bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-137. Contención de la resistencia a los antimicrobianos en entornos de recursos limitados: la experiencia de Argentina en la Red de Acción Global en Salud - Módulo de Resistencia a los Antimicrobianos
Authors: Colque Angel M , Alonso Laura , Barcelona Laura , Pagano Irene , Iantorno Paula , Mann Smith Rachel , Ines Staneloni Maria , Berdiñas Veronica , Echave Cecilia , Gonzalez Andrea , Velasquez Carretero Claudia , Fueyo Nora , Ponce Fabiana , Fueyo Tomas , Corso Alejandra , Pasteran Fernando 
Published: January 2025

Abstract

Background
The Global Action in Healthcare Network, antimicrobial resistance module (GAIHN-AR) is a CDC-led global network that partners with PAHO and Ministries of Health (MOH) in Argentina and Chile. Its goals are to prevent, detect, and respond to healthcare-related AR threats; it is a part of the CDC Global AR Laboratory and Response Network. We describe the containment response experience in 2 Argentine public hospitals participating in GAIHN-AR.

Methods
GAIHN-AR containment guidance was adapted to the local context and targeted carbapenemase-producing Enterobacterales (CP-CRE) carrying novel (Tier 1) or known, but rare, carbapenemases (Tier 2: non-OXA-163 OXA-48 variants, VIM, multiple carbapenemases, and pan-drug-resistant [PDR]). Hospital laboratories implemented new diagnostics for carbapenemase identification and developed protocols to communicate alerts of potential Tier 1 or 2 CP-CRE to hospital infection prevention and control (IPC) teams, MOH, and the National Reference Lab (NRL). Hospitals received training and support from MOH GAIHN-AR staff to conduct containment and IPC activities. Containment activities continued while alert organisms were confirmed or discarded by the NRL.

Results
During Jan 2023 -- March 2024, 20 alerts were generated (all Tier 2); 19 were not confirmed (17 were OXA-163, 1 was PDR non-confirmation, 1 was mixed culture). The remaining confirmed alert (NDM+KPC) generated a successful containment response with 7/7 contacts screening negative. With each alert, gaps were identified, particularly in communication across stakeholders and hospital IPC activities. In response, enhanced monitoring was implemented for hand hygiene, contact precautions and environmental hygiene, and the MOH developed a new informatic system to facilitate stakeholder communication.

Conclusion
Combating AR threats requires support and integration of IPC programs and clinical laboratories to ensure rapid communication and action when target organisms are detected. Support from CDC and PAHO was critical for implementation and MOH involvement is key for successful responses to AR threats. Although vital learning experiences, steps to limit false alerts are key to prevent response fatigue moving forward.

Disclosures
All Authors: No reported disclosures
P-147. Exploring the Complexity of Brucellosis: Findings from a Prospective Observational Study at AIIMS, Jodhpur
Authors: Naguthevar Santhanam , Ravindra Akshatha , Kumar Deepak , Kumar Midha Naresh , Shankar Meena Durga , Krishna Bohra Gopal , Tak Vibhor , Gadepalli Ravisekhar 
Published: January 2025

Abstract

Background
Brucellosis, a global health concern, is often misidentified due to diagnostic complexities. In India, its prevalence is estimated at 13.5%. This study examines its microbiological and clinical spectrum for improved management.

Methods
AIIMS, Jodhpur, conducted a prospective observational study from April 2021 to March 2024, examining patient records for demographic data, clinical presentations, laboratory and microbiological findings, treatment approaches, outcomes, and excluding alternative causes of pyrexia of unknown origin (PUO)

Results
Among 1142 cases analyzed, 43 were confirmed positive for brucellosis subsequent to thorough exclusion criteria. The most common age group affected by brucellosis, intriguingly, was those under 20 years, comprising 53.49% of the cases, followed by individuals aged 21 to 50 years at 30.23%, with those over 50 years representing 16.27% of the cases. The study unveiled a spectrum of clinical presentations, including 34 cases of PUO, 3 instances of spinal involvement, 5 cases with Central Nervous System (CNS) manifestations, as well as isolated occurrences of Endocarditis and Kikuchi Disease, underscoring the diverse clinical manifestations associated with brucellosis. Noteworthy clinical indicators included a high prevalence of unpasteurized milk consumption (76.74%), fever (88.37%), and joint pain (62.79%). Predominantly, B. Melitensis accounted for 30 cases, followed by B. Abortus with 11 cases and B. Suis with 2 cases.

