bluuebunny/crossref_metadata_2025 huggingface dataset:
P-883. Descriptive single center study on hospital acquired gram negative bloodstream infection: epidemiology, susceptibilities and outcomes in a six-year period
Authors: Palanivetpillai Sivanthini , Dingle Tanis , Smith Stephanie W
Published: January 2025

Background

Hospital acquired (HA)gram negative bacteremia contribute to substantial mortality and morbidity. Understanding the epidemiology of this entity including susceptibility patterns can inform appropriate antimicrobial therapy.

Objective: To describe the epidemiology, antimicrobial susceptibilities and outcomes of hospital acquired gram negative blood stream infection over six-year period in a quaternary care hospital.

Methods

We used the Infection Prevention Control data base to identify all cases of hospital acquired -gram negative bacteremia from Jan 1 2014 to Dec 31 2019. Charts and susceptibilities were reviewed retrospectively.

Results

440 HA-gram negative bacteremia cases with 469 gram negative bacterial isolates were included in the study after the exclusion of repeat positives within the first 2 weeks of first positive culture. 65% were male. The mean patient age was 62. Mortality was 23% at 30 days. 90% were monomicrobial infection. The majority had secondary blood stream infection accounting for 80% while 20% had primary blood stream infections. The most common source of secondary blood stream infections was UTI at38%. E. coli was the most common organism isolated during this period followed by K. pneumoniae and P aeruginosa, 44%, 16% and 11% respectively. 14% of isolates were ESBL/AMPC organisms with increasing rates over time. Only 77% of P. aeruginosa was susceptible to meropenem. 42%(n=22/52) of Pseudomonas isolates were multidrug resistant and 12%(n=6/52) were identified as difficult to treat resistance. Enterobacterales group organisms (n=372) were susceptible to ceftriaxone 82%, meropenem 99%, piperacillin-tazobactam 80%, ciprofloxacin 77% and TMP-SMX 74%. Overall, vast majority of gram-negative isolates were susceptible to meropenem (97%).

Conclusion

Over the six-year period there was a slight increase in ESBL/AMPC organisms but resistance of non ESBL organisms remained stable. The majority were susceptible to meropenem (97). A significant percentage of P. aeruginosa was resistant to meropenem (23%).

Disclosures

All Authors: No reported disclosures
P-924. Infective Endocarditis Outcomes in Older Patients with HIV
Authors: Papamanoli Aikaterini , Kalogeropoulos Andreas P , Psevdos George
Published: January 2025

Background

Previous reports in patients with HIV (PWH) and infective endocarditis (IE) have reported variable mortality compared to their non-HIV counterparts. However, most studies are older, have included younger patients with high rates of IV drug use, and uncontrolled HIV status with low CD4 count. Contemporary antiretroviral therapy has stabilized HIV, but little is known about IE outcomes in the current PWH population, as underlying HIV-related inflammatory process may impact outcomes or HIV status may affect therapeutic approaches due to access issues or provider bias.Table 1.Baseline characteritics of the propensity matched cohorts.

Methods

We used data from the TriNetX Research Network, an electronic health records network with over 100 million patients. We identified (1) a cohort of patients age ≥65 with HIV (ICD-10-CM code B.20) and IE (code I33.X) diagnosed between 1/1/2014 and 12/31/2023, and (2) a propensity score-matched cohort of patients age ≥65 with IE without HIV, matched for demographics, social history including substance abuse, and comorbid conditions. We evaluated 1-year rates of all-cause mortality, stroke, heart failure, and cerebral infections. We also evaluated the proportions of patients who underwent cardiac surgery in both groups. We used Cox proportional hazards regression to compare 1-year outcomes and logistic regression to estimate odds ratio for surgical treatment.Figure 1.One-Year Kaplan-Meier rates of death, incident stroke, incident heart failure, and cerebral infections among patients with infective endocarditis and HIV (+) (black line) vs. HIV (-) (red line) status

Results

We identified 269 PWH and IE and 269 matched patients with IE without HIV. The baseline characteristics of the cohorts were well balanced, Table 1. After 1-year, 68 (28.5%) patients in the PWH group had died vs. 69 (30.4%) in the non-HIV group (HR: 0.88, 95%CI 0.63 – 1.23; P=0.46). Both patient groups experienced similar 1-year rates of stroke (7.6% vs. 4.3%; P=0.23), heart failure (14.3% vs. 16.5%; P=0.55), and cerebral infections (0.8% vs. 0.8%; P=0.99), Fig. 1. Only 10 patients in each group (3.7% for both) underwent cardiac surgery (P >0.99).

Conclusion

In contemporary older (age ≥65) PWH and IE, compared to matched patients without HIV and IE, no difference in 1-year mortality was observed. Other IE-associated outcomes were also similar. Interestingly, rates of cardiac surgery were similar but low in both groups. Therefore, our data suggest that possible HIV-related inflammation does not affect outcomes in IE among older patients with stable HIV status.

Disclosures

All Authors: No reported disclosures
P-942. Infective Endocarditis in Pregnancy: a Retrospective Review of Maternal and Neonatal Outcomes
Authors: Robinson Andrew J , King Madeline , Hanretty Alexandra , Kludjian Geena
Published: January 2025

Background

Infective endocarditis (IE) in pregnancy has an annual incidence of 0.006%. As rates of injection drug use increase across the US, there is the likelihood that the rates of pregnant people with IE increases. There is a paucity of data of IE in pregnancy and implications on maternal and neonatal outcomes. The purpose of this retrospective chart review was to describe the maternal outcomes of patients who are pregnant with IE and neonatal outcomes from a tertiary care center with a level 3 neonatal intensive care unit (NICU).

