bluuebunny/crossref_metadata_2025_split huggingface dataset:
666. Evaluation of Vancomycin Harms for Intra-abdominal Infections
Authors: McCoy Christopher , Yan Xuping , Chapin Ryan W , Donohoe Kendall 
Published: November 2023

Abstract

Background
The Infectious Diseases Society of America recommends broad spectrum Gram-negative and anaerobic coverage for complicated intra-abdominal infections (IAI). Gram-positive beta lactam resistant organisms such as methicillin-resistant S. aureus (MRSA) are not typically associated with pathogenicity. Vancomycin, an empiric Gram-positive agent, is associated with nephrotoxicity. This study evaluated incidence of harm in patients treated with antimicrobial regimens which included vancomycin vs. those which did not.

Methods
This single center, retrospective cohort study included adult inpatients admitted between September 1, 2018 and September 30, 2022 with a diagnosis of IAI. Patients with concomitant MRSA infection from a different site or who received hemodialysis or continuous renal replacement therapy were excluded. The primary outcome was the rate of renal toxicity in patients treated empirically for IAI. Secondary outcomes included duration of treatment, duration of hospitalization, and evaluation of guideline concordant use of vancomycin in IAI.

Results
Of 61 included patients, 39 (64%) were treated empirically with vancomycin for IAI. Patients on vancomycin experienced more acute kidney injury compared to those on empiric standard regimens [9/39 (23%) vs. 1/22 (5%), p=0.05]. Median duration of hospitalization for patients on vancomycin vs. standard therapy was 11 days (IQR, 14) vs. 5 days (IQR, 4), p &lt; 0.05, respectively. Median length of inpatient therapy was 9 days (IQR, 12) vs. 4 days (IQR, 5), p &lt; 0.05, for patients on vancomycin vs. standard therapy. Notably, non-guideline concordant use of vancomycin occurred in 14/39 (46%) patients and no patients had cultures grow MRSA.Table 1.Baseline CharacteristicsTable 2.Primary and Secondary Outcomes

Conclusion
More patients who were treated with vancomycin experienced acute kidney injury. Patients who were treated with standard therapy were more likely to have a reduced hospital length of stay and shorter inpatient antibiotic duration of treatment. Institutional guidelines recommend no additional coverage outside of specific risk factors but stewardship efforts do not extend to this use. Future efforts to decrease use of vancomycin for IAI may result in a decrease in observed harms. Further studies are needed to refine which patients may truly benefit from empirical vancomycin therapy.

Disclosures
All Authors: No reported disclosures
681. Antibiotic Treatment During Hospitalization Is a Major Risk Factor for The Occurrence Of Clostridium Difficile Infection Among Carriers
Authors: Gilboa Mayan , Cohen Ido , Peretz Yovel , Meltzer Eyal , Yahav Dafna , Regev-Yochay Gili 
Published: November 2023

Abstract

Background
Asymptomatic carriers of Clostridium difficile (CD) have a higher risk of developing CD infection (CDI). Previous studies have shown that reducing inappropriate antimicrobial use through antimicrobial stewardship programs can decrease rates of CDI. However, risk factors for the development of CDI among carriers, particularly the role of antibiotic treatment, have not been well-defined.
Risk factors for Clostridium Difficile Infection - multivariable logistic regression analysis

Methods
We conducted a prospective cohort study between January 2017 and March 2023, assessing 2524 asymptomatic CD carriers admitted to internal medicine and hematology wards. Patients were screened for CD carriage upon admission and followed untill discharge for occurence of symptomatic CDI. We performed multivariable logistic regression analyses adjusted for age, gender, immunosuppression status, Carbapenem-resistant Enterobacteriaceae (CRE) carriage, Previous intensive care unit admission in the past 30 days, Presence of a nasogastric tube (NG), chronic Protein Pump Inhibitor (PPI) usage, and debilitation and examined whether at least one antibiotic dose, either Intra venous or oral, during the hospitalization, was related to the occurrence of clinical CDI.

Results
Of the 2524 CD carriers, 225 (8.9%) developed clinical CDI during their hospitalization. In a multivariable logistic regression analysis, antibiotic treatment during hospitalization was the most significant risk factor for the occurrence of CDI among carriers (OR 2.15, 95% CI 1.43-3.22). Other risk factors included CRE carriage (OR 2.08, 95% CI 1.35-3.19) and the presence of an NG tube (OR 1.56, 95% CI 1.12-2.15).

