model to estimate the expected attributable mortality, length of stay, and healthcare costs of MRSA infections in Singapore.

Methods

We conducted a retrospective case-cohort study in patients admitted to a Singapore tertiary hospital from 2018 – 2022. Patients with MRSA infections were matched to those without infections in a 1: 3 ratio, by age and admitting specialty. We used a multistate model to derive excess length of stay (Fig 1). Attributable cost of MRSA infections from the healthcare perspective (in 2023 Singapore dollar) was estimated by multiplying excess length of stay with the monetary value of a bed-day and MRSA incidence. Cox regression with adjustment of confounders was used to derive hazard ratios (HR) for mortality estimates.

Results

We matched 752 patients with MRSA infections to 2,256 patients without MRSA infections. The most common MRSA infections were skin and soft tissue infections (44.5%) and bacteraemia (18.9%). From the multistate model, the excess length of stay of a MRSA infection was 3.02 days (95% CI, 1.90 – 4.13 days). This translated to an excess healthcare cost of $594,128 (95% CI, $375,111– $813,144) per 100,000 admissions. MRSA skin and soft tissue infections had the longest length of excess stay (3.98 days; 95% CI, 2.50 – 5.46 days) and contributed most to health-care costs ($348,788 per 100,000 admissions; 95% CI, $219,099 – $478,476). After adjusting for potential confounders, the mortality risk of all MRSA infections compared to patients without infection was 1.40 (95% CI, 0.94 – 2.08). Among the different infection types, pneumonia (HR, 4.28; 95% CI, 1.25 – 14.57) and bacteraemia (HR, 2.60; 95% CI, 1.33 – 5.08) had the high mortality risk compared to patients without infection.

Conclusion

Patients with MRSA pneumonia and bacteraemia had highest mortality risk. MRSA skin and soft tissue infections were associated with the highest healthcare costs. Coordinated efforts to reduce these infections may save lives and free valuable resources.

Disclosures

Sean Whiteley, BSc (IT), Axomem: Board Member|Axomem: Fees received for service and software licenses
737. Timing, Microbiology, Antibiotic Use, and Financial Impact of Left Ventricular Assist Device Infections: A Prospective Case-Control Approach
Authors: Ficinski Matthew , Glassman Shannon , Wojciechowski Katrina J , West Jennifer , Feitell Scott , Lesho Emil P
Published: November 2023

Background

Left-ventricular assist devices (LVAD) are increasingly used to treat advanced heart failure, and infection is a leading complication. Although the main registries such as INTERMACS publish annual quality reports, recently they have called for more details regarding antibiotic exposure and microbiology, which are not typically included in those reports.

Infection Timing and Antibiotic Usage

Methods

All patients who receive an LVAD are prospectively monitored by a team of heart failure and infectious diseases specialists until death or they permanently leave the catchment area. All patients from program inception (11-01-18) were included. A cut-off date of 12-3-22 was used to allow for at least of 6-month follow-up period from the last insertion. Internationally standardized infection definitions, a case-control approach, and T and Chi Squared tests were used.

Results

46 of 73 patients developed an LVAD-associated or specific infection. Of those, 57%, 28%, and 13% were driveline, bacteremia, or surgical site infections, respectively. No baseline patient characteristic, including immune status, BMI, co-morbidity, guideline congruent perioperative prophylaxis, or device trauma was associated with infection (Table 1). 48% of infections occurred < 90 days, but there was no association with surgeon, surgical team, or operating room. The mean time to infection was 260 days (IQR 374). The mean days of antibiotic therapy ranged from 21 days for SSI to 37 days for driveline infection (Table 2). Staphylococcus aureus and Streptococcus species, and vancomycin and cefazolin were the predominant organisms and antibiotics used, respectively. The mean lengths of stay and costs were similar between infected and uninfected patients, but infected patients required 3x the number of re-admissions and 2x number of hospital days (Table 1).

Conclusion

Most infections occurred after 90 days, with 34% occurring ≥ 1 year after discharge, suggesting a potential role of community or socioeconomic factors. Other confounders that occurred during this study included COVID-19- related issues, staffing shortages, and shortages of chlorhexidine containing skin preparations and other supplies. 59% of patients with an initial infection had recurrent infections. Going forward, we aim to provide similar details for each subsequent infection.