Methods

33 patients were identified as having both IE and pregnancy from January 1, 2017, through January 31, 2022; 16 met inclusion criteria. Data was matched to birth records and 10 neonates were included. Maternal outcomes included survival, clinical cure, complications in pregnancy, type of birth and term of childbirth. Neonatal outcomes included survival, need for NICU admission, treatment for neonatal abstinence syndrome (NAS), and complications at birth including social issues. All maternal and neonatal results are reported in figures 1-3.

Results

All patients had IE of their tricuspid valve, and 1 had concomitant aortic valve infection. None had valvular surgery during pregnancy, and one had valvular surgery after pregnancy. Preeclampsia occurred in 1 patient. 40% of births were preterm, which is higher than the national average of 10.4%; 10% were cesarean births, 90% were vaginal. 70% of neonates required NICU admission and treatment for NAS, and 40% required respiratory support. The average neonatal length of stay was 39.9 days. 6 babies had delayed discharge due to social issues.

Conclusion

The study demonstrates 100% maternal and neonatal survival, however, conveys significant neonatal morbidity, including need for NICU level of care, increased rates of preterm births, need for treatment for NAS and prolonged hospitalization due to social issues. There are potential health consequences for the neonate, as treatment for NAS has been shown to increase risk for substance use disorder later in life. This study is limited by its small sample size; however, this cohort is one of the larger cohorts to represent this population.

Disclosures

Madeline King, PharmD, Innoviva: Advisor/Consultant Alexandra Hanretty, PharmD, Abbvie: Advisor/Consultant
P-943. Adherence to Guideline-Recommended Duration of Antibiotic Treatment for Uncomplicated Cardiovascular Implantable Electronic Device Lead Infections
Authors: Cummings Shenae , Al Shaikhli Hiba , Sohail Muhammad R , Vijayvargiya Prakhar , Hernandez Gabriel , Bensler James , Garrigos Zerelda Esquer
Published: January 2025

Background

Cardiovascular Implantable Electronic Device lead infection (CIEDLI) is defined as infection involving the leads without concurrent valvular endocardial involvement. These infections are categorized as complicated when extracardiac infection is present and as uncomplicated when distant sites of infection are absent. According to the American Heart Association (AHA), uncomplicated CIEDLI due to Staphylococcus aureus should be treated for 2 to 4 weeks of antibiotic treatment, while non-S. aureus infections typically require a 2-week course. We aimed to evaluate physician adherence to AHA guidelines regarding duration of treatment for CIEDLI.

Methods

We retrospectively reviewed adults presenting with CIEDLI at our institution between 2015 and 2023 to identify those with uncomplicated infection. Physician recommendations regarding treatment duration for CIEDLI were examined. Patients with evidence of CIED-related endocarditis, complicated CIEDLI, and pocket infections without evidence of CIEDLI were excluded.

Results

Twenty-three patients met study criteria. The median age at the time of presentation was 66 years (IQR 46-75) with the majority being male (13/23, 57%) and Caucasian (12/23, 52%). Most patients had an Implantable Cardioverter Defibrillator (11/23, 48%). S. aureus was the most common causative pathogen (13/23, 56%), followed by coagulase negative staphylococci. Only 30% (7/23) of patients received therapy for the duration recommended by guidelines, while the remaining 70% were treated for longer periods, up to six weeks, despite having uncomplicated infection. Side effects to antibiotic therapy (acute kidney injury) were reported in two patients receiving prolonged treatment, whereas none were reported in the group treated according to guidelines.

Conclusion

Our study highlights a lack of adherence to AHA guidelines regarding the duration of antibiotic treatment for uncomplicated CIEDLI. Future efforts should focus on improving awareness and implementing evidence-based practices to optimize patient outcomes, minimize unnecessary antibiotic exposure, potentially mitigating the development of antibiotic resistance, and conserve healthcare resources.

Disclosures

Muhammad R. Sohail, MD, Angiodynamics: consulting fees from Medtronic, Phillips and Angiodynamics|Medtronic: Honoraria|Medtronic: Consulting fees from Medtronic, Phillips and Angiodynamics|Phillips: consulting fees from Medtronic, Phillips and Angiodynamics
P-954. Integration Station - The Train Stops Here: Measuring Effectiveness of Integration of Medicinal Chemistry and Clinical Practice Content in a Required Infectious Diseases Pharmacotherapy Course for Pharmacy Students
Authors: Nieto Marcelo , Cady Beth
Published: January 2025

Background

Pharmacy school accrediting bodies require curricular integration with medicinal chemistry, pharmacology and practice in the curriculum. No studies discuss how to execute that integration effectively. Two pharmacy faculty (one from pharmaceutical sciences and one from pharmacy practice) developed an innovative method to integrate their content in a required ID course. The goal was to determine if exam scores improved.

Methods

Two faculty at one school of pharmacy developed an innovative method to deliver integrated content in a required ID pharmacotherapy course. They utilized methods of backward design and in-class application during the 2024 course delivery. Objectively, exam scores were compared to prior years (both overall scores and individual content questions such as pharmaceutical science and pharmacy practice) to assess effectiveness of content delivery.

Results

All of the infectious diseases content was assessed on two exams (exam 3 and 4) in the required course. The exam 3 average from 2024 was 71% and average scores from the three years prior were 72% (2023), 73.3% (2022), and 65.8% (2021). The exam 4 average from 2024 was 80.4%, and past average scores were 68.4% (2023), 69.3% (2022), and 67.1% (2021). Individual content between pharmaceutical sciences and pharmacy practice content from the exam scores from 2024 were higher than all previous exam scores, with a range of 1.6-14% points better in practice content, and 1.6-12.2% points better in science content.