Conclusion
In this large prospective cohort study, we found that antibiotic treatment during hospitalization was the most significant risk factor for the occurrence of CDI among carriers. These results emphasize the importance of antimicrobial stewardship programs and suggest that CD carriers represent a suitable target for focused stewardship efforts

Disclosures
All Authors: No reported disclosures
682. Novel rpoB mutations and trends in clinical Clostridioides difficile isolates with reduced fidaxomicin susceptibility
Authors: Gonzales-Luna Anne J , Le Thanh , Eubank Taryn A , Karim Md Ekramul , Jahangir Alam M , Begum Khurshida , Garey Kevin 
Published: November 2023

Abstract

Background
Fidaxomicin use is increasing to treat Clostridioides difficile infection (CDI) following clinical treatment guideline updates placing it as first-line therapy. This puts a selection pressure on the development of fidaxomicin resistance, which has been associated with in vitro fitness costs compared to wildtype isolates. Here we aimed to assess the epidemiology of reduced susceptibility (RS) to fidaxomicin and prevalence of rpoB mutations in a clinical cohort.

Methods
Stool samples from patients with CDI were collected from two different healthcare systems in Houston, TX between 2016-21. Fidaxomicin minimum inhibitory concentrations (MIC) were determined via agar dilution susceptibility testing following CLSI standards. RS was defined as MIC &gt; 0.5 mg/L based on the EUCAST [T]ECOFF. A subgroup of 40 isolates with RS underwent Sanger sequencing to detect rpoB single nucleotide polymorphisms (SNPs).

Results
Of 535 patients included, 114 (21.3%) had infecting strains with fidaxomicin RS (MIC50 = 0.5 mg/L, MIC90 = 1.0 mg/L). Fidaxomicin RS was more common in RT 027 (49.4%, 41/83) compared to non-027 strains (16%, 68/425; P &lt; 0.001). There were no differences in the proportions demonstrating RS across collection years (P=0.18) or based on location in or out of the Texas Medical Center (P=0.29). Mean MICs were similar between isolates collected before and after the IDSA/SHEA guideline update in 2018 (P =0.1). rpoB SNP mutations were detected in 12.5% (5/40) of isolates at 7 novel base positions; no SNPs were detected at previously reported position 3428.

Conclusion
RS to fidaxomicin occurred in one fifth of clinical isolates with no changes in incidence between 2016-21. Several new rpoB SNPs were observed in isolates with RS. Studies are needed to determine potential association(s) between fidaxomicin exposure and MIC changes.

Disclosures
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 Kevin Garey, PharmD, MS, BCIDP, Acurx Pharmaceuticals: Grant/Research Support|Cidara Therapeutics: Grant/Research Support|Ferring Pharmaceuticals: Advisor/Consultant|Paratek Pharmaceuticals: Grant/Research Support|Seres Therapeutics: Grant/Research Support|Vedanta Therapeutics: Grant/Research Support
709. Post-Clostridioides difficile Infection Neuroinflammatory Response in an Animal Model
Authors: Yang Suemin E , Costa Deiziane , Goldbeck Sophia M , Shin Jae Hyun , Warren Cirle A 
Published: November 2023

Abstract

Background
Clostridioides difficile infection (CDI) affects nearly half a million patients in the US annually. Previous studies have associated delirium and dementia with poor outcomes of CDI in older adults. We examined how CDI may affect the brain and induce neuroinflammation in the mouse model of CDI.

Methods
6 and 18-month-old mice were infected with 105 CFU of C.difficile, monitored daily (body weight and diarrhea score), and euthanized on day 3, day 7, and day 10 post-infection (p.i.). Cecum and colon tissues were processed for histopathology. Hippocampus, prefrontal cortex, and cecum samples were analyzed for pro-inflammatory cytokine levels (S100B, IL-6, IL-1β, and MPO) by ELISA and for phosphorylated NFκB by western blot.