Disclosures

Katrina J. Wojciechowski, MS, PA-C, Abbott: Honoraria Scott Feitell, DO, FACC, FHFSA, Abbott Laboratories: Advisor/Consultant|Abbott Laboratories: Honoraria
738. Spatiotemporal Patterns of Antimicrobial Resistance of Outpatient Staphylococcus aureus Isolates in the United States, 2010-2019
Authors: Smith Matthew , Carrel Margaret , Shi Qianyi , Hasegawa Shinya , Clore Gosia , Tang Austin , Perencevich Eli N , Goto Michihiko
Published: November 2023

Background

Oral non-beta-lactam antibiotics are commonly used for empiric therapy of Staphylococcus aureus infections, especially in outpatient settings. However, little is known about geographic heterogeneity in the prevalence and temporal trends of antibiotic resistance among different regions in the US. We aimed to characterize the spatiotemporal patterns of drug-resistance prevalence of S. aureus using the nationwide surveillance data from the Veterans Health Administration (VHA) system.

Methods

Utilizing a dataset of 383,514 S. aureus isolates obtained in outpatient settings in the VHA from 2010-2019, we explored the spatiotemporal variation of S aureus resistance to clindamycin, tetracyclines, trimethoprim-sulfamethoxazole, and macrolides, stratified by methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA), and subdivided by regions of the United States (Northeast, Midwest, South, and West).

Results

Over the ten-year study period there was a national decrease in the proportion of S. aureus isolates which were MRSA, from 54% to 39% (Figure 1). Amongst MRSA isolates (Figure 2, panels A-D), we observed stability of clindamycin resistance (from 24.5% to 31.1%), an increase in tetracycline resistance (from 3.9% to 13.1%), an increase in trimethoprim-sulfamethoxazole resistance (from 2.7% to 9.3%), and a decrease in macrolide resistance (from 72% to 60%). For MSSA (Figure 2, panels E-H), we observed relative stability of resistance over time for all four drug classes. Regional analysis (Figure 3) demonstrated that the Northeastern US had slightly higher rates of clindamycin resistance than other regions but lower rates of tetracycline resistance, while the South had notably higher rates of trimethoprim-sulfamethoxazole resistance than other regions, particularly amongst MRSA isolates.

Figure 1

Frequency of S. aureus isolates by year (A), proportion of S. aureus isolates resistant to methicillin (B), and proportion of S. aureus isolates resistant to methicillin by region (C)

Figure 2

Proportion of S aureus isolates resistant to Clindamycin, Tetracyclines, Trimethoprim-Sulfamethoxazole, and Macrolides, stratified by MRSA (panels A-D) and MSSA (panels E-H)

Figure 3

Proportion of S aureus isolates resistant to Clindamycin, Tetracyclines, Trimethoprim-Sulfamethoxazole, and Macrolides, stratified by MRSA (panels A-D) and MSSA (panels E-H), subdivided by region

Conclusion

Even though the prevalence of MRSA is decreasing nationally, there are variable levels of co-resistance to non-beta-lactam antibiotics amongst S. aureus isolates. There was some regional variability in co-resistance amongst MRSA isolates, but less so for MSSA isolates. Further studies are needed to better understand which biological mechanisms mediate these differences.

Disclosures

Michihiko Goto, MD MSCI, Merck & Co.: Grant/Research Support
747. Employer requirements of COVID-19 vaccination reported by healthcare personnel, April 2022
Authors: de Perio Marie , Srivastav Anup , Laney Anthony , Black Carla , Razzaghi Hilda
Published: November 2023

Background

Healthcare personnel (HCP) are at risk for acquiring and transmitting coronavirus disease 2019 (COVID-19) at work. Vaccination against COVID-19 is a primary strategy to prevent transmission in healthcare settings. Our objectives were to describe HCP reporting employer COVID-19 vaccine requirements, identify differences across occupations and settings, and describe policies.

Methods

In a national opt-in internet panel survey of HCP in April 2022 to assess influenza and COVID-19 vaccination coverage, respondents were also asked about employer vaccination requirements. We weighted responses to the U.S. HCP population by age, sex, race, ethnicity, work setting, and U.S. census region. We assessed differences using two-tailed t tests with significance set at p< 0.05. We used multivariable logistic regression to identify factors associated with reporting employer requirements.

Results

Of 3,618 responding HCP, 60.0% reported employer requirements for the COVID-19 primary series. Of those, 95.5% reported completing the primary series vs. 81.9% without requirements (p< 0.001). In addition, 24.0% of HCP reported employer requirements for a booster dose. Of those eligible, 90.8% reported receiving a booster vs. 60.2% without a requirement (p< 0.001). Employer requirements for the primary series varied by occupation [46.1% (assistants/aides) to 77.5% (nurses)] and work setting [40.4% (other clinical settings) to 75.4% (hospitals)]. Of 2,157 HCP reporting a primary series requirement, employer accepted reasons for not being vaccinated included medical (56.8%), religious (50.9%), philosophical (10.0%), all three reasons (16.7%), and no reason (14.9%). Factors independently associated with no reported primary series requirements included working as an assistant/aide, in a non-clinical or other clinical occupation, in ambulatory care, long-term care/home health, or other clinical setting, and in the Midwest and South.

