bluuebunny/crossref_metadata_2025_split huggingface dataset:
618. The current state of laboratory mycology in Asia/Pacific: a survey from the EuropeanConfederation of Medical Mycology (ECMM) and International Society for Human andAnimal Mycology (ISHAM)
Authors: Salmanton-Garcia Jon , Wing-Yan Au , Hoenigl Martin , Chakrabarti Arunaloke , Cornely Oliver A 
Published: November 2023

Abstract

Background
Invasive fungal infections (IFI) in Asia/Pacific are a threat to patients with malignancies, uncontrolled diabetes mellitus or undiagnosed/untreated human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS). Adequate and early access to diagnostic tools and antifungals is essential for the IFI clinical management and patient survival.

Methods
The IFI diagnostic capacity survey was online accessible at www.clinicalsurveys.net/uc/IFI_management_capacity/. The survey aimed to collect the following dimensions: a) institution profile, b) perceptions on IFI in the respective institution, c) microscopy, d) culture and fungal identification capacity, e) serology, f) antigen detection, g) molecular tests availability, and h) therapeutic drug monitoring.

Results
As of June 2022, 235 centres from 40 countries/territories in Asia/Pacific answered the questionnaire. More than half of them were from six countries: India (25%), China (17%), Thailand (5%), Indonesia, Iran, and Japan (4%, each). Candida spp. (93%) and Aspergillus spp. (75%) were considered the most relevant pathogens. Most institutions had access to microscopy (98%) or culture-based approaches (97%). Furthermore, 79% of them had access to antigen detection, 66% to molecular assays, and 63% to antibody tests. Access to antifungals varied between countries/territories. At least one triazole was available in 93% of the reporting sites (voriconazole [89%] was the most common mould-active azole), whereas 80% had at least one amphotericin B formulation, and 72% at least one echinocandin.

Conclusion
Currently, based on the provided replies, the resources available for the IFI diagnosis and management vary in Asia/Pacific countries/territories. Economical or geographical factors may play a key role in the incidence and clinical handling of this disease burden. Regional cooperation may be a good strategy to overcome shortcomings.

Disclosures
Martin Hoenigl, n/a, Astellas: Grant/Research Support|Euroimmun: Grant/Research Support|F2G: Grant/Research Support|Gilead: Grant/Research Support|Immy: Grant/Research Support|MSD: Grant/Research Support|Mundipharma: Grant/Research Support|Pfizer: Grant/Research Support|Pulmocide: Grant/Research Support|Scynexis: Grant/Research Support Oliver A. Cornely, MD PhD, DZIF: Advisor/Consultant|DZIF: Board Member|DZIF: Grant/Research Support|DZIF: Honoraria|DZIF: Stocks/Bonds
635. Morbidity and Mortality Associated with Respiratory Syncytial Virus Infections Among the Adult Hospitalized Patients
Authors: Bhargava Ashish , Szpunar Susan M , Malik Ambreen , Sharma Mamta , Johnson Leonard B 
Published: November 2023

Abstract

Background
Respiratory syncytial virus (RSV), commonly a virus of the fall and winter months, can be particularly serious in children under one year of age and in older adults or people with other comorbidities. Because of the precautions taken during the COVID-19 pandemic, recent RSV infections have deviated from the usual seasonal trend. The purpose of this study was to assess the overall morbidity and mortality in patients with RSV.

Methods
We conducted a multicenter historical cohort study of adult patients hospitalized for laboratory-confirmed RSV-related diseases in Ascension hospitals in southeast Michigan between January 2017 and December 2021. Hospitalized patients were identified using ICD 10 codes for RSV-related diseases. Electronic medical records were reviewed. Data were analyzed using the chi squared test, Student’s t test, and the Mann-Whitney U test using SPSS v. 29.0.

Results
Of 360 patients, the mean (sd) age of the cohort was 69.9 + 14.7 years, 228 (63.5%) were female and 227 (63%) were white. The mean body mass index (BMI) was 30.6 + 9.7 kg/m2 and 56.1% were smokers. The most common comorbidities were hypertension (66.7%), chronic lung diseases (57.2%), obesity (33.6%), diabetes mellitus (31.1%) and congestive heart failure (26.1%). The mean Charlson weighted index of comorbidity was 2.2 ± 1.9. Cough (79.2%) and shortness of breath (72.8%) was most common symptoms. Admission chest x-rays were abnormal in 44.7% of cases. RSV upper and lower respiratory tract infections (RTI) were present in 58.4% and 41.6% of patients, respectively. Antibiotics were given in 56.9% of patients. Mechanical ventilation was required in 11% and intensive care in 14.2 % of patients. Other complications were acute kidney injury in 23.3%, encephalopathy in 11.4%, and liver injury in 3.6 %; 13 (3.6%) patients died and 21 (5.8%) were readmitted within 30 days to an Ascension hospital.