Conclusion

While there may not have been a dramatic increase in exam scores from the 2024 iteration compared to the previous years, it can be noted that there were some improvements with the newly implemented method of integrated content delivery. Despite the fact that the overall exam 3 average did not increase in 2024 compared to 2023/2022, it is important to note that the content of the exam was weighted differently. There was 1.5x the amount of medicinal chemistry content on the 2024 exam vs previous exams. Students tend to perform worse on medicinal chemistry content. With improved exam scores, this method of integrated science and practice content appears to have been delivered more effectively than in past years.

Disclosures

All Authors: No reported disclosures
P-959. Evaluation of Online Medical Education to Improve Pre-Exposure Prophylaxis (PrEP) Knowledge and Competency among Providers
Authors: Devlin Samantha A , Friedman Eleanor E , Kasal Nikki , Ducheny Kelly , Johnson Amy K , Liegeon Geoffroy , Ridgway Jessica
Published: January 2025

Background

Pre-exposure prophylaxis (PrEP) use for HIV prevention remains low among Black women in the U.S. compared to their need. Barriers to uptake include provider discomfort prescribing PrEP to this group. We sought to evaluate the impact of medical education on providers’ knowledge and attitudes toward PrEP among Black women.

Methods

Providers at two community health centers in Florida and Illinois participated in a live, online PrEP training and completed an online pre- and post-test. The training lasted 45-60 minutes and included didactic and interactive content to equip providers with the clinical knowledge for prescribing PrEP (e.g., indications/side effects, PrEP during pregnancy/breast-feeding, maintenance of therapy) while building their competency discussing PrEP with Black women (e.g., culturally-competent and “health-based” rather than “risk-based” scripts). The test evaluated objective knowledge of PrEP, attitudes toward PrEP and discussing PrEP with/prescribing PrEP to Black women, and likelihood of prescribing PrEP in the future. Data were analyzed descriptively.

Results

Nineteen providers completed the pre-test and fifteen providers completed the post-test. Most were physicians or nurse practitioners (68%, 13/19 and 80%, 12/15, respectively) and female (63%, 12/19 and 60%, 9/15, respectively). In the pre-test, 32% (6/19) of participants thought that pregnant women should not use PrEP; 100% (15/15) of post-test participants understood that PrEP was safe during pregnancy. In terms of discussing PrEP with Black women, originally 53% (10/19) of participants rated their comfort level as “Poor” or “Fair”, which fell to 13% (2/15) after the training. In the pre-test, 47% (9/19) of participants rated their comfort level in prescribing PrEP to Black women as “Poor” or “Fair”, which decreased to 20% (3/15) in the post-test. When asked how likely they were to prescribe PrEP to a Black woman within the next 6 months, 42% (8/19) of participants stated “Likely or “Very Likely” which increased to 80% (12/15) after the training.

Conclusion

Knowledge of PrEP, comfort discussing PrEP with Black women, and intention to prescribe PrEP all improved post-education. Additional data is needed to evaluate the long-term impact of the training on PrEP uptake among Black women.

Disclosures

Jessica Ridgway, MD, Gilead Sciences: Expert Testimony
P-961. Preventing HIV Transmission: The Impact of Early HIV Prevention Education on The Road to Residency
Authors: Pavia Jonathan E , Roa Kyra , Hornak Joseph Patrik
Published: January 2025

Background

The emergence of HIV pre-exposure prophylaxis, or PrEP, has been effective and pivotal in reducing HIV transmission and incidence over the past decade. However, its utilization remains relatively low in the United States as barriers to acquiring PrEP persist. Some of these barriers include HIV risk perception, stigma, and provider bias. Therefore, this report investigates how increasing early career awareness of PrEP amongst fourth year medical students (MS4) matriculating into various specialties impacts their confidence around PrEP.

Methods

Anonymous, online, optional, pre- and post-intervention surveys were conducted to MS4s assessing awareness, knowledge, and perceived comfort around HIV prevention and prescribing PrEP. Students received a 1.5-hour lecture regarding statistics, formulations, indications, and side effects of PrEP from an HIV specialist. Additionally, students’ knowledge around the material was gauged through three interactive patient cases regarding HIV prevention throughout lecture material.

Results

Twenty-three pre- and post-intervention surveys were completed assessing familiarization and comfortability around PrEP. Seven (30%) of the students are pursuing internal medicine, five (22%) family medicine, three (13%) psychiatry, two (9%) OBGYN, and five (22%) in various specialties. Prior to attending the lecture, most students were aware of PrEP (91.3%), but most were uncomfortable initiating such a conversation with a patient (56.5%). The primary, initial limitation students cited in starting a PrEP conversation was their own knowledge around HIV prevention tools (39.1%). After the lecture, the primary constraint remained (39.1% vs. 26%), but a new challenge emerged: students’ comfort level in eliciting a comprehensive sexual history (21.7%).

Conclusion

These findings demonstrate the advantages of introducing HIV PrEP education to graduating medical students. To assist in curbing HIV transmission rates, PrEP utilization must be increased across various medical specialties. Integrating PrEP education within medical school curriculum could be vital in achieving broader aims to end the HIV epidemic. Further investigation should explore alternative approaches to bolster HIV PrEP education across all levels of medical education.