Conclusion

Most HCP in this sample reported employer requirements for the COVID-19 vaccination primary series although requirements were less common for boosters. Differences by healthcare setting exist. Implementing workplace strategies, including vaccine requirements, may lead to higher COVID-19 vaccination coverage.

Disclosures

All Authors: No reported disclosures
749. Interactive Technologies for Preventing HIV in Title X Clinics in Metropolitan Atlanta
Authors: Aldredge Amalia , Er Deja , Anderson Katherine M , Campos Ilse , Joseph Veronica , Kottke Melissa , Williams Peyton , Sullivan Sara , Brooks Michael W , Sales Jessica , Sheth Anandi N
Published: November 2023

Background

HIV prevention in women is imperative to end the HIV epidemic in the US. However, pre-exposure prophylaxis (PrEP) uptake in this population has been low, and innovative and feasible approaches are needed. The Title X Family Planning Program provides federal funding for sexual health services and HIV prevention to low income or uninsured individuals. We sought to increase PrEP awareness and reduce barriers to providing PrEP for women in Atlanta. We designed, implemented, and evaluated educational tools (trainings, resources, and technical assistance) for staff at Title X clinics on topics relevant for PrEP care for cisgender women.

Figure 1.

Comparison of pre- and post-training 5-point Likert scale evaluations of ability to meet training objectives for the Overview of PrEP and PrEP for Clinicians Trainings. Two-sample Satterthwaite t-tests comparing pre- and post-training scores were significantly different by individual objective, for each training, and overall (all p<0.001).

Methods

We offered a menu of nine 30-60 minute in-person or virtual trainings (Overview of PrEP, PrEP care for clinicians, PrEP insurance navigation, long-acting PrEP, alternative PrEP delivery models, reporting PrEP metrics, taking a sexual history, STI management, and substance use screening) to staff from 29 Atlanta Title X clinics. We also offered technical assistance with consultation on PrEP implementation planning or any training topic, and patient- and provider-facing resources about PrEP tailored for cisgender women. We used two-sample Satterthwaite t-tests to compare pre- and post- training self-reported ability to meet training objectives by 5-point Likert scale.

Results

In the first year, we provided 15 trainings covering 3 topics to 279 individuals in 20 clinics. We delivered 7 “Overview of PrEP” trainings; participants were medical assistants (31%), nurses (12%), advance practice providers (APPs, 6%), and other (37%). We delivered 7 “PrEP Care for Clinicians” trainings; participants were APPs (20%), physicians (17%), nurses (15%) and other (37%). Staff had significantly higher Likert scores (Figure 1) for ability to meet training objectives after trainings, both overall and by individual objective (all p < 0.001).

Conclusion

We provided guideline-based PrEP trainings tailored for cisgender women to a staff with diverse clinic roles from a wide-reaching network of Atlanta Title X clinics. Ability to meet training objectives substantially increased post-training. Next steps include evaluating program impact on HIV testing, PrEP counseling, and PrEP prescription among cisgender women in Atlanta.

Disclosures

Melissa Kottke, MD, MPH, MBA, HRA Pharma: Advisor/Consultant|Organon: Grant/Research Support
752. Development of an Outpatient Infectious Disease Rotation for Internal Medicine Residents at a Rural Academic Medical Center
Authors: Bryan Nicole , Fisher Melanie A
Published: November 2023

Background

Infectious disease (ID) training is essential to the education of internal medicine residents and has traditionally occurred on inpatient rotations focused on hospitalized patients. However, these rotations offer limited experience with infectious diseases managed in the outpatient setting. Furthermore, inpatient rotations expose residents to only one aspect of the multifaceted contributions ID specialists provide. Given the nationwide decline in ID providers, demonstrating the diverse career paths that can stem from ID training is a potential opportunity to attract trainees to this field. Developing interest in ID amongst residents is even more crucial in rural areas where the infectious disease provider shortage is severe. Here, we describe an ambulatory ID rotation for internal medicine residents at a rural academic medical center. We provide a model for a structured rotation with diverse learning opportunities for medical residents, and show the rotation has been received positively by those residents who have completed it to date.

Methods

We established an outpatient ID rotation to offer as an elective for internal medicine residents. The rotation consisted of working one-on-one with ID faculty in a variety of settings in 2 or 4 week rotation blocks. A schedule was provided to each resident. Anonymous evaluations of the rotation were obtained upon completion of each block and aggregated.

