bluuebunny/crossref_metadata_2025 huggingface dataset:
P-54. High Dose Intramuscular Influenza Vaccine in Solid Organ Transplant Patients. A Systematic Review and Meta-analysis
Authors: Rahimi Shahmirzadi Reza , Abdar Esfahani Meisam , Couban Rachel , Cairns Sarah , Elsayed Sameer , Silverman Michael
Published: January 2025

Background

Seasonal influenza can cause serious illness and even death, especially in immunocompromised people such as solid organ transplant recipients (SOT). Early results from some studies show that high dose (HD) intramuscular (IM) vaccine might help boost the body's immune response in transplant patients. Given the uncertain benefits and harms associated with various IM vaccine doses a synthetized appraisal of the evidence is warranted.Figure 1:Seroconversion rate in Influenza A(H1N1) (SC H1N1) Forest plot

Methods

Randomized controlled trials of adults who underwent SOT and received IM influenza vaccine and compared , IM influenza HD vaccine with standard dose. The outcomes of interests are seroconversion rate (SCR) for H1N1,H3N2, and graft rejection after vaccination. We searched MEDLINE, Embase, and Cochrane CENTRAL until Jan 2024. Screening, data extraction, risk of bias and certainty of evidence assessment were assessed by two reviewers.Figure 2:Seroconversion rate in Influenza A (H3N2) (SC H3N2) Forest plot

Results

Pooling data from the 5 studies (1281 patients) shows moderate quality of evidence in the SCR towards using HD influenza vaccine in H1N1 type and high-quality evidence for H3N2 type . (RR 1.87 (1.25 to 2.79), RR 1.54 [1.31 to 1.80]). Analysis of five studies indicated that HD influenza vaccine results in no difference in graft rejection. (RR 0.73 [0.37 to 1.45]). High quality evidence showed that HD influenza vaccine reduce serious adverse events in SOT patients. (RR 0.71 [0.52 to 0.96]). Data from three studies shows HD influenza vaccine may results in little to no difference in confirmed clinically influenza. (low certainty of evidence) (RR 1.16 [0.58 to 2.29]).Figure 3:Graft rejection (GR) Forest plot

Conclusion

Our systematic review indicates that HD influenza vaccine probably increases SCR in H1N1 and increases SCR in H3N2.HD vaccine, also may not increase graft rejection and reduces serious adverse events in SOT patients.

GRADE Summary of Findings (SoF) Table

Disclosures

Reza Rahimi Shahmirzadi, MD, Pfizer: Grant/Research Support Meisam Abdar Esfahani, MD, Pfizer: Grant/Research Support Michael Silverman, MD, FRCP, FACP, AAHIVMed, Pfizer: Grant/Research Support
P-63. Real-World Effectiveness of Influenza Vaccine Over a Decade During the 2011–2021 Seasons: Implications of Vaccine Mismatch
Authors: Jung Choi Yu , Young Song Joon , Wie Seong-Heon , Suk Choi Won , Lee Jacob , Lee Jin-Soo , Keun Kim Young , kim Shin-Woo , Hee Lee Sun , Park Kyung-Hwa , Won Jeong Hye , Gu Yoon Jin , Seong Hye , Nham Eliel , Yun Noh Ji , Jin Cheong Hee , Joo Kim Woo
Published: January 2025

Background

Influenza imposes a significant healthcare burden in Korea, leading the government to initiate a national immunization program. Previous studies on vaccine effectiveness (VE) were limited to single-season estimation in Korea.

Matching status of epidemic influenza virus strains and vaccine strains in each season from the 2011/2012 to 2020/2021 seasons

Methods

This multicenter prospective cohort study enrolled patients with influenza-like illnesses at 10 medical centers in Korea from 2011–2021. The demographic and clinical data were collected from questionnaire surveys and electronic medical records. Using a test-negative design, we aimed to investigate the effectiveness of a seasonal influenza vaccine for antigenic matching of the vaccine and circulating viral strains over 10 seasons.

Vaccine effectiveness against laboratory-confirmed influenza

Results

Overall, 5,322 adults aged ≥65 years were enrolled. Only three (33.3%) of nine seasons showed >70% antigenic match between vaccine and circulating strains. Influenza VE was significantly variable by season, ranging from -46.9% (95%confidence interval [CI]: -127.6–5.2) in the 2011/12 season to 47.7% (95%CI: 22.6–64.7) in the 2016/17 season. A significant difference was observed in the VE depending on whether the vaccine strains matched with epidemic strains: 28.8% (95%CI: 8.8–44.8) in matched seasons versus -12.0% (95%CI: -30.0–3.7) in mismatched seasons. Across the study period, influenza-related hospitalizations were reduced by 13.6% (95%CI: 0.7–24.8) with vaccination. In a subgroup analysis, the VE against influenza-related hospitalization was 48.4% (95%CI 29.6–62.2) in A/H3N2 dominant seasons and 53.8% (95%CI: -73.4–87.7) in A/H1N1 dominant seasons, respectively.

Vaccine effectiveness against laboratory-confirmed influenza by the matching status of vaccine and epidemic strains

Conclusion

Influenza vaccine mismatch was frequent over the study period, leading to negligibly low VE in mismatched seasons. Influenza vaccination reduces the risk of influenza-related hospitalizations.

