bluuebunny/crossref_metadata_2025 huggingface dataset:
699. Clinical Outcomes and Management of NAAT-Positive/Toxin-Negative Clostridium difficile Infection: A Systematic Review and Meta-Analysis
Authors: Prosty Connor , Hanula Ryan , Katergi Khaled , Longtin Yves , McDonald Emily , Lee Todd C
Published: November 2023

Background

Standalone nucleic acid amplification tests (NAATs) are increasingly used to diagnose Clostridium difficile infections (CDI), although they may be unable to distinguish colonization from disease. A two-stage algorithm pairing NAAT with a toxin immunoassay (Toxin) has been proposed to improve specificity. We sought to evaluate clinical outcomes among patients testing NAAT+/Toxin+ vs NAAT+/Toxin- by conducting a systematic review and meta-analysis. We further compared outcomes between NAAT+/Toxin- patients who were and were not treated.

Methods

We searched EMBASE and MEDLINE from inception to September 17, 2022 for articles comparing CDI outcomes among symptomatic patients tested by NAAT and Toxin tests. The risk differences (RD) of all-cause mortality and CDI recurrence were computed by random effects meta-analysis between NAAT+/Toxin+ and NAAT+/Toxin- patients, as well as between treated and untreated NAAT+/Toxin- patients.

Results

Twenty-three observational studies comprising 11749 patients were included. 30-Day all-cause mortality was not significantly different between NAAT+/Toxin+ and NAAT+/Toxin- patients (8.4% vs 6.8%, respectively; RD=0.2%, 95%CI -2.4, 2.9; I2=52.9%). Recurrence at 60 days was significantly higher among NAAT+/Toxin+ (19.8%) vs NAAT+/Toxin- patients (11.0%) (RD=7.7%, 95%CI=4.6, 10.7, I2=37.4%). Among treated compared to untreated NAAT+/Toxin- patients, the all-cause 30-day mortalities were 5.0% and 14.9%, respectively (RD=-9.5%, 95%CI=-15.0, -3.9, I2=0.0%), but 60-day recurrence was not significantly different (11.6% vs 7.0%, respectively; RD=5.3%, 95%CI -1.7, 12.2; I2=47.0%).

Conclusion

Compared to NAAT+/Toxin- patients, NAAT+/Toxin+ patients had a greater risk of recurrence at 60 days, but not all-cause mortality. Treatment of NAAT+/Toxin- patients was associated with reduced all-cause mortality, but not recurrence. While subject to the limitations of observational studies including the potential for confounding by indication and immortal time bias, these results suggest that treatment of NAAT+/Toxin- patients may be beneficial. A strategy comparing standalone NAAT or staged testing with up front combined NAAT/Toxin testing could be the topic of a randomized controlled trial to determine cost and efficacy.

Disclosures

All Authors: No reported disclosures
712. Dynamics of Colonization with Multi-Drug Resistant Organisms and Clinical Outcomes in Critically Ill Patients: A Prospective Cohort Study
Authors: Adelman Max W , Rydell Kirsten B , Detranaltes Andrea M , Atterstrom Rachel , Virk Muhammad H , Schettino Marissa G , Amaya Abigail A , Malikzad Husna , Jones Mary N , Pimentel Maya , Hanson Blake M , Shelburne Samuel A , Savidge Tor , Arias Cesar A
Published: November 2023

Background

Critically ill patients have frequent intestinal colonization with multi-drug resistant organisms (MDRO). However, the duration of colonization and its impact on clinical outcomes are unknown.

Methods

We performed a prospective cohort study of adult patients admitted to ICUs at a tertiary care hospital. All patients had stool samples collected twice weekly for up to four weeks or until discharge from the ICU. Stool samples were cultured with selective media for vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E), and carbapenem-resistant Enterobacterales (CRE). We characterized patient demographics and compared outcomes between patients with and without colonization.

Results

A total of 102 patients were included. Mean age was 62 years (SD±15), 62 (61%) were men, 67 (66%) were white, and 34 (33%) were admitted from a separate healthcare facility. Thirty-nine (38%) were colonized with ≥1 MDRO at ≥1 time point. There were no statistically significant differences in baseline characteristics between patients with and without colonization. Of the 39 patients with colonization, 23 (59%) were colonized with VRE at ≥1 time point, 18 (46%) with ESBL-E, and 7 (18%) with CRE; 8 (20%) were colonized with >1 organism (Figure 1). Notably, most patients (13/23 with VRE, 15/18 with ESBL-E, and 4/7 with CRE colonization) were colonized with each MDRO type at only one time point during their ICU stay (Figure 1). In-hospital mortality did not differ according to colonization status (21% with any colonization vs. 17% without, p=0.70). When assessing mortality according to specific MDRO type, VRE colonization was associated with in-hospital mortality (35% with VRE colonization vs. 14% without, p=0.02).

Figure 1.

Results of serial stool samples tested for target multi-drug resistant organisms in intensive care unit patients. Each horizontal line represents a different patient included in the study (N=102) and each circle represents a separate stool sample.

Conclusion

Nearly 40% of ICU patients were colonized with VRE, ESBL-E, and/or CRE, although colonization duration was generally limited, possibly reflecting antibiotic pressures and microbiome dynamics in critically ill patients. More research is needed to identify clinical, microbiome, and organism genomic factors that facilitate persistence and loss of colonization.