Results

There were a total of 11 internal medicine residents who participated in the ambulatory ID rotation from 7/1/2020 until 1/3/2023. Residents participated in a variety of clinical experiences, conferences, and didactics as summarized in Table 1. Each day of the rotation was divided into morning and afternoon clinics with conferences and didactics scheduled first thing in the morning or at noon. A sample rotation schedule is provided in Figure 1. Resident evaluations of the rotation were positive overall as summarized in Table 2.Figure 1.Example medical resident rotation schedule for outpatient ID elective rotation

Conclusion

We present a model for an ambulatory outpatient ID rotation consisting of a wide variety of educational and clinical opportunities that also provides a more comprehensive overview of different career paths within the ID specialty. Residents who have completed the rotation today have evaluated it favorably.

Disclosures

All Authors: No reported disclosures
753. Impact of a "Real-Time" Case-Based Infectious Disease Elective on Student and Preceptor Perceptions of Confidence with Entrustable Professional Activities
Authors: Cady Beth , Bourland Kendra
Published: November 2023

Background

Pharmacy students often struggle transitioning from the didactic to experiential setting, primarily due to the lack of live clinical interaction. A didactic infectious diseases case-based elective was designed to implement this concept (using volunteer preceptors) to create rotation-ready students. The purpose of this project is to evaluate the impact of patient cases on students’ ability to engage in professional, interdisciplinary interactions and to subsequently determine if the students’ perceptions correlate with the evaluation of their performance from volunteer preceptors.

Methods

Third-year pharmacy students were enrolled in the elective and presented with two infectious disease cases throughout the course. Cases required students to interact with an infectious disease pharmacist/resident volunteer acting in the role of an attending physician or microbiology lab technician. Students contacted team members daily (mimicking "rounds") as part of an infectious disease consult service. Students completed each case “in real time” and were tasked with updating the attending physician with appropriate changes to the antibiotic regimen as more information (ie-labs) became available . Volunteer preceptors were surveyed on specific student entrustable professional activities. Students were also asked to self-assess their confidence in these areas. Results from students vs preceptors were then compared.

Results

Of 47 students surveyed (over 2 course iterations), 100% of the students felt confident in their ability to engage professionally with other members of the healthcare team, make evidence-based recommendations, and research complex drug information questions using primary literature at the end of the course. Of 41 preceptors surveyed, > 85% of preceptors felt confident in the students’ abilities to interact professionally, utilize primary literature to make evidence-based recommendations, and answer complex drug information questions.

Conclusion

Student engagement in simulation activities requiring interactions with other healthcare members and research into primary literature leads to confidence in performing essential interprofessional and clinical skills. Preceptor assessment of these skills was in agreement with what students perceived.

Disclosures

All Authors: No reported disclosures
769. HIV Pre- and Post-Exposure Prophylaxis (PrEP/PEP) knowledge increases between Academic Curricula in Dominican Republic' Medical Students: A cross-sectional survey.
Authors: Tapia Leandro , Lora Hector J , Bisono Garcia Bismarck S , Nunez Marcos , Paulino-Ramírez Robert
Published: November 2023

Background

HIV knowledge and prevention strategies, like PrEP/PEP is a core element in current medical practice but represents a challenge for medical students’ curricula. In countries like Dominican Republic (DR), the stigma towards HIV infection restricts the delivery of HIV related information to the general population. Our study aims to understand the level of knowledge between different academical years pose regarding HIV/AIDS, PrEP and PEP and how their curricula content is covered across the years.

Methods

We survey medical students in the DR to measure knowledge on HIV, PrEP/PEP. Students who agreed to participate filled in a survey with 3 sections. Each section had 10 true or false questions. Responses were compared mean knowledge for each topic based on a score out of 10. We analyzed mean scores using ANOVA with Post Hoc analysis, assuming significance when p< 0.05.

Results

A total of 503 participants participated in the survey. ANOVA results showed that there was a statistically significant difference in mean HIV knowledge (F (3, 499) = [25,58], p< 0.001) and PEP knowledge (F (3, 499) = [13,77], p< 0.001) between the academical years. Post-hoc analysis revealed that MS4 had a higher mean score for HIV knowledge (M= 9.3) than MS2 (8.7, p< 0.01) and MS1 (m= 8.2, p< 0.01). Similarly, MS3 had a higher mean HIV knowledge than MS2 (p< 0.01) and MS1 (p< 0.01). Likewise, MS2 had an increased mean HIV knowledge when compared to MS1 (p< 0.01). When we compare mean PEP knowledge, we found that MS3 (m= 7.45) had increased knowledge than MS1 (6.4, p< 0.01) and MS2 (m= 6.9, p< 0.05). Similarly, we found that MS4 had increased mean PEP Knowledge (m= 7.5) when compared to MS1 and MS2 (p< 0.001). When we studied mean PrEP knowledge, ANOVA analysis found no significant difference (F (3, 499) = [1,24], p= 0.29).

