bluuebunny/crossref_metadata_2025 huggingface dataset:
P-1399. Impact of Positive Chlamydia and Gonorrhea Testing Among Male Military Trainees
Authors: Powers Rachel E , Winkler Erin , Casey Theresa , Jung Ga O , Osuna Angela , Marcus Joseph
Published: January 2025

Background

All females trainees entering the U.S. Air Force basic military training (BMT) are tested for chlamydia (CT) and gonorrhea (GC) and account for the vast majority of cases in this population. Recent studies have demonstrated that, when universally tested, BMT males had similar overall rates of CT and GC as compared to females, as most cases are asymptomatic. This study evaluates the incidence of CT and GC in male BMT trainees and follow-up.

Methods

Over 30,000 BMT recruits train at Joint Base San Antonio-Lackland each year. This study included all male trainees who tested positive for CT or GC during their 8-week training period between 2017-2023. Information was obtained regarding patient’s age, indication for testing, facility-type performing testing, date of test, follow-up testing, and occurrence of STIs within three years of diagnosis. Male trainees were then matched with female trainees based on age, date of diagnosis, and pathogen type to determine sex-based differences in follow-up.

Results

50 (0.03%) of the 182,726 males who attended BMT between 2017-2023 tested positive for CT or GC during their training. Most cases (88%) were detected in primary care and the median time in training until diagnosis was 12.5 [IQR: 8-27] days. (56%) of male trainees had symptoms on presentation for STI testing, with dysuria (40%) and penile discharge (35%) being the most common. When compared to matched-females, male trainees had significantly less follow-up testing within one year as compared to female trainees (56% vs. 75%, p=0.05). Despite the difference in follow-up testing, there was no difference in STIs diagnosed in the next three years (18% vs. 24%, p=0.5).

Conclusion

Despite universal access to care, only slightly more than half of male BMT trainees with CT or GC received guideline-directed follow-up within one year. Additionally, approximately one in five men who tested positive for CT or GC during BMT developed a subsequent STI in the next three years, at rates similar to women who tested positive, despite less frequent testing. More work is needed to improve follow-up testing services for those who test positive for CT or GC.

Disclosures

All Authors: No reported disclosures
P-1402. Will You Receive HIV and HCV Testing from a Mobile Pharmacy? Pre-implementation Needs Assessment and Pilot Findings from the United States First Legal Retail Mobile Pharmacy
Authors: Tarfa Adati , Frank Cynthia , Brooks Ralph P , Schultheis Alysse , Di Paola Angela , Shenoi Sheela , Springer Sandra Ann
Published: January 2025

Background

Connecticut enacted Senate Bill No.1102 in July 2023, allowing mobile pharmacies to operate in the state to meet the needs of individuals at risk for and living with HIV, including people who use drugs (PWUD), who often experience difficulties accessing and navigating health care systems. The mobile pharmacy and clinic (MPC) care delivery model uses clinicians, community health workers (CHW), and pharmacists to provide healthcare to people where they live (housed/unhoused), improving accessibility to care for people living with/at risk of HIV as well as Hepatitis C (HCV) and substance use disorder (SUD) treatment. We present pre-implementation needs assessment and pilot data of an MPC from an urban area of Connecticut.

Methods

CHWs conducted a needs assessment of community members from 08/2023 to 11/2023 to characterize barriers to accessing care and the acceptability of health screenings, including rapid HIV and HCV testing. Pilot implementation data includes service use, clinical assessment, and prescription fill data of the MCP from 12/2023 to 04/2024.

Results

Needs assessment: Among 158 respondents, the main barriers to accessing pharmacy services were transportation (67%) and medication cost (24%). The majority (89%) showed willingness to use a mobile pharmacy, and 57% were willing to receive HIV testing by a CHW (Table 1). Implementation: Among 167 individuals who received services from the MPC, a majority were male (62%), White (40%), and ethnicity of Latinx/Hispanic (42%), 11% had never tested for HIV, and 2 were living with HIV (Table 2). Among 38% accepting HIV testing, none tested positive and were all offered PrEP. Also, 56% accepted HCV testing, 10 (20%) had a positive viral load, and 8 (80%) started treatment. Of those screened, 35% (20/57) and 18% (12/66) were positive for Alcohol Use disorder (AUD) and Opioid Use Disorder (OUD), respectively. Of the 284 medications dispensed,10 (4%) were for PrEP, 2 (1%) for long-acting injectable ART, 9 (3%) for AUD, and 4 (1%) for OUD (Table 3).

Conclusion

The MPC can respond to the needs of an urban population when current services are impractical for patients. Providing health services through an MPC is feasible and should be expanded to meet gaps in health care.

Disclosures

Ralph P. Brooks, MS, Merck: Stocks/Bonds (Public Company) Sheela Shenoi, MD MPH, Merck Pharmaceuticals: Stocks/Bonds (Private Company) Sandra Ann Springer, MD, Alkermes Inc: Honoraria|Alkermes Inc: In kind study drug donation for NIH sponsored research|Indivior Pharmaceutical company: In kind study drug donation for NIH sponsored research
P-1404. Trends and Disparities in Viral Load Suppression Among People Living with HIV in Three Texas Cities: A Decade-Long Retrospective Study
Authors: Garcia Angie , Radunsky A L exander P , Naiman Nicole , Cabrejos Lucia , Taylor Barbara S , Vigil Karen J , Jain Mamta K
Published: January 2025

Background

HIV/AIDS remains a significant public health challenge in the United States, especially in states with diverse populations such as Texas. This study examines viral load trends among people living with HIV in Houston, Dallas, and San Antonio over ten years. The aim is to investigate variations in viral load suppression among individuals living with HIV across different cities, considering demographic variables like age, gender, race/ethnicity, and socioeconomic status.

Methods

A retrospective study was conducted on people with HIV (PWH) from 2009 to 2019. Demographic data, clinical variables, and viral suppression status were analyzed across different groups using time-to-event analysis.

