bluuebunny/crossref_metadata_2025 huggingface dataset:
P-99. Comparative Analysis of False Positive Results in Low and High Risk U.S. Populations: New Access HIV Ag/Ab combo Assay vs. Abbott ARCHITECT HIV Ag/Ab Combo Assay
Authors: Maher Danielle L , Jortani Saeed , Apple Fred S , Christenson Robert H
Published: January 2025

Background

The fully automated 4th gen HIV Ag/Ab combo assay by Beckman Coulter, Inc. on the DxI 9000 Access Immunoassay analyzer allows for separate reporting of HIV-1 p24 Ag and HIV-1/HIV-2 Ab results, with a time to first result of ̴30 minutes and a sample volume of 60µL. To evaluate its performance, a U.S. multisite study was conducted to compare the Access HIV Ag/Ab combo assay with the ARCHITECT HIV Ag/Ab Combo assay. False positive rates were assessed in low and high risk U.S. populations with unknown HIV status by comparing the new Access HIV Ag/Ab combo assay with the ARCHITECT HIV Ag/Ab Combo assay.1

Footnotes

Methods

The evaluation tested 6,981 low risk and 799 high risk samples (adult, pregnant, pediatric) at 3 clinical trial sites. Following the CDC recommended algorithm, samples that initially tested reactive were subjected to duplicate testing, if repeatedly reactive, were further confirmed using the HIV 1/2 differentiation assay (Geenius HIV-1/2 Supplemental Assay, Bio-Rad), and the HIV-1 RNA PCR Assay (Aptima HIV-1 Quantitative Dx Assay, Hologic, Inc).2

Results

The Access HIV Ag/Ab combo assay showed a lower incidence of false positive results (n=25) in the low risk group with a specificity of 99.6% (n=6981; 95% CI: 99.5-99.8%) compared to the ARCHITECT HIV Ag/Ab Combo assay (n=87) with a specificity of 98.8% (n=6981; 95% CI: 98.5-99.0%). Similarly, in the high risk group, the Access HIV Ag/Ab combo assay yielded fewer false positive results (n=1) with a specificity of 99.9% (n=799; 95% CI: 99.3-100.0%) than the ARCHITECT HIV Ag/Ab Combo assay (n=11) with a specificity of 98.6% (n=799; 95% CI: 97.6-99.2%).

Conclusion

Falsely reactive HIV test results can have significant consequences for patients and healthcare providers. Selecting an appropriate HIV assay with high sensitivity and specificity is essential. This study provides evidence that the Access HIV Ag/Ab combo assay is an attractive alternative to the ARCHITECT HIV Ag/Ab Combo assay with fewer false positive results, suggesting improved accuracy in identifying HIV infections in both low and high risk U.S. populations.

Disclosures

Fred S. Apple, PhD, Mindray: Advisor/Consultant|Werfen: Advisor/Consultant Robert H. Christenson, PhD, DABCC, FADLM, FACC, Beckman Coulter: Advisor/Consultant|Beckman Coulter: Grant/Research Support|Beckman Coulter: Honoraria|Becton Dickinson: Advisor/Consultant|Becton Dickinson: Grant/Research Support|Becton Dickinson: Honoraria|QuidelOrtho: Advisor/Consultant|QuidelOrtho: Grant/Research Support|QuidelOrtho: Honoraria|Roche Diagnostics: Advisor/Consultant|Roche Diagnostics: Board Member|Roche Diagnostics: Grant/Research Support|Roche Diagnostics: Honoraria|Siemens Healthineers: Advisor/Consultant|Siemens Healthineers: Board Member|Siemens Healthineers: Grant/Research Support|Siemens Healthineers: Honoraria
P-116. Impact of a gastrointestinal molecular panel in the tropics: going beyond E. histolytica
Authors: Agramonte-Medrano Alana M , Guzman-Marte Anel E , Rojas-Fermin Rita A , Sanchez-Marmolejos Ann S , Cedeño-Bruzual Maria Fernanda , Chaddy Báez Lia Michelle , Mejia De La Cruz Dolores Magdalena
Published: January 2025

Background

Acute diarrhea (AD) is a major cause of illness and hospital admissions, particularly in humid tropical climates. These infections can escalate rapidly, making an early and accurate diagnosis crucial for effective treatment. However, due to the variety of pathogens and the limitations of conventional diagnostic tests, clinicians often resort to empiric treatments based on epidemiological data. This study explores how effective a gastrointestinal molecular panel (GI panel) can be in identifying specific pathogens in a tertiary health center.

Methods

This observational, descriptive, cross-sectional study analyzed the clinical records of patients over 18 years old with symptoms of AD. These patients underwent treatment and took the FilmArray GI Panel between March 2021 and December 2022. The study also compared the results obtained by ova and parasite tests and/or stool culture, when available.

Viral, Bacterial & Parasitic infections

Source: Statistical registry of the authors

Results

Out of 59 patients (median age: 48 years; 57.63% female), the GI panel identified at least one pathogen in 66.1% (39/59) of samples, with 32.2% (19/59) showing two or more pathogens. Bacteria were the most common cause of infection (62.7%), with enteroaggregative E. coli (18.6%), Shigella/enteroinvasive E. coli (18.6%), and enteropathogenic E. coli (15.3%) being the most prevalent. Viruses accounted for 11.9% of cases, with Norovirus GI/GII (5.1%) and Adenovirus F 40/41 (3.4%) being the most common. Protozoa made up 6.8% of cases, primarily Cryptosporidium (5.1%) and Cyclospora cayetanensis (1.7%).

Out of 21 patients with a bacterial target in the GI panel, only one received a positive stool culture (Salmonella sp.). The 4 protozoa-positive samples were not detected through an ova and parasite test, and no stool sample was positive for Entamoeba histolytica (32 ova and parasite tests).