Disclosures

All Authors: No reported disclosures
713. Prevalence of Microbicide Resistance Genes in Clinical Isolates of Acinetobacter baumannii
Authors: Chatterjee Piyali , Hwang Munok , Choi Hosoon , Dhar Sorabh , Kaye Keith S , Donskey Curtis , Jinadatha Chetan
Published: November 2023

Background

The persistence of Acinetobacter on different surfaces and the continuous exposure of bacteria to disinfectants such as quaternary ammonium compounds (QACs) in the healthcare environment have led to microbicide tolerance. Acinetobacter baumannii have also rapidly acquired carbapenem resistance. Here we determined the prevalence of microbicide resistance genes in carbapenem susceptible and resistant clinical isolates of Acinetobacter.

Methods

All clinical isolates were collected from two separate hospitals in Detroit between 2017-2021. Following DNA isolation using Qiagen kit, Nextera Flex kit was used for library preparation of Acinetobacter clinical isolates. Whole genome sequencing (WGS) was performed via Illumina NextSeq 550 using the prepared DNA library. The FASTQ files from the sequencing run were then subjected to bioinformatic analysis with Bionumerics software v7.6. ResFinder was used for determination of presence or absence of QAC resistant genes and results were tabulated by Carbapenem-Resistant Acinetobacter baumannii (CRAb) or Carbapenem-Susceptible Acinetobacter baumannii (CSAb) with or without the QAC resistant genes.

Results

Out of the 139 Acinetobacter patient isolates, 70/139 (50.4%) were CRAb containing carbapenemase blaOXA-23 and 69/139 (49.6%) belonged to CSAb (Table 1). Figure 1. shows the prevalence of antimicrobial resistance (AMR) genes in CRAb and CSAb isolates with qacE genes. For CRAb isolates, 56% had qacE genes while 39% of CSAb had qacE genes. About 42% of CRAb isolates were multi-drug resistant (MDR), indicating a prevalence of qacE genes among the MDR isolates. Table 2 shows the presence of qacE genes by sequence type (ST). In the ST2 (Pasteur) and ST406 (Pasteur) strains, qacE gene was mainly present. Interestingly, most of the Acinetobacter isolates that belong to ST2 (ST195 and ST281, Oxford) are CRAb with qacE gene.Figure 1:Different AMR genes and qacE in both CRAb and CSAb isolates

Conclusion

Clinical isolates in our study had an even distribution of both CRAb and CSAb. The presence of qacE gene was more prevalent in the CRAb isolates compared to the CSAb isolates. While different STs harbored the qacE gene, the prevalence of qacE gene was highest in ST2 among all isolates. Future studies are needed to determine the reduced susceptibility to other commonly used hospital disinfectants.

Disclosures

Keith S. Kaye, MD, MPH, Abbvie: Advisor/Consultant|Abbvie: Honoraria|Entasis: Advisor/Consultant|Entasis: Honoraria|GSK: Advisor/Consultant|GSK: Honoraria|Merck: Advisor/Consultant|Merck: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria|VenatoRx: Advisor/Consultant|VenatoRx: Honoraria
722. Risk Factors for Infection or Colonization with Ceftolozane/Tazobactam Non-Susceptible Extensively β-Lactam Resistant Pseudomonas aeruginosa
Authors: Lee Michelle , Nagel Jerod , Wangchinda Walaiporn , Pierce Virginia M , Smith Aaron , Bishop Olivia , Pogue Jason M
Published: November 2023

Background

Treatment of infections due to multidrug resistant (MDR) Pseudomonas aeruginosa is complicated by co-resistance amongst traditional anti-pseudomonal β-lactams, as 50% of MDR isolates exhibit extensive β-lactam resistance (EBR, non-susceptible to cefepime, ceftazidime, piperacillin/tazobactam, and meropenem). Ceftolozane/tazobactam (C/T) was developed to combat MDR and EBR P. aeruginosa. Unfortunately, C/T resistance has proliferated. We designed this retrospective case-control study to identify risk factors for C/T non-susceptibility (NS) amongst EBR P. aeruginosa.

Methods

Between 2015 to 2020, hospitalized adult patients infected or colonized with EBR P. aeruginosa were identified. C/T susceptibility was defined per the 2023 Clinical and Laboratory Standards Institute (CLSI) guidelines (susceptible (S) if minimum inhibitory concentration (MIC) ≤ 4 mg/L, NS if MIC ≥ 8 mg/L). Patients with an EBR P. aeruginosa NS to C/T were classified as cases, whereas those with S isolates were controls. Patients with multiple EBR P. aeruginosa isolates over the study period were only included once. If a patient had a C/T NS isolate, they were classified as cases and the first C/T NS isolate was included as the index culture. If the patient did not have a C/T NS isolate over the study period, they were considered a control and the first C/T S isolate was the index culture. Bivariate and multivariate modeling was performed to identify independent predictors for C/T NS.

Results

188 unique patients with C/T susceptibility performed were included in the study; 96 (51%) were C/T NS and 92 (49%) were C/T S. Table 1 shows the bivariate comparisons of key baseline characteristics between groups. Independent predictors of C/T NS are displayed in table 2.

Conclusion

Independent predictors for C/T NS amongst EBR P. aeruginosa isolates were a history of cancer, cystic fibrosis, and isolation of EBR P. aeruginosa in the past 90 days. While receipt of cefepime or ceftazidime in the past 90 days was associated with C/T NS in bivariate comparisons, the association did not remain in multivariate modeling. C/T exposure was not a statistically significant risk factor, but it was numerically associated with NS and the lack of significance was likely due to the small number of patients (n = 15) who received it.