Results

The analysis revealed that being female was linked to a reduced hazard ratio for detectable viral load (HR: 0.89, 95% CI: 0.82 - 0., p = 0.005) after adjusting for other demographic factors (table 2). Additionally, younger age groups (18-29, 30-39, and 40-49) exhibited significantly higher hazard ratios compared to those aged 50 and above, indicating a higher risk of detectable viral load. Race/ethnicity emerged as a significant factor, with Non-Hispanic Black individuals displaying a higher hazard ratio compared to Non-Hispanic White individuals (HR: 1.35, 95% CI: 1.22 - 1.48, p < 0.001). Furthermore, Medicaid-insured individuals demonstrated higher risk of detectable viral load, consistent with both univariate and multivariate analyses. However, language preference did not significantly influence viral load detection status, as evidenced by the absence of a significant difference between English and Spanish speakers in the multivariate analysis.

Conclusion

Our research investigates disparities in achieving viral load suppression among individuals with HIV in Texas. Younger people seem to encounter challenges in maintaining viral suppression compared to older age groups. The influence of social determinants of health is highlighted by racial/ethnic disparities. While our study did not find a significant impact of language barriers on viral load detection, further exploration is needed to better comprehend these results.

Disclosures

Karen J. Vigil, MD, Gilead: speaker|theratechnologies: research|ViiV: Advisor/Consultant Mamta K. Jain, MD, MPH, Abbvie: Grant/Research Support|Gilead Sciences: Grant/Research Support|Laurent: Grant/Research Support
P-1406. Racial Disparities in HIV Prevalence and Complications in Hospitalized Patients
Authors: Safdarpour Armin , Harfouch Chawki , Umeh Chukwuemeka
Published: January 2025

Background

Racial and ethnic disparities in HIV care and outcomes are well known. Multiple causes have been reported including inequalities in access to care and pre-exposure prophylaxis (PrEP), housing instability, lack of antiretroviral insurance coverage, and economic disadvantages. We aim to evaluate the disparities in HIV prevalence and outcomes in hospitalized patients.

Methods

We analyzed the 2020 United States National Inpatient Sample (NIS) data of all patients with a diagnosis of HIV admitted inpatient. The NIS database is the largest publicly available database of patients hospitalized in the United States and contains approximately 20% stratified samples of all hospital discharges in the United States.

Results

There were 38,666 admissions with a diagnosis of HIV in 2020, of which 30.3% were females. 51.6% of the HIV patients were Blacks, 30% Whites, 13.7% Hispanics, 0.7% Asians, 0.6% Native Americans, and 3.4% others. The mean age was 50.8 years, and the mean length of stay was 6.4 days. In the bivariate analysis, the Hispanics were more likely compared to others to have Kaposi Sarcoma (1.8% vs. 1.1%, p< 0.001), cryptococcal meningitis (1.5% vs. 0.6%, p< 0.001), disseminated coccidioidomycosis (0.2% vs 0.0%, p< 0.001), hepatitis C (6.7% vs. 5.3%, p< 0.001), Covid-19 infection (7.9% vs. 4.9%, p< 0.001) and pneumocystis jiroveci pneumonia (3.2% vs. 2.3%, p< 0.001). The multivariate analysis showed no statistically significant racial or ethnic difference in all-cause mortality (p=0.17). However, patients in the highest income quartile had significantly lower all-cause mortality compared to those in the lowest quartile after adjusting for variables including race, ethnicity, and HIV complications (OR 0.69, 95% CI 0.54-0.89, p=0.004).

Conclusion

Our study showed that the prevalence of HIV is still disproportionally high in Blacks. While about 16% of all patients in our dataset are Black, about 52% of the HIV patients are Black. However, Hispanic patients appear to have more HIV complications. Cultural appropriate interventions to prevent HIV acquisition, increase HIV screening, and early initiation of treatment in racial and ethnic minorities are warranted.

Mining a national database can provide insights into morbidity and mortality trends in patients living with HIV.

Disclosures

All Authors: No reported disclosures
P-1407. The Growing Trend of Clinical Tick-Borne Diseases in South Carolina
Authors: Bramlett Kayla E , Pickle Emily Owens , Waltz Hanna , Saunders Eleanor , Vorobiov Julia , Commins Scott , Haldeman Matthew , Nolan Melissa
Published: January 2025

Background

The trend of human tick-borne disease (TBD) incidence has increased exponentially over the past two decades. Limited healthcare access, substandard housing, socioeconomic fragility, and absence of government-backed tick control initiatives significantly contribute to the high disease burdens nationwide. Given the wide prevalence of socioeconomic and health inequalities in the USA, the risk of TBDs often goes undetected in impoverished and minority communities. Alpha-gal syndrome (AGS) is one TBD that is often overrepresented in white, middle-income individuals, and little information on the incidence in populations of Color exists. Therefore, the current study aims to estimate the seroprevalence and exposure-associated risk factors of AGS among vulnerable populations in South Carolina.

Methods

First, a five-year retrospective clinical chart abstraction of AGS patients within a large healthcare system covering half of South Carolina was completed to characterize the clinical burden and natural history of AGS. Next, banked serum samples and associated surveys from a cross-sectional minority-represented COVID-19 study were analyzed for AGS seropositivity.

Results

Fifty patients with positive AGS IgE labs were identified via retrospective chart review. Of these, the majority were male (70%), covered by Medicare (84%), and had a history of tick bites or spent extended periods outdoors (46%). The cross-sectional AGS seroprevalence study detected 3.5% seropositivity among 753 serum samples. Risk factors associated with a positive titer included being male (58%), and regularly spending time outdoors (58%). Notably, the seroprevalence cohort consisted of primarily Black residents and individuals who live below the poverty line.