Estimates of vaccine effectiveness for influenza-related hospitalizations

Disclosures

All Authors: No reported disclosures
P-65. Results from A Phase 2 Clinical Trial for Treatment of Bone And Joint Infections with Afabicin, A First-in-Class Selective Anti-Staphylococcal Antibiotic
Authors: Shamaei Tousi Alireza , Marquardt Moritz , Menetrey Annick , Nowakowska Justyna , Dao Justine , Cameron David , Catala-Goldschmidt Charlotte , Chaves Ricardo
Published: January 2025

Background

Staphylococci are the most common causative pathogens in bone and joint infections (BJI). Treatment for BJI is a major clinical challenge, with recurrent and persistent infections occurring in 40% of patients. Afabicin is the most advanced FabI inhibitor in clinical development and has the potential to be the first microbiome-sparing anti-staphylococcal antibiotic. Currently, a Phase 2 trial in BJI (NCT03723551) is enrolling patients to be treated for 3-6 weeks with afabicin or standard of care (SoC). Results of the first cohort in this study (2-3 weeks treatment) are presented here

Methods

In an ongoing multicenter, open-label, Phase 2 study, the safety, tolerability, and efficacy of afabicin was compared to those of SoC, in the treatment of patients with BJI. Patients with osteomyelitis, septic arthritis, or prosthetic joint infections were randomized (5 afabicin: 1 SoC) to receive IV and oral treatment for 14 to 21 days. Afabicin treatment (55 mg IV/ 80 mg PO BID) was compared to a pre-defined SoC treatment.

Results

Twenty patients were included in microbiological intent-to-treat (mITT) population and were treated for up to 21 days with afabicin or SoC (17 afabicin and 3 SoC). The mean treatment duration was 20.1 days for afabicin and 19.7 days for SoC. Overall, osteomyelitis was the most common diagnosis (85%). The most frequent baseline pathogen was Staphylococcus aureus (19 patients), and 18 patients had methicillin-sensitive S. aureus. All 20 patients were treatment responders at End of Treatment (EoT) visit. The clinical response at 4 weeks post EoT was 13 of 15 patients in the afabicin arm, consistent with patient exposure being above PK/PD targets derived from non-clinical modeling. All 3 patients in the SOC arm achieved clinical response at 4 weeks post EoT. At 12 weeks post EoT, the clinical response rate was 13 of 15 patients in the afabicin arm and 2 of 3 patients in the SoC arm. A similar safety profile was observed in the afabicin arm versus SoC arm.

Conclusion

The clinical response rate and safety profile of 2-3 weeks treatment of staphylococcal BJI with afabicin was comparable to SoC. These data support exploring longer durations of treatment in the study. Additionally, the impact of Afabicin on BJI patient’s gut microbiota will be explored.

Disclosures

Alireza Shamaei Tousi, PhD, Debiopharm International: Salary Moritz Marquardt, n/a, Debiopharm International: Salary Annick Menetrey, n/a, Debiopharm International: Salary Justyna Nowakowska, n/a, Debiopharm International: Salary Justine Dao, n/a, Debiopharm International: Salary David Cameron, PhD, Debiopharm International S.A.: Salary Charlotte Catala-Goldschmidt, n/a, Debiopharm International: Salary Ricardo Chaves, n/a, Debiopharm International S.A.: Salary
P-68. Comparison of vancomycin vs daptomycin for prosthetic joint infections
Authors: Maria Tedeschi Carissa , Slain Douglas , Mehta Meera , Johnson Jessica , Lastinger Allison
Published: January 2025

Background

A combination of surgery and extended durations of antimicrobials are the mainstays of therapy for patients with prosthetic joint infections (PJI). In the Infectious Diseases Society of America Clinical Practice Guidelines for Diagnosis and Management of PJI, daptomycin is an ‘alternative regimen’ for patients with methicillin-resistant Staphylococcus aureus (MRSA) and other methicillin-resistant coagulase-negative Staphylococcus (CoNS) species. The side effect profile of daptomycin may also be more tolerable than that of vancomycin, the preferred agent. This study aims to investigate the tolerability and efficacy of vancomycin versus that of daptomycin for patients with PJI. This topic has not been widely compared in literature for patients with monomicrobial PJIs.

Methods

This was a retrospective, observational assessment of patients who received vancomycin or daptomycin after surgery for prosthetic knee or hip infections. Patients were followed in our University Hospital’s Orthopedic Infectious Diseases Clinic between 1/1/2019 and 4/30/2023. Medical records were reviewed including demographics, type of surgery, adverse effects (AEs), and relapse rates at 6 weeks, 6 months, and one year.

Results

Seventy-nine patients were included: 56 initiated therapy with vancomycin and 23 with daptomycin. The primary outcome was the incidence of therapy-altering AEs. Twenty-two patients in the vancomycin group and 4 patients in the daptomycin group experienced AEs that led to therapy changes (39.3% vs 26.1%, p=0.07). The secondary outcome was the incidence of recurrent infection and was tracked in a subset of 39 vancomycin and 23 daptomycin patients. At 1 year, 10 vancomycin patients required additional unplanned surgery, while only 1 daptomycin patient experienced this (17.9% vs 4.3%, p=0.04). The only statistically significant difference found in baseline characteristics was that more antibiotic spacers were placed in the long-term follow-up daptomycin patients (15 vs 16, p=0.034).

Conclusion

There was no statistically significant difference in tolerating vancomycin vs daptomycin, however, daptomycin may lead to fewer relapses long-term in patients with MRSA and CoNS infections.