Results
Infected mice developed diarrhea and weight loss, resulting in maximum weight loss around day 3 p.i., which resolved around day 7 and day 10 p.i. for 6 and 18-month-old mice respectively. Inflammatory marker analysis showed elevated levels of IL-1β (p=0.04) and myeloperoxidase (MPO, p=0.004) levels in the cecum, as well as higher histopathology scores in the cecal (p=0.04) and colon (p=0.009) tissue on day 3 p.i. By day 7 and day 10 post p.i., the measures of intestinal inflammation were no longer elevated, including IL-1β and MPO levels. The inflammatory markers in the hippocampus were not significantly elevated on day 3 p.i., but on day 7 p.i., levels of hippocampal S100B (p=0.003) and IL-6 (p= 0.03) were elevated in the 6-month-old mice, indicating that CDI is associated with an inflammatory response in the brain after the initial intestinal inflammation. Moreover, hippocampal phosphorylated NFκB levels were detectable on day 7 p.i. 6-month-old infected mice by western blot, pointing to an NFκB pathway as a mechanism by which the neuroinflammation is activated post-CDI. In addition to the hippocampus, the prefrontal cortex also showed a trend towards elevation of MPO levels on day 7 and day 10 p.i.

Conclusion
Our findings demonstrate that CDI promotes neuroinflammation which occurs after the peak of intestinal inflammation. NFκB signaling may be involved in the upregulation of the pro-inflammatory cytokines contributing to this neuroinflammatory effect; however, further investigation is needed.

Disclosures
Cirle A. Warren, MD, Ser-109 Coactuate: Advisor/Consultant|Ser-109 Coactuate: Honoraria
745. Title: Epidemiology of Hospital-onset Bacteremia (HOB) caused by Methicillin-resistant Staphylococcus aureus (MRSA) in a Multi-hospital Health System
Authors: Singh Harjot K , Ross Barbara , Quinn Margaret , Calfee David P , Simon Matthew , Torres Heidi M , Acker Karen P , Horowitz Harold , Wang Tina Z , Gunawardhana Nuwan , Goldberg Robin H , Segal-Maurer Sorana , Prasad Nishant , Johnson Candace L , Kuang David , Gouveia Adam L , Yoko Furuya E , Westervelt Karen , Saiman Lisa 
Published: November 2023

Abstract

Background
Hospital-onset bacteremia (HOB) is a quality metric proposed by CDC. HOB caused by methicillin-resistant Staphylococcal aureus (MRSA) is reported to Centers for Medicare and Medicaid services through the National Healthcare Safety Network (NHSN), yet few studies have described HOB-MRSA epidemiology. Thus, we report HOB-MRSA epidemiology from 2020-2022 at our multi-hospital health system to inform quality improvement initiatives.

Methods
We used data submitted to the NHSN to prospectively identify HOB-MRSA LabID cases and collected demographic and clinical characteristics from patients’ electronic medical records. Hospital epidemiologists at each of the 9 hospitals adjudicated suspected sources of HOB-MRSA. Annual standardized infection ratios (SIRs) were calculated. Characteristics of HOB-MRSA episodes were analyzed by descriptive statistics. Relevant institutional review boards deemed this study exempt from Human Subjects Research.

Results
From 2020-2022, 174 (0.029%) HOB-MRSA episodes occurred among 573,433 hospitalizations. Table 1 provides the characteristics of patients with HOB-MRSA and Table 2 provides the SIRS and suspected sources of HOB-MRSA. Overall, 43% of patients were in an ICU, 44% had a central line (CL), and 30% were on a ventilator. The SIR was lowest in 2022. Respiratory sources (non-ventilator and ventilator-associated pneumonia (VAP)) were the most common and declined over time (p=0.002). Suspected sources of HOB-MRSA were unknown for 11% of episodes.

Conclusion
We found that episodes of HOB-MRSA were attributed to multiple primary sources of infection. Thus, bundle strategies for VAP and CL-associated bloodstream infections, while crucial, are insufficient to reduce all HOB-MRSA. In addition, prevention strategies for patients with skin and soft tissue infections are needed. Our findings highlight the importance of adherence to all device and procedure-related bundles, hand hygiene, cleaning/disinfection, and MRSA decolonization when appropriate. Elucidating the epidemiology of primary infection sources can further tailor prevention strategies for HOB.

Disclosures
Sorana Segal-Maurer, MD, Gilead Sciences, Inc: Advisor/Consultant|Gilead Sciences, Inc: Honoraria|Janssen: Advisor/Consultant|Janssen: Honoraria|Theratechnologies: Advisor/Consultant|Theratechnologies: Honoraria|Viiv: Advisor/Consultant|Viiv: Honoraria Nishant Prasad, MD, Gilead Sciences, Inc.: Grant/Research Support Lisa Saiman, MD MPH, Merck & Co., Inc,: Grant/Research Support|Merck & Co., Inc,: Member, DSMB|Pfizer, Inc: Member, DSMB
746. A Bacteriophage-Based Validation of a Personal Protective Equipment Doffing Procedure to be Used with High Consequence Pathogens
Authors: Burke Kylie , Berryhill Brandon A , Kraft Colleen S , Smith Andrew , Morgan Jill , Tarabay Jessica , Mamora Josia , Varkey Jay , Mumma Joel , Grant Darryl , Busch Lindsay M , Carag Jessica 
Published: November 2023

