bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-858. Impact of Infectious Diseases Consultation on the Management of Staphylococcus Aureus Bacteremia in a Large, Predominately Rural, Health System
Authors: Murtaza Muhammad , Howard Catessa A , Thompson Jesse , Edmond Michael B , Stevens Michael 
Published: January 2025

Abstract

Background
Staphylococcus Aureus Bacteremia(SAB) is associated with high morbidity and mortality. Infectious Diseases (ID)consultation has been associated with a decrease in mortality. The WVU Medicine Health System (WVUM) serves as a predominantly rural population and includes 24 hospitals (9 of which are critical access hospitals). Access to ID consultations is limited across the system and region.

Methods
We generated a list of patients with SAB who presented to WVUM hospitals between 6/1/22 to 5/30/2023. A subset of patient charts were selected for review. We manually reviewed patient records and recorded key information and assessed whether patients met IDSA guidelines criteria for complicated versus uncomplicated SAB.

Results
Please see Table 1 Table 1.Management of SAB for Patients With and Without ID ConsultationVariablePatients with ID Consult (143)Patients without ID Consult (93)P-valueDiagnostic ImagingMRI C-spine: 27/143 (19%)MRI C-spine: 2/93 (2%)&lt; 0.001MRI T-spine: 32/143 (22%)MRI T-spine: 4/93 (4%)&lt; 0.001MRI LS spine: 41/143 (29%)MRI LS spine: 3/93 (3%)&lt; 0.001TTE: 129/143 (90%)TTE: 38/93 (41%)&lt; 0.001TEE: 62/143 (43%)TEE: 3/93 (3%)&lt; 0.001Metastatic Infection48/143 (34%)5/93 (5%)&lt; 0.001Complicated139/143 (97%)93/93 (100%)0.1557Antibiotic duration&lt; 2 weeks: 0/143 (0%)&lt; 2 weeks: 52/93 (56%)&lt; 0.0012 weeks 10/143 (7%)2 weeks 16/93 (17%)0.0254 weeks 24/143 (17%)4 weeks 2/93 (2%)&lt; 0.0016 weeks 95/143 (66%)6 weeks 10/93 (11%)&lt; 0.001Died within 72 hours of presentation0/143 (0%)16/93 (17%)&lt; 0.00130 Day re-admission*30/143 (21%)26/77 (34%)0.30130-Day mortality*10/143 (7%)11/77 (14%)&lt; 0.001*Excluding people who died within 72 hours of presentation

Conclusion
We found major differences in the work up of SAB and in clinical outcomes for patients receiving ID consultation and those who did not. Patients who received ID consultation were more likely to receive guidelines compliant evaluation and treatment, and were less likely to be re-admitted and die. When patients who died within 72 hours of presentation were excluded from analysis , patients without ID consults were still significantly more likely to die. These data will inform efforts to expand access to ID consultation for patients with SAB across our health system.

Disclosures
All Authors: No reported disclosures
P-865. Clinical Characteristics, Risk Factors and Outcome of Critically Ill Immunocompromised Patients with Bloodstream Infections and Sepsis
Authors: Vonineng Nirusdee , Sutherasan Yuda , Bruminhent Jackrapong 
Published: January 2025

Abstract

Background
Immunocompromised patients with sepsis have greater odds of in-hospital mortality compared to immunocompetent patients. A study focused on bloodstream infection (BSI) and sepsis in critically ill immunocompromised (CII) patients has not been extensively explored. We investigated the epidemiology of pathogens, risk factors, outcome, mortality associated with BSI and sepsis among CII patients.

Methods
A retrospective cohort study was conducted at the Medical Intensive Care Unit between January 2022 and December 2023. The participants included patients with immunocompromised status who had suspected sepsis and septic shock and developed documented BSI confirmed by positive blood cultures. A 1:1 propensity score matching without replacement was performed for creating comparable groups and used in Cox proportional hazards modeling to estimate the risk of all-cause mortality within 30 days.

