bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-900. Demonstrating Your Expertise: Advanced Leadership Certification in Infection Prevention
Authors: Dangles Jessica , Al Mohajer Mayar 
Published: January 2025

Abstract

Background
The Certification Board of Infection Control and Epidemiology (CBIC) developed the Advanced Leadership Certification in Infection Prevention (AD-CIP). This portfolio-based assessment indicates professional expertise and leadership in infection prevention and control and healthcare epidemiology. This longitudinal perspective provides valuable insights into an applicant’s achievement beyond a single snapshot assessment.

Methods
A group of ten IPC subject matter experts (SMEs), along with a psychometric consultant, applied principles of measurement theory and assessment design to ensure the reliability, validity, fairness, and practicality of the assessment. The SMEs met via focus groups to conduct a job task analysis (JTA) of advanced IPC professionals' job roles and responsibilities. The JTA determined the competency areas essential to advanced leadership within IPC.

Results
The resulting framework targeted specific learning outcomes guided by an existing competency model developed by the Association for Professionals in Infection Control and Epidemiology. Clear guidelines for collecting, organizing, and evaluating portfolio submissions within the scoring rubric were required to establish scoring procedures. Inter-rater reliability analysis was used to assess scoring consistency among multiple raters. A pilot test of the assessment was conducted to identify any issues with the assessment design, instructions, or scoring procedures. The final assessment measures two domains within IPC: leadership and professionalism. Within each domain are subdomains of practice and innovation, change management, quality improvement, and advocacy. Applicants are required to submit supporting evidence indicating how the criteria for each domain and subdomain are met.

Conclusion
IPC leaders use their skills to establish a clear vision and strategic direction, facilitate change that improves programs and practices, enhance individual and population health, and reduce the risk of infection across the lifespan in all settings. The AD-CIP allows IPC professionals to demonstrate how their leadership has a measurable impact on the profession.

Disclosures
All Authors: No reported disclosures
P-908. Implementation of Film Array Meningitis/Encephalitis Panel on diagnostic stewardship program in Memorial Hermann Health System, Houston, TX
Authors: Aguilera Elizabeth A , Wanger Audrey , Moussa Daniel , Hasbun Rodrigo 
Published: January 2025

Abstract

Background
The use of multiplex polymerase chain reaction (PCR) panel for detecting the most common pathogens that cause meningitis and encephalitis are increasing and are currently available worldwide. This study aims to evaluate the clinical impact of the implementation of the BioFire Film Array ME (FA ME) panel at Memorial Hermann Health System in Houston, TX.

Methods
This preliminary retrospective study included adults and children with community-acquired meningitis, encephalitis, and cerebrospinal fluid (CSF) WBC &gt; 5 cells/mm3. We categorized the patients into two cohorts: The Pre-Implementation FAME panel-control group (PRE-FAME), which was enrolled from June 2018 to October 2021, compared with the Post-implementation BioFire FilmArray -Intervention group (POST-FAME) evaluated from July 2022 to November 2023.

Results
A total of 440 patients were included (300 in the pre-implementation cohort and 140 in the post-implementation cohort). The majority were male (53%), white (40%), adults (87%) with a median age of 43 years, had a meningitis presentation (79%) and were immunocompetent (75%). There was no significant difference between the PRE-FAME and POST-FAME cohorts (P &gt; 0.05) in sex, age, and immune status, but the post-implementation cohort had a higher proportion of subjects with Charlson Comorbidity Index Score &gt; 1 and more cases with encephalitis (P&lt; 0.05). PRE-FAME patients underwent more singleplex PCR for Herpes Simplex Virus (82% vs. 60%, P&lt; 0.05) and for Varicella zoster virus (42% vs. 7%, P&lt; 0.05). There was a decrease in West Nile Virus (WNV) serologies (37% vs. 20%, P&lt; 0.05) in the POST-FAME cohort. The number of lumbar punctures (LP), CSF cultures, use of Computed Tomography (CT), Magnetic resonance imaging (MRI), duration of antiviral, and length of stay did not differ between the cohorts (P &gt; 0.05). However, there was a reduction in the duration of antibiotic therapy by one day in the POST-FAME cohort and an increase in the diagnostic yield by 10% [(42% in PRE-FAME vs 52% in POST-FAME cohorts (P &lt; 0.05)].

Conclusion
The implementation of the FAME panel increased diagnostic yield, decreased duration of antibiotic use, and decreased the use of single-plex PCR testing and WNV testing but did not impact duration of antiviral therapy or length of stay.