Disclosures

Joseph Patrik Hornak, MD, Innoviva Specialty Therapeutics: Advisor/Consultant|Innoviva Specialty Therapeutics: Advisor/Consultant
P-985. Understanding the Effect of Frailty on People Living with HIV- Online CME Improves Knowledge and Confidence
Authors: Thorpe Sara , Uravich Maria B , Mikhael Emily
Published: January 2025

Background

Frailty affects the clinical status of older people living with HIV (PLWH), increasing their risk of adverse outcomes while impacting quality of life and health span. This study evaluated the effect of an online CME curriculum on enhancing awareness and knowledge of contributing factors associated with frailty in PLWH, as well as improving confidence in supporting best practices for screening, management, and guidelines-based care for frail PLWH.

Methods

The CME intervention comprised of a 30- minute online video-based panel discussion between 2 expert faculty. Response to 3 multiple choice, knowledge questions 1 self-efficacy, 5-point Likert scale confidence question were analyzed using a repeated pairs pre-/post-assessment study design. Pre- to post responses were compared using a McNemar’s test to assess statistical significance. The activity posted on 12/8/2023; data were collected through 3/7/2024.

Results

The analysis set consisted of responses of HIV specialists (n=32) and Primary Care Physicians (n=244) who answered all pre/post questions. Analysis demonstrated a significant improvement in knowledge and confidence.50% of HIV specialists (P< .001, 35% v. 52% pre to post) and 37% of primary care physicians (P< .0010, 29% v. 39% pre to post) demonstrated improvement across all learning objectives57% relative increase among HIV specialists (P< .01, 44% v. 69% pre to post) and 47% relative increase among primary care physicians (P< .001, 34% v. 50% pre to post) in knowledge regarding the consequences of frailty in PLWH42% relative increase among HIV specialists (P< .05, 31% v. 44% pre to post) and 22% relative increase among primary care physicians (P< .001 27% v. 33% pre to post) in knowledge regarding screening tools for frailty assessment63% improved confidence in the use of available tools to screen/assess frailty in PLWH aged 50+

Conclusion

This study demonstrated the success of online, video-based panel discussion CME on improving knowledge and confidence related to individualizing and improving care aging populations who are living with HIV. These findings suggest the benefits of education that addresses clinicians’ individual needs across the continuum of their professional development.

Disclosures

All Authors: No reported disclosures
P-986. Integration of the National HIV Curriculum (NHC) into health professions programs: faculty and student/trainee reflections and perspectives
Authors: Schneegans Suyen , Melhado Trisha , Asuelime Eve , Teplitskly Nathaniel , Garcia-Ponce Alejandra , Allison Waridibo
Published: January 2025

Background

Targeted Access Knowledge and Education on HIV for Health Professions Programs (TAKE on HIV for Health Professions Programs) is a Health Resources and Services Administration (HRSA) funded effort to support National HIV Curriculum (NHC) integration into health professions programs (HPPs) to cultivate HIV prevention and care knowledge into student/trainee (learners) practice and build the HIV workforce. We report on faculty and learners perspectives within integrating HPPs.

Methods

Using mixed methodology, faculty and learners were asked about their NHC integration experience which was facilitated by the TAKE on HIV training and technical assistance (TTA) Team. Following an integration cycle, faculty participated in 1:1 structured interviews and a focus group to identify facilitators/challenges of integration and sustainment plans. Learners completed a digital survey about time to complete NHC lessons and ratings of HIV knowledge, confidence, and usability of the NHC platform (Likert scale: 1- strongly disagree to 5=strongly agree). Data were analyzed using rapid qualitative analyses, descriptive statistics and mean Likert scores.

Results

Nine participating faculty were from the following HPP disciplines: 3 from Pharmacy, 1 each from Physician Assistant and Family Medicine Residency, and 4 from Nursing. Integration facilitators included TTA support and guidance and NHC student tracking capability. A barrier was learner difficulty with navigating the platform and suggestion for improvement was providing additional visual learner resources for platform navigation. All faculty reported desire to sustain NHC integration with subsequent cohorts and additional NHC lessons. 46 learners completed the survey (13% response rate). 67% reported taking 15-30 minutes to complete an NHC lesson. Overall learners reported having improved HIV knowledge (mean=4.42), confidence in providing HIV care (mean=4.07), and ease of NHC platform navigation (mean=4.29).

Conclusion

NHC integration into HPPs is sustainable if sufficient resources are provided to faculty. TAKE on HIV effectively provides HPP faculty with free TTA resources to facilitate NHC integration and a framework for replicability. HIV knowledge gain amongst learners within integrating HPPs was demonstrated.

Disclosures

All Authors: No reported disclosures
P-987. Outcomes of a Program to Integrate the National HIV Curriculum into Health Profession Programs
Authors: Melhado Trisha , Teplitskly Nathaniel , Schneegans Suyen , Griner Stacey , Allison Waridibo
Published: January 2025

Background

The HIV epidemic is ongoing, but the HIV-specific workforce is decreasing. Targeted Access Knowledge and Education on HIV for Health Professions Programs (TAKE on HIV for Health Professions Programs) focuses on the integration of the National HIV Curriculum (NHC) into health professions programs (HPPs) to encourage health professional students/trainees (learners) to enter the HIV workforce and incorporate HIV prevention and care into their practice. This study details integration outcomes.

Methods

The NHC consists of six modules: Screening and Diagnosis, Basic HIV Primary Care, Antiretroviral Therapy, Co-Occurring Conditions, Prevention of HIV, and Key Populations. The number and types of HPPs integrating the NHC were assessed along with the number of learners using the NHC. Students were stratified into Learning Groups (LGs) based on their HPP discipline to track NHC module use and capture knowledge scores. Post integration cycle, a survey assessed learners’ intent to apply the knowledge gained from the NHC into their career (Likert scale: 1-not at all to 5-a great deal). Faculty indicated their intent to continue NHC integration from very unlikely to very likely (5-point Likert scale). Data were analyzed using descriptive statistics.