Results
A total of 211 CII patients were included. The mean age (SD) was 61 (16) years, and 57% were male, with a median SOFA score (IQR) of 7 (4-11) and a median APACHE score (IQR) of 16 (14-20). The immunodeficiency profile included hematologic malignancy (37.4%), solid organ malignancy (27.0%), autoimmune disease (19.0%), solid organ transplantation (5.7%), others (10.4%). There were 85 cases (40.28%) had positive blood cultures, predominately showing gram negative rod bacteria (65.9%) focusing of P. aeruginosa (17%), E.coli (17%) and K.pneumoniae (14%). There were 103 (48.82%) patients died within 30 days (p=0.73). There were 85 well balanced matches paired to positive and negative hemoculture groups, respectively. In a propensity score–matched cohort, factors associated with 30-day mortality included a higher SOFA score and lactate level above 4 mmol/L, showing a trend towards increased risk with [HR 1.12 (95%CI, 1.04-1.20, P = 0.003] and [HR 1.91 (95%CI, 1.06-3.42, P=0.031), respectively. Additionally, underlying COPD/asthma appeared to be a protective factor [HR 0.20(95% CI, 0.06-0.66, P = 0.009)].

Conclusion
Among CII patients, BSI, especially those derived from gram-negative bacteria, are not uncommon. Severe conditions characterized by higher SOFA scores and persistently high lactate level from inadequate resuscitation are risk factors for mortality within 30 days.

Disclosures
All Authors: No reported disclosures
P-872. Clinical and Microbiological Trends in Citrobacter Bacteremia: A Study from South India
Authors: Mulla Rukhsar Abdur Rahim , Ananthanarayanan Rajalakshmi , Niyas Vettakkara Kandy Muhammed , Hussain Febeena 
Published: January 2025

Abstract

Background
Citrobacter spp are anaerobic Gram-negative bacilli, accounting for approximately 0.8% of all Gram-negative infections. This study aims to elucidate the clinical manifestations and drug susceptibility in Citrobacter infections.
Clinical features of patients with Citrobacter bacteremia and comparison between Citrobacter koseri and other Citrobacter spp

Methods
We conducted a retrospective analysis of Citrobacter spp. bacteremia cases from 2016 to 2022. We assessed clinical profile, species, antimicrobial susceptibility and 28-day outcome.
Blood cultures were processed using the BacT/ALERT, Vitek 2 system was employed for bacterial identification and antimicrobial susceptibility testing and reported as per CLSI criteria. Isolates with intermediate susceptibility were classified as non-susceptible.
Comparison of antibiotic susceptibility between C Koseri and other Citrobacter spp

Results
Over the 7 year study period, 25 cases of Citrobacter bacteremia were identified, 60% were males. The median age was 52.5 years (IQR: 46 – 75), with 2 pediatric cases.
The annual incidence of Citrobacter bacteremia displayed an upward trend, from 12% in 2016 to 24% in 2022. C. koseri emerged as the predominant species (72%), followed by C. freundii (24%) and C. farmeri (4%).
The majority of patients (72%) had diabetes, 16% had chronic liver disease, 12% had malignancy. Risk factors for Citrobacter bacteremia included the presence of an indwelling bladder catheter (76%) and a central venous catheter (44%). Urinary tract was the most frequent source (56%), followed by abdominal (20%) and soft tissue (8%); a newborn had meningitis with brain abscess. The mean for Pitt’s bacteremia score was 1.52±2.6. The mean Charlson’s co-morbidity index was 2.76±2.3. Clinical features for the entire cohort and comparative results between C Koseri and other Citrobacter spp (grouped as non-koseri) is depicted in figure 1.
Ciprofloxacin susceptibility was higher among C koseri (94%) as compared to other spp (71%). Antibiotic susceptibility for ceftriaxone was almost similar between the 2 groups. Susceptibility rates for other antibiotics and comparison between C Koseri and other spp are shown in figure 2. All isolates were susceptible to ertapenem, imipenem and amikacin. The overall 28-day mortality rate was 12%.

Conclusion
We found C. koseri more commonly, urinary source as the most common source and device presence as a significant risk factor. Antibiotic susceptibility was better for C. koseri compared to others.

