bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1570. D-mannose for Prevention of Recurrent Urinary Tract Infection in Adult Women: An Updated Systematic Review and Meta-analysis
Authors: Krishna Mrinal Murali , Joseph Meghna , Ezenna Chidubem , Sreemathy Lal Sadasivan 
Published: January 2025

Abstract

Background
Urinary tract infections (UTIs) are prevalent, especially among women as approximately 50% of all healthy women will encounter at least one episode of UTI during their lifetime. An estimated 25%-35% of them will experience a recurrence within the following year. Prolonged antibiotic therapy for prophylaxis of UTI poses the risk of antimicrobial resistance, alteration of normal flora, and high costs to the patient. D-mannose, a polysaccharide may reduce UTI by preventing the adherence of bacteria to uroepithelium by binding to the type1 pili and saturating the adhesin FimH. D-mannose is commonly marketed for urinary tract health and is touted to contribute to better antimicrobial management within primary care settings. We performed an updated meta-analysis comparing prophylaxis with D-mannose versus placebo or no treatment for prevention of recurrent UTI in adult women.

Methods
We systematically searched PubMed, Scopus, and Cochrane Central databases for trials comparing D-mannose versus placebo or no treatment for UTI prophylaxis in adult women. Outcomes of interest included one or more episodes of UTI within 6 months of randomization and adverse events. Statistical analysis was performed using R software. Heterogeneity was assessed using I2 statistics. The analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline (Figure 1).
Risk estimation for recurrent UTI

Results
The systematic review identified three randomized controlled trials including 846 participants. Prophylaxis with D-mannose was given to 428 (50.59%) participants. The risk of recurrent UTI within 6 months of randomization (RR 0.75; 95%CI 0.46-1.23; p=0.259; I2=52%) showed no significant difference between the groups (Figure 2). Adverse events (RR 0.81; 95%CI 0.09-6.91; p=0.847; I2=94%) were also similar between the groups (Figure 3).
Risk estimation for adverse events

Conclusion
In contrast to a previous meta-analysis, our study found that prophylaxis with D-mannose did not reduce the risk of recurrent UTIs in adult women. Adverse events were also comparable between the groups.

Disclosures
All Authors: No reported disclosures
P-1576. An Exploration of the Utility of Urinalysis Criteria in Predicting Urine Culture Positivity
Authors: Patel Shivum , Njeri Wainaina J 
Published: January 2025

Abstract

Background
Urinalysis (UA) testing with reflex to culture is commonly ordered and is considered a tool for both diagnostic and antibiotic stewardship. Criteria for culture delineate normal from abnormal values leading to use for diagnosis of urinary tract infections (UTI). However, urinalysis criteria which predict urine culture growth that correlate with UTI are not well elucidated. The objective of this study is to evaluate the utility of several different indicators in urinalysis as reflex criteria to urine culture.
The area under the curves are: 0.618 for WBCs, 0.607 for nitrites, 0.570 for LE by semi-quantitative testing, and 0.479 for LE by numeric testing.

Methods
Retrospective review of 14,212 unique de-identified samples of paired urinalysis and urine culture collected in the Froedtert Health System in Milwaukee, Wisconsin from 9/22/22 to 8/23/23. All urine specimens were included regardless of collection method. Cultures were deemed to be positive if growing at least 100,000 colony-forming units (CFU) of a likely urinary pathogen and were evaluated for white blood cells (WBC), leukocyte esterase (LE), and nitrite positivity in the corresponding urinalysis.

Results
For each criterion, sensitivity and negative predictive values (NPV) were calculated at varying thresholds. A threshold of 5 WBCs provided the greatest NPV at 88.60%, and the greatest sensitivity at 89.76%. Next, receiver operating characteristic (ROC) curves were generated and the area under the curves were: 0.618 for WBCs, 0.607 for nitrites, 0.570 for LE by semi-quantitative testing, and 0.479 for LE by numeric testing.

Conclusion
Of the three urinalysis criteria, WBC had the best sensitivity and NPV but the ROC curves suggest that none of the tests predict significant urine culture growth well, emphasizing the importance of clinical context in both determining when to test and how to interpret. As diagnosis of a UTI does not simply rest on certain CFU growth or uropathogen on urine culture, but requires incorporation of history and physical findings, the next stage will be to correlate urine testing results with symptoms.