Conclusion

Our study suggests that the mean knowledge of HIV and PEP increases throughout the academic progression of medical school. Although there is no difference in PEP knowledge, this may suggest that medical schools are teaching PEP during MS3-MS4 cycle rather than the M1-M2 cycle. Also, the homogenous mean PrEP knowledge could suggest that the students are learning from non-academic sources. This emphasizes the curricular designers of medical schools to review the contents on prevention of communicable diseases.

Disclosures

All Authors: No reported disclosures
770. HIV Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) knowledge among Medical Students in the Dominican Republic: Are we missing the role of Future Healthcare Provider in PrEP and PEP roll out?
Authors: Lora Hector J , Bisono Garcia Bismarck S , Tapia Leandro , Paulino-Ramírez Robert
Published: November 2023

Background

HIV prevention continues to be a care gap in developing countries, like Dominican Republic. The lack of sufficient programs for prescription and information of general populations are barriers for better control of HIV infection in this country. The knowledge of HIV prevention strategies such as Pre-Exposure Prophylaxis (PrEP) or Post-Exposure Prophylaxis (PEP) among medical professionals and medical students is unknown. The goal of ending HIV Pandemic by 2030 is to rely on prevention strategies.

Our study aims to determine the level of knowledge of medical students in a pre-preclinical cycle and in a clinical cycle regarding HIV/AIDS, PrEP and PEP

Methods

We survey medical students in the Dominican Republic to measure knowledge on HIV, PrEP/PEP. We compared mean knowledge for each topic based on a score out of 10. We analyzed mean scores by using T-Tests and ANOVA with Post Hoc or Tukey Analysis, assuming significance when p< 0.05.

Results

A total of 503 students participated in the survey. ANOVA results showed that there was a statistically significant difference in mean knowledge scores for HIV, PEP, and PrEP (F (2, 1506) = [196.6], p < 0.001). Post hoc analysis revealed that medical students had a higher mean score for HIV knowledge (M= 8.9) than mean scores for PrEP (M= 7.6, p< 0.01) and PEP (M= 7.1, p< 0.01). Similarly, the difference in knowledge scores for PrEP was significantly higher than for PEP (p< 0.01). We further divided participants into Preclinical Years and Clinical years and found that participants within the Clinical Years of Med School had a significantly increased mean PEP knowledge (m= 7.5) than Preclinical Years participants (m= 6.7) (t (460) = 5.8, p< 0.001). Similar results were not appreciated with PrEP, where Clinical year participants had a non-significant increased mean knowledge (m=7.8) compared to their counterparts (m= 7.5) (t (486) = 1.4, p= 0.79).

Conclusion

Our findings might suggest that medical students acquire more knowledge about PEP as they progress into clinical training, but that PrEP knowledge may be emphasized equally in both pre-clinical and clinical training. Further studies should focus on identifying points for improvement and implementing strategies to tackle barriers. One of several limitations of this study is a response bias.

Disclosures

All Authors: No reported disclosures
771. The impact of infectious diseases research involvement on future infectious disease fellowship application
Authors: Marcus Joseph , Yun Heather , Barsoumian Alice E
Published: November 2023

Background

Infectious diseases physicians invest significant time mentoring medical students and internal medicine residents developing research projects as well as writing case reports. The impact of research or case reports on future application to infectious diseases fellowship is unknown.

Methods

All research projects and case reports published or presented at conferences from Brooke Army Medical Center between 2014-2022 with an infectious diseases senior author and a medical student or internal medicine resident first author were evaluated. The presentations and publications that resulted from each project as well as whether the trainee applied to infectious diseases were recorded.

Results

During the study period, 12 faculty mentored 51 trainees in 35 research projects and 26 case reports. Research and case reports were primarily performed by residents (88% and 96% respectively) (Table 1). Most trainees presented or published their research in multiple venues. Compared to case reports, research projects were more likely to be presented at national meetings (77% vs 31%, p=0.0003). Individuals who completed research projects had greater rates of infectious diseases fellowship application as compared to those who completed case reports (42% vs. 5%, p=0.006) (Table 2).

Summary of Research and Case Reports by Medical Students and Residents Mentored by Infectious Diseases Faculty at Brooke Army Medical Center, 2014-2022

Internal Medicine Resident and Medical Student Application to Infectious Diseases Fellowship Organized by Projects Mentored by an Infectious Diseases Faculty Member at Brooke Army Medical Center, 2014-2022

Conclusion

Internal medicine resident and medical student involvement in research mentored by an infectious disease physician was associated with a higher infectious diseases fellowship application rate as compared to those who were mentored for case reports. Despite the significant time required to mentor trainees, investment in trainee research should be considered as an important component to the infectious diseases recruiting effort.