Disclosures

All Authors: No reported disclosures
P-93. Contezolid in Patients with Spinal Infections
Authors: Wei Bo , Zhang Xiucui , Wang Jianrong
Published: January 2025

Background

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of spinal infections (SI) requiring long-term use of antibiotic therapy. Linezolid (LZD) is effective in treating MRSA in different clinical scenarios, but its long-term use is limited due to risk of significant thrombocytopenia. Contezolid (CZD) is a new generation of oral oxazolidinone with potentially less myelosuppressive effect. However, data on the use of CZD in patient with SI is currently lacking. This study aims to evaluate the use of oral CZD in patients with spinal infections due to MRSA.

Methods

Single-center, retrospective study in 7 patients with SI caused by MRSA. All patients experienced platelet count decreased during treatment with LZD and were rapidly switched to CZD (800 mg, po, bid) for > 4 weeks. We evaluated the clinical outcomes (within six months after treatment), adverse reactions and the platelet counts.

Results

7 patients met the criteria for this study (median age 58, IQR 56.5-64.5, 14.3% female). With LZD treatment for a median of 14 days ( IQR 12-14 ), platelet count decreased from normal range 125-300 × 109/L to 65–75 × 109/L. After switching to CZD for 2 weeks, the platelet counts recovered to > 100 × 109/L in all subjects. At the time of the switch 5 patients still had increased C-reactive protein. After approximately 2 months of oral CZD treatment(median duration 28 days, IQR 26-31.5 ), all patients improved clinically and CRP levels returned to normal (Table 1). Follow up MRI results also indicated radiologic improvement (Figure 1). Clinical evaluation, CRP and MRI six months after therapy indicated no recurrence in any subjects. During the treatment with CZD, only 2 patients experienced mild nausea, with no serious adverse reported.

Conclusion

In patients with SI due to MRSA experiencing thrombocytopenia with LZD, This limited study of oral CZD, as a rescue therapy for hematogenous osteomyelitis and thrombocytopenia after treatment with LZD, is encouraging and suggests that CZD may with more study be an excellent option for the treatment of SI due to MRSA.

Disclosures

All Authors: No reported disclosures
P-94. Can Fluoroquinolones Be Used for the Treatment of Deep-Seated Streptococcus anginosus group Infections?
Authors: Miller Whitney , Jenkins Timothy C , Parry Joshua , Studnicka Sebastian , Delino Nicole , Young Heather
Published: January 2025

Background

Invasive infections caused by Streptococcus anginosus group are increasingly common. Some experts recommend against treatment with fluoroquinolone (FQs) dues to potential development of fluoroquinolone resistance; however, this is not based on clinical data. The aim of this study is to compare the safety and effectiveness of FQ-based antibiotic regimens with non-FQ regimens for the treatment of deep-seated S. anginosus group infections.

Methods

This was a retrospective cohort study of patients hospitalized at Denver Health Medical center between 4/1/2016 and 10/31/2023 with a deep-seated infection and isolation of S. anginosus group from tissue, bone, synovial or pleural fluid. Cases were categorized as having been treated with a fluoroquinolone as part of their antibiotic regimen or not. The primary outcome was treatment success at 90 days as defined as absence of the following: recurrent infection, need for repeat surgical intervention or hospital readmission related to the primary infection. Secondary outcomes included antibiotic-related adverse events and central venous catheter complications.

Results

144 cases of deep-seated infection involving a S. anginosus group were identified; 69 received a FQ while 75 were treated with other antibiotics. Those in the FQ group were more likely to discharge on oral antibiotics (64 [93%] vs. 40 [53%], p< .001) and had a shorter duration of intravenous therapy (2 days vs. 13 days, p< .001). Treatment success occurred in 62 (90%) patients in the FQ group and 69 (92%) patients in the non-FQ group (p=0.65). Rates of antibiotic-related adverse events and vascular complications were similar between groups. Of patients who received a FQ, no patients had treatment failure or recurrent infection with an isolate resistant to a FQ.

Conclusion

FQs appeared to be a safe and effective treatment option for deep-seated S. anginosus group infections and facilitated early transition to oral therapy, while the development of FQ resistance was not observed.

Disclosures

All Authors: No reported disclosures
P-126. Host Factors Associated with Failure of Fecal Microbiota Transplant for Recurrent Clostridioides difficile Infection: 10- Year Real World Experience in a Dedicated C. difficile Clinic
Authors: Yohannes Kibret , Nguyen Joseph D , Setiady Initha , Hyun Shin Jae , Warren Cirle A , Phillips Emma C , Hays R Ann , Behm Brian
Published: January 2025

Background

Clostridioides difficile infection (CDI) continues to be an antibiotic-associated infection of urgent concern. Fecal microbiota transplantation (FMT) is the most effective treatment of recurrent CDI (rCDI). Despite high success rates, FMT has proven to be ineffective in 5-20% of cases. Factors associated with failure have not been clearly defined. We seek to better understand factors predictive of failure in patients who have undergone FMT.

Failure Rate by Comorbidity

Methods

A retrospective chart review was conducted on adult patients who were screened at the Complicated C. difficile Clinic at the University of Virginia Health System and received FMT for rCDI between 2013 and 2022. Electronic medical records were thoroughly reviewed to collect data on demographics, comorbidities, CDI history, laboratory values prior to FMT, and performance after FMT. Primary outcome was failure of FMT, defined as either rCDI or death within one year.

Failure Rate by Lab Values

Results

240 patients with rCDI were treated with FMT: 70.4% were female, median age was 68 (range: 20 to 96), and median episodes of CDI was 4 (range: 1 to 25). Within one year, 24.6% of patients experienced failure: 18.3% of patients experienced rCDI and 7.1% died. Univariate analysis showed that older age (≥70), male sex, ≥4 episodes of CDI, hypertension, diabetes mellitus, malignancy, elevated TSH, anemia, and low zinc were linked to failure. Older age, ≥4 episodes of CDI, hypertension, and elevated TSH were also associated with recurrence. Male sex, diabetes mellitus, elevated TSH, anemia, and low zinc were associated with death. Multivariate analysis showed that older age, ≥4 episodes of CDI, and diabetes mellitus were linked to failure while older age and ≥4 episodes of CDI were linked to recurrence.

