bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1784. Reduction of bacterial resistance in isolates from nosocomial infections through a program of antibiotic stewardship based on a local mobile application in a hospital in Mexico City; 10 years of success
Authors: Castañeda-Méndez Paulo , Castillo-Álvarez José Luis , Aguilar Esperanza Aleman , Medina-Montaño Griselda , Soto-Ramirez L U I S E , Aguilar-Zapata Daniel , Mar Javier Reyes 
Published: January 2025

Abstract

Background
Hospital-acquired infections caused by multidrug-resistant microorganisms (MDR-HAI) are associated with high healthcare costs, prolonged hospital stays, and concerning morbidity and mortality. The prevalence of MDR-HAI has increased worldwide as a result of the COVID-19 pandemic. In this context, antimicrobial stewardship programs (ASP) have become more relevant.

Methods
A mobile application was implemented for hospital staff to guide optimal antibiotic use. This application is based on local resistance patterns for major nosocomial microorganisms, to provide treatment recommendations (initial regimen based on suspicion, adjustment according to microbiological results, antibiotic discontinuation, etc.). Descriptive statistics were performed.

Results
In 2013, before the implementation of the application, the compliance rate was 25% for hospital-acquired infections and 42.2% adherence to guidelines. After the introduction of the application, compliance in 2014 was 56.7%, with a reported 20% MDR-HAI rate. In 2015, the usage was 60.7% and MDR-HAI rate was 18%. In 2016, compliance was 68.7% and MDR-HAI rate was 16%. In 2017, compliance was 73.7% and MDR-HAI rate was 14%. In 2018, the prevalence of MDR-HAI was 15%, while the usage of local guidelines was 78.7%. In 2019, compliance was 81.1% and MDR-HAI rate was 16.9%. Considering the COVID-19 pandemic (starting in 2020) as a period in which there was a significant increase in the presence of MDR-HAI worldwide, thanks to the implementation of the application, the percentage of MDR-HAI decreased from 27.8% to 11.1% in 2023 (Image 1). The number of different types of infections (VAP, HAP, UTI, ICS, BSI) also decreased by following the guidelines recommendations.

Conclusion
These programs are necessary as part of the healthcare program to control the morbidity and complications of MDR-HAI. Simple and user-friendly electronic applications, such as the one implemented in our hospital, have led to increased compliance and a decrease in bacterial resistance of infections acquired in our institution.

Disclosures
All Authors: No reported disclosures
P-1790. Multifaceted Stewardship for Oral Antimicrobial Agents in the Outpatient Setting of a Japanese Tertiary Care Center
Authors: Horiuchi Hiroshi , Tagashira Yasuaki , Takizawa Asami , Gu Yoshiaki 
Published: January 2025

Abstract

Background
Oral antimicrobials accounted for approximately 90% of all antimicrobial prescriptions. The 2023-2027 Japanese National Action Plan on Antimicrobial Resistance encourages reducing prescriptions for oral broad-spectrum antimicrobials, especially third-generation cephalosporins (3GC), fluoroquinolone (FQ), and macrolide (MC). However, only a few studies have examined antimicrobial stewardship programs (ASP) in the outpatient setting in Japan.
In this study we aim to evaluate the effectiveness of multifaceted ASP for oral antimicrobials in the outpatient setting of a Japanese tertiary care center.

Methods
The present, before-after trial was conducted in the outpatient setting of a Japanese tertiary care center. The pre-intervention period was from October 2021 to September 2023, and the implementation period was from October 2023 to March 2024. The intervention consisted of 1) an infectious disease (ID) physician’s focused, educational lectures for prescribers; 2) local treatment guidelines for common infectious diseases; 3) monthly reports to all physicians on changes in days of therapy (DOT) with 3GC, FQ, and MC per 100 visits; and 4) post-prescription review and feedback from a designated ID physician. Interrupted time-series analysis (ITSA) was used to assess changes in the monthly DOT per 100 visits.

Results
In total, 344,330 and 89,898 patients visited, and 15,324 (4.45%) and 3,845 (4.28%) prescriptions were issued during the pre-intervention and intervention periods, respectively. ITSA revealed an immediate decrease in DOT per 100 visits for 3GC (-1.03; 95% confidence interval [CI]: -1.31 to -0.74; P&lt; 0.001 for intercept) and a decreasing trend in FQ and MC during the intervention period (-0.71 and -0.41; 95% CI: -0.54 to -0.27 and -1.18 to -0.25; P&lt; 0.001 and 0.004, respectively). ITSA also found a decreasing trend in the DOT per 100 visits for all oral antimicrobials (-2.04; 95% CI: -2.88 to -1.20; P&lt; 0.001).