Disclosures

All Authors: No reported disclosures
774. Trivia Game for Learning Zoonotic Diseases in Pre-clinical Medical Curriculum
Authors: Moreland Celeste L , Henry Catherine , Carey Adrienne
Published: November 2023

Background

Zoonotic diseases are high-yield material, frequently tested on USMLE Step 1. For learning infectious diseases, many medical students supplement or replace coursework with outside resources that are personalizable and utilize active learning1,2, but these resources can be prohibitively expensive, have questionable reliability, and align imperfectly with course content2. Spencer Fox Eccles SOM historically used a Team-Based Learning (TBL) format for teaching zoonotic diseases, but this content is primarily memorization-based, while TBL is well suited for conceptual material. To teach zoonotic diseases, we created a trivia game3 (“ZooTrivia”) to mimic the low-stakes, fast-paced, engagement of outside resources, while still capturing the cooperative learning environment of TBL.

Methods

We used the Kirkpatrick model for student reaction and learning to assess efficacy of ZooTrivia. The session was opt-in and students chose their own teams to answer trivia questions. All answers were provided at the end. We used attendance data and surveys to assess student enjoyment of and perceived learning from ZooTrivia.

Results

Twenty (20/125) students reported attending ZooTrivia. Three students, who do not usually attend class, chose to attend ZooTrivia, which suggests that trivia is an attractive format. 60% of attendees reported that they would like more games like this in their education. 30% responded that they would “maybe” want more games like this. For enjoyment, students on average reported preferring trivia over both TBL and outside resources (average 3.9 and 3.6, respectively on a scale of 1-5). However, for student learning, students on average reported TBL and outside resources as better learning formats (average 2.8 for both, on a scale of 1-5).

Conclusion

Trivia is an alternative to TBL-based learning of zoonotic disease that students report enjoying more but learning slightly less than TBL. Analysis of student learning was limited by incomparable attendance of ZooTrivia and TBL; ZooTrivia was an optional session, while TBL was required attendance. This comparison is a direction for future study.

Disclosures

All Authors: No reported disclosures
776. Clinical Practice Gap Analysis of Physicians’ Understanding of Cytomegalovirus
Authors: Larkin Amy , Nair Arun S , Misiuta Iwona
Published: November 2023

Background

Understanding clinical practice related to awareness and clinical understanding of cytomegalovirus (CMV) and can inform development of tools to improve physician practices and patient screening, diagnosis and management.

Methods

A survey instrument of 25 multiple choice, knowledge- and case-based questions allowed participants to assess their clinical knowledge with regard to CMV. These questions are designed to assess clinicians’ baseline knowledge, competence, and current practice. Immediate peer-response data solidify support for correct responses. The survey was available online to physicians without monetary compensation or charge. Respondent confidentiality was maintained and responses were de-identified and aggregated prior to analyses. Initial data collection occurred from July 27, 2022 to October 18, 2022.

Results

In total, 107 OB/GYNs and 77 pediatricians completed the full assessment within the data collection period. Physicians demonstrated gaps in the following areas:

Conclusion

This educational research on assessment of physicians’ clinical practices yielded important insights into clinical gaps related to CMV among OB/GYNs and pediatricians. While the gaps were similar in most areas, OB/GYNs showed larger gaps in identifying source of transmission, and management of possible congenital CMV compared with pediatricians, whereas pediatricians showed larger gaps in identifying seropositivity rates and diagnosing CMV.

Disclosures

All Authors: No reported disclosures
777. Cytomegalovirus: Curriculum-Based Online Education Improves Knowledge, Competence, and Confidence of Physicians
Authors: Nair Arun S , Larkin Amy , Misiuta Iwona
Published: November 2023

Background

This study assessed the impact of an online continuing medical education (CME) curriculum regarding CMV infection for obstetricians/gynecologists (OB/GYN) and pediatricians (Peds).

Methods

The educational intervention consisted of 4 online, CME-certified activities in multimedia formats published on a dedicated learning center on Medscape Education from March-July, 2022. Data were collected through January 2023. A repeated pairs pre-/post-assessment study design and a McNemar’s test (P < .05 is considered significant) assessed educational effect. To assess changes in knowledge, competence, and confidence data were aggregated across activities and stratified by learning themes.

Results

The education reached over 65,979 clinician learners, including 20,349 physicians, 9,295 OB/GYN, and 4,407 Peds.

Overall, there were significant improvements in knowledge/competence among OB/GYN and Peds. Specific significant (P < .001) pre-vs-post educational improvements across the curriculum include:

Remaining educational gaps (% incorrect answers):

Conclusion

The metrics and outcomes gathered in this assessment are a strong indicator that multimedia curriculum-based online activities on Medscape Education improve the knowledge, competence, and confidence of OB/GYN and Peds related to CMV care strategies. Despite the effectiveness of the education, persistent gaps remain that serve as future educational targets for continuing education.