Conclusion

It is necessary to rethink the etiology of AD in low- and middle-income countries like the Dominican Republic, which has long been based on low-sensitivity routine tests. Despite being in the tropics, protozoa were not the most frequent pathogens, and E. histolytica was largely absent, regardless of the diagnostic method used. Diagnostic routine tests should be revised to include targets that may be missed due to method limitations.

Disclosures

Rita A. Rojas-Fermin, MD,FIDSA, Gilead: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria
P-117. Wastewater-Based Surveillance (WBS) of Shiga Toxin-Producing Escherichia coli (STEC) in Alberta, Canada
Authors: Waddell Barbara Jean M , Du Kristine , Au Emily , Lee Jangwoo , Acosta Nicole , Bautista Chavarriaga Maria , Clark Rhonda , Conly John , Chui Linda , Berenger Byron M , Griener Thomas , Cabaj Jason , De Vinney Rebekah , Pang Xiaoli , Lee Bonita , O’Grady Christine , RJ Hubert Casey , Parkins Michael
Published: January 2025

Background

Shigatoxin-producing E. coli (STEC) are responsible for significant human morbidity, with the potential to cause severe food-borne illness and outbreaks. STEC incidence varies between communities and peaks in summer months (PMID 31652648). Leveraging a SARS-CoV-2 WBS program, we sought to explore genomic targets for STEC WBS.Figure 1.Prevalence of STEC differs across Alberta’s municipal sewer sheds

Methods

Composite-24h wastewater (WW) was collected from geographically disparate, and socioeconomically diverse Alberta communities (n=5) at the level of municipal WW treatment plants. From 04/2022-03/2024, monthly WW underwent pelleting and DNA extraction by Qiagen DNeasy PowerSoil Pro kit. WW extracts were assessed for four potential genomic STEC targets: Shiga Toxin 1 (stx1), Shiga Toxin 2 (stx2), Intimin (eae) and LPS O antigen gene specific for O157 (rfbEO157), by multiplex PCR. Each target was normalized by 16S rRNA-for total bacterial burden. WW STEC targets were assessed for correlation using Spearman’s and compared between communities and seasonality (July-Sept vs Jan-Mar) by Mann-Whitney U-test.Figure 2.STEC WBS demonstrates seasonal prevalence trends

Results

Of 111 WW samples assessed, 108 (97%) were positive for all targets, and individual targets were identified in 110 (99%) stx1; 110 (99%;) stx2; 111 (100%) eae, and 110 (99%) rfbEO157. Gene abundance for each STEC target exhibited strong correlations across sites (stx1 vs stx2, r=0.802, p< 0.0001; stx2 vs rfbEO157, r=0.634, p< 0.0001; eae vs rfbEO157, r =0.551, p< 0.0001; stx2 vs. eae r=0.542, p< 0.0001). WW measured STEC gene targets exhibited significant differences between municipalities (Figure 1) with strong seasonal trends (Figure 2).

Conclusion

WBS for STEC yielded patterns consistent with established patterns of disease (PMID 31652648). All four STEC genomic targets demonstrated significant correlation across sewersheds. STEC WBS may represent a novel tool to understand and monitor population-level activity and prevent disease.

Disclosures

All Authors: No reported disclosures
P-124. Ongoing Infections with Extensively Drug-Resistant Campylobacter jejuni Linked to Pet Store Puppies
Authors: Francois Watkins Louise , Stapleton G Sean , Joseph Lavin , Bennett Christy , Vahey Grace , Benedict Katharine , Cooley Laura A
Published: January 2025

Background

Campylobacter is the leading cause of enteric bacterial infections in the United States, causing an estimated 1.5 million illnesses annually. Antimicrobial therapy can reduce the duration of illness and limit complications; macrolides and fluoroquinolones are typically recommended as first- and second-line treatment, respectively. The Centers for Disease Control and Prevention (CDC) investigates emerging resistance in Campylobacter strains to identify potential sources and collaborate on approaches to reduce its spread. Here, we describe extensively drug-resistant (XDR) strains linked to pet store puppies.

Methods

State public health departments perform whole genome sequencing on Campylobacter isolates as resources allow and submit sequence data to CDC. CDC assesses isolate relatedness using core genome multilocus sequence typing (cgMLST) and screens isolate sequences for resistance determinants to predict antimicrobial resistance (older isolates sequenced retroactively are also screened). We considered isolates to be XDR if they showed predicted resistance to macrolides, fluoroquinolones, and ≥ 3 additional antibiotic classes. Persons with XDR isolates were interviewed about exposures when possible.

Results

We identified three strains of XDR C. jejuni; the oldest isolates were from 2007. Although these strains are not highly related phylogenetically ( > 200 allele differences between strains by cgMLST), cases share epidemiological and clinical characteristics. As of June 30, 2023, CDC received reports of 274 cases associated with these strains. Affected individuals had a median age of 36 years (interquartile range, 20–52); 66% were female, and 23% were hospitalized. Of those affected, 97% reported contact with a dog before becoming ill, among whom 78% reported contact with a puppy from a pet store.

Conclusion

Clinicians should be aware that strains of XDR Campylobacter are circulating in the United States and should consider XDR infection when patients fail to respond to routine treatment, particularly if they have recently had contact with pet store puppies. Carbapenem antibiotics may be used for severe infections that are resistant to recommended treatment agents.