Disclosures
All Authors: No reported disclosures
P-1591. Harnessing Artificial Intelligence for Rapid Interpretation of BCID2 Results: A Pre-Validation Study of a Generative Pre-trained Transformer (GPT)
Authors: Tassone Daniel , Ian Langford , Markley John D , Ye Julia , Hitchcock Matthew M 
Published: January 2025

Abstract

Background
Artificial intelligence (AI) has great potential to enhance patient care, but significant questions remain about implementation and safety. Antimicrobial stewardship programs (ASP) could leverage AI to assist with prospective audit and feedback (PAF) interventions such as interpretation of blood culture results and rapid optimization of antimicrobials. At our institution, PAF interventions are performed by the ASP as soon as possible when BioFire® Blood Culture Identification 2 Panel (BCID2) results are available. However, these interventions are time consuming and often delayed due to limited resources. To address this gap, we developed a Generative Pre-trained Transformer (GPT) tool to assist non-infectious disease (ID) providers with interpretation of BCID2 results. Herein, we aim to describe the process of training the GPT and report pilot study results of the tool’s accuracy compared with ASP recommendations.

Methods
Using OpenAI’s GPT-4.0, our GPT was trained to synthesize patient-specific treatment advice by analyzing BCID2 results and anonymized patient data. Training focused on applying local as well as national evidence-based recommendations for the management of bacteremia, and providing feedback to the GPT when errors were recognized. A scoring rubric was designed to compare GPT treatment recommendations to gold standard ASP recommendations for the management of bacteremia (Figure 1). An independent infectious disease expert reviewer applied the rubric to determine the accuracy of the GPTs recommendations.

Results
Five cases of bacteremia were retrospectively reviewed. The GPT recommendations were 67% concordant with best practices, compared to 93% for the ASP (Table 1).

Conclusion
In this pilot study, a GPT was trained to interpret and manage bacteremia and achieved 67% concordance with best practices. Although inferior to ASP recommendations, GPT is a promising AI tool that warrants further investigation to aid in ASP interventions. Our GPT has been retrained based on our findings, and a larger prospective validation study is underway.

Disclosures
Daniel Tassone, PharmD, BCIDP, Merck: Honoraria
P-1592. Diagnostic Stewardship Cutoffs for Urinalysis Results Prior to Performing a Urine Culture: Analysis of Data from a Healthcare System
Authors: Kupferwasser Deborah , Kang Amy Y , Chen Liz , Huse Holly K , Miller Loren G 
Published: January 2025

Abstract

Background
Urinary Tract Infections (UTIs) are commonly overdiagnosed. Some labs conduct urinalysis (UA) as a preliminary screening before proceeding to urine culture to reduce processing unnecessary samples. However, the optimal UA cutoffs for this diagnostic stewardship intervention are not well defined.
UA squamous epithelial cells were not graphed b/c the value crossed the diagonal at multiple points.

Methods
We performed a retrospective, cross-sectional analysis of urine studies performed from 2/1/21-1/31/23 at the Los Angeles County Department of Health Services (4 medical centers & 20 clinics). We examined patient encounters in which a UA was ordered synchronously with a urine culture. We excluded patients who were pregnant, undergoing a urologic procedure, &lt; 3 months of age, or neutropenic. We examined the diagnostic accuracy, receiver operating characteristic (ROC) curves, and area under the curve (AUC) for pre-screening urinalysis parameters prior to urine culture performance. From the macroscopic test, we examined leukocytes and nitrite. From the microscopic exam, we examined bacteria, white blood cells (WBC), and squamous epithelial cells. We investigated each test’s correlation with a uropathogen isolated from culture.
Sensitivity and specificity of urinalysis WBC cutpoints for identifying uropathogens

Results
We examined 81,907 paired urinalysis and urine cultures (17,842 inpatient and 64,065 outpatient). Among the urine cultures, organisms isolated included 24,683 (30%) uropathogens, 4,373 (5%) organisms sometimes considered uropathogens, 3,000 (4%) organisms rarely considered a uropathogen, 30,511 (37%) multiple organisms, and 293 (0.7%) a non-uropathogen of clinical significance; 19,047 (23%) cultures were negative. When predicting a urine culture positive for a uropathogen, the UA parameter with the best diagnostic accuracy was WBCs (AUC: 0.758), followed by leukocytes, bacteria, nitrite, and squamous epithelial cells. (AUC: 0.723, 0.707, 0.652, and &lt; 0.500, respectively) (Figure). The sensitivity and specificity of WBC cutoffs are outlined in the Table.