Conclusion
Our study finds elderly patients hospitalized with RSV had substantial comorbidities. While overall mortality was low, the hospital course and complications suggest a disease that was costly both in human and financial suffering. Our study supports a need for RSV preventable initiatives and immunizations for this susceptible adult population.

Disclosures
All Authors: No reported disclosures
660. Pediatric Rotavirus Hospitalization Rates in the Military Health System Before and During the COVID-19 Pandemic
Authors: Penfold Matthew , Prabhakar Sarah , Susi Apryl , Rajnik Michael , Nylund Cade M , Eberly Matthew 
Published: November 2023

Abstract

Background
Rotavirus, a vaccine preventable disease, causes significant morbidity and mortality in children &lt; 5 years of age. Globally, the COVID-19 pandemic reduced the rates of pediatric vaccinations, and the Military Health System (MHS) was no different (Figure 1). This gap in immunizations left many children vulnerable to preventable illnesses, including rotavirus. We hypothesized that the reduction in rotavirus vaccine administration during the pandemic would lead to an increase in rotavirus related hospitalizations within the MHS.

Methods
A repeated monthly cross-sectional study was performed using inpatient data from the MHS to observe differences in rotavirus rates and risk factors before and during the COVID-19 pandemic. Data from March 2018 to February 2020 was considered pre-pandemic, while the following two years (until February 2022), were divided into COVID Year 1 and Year 2. Children included in the study were between 0-59 months of age and those with rotavirus were identified using ICD-10 codes. Poisson regression calculated rate ratios of rotavirus, adjusting for several demographic variables and time period at diagnosis. Monthly counts and rates of rotavirus were also documented.

Results
Across the cohort of 1.14 million MHS beneficiaries, there were 3,503 unique cases of rotavirus infections in hospitalized children &lt; 5 years old (Table 1). During both Years 1 and 2 of COVID-19, there was a significant decrease in rotavirus related hospitalizations compared to the pre-pandemic period (Figure 2). Younger age was associated with increased risk. Patient sex, parent military rank, and region were not statistically significant (Table 2).

Conclusion
Despite the reduction in routine immunization administration to children in the MHS after the COVID-19 pandemic started, there was not an increase in rotavirus related hospitalizations. In the two years following the start of the pandemic, there was a statistically significant decrease in hospitalizations related to rotavirus in our cohort. Social distancing to include daycare closures, increased hygiene measures, and catch-up immunizations may explain this finding. Continued research into this topic will help determine if rotavirus related hospitalizations return to pre-pandemic levels.

Disclosures
All Authors: No reported disclosures
661. Mortality Rates and Resistance Profiles of Salmonella spp. Infections: Implications for Clinical Practice and Public Health Interventions
Authors: Rosso Fernando , Rebellon-Sanchez David E , Llanos-Torres Julio , Álvarez-Ortega Carolina , Hurtado-Bermudez Leidy J 
Published: November 2023

Abstract

Background
Salmonellosis is a frequent foodborne infection. There is not much information about the mortality and resistance profiles of Salmonella spp. infections in Latin America. The aim of the study was to determine overall mortality, related risk factors, and antibiotic resistance in patients with Salmonella infection attended at university hospital of Colombia between 2012 - 2021

Methods
Retrospective observational study. All patients with a microbiological confirmed diagnosis of Salmonella spp. were included. The sociodemographic, clinical and microbiological characteristics were described. Log binomial regression models were used to establish factors associated with mortality

Results
A total of 522 patients were included, 54.8% were females, the median age was 16 years (IQR= 1-50). Mortality occurs in 4.02% of the patients. The proportion of deaths was higher in patients with bacteremia (RR = 3.65, 95% CI 1.59 - 8.40) hematologic malignancy (RR = 2.39, 95% CI 0.90 - 6.29) and those who require treatment in the intensive care unit (ICU) (RR=7.92, 95% CI 3.14 -19.97). There was no significant difference in mortality among those younger than 15 years old than older (2.8% vs. 5.4%, p = 0.13). Factors associated with mortality were bacteremia (aPR = 3.41 CI95%, 1.08 - 10.76) and requirement of ICU (aPR = 8.13 CI95%, 1.82 - 37.76). An increase in resistance rates over the study period (trend chi2: p&lt; 0.05). Increment in resistance was observed against ciprofloxacin (from less than 1% to 60%) and ampicillin/sulbactam (from 10.9% to 50%) (Fig. 1). No association was found between salmonella susceptibility and mortality