Disclosures

All Authors: No reported disclosures
P-130. A Case-Control Study of Post-Infectious Sequelae Following a Shiga Toxin-Producing Escherichia coli (STEC) Outbreak at a U.S. Marine Corps Recruit Depot
Authors: Kautz Michelle , Larson Derek , Sanders Terrel , Hsieh Hsing-Chuan , McAnany Jennifer , Khodr Zeina G , Castaneda Sheila F , Maves Ryan C , Lalani Tahaniyat
Published: January 2025

Background

In November 2017, an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 and O26 occurred among male recruits at a United States Marine Corps Recruit Depot, San Diego, CA. We sought to evaluate the 6-year risk of hypertension (HTN), chronic kidney disease (CKD), and irritable bowel syndrome (IBS) following STEC infection by conducting a retrospective, case-control study utilizing medical record data.Table 1.Proportion of STEC cases and matched asymptomatic controls with post-infectious sequelae following November 2017 outbreak

Methods

Data from the outbreak investigation were used to identify cases and asymptomatic controls. Asymptomatic controls were recruits who were in the exposure area during the outbreak but remained asymptomatic and were negative for STEC by stool PCR. Cases were matched 1:4 with asymptomatic controls based on the duration of follow-up available in the Military Health System Data Repository (MDR). Controls could be matched to > 1 case. Post-infectious outcomes were assessed using ICD-10 diagnostic codes in the MDR.

Results

239 cases were identified of whom 192 (80%) developed bloody diarrhea, 30 (13%) were hospitalized, and 17 (7%) developed hemolytic uremic syndrome (HUS). The stx-2 gene was detected in 39% of PCR positive cases. The median age of recruits was 19 years, and the median duration of MDR follow-up for cases and controls was 3.7 years (IQR: 2.9-5.4). There was no significant difference in the proportion of cases and controls with post-infectious sequelae (Table 1). Resolution of renal dysfunction was noted within 3 months after discharge for all HUS cases, and only 1 case remained hypertensive following discharge. There was no significant difference in the proportion of bloody diarrhea and HUS cases that developed IBS compared to controls. A limitation of the analyses was the short duration of MDR follow-up available for 6/30 hospitalized cases due to military separation after hospital discharge.

Conclusion

STEC infection in this cohort of young military recruits was associated with a good prognosis, even among cases of STEC-associated HUS, with resolution of renal dysfunction and no increase in incidence of IBS or HTN compared with asymptomatic controls. The findings suggest that STEC infection in young adults who recover from acute illness is not associated with a higher likelihood of post-infectious sequelae.

Disclosures

Ryan C. Maves, MD, AiCuris: Grant/Research Support|Biotest: Grant/Research Support|GeoVax: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria|Sound Pharmaceuticals: Grant/Research Support
P-131. Study of Enteric Parasitic Infections to Delineate Low Grade Inflammation in Patients with Functional Dyspepsia
Authors: Pant Sanjana , Ranjan Mirdha Bijay , Makharia Govind , Das Prasenjit , Singh Jadon Ranveer
Published: January 2025

Background

Growing evidence of chronic low-grade intestinal inflammation in post-infectious functional gastrointestinal disorders (FGID), including functional dyspepsia (FD), have been observed. Present study aimed to investigate the role of enteric parasitic infestations along with Helicobacter pylori and associated inflammatory cellular components among FD patients.

Methods

Prospective observational study included 183 adult patients with symptoms of FD consistent with the ROME IV criteria. All these patients were subjected to clinical evaluation, routine blood tests, and stool sample analyses for parasitological examination. Upper gastrointestinal endoscopic biopsy samples were examined for the presence of H. pylori and to extrapolate cellular components of low-grade inflammation.

Results

Among the 183 individuals, (85/183) 46.4% and (98/183) 53.6% belonged to the subtype post-prandial distress syndrome (PPDS) and epigastric pain syndrome (EPS) respectively. 46/183 (25.14%) of the stool samples tested positive for parasites, most common being Blastocystis species. The distribution of Blastocytis cells were 14/85 (16.47%) for PPDS and 16 (16.32%) for EPS patients. Histopathological analysis revealed significantly elevated duodenal mast cells and their degranulation among 85.24% and 76.5% FD patients respectively whereas, duodenal eosinophilia, duodenal eosinophil degranulation, and duodenal intra-epithelial lymphocytosis were observed in 3.28%, 15.3%, 1.7% respectively. Patients of the EPS subtype with intestinal parasitosis had elevated duodenal mast cell count, albeit statistically non-significant (p value = 0.078). There was no significant correlation between intestinal parasitosis or H. pylori with any of the clinical parameters examined, other than intestinal parasitosis with anemia (PPDS, p-value < 0.02).

Conclusion

Presence of duodenal mast cells along with the presence of Blastocystis cells in some of the FD patients suggests their potential involvement in symptom generation, albeit lack of experimental studies. Our findings also give impetus to further understand the complex interplay between elevated duodenal mast cell count and mast cell degranulation with FD symptoms.

Disclosures

All Authors: No reported disclosures
P-138. Effect of diabetes mellitus on the disease entity and clinical parameters in culture positive melioidosis
Authors: Piyasiri Bhagya , Krishantha Jayasekera Pathirawasam , Marie Corea Enoka
Published: January 2025

Background

Melioidosis is a multi-system infection caused by Burkholderia pseudomallei, a bacterium living in soil which is transmitted to humans through inoculation, inhalation or ingestion. According to numerous studies, diabetes mellitus (DM) is the major risk factor, not only predisposing to melioidosis but also altering the immune response to the infection.

Objectives of this study were; to analyze the prevalence of DM among a local cohort of culture positive melioidosis patients and to assess the effect of DM on the disease entity and clinical parameters.

Methods

Anonymized data of 83 culture positive melioidosis patients from December 2014 to February 2024 were accessed to analyze disease entity, risk factors and laboratory investigations on admission. Fisher’s exact test was used to determine any statistical association between variables and a p value of less than 0.05 was taken as significant.