Conclusion
This study reaffirms the significant diagnostic challenge posed by brucellosis, particularly within the spectrum of PUO. Blood culture emerges as a cornerstone in the reliable diagnosis of the infection.

Disclosures
All Authors: No reported disclosures
P-148. Melioidosis: A Seven-Year Review (2017-2023)
Authors: Thangaraju Deepak , Sundaramoorthy Varun , Thiagarajan Vigna 
Published: January 2025

Abstract

Background
Melioidosis, caused by Burkholderia pseudomallei (B pseudomallei), is a severe disease endemic to Southeast Asia and northern Australia. A high index of clinical suspicion is required for diagnosis. In resource-limited settings, a lack of training and expertise leads to the misidentification of this pathogen. Delay in laboratory diagnosis and non-compliance with treatment can have devastating consequences. A study on the epidemiology of melioidosis will help in training, raising awareness, and improving the disease management. Therefore, this study was done to describe the clinical findings of melioidosis diagnosed at our center in south India.
colonies of Burkholderia pseudomallei on sheep blood agar and MacConkey agar

Methods
A retrospective study was done from 2017 to 2023 (7 years). Patients’ data were obtained from medical records. Quantitative variables were expressed as means, and qualitative variable as frequencies.

Results
During the study period, 70 patients were diagnosed with melioidosis. The mean age group was 52 years. Ninety-one percent of them were men. Except for two patients, none of the other patients (97%) were residents of coastal areas. The risk factors were diabetes mellitus (the most common), chronic kidney disease, steroid use, cirrhosis, alcoholism, and others. In 5 patients, more than one organ system was involved. In 43% of patients, the organism was isolated in more than one sample. B pseudomallei was isolated in 71% of patients from the blood, 39% of patients from the musculoskeletal system, 21% of patients from the respiratory system, 9% of patients from the liver and spleen each, 4% of patients from the central nervous system, 3% of patients from ascitic fluid, and urine in one patient (1%). All the isolates were sensitive to ceftazidime. Twenty-three percent of patients died due to the infection.

Conclusion
Our institute is one of the high-volume centers for melioidosis. Diabetes mellitus is the most common risk factor. In contrast to data from other endemic countries, musculoskeletal involvement is the most common in our study. This is probably because of a delay in contacting health care or because the diagnosis is missed during the acute phase of illness, when the pulmonary system is commonly affected. B pseudomallei should be actively looked for while investigating infections in diabetic patients from India.

Disclosures
All Authors: No reported disclosures
P-150. Antibiogram Creation at King Faisal Hospital in Kigali, Rwanda to Inform Antimicrobial Stewardship Priorities
Authors: Sous Jinan , Rafiki Gatera Michel , Nduwayezu Richard , Kreuger Mariska , Uwizeyimana Jean-Pierre , Muvunyi Thierry , Siraj Dawd , Shirley Daniel 
Published: January 2025

Abstract

Background
Antimicrobial resistance (AMR) is a major global health challenge. King Faisal Hospital (KFH) in Kigali, Rwanda, is the country’s quaternary referral hospital. Creating antibiograms provides useful information for assessing the burden of resistance and for establishing pertinent antimicrobial use guidance.Figure 1:Susceptibility Patterns of Select Gram Negative Bacteria to Common Antibiotics

Methods
We analyzed all positive cultures at KFH from January 1, 2018 – December 3, 2023. An electronic laboratory system was used to extract data. Duplicate samples were excluded based on CLSI guidelines. Data were organized by organism and susceptibility to reported antibiotics was recorded. Using this raw data, we created yearly antibiograms that showcased susceptibility patterns over time.

Results
Susceptibilities of key Enterobacterales species were relatively low for ceftriaxone and cefepime but higher for piperacillin-tazobactam and meropenem; all were generally stable over time (Figure 1). Ciprofloxacin susceptibility for these organisms decreased over time. Methicillin (oxacillin) resistance in Staphylococcus aureus and vancomycin resistance in Enterococcus species were relatively rare and stable over time.