Conclusion
Despite being a preventable and treatable disease, Salmonellosis still poses a public health concern. Our study highlights the persistence of mortality due to this condition and a significant increase in antibiotic resistance rates over the last decade. Vulnerable patient groups showed higher mortality rates

Disclosures
All Authors: No reported disclosures
671. Introduction of simultaneous Clostridioides difficile Antigen and Toxin A and B detection for diagnosis of C. difficile related diarrhea at Michael E. DeBakey VA Medical Center
Authors: Ashley Patrycja , Robins Alison , Morones Rosalba Gomez , Aguayo-Millan Claudia , Morales-Aseff Daniela , Rodriguez-Barradas Maria C 
Published: November 2023

Abstract

Background
Nucleic acid amplification test (NAAT) for diagnosis of Clostridioides difficile infection (CDI) is highly sensitive but is unable to distinguish colonization from infection. Antigen/toxin testing on the other hand may have lower sensitivity, especially early in infection with associated delay in diagnosis.

Methods
We conducted a retrospective study at Michael E. DeBakey VA Medical Center prior and post the introduction of simultaneous C.difficile GDH Antigen and Toxin A/B (GDH/Tox) detection.

Results
In the pre-intervention period 83 patients underwent NAAT, 16 patients had a positive test result (19.3%). In the post-intervention 120 patients were tested; 99 (82.5%) were negative for both GDH Antigen and toxin A/B (GDH-/tox-), 16 (13.3%) tested positive for the GDH Antigen but negative for Toxin A/B (GDH+/tox-) and 5 (4.2%) tested positive for both Antigen and Toxin (GDH+/tox+). Two patients (1.7%) who initially tested GDH+/tox- were subsequently retested due to persistent symptoms or evidence of colitis and were noted to have GDH+/tox+ result.
The rate of positivity of C.difficile testing in our institution decreased form 19.3% to 4.2% (p&lt; .001) post introduction of the GDH/toxin A/B detection. The treatment rate of patients who had the test performed decreased from 18.1% to 9.2% (p=.062).
30-day readmission rate for any reason in the group that tested positive for CDI in the pre-intervention group was 18.5% (3 patients), with 30-day all-cause mortality 6.25% (1 patient). In the GDH+/tox+ and GDH+/tox- groups in the post-intervention period, the 30-day readmission rate for any cause was 9.5% (2 patients), and 30-day all-cause mortality was 6.25% (1 patient).
CDI testing results before and after the intervention.

Conclusion
Distinguishing asymptomatic carriage or colonization from CDI remains an important goal. Implementing GDH Antigen and toxin A/B C.difficile testing can help reduce the risk of inappropriate treatment of colonization and possibly reduce the risk for development of antibacterial resistant C.difficile strains, however in our case it initially missed 2 cases of CDI that fortunately was not associated with negative outcome. With use of the GDH/tox test repeat testing and/or treatment might be considered on case-by-case basis depending on persistence of symptoms or high suspicion of infection.

Disclosures
All Authors: No reported disclosures
672. Impact of Multistep Testing Algorithm on Hospital Acquired Clostridioides difficile Infection Rates
Authors: Betancourth Adriana C , Gill Arshpal , Bangash Salman , Abalos Charmaine , Bhanot Nitin , Min Zaw , Moffa Matthew A , Shively Nathan R , Walsh Thomas L 
Published: November 2023

Abstract

Background
Clostridioides difficile infection (CDI) is one of the leading causes of hospital-acquired (HA) infections. Clinically distinguishing true CDI versus colonization is challenging. Our center previously used a polymerase chain reaction (PCR) assay as a standalone test for diagnosing CDI. While PCR is very sensitive for diagnosing CDI, it cannot distinguish between CDI and asymptomatic colonization. A multistep testing algorithm, which consists of an initial C. difficile PCR test followed by a reflex enzyme immunoassay (EIA) for glutamate dehydrogenase (GDH) and Toxin A/B testing, was implemented in our institution. We conducted this study to determine the rates of HA-CDI and C. difficile colonization based on laboratory results.