Disclosures

Virginia M. Pierce, MD, FIDSA, UpToDate, Inc.: Authorship royalties jason M. Pogue, PharmD, AbbVie: Advisor/Consultant|Entasis: Advisor/Consultant|Ferring: Advisor/Consultant|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Qpex: Advisor/Consultant|Shionogi: Advisor/Consultant
729. I Can CPO Clearing Now, the Iso is Gone
Authors: Schwartz Danielle , Trepanier Kailee , Lytvyak Ellina , Zakhary Michael , Kim Joseph , Chandran Uma
Published: November 2023

Background

There is little research or guidance about clearing patients who are colonized with carbapenemase-producing organisms (CPO). The use of isolation precautions to reduce transmission needs to be balanced with the potential negative impacts of isolation on patient experience, quality of care and non-infection patient safety and outcome measures. Our objective was to develop and implement a standardized provincial protocol for clearing patients of their CPO-positive status.

Methods

PubMed, Web of Science, EMBASE and Cochrane Library were searched from January 2000 to February 2023. Randomized control trials, retrospective and prospective cohort studies, cross-sectional studies and case series were included. This information was used to create a CPO clearing protocol for use by Alberta Health Services (AHS) Infection Prevention and Control (IPC). The protocol will be monitored through the provincial surveillance system (ProvSurv) to guide future changes.

Results

The literature showed that although CPO colonization can be prolonged (more than 12 months), a significant number of patients tested CPO-negative by 3 months since the last positive test. In addition, one-third of patients with 1 or 2 negative swabs subsequently tested CPO-positive. Therefore, the proposed provincial guidance is to re-screen patients 3 months after their last CPO-positive result. Three negative sets (without antibiotic pressure) done at least one week apart are required to clear a CPO flag; where a negative set includes a rectal swab or stool culture, cultures of previously positive sites if still clinically relevant, and additional currently relevant sites.

Conclusion

This project aimed to create a standardized provincial protocol for clearing patients of their CPO-positive status to decrease the duration of isolation, while also balancing resource management and patient-centred care. After implementation, next steps include evaluation by monitoring compliance and examining specific CPO-related indicators. There is potential for use by other healthcare institutions and organizations.

Disclosures

All Authors: No reported disclosures
759. Gaps on Lyme Disease Knowledge Among Healthcare Providers in an Endemic Area: a Call for Educational Programs
Authors: GARY E V A N , Lamba Pooja , Handel Andrew S , Saldivar Miguel A , Marcos Luis A
Published: November 2023

Background

Lyme disease (LD) is hyperendemic in Long Island, NY. Identifying the practices of healthcare providers regarding LD epidemiology, clinical features, diagnosis, and treatment is crucial to continue improving patient care. Our study aims to assess the general understanding of LD among front line healthcare providers in order to identify knowledge gaps and produce targeted educational materials.

Methods

A 20-question IRB-approved online survey on LD prevention, diagnosis, and treatment practices based on IDSA national multidisciplinary LD guidelines was developed. From January to April 2023, this survey was sent to front line providers including physicians, residents, nurse practitioners, and physician assistants at Stony Brook Medicine. A p-value < 0.05 was considered significant using SPSS software.

IRB-approved survey for Lyme disease.

Results

Out of 140 respondents, 93 (66%) fully completed the survey (72% female). Regarding years in training, 53 (57%) reported being in practice for >5 years post-training, 15 (16%) were 1-5 years post-training, and 25 (27%) were still in training. Participants practiced the following specialties: Emergency Medicine 25% (n=23), Internal Medicine (IM) 15% (n=14), Pediatrics (Ped) 54% (n=50), and combined IM/Ped 6 % (n=6). Regarding knowledge of LD: 69% (n=64) of participants correctly identified the tick associated with LD, 48% (n=45) knew the correct description of erythema migrans, 75% (n=70) correctly identified the guideline recommendation for single dose doxycycline prophylaxis after a high-risk tick bite, 68% (n=63) offer single dose doxycycline prophylaxis after any tick bite, 35% (n=33) answered that a 7-10 day course of doxycycline for prophylaxis is indicated after a high-risk bite and only 3% (n=3) correctly identified the CDC-recommended testing strategies for the diagnosis of LD. In regression models, age, gender, specialty, or years in practice did not improve knowledge in these variables.

Demographics table.

Conclusion

Our pilot study found numerous important knowledge gaps among the surveyed providers regarding the current recommendations for prevention, diagnosis and treatment of LD. Based on these findings, we plan to create targeted educational efforts in order to improve mainly two areas on LD: diagnosis and management.

Disclosures

All Authors: No reported disclosures
761. Provider Perceptions of Antimicrobial Use and Educational Needs at Two Community Hospitals Within a Health System
Authors: Greenfield Adam , Sims Kathy M , Sastry Sangeeta , Bearman Gonzalo , Doll Michelle , Rittmann Barry
Published: November 2023

Background

Variability in ASP practices was identified across sites within a recently consolidated health system. A needs assessment was developed to identify knowledge gaps in infectious diseases management and antimicrobial stewardship practices at non-academic, resource-limited community sitesto tailor educational initiatives and promote practice changes.

Methods

A survey was conducted among physicians, pharmacists, advanced practice providers (APPs), and nurses at 2 rural, community hospitals in Virginia containing 80 and 70 beds respectively. The questionnaire contained 6 parts encompassing three domains: confidence in management of infectious diseases, antimicrobial stewardship practices, and educational needs.