Results

Among 83 patients, 59 (71.1%) were diabetics. Age groups >60yrs females and < 20yrs males were 100% diabetics. Among 40-60yrs males had 88% prevalence of DM. There were patients with abscesses including deep seated ones (35, 42%), pneumonia (17, 21%), septic arthritis (7, 9%), pyelonephritis (6, 7%) and other disease entities (18, 22%) including rare ones like endocarditis (2, 2%). Mortality rate was 18/83 (22%) of which 13 (72%) were DM.

There was a significant association between abscesses/pus formation and the presence of DM (p=0.0016). Melioidosis antibody titer was tested in 64 (77%) and there was a highly significant association of high titers >1:160 with the presence of DM (p=0.0004). Associations of white cell count (WCC) >11000/µL, and ESR >100mm/1st hr. with DM were statistically significant (p=0.0219 and p=0.0305 respectively). Association of high platelet counts ( >400000/µL) with DM was not statistically significant (p=0.19750).

Conclusion

Diabetes was a significant comorbidity in culture positive Melioidosis. Meticulous investigation for pus formation in melioidosis among diabetics is recommended to ensure proper treatment including pus drainage. Presence of DM is in significant association with higher antibody titres, high ESR and high WCC which may indicate more chronic or extensive disease needing aggressive and prolonged treatment.

Disclosures

All Authors: No reported disclosures
P-166. Susceptibility to Measles among immigrants in South Korea
Authors: Lee Ran , Gwan Yoon Jang , Park A Ram , Hyun Bae So , Hwi Cho Jun , Kim Jin , Park Kyung-Hwa , Woo Choi Seong , Kyu Sun Bong , Hak Kim Kyung , Seog Kweon Sun , Eun Kim Seong
Published: January 2025

Background

Despite the World Health Organization's declaration of measles elimination in Korea in 2014, the country continues to encounter outbreaks, predominantly from cases imported via international travel. This study investigates the susceptibility to measles among immigrants residing in Korea, with an emphasis on their immunity status.

Methods

Conducted in Gwangju, Republic of Korea, this research measured measles immunoglobulin G (IgG) serum levels among immigrants from various nationalities.

Results

The study enrolled 415 participants, predominantly from Vietnam (18.8%), Uzbekistan (17.1%), Kazakhstan (10.4%), and the Russian Federation (10.1%). Overall, 82.2% exhibited seropositivity for measles IgG. Individuals under 30 years showed significantly lower seroprevalence at 61.8%, compared to 90.8% in those aged 30 and above. The lowest seroprevalences were noted in Cambodia (64.9%), the Russian Federation (69.8%), Ukraine and Mongolia (71.4% each), Nepal (75.0%), Kazakhstan (76.7%), and Uzbekistan (86.5%). The countries with the largest gaps from WHO/UNICEF published MCV2 coverage rates were Russian Federation and Mongolia (average MCV2 coverage rate 95.9% and 95.5% from 2000 to 2022, respectively). There were also significant disparities in measles immunity based on visa types, with work visa holders showing considerably lower immunity (75%) compared to those with residence visas (87.2%; Chi-square test, P=0.02).

Conclusion

The results highlight significant disparities in measles immunity among immigrants, particularly according to age, countries, and visas. The study underscores the critical need for targeted vaccination strategies and enhanced surveillance in Korea. Implementing tailored catch-up vaccination programs is essential to reduce the risk of measles outbreaks within this vulnerable population.

Disclosures

All Authors: No reported disclosures
P-173. An Exploration of the Reported Cases of Acanthamoeba Keratitis
Authors: Nagi Nazia , Farid Tahsin
Published: January 2025

Background

Acanthamoeba keratitis (AK) is a rare manifestation of infection caused by this ubiquitous protozoan parasite. Treatment is complicated by the absence of FDA approved treatments. Here we aim to review reported cases of AK to identify case characteristics and potential successful treatments.

WHO Region wise distribution of Acanthamoeba Keratitis

Methods

All cases of AK from 2012-2024 reported on PubMed (684) and Embase (816) were identified using relevant keywords, MeSH terms and Emtree terms. Rayyan.ai was used to screen cases using PRISMA protocol. Cases meeting inclusion criteria were uploaded to CureID. All AK cases in CURE ID (170) were then analyzed in aggregate.

Outcomes in Patients with Acanthamoeba keratitis

Results

Most cases occurred in the Americas (44.1%), followed by Europe (22.4%) and the least number of cases were contracted in the Eastern Mediterranean (5.3%) region (Figure 1). 76/170 cases of AK showed partial response to the treatment and 12/170 remained unchanged (Figure 2). Table 1 shows the most commonly used medications and their respective outcomes. Figure 4 represents the correlation between type of contact lens used and severity of disease presentation for the 90 cases where this information was available.

Most commonly used medications and their respective outcomes

Conclusion

Although majority of the patients responded to treatment, most did not fully recover, and 4 patients died. This underscores the significant morbidity caused by this disease. We noticed diagnostic delays due to misdiagnoses as fungal or viral eye infections. Improved diagnosis will be vital to improving outcomes. Outcomes appeared to be better with combination therapies that included Chlorhexidine, Propamidine and PHMB. This finding supports the inclusion of these drugs in a standardized regimen for treatment of AK. Conversely, Miltefosine produced mixed results and should be excluded. It also appears that severity of AK may be related to contact lens use and soft contact lenses may be associated with higher severity of AK. We speculate that higher incidences in the Americas and Europe may also be related to higher lens usage. Our aim is to further investigate these correlations through a full manuscript.