Results

From September 2023 to April 2024, 15 unique student LGs with 591 learners were integrating the NHC overseen by 14 faculty members at 12 HPPs. Learner NHC enrollment by discipline was as follows: 353 Pharmacy students, 72 Physician Assistant students, 50 Nursing students, 103 Medical Residents, and 13 Occupational Therapy students. The Co-Occurring Conditions NHC module was used the most (1,689 lessons completed) whereas the Key Populations module was used the least (342 lessons completed). Overall mean NHC module scores ranged from 88% to 95% with the Antiretroviral Therapy module and Key Populations module scoring highest and lowest, respectively. Mean student score for intent to apply NHC knowledge = 3.80 (N=175). All integrating faculty indicated they were "very likely" to implement the NHC in future courses.

Conclusion

TAKE on HIV program outcomes indicate successful facilitation of NHC integration into HPPs. The NHC is an effective online mechanism to educate health professional learners and to bolster the HIV workforce pipeline.

Disclosures

All Authors: No reported disclosures
P-988. Evaluation of Intramuscular Penicillin Use and Treatment Outcomes in Neonatal Patients
Authors: Rochat Ryan H , Goldensoph Ali L , Stimes Grant T
Published: January 2025

Background

The prevalence of syphilis in the United States has been increasing despite available treatment options. Penicillin (PCN) is the cornerstone of syphilis treatment, and patients who do not have evidence of central nervous system involvement are often recommended a single dose of intramuscular (IM) PCN as treatment. At this time, IM PCN is on shortage nationwide, and is estimated to continue throughout 2024. The purpose of this study was to identify current length of stay trends for neonatal patients who are treated with a single dose of IM PCN with follow up performed within the Texas Children’s Hospital (TCH) healthcare system and compare this to current guidelines. Ultimately this work will help identify patient characteristics and recommend areas for reduced priority of intramuscular PCN usage in situations of drug shortage.

Result Tables

Demographic and Treatment Tables/Figures for infants who received treatment with IM benzathine Penicillin at birth.

Methods

All infants who received a single dose of IM benzathine PCN between 08/2018 and 08/2023 were considered in this study. Demographic (race, ethnicity, sex, age), and treatment data (PCN administration and discharge dates, treponemal/nontreponemal test results for mother-infant dyad, location of follow up, and gestational age (GA) at time of maternal evaluation) were abstracted from the Epic® EHR.

Results

Eighty-one infant received a single dose of IM benzathine PCN between 8/2018 and 8/2023. The average GA at maternal diagnosis was 18 weeks. Pending laboratory/screening results was the largest factor keeping neonates in the hospital 1 day or more past IM PCN administration. Premature infants were the largest population to remain hospitalized for greater than 10 days. Most neonates (71.6%) had a LOS greater than or equal to 1 day while 13 (16.0%) had a LOS of greater than or equal to 10 days. Twenty-six patients (32.1%) completed follow up within the TCH system with more than half being evaluated at TCH.

Conclusion

Neonates with pending laboratory results, prematurity status, and mothers with extended stays should be further evaluated prior to IM PCN administration during times of shortage. Neonatal follow up screening could be improved with a dedicated syphilis clinic/screening program (such a clinic started at TCH in quarter 1 of 2022). Additional research is necessary to optimize inpatient/outpatient IM PCN use when treating congenital syphilis.

Disclosures

Ryan H. Rochat, MD, PhD, MS, Merck Sharpe Dohme: Grant/Research Support
P-995. Increased Red Cell Distribution Width (RDW) is associated with culture positive sepsis and with increased need of escalation in respiratory support in very low birth weight infants more than seven days of life undergoing sepsis workup secondary to vitals instability in the form of multiple episodes of true apneas or bradycardia and desaturations associated with apnea
Authors: Tilak Kedar , Patel Aashka
Published: January 2025

Background

Apnea of prematurity is nearly universal among very low birth weight infants (VLBW). In VLBW infants, changes in clinical status usually occur due to sepsis or non-infectious causes and it is challenging to differentiate between the two. We as clinicians use irregularities in vital signs as an early warning sign of sepsis to facilitate early treatment and improve patient outcomes. Adults have used RDW as a marker of worsening respiratory status and mortality from acute respiratory distress syndrome (ARDS). In this study, we seek to investigate elevations in Red Cell Distribution Width (RDW) as markers for culture positive sepsis and need for escalation of respiratory support in VLBW neonates.

Association between RDW values and positive cultures

Methods

We did a retrospective chart review using the Electronic Medical Records (EMR) of VLBW infants (< 1500g) admitted to the Neonatal Intensive Care Unit (NICU) of a community hospital over 3 years. We included all babies who had True apnea (apnea > 20 seconds) or apnea with bradycardia and desaturations, after day seven of life and had CBC tests sent and were being managed for presumed late onset sepsis secondary to this vital sign instability. Other demographic data was gathered and tabulated. The data was analyzed to check for association between increased red cell distribution width (RDW) and need for escalation of respiratory support. Escalation in respiratory support included an increased need of assisted ventilation to support breathing. We also looked at positive blood / urine cultures and RDW values.

Association between RDW values and change in baseline respiratory support

Results

50 babies matched our inclusion criteria. 31 babies had a positive blood /urine culture. 21 of the 31 had elevated RDW which was statistically significant at p< 0.05 (Table1), hence showing that positive culture late onset sepsis had elevated RDW. Also, we saw increased need for escalation in respiratory support amongst culture positive babies with an elevated RDW at p < 0.05 (Table 2).