Disclosures
All Authors: No reported disclosures
P-874. Clinical Characteristics and Outcomes Associated with Enterococcal Bloodstream Infections at an Integrated Healthcare Network
Authors: Rothman Ryan , BCHECH G E O R G E , Saleh Saleh , Bhanot Nitin , Abdulmassih Rasha 
Published: January 2025

Abstract

Background
Enterococcus spp. represent a frequent cause of blood stream infections in the United States. We wanted to gather data on clinical characteristics and outcomes associated with enterococcal bloodstream infections encountered at our quaternary care integrated health network.Table 1:Patient demographics and comorbiditiesBaseline characteristics of patients reviewed in the study, including their demographic data and underlying medical history

Methods
We conducted a multicenter retrospective chart review from 2022 to 2023 of patients hospitalized (community or healthcare acquired) with enterococcal bacteremia. Information on demographics, comorbidities, duration of treatment, readmission rates, and mortality were obtained.Figure 1:Prescribed treatmet duration
Treatment duration in patients who completed their prescribed antimicrobial therapy course

Results
146 patients (mean age 67.5 years) were identified with enterococcal bacteremia. Demographics and comorbidities are shown in Table 1. Prescribed treatment duration varied based on the underlying clinical presentation, and is outlined in Figure 1, which only includes patients who were able to complete the prescribed course. 30-day all-cause readmission was 34/146 (23.3%), with only 1 readmission due to recurrence of bacteremia. 30-day all-cause mortality was 51/146 (35%). Most of these patients (48/51; 94%) died prior to completing the antimicrobial therapy; 3/48 (6%) patients died following completion of an 11-14 day treatment course.

Conclusion
There was a significant burden of enterococcal bacteremia at our institution during the study period. Although 30-day readmission was seen in about 23% of patients, there was only 1 patient who was readmitted for recurrent bacteremia, notably in a patient who had not yet finished his prescribed course of antibiotics. Additionally, we encountered a high all-cause mortality rate of 35%, with the majority dying while on active antimicrobial therapy. These findings are congruent with other studies measuring the mortality rate of enterococcal bacteremia. This study highlights the importance of identifying high-risk comorbidities in patients that might portend a poor prognosis, and helps to educate both providers and patients on the overall prognosis of enterococcal bacteremia.

Disclosures
All Authors: No reported disclosures
P-889. Therapeutic Failures of High Inoculum Infections with Cefazolin: Role of A Rapid Test and Prevalence of the Cefazolin Inoculum Effect in Methicillin-Susceptible Staphylococcus aureus (MSSA) Bloodstream Infections
Authors: Flores Erika , Dziadula Jacob , Panesso Diana , Singh Kavindra , Carvajal Lina Paola , Rincon Sandra , Reyes Jinnethe , Ghosh Asmita , Wesley Long S , Cernoch Patricia L , Howden Benjamin , Tong Steven , Munita José M , Miller William R , Tran Truc Cecilia , Arias Cesar A 
Published: January 2025

Abstract

Background
Cefazolin (CFZ) remains a key therapy for MSSA bloodstream infections (BSIs), yet some studies suggest poorer outcomes when CFZ is used in the presence of cefazolin inoculum effect (CzIE). We developed a rapid colorimetric test with nitrocefin to detect CzIE in MSSA. Here, we report the performance of the rapid test in four recurrent BSIs caused by MSSA exhibiting the CzIE. Furthermore, we assess the local prevalence of CzIE using both standard broth microdilution (BMD) and the rapid test.

Methods
A chart review collected clinical data from four patients, including demographics, microbiologic features, antibiotic therapies, and clinical outcome. Patients were selected based on positive MSSA BSI after initial clearance, and availability of their index isolate. The nitrocefin-based rapid test was performed according to a published protocol. For the surveillance step, MSSA were collected from initial cultures of adult patients diagnosed with BSIs between July 2023 and April 2024 from 8 hospitals. The CzIE was assessed using BMD at standard (105) and high (107) inocula, with a cutoff CFZ MIC ≥ 16 μg/ml. The rapid test was performed in all isolates.

Results
All four patients had deep-seated infections, including endocarditis, osteomyelitis, or device-related infections, with two patients undergoing surgical interventions. While receiving CFZ therapy, all patients successfully cleared their MSSA BSI. After initial clearance, these patients received prolonged antibiotic therapy lasting ≥ 6 weeks, with 3 of 4 patients continuing with CFZ, as part of their initial therapy. Despite this, MSSA BSI recurred between 34 and 155 days after initial hospitalization. Notably, all index isolates tested positive for CzIE via the rapid test. During the surveillance period, we collected 196 isolates, with a 40% (79/196) prevalence of the CzIE based on BMD. The rapid nitrocefin test correctly identified 72 of 79 strains exhibiting the CzIE, with 91% sensitivity and 80.3% specificity.