Results

The survey was distributed to 134 individuals. A total of 42 respondents completed the survey (response rate 31.3%) including 10 physicians/APPs, 11 pharmacists, 19 nurses, and 2 others.

The most commonly encountered infectious disease syndromes treated in patients is represented in Figure 1. Sepsis and pneumonia were identified as the most common clinical syndromes treated. Overall confidence in managing ID syndromes in accordance with national guidelines was high, particularly among physicians (Figure 2). Pooled results demonstrated greatest confidence in managing urinary tract infection (mean rating 7.8/10) and least confidence in managing organ space/deep surgical site infections (mean 6.7/10).

80% of clinical providersreported evaluating the necessity of antimicrobials dailyand 70% reported utilizing minimal durations of therapy. The most requested topics of education on antimicrobials were: optimization of dosing in special populations, dosing of high-risk medications and strategies for de-escalation. The preferred choice for content delivery was live webinar (36.8%) followed by an online module (31.6%). Newsletter and in-person presentations were less popular (2% each).

Conclusion

Among healthcare professionals practicing in rural community settings, sepsis was the most common treated syndrome with high confidence in treating all infectious disease syndromes in accordance with guidelines. Future education should focus on both self-reported and demonstrated needs.

Disclosures

Michelle Doll, MD, MPH, Molnlycke: Grant/Research Support
762. Conversations that Matter: Developing an AI-Based Training Algorithm to Improve Provider Competence to Work with SGM Youth
Authors: Hanshaw Brady , Rachal Laura , Gross Jessica , Finacchio Zachary , McElroy Sarah , Noble Skyler , Espada Joshua , Shen Thomas , Lina Rosengren A
Published: November 2023

Background

Cultural incompetence hinders the engagement of sexual and gender minority (SGM) youth in the HIV prevention and care continuum. Improving providers’ cultural competence is critical to reducing HIV health inequities. Medical education lacks opportunity for practice and SGM perspectives. We are developing an AI training app that uses virtual patients and a framework of educational and behavior change theory to increase provider clinical and communication competence with SGM youth. SGM youth and healthcare providers have unique knowledge about provider bias and stigma barriers to care, which can inform intervention content.

Methods

From Twitter's API, 42,213 Tweets were iteratively sampled by 11 SGM youth (the “YAB”) and analyzed thematically. These themes were combined with current clinical care guidelines for SGM youth to generate 111 stigma barriers to care agreed upon by the YAB by consensus. These themes were edited and ranked by importance by the YAB using a modified Delphi method. Using this content as a starting point, we held workshops with providers and the YAB to develop a comprehensive list of scenarios where providers noted deficient training in providing culturally competent care to SGM youth. Prioritized training scenarios selected from this list were developed into detailed scripts for AI virtual patient encounters.

Results

Using a model of social media mining informed by SGM youth and provider collaborative work, training scenarios were developed for integration into a GPT/AI provider training app. Scenarios address topics selected by SGM youth that are particularly salient to this population based on social media conversations around provider stigma and the YAB members’ lived experiences. Scenarios will progress from basic to advanced topics to train providers in culturally appropriate language and foster competent care for SGM youth.

Conclusion

SGM youth have deep insight into their care needs and lived experiences of healthcare trauma. Understanding these care needs and building provider competence is critical to reduce HIV inequities among SGM youth. Our data provide new insight into how interactions between providers and SGM youth may improve. Future research will test the app’s effect on the clinical care behaviors of providers in a randomized control trial.

Disclosures

All Authors: No reported disclosures
764. Return to the Roundtable: A Clinical Case Discussion Curriculum for Infectious Diseases Fellows
Authors: Hillenbrand Molly , Perez Reinaldo , Shoff Christopher , Maziarz Eileen K , Sparks Matthew A
Published: November 2023

Background

The Accreditation Council for Graduate Medical Education (ACGME) and the Infectious Diseases Society of America (IDSA) require infectious diseases fellowship programs to include a core curriculum as part of their requirements for clinical training, though recommendations regarding content and structure are limited. Despite advances in online tools available for asynchronous learning in medical education, there remains a scarcity of published ready-to-teach content. We hypothesized that case-based clinical reasoning sessions covering core clinical topics would improve the attitudes and confidence of infectious diseases fellows.

Methods

We conducted an informal needs assessment of current fellows, reviewed published recommendations and other fellowship curricula. Then, we developed a series of case-based clinical reasoning sessions for clinical and research fellows based on constructivist theory and emphasizing adult learning principles. Topics were rooted in published guidelines and evidence-based practice, prioritizing complex and high-yield clinical topics. Content was peer-reviewed by faculty and sessions were facilitated by senior fellows. Facilitation guides were created to allow for dissemination in the future. Faculty and pharmacists attended the sessions as expert discussants. Fellows completed anonymous surveys assessing attitudes and confidence after each session.

Results

Three sessions covering Endemic Mycoses, Non-tuberculous Mycobacteria, and Toxoplasmosis were completed with 6-8 fellows in attendance at each. Surveyed fellows felt that the sessions were valuable and improved their confidence in clinical management of the topics presented (Figure 1). Participants also provided narrative feedback (Table 1).

Post-session Survey ResultsFigure 1.Post-session survey results from Likert-scale questions assessing attitudes and confidence, n=11 surveys completed by infectious diseases fellows.