Failure Rate by Number of C. difficile Infections

Conclusion

FMT continues to hold up as an effective treatment for rCDI. At one year follow-up, about 1 in 4 patients who underwent FMT at our institution experienced failure. Older age, ≥4 episodes of CDI, elevated TSH, anemia, and low zinc appear to be associated with failure, but additional research is needed to clearly define causality. Our results underscore the importance of recognizing factors that can predict failure and be targeted to further improve outcomes of FMT.

Failure Rate by Sex

Disclosures

Jae Hyun Shin, MD, Ferring: Grant/Research Support Cirle A. Warren, MD, Ferring Pharmaceuticals: Site PI for ROAR
P-139. Characteristics of Veteran Travelers at the Clement J. Zablocki Veterans Affairs Medical Center
Authors: Mulaikal Bianca , Gundacker Nathan , Sherman Katherine
Published: January 2025

Background

Travel location, demographics, and the type of travel are critical determinants of the pre-travel consultation. Veterans represent a unique subpopulation of the US. They earn higher average salaries than their non-veteran counterpart and have access to free healthcare. This puts them in a position to spend more on personal travel, yet there is a paucity of data on veterans' travel preferences and habits. In this study, we examined veteran travel characteristics to provide information on how best provide pre-travel consultation.

Methods

This is a retrospective chart review of veterans who presented to the Clement J Zablocki Veterans Affairs Medical Center (VAMC) infectious disease clinic for a pre-travel consultation between 7/1/2017 and 4/11/2023.

Results

Of the 181 veterans in this study, 150 were male, 29 were female, and two were unknown. The mean traveler was 55.62 years old. Asia (n=87, 48.1%) was the most frequently traveled continent, followed by Africa (n=47, 26%). Veterans were independently traveling (n=121, 67%) for durations greater than one week (n=164, 91%), with 13.3% traveling for at least 2-3 weeks. Within Asia, 23% (n=20) traveled to the Philippines, 26% (n=23) to Vietnam, and 17% (n=15) traveled to Thailand, of these 67% traveled for 4 weeks or more (n=29, 67%).

Conclusion

According to data collected in 2020 by the United Nations World Tourism Organization (UNWTO), the world's top 10 destinations are all within Europe and North America and account for 40% of all global travel. In addition, most group travel is generally one week long. Comparatively, veterans travel longer, more independently, and to more diverse parts of the world. Veteran travel clinics need to be equipped to discuss risks or longer term travel including international health care, safe sex practices and vaccines such as rabies and Japanese encephalitis.

Disclosures

All Authors: No reported disclosures
P-143. Interpreting Prognostic Factors Associated with In-Hospital COVID-19 Mortality in a Peru Sample using Shapley Additive Explanations on Ensemble Learning
Authors: Dai Na , Briceno Ruben K , Castaneda Alex , Tresierra Miguel , Esteban Maribel , Rosas Moises , Hinojosa Rene
Published: January 2025

Background

COVID-19 has infected over 4.5 million and killed more than 222,000 people in Peru. Research on key factors for in-hospital mortality in these patients is limited. Our study aims to understand prognostic factors linked to the mortality of patients with COVID-19 receiving treatment in Peru. A modified SHapley Additive exPlanations (SHAP) method was proposed.

Table 1

Methods

Clinical and laboratory data were collected prospectively about all patients that were admitted in the inpatient setting at Hospital De Alta Complejidad Virgen De La Puerta and Hospital víctor Lazarte Echegaray Essalud from March 1st to December 31st 2020 with a COVID-19 diagnosis clinically. Ten base predictors were first implemented using the ML algorithms such as Random Forest. Prediction performance on the area under the receiver operating characteristic (AUC) was computed. The SHAP method was then applied to each predictor based on resampled train sets for 30 trials. Factor importance in each trial was estimated by averaging SHAP scores across all predictors, weighted by AUC.

Table 2 (Part 1/3)

Results

After applying inclusion and exclusion criteria (n=) 1,857 patients were selected from a total of 2,000 admitted patients. Several factors out of 281 in total achieved stable importance scores with statistical significance while others were not. Among poor prognostic factors were low PaO2/FiO2 ratio (SV: 4.135, 95% CI: [4.107, 4.163]), shortness of breath (SV: 4.975, 95% CI: [4.864, 5.086]), and productive cough (SV: 2.037, 95% CI: [1.99, 2.080]). Among favorable factors were high PaO2/FiO2 ratio (SV: 3.832, 95% CI: [3.816, 3.848]), low D dimer (SV: 0.875, 95% CI: [0.859, 0.891]) and lymphocyte counts (SV: 1.319, 95% CI: [1.297, 1.340]). For medications, dexamethasone w. air (SV: 2.186, [2.095, 2.277]) was the most effective. For oxygen support, binasal cannula (SV: 0.841, 95% CI: [0.826, 0.857]) and high flow cannula (SV: 0.663, 95% CI: [0.633, 0.693]) are associated with more favorable prognosis than invasive ones.

Table 2 (Part 2/3)

Conclusion

Clinical symptoms and evidence associating acute respiratory distress and sepsis, as well as immune responses less specific to viruses, suggest a likelihood of COVID-19 mortality, consistent with global findings. Our SHAP variant generated reasonable prognostic interpretation about COVID-19 mortality in Peru.