Conclusion
Antimicrobial resistance is increasing worldwide and determining local resistance patterns through antibiograms is one important step to impacting this global problem. Decreased susceptibility to some antibacterial drugs was noted at KFH which helps inform areas for future study and intervention. Challenges to data collection were variations in lab reporting, data, and storage collection systems in the past five years. These findings also provide a basis for the creation of an antimicrobial stewardship program at KFH.

Disclosures
All Authors: No reported disclosures
P-152. Chitinase-3-like Protein 1 is Associated with Stunting and Neurodevelopmental Delay in Ugandan Children Who Are HIV Exposed But Uninfected
Authors: MacBain Elspeth , Conroy Andrea , Namasopo Sophie , Opoka Robert , Hawkes Michael 
Published: January 2025

Abstract

Background
Children who are HIV exposed but uninfected (cHEU) are at risk for impaired linear growth and neurodevelopment, which evolving evidence suggests may be associated with elevated inflammatory biomarkers. Chitinase-3-like protein 1 (CHI3L1) is produced by activated neutrophils and has been linked to clinical manifestations of systemic inflammation in children living with HIV. We aimed to explore CHI3L1 as a potentially relevant marker for adverse growth and neurodevelopment outcomes experienced by cHEU.

Methods
This was a prospective cohort study conducted at two pediatric HIV centres in Uganda (Jinja Regional Referral Hospital and Kambuga District Hospital). We enrolled children at birth, born to mothers living with HIV, diagnosed prior to the pregnancy or at the time of delivery. We excluded children who were subsequently found to be vertically infected (n=8), children who died before 18 month of age (n=3), as well as those lost-to-follow-up and those with missing CHI3L1 measurement. Neurodevelopmental ability (rank) was assigned based on the standardized score of Malawi Developmental Assessment Tool (MDAT) milestones achieved at 18 months of age. CHI3L1 levels were quantified by ELISA (R&D Duoset, Minneapolis, MN, USA).

Results
We included 153 cHEU (53% female) born between March 2016 and June 2018. At 18 months of age, 42%, 0.7%, and 2.8%, were severely stunted, wasted, and underweight, respectively. Performance on the MDAT was similar to Malawian norms. The median CHI3L1 level was 30 µg/L (IQR 18-47). CHI3L1 levels were inversely correlated with weight-for-age (ρ= -0.22, p=0.0091) and height-for-age (ρ= -0.24, p=0.0039) z-scores, but not the weight-for-height or head circumference-for-age z-scores. CHI3L1 levels were higher in children with severe stunting (median 40 µg/L, IQR 26-86) than those without severe stunting (median 27 µg/L, IQR 16-39, p=0.0010). CHI3L1 was inversely correlated with the standardized MDAT scores (ρ= -0.29, 0.00023). Lower scores in the language and gross motor domains were associated with higher CHI3L1 whereas scores in the fine motor and social domains were not associated with CHI3L1.

Conclusion
CHI3L1 was associated with severe stunting and neurodevelopmental delay in our cHEU cohort in Uganda.

Disclosures
All Authors: No reported disclosures
P-169. Comprehensive Sexuality Education in Secondary Schools and Syphilis Incidence by Country: An Ecological Study
Authors: Davidson Michelle C , Ikuta Kevin 
Published: January 2025

Abstract

Background
Comprehensive sexuality education (CSE) is essential curriculum covering sexual and reproductive health topics, including transmission of sexually transmitted infections. CSE has been added as a Sustainable Development Goal (SDG) indicator (4.7.2) and is becoming more widespread, but the relationship between degree of CSE implementation and incidence of STIs has not been previously described. The aim of this study was to investigate whether countries with more widespread CSE in secondary schools have lower incidence rates of syphilis than those with limited CSE.Table 1:Percent of secondary schools implementing CSE in 2018 vs. median syphilis incidence in 2019.

Methods
We used CSE implementation estimates from WHO as described in the 2021 UNESCO report: The Journey Towards Comprehensive Sexuality Education. This report utilizes data from multiple surveys to produce an estimate of the percent of secondary schools providing CSE by country in 2018, categorized as “0-25%”, “26-50%”, “51-75%”, or “76-100%”. We used syphilis incidence rates from the Global Burden of Disease Study 2019. We conducted a multivariable Poisson regression evaluating the relationship between percent of schools with CSE and syphilis incidence, adjusting for WHO region and income level.