Lens use V/S No Lens use and severity in presenting symptoms

Disclosures

All Authors: No reported disclosures
P-180. Enhancing Mortality Surveillance: Insights from Excess Deaths Analysis during the COVID-19 Pandemic
Authors: Skocibusic Sinisa , Cilovic Lagarija Seila
Published: January 2025

Background

The global repercussions of the COVID-19 pandemic extend beyond reported fatalities, imprinting a lasting effect on global health. The COVID-19 pandemic has presented substantial issues, encompassing not only direct infections but also excess mortality. The death rates in the Federation of Bosnia and Herzegovina (FB&H) have been significantly affected by the pandemic, leading to a need for a thorough analysis of the elements that contribute to this phenomenon.

Mortality in Federation of Bosnia and Herzegovina age 15 - 44

Methods

The objective of this study was to quantitatively assess the rise in overall excess mortality rates in the FB&H region for the years 2020, 2021, and 2022. We employed data from the FB&H mortality record, along with population statistics and official COVID-19 death counts, to emphasize the often underestimated number of deaths. Our objective was to offer a thorough comprehension of the actual scale of the pandemic.

Mortality in Federation of Bosnia and Herzegovina age above 65

Results

During the initial three years of the pandemic, FB&H encountered three separate instances of heightened mortality from any cause, accounting for 18 % of the overall excess mortality during the period of 2020–2022. The biggest burden was recorded among adults aged 45–74, with 22.4% falling within the 45–64 age group, 22.1% within the 65–74 age group, and 19.4% within the 75–84 age group. Children under 15 years old did not exhibit any excess mortality.

Conclusion

COVID-19-related mortality in FB&H are significantly underreported, especially among younger persons. This statement highlights the pressing necessity to enhance civil registration and vital statistics, while pushing for the implementation of comprehensive surveillance systems for all causes of mortality. These measures are of utmost importance in improving the surveillance of forthcoming pandemics and effectively addressing other significant public health occurrences.

Disclosures

Sinisa Skocibusic, Medicopharmacia: Travel grant to ECCMIDs
P-181. Limited oxygen therapy capacity against COVID-19 and the public health response in Zambia 2021
Authors: Sivile Suilanji , Imamura Takeaki , Imamura Tadatsugu , Msanzya Zulu Paul , Zyambo Masuzyo , Ntambwe Papytcho , Spuka Ndaba , Chomba Julien , Enane Anita , Sikanga O T IP O , Hamalala Alphonsina , Innocent Hamuganyu , Chanda Christopher , Mulenga Lloyd
Published: January 2025

Background

The coronavirus disease 2019 (COVID-19) pandemic revealed the limited capacity of intensive oxygen therapy in Zambia, especially in provincial medical facilities.

Zambia COVID-19 treatment centers with newly installed HFNC and NPPV devices in 2021

Methods

The Ministry of Health (MoH) conducted a clinical chart review of COVID-19 cases admitted to 11 COVID-19 treatment centers across Zambia to evaluate oxygen therapy practices and clinical outcomes. Then, MoH launched a multidisciplinary capacity-building project targeting four national COVID-19 treatment centers in the provinces aiming to deploy high-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NPPV) coupled with training for healthcare workers. The chart review and the reporting of the project were approved by National Health Research Authority, Zambia (NHRA000006/15/10/2021, NHRA00003/25/04/2022), and Tohoku University, Japan (2021-1-983, 2022-1-287).

Results

Among 1,687 cases of severe/critical COVID-19, 84 cases (5%) were treated without oxygen, 687 (41%) were administered with oxygen only via nasal cannula, 759 (45%) via conventional masks, and 157 cases (9%) received intensive oxygen therapy, including HFNC, NPPV, and invasive mechanical ventilation. Compared to the capital Lusaka, COVID-19 cases treated in the provinces were more likely to receive oxygen administration only via nasal cannula and less likely to receive intensive oxygen therapy. To strengthen the intensive oxygen therapy capacity in the provinces, MoH installed HFNC and NPPV devices in four provincial medical facilities equipped with oxygen plants and piping in October and November 2021. MoH also provided a five-day training program for healthcare workers focusing on clinical knowledge/skills of HFNC and NPPV in COVID-19 and infection prevention and control in aerosol-generating procedures.

Conclusion

Our study identified the inequity of intensive oxygen therapy capacity between Lusaka and the provinces in Zambia and the need for further strengthening. A multidisciplinary approach coordinating national experts was practical in rapidly deploying HFNC and NPPV amid the COVID-19 pandemic.

Disclosures

All Authors: No reported disclosures
P-185. Seroprevalence and Clinical Spectrum of Toxocara Infections: A Retrospective Study from a Tertiary Care Center in Lebanon
Authors: El Ayoubi L’Emir Wassim , El Meski Nour , Hassani Samar , Bidikian Nayda , Bou Khalil Jad , Kanj Souha S
Published: January 2025

Background

Toxocara is a prevalent zoonotic disease worldwide. It exhibits a broad spectrum of clinical manifestations, ranging from asymptomatic cases to severe conditions like myelitis and, in rare instances, fatal outcomes such as aortic thrombosis. Despite its prevalence, studies focusing on the seroprevalence, clinical manifestations, and laboratory findings of Toxocara in the MENA region are limited, highlighting a significant gap in research.

Methods

This is a retrospective, single-center cohort study conducted at the American University of Beirut Medical Center. The charts of 227 patients who were tested for Toxocara via ELISA IgG, presenting either as inpatients or outpatients from January 2002 to September 2022, were examined.

Results

The majority of the patients were middle-aged, generally exhibiting few co-morbidities as evidenced by 75% (75/100) of the study population being classified as “mild” on the Charlson co-morbidity index and only 16% (16/100) being immunosuppressed. 95.3% (61/64) of the patients were residents of Lebanon, most of whom were living in either Beirut or Mount Lebanon (22/59 (37.3%) and 20/59 (33.9%), respectively). 78.5% (62/79) of the patients presented with symptoms, and 67.7% (42/62) primarily complained of neurologic symptoms, mostly tingling or weakness in the extremities (37/43 (86%)). Asymptomatic patients were typically investigated for incidental eosinophilia (15/17 (88.2%)). Except for a lower overall age (44 vs 55, p=0.005), no statistically significant variable was detected between symptomatic and asymptomatic patients in terms of demographic characteristics. Among patients with Toxocara myelitis, most of the MRIs examined revealed enhancing (7/8 (87.5%)) longitudinal lesions (6/10 (60%)), mainly involving the thoracic levels of the spine (4/10 (40%)).