Conclusion
Multifaced ASP was able to reduce the prescription rate of three antimicrobials targeted by the Japanese National Action Plan on Antimicrobial Resistance in the outpatient setting of a community hospital.

Disclosures
Yoshiaki Gu, MD, PhD, MPH, MSD K.K.: Grant/Research Support
631. Cost-effective diagnostic algorithms for Ugandan patients with solid tumors who develop chemotherapy-associated febrile illness
Authors: Gulleen Elizabeth , Mbrusha Immaculate , Mubiru Dennis , Pedun Bernadette , Omoding Abrahams , Moore Christopher , Phipps Warren , Rajasingham Radha 
Published: January 2025

Abstract

Background
Microbiology diagnostic tests are often prohibitively expensive in resource-limited settings. Cost-effective diagnostic algorithms could potentially guide diagnostic evaluation for chemotherapy-associated febrile illness in resource-limited settings where comprehensive testing is not possible. This is particularly true in sub-Saharan Africa, where the high prevalence of HIV and tuberculosis (TB) place patients at increased risk of developing opportunistic infections that do not frequently occur among patients receiving chemotherapy in the United States or Europe.

Methods
We created a decision analytic model to evaluate the costs, diagnostic yield, and cost-effectiveness of diagnostic algorithms for adult inpatients with solid tumors who developed fever within 30 days of receiving chemotherapy in Uganda. Since Uganda has a high prevalence of HIV and TB, diagnostics included serum cryptococcal antigen (CrAg) lateral flow assay, Alere TB urinary lipoarabinomannan (LAM), malaria rapid testing, and aerobic blood cultures. We considered the following testing algorithms: 1) a comprehensive approach where all tests were performed, and 2) various stepwise algorithms where tests were performed in series and stopped testing with the first positive result. We obtained prevalence data from a cohort of 100 patients with solid tumors who were admitted to the Uganda Cancer Institute (Kampala, Uganda) with fever. Test performance was taken from the published literature.

Results
A comprehensive diagnostic testing strategy yielded 64% of correct diagnoses at a cost of $97.85 per correct diagnosis. Of the stepwise strategies, testing CrAg first yielded the cheapest strategy, at a cost of $85.49 per correct diagnosis, and the highest number of appropriate diagnoses (59%). The incremental cost-effectiveness ratio was $234 per additional correct diagnosis for the comprehensive over this sequential strategy.

Conclusion
Comprehensive diagnostic testing is optimal for patients who experience post-chemotherapy febrile illness in resource-limited settings. If this strategy is not available, stepwise testing with CrAg then TB LAM is the optimal strategy to maximize correct diagnosis and minimize costs.

Disclosures
All Authors: No reported disclosures
P-1806. ABLE to De-Label: Liberating Patients from Penicillin Chart Allergies
Authors: Martinez-Palmer Meaghan , Olabode Adenike , Xu Teena , Khan Parisa F 
Published: January 2025

Abstract

Background
The Veterans Affairs Clinical Pharmacy Practice Office Allergy to Beta Lactam Evaluation (ABLE) initiative was launched at the at the Michael E DeBakey VA Medical Center in October 2023. The primary implementation tool was a standardized note template, streamlining the documentation and assessment of penicillin allergy information. Patients who had tolerated penicillins since reaction or had side effects were eligible for immediate de-labeling. Those with unknown reactions, IgE-mediated allergies &gt;10 years ago, or non-severe IgE-mediated allergies &gt;5 years ago were considered candidates for penicillin allergy testing. All other reactions were considered ineligible for further evaluation.
Results of ABLE intervention
Results of ABLE intervention from October 2023-February 2024

Methods
Patients labeled as penicillin allergic who were previously seen in ID clinic were contacted via unscheduled telephone calls to clarify allergy histories, identify opportunities for de-labeling, and provide recommendations for alternative beta-lactam use. The primary outcome was the proportion of “penicillin-allergic” patients successfully de-labeled.
ABLE Intervention Flowchart

Results
Of 88 patients identified, 16 (18%) were deceased and 13 (15%) were de-labeled prior to ABLE implementation in October 2023. 56 of the 59 remaining patients received at least one attempt at telephone contact. 24 patients received the ABLE intervention. Of these, 8 patients (33%) were immediately de-labeled, and 1 declined to have the allergy removed despite being eligible. Another 13 patients (54%) were eligible for further allergy testing, of which 5 (21%) accepted a referral to Allergy clinic. Two patients (8%) were not eligible for further testing. One patient who was successfully de-labeled regained the penicillin allergy label.