Conclusion
In a large dataset of paired urinalysis and urine cultures, WBC on microscopic urinalysis showed highest diagnostic accuracy at predicting isolation of a uropathogen on urine culture. Stewardship programs should consider this parameter as the screening test for urine culture performance.

Disclosures
Amy Y. Kang, Pharm.D., BCIDP, Paratek Pharmaceutical: Grant/Research Support Loren G. Miller, MD MPH, Armata: Grant/Research Support|Contrafect: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Paratek: Grant/Research Support
582. Feeling the Vibes: An Investigation Into Resident Physician Antibiotic Prescribing Practices
Authors: Dickson David , Jordan Jaime , Vijayan Tara 
Published: January 2025

Abstract

Background
Efforts to improve inpatient antibiotic prescribing are limited by a lack of insight into the heuristics and thought processes that influence the complicated decisions around antimicrobial use. We aimed to explore antimicrobial therapeutic decision making among resident physicians at a large academic health system.

Figure 1. Thematic map of resident trainee antibiotic decision making process

Methods
We performed a qualitative study with a constructivist paradigm employing semi-structured, in-person focus groups of Internal Medicine interns and residents at the UCLA Ronald Reagan and Santa Monica Medical Centers from December 2023 through January 2024. Sessions were recorded, auto-transcribed, and edited for accuracy. Two researchers independently performed a thematic analysis of three distinct focus group transcripts.

Results
25 residents participated in a total of three focus groups. Residents consistently identified a clear general approach to prescribing antibiotics, including triaging critical illness and identifying the following: the presence of infection; the source of infection; the antibiotic that covers the likely pathogens; and co-morbid conditions and risk factors. Two broad themes regarding initial acquisition of an approach to antibiotics emerged: institutional culture or “oral tradition,” and internal and external clinical resources. A major challenge in therapeutic decision-making centered around navigating uncertainty (Figure 1). Comments on the inconsistency of clinical reasoning and “vibes-based” prescribing were common. Residents identified certain safety net strategies to mitigate the anxieties associated with this uncertainty (Figure 1). Resident confidence improved over time via habit formation and trial and error, particularly when working independently as the Night Admitting Resident. ID physicians and pharmacists provided a model approach for therapeutic reasoning and supported residents to take risks they were otherwise reluctant to take (such as de-escalation).

Conclusion
Despite articulating a systematic approach to antimicrobial prescribing, resident therapeutic decision-making remains subject to many vulnerabilities, including emotional prescribing. A reliance on the ID consult as a safety net may account for increases in consult volume and requires further investigation.

Disclosures
All Authors: No reported disclosures
P-1604. Utilization of MRSA Nasal PCR to De-escalate Vancomycin Therapy in Inpatients with Suspected Pneumonia
Authors: Hedvat Jason , Patel Mudita , Ajit Anjali Anne , Rosen Elisabeth L , Perlman David C , Koshy Sanjana 
Published: January 2025

Abstract

Background
MRSA nasal screening has been proposed as a tool to facilitate de-escalation of vancomycin in patients with pneumonia. The objective of this study was to evaluate the impact of MRSA nasal PCR testing in patients with pneumonia in terms of length of anti-MRSA therapy and clinical outcomes.

Methods
This was a retrospective single center pilot study conducted at Mount Sinai Beth Israel during January 1, 2022 – March 31, 2022 (pre-availability of MRSA nasal PCR) and August 1, 2023 – October 31, 2023 (post-availability of MRSA nasal PCR). The primary outcome was the duration of vancomycin therapy in days in the pre-PCR compared to the post-PCR group. Secondary outcomes included the number of vancomycin levels drawn, 30- and 90- day mortality, hospital length of stay, and incidence of new acute kidney injury (AKI) during treatment. Comparisons were performed using Chi-squared or Fischer’s exact test for categorical variables and Student’s t test or the Mann-Whitney U test for continuous variables, as appropriate. P &lt; .05 was considered statistically significant.