Post-session Narrative FeedbackTable 1.Narrative feedback from fellows who completed the post-session surveys.

Conclusion

This curriculum represents a novel initiative by trainee physicians to create a series of peer-facilitated, discussion-based sessions for learners at the level of subspecialty fellowship. We demonstrated that these sessions improve the attitudes and confidence of fellows in a single-program pilot. Future directions will include studying the intervention in other fellowship programs and sharing this program broadly within the infectious diseases education community.

Disclosures

Eileen K. Maziarz, MD, Karius, Inc: Advisor/Consultant
767. Impact of Standardized Patient Simulation on Pharmacy Students' Confidence and Perceptions in Community-Acquired Bacterial Meningitis Management
Authors: Kufel Wesley D , Mastro Keri , Blaine Bruce
Published: November 2023

Background

Limited data describes the use of standardized patient simulation (SPS) for infectious disease (ID) education, particularly among pharmacy students. We sought to assess the impact of SPS on pharmacy students’ knowledge and confidence of community-acquired bacterial meningitis (CABM), and to evaluate students’ perceptions of SPS.

Methods

This single-center, cross-sectional, voluntary, anonymous survey was conducted among second-year Doctor of Pharmacy students (n=69). CABM education was initially delivered via didactic, large classroom instruction, which occurred 1.5 weeks prior to the SPS. The pre-SPS survey asked students to assess their confidence in CABM. The confidence questions focused on pathophysiology, microbiology, clinical presentation, diagnosis, and empiric/targeted management. The SPS included two group graded sections: a rounding experience focused on patient assessment, clinical presentation, and empiric management (Figure 1) followed by a microbiology lab simulation, targeted management, and duration/monitoring. A post-SPS survey was distributed, which included the same pre-survey questions and questions related to perceptions of SPS. All survey confidence and perception questions were evaluated using a Likert scale from strongly disagree (1) to strongly agree (5). Descriptive statistics and Student’s t-test were used.

Standardized Patient Simulation Rounding Experience

Student group engaged in the standardized patient simulation rounding experience (all individuals pictured gave permission for the use of this picture).

Results

Sixty-three students fully completed the pre- and post-SPS surveys (91.3% response rate), and pre-post responses were matched. Overall mean (+SD) confidence in CABM management was significantly higher following SPS (4.3+0.5 vs. 3.5+0.7; p< 0.001). A statistically significant mean increase was also observed for each individual confidence item following SPS. Mean (+SD) perceptions following SPS for feeling more comfortable with patient interaction skills, preferring SPS compared to written case-based instruction, and having interest in more ID SPS were 4.2+0.8, 4.2+0.9, and 4.3+0.9, respectively.

Conclusion

SPS was associated with increased confidence in CABM management among pharmacy students. Students appeared to have a positive impression of SPS and are interested in future ID SPS. SPS appears to be an effective educational modality for CABM and should be assessed among other student clinicians for ID.

Disclosures

Wesley D. Kufel, Pharm.D., BCPS, BCIDP, AAHIVP, Merck & Co.: Grant/Research Support
772. Learning from our patients: An exploratory study to inform the development of a case tracking dashboard for subspecialty fellows
Authors: Minter Daniel J , Frank Annabel K , Schwartz Brian S , Narayana Sirisha
Published: November 2023

Background

Educators identify case tracking (following-up prior patient encounters) as a valued practice to cultivate physician expertise. Much of the existing research has focused on the practices of general medicine providers, where challenges include insufficient time and difficulty tracking patients in the electronic health record (EHR). Subspecialty fellows constitute a group of advanced learners who see a high volume of patients and need to quickly become subject matter experts, yet little is known about their particular needs and motivations around case tracking. In this study, we performed a needs assessment with fellows to inform the design of an EHR-based case tracking dashboard that can facilitate learning from prior patient encounters.

Methods

We conducted semi-structured interviews with 22 medicine subspecialty fellows (including 4 Infectious Diseases [ID] fellows) at a single academic medical center that explored participants’ motivations, preferences, and practices around case tracking. Interview transcripts were coded and analyzed with directed qualitative content analysis. Results of this analysis will be used to inform the design of a subspecialist EHR-based case tracking dashboard.

Results

Participants were motivated to engage in case tracking, with curiosity regarding patient outcomes as a strong motivator. Although some attempted to track all consults, most focused on subsets of patients, feeling that not all encounters were of equal educational value. Participants highlighted particular results, specialty-specific notes, and major outcomes as the most useful information. ID fellows specifically were interested in post-discharge ID clinic encounters, send-out tests, and outcomes of their management decisions. Despite widespread motivation to engage in case tracking, manually adding patients to lists and remembering to follow up poses logistical and time barriers.

Conclusion

An ideal EHR case-tracking dashboard would automatically keep a list of patients cared for by fellows and provide easy access to own-specialty notes, specific results of interest, and information on the global clinical course. The ability to highlight specific cases anticipated to have more educational value would also be of benefit.

Disclosures

All Authors: No reported disclosures
775. Needs Assessment to Support Continuing Education and Training Modalities for High-Consequence Pathogen Preparedness in Pediatric and Obstetric Populations
Authors: Mowrer Clayton , Fischer Laura J , Horton John , Huff Nichole L , Imonugo Chimora , Shane Andi L , Stone Lisa , Simonsen Kari
Published: November 2023

Background

High-consequence pathogens present complex challenges in United States (US) healthcare, with knowledge gaps existing in the provision of safe and effective treatment. The National Emerging Special Pathogens Training and Education Center (NETEC) aims to standardize guidance and care coordination across the healthcare continuum for suspected or confirmed infection with high-consequence pathogens through education, training, research, monitoring, evaluation, and funding. The NETEC Special Populations Committee applies this mission to pediatric and obstetric care.