Results
CSE data were available for 66 countries, all of which had syphilis incidence estimates available (Table 1). Countries that reported CSE in fewer than 25% of secondary schools had a syphilis incidence that was 1.83 (95% CI 1.78 – 1.89) fold higher than countries with CSE in greater than 25% of schools. This difference was attenuated but remained significant after adjusting for region and income level with a relative rate of 1.40 (CI 1.36 – 1.44). Each increase in CSE category was associated with a 26.6% (CI 25.9 – 27.4) relative reduction in syphilis incidence rate (Figure 1). This reduced to 7.1% (CI 6.2 – 8) when adjusted for region and income level.

Conclusion
More widespread CSE is associated with lower syphilis incidence, likely by reducing unsafe sex practices, although a causal relationship cannot be inferred given study design. These findings suggest that countries with the greatest need for CSE are the ones with the most limited availability. Further research on this topic would be beneficial to more thoroughly evaluate how CSE programs impact rates of syphilis and other STIs.

Disclosures
All Authors: No reported disclosures
P-192. Evaluating the Association of Unnecessary Antibiotic Use with Hospital-Onset Clostridioides difficile Infection at a New York City Hospital
Authors: John Amie , Acbo Antoinette M , Cowman Kelsie , Guo Yi , Nori Priya , Weston Gregory D 
Published: January 2025

Abstract

Background
Hospital Onset-Clostridioides difficile infection (HO-CDI) is defined as collection of a positive C. difficile lab result on or after day 4 of a patient’s hospital admission. Reduction of HO-CDI remains a multidisciplinary effort. Prior studies have demonstrated frequent inappropriate antibiotic use among patients with CDI. The objective of this study is to evaluate unnecessary antibiotic use in patients with cases of National Healthcare Safety Network (NHSN)-defined HO-CDI compared to non-CDI controls.

Methods
This case-control study included inpatient adult patients, from 1/1/23 – 2/28/24. HO-CDI cases were selected from standard institutional review. Non-CDI controls were selected based on hospital admission and negative CDI test sent on or later than day 4 of their admission. Cases and controls were matched 2:1 using patient location and index tests within the same month. Antibiotic use (AU) rate of cefepime, ciprofloxacin, levofloxacin, ceftriaxone, and piperacillin-tazobactam 30 days prior to index test was calculated using NHSN definitions. Primary exposure of interest was inappropriate antibiotic use. Outcomes including hospital length of stay (LOS), all-cause mortality, and subsequent recurrent CDI were recorded. A secondary analysis assessed the relationship between race/ethnicity, inappropriate antibiotic use and HO-CDI.

Results
Two hundred ninety-six patients were included. AU rate was greater in controls compared to HO-CDI cases (p = 0.01) (Table 1). Inappropriate AU was observed in 24% of cases and 28% of controls (p = 0.48). The most common category of inappropriate AU was inappropriate spectrum, 55% in cases and 81% in controls (Fig 1). There were no statistically significant differences in outcomes.

Conclusion
HO-CDI cases did not have greater exposure to antibiotic therapy and did not have a higher proportion of inappropriate antibiotic use compared to patients who tested negative for C. difficile. This demonstrates an opportunity to improve antibiotic use, but does not show an association between inappropriate antibiotic use and C. difficile infection.

Disclosures
All Authors: No reported disclosures
P-202. 7- Year experience with Clostridioides difficile Infection (CDI): pre- and post-COVID-19 pandemic, effect of diagnostic stewardship and the gender difference
Authors: Younas Mariam , Newell Ann , Armor Anthony , Rios-Bedoya Carlos 
Published: January 2025

Abstract

Background
Diagnostic stewardship interventions, such as order sets, reflex orders, hard and soft stop alerts and decision algorithms have shown to improve facility C. difficile rates. We aimed to examine the impact of COVID-19 infection and diagnostic stewardship on incidence and prevalence of CDI at our institution, based on gender.