Conclusion
These findings underscore a high prevalence of MSSA isolates exhibiting CzIE in BSIs. Patients infected with MSSA displaying CzIE may face an increased risk for recurrence when treated with CFZ. Further validation of these observations is warranted to better understand their clinical implications.

Disclosures
José M Munita, MD, MSD: Grant/Research Support|Pfizer: Grant/Research Support William R. Miller, M.D., Merck: Grant/Research Support|UptoDate: Royalties
P-892. Impact of early continuous renal replacement therapy in patients with septic acute kidney injury: an analysis of the MIMIC-IV database
Authors: Lee Yongseop , Seo Jun Hye , Seong Jaeeun , Ahn Sangmin , Han Min , Lee Jung Ah , Kim Jung Ho , Ahn Jin Young , Jeong Su Jin , Choi Jun Yong , Yeom Joon-sup , Oh Hyung Jung , Ku Nam Su 
Published: January 2025

Abstract

Background
Renal replacement therapy (RRT) is an important treatment option for septic acute kidney injury (AKI); however, the optimal timing for its initiation remains controversial. Here, we aimed to investigate the clinical outcomes of early continuous renal replacement therapy (CRRT), which was defined as CRRT initiation within 6 hours of the onset of septic AKI, which is earlier than the time of initiation defined in previous studies.Figure 1.Study flowchart.

Methods
We used clinical data sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. This study included patients aged ≥18 years who met the sepsis diagnostic criteria and received CRRT because of stage 2 or 3 AKI. Early and late CRRT were defined as CRRT initiation within 6 hours and after 6 hours of the development of septic AKI, respectively.Table 1.Clinical characteristics of patients with sepsis after propensity matching

Results
Of the 33,236 patients diagnosed with sepsis, 553 underwent CRRT for septic AKI. After excluding cases of early mortality and patients with a history of dialysis, 45 and 334 patients were included in the early and late CRRT groups, respectively. After propensity score matching, the 28-day mortality rate was significantly lower in the early CRRT group than that in the late CRRT group (26.7% vs. 43.9%, P=0.035). The early CRRT group also had a significantly greater number of days free of mechanical ventilation (median days, 19; interquartile range [IQR] 3–25) and vasopressor administration (median days, 21, IQR 5–26) than did the late CRRT group (median days, 10.5; IQR, 0–23; P=0.037 and median days, 13.5; IQR, 0–25; P=0.028, respectively). The Kaplan–Meier curve also showed that early CRRT initiation was associated with an improved 28-day mortality rate (log-rank test, P=0.040). In contrast, there was no significant difference in the 28-day mortality between patients who started CRRT within 12 h and those who did not (log-rank test, P=0.237).Table 2.Clinical outcomes of patients with sepsis after propensity score matching

Conclusion
Early CRRT initiation can improve the survival of patients with septic AKI. CRRT must be initiated as early as possible after the onset of septic AKI, preferably within 6 hours.Figure 2.Kaplan-Meier survival curves of patients with septic acute kidney injury after propensity score matching.A. Comparison of 28-day survival and B. 90-day mortality among patients with sepsis between continuous renal replacement therapy initiation &lt; 6 hours and ≥ 6 hours. C. Comparison of 28-day survival and D. 90-day mortality among patients with sepsis between continuous renal replacement therapy initiation &lt; 12 hours and ≥ 12 hours.

Disclosures
All Authors: No reported disclosures
P-895. Perceptions of Bias and Discrimination Among Antimicrobial Stewardship Providers
Authors: Giuffre Allison M , Taylor Lindsay , Cinnamon Katie , Osman Fauzia , Tischendorf Jessica S 
Published: January 2025

Abstract

Background
Bias and discrimination influence the experience of many in healthcare, and antimicrobial stewardship providers are no exception as demonstrated by work documenting differential uptake of recommendations made by men and women stewards. In this mixed method study, we explored the perceptions and experiences of bias and discrimination among antimicrobial stewards.