Conclusion
The ABLE initiative improves antimicrobial stewardship and patient care by accurately assessing and managing penicillin allergies. These findings suggest those who are eligible for immediate de-labeling based on chart review should be prioritized for intervention. However, based on the acceptance rate of this telephonic intervention, alternative modalities of implementation should be explored.

Disclosures
All Authors: No reported disclosures
P-1807. Using The Modified Delphi Method to Create Expert Consensus for Candidate Variables for Risk-Adjusted Benchmarking Metrics of Hospital Antimicrobial Consumption
Authors: Goto Michihiko , Barlam Tamar F , Cosgrove Sara E , Davila Heather , Drekonja Dimitri M , Echevarria Kelly , Goedken Cassie Cunningham , Goetz Matthew B , Hsueh Kevin , Mergenhagen Kari A , Taylor Lindsay , Hernandez David , Livorsi Daniel J 
Published: January 2025

Abstract

Background
Studies have shown that both patient- and hospital-level factors can influence the evaluation of antimicrobial consumption, and appropriate risk adjustments are necessary for reliable benchmarking. The curation of candidate variables through experts can be helpful in gaining the trust of users. We conducted a modified two-stage Delphi method to build consensus on candidate variables that should be considered in developing a risk-adjustment model for benchmarking metrics of hospital antimicrobial consumption.
Summary of Expert Consensus for Candidate Variables for Risk-Adjusted Benchmarking Metrics

Methods
In preparation, we listed potential variables for consideration from past literature (8 facility characteristics, 6 patient demographics, 4 care processes, 56 comorbidities, 42 procedure categories). We distributed a survey to a 9-member expert panel to rate variables independently to “can be considered” or “should not be included” with comments. Consensus was defined as agreement by 7 or more out of 9 members, and the results with comments were presented to the panel at a conference call for further discussions. The second survey was distributed, focusing on items that did not reach consensus or the panel suggested reconsideration.

Results
At the first survey, 8 facility characteristics, 3 patient demographics, 4 care processes, 27 comorbidities, and 19 procedure categories reached a consensus. The panel discussed the remaining 29 comorbidities and 23 procedure categories and whether any item that reached consensus required reconsideration on a follow-up conference call. In the second survey, 3 facility characteristics, 2 patient demographics, 27 comorbidity categories, and 4 procedure categories were included in the second survey based on the discussion. At the end of the process, 7 facility characteristics, 6 patient demographics, 4 care processes, 49 comorbidities, and 41 procedure categories reached a consensus (Figure).

Conclusion
In this modified two-stage Delphi process, we successfully classified the majority of variables as either to be considered or not to be included in statistical model development. These variables, curated by subject matter experts, can serve as a foundation for further model development for objective evaluation and benchmarking of hospital antimicrobial consumption.

Disclosures
Michihiko Goto, MD MSCI, Merck: Grant/Research Support Daniel J. Livorsi, MD, Merck: Grant/Research Support
P-1809. Strategies to Optimize Antibiotic Stewardship for Patients with COVID-19 Using a Systems Engineering Framework
Authors: Pulia Michael , Griffin Meggie , Schwei Rebecca , Scalzo Sarah , Ikenberry Helena , Kaur Ashleen , Pop-Vicas Aurora E , Schulz Lucas , Werner Nicole 
Published: January 2025

Abstract

Background
The COVID-19 pandemic stressed antimicrobial stewardship (AMS) programs with increased workloads and lack of guidance on the treatment of COVID-19. Throughout the pandemic, COVID-19 patients have received antibiotics for this viral illness despite reported low rates of confirmed bacterial co-infections. The purpose of this study was to identify challenges to and strategies for successful antibiotic stewardship for COVID-19 inpatients.
Part 1 of Table 1

Methods
We utilized the Premier Healthcare Database to identify hospitals with appropriate antibiotic prescribing before and maintained during the pandemic while facing significant COVID-19 patient burden. We conducted semi-structured interviews with pharmacists, physicians, and quality leaders involved in AMS during the pandemic. Interview guides were developed according to participants’ roles using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Interviews were recorded, transcribed, and analyzed iteratively using directed content analysis guided by the SEIPS model.
Part 2 of Table 1