Conclusion

According to our center's experience, most patient who presented were symptomatic, mainly complaining of neurologic symptoms, with those diagnosed with Toxocara myelitis mainly showing longitudinal enhancing lesions involving the thoracic levels. Further studies are crucial to ascertain the actual prevalence and clinical presentations of Toxocara in the region.

Disclosures

All Authors: No reported disclosures
P-186. Trends in Antimicrobial Resistance Among Adults Across 6 Hospitals in Argentina, Brazil, and Chile, 2018-2022
Authors: Siza Charlene R , Mahon Garrett W , Patel Twisha S , Garzon Maria I , Boszczowski Icaro , Munita José M , Lessa Fernanda C , Chiarastelli Salomao Matias , Marssola Giovanna , Tavares Bruno , Verónica Hernandez Daniela , Peters Anne S , Spencer Maria , McGovern Olivia L
Published: January 2025

Background

In 2019, an estimated 1.27 million deaths were attributed to bacterial antimicrobial resistance (AR) globally. During the Coronavirus Disease 2019 (COVID-19) Pandemic, additional strain was placed on healthcare systems that may have led to further increases in AR. We evaluated AR prevalence before and after the onset of COVID-19 in 6 healthcare facilities (HCF) in South America.

Methods

We conducted an ecological evaluation of HCF-wide AR prevalence in 4 private and 2 public HCFs in Argentina, Brazil, and Chile; 2 HCFs per country. We calculated percentage of non-susceptible (NS) or resistant (R) to select antibiotics among clinical isolates of Acinetobacter baumannii, Pseudomonas aeruginosa, Enterococcus spp., and Enterobacterales cultured from adult acute care inpatients. We compared percentage-NS or -R between the periods pre- (March 2018–February 2020) and post- (March 2020–February 2022) onset of the COVID-19 pandemic. Chi-square or Fisher’s exact tests were used with statistical significance set at a two-tailed p< 0.05.

Results

When comparing 2020-2022 to 2018-2020, 2/6 hospitals showed statistically significant increases (+14.1–19.2%) in carbapenem-NS A. baumannii. For carbapenem-NS P. aeruginosa, 1/6 hospitals showed a significant increase (+76.6%) and 1/6 showed a significant decrease (-52.4%). For carbapenem-NS Enterobacterales, 2/6 hospitals had significant increases (+50.7–236.2%) and 1 exhibited a significant decrease (-91.7%). For vancomycin-R Enterococcus spp., 2/6 hospitals had significant increases (+43.9–400.0%) and 2/6 hospitals had significant decreases (-49.0-60.7%). For Enterobacterales-R to 3rd generation cephalosporins, 2/6 hospitals showed significant increases (+16.0–110.9%) and 1/6 hospitals had a significant decrease (-40.4%) (Table).

Conclusion

Among the isolates from our study hospitals, we noted not only significant increases but also significant decreases across multiple AR profiles associated with multi-drug resistance. These data suggest that the pandemic may have led to changes in resistance among both gram-negative and gram-positive bacteria. Given the variability in these changes, further evaluation of infection rates would be valuable to confirm these findings.

Disclosures

José M Munita, MD, MSD: Grant/Research Support|Pfizer: Grant/Research Support
P-241. Epidemiology of ventilator-associated pneumonia among patients requiring extracorporeal membrane oxygenation (ECMO): a retrospective cohort study
Authors: Nowak Caden , Albin Owen
Published: January 2025

Background

Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality among critically ill patients requiring extracorporeal membrane oxygenation (ECMO), yet the epidemiology of VAP in this patient cohort remains uncertain, particularly following the COVID-19 pandemic. The aim of this study is to characterize the epidemiology and microbiologic causes of VAP in patients requiring ECMO at a tertiary care academic referral center following COVID-19 (2020-23). Here, we present preliminary study data for the year 2020.Figure 1.Histogram showing number of VAP episodes per patient among 14 ECMO patients who experienced VAP.

Methods

Retrospective cohort study of adult patients (age ≥ 18) hospitalized at Michigan Medicine University Hospital in calendar year 2020 who required use of ECMO (venoarterial or venovenous) during hospitalization. Patient demographic characteristics, medical comorbidities, and microbiologic data were abstracted from the electronic medical record via a structured query. VAP was defined as occurrence of a positive quantitative respiratory culture obtained via distal lung sampling.Figure 2.Pathogens isolated from 30 positive quantitative respiratory cultures obtained in 14 ECMO patients in 2020.

Results

102 adult patients required use of ECMO in 2020. The mean patient age was 50.3 (SD 14.3) years of age. 61 (59%) of patients were male. 64% of patients were Caucasian, and 21% were African-American. Relevant patient comorbidities included congestive heart failure (67%), liver disease (44%), chronic pulmonary disease (43%), and diabetes (36%). 14 (14%) of patients experienced VAP. Of these patients who experienced VAP, 8 (57%) experienced >1 episode of VAP (Figure 1), and 7 (50%) died prior to hospital discharge. Figure 2 illustrates the microbiologic causes of VAP in this patient cohort.

Conclusion

In a tertiary referral academic medical center, a minority of ECMO patients experienced the vast majority of VAP cases and suffered high rates of in-hospital mortality. Enterobacteriales and Staphylococcus aureus were responsible for the majority of VAP cases among patients requiring ECMO. Future work will extend these analyses through the year 2023 and capture antimicrobial use rates.