Table 2 (Part 3/3)

Disclosures

All Authors: No reported disclosures
P-153. Malaria in a military hospital in Bogotá, Colombia, 2023 – 2024
Authors: Medina-Lozano Leidy J , Oviedo Naranjo Julián Camilo , espinosa Murcia Mariana , Faccini-Martínez Álvaro A
Published: January 2025

Background

In Colombia malaria is an endemic mosquito-borne disease. Although military personnel are recognized as a high-risk group for malaria, little is known about on features of this parasitic disease in Colombian military members.

Methods

We recorded data on demographic, clinical, laboratory and treatment of patients with confirmed malaria diagnosis (positive thick blood smear or Rapid Diagnostic Test), attended in a reference military hospital, located in Bogotá, Colombia, from February 2023 to April 2024. Cases of severe malaria and recurrence were classified following the last WHO guidelines. Dengue and malaria coinfection were defined as a confirmed malaria case with positive dengue NS1 antigen.

Results

During the study period, 97 patients were attended; all of them males, in active military service, and the median age was 25 years. Most (70%) consulted between November 2023 and April 2024 (Figure 1), and the main Colombian departments where the infections were acquired were Chocó (29%), Córdoba (22%) and Nariño (12%) (Figure 2). Plasmodium vivax was the main etiology (79%), follow by P. falciparum (17%), mixed infections (3%) and Plasmodium sp. (1%); four patients had coinfection with dengue. Most (51%) were attended at the emergency department, 39% at general ward, and 10% required intensive care unit. Recurrences were diagnosed in 36%, and the remaining as new infections. Among clinical features, the main symptoms were fever (88%), headache (75%) and chills (64%); and the main signs were jaundice (25%), abdominal pain (21%) and mild dehydration (12%) (Table 1). The median days of fever at hospital admission was five. Severe malaria was diagnosed in 8 patients. Among laboratory findings, thrombocytopenia was the most frequent (77%), follow by hyperbilirubinemia (71%). Hepatosplenomegaly was the most finding at the abdominal ultrasound (49%) (Table 2). Regarding treatment, 92% of P. vivax cases received chloroquine-primaquine; 69% of P. falciparum cases received artemether-lumefantrine and single dose primaquine; mixed infections cases received artemether-lumefantrine and primaquine; and all severe malaria received intravenous artesunate. No deaths were recorded.

Conclusion

Malaria remains a potential health threat to Colombian military personnel.

Disclosures

All Authors: No reported disclosures
P-155. Challenges with Artemether and Lumefantrine in the Management of Uncomplicated Malaria Infection
Authors: Olcott Flora
Published: January 2025

Background

Annually there are approximately 1,500 cases of imported malaria in the UK, with the majority being falciparum infection in African diaspora visiting friends and relatives (VFR). The management of uncomplicated falciparum infection usually entails a treatment course of artemether and lumefantrine. However, this medication can pose challenges to prescribers and patients alike due to the dosing schedule and administration requirements.

We assessed the management of uncomplicated falciparum malarial infection in the emergency department and designed a tailored treatment package for patients being managed in an outpatient setting in order to improve medication compliance and clinical outcome for this cohort.

Compliance Aid for Artemether/Lumafantrine - Patient Information Leaflet

Customised patient information leaflet to be completed by prescriber and given to patient to improve medication adherence

Methods

A retrospective audit was conducted at a hospital in London from December 2021 to January 2023. The management of uncomplicated falciparum malarial infections and the adequacy of existing clinical pathways were assessed using electronic patient records.. Patients that presented to the emergency department, diagnosed with uncomplicated falciparum infection and discharged home with oral treatment with subsequent outpatient clinic follow-up were included

Results

A total of 17 patients were included in the audit. 41% (7/17) patients were identified as experiencing issues with medication including confusion regarding when to take tablets, not taking medication with food and not completing the course due to symptom resolution. 3 patients consequently required further course of Riamet and 1 person required admission to hospital due to rising parasitaemia as a result of not taking artemether and lumefantrine correctly. As a result of these findings, a customised patient information leaflet and artemether and lumefantrine prepacks were created and made available in the emergency room.

Conclusion

This study demonstrates the challenges posed by artemether and lumefantrine for prescribers and patients. Patients with falciparum infection are at risk of rapid deterioration and therefore clear instructions on when and how to take the medication are needed. Follow-up is essential in this cohort and medication compliance issues should be considered in persistent/rising parasitaemia or ongoing symptoms.

Disclosures

All Authors: No reported disclosures
P-162. Estimating the Seroprevalence of HTLV-1 in Pregnant Peruvian Women Based on Blood Bank Markers: a Road to Elimination of Mother-to-Child Transmission of HTLV-1
Authors: Robledo Jorge , Meisner Julianne , Zunt Joseph , Gonzalez-Lagos Elsa
Published: January 2025

Background

The prevention of mother-to-child transmission (PMTCT) of human T-cell lymphotropic virus type 1 (HTLV-1) is a top priority for HTLV-endemic countries due to its chronicity, lack of treatment and association with the aggressive adult T cell leukemia/lymphoma in comparison to other routes of infection. As of 2024, Japan, Brazil and Chile are few of the countries with national policies regarding antenatal screening. Peru, also an endemic country with around 150,000 to 450,000 HTLV-1 carriers, has limited data in pregnant women and does not have any PMTCT policy in place. By contrast, HTLV-1/2 antibody screening of blood donations has been endorsed since 1997 and national data are available. We aim to leverage these data to estimate the prevalence of HTLV-1 in pregnant women as a first step towards development and implementation of a PMTCT policy in Peru.