Results
One-hundred and eighty-five patients were included, 91 in the pre-PCR group and 94 in the post-PCR group. The most common pneumonia indication was community acquired pneumonia (CAP) in 78% of patients. Among patients that received vancomycin therapy for CAP, only 30% (21/70) and 17.3% (13/75) had risk factors warranting anti-MRSA therapy in the pre-PCR and post-PCR groups respectively. The median duration of vancomycin therapy was significantly shorter in the post-PCR group than the pre-PCR group (0.9 days vs. 1.8 days; p &lt; .05). Fewer patients required 2 or more vancomycin levels drawn in the post-PCR versus the pre-PCR group (20.2% vs 41.8%; p &lt; .05). 30-day mortality was lower in the post-PCR group (12.8% vs 25.3%), but not significantly (p=0.08). No differences were found in other clinical outcomes including 90- day mortality, hospital length of stay, and incidence of new AKI during treatment.

Conclusion
MRSA nasal PCR testing resulted in shorter duration of vancomycin therapy and reduced drug level monitoring without compromising clinical outcomes in patients with suspected pneumonia. Additional education is needed to ensure appropriate utilization of empiric anti-MRSA therapy in CAP patients with risk factors.

Disclosures
All Authors: No reported disclosures
P-1606. Utilizing Diagnostic Stewardship to Help Increase the Yield and Clinical Value of Broad Range PCR Testing at a Tertiary Children’s Hospital
Authors: Fortna Sarah , Alali Muayad , Prabhudas-Strycker Kirsten , Mellencamp Kagan A , Boyd LaKeisha , Goings Michael , Khan Haseeba , Fahey Mackenzie , Samaro Matthew , Schneider Jack G 
Published: January 2025

Abstract

Background
Broad range PCR testing (BR-PCR) in various clinical samples has the ability to provide timely diagnoses that cannot always be made through conventional testing (CT), yet its diagnostic yield and clinical impact have been variable, especially by specimen type. As such, we developed an ID-physician led diagnostic stewardship approval protocol to help optimize test usage.

Methods
We conducted a single-center, retrospective pre/post study to assess the impact of an ID-led diagnostic stewardship approval protocol for BR-PCR testing. All clinical specimen types obtained for BR-PCR at Riley Hospital for Children were evaluated between 10/1/2019 to 4/30/2022 (pre-intervention) and 5/1/2022-12/31/2023 (post-intervention). Clinical relevancy of BR-PCR results was determined after review from two ID physician experts and compared between the two time periods, along with clinical impact and overall cost savings.

Results
A total of 931 BR-PCR tests were sent from 238 specimens collected from 175 patients in the pre-intervention period, while 208 BR-PCR tests were sent from 65 specimens collected from 65 patients in the post-intervention period. Clinical relevancy of results was determined to be 30.7% and 56.9% for pre-and post-intervention periods, respectively (p&lt; 0.001). 23.1% of post intervention results led to a change in clinical management, compared to 12.6% in the pre-intervention period (p=0.035). Bronchial lavage (BAL) was the most common specimen type with 52.9% of results being clinically relevant post-intervention, compared to 29.6% in the pre-intervention period; p=0.068). Results that led to a clinical change in management were also slightly higher but non-significant for BALs post-intervention (11.8% vs 9.9% pre intervention; p=0.816). Overall cost savings post-intervention was estimated to be $200,000.

Conclusion
Use of an ID-physician led diagnostic stewardship approval protocol led to an overall improvement in clinical utility for BR-PCR testing at our institution and was influenced by specimen type. Prospective, multi-center studies are needed to determine which specimen types, diagnoses, and potential diagnostic stewardship measures will help increase the yield and clinical value of BR-PCR testing.