Disclosures
Rodrigo Hasbun, MD MPH FIDSA, Biomeriaux: Grant/Research Support|Biomeriaux: Honoraria
369. Antibiotic Stewardship at a New York City Public Hospital NICU using Neonatal Early-Onset Sepsis Calculator in the Presence of Maternal Chorioamnionitis
Authors: Rodas Cedeno Gabriela A , Chamavaliyathil Adila , Verdi Jean-Marco , Flores Jairus , Noble Lawrence , Rousseau-Pierre Thaina , Pintiliano Jennifer , Patil Uday 
Published: January 2025

Abstract

Background
Maternal chorioamnionitis is a major risk factor for neonatal early-onset sepsis (EOS) driving the use of empiric antibiotics in the neonatal intensive care unit (NICU). Utilization of the neonatal EOS calculator can guide the management and decrease antibiotic usage. Our objective is to safely reduce the exposure to empiric antibiotics (Ampicillin and Gentamicin) by 30% in a period of 6 months using the neonatal EOS calculator in full-term infants admitted to NICU in the setting of maternal chorioamnionitis at our public hospital.
Driver Diagram

Methods
Using the Model for Improvement framework, we developed a management algorithm with the neonatal EOS calculator along with documentation and workflow changes. A multidisciplinary team implemented PDSA cycles to promote adherence to the algorithm using education, training, and reinforcement. Baseline antibiotics usage rate (AUR) was calculated using chart reviews in the pre-quality improvement (QI) period (January 2023-July 2023).
Antibiotic Usage Rate (AUR) for PDSA 1 and PDSA 2

Results
During the QI period (August 2023-February 2024) a total of 127 at-risk full-term neonates were managed using the neonatal EOS calculator. Of these, only 18 neonates received empiric antibiotics. When compared to the baseline AUR, this was a significant decrease by 85.8%. Additionally, the rates of laboratory investigations (blood culture and complete blood count) also showed significant decrease by 77% in this cohort with no positive blood cultures.
EOS Workflow Algorithm

Conclusion
Our QI study demonstrates that the implementation of neonatal EOS calculator-based management in full-term infants born after maternal chorioamnionitis is safe and can be highly effective in establishing antibiotic stewardship in the NICU at a public hospital.

Disclosures
All Authors: No reported disclosures
P-921. A Decade of Changing Incidence and Microbial Aetiology of Brain Abscesses in England between 2014 and 2023
Authors: Guy Rebecca L , Coelho Juliana , Moganeradj Kartyk , Gil Eliza , Sabtu Nurfarah , Brown Colin S , Mirfenderesky Mariyam , Lamagni Theresa 
Published: January 2025

Abstract

Background
Following international and anecdotal domestic reports of post-pandemic increases in incidence of brain abscesses, including from the United States (US), we investigated trends, patient demographics and microbial aetiology of hospital admissions for brain abscess in England.

Methods
National patient admissions data from NHS England Hospital Episode Statistics with an ICD10 code for brain abscess (G06.0/G06.2) between 2014 and 2023 were extracted. Data were linked to the UKHSA national laboratory surveillance database to identify microbiological specimens (blood, CSF, pus/abscess or selected nasopharyngeal) taken within -1 and 30 days of admission. Incidence and mortality trends were assessed by patient demographic and identified organism.

Results
Between 2014-2023, 11,011 brain abscess admissions were identified from 1775 (16.1%) children and 8553 (77.7%) adults (≥18y). Median age was 54y; 64.4% (n=7088) were men, 84.0% (n=7818) were of white ethnicity, lower in children compared to adults (71.5% vs 87.3% for adults).
Brain abscess incidence in adults increased 42% between 2014 and 2023 (1.6 to 2.2/100,000 population), and for children 23% increase (1.5 to 1.7/100,000) particularly in extradural/subdural abscess (G06.2) since 2020, overtaking the rate in adults (figure 1).
Microbiology data were available for 3545 cases (32.2%), with 316 and 109 different species identified in adults and children respectively. In adults, the most frequently identified species was Staphylococcus aureus (26.1%, n=1303; range 22-36%/year), followed by Streptococcus anginosus group (11.1%; n=590; range 9-16%/year; figure 2). In children, 23.6% cases had S. anginosus group identified (n=178; range 12-32%/year), followed by group A Streptococcus at 9.7% (n=73; range 0-18%/year; figure 3).

Conclusion
This is the first national study on brain abscess incidence and microbial aetiology in England. Brain abscess reports showed a marked increase since 2014, with dramatic increases in children since 2020, a similar picture to the US. The microbial aetiology differed between adults and children, with a greater diversity in adults. Differences between surgical and community acquisition and predisposing conditions need to be assessed to identify opportunities for prevention.