Conclusion

These findings highlight the growing issue of TBDs, namely AGS, among minority populations in South Carolina, urging healthcare providers to be more informed.

Disclosures

All Authors: No reported disclosures
P-1409. Differential Impact of a Penicillin Allergy Assessment Tool on Orthopedic Surgical Patients from Areas of High Social Vulnerability
Authors: Passaretti Catherine , Boger Michael S , Jaffa Rupal K , Neelakanta Anupama , Inman Michael , Davidson Lisa
Published: January 2025

Background

Penicillin allergy labels (PAL) have been associated with increased risk of surgical site infections. Many penicillin allergy assessment tools are being trialed to improve perioperative β-lactam utilization. We report on the sociodemographic characteristics associated with receipt of β-lactam antibiotics (BLA) in orthopedic surgical patients with a PAL after implementation of a penicillin allergy assessment tool built into the electronic health record (EHR).Table 1:Clinical and Sociodemographic Characteristics of Penicillin Allergy Label Patients by Preoperative β-Lactam Antibiotic (BLA) Administration Following Implementation of Penicillin Allergy Assessment Tool in the Electronic Health Record

Methods

We performed a retrospective cohort study of patients who underwent hip (HPRO) and knee arthroplasty (KPRO) procedures in a large health system between August 2022 and December 2023. Patients with a PAL were identified and demographic, clinical and antibiotic administration data were obtained from the EHR. Clinical data was merged with Social Vulnerability Index (SVI) census-track data comprising 4 subthemes (socioeconomic status, household characteristics, racial/ethnic minority status and housing type/transportation). Higher SVI indicates higher vulnerability. Patients with a PAL who did and did not receive a BLA post protocol implementation were compared.Figure 1:Impact of a Penicillin Allergy Assessment Tool on Beta Lactam Utilization in Patients who Live in High vs Low Social Vulnerability Index Census Tracks*Statistically significant p<0.05

Results

1851 patients with a PAL who had undergone a HPRO and/or KPRO were identified. After implementation of the penicillin allergy assessment tool, 443 (24%) did not receive a BLA preoperatively. PAL Patients that did not receive a BLA after implementation of the tool were more likely to be female and less likely to have an admit status at the time of surgery. Other clinical characteristics including surgical site infection rates were similar between the groups. (Table 1) PAL patients who did not receive BLA were more likely to live in areas with higher socioeconomic status SVI (26% vs 20%), higher household characteristics SVI (27% > vs 22%), and higher housing type SVI (20% vs 15%) than those who did receive BLA. (Figure 1)

Conclusion

Following implementation of an electronic penicillin assessment tool, most patients with a PAL were able to receive BLA safely. The subset of PAL patients who still did not receive BLA more frequently lived in areas with increased social vulnerability. Additional efforts may be needed to ensure the full benefit of tools is achieved in operative patients from areas with high SVI.

Disclosures

All Authors: No reported disclosures
P-1416. Association Between Adherence Barriers and Pharmacy Refill History in Patients with HIV After Medicaid Expansion in Nebraska: An Observational Retrospective Cohort Study
Authors: Amato-Hanner Elizabeth A , Essam Nkodo Emmanuel Nazaire , Furl Renae , Lyden Elizabeth , Timblin Quentin , Havens Josh , Fadul Nada
Published: January 2025

Background

Despite effective HIV treatment, Nebraska's viral suppression rate falls short of national targets (66% vs. 90%). Adherence to Antiretroviral (ART) is a major factor in achieving viral suppression (VS). ART refill history has been shown to correlate with VS, but limited data exists on factors that influence ART refill history. We aimed to explore the relationship between self-reported adherence barriers and ART pharmacy refill data in PWH who gained Medicaid coverage through recent expansion.

Methods

We conducted a prospective cohort study of PWH who enrolled in Medicaid, between October 1, 2020, and December 31, 2021. Adherence Barrier Questionnaire for HIV (ABQ HIV), a validated self-reported 17 items questionnaire and ART refill history, as measured by the percentage of days covered (PDC) were recorded at baseline and 12 months post Medicaid enrollment. PDC was categorized as < 82% or ≥82% which correlates with viral suppression, and ABQ HIV score on a single item >2 indicated a barrier. We performed a Fisher Exact test to look at the association between PDC (categorized < 82 and ≥82) and ABQ-HIV scores (categorized < 2 and ≥2) at baseline and post Medicaid enrollment.

Results

98 PWH completed the ABQ HIV and had PDC data at baseline and follow-up. An average of 42 (SD 33) reported barriers at baseline, compared to 40 (SD 30) at the end of the study. Mean baseline PDC was 73% (SD 25%), increasing to 76% (SD 25%) at the end. At baseline, the majority of respondents for 12 of the 17 ABQ HIV items faced barriers, with items 4 (p=.03), 9 (p=.00), 13 (p=.03), and 15 (p=.00) associated with PDC < 82% (Table 1). Following Medicaid enrollment, majority of respondents still faced barriers, with items 7 (p=0.04), 11 (p=0.00), 13 (p=0.04), 15 (p=0.04), and 17 (p=0.00) significantly associated with PDC ≥82%.

Conclusion

While a substantial proportion of participants continued to face adherence barriers after Medicaid enrollment, there was an improvement in medication adherence from baseline to the end of the study. Self-reported barriers appeared to have a mixed impact on refill history before and after Medicaid enrollment suggesting an indirect impact of insurance status. Future studies are needed to further examine these associations.

Disclosures

Josh Havens, PharmD, Gilead Sciences: Grant/Research Support|Medscape: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant Nada Fadul, MD, ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support
P-1430. Use of Patient-Informed Resources Tailored to Diverse Populations Living with HIV to Improve Shared Decision-Making (SDM)
Authors: Nall Ryan W , Collins-Ogle Michelle , Short William R , Springer Sandra Ann , Molloy Leah , Simone Laura , Napolitan Chris , Carter Jeffrey D , Meza Jimenez Jenniffer A , Pillinger Kelly E
Published: January 2025

Background

People with HIV (PWH) who are engaged in decision-making with their provider are more likely to report treatment satisfaction. Yet, tailored SDM tools for diverse populations of PWH are lacking.