Figure 1

Estimation of number of HTLV-1 infected pregnant women and HTLV-1 seroprevalence in pregnant women in Peru (2017)

Methods

This was an ecological study using public-use data from the Peruvian Bulletin on Blood Supply 2015-2020, the 2017 National Census, the 2017 Demographic and Health Survey (DHS) and the National Registry. The unit of analysis was Peru and its subregions in the year of 2017. To estimate the number of infected women of reproductive age (WRA, 15-49 years), we used census data and a calculated percentage of HTLV-1/2 reactive blood units for this group based on a weighted factor by sex and age (Figure 1, Table 1). Using the DHS percentage of WRA currently pregnant, we estimated the number of infected pregnant women. To obtain the HTLV-1 prevalence for this group, we used the number of life births adjusted for a 9-month period (0.75) as the denominator.

Calculation of weighted factor for HTLV-1/2 seroprevalence by age and sex based on local blood bank data

Results

A total of 359,458 blood units were screened and 2,809 were reactive for HTLV-1/2 (0.78%) (Figure 2). We estimated between 68,456 to 72,978 HTLV-1 carriers who were WRA, of whom 2,463 to 2,773 were pregnant (Figure 3). This is comparable to rates in Japan and Brazil. Our estimated HTLV-1 seroprevalence in pregnant women was 0.61% for the entire country.

Number and percentage of HTLV-1/2 reactive blood units in 2017 by departments of Peru

Conclusion

Our findings could help guide future strategies for PMTCT, such as universal antenatal screening and assessing the feasibility of formula supplementation for infants born to HTLV-1 positive mothers. Our limitations included the use of one-year data, HTLV-1/2 false-positives in blood donors and not using inverse probability weighting.

Estimated number and percentage of HTLV-1 infected pregnant women in 2017 by Departments of Peru

Disclosures

All Authors: No reported disclosures
P-167. New epidemiological routes of Coccidioidomycosis in Mexico – the extension of this pathogen to new areas
Authors: Romo Leija Eduardo , Maldonado Barrientos Carlos Eduardo , Aranda-Audelo Mercedes , Corzo Leon Dora Edith , Rodriguez Llamazares Sebastian , Hernandez Teran Alejandra , Morales Villarreal Fernando Rosalio , Palma Cortes Gabriel , Hernandez-Hernandez Victor A , Flores Nunez Carlos , Becerril-Vargas Eduardo , Ahumada Topete Victor Hugo , Reza Marco Villanueva
Published: January 2025

Background

Due to specific growing conditions, Coccidioidomycosis is a fungal disease typically found in northern Mexico, near California or Arizona. However, due to climate change, there has been an increase in cases in non-endemic areas. In this study, we describe areas where cases of Coccidioidomycosis have been reported, which were previously not known to have this disease.

Image of a map of Mexico that highlights both high-risk and low-risk areas.

Dots represent origin and migration. Blue circles represent areas where patients lived while yellow represents areas where people migrated. The reason for migration was not studied. Pink circles represent those without travelling.

Methods

We developed a registry of Coccidioidomycosis cases, which collects data on sociodemographic, travel, and clinical conditions, including tomography, pathology, and outcomes. The patients were categorized into groups based on migration and geographical living area, and we collected data from physical or electronic health records.

Results

Between 1991 and 2023, we diagnosed 122 patients with coccidioidomycosis. The most common comorbidities were diabetes mellitus (41%) and overweight (24%). Forty-eight patients (39%) living in endemic areas had high-risk working conditions, such as construction, archaeology, and topography. Diagnosis was made using culture in 79.5% of cases, serology in 54%, and biopsy in 51%. CT scans showed predominant nodular (77%) and cavitary lesions (61%). Surprisingly, 46.7% of patients had no risk factors, such as travelling or living in endemic areas. 29.5% of patients had a history of migration as a risk factor to a high-risk area. The average time from symptom onset to diagnosis was 150 days (IC95 61-518 days). The patients were divided into four groups based on their risk factors. 8 (6.5%) lived and travelled in high-risk areas, 19 (15.5%) lived in high-risk areas without migration, 36 (29.5%) lived in low-risk, travelling to high-risk, and 57(46.7%) lived in low-risk and did not travel.

Conclusion

This division through risk factors highlights areas not known to be at risk, with patients without a history of travelling presenting with Coccidioidomycosis. We estimate an increasing number of fungal infections due to climate change, characterized by increased drought in some areas. As with other diseases, diagnosing Coccidioidomycosis outside of endemic areas should raise awareness of its expansion, and healthcare workers should consider it as a possible differential diagnosis. It is crucial to have this area known to consider resources for treatment.

Disclosures

Carlos Flores Nunez, PHD, Pfizer: Grant/Research Support
P-190. Enhancing Clostridium difficile Diagnosis and Management: A Structured Approach to Early Recognition with Two-Step Testing
Authors: Yasser Alsafadi Muhammad , Patel Shivani , Zabaneh Firas , Drews Ashley
Published: January 2025

Background

Clostridium difficile is a significant challenge in healthcare settings, requiring accurate and timely diagnosis while avoiding unnecessary treatment. To reduce false positives, IDSA/SHEA recommends two-step testing: a sensitive assay to detect C. difficile followed by a specific assay to confirm toxigenic CDI. Our longstanding CDI prevention program, with a comprehensive testing algorithm, consistently outperformed the national NHSN benchmark. This CDI infection prevention program is multifaceted, including early recognition, appropriate testing strategies, accurate attribution, and stewardship interventions. Here, we evaluated the performance of two-step testing on identifying patients with discordant results and related antimicrobial consumption.

