bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-155. Challenges with Artemether and Lumefantrine in the Management of Uncomplicated Malaria Infection
Authors: Olcott Flora 
Published: January 2025

Abstract

Background
Annually there are approximately 1,500 cases of imported malaria in the UK, with the majority being falciparum infection in African diaspora visiting friends and relatives (VFR). The management of uncomplicated falciparum infection usually entails a treatment course of artemether and lumefantrine. However, this medication can pose challenges to prescribers and patients alike due to the dosing schedule and administration requirements.
We assessed the management of uncomplicated falciparum malarial infection in the emergency department and designed a tailored treatment package for patients being managed in an outpatient setting in order to improve medication compliance and clinical outcome for this cohort.
Compliance Aid for Artemether/Lumafantrine - Patient Information Leaflet
Customised patient information leaflet to be completed by prescriber and given to patient to improve medication adherence

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

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

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

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

Abstract

Background
The prevention of mother-to-child transmission (PMTCT) of human T-cell lymphotropic virus type 1 (HTLV-1) is a top priority for HTLV-endemic countries due to its chronicity, lack of treatment and association with the aggressive adult T cell leukemia/lymphoma in comparison to other routes of infection. As of 2024, Japan, Brazil and Chile are few of the countries with national policies regarding antenatal screening. Peru, also an endemic country with around 150,000 to 450,000 HTLV-1 carriers, has limited data in pregnant women and does not have any PMTCT policy in place. By contrast, HTLV-1/2 antibody screening of blood donations has been endorsed since 1997 and national data are available. We aim to leverage these data to estimate the prevalence of HTLV-1 in pregnant women as a first step towards development and implementation of a PMTCT policy in Peru.
Figure 1
Estimation of number of HTLV-1 infected pregnant women and HTLV-1 seroprevalence in pregnant women in Peru (2017)

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

Results
A total of 359,458 blood units were screened and 2,809 were reactive for HTLV-1/2 (0.78%) (Figure 2). We estimated between 68,456 to 72,978 HTLV-1 carriers who were WRA, of whom 2,463 to 2,773 were pregnant (Figure 3). This is comparable to rates in Japan and Brazil. Our estimated HTLV-1 seroprevalence in pregnant women was 0.61% for the entire country.
Number and percentage of HTLV-1/2 reactive blood units in 2017 by departments of Peru

Conclusion
Our findings could help guide future strategies for PMTCT, such as universal antenatal screening and assessing the feasibility of formula supplementation for infants born to HTLV-1 positive mothers. Our limitations included the use of one-year data, HTLV-1/2 false-positives in blood donors and not using inverse probability weighting.
Estimated number and percentage of HTLV-1 infected pregnant women in 2017 by Departments of Peru

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

Abstract

Background
Due to specific growing conditions, Coccidioidomycosis is a fungal disease typically found in northern Mexico, near California or Arizona. However, due to climate change, there has been an increase in cases in non-endemic areas. In this study, we describe areas where cases of Coccidioidomycosis have been reported, which were previously not known to have this disease.
Image of a map of Mexico that highlights both high-risk and low-risk areas.
Dots represent origin and migration. Blue circles represent areas where patients lived while yellow represents areas where people migrated. The reason for migration was not studied. Pink circles represent those without travelling.

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

Results
Confirmed CLABSI cases with no intervention indicated were 35.5% of cases reviewed; 38.1% were determined to meet CLABSI exclusion criteria. Evidence of 2° BSI was identified in 26.5% of cases, which prompted queries to the care team to consider additional imaging, cultures, or documentation needed to clarify the clinical assessment. Feedback related to possible B/C contamination was given in 17.5% of cases. (Fig. 1-3)
CLABSI Standardized Infection Ratio (SIR)
Standardized infection ratio (SIR) trend: Tactic was adopted in May 2023

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

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

Abstract

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

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

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

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

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

Abstract

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

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

Results
Analysis of UC requests from 2020 to 2023 revealed several notable findings: 37% of the urine samples were approved for culture, 44% of those yielded positive results, and 56% showed either mixed flora or no bacterial growth. All UC samples that met criteria had white blood cell counts between 25 and 50 /HPF, with 91% displaying over 50 /HPF. Notably, none of the excluded samples resulted in patients developing urinary complications.
Amongst the suppressed UC, 9% yielded positive culture results consistent with asymptomatic bacteriuria. We noticed CAUTI reductions from 31/year in 2018 to 8/year in 2023. Our intervention helped avoid unnecessary antibiotics use, decreasing the number of hospitals acquired Clostrioides difficile infections from 31 cases in 2018 to 9 cases in 2023.

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

Disclosures
All Authors: No reported disclosures