Methods
This retrospective observational study was conducted at Allegheny General Hospital (Pittsburgh, PA, US). Patients with a positive C. difficile PCR assay at day 3 or later from admission date were included for analysis. The pre-intervention period was from August 2021 to February 2022 and post-intervention period was from August 2022 to February 2023. Before the intervention, results for C. difficile testing were reported as PCR positive (PCR+) or negative (PCR-). On July 2022, a multistep testing algorithm was implemented with an initial C. difficile PCR assay; if results were positive, a reflex EIA for GDH and Toxin A/B testing was performed and resulted as follows: Figure 1.
The HA-CDI rates before and after implementation of a multistep testing algorithm were compared.

Results
A total of 112 unique patients were included. HA-CDI in the post intervention period decreased by 53% after the intervention (N=57 [pre-intervention] versus N=26 [post-intervention]; P &lt; 0.001). During the post-intervention period, there were 55 PCR+ C. difficile assays, of which 29 (53%) were resulted as "indeterminate, likely C. difficile colonization." Of the 29 indeterminate results, 23 (79%) still received CDI therapy.

Conclusion
Our study demonstrated that a multistep C. difficile testing algorithm significantly reduced the rates of HA-CDI in our institution. We found that the majority of patients still received CDI therapy despite having a negative EIA toxin result. We plan to analyze the clinical impact of this multistep testing algorithm in a follow-up study.

Disclosures
Thomas L. Walsh, MD, Accelerate Diagnostics: Advisor/Consultant
673. Sniffing Out Adherence: Evaluation of a Clostridioides difficile guideline at a Tertiary Academic Medical Center
Authors: Mei Tiffany , Campion Maureen , Vazquez Gabriela Andujar , Foong Kap Sum , Doron Shira 
Published: November 2023

Abstract

Background
Tufts Medical Center’s (TMC) Antimicrobial Stewardship Team (AMT) in collaboration with gastroenterology (GI) developed an institutional treatment algorithm to guide appropriate inpatient management of Clostridioides difficile infection (CDI). The CD treatment algorithm was revised in April 2022 to reflect updated national clinical practice guidelines and disseminated to TMC providers. Our study aimed to assess provider compliance to TMC’s CD treatment algorithm.

Methods
A retrospective study of adult patients hospitalized from April 15, 2022 to October 31, 2022 and tested for CD was conducted. We collected patient demographics, white blood cell count, serum creatinine (SC), length of stay, CD treatment, Infectious Diseases (ID) & GI consult, occurence of severe CDI (defined as white blood cell &gt; 15 K/uL or SC &gt; 1.5 mg/dL), occurrence of recurrent CDI, and immunocompromised status (defined by having had organ or bone marrow transplant, receiving immunomodulatory therapy or chronic steroids). A 2-step Clostridioides difficile (CD) testing algorithm was used. For CD toxin A/B & glutamate dehydrogenase antigen (GDH) indeterminate results, reflex to nucleic amplification test (NAAT) was performed only with AMT approval.

Results
A total of 111 inpatients had CD toxin/GDH stool testing; 70 (63%) positive and 41 (37%) indeterminate. Of patients who had an indeterminate CD toxin/GDH, none had subsequent CD NAAT testing, and none receive CDI treatment. Of the others, 81 (73%), 23 (21%), and 7 (6%) were diagnosed with non-severe, severe, and fulminant CDI, respectively. The overall adherence to the institutional CD treatment algorithm was 58% (figure 1). More patients were appropriately treated with oral vancomycin (11, 65%) compared to those who were appropriately treated with fidaxomicin (9, 24%). Guidance adherence was (3) 38% among patients who had one or more recurrent episodes of CD, and none received suggested ID or GI consultation for additional CDI treatment consideration.

Conclusion
Adherence to institutional CD treatment algorithm was low. This study highlights opportunities to improve prescription of first line CDI therapy, especially among patients who are at higher risk for recurrence.

Disclosures
Maureen Campion, PharmD, BCIDP, Shinoigi: Speaker
674. Host and Pathogen Risk Factors for Fulminant Clostridioides difficile Infection
Authors: Chua Hubert C , Eubank Taryn A , Jo Jinhee , Garey Kevin W , Gonzales-Luna Anne J 
Published: November 2023

Abstract

Background
Fulminant Clostridioides difficile infection (FCDI) is associated with high rates of mortality and morbidity; however, risk factors for FCDI are poorly understood. The objective of this study was to identify clinical and microbiological factors predictive of FCDI.