Results
We conducted 30 interviews from 19 different high-performing health care systems across the country. We interviewed 17 pharmacists, 12 physicians and 1 nurse. The main challenges participants identified included lack of knowledge and formal guidance on how to treat COVID-19, feelings of helplessness, and diagnostic uncertainty. Strong, clear leadership from hospital leaders or infectious disease groups, organizational and national guidelines and clinical experience caring for COVID-19 helped providers overcome lack of knowledge, and guidelines on how to treat COVID-19 assuaged feelings of helplessness. Diagnostic tools including host response biomarkers (e.g. procalcitonin) and chest imaging were utilized and incorporated into workflows to help overcome diagnostic uncertainty and guide antibiotic prescribing.
Part 3 of Table 1

Conclusion
Successful strategies for COVID-19 antibiotic stewardship included overcoming knowledge gaps with clear leadership from infectious disease teams and implementation of structured COVID-19 diagnostic and treatment guidelines.

Disclosures
All Authors: No reported disclosures
P-1831. Clostridioides difficile infection alters the prefrontal cortex transcriptomics in a preclinical model
Authors: Costa Deiziane , Yang Suemin E , Brett Moreau G , Shin Jae Hyun , Warren Cirle A 
Published: January 2025

Abstract

Background
Dementia is associated with poor outcomes of Clostridioides difficile infection (CDI) in older adults. Changes in brain metabolites profile was detected in preclinical model of CDI. Recently, we discovered that CDI-promoted brain neuroinflammation occurs after peak of the infection. Here, we investigated how CDI changes the transcriptomics of prefrontal cortex of C. difficile-infected mice.

Methods
6-month-old mice were infected with C. difficile and euthanized on day 7 post-infection (pi) and bulk RNA-sequencing was performed on prefrontal cortex. Changes in the main upregulated or downregulated genes were confirmed by protein assays. Spearman correlation analyses were also performed.

Results
Infected mice developed diarrhea and weight loss, resulting in maximum weight loss and diarrhea on day 3 pi, which were resolved by day 7 pi. Differential gene expression analysis pointed 136 differentially expressed genes: 75 upregulated (Lcn2, Plin4, Fkbp5, Slc38a5, Lrg1, Ucp2, Slc2a1, Spint1, and Trpv4) and 61 downregulated (Pprc1, Zfp169, Bnip5, Chrm4, Grm3, Hmgcr, Zfp804b, Gpm6b, and Ncam) on day 7. Gene set enrichment (KEGG) analysis showed upregulation of genes associated with oxidative phosphorylation, Parkinson’s disease and Alzheimer’s disease, as well as downregulation of genes associated with axon guidance and neuroactive ligand-receptor interaction and T cell receptor signaling pathway in infected mice. Using protein assays, prefrontal cortex levels of GFAP, a marker of astrocytes, were increased in the infected mice, pointing to reactive astrocytes response. Increased levels of Lcn2, which can be secreted by astrocytes, followed by increased MPO and calprotectin in prefrontal cortex, cecum and serum of infected mice were detected. Levels of systemic MPO, a marker of inflammation, and fecal Lcn2, a marker of epithelial barrier disruption, correlates positively with the levels of Lnc2 in prefrontal cortex.

Conclusion
Our findings demonstrate that CDI induces transcriptomic changes in the prefrontal cortex, including genes associated with oxidative phosphorylation and dementia secondary to Parkinson’s and Alzheimer’s disease, among others. Astrocytes-derived Lnc2 in the prefrontal cortex may contribute to the neuroinflammatory effect associated with CDI.

Disclosures
Jae Hyun Shin, MD, Ferring: Grant/Research Support
P-1839. Elucidating Key Interactions Between Macrophages and the Fungal Pathogen Coccidioides
Authors: Symington Jane , Voorhies Mark , English Bevin , Sil Anita 
Published: January 2025

Abstract

Background
In the environment, the fungal pathogen Coccidioides grows as hyphae, yet when its spores (arthroconidia) are inhaled by a host, they develop instead into a parasitic form called the spherule. Spherules can be elicited in vitro in the presence of specific media, elevated temperatures, and high CO2, yet what triggers this transition in vivo and the role of host immune cells in this transition remains largely unknown.