We conducted a needs assessment to optimize education and training opportunities for healthcare teams related to high-consequence pathogen preparedness for children and pregnant women.

Methods

Stakeholders received a needs assessment survey via email, social media, and NETEC website from 10/3/22-11/15/22. Questions targeted demographics, topics of interest for continuing education within the special populations: pathogen awareness, frontline care, infection prevention, and emergency preparedness, and learning modality preferences.

Results

Of the 20,600 impressions, the survey was completed by 145 persons (with 97 additional partial completions). The use of targeted emails had the highest engagement, with a 25% open rate (29% industry average) and click-through rate of 18% (5% industry average). Respondents were located across the US, mainly in academic healthcare settings (46%). Infection Preventionists (30%) represented the greatest proportion, but many institutional roles were reported (Table 1). Responses to educational topics were widely distributed (Table 2). Webinars (77%), in-person training (64%), and brief written summaries or updates (54%) were the most common preferred learning modalities (Figure 1).

Conclusion

Myriad healthcare team members are involved in the care of pediatric and obstetric patients with high-consequence pathogens. They represent an engaged group of NETEC stakeholders that, despite recent experience with the SARS-CoV-2 pandemic, express interest in continuing education on topics related to high-consequence pathogens across the care continuum via interactive, engaging, and collaborative learning modalities, led by subject matter experts.

Disclosures

Andi L. Shane, MD, MPH, MSc, International Scientific Association for Probiotics and Prebiotics: Travel and lodging support to attend an international meeting June 2022|Pediatric Infectious Disease Society (PIDS): Stipend for serving as Deputy Editor Kari Simonsen, MD, MBA, Astra-Zeneca: Grant/Research Support|Melinta Therapeutics: Grant/Research Support|Pfizer: Grant/Research Support
780. A Quality Improvement Initiative to Identify and Close Gaps in Rapid Initiation of Antiretroviral Therapy (ART)
Authors: Colasanti Jonathan , Rana Aadia I , SAWYER J E W E L , Rodriguez Melissa , Meza Jimenez Jenniffer A , Carter Jeffrey D , Corona Abigail K , Simone Laura , Molloy Leah
Published: November 2023

Background

Treatment guidelines recommend prompt ART initiation after HIV diagnosis, but implementation barriers persist. This project aimed to identify gaps and improve clinical practices surrounding rapid ART initiation in the US.

Methods

Baseline surveys were completed by 130 healthcare professionals (HCPs) in 8 HIV clinics assessing knowledge and practice around ART initiation. Responses informed the development of interactive, live virtual audit-feedback sessions at 8 clinics from 5/2022 – 8/2022. Pre and post-program surveys were administered, team-based action plans developed, and HCPs completed 60- and 120-day follow-up surveys.

Results

Top reported challenges impeding rapid ART initiation were medication adherence for patients with unstable housing/substance use disorders (SUD) (63%), incomplete lab results (33%) and co-infections/opportunistic infections (28%). Knowledge was assessed using case vignettes. For a patient with hepatitis C and SUD, 45% of learners correctly chose to promptly start ART, which improved to 94% after the sessions (p< .001). More HCPs were confident initiating ART for patients with unstable housing/SUD (70%) and before confirmatory HIV testing (74%) after the sessions than before (38% and 39%, respectively, p< .001 each).

Follow-up surveys noted a 10% increase in proportion prescribing ART within 7 days of a positive screening test (32% to 42%) along with increased ART prescribing the same day as a positive test and before additional test results, Figure 1. Action plans implemented after the sessions included coordination with off-site labs, new intake forms, and staff training. HCPs self-reported improvements including appropriate prompt ART initiation (81% and 88%), integrating new patients to avoid loss to follow-up (85% and 88%), and alignment with guidelines (88% and 91%). HCPs identified care coordination (31%) and identifying candidates for rapid ART initiation (31%) as areas of need to improve rapid ART initiation. Challenges reported included scheduling conflicts, timely lab results and coordination with case management.Figure 1.Proportion of HCPs reporting ART initiation practices occurring for >75% of their patients

Conclusion

Tailored implementation discussion with live audit-feedback and action planning led to measurable practice improvements. These outcomes may inform other practice-changing implementation needs.

Disclosures

Jonathan Colasanti, MD, MSPH, DKB MED LLC: Honoraria|Prime Education LLC: Advisor/Consultant Aadia I. Rana, MD, Merck: Grant/Research Support JEWEL SAWYER, PA-C, MSHS, AAHIVS, Janssen: Speakers Bureau|Prime Education: Speakers Bureau
781. “Rashional” Infectious Diseases Training: A “Dermatology for Infectious Diseases Fellows” Pilot Curriculum Evaluation
Authors: Rockney Danica , Melia Michael T
Published: November 2023

Background

Rashes are common among patients with infections. A prior survey of United States adult infectious disease (ID) fellowship program directors showed that most respondents (55/90; 61%) do not have a formal dermatology curriculum for their fellows and 76% (41/54) were interested in incorporating an externally produced dermatology curriculum if made available to them. To address this education gap, a “Dermatology for the ID Fellow” curriculum was created.