Disclosures
All Authors: No reported disclosures
P-925. Diagnostic value of 18-F-FDG-PET scan in endovascular infections
Authors: Ittaman Ajithkumar , Hadi Hamad Abdel 
Published: January 2025

Abstract

Background
There have been multiple studies evaluating the use of 18-fluorine-fluorodeoxyglucose positron emission tomography (18F-FDG PET) as a diagnostic tool for endovascular infections with mixed results. The aim of this study will be to assess the efficacy of 18F-FDG PET scan in endovascular infections
demographic details of confirmed IE by criteria

Methods
Our study plan to evaluate the accuracy of PET scan in diagnosing VPGI, infective endocarditis and other endovascular infection. We will use MAGIC criteria3 and Modified Dukes criteria 1 regarding comparative diagnosing evaluation of VPGI and Infective endocarditis which has been previously validated. It will be correlated with 18 FDG PET report to calculate sensitivity, specificity, negative and positive predictive value of PET scan in diagnosing endovascular infections.
IE according to location (True positives- as per criteria )

Results
•Referred with suspected IE ,Graft infections, endovascular infections and FUO- 158 cases.Analysed PET scan report – IE ,endovascular infections.
PET scan with positive/negative reports for endovascular infections was analysed with confirmed cases by Modified Dukes and MAGIC criteria to calculate sensitivity, specificity, positive and negative predictive value.53- Confirmed and possible IE.Of 53 , 44 positive in PET scan Sensitivity- 83.01%.PET scan done for 14 suspected cases Vascular graft infections. Sensitivity of 64.28%.Sensitivity is variable: excellent for the diagnosis of PVE and CDRIE-pocket infections, but poor for NVE and CDRIE-lead infections.

Conclusion
PET scan was found to be efficient diagnostic tool in endocarditis and vascular graft infection.Need prospective studies for validation in vascular graft inefctions

Disclosures
All Authors: No reported disclosures
P-926. A Comparative Analysis of Infection-Related Mortality and Relapse Rate: Restarting vs. Continuing Antibiotic Regimens in Endocarditis Patients Post-Cardiac Intervention
Authors: Al Safi Ali , Nichols Courtney , Hebert Courtney , Ma Jianing , Peng Jing , Sobhanie Mohammad Mahdee 
Published: January 2025

Abstract

Background
The duration of antibiotic therapy post cardiac intervention (PCI) for treatment of infective endocarditis (IE) remains controversial despite current clinical guidelines. There is paucity of data on the PCI antibiotic duration relating to pathogens, presence of an infected cardiovascular implantable electronic device (CIED), vegetation size, and duration of bacteremia. Due to these limitations, antibiotic therapy may be extended although the impact in clinical practice remains unknown.

Methods
This was a retrospective study comparing outcomes in patients with IE admitted to The Ohio State Wexner Medical Center who underwent valve replacement and/or CIED extraction from January 2013 to November 2017 based on whether the course of antibiotic therapy was restarted PCI (extended group) or if antibiotics prior to cardiac intervention were included in the total antibiotic duration (continuation group). Patients who completed the full course of antibiotics prior to cardiac intervention were excluded. The primary outcome was a composite of one-year infection-related mortality and IE relapse PCI. The proportional win-fractions regression model was used to compare the composite outcome between the groups.

Results
235 patients met study inclusion criteria, 182 in the extended group and 53 in the continuation group. Patient demographics are shown in table 1. 91.5% of patients had positive blood cultures (n = 215) with a median bacteremia duration of 4 days with the most common pathogen being Staphylococcus aureus as shown in figure 1. 79.6% of patients had OR cultures sent (n = 187) shown in table 2. The average antibiotic duration PCI was 39.7 days. 5 patients had bacteremia at the time of surgery. The study revealed no statistically significant difference between the two groups in the primary outcome (Win Ratio 1.59, CI: 0.80-3.15, p-value 0.18) shown in table 3.

Conclusion
For patients with IE requiring surgical intervention, the outcome of one year mortality and infection relapse was not significantly different between the two groups after adjusting for potential confounders. This study suggests that extending antibiotics may not be associated with improved survival or infection relapse, however prospective studies are needed to confirm these findings.

Disclosures
All Authors: No reported disclosures
P-927. Clinical Outcome of Ampicillin plus Ceftriaxone Compared to Nafcillin or Cefazolin plus Gentamicin as an Empirical Treatment for Infective Endocarditis
Authors: Kang Min Seo , Hwang Ji-won , Park Seung Woo , Peck Kyong Ran , Kim Jihoon , Kim Eun Kyoung , Park Sung-Ji , Yang Jinyoung , Cho Sun Young , Ko Jae-Hoon , Kang Cheol-In , Chung Doo Ryeon , Huh Kyungmin 
Published: January 2025

Abstract

Background
A combination of anti-staphylococcal penicillin or cefazolin and gentamicin has been recommended as an empirical treatment regimen for native valve or late prosthetic valve infective endocarditis (NV/LPVIE), while the recent European Society of Cardiology Guidelines proposed ampicillin plus ceftriaxone (AMP+CRO) as an empirical option. However, clinical data supporting either regimen are scarce.
Risk factors of composite outcome in a Cox proportional hazard model with overlap weighting.