Methods

Four steering committees of PWH and expert providers convened to develop SDM tools for diverse groups living with HIV, including gay and bisexual men, cisgender women, aging adults, and transgender individuals. From 9/23 – 12/23, the tools were implemented in 4 HIV clinics which entailed a short video introducing the concept of SDM and survey on a tablet during check-in, a paper conversation guide with prompts to identify specific health needs, and a survey at the end of the visit. An on-demand video describing SDM and the initiative’s results was disseminated to HCPs nationwide.

Results

There were 87 PWH who participated in the use of the SDM tools (Table 1). A majority felt the SDM tools were helpful (83%) and were empowered to bring up questions about specific health care needs to their team (61% pre- vs. 74% post-survey; p = 0.063). 64% reported discussing their concerns and questions with their HIV care team more or much more than in previous visits, with 50% feeling very involved in decisions at their visit. Interestingly, a third of participants felt it was the care team’s role to make the decisions or they did not want to be involved in SDM. Of the 15 HCPs involved, 67% had previous formal training in SDM. They felt the biggest barriers to SDM were lack of time during visits (40%) and lack of patient interest (33%).

Of HCPs who participated in the on-demand video (N = 405), there was an increase in commitment to talking about barriers to staying engaged in HIV care (34% pre vs. 50% post; p < 0.001) and involving PWH in treatment decisions (45% pre vs. 62% post; p < 0.001). Top barriers to SDM among this group were low health literacy (38%), lack of professional training in SDM (28%), and scarcity of resources for PWH with diverse needs (27%). Confidence in engaging people from diverse backgrounds in SDM increased from 65% to 77% (p < 0.001).

Conclusion

Implementation of SDM tools tailored to diverse populations of PWH are needed and can improve engagement in care. Reasons for lack of interest in SDM among some PWH should be explored further. Formal training in SDM for HCPs can increase confidence and use in real-world settings.

Disclosures

William R. Short, MD, Gilead: Grant/Research Support|Janssen: Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Honoraria Sandra Ann Springer, MD, Alkermes Inc: Honoraria|Alkermes Inc: In kind study drug donation for NIH sponsored research|Indivior Pharmaceutical company: In kind study drug donation for NIH sponsored research Kelly E. Pillinger, PharmD, AHFS: Contractor
P-1432. Assessing Equitable Access to Carbapenemase Production Testing in Los Angeles County Hospitals
Authors: OYong Kelsey , Bhaurla Sandeep , Knight Wendy , Hindler Janet A , Rubin Zachary A
Published: January 2025

Background

Carbapenemase producing organisms (CPO) are the cause of difficult-to-treat infections that result in substantial morbidity and mortality. Due to this and because CPOs can spread quickly between patients, hospital microbiology laboratories should be incentivized to test for carbapenemase production (CP), yet testing costs have stifled uptake. In Los Angeles County (LAC), laboratory professional organizations and the LAC Department of Public Health have broadly promoted CP testing, without emphasis on hospitals that accept patients of highest risk of acquiring a CPO, including patients with a history of long-term care. This analysis assesses CP testing uptake in LAC hospitals and association with patient population and social vulnerability.

Methods

CP testing in hospitals was assessed using the 2022 National Healthcare Safety Network Annual Facility Survey. We assessed patient origin from the Centers for Medicare and Medicaid Services claims and Minimum Data Set and patient characteristics from the California Department of Health Care Access and Information Healthcare Utilization. Frequencies, logistic regression, and Fisher’s exact tests were performed to evaluate the relationship between CP testing and hospital patient and facility-level characteristics.

Results

Of the 79 surveyed hospitals in LAC, 51 (65%) tested for CP. No significant relationship was identified between access to CP testing and the number of patient transfers from high-risk facilities (OR=1.00 , 95% CI [1.00, 1.00]), area poverty (OR=1.01 , 95% CI [0.95, 1.07]), the percent of patients with Medicaid or Medicare (OR=0.94 , 95% CI [0.91, 0.98]), the percent of non-white patients (OR=1.01 , 95% CI (0.99, 1.03]), and hospital ownership (p=0.66).

Conclusion

Access to CP testing was lower among hospitals serving more patients with public insurance and did not differ based on number of high-risk patients. This analysis is limited in that testing capacity was assessed, but data were not available on frequency of testing or implementation of a process to test at-risk individuals. Testing performed at the LAC Public Health Laboratory can supplement testing gaps for facilities of high need. More outreach to hospitals serving highest risk patients to support access to CP testing is needed.

Disclosures

All Authors: No reported disclosures
P-1459. Racial Disparities in Treatment of Community-Acquired Pneumonia in Hospitalized Patients
Authors: Walker Ramara E , Schulte Rebecca , Pallotta Andrea , Wang Ming , Criswell Victoria A , Rothberg Michael , Deshpande Abhishek
Published: January 2025

Background

Community-acquired pneumonia (CAP) is a leading cause of hospitalizations and mortality in the US. Studies have reported racial disparities in various infectious syndromes, but race is not known to be associated with antimicrobial resistance. Limited data exist on racial differences in CAP treatment in the inpatient setting. The aim of this study was to assess the impact of racial/ethnic differences on prescribing habits in hospitalized patients with CAP.

Methods

This retrospective cohort study of 10,224 patients assessed associations between race/ethnicity and initiation of extended spectrum antibiotics (ESA) for non-Hispanic White (NHW), non-Hispanic Black (NHB), and other minoritized patients ≥ 18 years hospitalized at 12 Cleveland Clinic hospitals with CAP between November 1, 2022 – January 31, 2024. Parametric and non-parametric methods were used to describe demographic and clinical differences amongst the comparator groups. The association between race/ethnicity and ESA initiation was assessed using a multivariate logistic regression model adjusting for age, gender, area of deprivation index (ADI), certain comorbidities, clinical instability on day 1, and CURB65 score upon admission.