Abstract

Background
Personal protective equipment (PPE) is the cornerstone of healthcare worker (HCW) safety and prevention of the spread of pathogens. To limit the potential risk to HCWs, healthcare institutions have employed infection control policies and procedures. When treating patients with high consequence infectious diseases, such as Ebola virus disease, HCWs wear complex personal protective equipment (PPE) ensembles that cover their entire body with multiple layers. These layers build redundancy to ensure protection of the HCWs' skin and clothing. Manufacturers typically provide recommendations for donning and doffing individual PPE pieces, but protocols differ between healthcare institutions for PPE ensembles. These PPE ensembles and their associated doffing protocols are rarely tested empirically.

Methods
We reviewed footage of the doffing protocol currently employed at a Regional Emerging Special Pathogen Treatment Center. From this analysis we identified potential contamination pathways which we verified by using a fluorescent pathogen proxy. To account for viable pathogen susceptibility to alcohol-based disinfectant, HCWs donned the PPE ensemble and were then contaminated with three genetically marked bacteriophages (phage). After completing the doffing protocol, the HCW’s skin and PPE were swabbed to test for the transfer of viable phage to the HCW.

Results
All four of the HCWs that completed the initial doffing protocol had a high recovery of phage from at least one sampling location. Subsequently, we implemented interventions to both the equipment and the doffing procedure. In nine trials with this modified protocol, no viable phage was recovered from any of the HCWs.

Recovery of Bacteriophage Transferred to HCW during Doffing Before and After Protocol Interventions. N=4 subjects for original protocol, N=9 subjects for revised protocol. Percentage of HCW for whom bacteriophage PCR was positive, average density of recovered phage when available--% (avg density). X- PCR positive, phage inactivated

Conclusion
Our experiments revealed potential contamination pathways that allowed for high densities of viable phage to move from areas of the outermost layers of PPE to the skin and clothing of HCWs. While the individual PPE functioned correctly, the original ensemble and doffing procedure were not effective. Our updated protocol eliminated phage contamination. This study highlights the need for infection prevention protocols to be evaluated in an empirical manner in a framework such as this.

Disclosures
All Authors: No reported disclosures
755. Infectious Diseases Journal Watch: a Pilot Study
Authors: Chen Benjamin , Wooten Darcy 
Published: November 2023

Abstract

Background
Staying apprised of the scientific literature can be a challenge for health science researchers and clinical practitioners alike [1, 2]. Journal surveillance is a popular modality for disseminating curated topic-specific health science research in a scheduled newsletter. The New England Journal of Medicine (NEJM) Journal Watch is a prominent example of this format [3], but despite its wide adoption, little research has examined the effectiveness of this model as an educational tool.

Methods
We conducted a pilot study examining the impact of journal surveillance as an educational tool within the University of California San Diego’s (UCSD) Division of Infectious Diseases. Modeled after the NEJM Journal Watch, we created an internal monthly newsletter summarizing the latest research in the field of infectious diseases (ID). We then surveyed readers to evaluate the content covered in article summaries, the barriers and facilitators to learning from the newsletter, and the impact on self-reported clinical knowledge and practice.

Results
Across 10 monthly editions we summarized 45 articles covering a diverse array of content topics published in high impact journals (Figure 1). Thirty-two (71.1%) summaries included an infographic or visual abstract. Eighteen ID division members completed the survey evaluation of the monthly newsletter; most were fellow physicians or early career faculty (Figure 2). Thirteen respondents (71.1%) had read 4 or more editions. Most (94.4%) viewed ID Journal Watch favorably, citing the ability to remain up to date with literature and to improve clinical care after reading the newsletter (Figure 3). Eleven (61.1%) reported that their main barrier to engaging with the newsletter was a lack of time. Infographics were viewed favorably by a majority (66.7%) as a learning tool, supporting previous findings that visual media can decrease cognitive load when interpreting new information [4].
Figure 1
Article topics and journals surveyed from 45 article summaries
Figure 2
Demographics of survey respondents, n = 18 (%)
Figure 3
Self-reported benefits of engaging with ID Journal Watch, n = 18

Conclusion
Journal surveillance is a valuable learning tool particularly for trainees and early career faculty. The format allows for rapid acquisition of knowledge that is relevant to clinical care. Visual media should remain a key component of journal surveillance due to its ability to facilitate comprehension.