Methods
We performed live imaging of Coccidioides posadasii Silveira arthroconidia in the presence or absence of murine bone marrow derived macrophages isolated from wildtype (C57BL/6) mice. Images were taken hourly over a 3-day time course. We recorded the time at which hyphae first appeared, the number of spherules at the final time point, and average size of spherules at the final time point. We utilize fluorescent dyes to determine if arthroconidia are phagocytosed and to assess host cell death. RNAseq was performed on RNA isolated from arthroconidia cultured with macrophages over 48hrs. Experiments were conducted at 37C and 5% CO2.

Results
We observed that the presence of macrophages strongly promotes the ability of Coccidioides arthroconidia to transition to spherules at conditions that would otherwise promote formation of hyphae. In wells with macrophages, arthroconidia produced more spherules, and these spherules were generally larger in size than those produced in vitro in the absence of host cells. The presence of macrophages also delayed the time that hyphae first appeared. Using a transwell system, we found that physical contact with macrophages was necessary to promote spherule development and reduce hyphae formation. We discovered that Coccidioides arthroconidia are phagocytosed by macrophages and spherules can develop within macrophages. RNAseq of Coccidioides arthroconidia cultured with macrophages show enrichment of transcripts associated with spherule growth in vitro as well as those previously identified from Coccidioides-infected murine or human lungs.

Conclusion
Macrophages strongly promote the ability of Coccidioides arthroconidia to transition to the parasitic form of Coccidioides in a contact-dependent manner. This work creates a foundation for better understanding initial critical interactions between macrophages and Coccidioides.

Disclosures
All Authors: No reported disclosures
P-1848. Reduction of microbial burden on environmental floor samples through advanced photohydrolysis technology and its impact on Candida auris, fungi, and aerobic bacteria
Authors: Trosch Kimberly , Carenza Amy , Birx Deborah , Huslage Kirk , Obiekwe Uzoamaka D 
Published: January 2025

Abstract

Background
The continued rise of antimicrobial resistance (AMR) and reduction of pharmacological options has created an urgent need for new treatments or countermeasures to combat the spread of multi-drug resistant organisms (MDROs). Focus on MDROs has become paramount with the rise of Candida auris (C. auris) infections that are associated with high mortality and AMR. Attention must be given to pathogen reservoirs such as the surfaces of floors, which have an underappreciated potential to transfer pathogens to hands from objects in contact with the floor.

Mean CFUs of Aerobic Bacteria from Baseline to Post-Activation #4.

Methods
An experimental study to explore the impact of advanced photohydrolysis (AP) technology inside a high acuity hospital unit with active C. auris infections was performed from September 2023 to January 2024 and investigated the effect of the AP system on floor colony forming units (CFUs) of aerobic bacteria, fungi, and C. auris. Baseline pre-activation samples were compared to post-activation samples, which occurred every four weeks on Tuesday mornings prior to shift change and daily environmental services (EVS) cleaning.

Mean CFUs of Fungi from Baseline to Post-Activation #4.

Results
Pairwise comparisons with a Bonferroni correction found median floor fungal CFUs achieved a statistically significant reduction of 99% (p=.011) from Baseline to Post-Activation #4. Aerobic bacteria decreased 98%; C. auris by 66% but did not achieve statistical significance.
The mean CFUs on high-touch surfaces were reduced for aerobic bacteria by 82% and fungi by 99%. C. auris was reduced by 100% from Baseline to Post-Activation #3 (41 CFUs to 0 CFUs) but increased in Post-Activation #4 due to two positive sample locations in a patient room with an active C. auris infection. Although the locations were positive for C. auris, they both tested under 500 CFU/cm2, which is associated with a reduced level of infection risk from environmental bioburden.

Mean CFUs of Candida Auris from Baseline to Post-Activation #4.

Conclusion
This study clearly demonstrates that despite intensive efforts by EVS, serious microbes remain on floors; however, application of the AP technology provided a continual and persistent decline in floor microbial burden all without the need for additional skilled labor or increases in cleaning and disinfection practices. A forthcoming study will analyze how these demonstrated environmental changes affected patient outcomes.

Disclosures
Kimberly Trosch, RN, BSN, ActivePure Technologies: Full time employee Amy Carenza, BBA, ActivePure Technologies: Full time employee Deborah Birx, MD, ActivePure Technologies: Advisor/Consultant