Results

Compared to NHW patients, NHB patients lived in areas with higher ADI and were more likely to have Medicaid insurance, diabetes, cardiovascular disease, renal failure, and alcohol and substance abuse. Viral respiratory pathogens were more common among NHW and others versus NHB (12% vs 15% vs 10%; p < 0.001), but bacterial respiratory pathogens were similar for NHW and NHB patients with lower rates for others (8% vs 6%; p < 0.001). No racial differences were observed amongst comparator groups regarding rates of clinical stability or resistant organisms. NHB patients were initiated on ESA more often than NHW and other patients (29% vs. 26% vs. 28%, respectively; p = 0.04). In the multivariable logistic regression, NHB patients had 23% higher odds of being initiated on ESA than NHW patients (adjusted OR = 1.23; 95% CI = 1.09-1.39).

Conclusion

After adjustment for clinical and sociodemographic characteristics, NHB patients with CAP were more likely to be initiated on ESA than NHW patients. Further studies are warranted to understand these differences.

Disclosures

Andrea Pallotta, PharmD, Astra Zeneca: Advisor/Consultant|Viiv: Advisor/Consultant Michael Rothberg, MD, MPH, Blue Cross Blue Shield: Advisor/Consultant|CRISPER: Stocks/Bonds (Public Company)|Moderna: Stocks/Bonds (Public Company) Abhishek Deshpande, MD, PhD, AHRQ: Grant/Research Support|Clorox Healthcare: Grant/Research Support
P-1473. Amoxicillin-Clavulanate Transition Therapy in ESBL Urinary Tract Infections
Authors: Radoncic Abigail , Box Maggie
Published: January 2025

Background

Extended-spectrum beta-lactamase (ESBL)-producing bacteria are notoriously resistant to many antibiotics, resulting in limited treatment options for such infections. Pathogens that possess this resistance mechanism typically necessitate the use of broad-spectrum antibiotics. An often-overlooked option for ESBL urinary tract infections (UTIs) is amoxicillin-clavulanate (AMC). Currently, there is a dearth of evidence supporting its use. This analysis was done to assess the efficacy of AMC on ESBL UTI clinical cure and associated outcomes.

Methods

This was a retrospective chart review conducted at Scripps Memorial Hospital La Jolla between January 1st, 2018 and January 31st, 2023. Adults with UTIs caused by ESBL pathogens who completed an AMC course as UTI treatment were included. The primary outcome was clinical cure, defined by the absence of reported symptoms in hospital or clinic encounters within 7 days of AMC completion. Secondary outcomes included 30-day relapse (UTI with the same organism within 30 days), 30-day reinfection (UTI with a different organism within 30 days), or 90-day recurrence (infection with same organism within 90 days).

Results

A total of 196 patients were screened for enrollment, of which 100 were included. Uncomplicated cystitis (UC) was identified in 39% of patients, complicated cystitis (CC) in 17%, pyelonephritis in 25%, and catheter-associated UTI (CAUTI) in 19%. Concomitant bacteremia was identified in 9% of patients. AMC oral transition (IV step down) therapy was used in 61% of patients. Overall, 7-day clinical cure regardless UTI type was 96%. Clinical cure was 97.4% for UC, 94.1% for CC, 92% for pyelonephritis, and 100% for CAUTI. Of the patients who received AMC as primary therapy (n = 39), 100% achieved 7-day clinical cure. Clinical cure in those with an AMC MIC of ≤ 4/2 was 95.8% (n =56) and in those with a MIC of 8/4 was 96.2% (n = 53). In those with concomitant bacteremia, 77.8% (7/9) achieved 7-day clinical cure. UTI 30-day relapse, 30-day reinfection, and 90-day recurrence occurred in 17%, 8%, and 16% of patients, respectively.

Conclusion

Amoxicillin-clavulanate may be a promising oral transition therapy for ESBL UTIs. Larger, more robust studies should be done to analyze the efficacy of AMC as an option for primary or transition therapy for ESBL UTIs.

Disclosures

All Authors: No reported disclosures
P-1478. Assessment of Beta-lactam Susceptibility Profiles in Pseudomonas aeruginosa: A Comprehensive Analysis at an Academic Medical Center
Authors: Burgess David S , Olney Katie B , Burgess Donna R
Published: January 2025

Background

Pseudomonas aeruginosa is one of the most difficult bacterial pathogens to treat. As beta-lactams remain the most prescribed class of antimicrobials to treat P. aeruginosa infections, the objective of this study was to describe susceptibility profiles of first line beta-lactam antimicrobials against P. aeruginosa at our academic medical center.

Methods

All non-duplicate P. aeruginosa isolates from 2021-2023 were analyzed. First line beta-lactams evaluated included aztreonam (AZT), ceftazidime (CAZ), cefepime (CFP), piperacillin/tazobactam (PTZ), meropenem (MEM) as well as newer beta-lactams ceftolozane-tazobactam (C/T), and ceftazidime/avibactam (C/A). Susceptibility testing was performed with the BD Phoenix™ automated system or E-test. Data obtained for each patient included culture date, source of infection, hospital location, and MIC. Each MIC was categorized as susceptible, intermediate, or resistant based on 2024 CLSI MIC breakpoints.