Disclosures
All Authors: No reported disclosures
756. Factors that Increase Engagement on Social Media for an Infectious Diseases Fellowship Program
Authors: Cherian John , Herc Erica , Yared Nicholas F , Brar Indira , Gudipati Smitha , Shallal Anita 
Published: November 2023

Abstract

Background
Social media is increasingly being used among Infectious Disease (ID) programs. It can be a valuable recruitment tool in addition to providing education, self-promotion, and increasing collaborations across the ID community. We sought to analyze factors associated with increased engagement for our ID fellowship program’s Twitter account.

Methods
We analyzed various metrics from consecutive Twitter posts and utilized the Twitter Analytics Dashboard to extract data from time of account inception. Impressions were defined as the number of times a tweet was seen by users, and engagements as a composite of interactions with a tweet. Tweet content was organized into educational, social, promotional, and other categories. Educational content was subcategorized into tweetorial, microbiology, question & answer (Q&A), and journal articles. A subset of tweets were analyzed for engagement from April 2022 to March 2023 for trends according to content and date the tweet was posted. Standard univariate descriptive statistical analyses, moods median test, and one-way analysis of variance was performed. Data analysis was performed using R version 3.4.0.

Results
460 tweets were posted from October 2020 to March 2023 (Figure 1). Educational subcategories showed a large amount of engagement related to microbiology, with specifically more retweets, likes, and profile clicks (Table 1). There was no difference in engagement based on time of day of tweet (Table 2), although profile clicks were significantly more likely if tweets occurred on a weekend (p=0.04). A subset of 284 tweets from April 2022 to March 2023 revealed that months where multiple content categories were tweeted resulted in the most engagement (Figure 2). Generally, more twitter posts correlated with more engagement with a Pearson correlation coefficient of 0.7.Figure 1.Tweet content by (a) overall categories and (b) educational categories.

Conclusion
To increase engagement with social media, there should be frequent tweets with varied content categories. Subcategories of content such as microbiology tweets draw further interest and showcase a program's educational and clinical innovation.Figure 2.Composite categorical engagement from April 2022 – March 2023.

Disclosures
Indira Brar, MD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Janssen: Grant/Research Support|Janssen: Honoraria|ViiV: Advisor/Consultant|ViiV: Grant/Research Support|ViiV: Honoraria
766. "Assessing the impact of advanced vaccine education on pharmacy students’ knowledge, confidence, and preparedness in becoming future immunization providers: A National Study"
Authors: Johal Ajit 
Published: November 2023

Abstract

Background
With community pharmacists emerging as prominent immunization providers, there is an increased need for additional training in this area. The primary objective of this pre-post questionnaire study was to evaluate the impact of a comprehensive webinar on advanced vaccine education on the knowledge, confidence, and preparedness of undergraduate PharmD students across Canada.

Methods
A 25-question, web-based survey was administered to PharmD students at seven Canadian pharmacy schools prior to and immediately after attending a comprehensive educational webinar from March 13th to April 7th, 2023. The pre- and post- survey data were analyzed using SPSS 26. A Friedman rank test was performed on questions which answers consisted of ordinal data.

Results
In a group of 355 pharmacy students across Canada who attended our live educational webinars, 279 completed the pre-survey questionnaire, and 132 students completed the post-survey questionnaire. Pre-survey questionnaire results showed knowledge and confidence gaps in the areas of addressing vaccine hesitancy, immunization assessment, and recommended vaccinations. After the educational webinar event, students showed higher knowledge and confidence across all domains, and statistically significant improvements in critical areas pertaining to community vaccination practice. This highlights pedagogical changes which can be made to pharmacy school curriculums to better prepare students for future immunization practice.

Conclusion
Considerable knowledge gaps exist for graduating community pharmacists in vaccine education. Pharmacy students will benefit from integrated education focusing on addressing vaccine hesitancy, immunization status assessment, and jurisdictional routine immunization programs. Communities may also benefit from frontline healthcare providers who are highly trained and empowered with an expanded scope of practice to address their lifespan vaccination needs.

Disclosures
Ajit Johal, BSP BCPP RPh, CSL Seqirus: Advisor/Consultant|GSK: Honoraria|Merck: Honoraria|Pfizer: Honoraria