Disclosures

All Authors: No reported disclosures
779. Make Micro Cool Again: Implementing a Longitudinal Lab-based Microbiology and Mycology Curriculum to Engage Infectious Diseases Fellows in Hands-On Learning
Authors: Pollock Erin , Keri Vishakh C , Salimnia Hossein , Monday Lea M
Published: November 2023

Background

Microbiology wet labs have been eliminated in many medical schools and infectious diseases (ID) fellows are training in a post-COVID era where hands-on experience is lacking. The IDSA recommends 120 hours of microbiology experience for fellows, but feasibility is limited in centers struggling to retain adequate staff, and technicians are limited in their ability to integrate clinical skills. We aimed to overcome these struggles by implementing a microbiology and mycology curriculum for ID fellows using a case-based approach within the microbiology lab (Fig1).

Methods

In a quasi-experimental study, eight ID fellows from Wayne State University were taught in interactive, 1-hour sessions delivered monthly in the lab over 11 months using existing samples. Planning included a needs assessment, review of in training scores to identify weak spots, and pre-tests to assess baseline knowledge (Fig 1). Sessions topics are shown in Table 1. All sessions were delivered by an ID faculty to ensure homogeneity. Prior to each session, specimens were procured and objectives were outlined and linked to core content areas. An example of the objectives and core content for the hyaline mold session is shown in Table 2. A post-test occurred after session 9. Primary outcome was comparison of de-identified pre and post test scores by Wilcoxon signed-rank test for paired non-parametric data. Fellows experience and feedback for improvement were also collected.

Results

Sessions were performed as described and included hands on activities and a summary handout (Fig 2). Pre versus post test scores showed significant median improvement (65% to 82.5%. p=0.048, table 3). Feedback on the sessions was overwhelmingly positive, with suggestions for encore sessions and request to make a similar parasitology curriculum (Table 4). Sessions became so popular that pharmacists and other trainees began attending. Although not an intended outcome, it was noted that after posting handouts to twitter, fellowship following increased by 250%.

Conclusion

A monthly longitudinal microbiology and mycology curriculum was well received by ID fellows and objectively increased their knowledge. This is the first study attempting to objectively quantify knowledge gained using a hands-on microbiology lab curriculum to teach ID fellows.

Disclosures

All Authors: No reported disclosures
784. Feet First: A Innovative Curriculum for Podiatry Residents on Infectious Disease using Padlet
Authors: Sharma Amit M , Srinivas Sindhu , Wessinger Jaclyn Denise , Nasser Elliane
Published: November 2023

Background

Infectious Disease Rotation is mandatory for Podiatry trainees. Unfortunately, a standardized Infectious Disease rotation is lacking despite the above requirements. Therefore, we performed a nationwide needs assessment for a dedicated podiatry curriculum for Infectious Disease Elective. We also created a curriculum using Padlet to provide education to our trainees.

Results Table Program Characteristics

Podiatry Training Program Characteristics across the nation

Table 2 Curriculum characteristics

Variation in curriculum

Methods

We performed a nationwide survey to assess the current uniformity between podiatric programs regarding their infectious disease rotation. In addition, each podiatric surgical residency program was surveyed to gather data on its current curriculum and evaluation processes. We surveyed Geisinger North East Podiatry Residents to identify the common topics they wanted to learn from their ID rotation and the learning curriculum best suited to their needs. Finally, we devised a novel approach to medical education that leverages educational technology's power to enhance podiatry residents' learning experience. Using Padlet, a versatile and user-friendly platform, this curriculum offers learners an interactive and engaging learning experience featuring lectures, videos, case studies, quizzes, polls, and assignments.

Results

The Northeast region had 38% of programs, followed by the Midwest (26%), Southeast (18%), West (12%), and Southwest (6%). Common regional themes included identifying nosocomial infections, understanding precautions and quarantine for specific infections, and understanding and treating MRSA, VRE, Clostridium difficile, osteomyelitis, and necrotizing fasciitis among Northeast Programs. In the Western region, programs focused on attitudinal assessments detailing the importance of punctuality, self-study and literature review, accepting criticism, quality improvement, willingness to enhance knowledge and practice, and practicing with professionalism. Based upon the discrepancies in the duration of rotation, breadth of topics covered, and lack of uniformity in teaching techniques, we created a curriculum using the Flipped Classroom method and EdTech tools like Padlet. Through Padlet we hope to combine synchronous and asynchronous educational techniques.

Distribution of podiatry training programs across the United States

Conclusion

Edtech tools like Padlet can help provide quality education effectively to podiatry trainees.