Results

Overall susceptibility rates for each beta-lactam for 1177 isolates were as follows: AZT (75%), CAZ (82%), CFP (83%), PTZ (79%), MEM (84%), C/T (99%), and C/A (99%). Moreover, 70% of P. aeruginosa strains were susceptible to all first line beta-lactams tested, while 25% displayed non-susceptibility to at least 1 first line beta-lactam, and 5% exhibited non-susceptibility to all first line beta-lactams tested. Among strains non-susceptible to at least 1 first line beta-lactam, the majority (37%) exhibited non-susceptibility to only 1 beta-lactam, while 20% and 19% displayed non-susceptibility to 2 or 3 beta-lactams, respectively. Additionally, 25% demonstrated non-susceptibility to 4 beta-lactams. Finally, respiratory isolates consistently displayed the highest incidence of non-susceptibility for each beta-lactam compared to blood, urine, wound, and miscellaneous body sites.

Conclusion

This study highlights the variable susceptibility of first-line beta-lactam antimicrobials against P. aeruginosa infections. These findings stress the importance of customized treatment strategies, surveillance for evolving resistance, and considering newer beta-lactams such as ceftolozane-tazobactam and ceftazidime-avibactam, alongside prudent antibiotic utilization in clinical practice.

Disclosures

All Authors: No reported disclosures
P-1479. Patterns of surgical antibiotic prophylaxis among patients undergoing Cesarean deliveries in tertiary care hospitals in Bangladesh
Authors: Dostogir Harun Md Golam , Sumon Md Shariful Amin , Qadri Firdausi , Ghosh Robir Kumar , Rahman Aninda , Md Abdullah Syed Abul Hassan , Islam Md Saiful , Weiser Thomas G , Oakley Lisa P , Styczynski Ashley R , Kaydos-Daniels S Cornelia
Published: January 2025

Background

The World Health Organization recommends a single dose of a first-generation cephalosporin given 30-60 minutes prior to surgery to prevent surgical site infections (SSI) in Cesarean deliveries (C-section). Perinatal exposure to antibiotics may modulate the microbiome of mothers and newborns, favoring the persistence of drug-resistant organisms which are frequently implicated in neonatal sepsis. This study investigated the pattern of surgical antibiotic prophylaxis (SAP) among patients undergoing C-sections in Bangladeshi tertiary care hospitals

Commonly prescribed antibiotics to surgery patients

Commonly prescribed antibiotics to surgery patients

Methods

From May through December 2023, we conducted a prospective observational study in six tertiary care hospitals and enrolled 1,335 women who underwent C-sections. Information on demographics and types of prophylactic antibiotic use was collected during the preoperative, postoperative, and post-discharge phases

Results

The median age of enrolled participants was 26 years (IQR: 22-28) and nearly half (48.9%) had a prior C-section. Pre-operatively, ceftriaxone was the most common SAP, which was used in 88% of cases. The median time for pre-operative antibiotic administration until incision was 180 minutes (IQR: 90-270). Post-operatively, injectable antibiotics were administered to all patients, with ceftriaxone (92.6%) and metronidazole (95.3%) being the most frequently prescribed. Similarly, all patients received oral antibiotics upon discharge. Cefixime (84.6%) and metronidazole (51.0%) were the most prescribed antibiotics at hospital discharge, followed by flucloxacillin (48.4%) and amoxicillin-clavulanic acid (13.1%), for a median duration of 5 days

Conclusion

Patients undergoing C-sections were frequently prescribed broad-spectrum antibiotics as part of SAP with extended post-operative dosing. Extensive SAP use may suggest underlying concerns regarding patient population, local antimicrobial resistance profiles, infection prevention lapses, and a lack of local hospital-based SAP guidelines. Understanding motivations for and effects of SAP patterns is essential for mitigating unnecessary perinatal antibiotic exposure and guiding antimicrobial stewardship efforts. Additionally, the timing of pre-operative SAP administration warrants further optimization

Disclosures

All Authors: No reported disclosures
P-1482. Ceftazidime-Avibactam for Treating Bacteremic and Non-Bacteremic Carbapenemase-Producing Enterobacterales Infections in Immunocompromised Patients
Authors: Herrera Fabián , Leone María V , Torres Diego , Rojas Rocío , Bues Florencia , Rearte Andrés N , Temporiti Elena , Querci Marcia , Carlos Jimena , Nicola Federico , Relloso Silvia , Smayevsky Jorgelina , Bonvehi Pablo E
Published: January 2025

Background

Ceftazidime-avibactam (CA) and CA plus aztreonam (ATM) are the preferred treatment options for KPC and metallo-beta-lactamase (MBL) carbapenemase-producing Enterobacterales infections (KPC-CPE and MBL-CPE), respectively. There are not many studies in immunocompromised patients (IP).

Methods

Observational and prospective cohort study. All episodes of KPC-CPE and MBL-CPE infections in IP admitted to a university hospital from August 2018 to April 2023, who received definitive antibiotic therapy (DAT) with CA or CA+ATM for at least 48 hours, were included. Non-bacteremic episodes (NBE) were compared with those with bacteremia (BE). Logistic regression analysis was performed to identify risk factors for 30-day mortality (RFM).

Results

Seventy-six episodes were included (36 NBE and 40 BE). Hematological malignancies and neutropenia were more frequent in BE (NBE 13.9% vs. BE 50.2%, p< 0.001; and NBE 5.6% vs. BE 42.5%, p< 0.001), while solid organ transplantation was in NBE (NBE 66.7% vs. BE 32.5%, p=0.003). The urinary source was more frequent in NBE (NBE 72.2% vs. BE 30%, p< 0.001), while the abdominal source was in BE (NBE 2.8% vs. BE 17.5%, p=0.04). K. pneumoniae was the main isolated microorganism, and KPC-CPE was the most common resistance mechanism in both groups, followed by MBL-CPE, without significant differences. Septic shock at onset was higher in BE (NBE 8.3% vs. BE 30%, p=0.18). Empirical treatment was appropriate in 59.3% of NBE vs. 75% of BE, p=0.12. Seven-day mortality, 30-day overall and infection-related mortality in NBE and BE were 2.8% vs. 5%, p=0.40; 11.1% vs. 27.5%, p=0.07; and 0% vs. 10%, p=0.07; respectively. The RFM were APACHE II score >20 [OR 5.80 (95% CI 1.19-28.17)], and acute renal failure [OR 16.15 (95% CI 1.78-146)].