Conclusion

We conclude from this, that elevations in RDW is a marker for VLBW babies needing escalation in respiratory support. Elevations were also seen in culture positive sepsis. More studies need to be done as most of the available data is in adults. We can look more associations in babies with RDS (respiratory distress syndrome) and predict respiratory distress and for early interventions and better outcomes.

Disclosures

All Authors: No reported disclosures
P-1056. Association of High-Risk Clones Of P. aeruginosa With MBLs Poses Heightened Treatment Challenge, however there is a Silver Lining
Authors: Nagvekar Vasant , Patel Neha , Gohel Tejas , Hodgar Shailendra , Srinivasan R , Vas Conrad , Veeraraghavan Balaji , gupta Anumeha
Published: January 2025

Background

Globally, ‘high-risk’ clones of P. aeruginosa continue to pose treatment challenges. These clones, in addition to intrinsic non-enzymatic β-lactam resistance mechanisms such as hyper-expressing efflux and down-regulated porins, have been acquiring broad-spectrum β-lactamases including carbapenemases. In India, recent reports indicate that most of carbapenem-resistant isolates carry MBLs in particular NDMs. However, genomic characterization of such isolates is lacking and therefore their relatedness to internationally circulating high-risk clones is not known. Herein, we have genomically characterized 35 P. aeruginosa index isolates collected from hospitalised patients including admitted at our intensive care unit in 2022 - 2024. We also determined their susceptibility to cefepime/zidebactam (Phase 3-stage) and other newer BL/BLIs, for both serine and MBL-producing Gram-negative bacteria.

Methods

The index P. aeruginosa pathogens were isolated from sputum, tracheal secretion, blood and drain fluid and identified by Vitek 2 (one isolate per patient). The whole genome of these isolates were sequenced (WGS) using HiSeq (Illumina 6000 platform). Susceptibilities to cefepime/zidebactam and other antibiotics were determined by reference broth micro-dilution MIC method according to CLSI M07-A11, 2018.

Results

WGS revealed existence of 9 distinct multi-locus sequence types (ST), a high clonal variation despite isolates belonged to a single centre (Figure 1). Among them, 3 were international high-risk clones and nearly half of the isolated belonged to these 3 STs. Three MBL types, NDM, VIM and DIM were detected and none of the isolates carried serine carbapenemase. Mutations were noted in genes encoding efflux and impermeability. Susceptibilities to aminoglycosides and fluoroquinolones were < 30%. Except 5, all isolates were resistant to carbapenems. There was a 100% susceptibility to cefepime/zidebactam

Conclusion

WGS analysis showed multiplicity of resistance mechanisms including MBLs in high-risk clones thus severely limiting treatment options. Investigational antibiotic cefepime/zidebactam may be a potential treatment option for infections caused by such isolates. In India VIM was the most common Carbapenemase resistance is being replaced by MBL(NDM)

Disclosures

All Authors: No reported disclosures
P-1084. Antimicrobial Activity of Aztreonam-Avibactam and Other β-Lactamase Inhibitor Combinations Tested against Enterobacterales Isolates from Pediatric Patients from United States Medical Centers (2019–2023)
Authors: Sader Helio S , Winkler Marisa , Mendes Rodrigo E , Castanheira Mariana
Published: January 2025

Background

We evaluated the activities of aztreonam-avibactam (ATM-AVI), ceftazidime-avibactam (CAZ-AVI), meropenem-vaborbactam (MEM-VAB), imipenem-relebactam (IMI-REL), ceftolozane-tazobactam (C-T), and comparators against Enterobacterales (ENT) isolates causing infection in pediatric (PED) patients.

Activity of β-lactamase inhibitor combinations against Enterobacterales isolates from pediatric patients

Methods

Among 43,325 ENT (1/patient) collected in 2019–2023 via the INFORM Surveillance Program, 5,723 (13.2%) were from PED patients (≤ 17 years old [yo]). The isolates were consecutively collected from 81 US medical centers and susceptibility tested by CLSI broth microdilution method. Susceptibility was stratified by infection type and patient age: ≤1 yo (n=2,275), 2–5 yo (n=1,130), 6–12 yo (n=1,213), and 13–17 yo (n=1,105) and compared to adults (18–64 yo; n=17,712).

Results

PED isolates were mainly from pneumonia (21.8%), bloodstream (BSI; 15.3%), and urinary tract infection (UTI; 51.8%). ATM-AVI inhibited > 99.9% of PED isolates at ≤ 8 mg/L; CAZ-AVI and MEM-VAB were active against > 99.9% and 100.0%, respectively, whereas IMI-REL and ceftolozane-tazobactam (TOL-TAZ) were slightly less active (Table). Meropenem, ceftriaxone (CRO), and gentamicin were active against 99.8%, 87.6%, and 92.1% of PED isolates, respectively. CRO susceptibility ranged from 84.5% (6–12 yo) to 89.2% (2–5 and 13–17 yo) among PED isolates and was 81.5% against adult isolates. CRO was active against 86.0%, 87.3%, and 88.4% of PED isolates from pneumonia, BSI, and UTI, respectively. Multidrug-resistant (MDR; non-susceptible [NS] to ≥ 3 classes) phenotype varied from 14.3% (13–17 yo) to 19.7% (6–12 yo) among PED isolates (15.8% overall) and was 20.7% among adult ENT. Carbapenem resistance rate was markedly lower among PED (0.1%) compared to adult isolates (1.3%). TOL-TAZ and piperacillin-tazobactam (PIP-TAZ) exhibited limited activity against CRO-NS and MDR isolates. Susceptibility rates for most comparators were higher among PED than adult isolates, including CRO (87.6% vs. 81.5%), PIP-TAZ (92.2% vs. 88.0%), TOL-TAZ (96.9% vs. 93.9%), and levofloxacin (90.8% vs. 82.1%).