Methods

In December 2023, we updated our CDI prevention program with enhanced focus on early detection using a testing selection algorithm (Fig 1) as well as two-step testing (Fig 2) including a tcdB PCR assay and a toxin enzyme immunoassay to identify discordant results (PCR+/toxin-) that usually do not require treatment. We assessed C. difficile testing and treatment at all 8 hospitals in our system and hospital-onset (HO)-CDI at the flagship hospital from January to March 2024.

Results

From January 1 to March 31, 2024, 1,864 patients were tested for CDI by PCR assay; of the 328 that were positive, 111 (33.8%) were also positive for toxin (+/+), with the other 217 (66.2%) negative for toxin (+/-) representing non-toxigenic colonization for which treatment is not recommended. Out of 1,428 days of treatment given for CDI, 274 and 574 were in patients with negative (-/-) and discordant (+/-) results, respectively, indicating that treatment is still prevalent in these groups despite recommendations. HO-CDI rates decreased, with the NHSN standardized infection ratio significantly lower in March 2024 than in 2023 (Fig 3).

Conclusion

In 2024, we observed a reduction in reportable HO-CDI across the health system. Additional stewardship interventions will be required to decrease treatment in patients with discordant results. This will be of increased importance as NHSN evaluates and updates changes to definitions around reportable CDI.

Disclosures

All Authors: No reported disclosures
P-216. Using an EHR Tool to “Nudge” Earlier C. difficile Testing
Authors: Briody Carol , Eppes Stephen C , Wingel Serena , Coles Krystal , Hartman Edwin , Hogate Crystal , Sanderson Lindsay , Sweetser Hayley , Wilton Shannon , Drees Marci
Published: January 2025

Background

After observing an increase in hospital-onset Clostridioides difficile infections (HO-CDI), case review revealed that 50% had community-onset (CO) symptoms, but testing had not been performed until after hospital day 3. An interdisciplinary group convened to determine methods to encourage earlier testing in symptomatic patients and implemented a “Smart Zone Alert” (SZA) in our electronic health record (EHR; Cerner).

Methods

ChristianaCare is a 3-hospital, > 1200-bed community-based academic health system based in northern Delaware. The SZA is an integrated, real-time notification that encourages frontline providers to order C. diff testing if nursing documents ≥ 3 loose stools/24 hours during the first 3 hospital days. The SZA does not interfere with workflow and can be dismissed or acted upon. The SZA was piloted during Dec 2022 – Feb 2023, initially on 2 but expanding to 12 units at 2 hospitals. A PowerInsight report was built to allow tracking of SZAs and whether testing was ordered. In Mar 2023, the SZA went live across all 3 hospitals. We calculated rates of HO, CO, and community-onset healthcare-facility-associated (COHCFA) CDI for each period (pre-, pilot, and post-SZA) using NHSN definitions, and number and rates of C diff tests obtained before (CO) and after (HO) hospital day 3. We calculated rate-ratios (RR) and standardized infection ratios (SIR) comparing the 10-month pre-SZA-implementation period to the 10-month post-implementation period.

Results

Comparing the pre-SZA and post-SZA periods, the total number of C. diff tests performed increased from 1800 (4.4/1000 pt-days) to 2265 (5.6/1000 pt-days), and the proportion of CO tests increased from 60.2% to 71.5% (RR 1.6, 95% CI 1.5, 1.8) (Table). The HO-CDI rate decreased 30% (RR 0.7, 95% CI 0.45, 1.1), although not statistically significant; while COHCFA-CDI doubled (RR 2.0, 95% CI 1.1, 3.7). As of Dec 2023, the SZA had fired 2876 times and prompted earlier testing that avoided 25 HO-CDI. The SIR decreased from 0.35 (95% CI, 0.26, 0.46) to 0.27 (95% CI 0.19, 0.38).

Conclusion

The SZA is an integrated real-time tool that provides actionable and trackable information about patients’ stooling patterns and encourages earlier C. diff testing, enabling earlier isolation and treatment and avoiding falsely attributing CDI cases as HO.

Disclosures

All Authors: No reported disclosures
P-239. Leveraging Preliminary Blood Culture Reports at an Academic Medical Center: A Real-time Central Line-Associated Bloodstream Infection (CLABSI) Reduction Strategy
Authors: Hudziec Meghan , Rice Kathryn , Wenger Barbara , Elizabeth Totten Sarah , Pisney Larissa
Published: January 2025

Background

CLABSIs have been shown to result in adverse outcomes including increased morbidity and mortality, length of hospital stays, and healthcare costs. The National Healthcare Safety Network (NHSN) surveillance criteria are meant to be applied in a standardized manner, but this can result in discordance between clinical diagnoses and the surveillance definitions of secondary bloodstream infections (2° BSI). We hypothesized that routine review of preliminary positive blood cultures (B/Cs) in patients with central lines would result in the identification of possible CLABSI events in real-time and promote dissemination of feedback, thus reducing CLABSI cases and increasing 2° BSI attribution.Figure 1:CLABSI Case DeterminationClassification of cases identified by review of a preliminary blood culture report for patients with a central line eligible for CLABSI surveillance

Methods

An automated electronic medical record (EMR) report was developed to capture preliminary B/C results for patients with a central line eligible for CLABSI surveillance. Daily EMR review was performed to identify opportunities contributing to the event or evidence of a clinical 2° BSI without corresponding elements needed to meet NHSN definitions. Possible B/C contamination, gaps in care and, if clinically appropriate, necessary elements required to meet NHSN 2° BSI definitions were communicated to the care team.