Conclusion

KPC-CPE and MBL-CPE infections in IP with or without bacteremia who received DAT with CA or CA+ATM had low early and 30-day infection-related mortality. RFM were related to the severity and complications of the infections.

Disclosures

Diego Torres, Medical Doctor, Gador: Honoraria|GSK: Advisor/Consultant|Khight Therapeutics: Honoraria|MSD: Honoraria
P-1483. Clinical Features and Outcomes of KPC and NDM Carbapenemase-Producing Enterobacterales Infection in the Era of Avibactam
Authors: Herrera Fabián , Leone María V , Torres Diego , Rojas Rocío , Bues Florencia , Rearte Andrés N , Temporiti Elena , Querci Marcia , Carlos Jimena , Nicola Federico , Relloso Silvia , Smayevsky Jorgelina , Bonvehi Pablo
Published: January 2025

Background

Carbapenemase-producing Enterobacterales infections (CPEi) often have poor prognosis and high mortality. However, no local studies compare KPC and NDM-CPEi treated with ceftazidime-avibactam (CA) or ceftazidime-avibactam plus aztreonam (CA+ATM).

Methods

Prospective cohort study. We included episodes of KPC and NDM-CPEi in patients admitted to a university hospital (from August 2018 to April 2023) who received definitive antibiotic treatment (AT) with CA or CA+ATM, respectively. We compared clinical characteristics and outcomes with 30-day follow-up. We performed a logistic regression for 30-day mortality analyses.

Results

One hundred and fifty-six episodes of CPEi were included (117 KPC and 39 NDM). Median APACHE II score was 15 (10-21) vs. 16 (10-20.5), p=0.755. Patients were immunocompromised in 53.8% vs. 41%, p=0.165. Bacteremia was present in 47% vs. 59%, p=0.196, and urinary and abdominal were the most frequent clinical sources of infection (44.4% vs. 38.5%, p=0.513; and 9.4% vs 15.4%,p=0.224; respectively). Klebsiella spp. was the main isolate in both groups (75.2% vs. 87.2%, p=0.117). Empirical AT was appropriate in 59.8% vs. 56.4%, p=0.707; and they received empirical CA in 45.3% vs 38.5%, p=0.456. Septic shock occurred in 24.8% vs. 35.9%, p=0.179. Seven and 30-day mortality and infection-related mortality were 3.4% vs. 0%, p=0.312; 13.7% vs. 25.6%,p=0.082; and 4.3% vs. 12.8%, p=0.071. APACHE II >20 [OR 5.9 (95% CI 1.97-17.98), p=0.002], and skin and soft tissue infection [OR 6.02 (95% CI 1.22-29.62), p=0.027] were independently associated with 30-day mortality, while the 7-day clinical response was a protective factor [OR 0.04 (95% CI 0.004-0.405) p=0.006].

Conclusion

In patients with KPC and NDM-CPEi treated with CA or CA+ATM, clinical features and outcomes were similar. Mortality was associated with the severity and the source of infection while the seven-day clinical response was a protective factor. Our data support the role of CA AND CA+ ATM in these types of infections.

Disclosures

Diego Torres, Medical Doctor, Gador: Honoraria|GSK: Advisor/Consultant|Khight Therapeutics: Honoraria|MSD: Honoraria
P-1487. β-tricalcium Phosphate/Calcium Sulfate Loaded with Contezolid Acefosamil (MRX-4) for Antimicrobial Potency, Prevention and Killing Efficacy of MRSA Biofilm
Authors: Jiang Nan , Chen Peng , Wan Haoyang , Liu Guanqiao , Lin Qinrong , Yu Bin
Published: January 2025

Background

The use of local antibiotics loaded by antibiotic carriers represents an important strategy for the treatment of osteoarticular infections. This study evaluated the antimicrobial duration of potency and the prevention and killing efficacies of contezolid acefosamil (MRX-4) against MRSA biofilm in in-vitro assays.Figure 1ZOIs of C+G versus V+G loaded by CS

Methods

The elution kinetics of contezolid acefosamil (C) and vancomycin (V) in combination with gentamicin (G), loaded with either β-tricalcium phosphate/calcium (β-TCP/CS) sulfate or CS, in the presence of an MRSA (ATCC43310) infection was assessed. The efficacies of the agents in preventing biofilm formation and killing pre-formed biofilms were assessed using colony-forming unit count and confocal laser scanning microscopy.Figure 2Changes of ZOIs of C+G versus V+G (a, b) and β-TCP/CS versus CS (c, d)

Results

In a repeated Kirby-Bauer like zone of inhibition (ZOI) assay, V+G showed potency against MRSA for approximately 40 days. While the ZOIs of C+G at 40 days were similar to those at 15 days, which were significantly larger than those of V+G (P < 0.05). In the MRSA biofilm prevention assays, both C+G and V+G showed similar efficacies in preventing bacterial colony formation, with approximately 8 logs lower colony-forming units than those in the control group at 1 and 3 days (P < 0.01). The killing efficacies on pre-formed biofilms showed significant decrease of approximately 3 to 4 logs at 1 and 3 days following treatment with C+G and V+G (P < 0.001). Furthermore, the confocal laser scanning microscopy results supported the colony-forming unit outcomes. Additionally, β-TCP/CS and CS revealed similar antimicrobial potency and prevention and killing efficacies in these in-vitro assays.Figure 3Colony-forming units in the prevention and killing groups(C1:control group 1: blank groups, C2: control group 2: β-TCP/CS or CS beads without antibiotics; ns: not statistically significant, *P ＜ 0.05, **P ＜ 0.01, ***P ＜ 0.001 )

Conclusion

The present study demonstrated that contezolid acefosamil displays similar prevention and killing efficacies against MRSA biofilms in comparison to vancomycin. However, the antimicrobial duration of potency of contezolid acefosamil is longer than vancomycin. Further clinical trials are required to determine whether contezolid acefosamil can be locally applied for the treatment of osteoarticular infections.