Methods
This was a multicenter cohort study involving adult hospitalized patients diagnosed with an incident case of CDI (2015-22). Leftover stool samples were collected for ribotyping and determination of binary toxin presence (CDT; assumed presence in ribotypes 019, 027, 075, and 078-126). Disease severity was defined according to IDSA-SHEA CDI severity classification utilizing laboratory values obtained within 24 hrs of a positive CDI diagnostic test. FCDI was defined as CDI with hypotension (systolic blood pressure ≤ 90 mmHg), shock, ileus, or megacolon. Risk factors predictive of FCDI were assessed through multivariable logistic analysis.

Results
Overall, 440 patients aged 62±18.2 years were identified (58.9% female). In univariate analysis, hypoalbuminemia (odds ratio [OR], 4.94; 95% confidence interval [CI], 2.94-8.31) and infection with a CDT-producing strain (OR, 1.99; 95% CI, 1.16-3.42) were associated with FCDI, and presence of both variables was associated with the highest odds of FCDI (OR, 5.73; 95% CI, 2.19-14.9). Using backwards stepwise logistic regression, CDI due to a CDT-producing strain and concomitant hypoalbuminemia was an independent predictor of FCDI (OR, 5.21; 95% CI, 1.97-13.8) after controlling for Charlson Comorbidity Index score &gt;5 (OR, 1.85; 95% CI 0.99-3.48) and admission from a healthcare facility (OR, 1.73; 95% CI 1.02-2.95).

Conclusion
Both clinical and microbiological factors were associated with increased odds of FCDI. Early identification of patients at high-risk for FCDI allows for more timely interventions to help mitigate the risk of disease progression. Future studies incorporating host microbiome features and novel biomarkers into CDI severity predictive models are needed.

Disclosures
Kevin W. Garey, MS;PharmD, Paratek Pharmaceuticals: Grant/Research Support Anne J. Gonzales-Luna, PharmD, BCIDP, Cidara Therapeutics: Grant/Research Support|Ferring Pharmaceuticals: Personal Fees|Paratek Pharmaceuticals: Grant/Research Support|Seres Therapeutics: Grant/Research Support
697. Characteristics of Hospitalized Patients Colonized with Clostridioides difficile at an Academic Medical Center
Authors: Percival Kelly M , Kinn Patrick M , Ford Bradley A , Brust Karen , Ince Dilek 
Published: November 2023

Abstract

Background
Clinical spectrum of C. difficile can range from colonization to fulminant colitis. Patients with toxin antigen negative, C. difficile nucleic acid amplification (NAAT)-positive diarrhea are frequently only colonized and do not suffer consequences of C. difficile associated disease (CDAD) but receive treatment for CDAD due to the perceived low risk of oral vancomycin vs. the risk of developing CDAD.

Methods
We performed a retrospective cohort study of hospitalized adult patients with positive C. difficile NAAT and negative toxin antigen results at University of Iowa Health Care between 9/1/2021 and 9/30/2022. Chart review was conducted to obtain patient age, immunocompromised state, involvement of infectious disease (ID) consultant, prior C. difficile test status and treatment course.

Results
Of the 295 NAAT-positive C. difficile results, 210 (71%) were toxin antigen negative. Patient characteristics and frequency of common risk factors are shown in Table 1. C. difficile colonization was detected ≥4 days after admission in 111 (53%), with internal medicine and stem cell transplant (SCT)/hematologic malignancies (HM) services having the most patients with colonization (31% and 18%, respectively). Antibiotic use in the prior 30 days was reported in 154 (73%). Of 134 (64%) patients on systemic antibiotics at time of C. difficile testing, antibiotics were discontinued in 29 (22%). Only 43 patients (20%) did not receive any treatment for C. difficile. Median treatment duration was 10 days with 133 (80%) being treated for 10-14 days (Table 2). ID consult was obtained in 48 (23%) and recommended no treatment initially in 11 (23%), 4 of whom were started on treatment in subsequent days. Oral twice a day vancomycin for prophylaxis was given to 28 (13%) patients, 19 (68%) of whom were immunocompromised (16 SCT/HM and 3 solid organ transplant).

Conclusion
Patients with C. difficile colonization have similar risk factors as patients with CDAD. Understanding treatment patterns for C. difficile colonization can guide educational activities. Most colonized patients received C. difficile treatment and/or prophylaxis, likely due to ongoing systemic antibiotic use and immunosuppression. Benefit of treatment and prophylaxis in colonized patients remains an unresolved issue.

Disclosures
Kelly M. Percival, PharmD, Gilead Sciences Inc: Advisor/Consultant