Disclosures

All Authors: No reported disclosures
P-253. Impact of Restroom Disinfecting/Cleaning Frequency and Product Selection on Risk of Infection
Authors: Gerba Charles P
Published: January 2025

Background

Restrooms are associated with transmission of bacterial and viral illnesses. Disinfecting pathogen-contaminated surfaces represents an intervention for reducing transmission risk. This study assessed whether cleaning/disinfecting frequency affects bacterial pathogen contamination in American patient rooms, long term care facilities and households with ≥ four occupants.

Methods

During the control phase, toilet surfaces (toilet bowl, water, and rim) were cleaned using a 9.5% w/w hydrochloric acid product only. During the intervention phase, multiple restroom surfaces (vanity/sink, toilet surfaces, floor, doorknob including toilet bowl) were cleaned/disinfected with disinfecting/cleaning products selected for the specific surfaces. Surface samples were collected and tested for heterotrophic and coliform bacteria after 1, 2, 3, or 7 days, with sampling being randomized during the week. The ratio of E. coli to norovirus in feces from an infected person was then used to perform a quantitative microbial risk assessment.

Results

The greatest numbers of bacteria were recovered on surfaces after three days. The largest reduction in bacterial recovery occurred during a three-day (∼twice-a-week) cleaning cycle, resulting in statistically significant reductions in recovery of heterotrophic bacteria (P = 0.00898) and Escherichia coli (P = 0.01).

Conclusion

Quantitative microbial risk assessments of commonly touched surfaces suggests that risk of infection by norovirus (highly contagious, excreted in high numbers, low human infectious dose) may be reduced by 91.5% using a three-day (twice-a-week) restroom cleaning/disinfection cycle.

Disclosures

Charles P. Gerba, PhD, Rickitt Benckiser: Grant/Research Support
P-254. The Effect of Disinfection with 222-nm Ultraviolet C on Surfaces Contaminated with Clostridioides difficile and Vancomycin-resistant Enterococci in the Bathrooms of Isolation Patients
Authors: Kitagawa Hiroki , Tadera Kayoko , Omori Keitaro , Nomura Toshihito , Shigemoto Norifumi , Ohge Hiroki
Published: January 2025

Background

Contaminated environmental surfaces are important sources of transmission for healthcare-associated pathogens, including Clostridioides difficile (CD) and vancomycin-resistant enterococci (VRE). Toilet surfaces are easily contaminated by pathogens excreted in stools. In this study, we investigated the efficacy of a 222-nm ultraviolet C (UVC) disinfection device, Care222®, for removing bacterial contamination in the bathrooms of isolated patients.

Methods

This study was conducted in the rooms of five patients diagnosed with C. difficile infection and in the rooms of five patients colonized with VRE. The Care222® device is mounted on a mobile cart and fixed at a 45-degree downward angle. The Care222® emission window was placed 1 m from the farthest end of the toilet seat and at a height of 1.1 m from the floor. At this position, UVC irradiation was performed for 45 min at a total 222-nm UVC fluence of 27 mJ/cm2. Before and after UVC irradiation, samples were collected from the toilet seat and control panel of the electric warm-water bidet toilet seat, in each room, and colony-forming units (CFUs) were determined.

Results

Disinfection with 222-nm UVC resulted in a significant decrease in the number of CD CFUs compared to the number of CFUs before disinfection (Median CFUs (range), 8 (0–51) vs. 1 (0-5), P=0.004). It also resulted in a significant decrease in the number of VRE CFUs compared to the number of CFUs before disinfection (Median CFUs (range), 7 (1–32) vs. 1 (0-3), P=0.001).

Conclusion

The disinfection with the 222-nm UVC device significantly reduced CD and VRE surface contamination in the bathrooms of isolated patients. Further studies are required to investigate the effectiveness of 222-nm UVC disinfection for reducing environmental pathogen contamination.

Disclosures

All Authors: No reported disclosures
P-288. High Prevalence of Carbapenem-Resistant Gram-Negative Bacteria Among ICU Patients in a Tertiary-Care Hospital
Authors: Protonotariou Efthymia , Meletis George , Tychala Areti , Sereni Zoe , Trikoupis Petros , Oikonomou Margarita , Amoiridou Pinelopi , Rizopoulos Rizos , Tampakas Lampros , Pantelidou Parthenopi , Efthymiou Aikaterini , Argiriadou Elena , Mantzana Paraskevi , Skoura Lemonia
Published: January 2025

Background

Infections by carbapenem-resistant organisms (CROs) are causing worldwide concern. Some Gram-negative CROs may act as colonizers of the intestinal flora. Starting from colonization, they may develop serious infections to their host under favorable circumstances. In the present study, the data of patients hospitalized in the Intensive Care Unit (ICU) of AHEPA University Hospital regarding their surveillance rectal detection for carbapenem-resistant Enterobacterales, Pseudomonas aeruginosa and Acinetobacter baumannii was reviewed.

Methods

From October 2022 to December 2023, 578 individual patients’ surveillance rectal specimens were evaluated using the chromogenic BrillianceTMCRE Agar (Oxoid, UK). Moreover, among recovered Enterobacterales and P. aeruginosa isolates, carbapenemase production was investigated using the NG-Test CARBA 5 multiplex immunoassay (NG-Biotech, France).

Results

Among the 578 patients evaluated, 178 (30.8%) were colonized with at least one and 68 (38%) with more than one carbapenem-resistant microorganism (Table 1). In total, 303 CROs were identified. Klebsiella pneumoniae was present in most samples (n=134); 119/ 134 were found carbapenemase-producers with KPC being the most frequent (n=46) enzyme identified. A. baumannii (n=110) followed in order of pathogen detection. 57 carbapenem-resistant P. aeruginosa isolates were also recovered and 45 of them were found positive for metallo-β-lactamase production (VIM or NDM) (Figure 1). 115 (64.6%) of the colonized patients were male and 63 (35.4%) were female. Mortality rate for men was 60.87% with an average age of 62 years, while for women it was 72.58% with an average age of 67 years (Figure 2).