Methods
We conducted a nationwide survey of stewardship providers including physicians, pharmacists, advanced practice providers and trainees. Participants were recruited via convenience sampling using X and professional listservs during May and June 2023. We solicited steward and program demographics and responses to statements exploring bias and discrimination in the execution of stewardship duties through a 67-item electronic survey (Qualtrics). Statistical analysis using chi-squared were performed in STATA. We further explored these experiences through semi-structured interviews.

Results
Stewards identifying as females and those with &lt; =5 years were more likely to report their identities negatively influenced interactions with primary teams than male and more experienced stewards, respectively (table 1). Similarly, female stewards and those with the least experience reported these identities negatively influenced their interactions with health system representatives compared to male and more experienced stewards, respectively (table 2). Although there was no difference in the reported negative influence of race/ethnicity on interactions with primary teams, more non-white stewards reported their race/ethnicity negatively influenced interactions with health system representatives (tables 1 & 2). Themes from our 16 interviews illuminated sources of perceived bias, the impact they had, and strategies to mitigate the influence of these biases.

Conclusion
Bias and discrimination are felt disproportionately by women and junior antimicrobial stewardship providers and can lead to poor job satisfaction and lack of perceived effectiveness. Acknowledging these experiences and equipping stewards with strategies to mitigate the harmful personal, professional and programmatic effects of bias and discrimination should be a priority of institutions and professional societies.

Disclosures
Jessica S. Tischendorf, MD, MS, Merck: Grant/Research Support
368. Impact of Social Determinants of Health (SDOH) on Outcomes of OPAT (Outpatient Parenteral Antimicrobial Therapy)
Authors: Sportiello Mike , Burgoyne Colleen , Yamshchikov Alexandra 
Published: January 2025

Abstract

Background
Complex infections may warrant extended antibiotics traditionally reserved for inpatient settings. OPAT is safe and cost effective, allowing return to regular activities and decreased risk of hospitalization. Understanding of SDOH-sensitive risk parameters and impact on adverse events is needed to guide safety and adherence interventions.Figure 1.Most Common OPAT Antibiotics and Indications in Study Cohort

Methods
Records of patients treated 7/15-10/31/2023 by URMC OPAT program, exclusive of concurrent Transitions of Care Program, were retrospectively reviewed for race, social vulnerability index, insurance type, substance use, needs insecurity, household composition, and outcomes such as OPAT-related orders errors, intravascular device (IVAD) complications, emergency utilization, organ system adverse events, and clinical outcome. A composite Undesirable OPAT Outcome was derived. The impact of SDOH was assessed by chi-square, univariate and multivariate logistic regression using R v4.3 3, rstatix v0.7.2, and sjPlotv2.8.15.Table 1.Proportion and Rates of Errors, Complications, and OPAT Treatment Outcomes in Study Cohort

Results
Total 116 patients received 3573 OPAT days for varying indications (Fig 1). High rates of discharge order errors, ED utilization, IVAD complications, adverse events, and composite Undesirable Outcomes were noted (Table 1). Those with public insurance (OR=13.6, CI: 1.95-322) or who used cannabis (OR=5.23 CI: 1.1- 27.2) were more likely to incur a laboratory order error on discharge. Patients of color were more likely to experience IVAD complications (OR=3.61, CI: 1.1-12.6) and multiple organ system adverse events (OR= 6.55, CI: 1.45-34.9). High-risk tobacco use was associated with shortened OPAT duration due to adverse event (OR=28.47, CI: 1.72-1299) (Fig 2). OPAT patients with public insurance were least likely to follow up with the ID clinic (OR=7.65, CI: 1.27-152). Time to ID follow-up correlated with multiple SDOH parameters, with publicly insured and persons of color experiencing significantly longer time to follow-up appointments (Fig 3). Incurring a non-IVAD adverse event correlated to composite undesirable outcome in multivariate analysis.Figure 2.Odds Ratios in Univariate Analysis of OPAT Complications Based on Social Determinants of Health

Conclusion
Social determinants may be predictors in OPAT-related unwanted events. A dedicated focus of evaluating SDOH as contributing drivers of adverse OPAT outcomes may assist creating interventions to support marginalized patient groups.Figure 3:Time-to-event probability analysis for timing of post-discharge ID clinic follow up among OPAT patients by Insurance Type (3A), Race (3B), and All Patients (3C)

Disclosures
All Authors: No reported disclosures