Methods
Using National Healthcare Safety Network (NHSN) surveillance Laboratory Identification (Lab ID) events, 926 CDI cases, ≥ 18 years of age were identified among patients hospitalized at Hurley Medical Center from 01/2015 to 07/2022. NHSN surveillance definitions were used to describe the incident, recurrent cases and determine the epidemiologic categories. Hospital onset (HO) incident rate is described as per 10,000 patient days and inpatient community-onset (CO) CDI prevalence rate described as per 10,000 admissions (Figure 1).Table 1:Diagnostic stewardship and infection control interventions

Results
During the 7.6-year study period, overall HO CDI incident rate and inpatient CO CDI prevalence rate decreased, a percentage decrease of 34% and 53% respectively. The rates were lowest in 2020, onset of COVID-19 pandemic (percentage decrease of 22% for HO CDI incident and 7% for CO CDI prevalence rates as compared to 2019 pre-COVID-19 pandemic). There was a transient increase in 2021 (percentage increase of 36% for HO CDI incident and 14% for CO CDI prevalence rates as compared to 2019) (Figure 2, 3). HO CDI incident rates were slightly higher in men (average 11.4% difference) as compared to women except in 2017. CO CDI prevalence rates were much higher in women as compared to the men (average 13.4% difference) with the exception of 2017 and 2022.Figure 2:HO CDI Incidence rate 2015-2022, with 95% confidence intervals

Conclusion
HO CDI incident rate and inpatient CO CDI prevalence rates were lowest in 2020 (the onset of COVID-19 pandemic), likely secondary to computerized clinical decision support (CCDS) interventions introduced in 2019 (Table 1). The transient increase in rates seen in 2021, was likely due to increase in antibiotic utilization during the pandemic. Diagnostic stewardship played a key role in optimizing the diagnosis of CDI and improving CDI rates at our institution. There was a discrepancy of the CO CDI and HO CDI rates between the sexes, likely owing to the higher outpatient antibiotic use in women as compared to men, highlighting the importance of ambulatory stewardship.Figure 3:Inpatient CO CDI prevalence rate, with 95% confidence intervals

Disclosures
All Authors: No reported disclosures
P-203. Successful Elimination of Clostridioides difficile Admission Surveillance in favor of a Two Step Stool Algorithm and Early Detection Stool Counter
Authors: Schora Donna , Hines Carolyn , Faith Monsalud Cherie , Muthiah Chethra , Grant Jennifer , Kharasch Maureen 
Published: January 2025

Abstract

Background
We began Clostridioides difficile (Cdif) admission surveillance (CDAS) in 2017 to decrease the rate of hospital onset (HO) Cdif across our hospital system. We created an algorithm to screen patients with a high risk of Cdif colonization and flag them by a best practice alert in the electronic medical record (EMR). The surveillance program helped to mitigate the spread of Cdif as evidenced by our HO Cdif rate the following 6 years. In 2023, we adopted a 2 step Cdif testing algorithm for symptomatic patients featuring a stool Cdif PCR test followed by EIA testing for PCR positives. This program reduced our hospital onset Cdif rate by 60% (unpublished data). We also reviewed lab test utilization and wondered if the admission screen test could be eliminated in favor of the 2 step system and an early detection stool counter. The goal of the trial was to determine if elimination of the admission testing can keep our Cdif HO rate at the level of our 2023 performance ( &gt;75% of NHSN benchmark).
Number of Clostridioides difficile admission tests and Standardized Infection Ratio

Methods
The CDAS algorithm identifies hospitalized patients with prior nursing home or hospital admission, history of Cdif disease/colonization and a control group. A rectal sample was collected and tested with PCR. In June of 2023 the algorithm was updated to include ‘the receipt of antibiotics within the past 24 hours’.
The 2 step Cdif testing for symptomatic patients is a stool Cdif PCR test followed by EIA testing for PCR positives.
In November 2023, we stopped the admission testing at 1 of 4 hospitals, and in March 2024, testing stopped at all 4 hospitals.
A stool counter in the EMR tells the number of bowel movements in the first 48 hours of admission.
The standardized infection ratio (SIR) of hospital onset Cdif infection is used to measure the success of the trial.

Results
Results of the trial are shown in Figure 1. The modified algorithm reduced the tests by half. The rate of HO Cdif infection has remained below the SIR goal for fiscal years 2023 (0.26) and 2024 (0.21). Estimated savings for calendar year 2023 was $210,000 as provided by the financial department.

Conclusion
Replacing the Cdif admission surveillance with a 2 step test process for symptomatic patients did not affect the SIR for HO Cdif during the trial period. Eliminating the admission screen test will help to save financial resources while maintaining patient wellbeing.

Disclosures
All Authors: No reported disclosures