Padlet Snapshot

Disclosures

All Authors: No reported disclosures
806. Candida Gut Colonization in Critically Ill Patients
Authors: Adelman Max W , Tran Truc T , Detranaltes Andrea M , Rydell Kirsten B , Atterstrom Rachel , Schettino Marissa G , Amaya Abigail A , Malikzad Husna , Virk Muhammad H , Jones Mary N , Deyanov Alex E , Perez Jose C , Corry David B , Lorenz Michael C , de Paula Baptista Rodrigo , Arias Cesar A
Published: November 2023

Background

Candida spp. colonization is a risk factor for candidemia in intensive care unit (ICU) patients. Recent data suggest that the epidemiology of Candida infections is shifting away from C. albicans, but prospective data on the epidemiology of Candida spp. gut colonization are limited.

Methods

We conducted a prospective cohort study of adult patients admitted to an ICU at a tertiary care hospital. Patients had stool samples collected twice weekly for up to four weeks or until ICU discharge. A convenience sample of stool samples was plated on CHROMagar Candida Plus for 48 hours. Colonies of different morphologies were isolated on Sabouraud dextrose agar and identified with MALDI-ToF.

Results

A total of 102 patients were included in the cohort. We performed screening for stool Candida colonization in 12 patients: 8 (67%) men, median age 65 (IQR 54.5-68.5). Three (25%) were in shock and eight (67%) required mechanical ventilation on ICU admission. In-hospital mortality was 25%. Seven patients (58%) were colonized with Candida at ≥1 time point (Figure 1). Of 30 total time points tested (median per patient=2, range 1-5), 15 (50%) were positive for Candida spp. Most time points (9/15, 60%) were positive for C. glabrata; 4/15 (27%) were positive for both C. glabrata and C. albicans. A minority (1/15; 7%) were positive for C. albicans and C. parapsilosis alone, respectively. None had C. auris colonization. Most colonization was persistent: Of 6 colonized patients with ≥1 time point tested, 5 (83%) were colonized at multiple timepoints. Eleven patients had data collected on anti-fungal administration during the study period, and five of these received an antifungal (Figure 1). Of these five, three (60%) had no Candida colonization. One lost C. albicans colonization but had persistent C. glabrata colonization despite azole therapy, and another developed C. parapsilosis colonization despite azole and amphotericin administration.

Figure 1.

Results of serial stool samples tested for Candida colonization per individual patient.

Conclusion

Most ICU patients in this study had Candida spp. gut colonization, commonly with intrinsically azole-resistant C. glabrata. This study is limited by small sample size, and further data are needed to determine the clinical impact of antifungal-resistant Candida in ICU patients at high risk of candidemia.

Disclosures

All Authors: No reported disclosures
808. Outcomes of Invasive Candidiasis Stratified by Antifungal Therapy
Authors: Box Maggie , Anwar Lara , Molina Kyle
Published: November 2023

Background

IDSA guidelines for invasive candidiasis recommend echinocandins (ECH) as first-line agents for initial therapy, with fluconazole (FLU) as an acceptable alternative. Transitioning from an ECH to FLU is also recommended in clinically stable patients with FLU susceptible isolates. All-cause mortality is high for candidemia, typically due to medical comorbidities in patients who develop candidiasis. The objective of this study is to report outcomes of invasive candidiasis stratified by antifungal therapy received, comparing micafungin (MIC), fluconazole, and micafungin to fluconazole step down therapy.

Methods

This multicenter, retrospective study was conducted at Scripps Health from 6/1/2019 – 6/30/2022. Adult patients with culture confirmed invasive candidiasis were included. Patients were excluded if they were pregnant, care was withdrawn within 7 days of treatment initiation, or had prolonged course of therapy due to uncontrolled source. The primary endpoint was 28-day mortality based on antifungal therapy. Secondary outcomes included time-to-death among and duration of therapy trends.

Results

A total of 95 patients were included. Candida glabrata was most frequently isolated (43.2%) followed by Candida albicans (36.8%). There was no difference in 28-day mortality among patients receiving fluconazole only (15.4%, n = 13), micafungin only (20.5%, n = 44), micafungin only due to fluconazole resistance (12.5%, n = 8), and micafungin to fluconazole step down therapy (13.3%, n = 30), p = 0.849. Among patients who died, there was no difference in time-to-death between groups (p = 0.678) or mortality by organism (C. albicans 37.5%, p = 0.952 and C. glabrata 43.8%, p = 0.958). Six patients with non-C. albicans isolates that were susceptible dose-dependent (SDD) to FLU were successfully treated with FLU step-down therapy with a dose/MIC ratio of > 100.

Conclusion

There was no difference in 28-day mortality or time-to-death between patients who received fluconazole versus micafungin for invasive candidiasis. Fluconazole step down therapy (including oral) is a viable option for patients who are candidates, including non-C. albicans SDD organisms.

Disclosures

All Authors: No reported disclosures