Disclosures
Jack G. Schneider, MD, MiraVista Diagnostics: Advisor/Consultant
P-1624. Are Follow-Up Blood Cultures Necessary in Children with Gram-Negative Rod Bacteremia?
Authors: Doshi Shreya M , Jadhav Shamily , Rueda Altez Maria Susana , Ansusinha Emily , Hamdy Rana F , Hamdy Rana F 
Published: January 2025

Abstract

Background
The utility of follow-up blood cultures (FUBCs) in children with a gram-negative rod (GNR) bacteremia is unclear. A prior pediatric study showed that FUBC positivity rate was 21%. Many adult studies have demonstrated that a FUBC is not always necessary in the setting of a UTI. Primary objectives were to determine 1. the rate of positivity in follow up blood cultures in children with gram negative bacteremia 2. To understand the clinical risk factors associated with positivity in follow up blood cultures in children with gram-negative rod bacteremia.Figure 1Flowchart depicting chart analysis

Methods
A retrospective cohort study in patients &lt; 21 years of age at Children’s National Hospital that had a positive blood culture for gram negative rods from 01/2013 to 06/2023. FUBC was defined as a subsequent blood culture collected at least 24 hours after and &lt; 7 days from the time of collection of the initial positive blood culture. Structured chart review was performed to collect clinical features, source of bacteremia, time to positivity, and FUBC positivity and contamination rate . Univariate analysis of each risk factor with FUBC positivity and multi-variable logistic regression model for association of each risk factor with FUBC positivity will be performed. Figure 1 - Flowchart depicting chart analysis.Table 1.Demographics and Clinical Characteristics of patients

Results
In an analysis of 35 patients, rate of FUBC positivity was 23% (n=9), contamination rate in the FUBC was 11% (n=1). Clinical factors of and outcomes are depicted in Table 1 and 2. E.coli was the most common organism found in the initial blood culture depicted in Figure 2.Table 2.Blood culture data and outcomes

Conclusion
Preliminary results for this ongoing study demonstrate that FUBC positivity was 22% in children with gram negative bacteremia, which is higher than what has been reported in adult studies. More data and subset analysis required for immunocompromised patients and patients with a central line.Figure 2Microbiologic distribution by percentage for initial and follow-up blood culture

Disclosures
All Authors: No reported disclosures
P-1627. The Impact of Microbiology Diagnosis Process Optimization on Clinical Outcomes and Health Economics in Hospitalized Bloodstream Infection Patients in China
Authors: AI Genwei , ZHAO Lu , LI Zhi , GUO Kunshan , ZHANG Ying , JIA Erjuan , XIA Yijun 
Published: January 2025

Abstract

Background
Bloodstream infection (BSI) is one of the leading causes of morbidity and mortality worldwide. Early identification of bacteria is essential for antimicrobial stewardship and the key to improve outcomes. The aim of this study was to evaluate the impact of an optimized microbiology lab process on turnaround times, antibiotics use and economics in adult hospitalized BSI patients.Figure 1:Gram stain, ID and AST reporting times between pre- and post-optimization groups.

Methods
Since Oct-2021, the microbiology laboratory in Xuchang Central Hospital, Henan, China had implemented a series of improvements, including the utility of BacT/Alert Virtuo blood culture (BC) system, the new resin anaerobic/aerobic BC bottles, VITEK MS (bioMérieux), and an optimized sample reception process. Patients with positive BC results in ICU, general surgery, respiratory, hematology and emergency wards from Oct-2020 to Sep-2021 and Oct-2021 to Sep-2022 were grouped into the pre-optimization (pre-op) and the post-optimization (post-op) groups, respectively.Table 1:The impact of optimized microbiology lab process

Results
A total of 134 patients were included in the pre-op group, 79 patients were included in the post-op group. There were no differences in baseline characteristics. Compared to pre-op group, the Gram stain reporting time of post-op group decreased significantly (37.27 vs 45.88h, p=0.001). The use of VITEK MS allowed a faster ID report, which significantly reduced the ID reporting time (48.18 vs 70.14h, p&lt; 0.001) compared to pre-op group (Figure 1). These faster reports resulted in rapid targeted antibiotics use. The time from blood sample collection to targeted antibiotic therapy within 48h of each report (Gram stain, ID and AST) was much shorter in post-op group (Table 1). In post-op group, although the decreases of total antibiotics days and length of hospital stay didn’t show significance, the total antibiotics fee was significantly reduced (5902.80 vs 9791.85 RMB, p=0.022). Such fee saving possibly contributed in the saving of total hospitalization cost in post-op group (53816.67 vs 66991.58, P=0.243).

Conclusion
Optimization of the microbiology lab process resulted in significant decreases in reporting time and ensured faster targeted antibiotic therapy in hospitalized BSI patients. Such improvements might potentially bring positive impact on antimicrobial stewardship, clinical outcomes and health economics.

Disclosures
All Authors: No reported disclosures