Methods

During the 2022-2023 academic year, a “Dermatology for the ID Fellow” curriculum was piloted with the 11 fellows in the Johns Hopkins adult ID fellowship program. The curriculum included two lectures, multiple asynchronous board-style questions, and three knowledge assessments (Figure 1). Curricular objectives were evaluated by pre-, mid-, and post-curriculum knowledge assessments. Descriptive data analysis was performed. This study was IRB exempt.

Results

The response rates for the pre-, mid-, and post-curriculum knowledge assessments were 91%, 64%, and 55% respectively. The response rate of asynchronous questions averaged 63% across all participating fellows (range 13%-100%). Most fellows correctly identified primary rash morphologies by verbal description (88% correct) and photographs (96% correct). At the end of the curriculum, 50% (4/8) of the fellows ranked their comfort level in approaching cutaneous manifestations of infections as higher than before the curriculum, with 38% (3/8) staying the same. More fellows used a systematic approach to unknown rashes after the curriculum (83%; 5/6) as compared to before the curriculum (30%, 3/10) (Figure 2). There was no improvement in fellows' ability to determine a differential diagnosis based on rash appearance. Overall, 100% of the fellows felt like the lectures presented new and important knowledge.

Conclusion

Incorporation of a “Dermatology for ID Fellows” curriculum was viewed favorably. The curriculum increased the use of a systematic approach to a rash and helped some fellows improve comfort level in approaching a rash. Data from this pilot curriculum will inform subsequent iterations that may help increase the ability to develop infectious differentials based on rash appearance, addressing an important knowledge gap in ID fellowship training.

Disclosures

All Authors: No reported disclosures
811. A prospective pilot multicenter study of Aspergillus colonization in the nasal cavity as a surrogate marker of invasive aspergillosis among acute myeloid leukemia patients and allogeneic stem cell transplant recipients
Authors: Charoonrochana Natnai , Jinawath Natini , Santanirand Pitak , Jiaranaikulwanich Atisak , Taweewongsounton Aruchalean , Setthaudom Chavachol , Tanpaibule Tananun , Surin Dootsadeephorn , Damronglerd Pansachee , Limvorapitak Wasithep , Rungwittayatiwat Sirapat , Pinsai Subencha , Niparuck Pimjai , Rotjanapan Porpon
Published: November 2023

Background

Invasive aspergillosis (IA) is a common opportunistic infection in patients with acute myeloid leukemia (AML) and allogeneic stem cell transplant (SCT) recipients. Identifying at–risk patients may improve clinical outcomes when universal prophylactic therapy is not possible in a resource-limited setting. Aspergillus spp. colonization has been listed as a potential risk for infection development among patients with hematologic diseases, but this has not been explored in real-life clinical practice.

Objectives

To evaluate the correlation of Aspergillus spp. colonization and invasive aspergillosis development and to assess nasal wash galactomannan as a potential predictor for IA among AML patients and allogeneic SCT recipients.

Methods

A prospective pilot study at four tertiary care hospitals in Thailand was conducted from April 2021 to January 2023. All AML individuals requiring induction chemotherapy and patients admitted for a conditioning regimen for allogeneic SCT were enrolled. Nasal wash fluid was obtained for galactomannan and fungal culture to assess Aspergillus spp. colonization before chemotherapy. The patient’s demographic and relevant data were retrieved. All patients were monitored for IA development and the need for antifungal use for IA treatment.

Results

25 AML patients and nine allogeneic SCT recipients were included. A nasal wash fungal culture positive for Aspergillus spp. was identified in 3/34 patients. Eighteen (52.9%) patients were diagnosed with invasive aspergillosis after a six-month follow-up, 15/25 among AML patients, and 3/9 among allogeneic SCT. 8 patients (23.5%) had nasal wash galactomannan >0.46, and 5/8 patients had IA. The cut-off value of nasal wash fluid galactomannan of 0.46 provided a sensitivity of 55.56% and specificity of 78.57% in diagnosing IA in AML patients.

Conclusion

The incidence of Aspergillus spp. colonization by the traditional culture-based method was low at treatment initiation and did not suggest future IA development in this study. However, nasal wash galactomannan may help predict future IA development in AML patients, but due to low sensitivity may limit its role in actual clinical practice at a larger scale. Further studies are needed to verify the best strategy to predict the risk of IA in this population.

Disclosures

All Authors: No reported disclosures
821. Positive Follow-Up Blood Culture in Candidemia and Ocular Involvement
Authors: Iqbal Hamail , Nikolic Dejan , Palacios Carlo Foppiano
Published: November 2023

Background

Candidemia can lead to ocular complications, including endophthalmitis and chorioretinitis. Prompt management of such ocular diseases is paramount due to the risk of blindness. Management of candidemia usually includes a dilated ophthalmic exam; however, there are concerns regarding the utility of performing ophthalmic exams in all patients due to a low rate of ocular complications and lack of changes in medical management. Thus, there is a need for prognostic factors suggestive of ocular involvement that warrant a thorough ophthalmic examination. We sought to evaluate if positive repeat blood cultures are associated with ocular involvement in candidemia.

Methods

A single-center, retrospective chart review was conducted at an academic medical center. All candidemia cases from 2017 to 2022 were analyzed for demographics, culture results, treatment, inpatient ophthalmic exam findings, and mortality at discharge, at 30 days, and at 90 days. Descriptive statistics and Chi-Square tests were performed on the collected data.