Conclusion

ATM-AVI, CAZ-AVI, and MEM-VAB were highly active against ENT isolates from PED patients. Susceptibility differences were observed among age groups and infection types.

Disclosures

Marisa Winkler, MD, PhD, Element Iowa City (JMI Laboratories) was contracted to perform services in 2023 for > 30 biotech and pharmaceutical companies: Grant/Research Support Rodrigo E. Mendes, PhD, GSK: Grant/Research Support
P-1122. Impact of an Antimicrobial and Diagnostic Stewardship Program in Children with Lower Respiratory Tract Infection admitted to Intensive Care Unit in Argentina
Authors: Perez Guadalupe , Carmona Rodrigo , Zuazaga Marcela , Ansio Carolina , Kijko Ivana , Gonzalez Gabriela , Velardez Daniel , Isasmendi Adela , Tevez Agustina , Borgnia Daniela , Taicz Moira , Rosanova Maria Teresa , Bologna Rosa
Published: January 2025

Background

Lower respiratory tract infection (LRTI) is a common cause of admission and antibiotic (ATB) overuse in children. Adequate use of diagnostic methods and ATB prescription in intensive care units (ICU) remain a challenge for antimicrobial stewardship programs.

Aims

to evaluate the impact of a multilevel intervention to improve diagnostic testing and ATB use in children with LRTI admitted to ICU.

Methods

Quasi-experimental, before-after study. Patients admitted to ICU from April to June 2023 (Pre Intervention period: PreI) and July to October 2023 (Post Intervention: PostI) with community acquired LRTI were included. Intervention consisted in educational activities, daily review and feedback of ATB prescription, development and dissemination of an institutional Guideline of ATB use in LTRI, including a Clinical Score to distinguish viral from bacterial pneumonia.

Results

95 patients were included. Median age was 11 months (IQR 4-19).Fifty eight (61%) had any underlying condition, including: previous bronchiolitis N:16 (17%), Asthma N:8(8%) and Neurological Disorders N:7 (7%). Clinical diagnosis upon ICU admission was: bronchiolitis (N:42, 44%), asthmatic crisis (N: 33, 35%) and Pneumonia (N: 11, 12%). A viral etiology was documented in 76 patients (80%). The most common was RSV (N: 52, 55%) followed by Rhinovirus (N: 19, 20%). Viral coinfection was detected in 15 patients (16%). Sixty-three patients were admitted during PreI and 32 during PostI. Children admitted to ICU during PreI were more frequently healthy (PreI: 48% vs PostIn 22%, p 0.015), with bronchiolitis as admission diagnosis (PreI 56% vs PostI 23%, p 0.002) and confirmed respiratory infection (PreI 87% vs PostI 66%, p 0.01). In PreI more Blood cultures (PreI 61% vs PostI 51%, p 0.06) and tracheal aspirate cultures (PreI 48% vs PostI 22%, p 0.04) were performed. Empirical ATB were started on admission in 39 patients (62%) during PreI, and in 13 patients (41%) in PostI (p: 0.04). Adequate ATB prescription increased from 14% in the PreI to 37% in the PostI (p 0.01). Patients in PostI had shorter hospital length of stay (8 vs 14 days, p 0.02)

Conclusion

A multilevel intervention in children with LRTI on admission to ICU improved the use of blood and tracheal aspirate cultures and ATB prescription. Length of stay decreased in PostI.

Disclosures

All Authors: No reported disclosures
417. Should We Be Doing This? Evaluating Pleural Fluid Inoculation into Blood Culture Bottles
Authors: Fraker J Hunter , Lee Matthew S
Published: January 2025

Background

Sterile fluid inoculation into blood culture (BCx) bottles has primarily been shown to be beneficial with peritoneal fluid. However, we have observed widespread expansion of this practice for other sterile fluid specimens at our institution. We investigated whether there was a clinical benefit to inoculating pleural fluid specimens into BCx bottles.

Methods

This was a retrospective chart review of patients who had pleural fluid inoculated into BCx bottles from July 1, 2021 through June 30, 2023. Clinical, microbiologic, and pharmacy data were extracted from medical records of patients that had at least one organism isolated from these samples and had a routine (non-blood culture bottle inoculation) pleural fluid culture sent from the same procedure. The primary outcome was the proportion of clinically relevant organisms based on evaluation by the primary or a consultant team.

Results

A total of 334 pleural fluid specimens were inoculated into BCx bottles during the study period; positive cultures were found in 12.2% (41/334). Five patients were excluded as they did not have a concomitant routine pleural fluid culture, leaving a study cohort of 36 patients.

In the study cohort (n=36), 61.1% (22/36) had the same organism(s) isolated from both BCx inoculated and routine pleural fluid cultures, while 38.9% (14/36) had additional organisms from the BCx bottle inoculated specimens that were not isolated on the routine pleural fluid culture.

Of the 14 patients with additional organisms from BCx bottle inoculation (Table 1), 4 were deemed contaminants. Ten patients had clinically relevant organisms and 4 of these led to changes in antimicrobial management (change in agent or duration).

Overall, 3% (10/334) of specimens with pleural fluid inoculated into BCx bottles had a clinically relevant organism that was not isolated in routine culture. 1.2% (4/334) of specimens led to a change in clinical management based on the additional organism(s) isolated.