Secondary BSI Attribution

Categorization of cases with a final determination of secondary BSI attribution

Results

Confirmed CLABSI cases with no intervention indicated were 35.5% of cases reviewed; 38.1% were determined to meet CLABSI exclusion criteria. Evidence of 2° BSI was identified in 26.5% of cases, which prompted queries to the care team to consider additional imaging, cultures, or documentation needed to clarify the clinical assessment. Feedback related to possible B/C contamination was given in 17.5% of cases. (Fig. 1-3)

CLABSI Standardized Infection Ratio (SIR)

Standardized infection ratio (SIR) trend: Tactic was adopted in May 2023

Conclusion

CLABSI reduction requires a comprehensive approach that addresses various aspects of care including appropriate line selection, safe insertion practices, care bundles, and prompt line removal. The EMR can be used to hard-wire best practices, facilitate real-time communication, and identify CLABSI cases in a timely manner. We have shown that prompt review of positive B/Cs of patients with eligible central lines facilitates opportunities to align the clinical impression with the surveillance definitions for 2° BSI while bolstering quality improvement efforts and staff education.

Disclosures

All Authors: No reported disclosures
P-240. Comparing Infection Rates Against Mechanical Complications By Site of Placement of Central Venous Catheters in the ICU, a Moot Point Based on Excessive Mortality?
Authors: Stevens Michael T , Ponce Rafael , Patel Arjun , Kinsella Patrick
Published: January 2025

Background

In the ICU the decision regarding site selection for central venous catheters (CVC) is largely influenced by the historic infection rates by site. It is thought that femoral placement has the highest incidence of line infections and therefore is often avoided. However, few studies have aimed to look at the overall risk to the patient regarding site placement taking not only risk of infection, but also risk of mechanical injury and complications into consideration.

Methods

We did a retrospective review of all patients who had a new central line (either triple lumen catheter or hemodialysis catheter) placed in the ICU for any indication between 1/31/2022 - 5/4/2023. Key information including demographics, Charlson Comorbidity index, type of catheter, site, date of insertion, and date of removal was obtained. Manual chart review was done for each patient in order to ascertain presence of CLABSI as well as mechanical complications.

Results

472 lines were placed during the study period. The average age was 63.5 years. The average Charlson Comorbidity index was 5. There was no statistical significant difference in infection rates among femoral 5/196 (2.5%) and internal jugular (IJ) 9/247 (3.6%) CVCs, although IJ lines had a trend towards higher rates of mechanical complications 21/247 (8.5%) vs 11/195 (5.6%), respectively. Rate of infection was twice as high, 6/267 (2.3%) vs 9/205 (4.4%) in the BMI >30 group vs those with a BMI < 30. The 6-month all-cause mortality for patients requiring a central line in the ICU was >80%, regardless of the site of placement, presence of line infection, or mechanical complication.

Conclusion

Infection rates between IJ and femoral lines were comparable. Femoral lines had numerically less mechanical complications as compared to IJ lines. BMI > 30 had a trend towards an increased risk of CLABSI. Overall mortality was > 80% for patients who required a CVC for any reason in the ICU setting. Clinicians should take a balanced approach regarding infection and mechanical complication risk when placing a central line. Further research into determining infection rates for patients with higher BMI is needed. Intensivists should consider early palliative care consultation for patients requiring a central line.

Disclosures

All Authors: No reported disclosures
P-243. Catheter-Associated Urinary Tract Infections: What’s the secret?
Authors: Abi Assaad Rawad , Maamari Julian , Mughrabi Abdallah , Fleisher Jorge
Published: January 2025

Background

In the United States, more than 1 million CAUTIs are diagnosed each year, ranking among the top 5 most common healthcare-associated infections; however, our observations suggest that these numbers are inflated due to the lack of clear diagnostic guidelines. Most laboratories process urine cultures (UC) in reflex when a urinalysis (UA) sample shows 10 or more cells/µL. By adding specific criteria to decrease the number of UC, we decreased unnecessary use of antibiotics and overall cost from CAUTI misdiagnosis.

Methods

In this study, we enforced conditions that increase standards for reflex UC processing. These conditions included patient symptoms, presence of indwelling catheter, and levels of red blood and epithelial cells. We prospectively evaluated outcomes for patients whose UA samples did not meet our criteria. We suppressed UA samples that did not meet our criteria and did not report the culture results.

Results

Analysis of UC requests from 2020 to 2023 revealed several notable findings: 37% of the urine samples were approved for culture, 44% of those yielded positive results, and 56% showed either mixed flora or no bacterial growth. All UC samples that met criteria had white blood cell counts between 25 and 50 /HPF, with 91% displaying over 50 /HPF. Notably, none of the excluded samples resulted in patients developing urinary complications.

Amongst the suppressed UC, 9% yielded positive culture results consistent with asymptomatic bacteriuria. We noticed CAUTI reductions from 31/year in 2018 to 8/year in 2023. Our intervention helped avoid unnecessary antibiotics use, decreasing the number of hospitals acquired Clostrioides difficile infections from 31 cases in 2018 to 9 cases in 2023.

Conclusion

The high rejection rate of UC samples suggests opportunities for optimizing appropriateness criteria to improve diagnostic yield and resource utilization. Further analysis of rejection reasons may help identify areas for clinician education regarding appropriate UC ordering.

Disclosures

All Authors: No reported disclosures