Conclusion

Our study highlights the high prevalence of carbapenem-resistant bacteria in ICU patients in our hospital, with a significant proportion of patients being colonized with these organisms. Additionally, the identification of the most common carbapenemase-producing pathogens as well as the high mortality rates among colonized patients provides valuable information for guiding treatment strategies and improving patient outcomes.

Disclosures

All Authors: No reported disclosures
P-292. Epidemiology of Escherichia coli from Urine Sources at Three U.S. Sites, August 2023
Authors: Brandenburg Joshua M , Grass Julian E , Che Looi Hsioa , Tellerman Julia , Dietz Jenna , Rebolledo Paulina , Smith Gillian , Jacob Jesse T , Parker Erin , Longson Rebecca , Guh Alice , Grome Heather N
Published: January 2025

Background

Escherichia coli is the most frequent cause of urinary tract infections (UTIs) in the US, but surveillance for urinary E. coli (uEC) is often limited to multidrug-resistant strains. The CDC’s Emerging Infections Program piloted one month of active population- and laboratory-based surveillance for uEC of any phenotype in 3 U.S. sites (representing >3.4 million people) to better characterize its epidemiology and burden.

Methods

We defined an incident uEC case as the first E. coli isolated from urine in a resident of the surveillance area during August 2023. Demographic data were obtained for all incident cases. Approximately 400 cases per site were randomly selected for chart review. One-month incidence rates were generated using 2022 US census data for participating surveillance areas. Cases were classified as community-associated (CA; no healthcare risk factors); hospital-onset (HO; urine obtained ≥ 3 days after hospital admission), or healthcare-associated, community onset (HACO; urine obtained in a non-hospital setting or < 3 days after hospital admission with healthcare exposures in the prior year).

Results

Of 5241 uEC patients, 86.1% were female; median age was 60 years (IQR 37–76). The 1-month incidence rate was 151.7 per 100,000 population and greater among those aged ≥ 60 vs < 60 years (362.7 vs 94.0).

Of 1197 patients with data from chart review, 1104 (92.2%) had cultures collected as an outpatient; 732 (61.2%) had an underlying comorbidity reported; 1113 (93.0%) had a documented UTI diagnosis; 269 (22.5%) reported recurrent UTI; and 43 (3.6%) developed E. coli bacteremia. No signs or symptoms associated with uEC were reported for 372 (31.1%) patients. In total, 287 (24%) were hospitalized within 30 days after urine culture collection; 51/287 (17.8%) had a urinary catheter in place 2 days before culture collection. Most uEC were CA (867; 72.4%), followed by HACO (325; 27.2%) and HO (3; 0.3%).

Of 3289 uEC isolates with local testing results, 255 (7.8%) were extended-spectrum β-lactamase producing and 5 (< 1%) were carbapenem-resistant.

Conclusion

These findings emphasize the high burden of uEC in these communities, notably among older adults and females. Effective prevention strategies are needed to decrease uEC-associated morbidity.

Disclosures

All Authors: No reported disclosures
P-296. Risk Factors and Treatment Outcome of Multidrug-Resistant Acinetobacter baumanii Pneumonia with or without COVID-19 Infection in an Infectious Diseases Hospital from January 2020 to December 2022: A Retrospective Cohort Study
Authors: Yanes Ryan R , Edrada Edna M , Solante Rontgene
Published: January 2025

Background

Acinetobacter baumanii has become one of the most virulent pathogens for most hospitalized patients worldwide. Compared to the United States, Asia has a higher incidence and percentage of multidrug resistance (MDR). With the emergence of COVID-19 infection, patient's risk factors and outcomes are important to understand the correlation of the two disease entities.

Methods

Single-center, retrospective cohort study that utilized records to determine the risk factors and clinical outcome of adult patients with Multidrug-resistant Acinetobacter baumanii pneumonia admitted at San Lazaro Hospital for a 3 year period. Cox regression analysis was employed to determine predictors for mortality.

Results

A total of 70 patients were included and 9 (12.8%) of which were seen to have COVID-19. With regards to Acinetobacter baumanii resistance; 51.4% had Multidrug-resistance, 21.4% had Pandrug-resistance, and 27.1% had Extensively drug-resistance. In terms of treatment, most patients had Meropenem (31.4%) or Meropenem + other antibiotics (27.4%). The mean length of hospitalization did not differ significantly between non-COVID-19 (21.4 days) and COVID-19 patients (18.4 days) (p=0.711). Also, mortality rates did not differ significantly between non-COVID-19 (60.7%) and COVID-19 patients (55.6%) (p=0.771). Having Endotracheal tube was seen to be a significant predictor for mortality among patients with Multidrug-resistant Acinetobacter baumanii pneumonia (HR=5.0, 95%CI=1.4 to 16.4, p< 0.0001). On the other hand, Meropenem use was significantly associated with improved survival whether in single (HR=0.3, 95%CI=0.08 to 0.8, p=0.025), or in combination (HR=0.2, 95%CI=0.07 to 0.8, p=0.026).

Conclusion

Among patients with Multidrug-resistant Acinetobacter baumanii pneumonia, length of hospital stays, and mortality rates did not differ significantly between those with and without COVID-19. Being on an Endotracheal tube increases the risk of mortality compared to those without invasive procedures. Meropenem with or without combination was seen to be effective in reducing the risk of mortality in this study.

Disclosures

All Authors: No reported disclosures