Conclusion

In our single-institution study, we found widespread practice of inoculating pleural fluid into blood culture bottles. The practice may slightly increase microbiological yield over routine fluid cultures, but few patients had a change in clinical management at our institution.

Disclosures

All Authors: No reported disclosures
P-1152. Cefepime, Meropenem, and Piperacillin Therapeutic Drug Monitoring in Neonatal and Pediatric Patients
Authors: Dinnes Laura , Ristagno Elizabeth H , Brumbaugh Jane E , Stetson Raymond , Levy Emily Ruth , Lee Grace , Rivera Christina G , Smith Brandi , Thurber Gregory , Gullickson Taylor , Barreto Erin F
Published: January 2025

Background

Pharmacokinetics of beta-lactams vary widely in neonatal and pediatric patients due to developmental biology and critical illness. Cefepime (FEP), meropenem (MEM), and piperacillin/tazobactam (TZP) are highly susceptible to pharmacokinetic changes as hydrophilic, small molecules with renal clearance. Subtherapeutic levels are associated with clinical and microbiologic failure, and supratherapeutic levels associated with toxicity. Beta-lactam therapeutic drug monitoring (TDM) may optimize the effectiveness and safety of these agents. The purpose of this investigation is to describe the % of pediatric and neonatal patients with beta-lactam serum levels within target range.

Methods

In August 2023, TDM launched at the Mayo Clinic Children’s Center for select patients treated with FEP, MEM, or TZP with expected durations ≥ 48 hours, or who were on kidney replacement therapy (KRT), extracorporeal membrane oxygenation (ECMO), weighed > 120 kg, had a BMI > 95th percentile, or at the discretion of pediatric ID team. Validated drug assays were performed daily, Monday through Friday. A two-level sampling strategy was preferred with a peak 1 hour after the end of the infusion and a trough 30 minutes before the next dose. Empiric trough target ranges were set at FEP 8-50 mg/L, MEM 2-30 mg/L, and piperacillin 16-150 mg/L. These target ranges were adjusted with confirmed microbiology to a time above the minimum inhibitory concentration of the organism for 100% of the dosing interval (100%T > MIC).

Results

From August 2023 to April 2024, 74 episodes of TDM were performed on 45 patients. Thirty-seven (82%) patients were in an intensive care unit (ICU) at the time of TDM, 8/45 (22%) of whom were in the neonatal ICU. Target range was achieved in 67% of patients on FEP, 50% on MEM, and 52% on TZP. Median (IQR) trough values were 22.1 (8.6, 44.2) mg/L for FEP, 0.6 (0, 4.1) mg/L for MEM, and 15.5 (3.8, 27.1) mg/L for TZP. Seven levels were above target for FEP and 0 for MEM and TZP. Seven levels were below target for FEP, 4 for MEM, and 11 for TZP.

Conclusion

Implementation of a TDM program for FEP, MEM and TZP in pediatric and neonatal patients revealed drug levels frequently outside target range. TDM may facilitate dose individualization to optimize medication efficacy and minimize toxicity.

Disclosures

Raymond Stetson, MD, MS, Moderna: Grant/Research Support Christina G. Rivera (O'Connor), Pharm.D, Gilead Sciences: Board Member Erin F. Barreto, PharmD, MSc, Baxter Health: Advisor/Consultant|Wolters Kluwer: Advisor/Consultant
P-1165. Factors Associated with Initial Antifungal Choice for Invasive Candidiasis
Authors: Said Amira , Banerjee Ankona , Dutta Ankhi
Published: January 2025

Background

The Infectious Disease Society of America (IDSA) and European Society of Clinical Microbiology and Infectious Disease (ESCMID) recommend an echinocandin (EC) for first line initial therapy for candidemia. No randomized clinical trial has demonstrated superiority for any antifungal (AF) over another for invasive candidiasis (IC). The EC have become preferred agents due to their favorable side effect profile and early fungicidal activity. Despite current recommendations, there are variabilities in prescribing practices of AF in children with IC. Our goal was to investigate factors influencing initial choices of AF for children with IC.

Methods

We performed retrospective analysis of de-identified data collected as part of the Pediatric Antifungal Comparative Effectiveness Study (PEACE), a collaborative effort by the International Pediatric Fungal Network, conducted 2014 to 2017. 750 patients from 35 centers were included. We looked at demographics, clinical features, risk factors (underlying diagnosis, neutropenia, immunosuppressive medications, stem cell or organ transplant, parenteral nutrition etc) which determine the initial choice of AF within the first 72 hours of IC.

Results

Males comprised 55.6% and White race 58.3%. Majority were non-Hispanic ethnicity (67.7%). Triazoles (TZ) (40.1%) were the most used initial AF followed by EC (33.7%) and amphotericin B (AmB) (17.9%). When EC use was compared to other AF, there was no difference in age or gender. Multivariate logistic regression showed that patients with prior steroid use were more likely to receive AmB than EC. However, patients who had solid tumor malignancy, gastrointestinal insufficiency, neutropenia, prior steroid use and on vasopressors were more likely to receive EC than TZ. Patients who identified as Black were more likely to receive combination AF than an EC alone (OR 2.36, 95% CI 1.03-5.43, P=0.016). The most common reason for changing AF from the initial therapy was for step-down therapy followed by treatment failure.

Conclusion

Combination AF use was higher in Black patients. Though overall use of TZ was higher among children with IC, presence of risk factors like steroid use, underlying solid tumor malignancy, neutropenia or vasopressors was associated with EC use. AmB use was not as common as anticipated.

Disclosures

All Authors: No reported disclosures