Results

104 episodes of candidemia among 84 patients were included: the mean age was 54 years, 55% were male, 74% were Black, and 13.1% were Latino. The most common Candida species isolated was C. albicans (37%) and most patients were treated with micafungin (51%). 12% had visual symptoms and 84% underwent ophthalmic exams. 15% of the exams were concerning for ocular involvement: 5% endophthalmitis, 5% chorioretinitis, and 5% other infectious findings (Roth spots and other retinal lesions). There was no significant association between repeat positive blood culture results and development of endophthalmitis (p = 1.00), chorioretinitis (p = 0.93), or any ocular involvement (p = 0.97). Furthermore, no significant associations were found between repeat blood culture and death at discharge, 30 days, or 90 days.

Conclusion

No significant associations were found between repeat positive blood culture and ocular involvement in the setting of candidemia. Other indicators of ocular involvement in candidemia are needed to assess patients who would benefit from ophthalmic exam.

Disclosures

All Authors: No reported disclosures
830. Risk factors for late Pneumocystis jirovecii pneumonia in kidney transplant recipients: A Case-Control Study of United States Renal Data System Data
Authors: Mendoza Maria Alejandra , Vergidis Paschalis , Friedman Daniel Z P
Published: November 2023

Background

Organ transplant recipients are at increased risk of potentially life-threatening opportunistic infections, including Pneumocystis jirovecii pneumonia (PJP). Given the use of effective prophylaxis, PJP has become less common, especially during the first-year post-transplant. Recent data has shown that the risk of infection has shifted within the first 2 years after discontinuing prophylaxis. We aimed to determine risk factors for late posttransplant PJP using a national database.

Methods

Using the United States Renal Data System database, we performed a retrospective case-control study of patients who underwent kidney transplant from 1998 through 2019. To evaluate risk factors for late PJP, we performed logistic regression analysis by comparing characteristics between infected patients and their matched uninfected controls.

Results

We identified 407 cases with PJP and matched to 1628 controls (1:4). 60 (14.7%) of the cases occurred within one year post transplant and 347 (85.3%) patients were diagnosed after one year of transplant. In the late period, the median time between transplant and PJP diagnosis was 68.7 (IQR 28 -134.2) months. Seventy cases (20.1%) occurred between 12 and 24 months.

In multivariate analysis (table 1), risk factors for late infection included a higher Elixhauser Comorbidity Index (ECI), history of cytomegalovirus disease, older donor age, use of antilymphocyte agents, history of re-transplant and a longer time of hemodialysis prior to transplant. Of note, in the early period, we found that having a living donor was protective.

Multivariate analysis of risk factors for late Pneumocystis jirovecii pneumonia

Conclusion

Our findings highlight the importance of a timely transplant to mitigate the risk of post-transplant PJP in the late post-transplant period where prophylaxis is not routinely used. These results also raise the consideration of PJP prophylaxis in the late period in patients diagnosed with CMV disease, history of re transplant and recent use of antilymphocyte agents.

Disclosures

Paschalis Vergidis, MD, MSc, AbbVie: Advisor/Consultant|Ansun: Grant/Research Support|Cidara: Grant/Research Support|Scynexis: Grant/Research Support
841. An Evaluation of Outcomes and Hospital Readmissions Among Individuals with Candidemia in Connecticut (2019-2020)
Authors: Suschana Elizabeth , Banach David , Meek James , Clogher Paula , Correa Maria
Published: November 2023

Background

In addition to significant morbidity and mortality, sepsis is a leading cause of hospital readmission. Candidemia, a leading cause of sepsis, has a particularly high morbidity and mortality rate. Previous studies defined risk factors for poor outcomes and readmission after general sepsis. However, specific risk factors for readmission after candidemia are unknown.

Methods

The study is retrospective cohort study of adults in Connecticut with an episode of candidemia between 2019-2022 using statewide surveillance data. Individuals were classified based on primary outcome (died versus survived) at incident admission. Candidemia survivors were further classified by readmission status. A descriptive analysis of demographics, healthcare related factors, and readmission characteristics was performed in univariate and multivariate analyses to identify factors associated with mortality and readmission after an episode of candidemia.

Results

Among 347 candidemia cases, 226 (65.1%) survived the incident episode. Those who survived were more likely to be younger (age > 65 = 70% vs age < 65 = 59.2%; p = 0.036), have community-onset infections (84.4% community-onset vs 47.2% hospital-onset; p < 0.001), and have an infection from a non-Candida albicans species (56.5% with C. albicans vs 70.8% with non-C. albicans; p = 0.006). In multivariate analysis, mortality was associated with hospital-onset infection [OR = 6.866, CI = 4.009 – 11.760]. Among survivors of the incident episode (n = 128), 56% were readmitted within 180 days post- incident episode. Of those readmitted, 13 (10.1%) were readmitted for a new incident candidemia episode. Readmission was associated with hospital-onset infection (OR=1.791, CI = 1.008 – 3.184).Table 1.Demographic and clinical factors of incident case outcome and readmissions, 2019-2020 (Abbreviated).* Indicates a significant p-value (p < 0.05)Table 2.Multivariate analysis for age and class of infection by incident case outcome and readmission status

Conclusions

Individuals with candidemia have a high risk of mortality and readmission. Individuals with hospital-onset infection are at particularly high risk of mortality and subsequent readmission. Efforts to prevent hospital-onset candidemia are critical. Additional measures focused on individuals with risk factors for readmission are needed to reduce overall morbidity and mortality associated with candidemia.

Disclosures

All Authors: No reported disclosures