Disclosures

All Authors: No reported disclosures
P-1488. Clinical Efficacy of Minocycline in the Treatment of Carbapenem-resistant Acinetobacter baumannii Pneumonia
Authors: Seok Hyeri , Kim Si-Ho , Shi Hye Jin , Huh Kyungmin
Published: January 2025

Background

Minocycline is one of the few antibiotics that remain active against carbapenem-resistant Acinetobacter baumannii (CRAB). However, the efficacy of minocycline in CRAB pneumonia has not been clearly demonstrated.

Methods

We conducted a multicenter retrospective cohort study at three university-affiliated teaching hospitals in patients with CRAB pneumonia who were admitted between October 2017 and October 2022. Patients were divided into two groups depending on whether minocycline was included in the antibiotics treatment regimen. Propensity scores for minocycline use were calculated using logistic regression, and logistic regression with overlap weighting was conducted to assess whether there were significant differences in outcome variables and safety variables between the two groups.

Results

We enrolled 430 CRAB pneumonia patients, among which 201 patients were treated with minocycline and 229 patients without minocycline. Intensive care unit stay was more frequent (77.6% vs 65.1%, P value = 0.006) and serum creatinine was higher (0.9 vs 0.8 mg/dL, P = 0.023) in the minocycline group than in the non-minocycline group. Variables associated with minocycline use in logistic regression were cerebrovascular disease (odds ratio [OR] 4.51, 95% confidence interval [CI] 2.07–9.85, P < 0.001), higher serum creatinine (OR 1.37, 95% CI 1.01–1.87, P = 0.046), and combination antibiotic regimen (OR 124.73, 95% CI 43.23–359.84, P < 0.001). Bacteremia (OR 0.19, 95% CI 0.05–0.73, P = 0.016) and lower Charlson comorbidity index (CCI) (OR 0.76, 95% CI 0.64–0.91, P = 0.003) were inversely associated with minocycline use. The clinical success rate on day 14 was higher in the minocycline-treated group (58.3% vs 41.7%, P < 0.001). In the adjusted model, the use of minocycline was significantly associated with clinical success (adjusted OR [aOR] 3.88, 95% CI 1.55–9.70, P = 0.004), lower 28-day mortality (aOR 0.28, 95% CI 0.10–0.79, P = 0.016), and a longer mechanical ventilator-free day (4.51 days longer, 95% CI 2.64–6.37, P < 0.001).

Conclusion

Minocycline, when used as a combination treatment in the treatment of CRAB pneumonia, showed superior results in terms of 14-day clinical success and 28-day mortality. Minocycline may be considered one of the antibiotic treatment options for CRAB pneumonia.

Disclosures

Kyungmin Huh, M.D., Ph.D., bioMérieux: Grant/Research Support|GSK Korea: Advisor/Consultant|Pfizer Korea: Honoraria|Takeda Korea: Advisor/Consultant
P-1489. Shaken Not Stirred: Novel Antibiotic Cocktails to Combat Pan-Drug Resistant Klebsiella pneumoniae
Authors: Kaur Jan Naseer , Chen Albert , Hanna Allison , Klem Jack F , Holden Patricia N , Chen Liang , Smith Nicholas M , Tsuji Brian T
Published: January 2025

Background

K. pneumoniae producing Metallo-Beta-Lactamases (MBL) confers resistance to a large spectrum of beta-lactam antibiotics which is a cause for significant concern. Novel combinatorial therapies can be an effective option for treating MBL Gram-negatives. The present study assessed the synergistic potential of Polymyxin B combinatorial strategies to combat the rising tide of PDR Gram-negative strains which have emerged worldwide.

Methods

K. pneumoniae producing blaNDM-5, blaCTX-M-55 and mcr-1 was exposed to an array of therapeutic regimens in a Hollow Fiber Infection Model (HFIM) over 9 days. These regimen arms included Polymyxin B (fCss = 4 mg/L), Aztreonam (fCss = 21 mg/L) + Avibactam (fCss = 5.5 mg/L), Aztreonam (fCss = 21 mg/L) + Avibactam (fCss = 5.5 mg/L) + Polymyxin B (fCss = 4 mg/L). Bacterial plate counts were taken throughout the experiment. Samples were also fixed and imaged under a Scanning Electron Microscope.

Results

Closely mirroring the growth control, Polymyxin B monotherapy did not inhibit the growth of K. pneumoniae S200. The clinical combination of aztreonam + avibactam demonstrated initial bactericidal activity with 6 log fold reduction (total count 1.6 log10 CFU/mL) over 24h followed by rapid recovery as the counts bounced back to 6.07 log10 CFU/mL by 48h. Reversion experiments demonstrated complete regrowth to 9.53 log10 CFU/mL by the 216h time point. In contrast, the addition of polymyxin B to the β-lactam/β-lactamase inhibitor combination resulted in prolonged marked bactericidal activity with 6.05 log fold reduction within 24h and eventually below the detectable limits over 168h.This was supported by tracking the evolution of salient phenotypic alterations using SEMs over 216h that showed filamentation in response to aztreonam containing regimens and lack of viable cells as well as overwhelming presence of cellular debris in Polymyxin B combination arm at 24 and 168h.

Conclusion

The results of the present study suggest that despite the intrinsic mcr-1 and blaNDM-5 resistance mechanisms our novel antibiotic cocktails show significant promise. Novel therapeutic options that enhance combinatorial pharmacodynamics are necessary to combat the urgent threat of MBL Gram-negative strains which are resistant to all antibiotics.

Disclosures

All Authors: No reported disclosures