Methods
A retrospective cohort study was conducted in a large tertiary care hospital. Adults aged ≥18 years who were diagnosed with NV/LPVIE by the modified Duke criteria from 2000 through 2022 were included. Patients were grouped by empirical antibiotic regimens including AMP+CRO versus nafcillin or cefazolin plus gentamicin (NAF/CFZ+GEN). Multiple logistic regression with overlap weighting was used to compare outcome between the two groups. Primary outcome was all-cause mortality or relapse within 6 months since diagnosis.
Survival probabilities by empirical treatment regimen. (A) Observed survival without relapse, (B) probability of survival without relapse in the Cox proportional hazard model with overlap weighting.

Results
A total of 172 patients were included and divided into two groups by the empirical antibiotic regimens of AMP+CRO (n=102) or NAF/CFZ+GEN (n=70). Both groups exhibited similar baseline characteristics, including underlying diseases, preexisting valvular conditions, and involved valves. However, diabetes, cardiovascular diseases, and congestive heart failure were more common in the AMP+CRP group. Viridans group Streptococcus was the most frequently identified pathogen (33.3%) who were administered AMP+CRP, while Staphylococcus aureus was the most prevalent pathogen in the NAF/CFZ+GEN group (42.9%). In the AMP+CRO group, 6 (5.9%) met the composite outcome compared with 6 (8.6%) in the NAF/CFZ+GEN group (P = 0.551). There was also no statistically significant difference in the risk of composite outcome between the two groups in a multivariable analysis with overlap weighting (adjusted odds ratio, 0.27; 95% confidence interval, 0.05–1.43; P = 0.125).
Factors associated with initial treatment with ampicillin + ceftriaxone in a logistic regression model

Conclusion
In the patients with NV/LPVIE, AMP+CRO as empirical antibiotic therapy showed no significant difference in the all-cause mortality or relapse within 6 months since diagnosis compared to NAF/CFZ+GEN. Our results suggest that AMP+CRO can be used as a primary empirical regimen for the treatment of NV/LPVIE.
Covariate balance before and after overlap weighting

Disclosures
All Authors: No reported disclosures
P-932. Re-classification of Endocarditis Diagnoses in Patients who Inject Drugs using the 2023 Duke-ISCVD Microbiologic Criteria
Authors: Henson David M , Alnabelsi Talal , Collis Bennett , Hall Evan , Stoner Bobbi Jo , El-Dalati Sami 
Published: January 2025

Abstract

Background
In 2023, the Duke Criteria for infectious endocarditis (IE) were modified for a second time. Many criteria were adjusted with significant changes to the microbiologic criteria, introduction of new imaging criteria, and greater clarity of predisposing conditions contributing to the IE diagnosis. The changes to the microbiological criteria included expanding the list of typical organisms and adding cultures from a sterile site as a possible minor criterion. Other studies have assessed the impact of the updated criteria on the diagnosis of IE in large patient subsets. However, none have evaluated the effect of the criteria on diagnosis specifically in patients who inject drugs.

Methods
Patients were identified through pre-existing data from a previous study and from the records of the institutional multidisciplinary endocarditis team. Charts of 237 patients with a preliminary classification as possible or rejected IE were reviewed by study investigators in the electronic medical record based on the 2000 modified Duke Criteria, the 2023 Duke-ISCVD Criteria, and for a history of intravenous drug use (IVDU).

Results
Between January 1st, 2017 and November 1st, 2023, 51 patients with possible or rejected IE by the modified Duke Criteria and a history of IVDU were identified. Seven (13.7%) were re-classified from possible IE to definite IE based on the 2023 Duke-ISCVD criteria. All upgraded diagnoses were secondary to the new microbiologic criteria. Three patients were re-classified due to Streptococcus agalactiae bacteremia. An additional patient was re-classified due to Staphylococcus epidermidis bacteremia in the context of intra-cardiac material. The remaining three patients were re-classified due to positive cultures from sterile sites other than blood. All three patients received antibiotics prior to blood culture collection.

Conclusion
Compared to the modified Duke Criteria, applying the 2023 Duke-ISCVD criteria for IE resulted in the re-classification in 13.7% of patients with a history of IVDU from possible or rejected IE to definite IE. All upgraded diagnoses were secondary to changes in the microbiologic criteria. The 2023 Duke-ISCVD criteria may lead to increased diagnosis of definite IE in patients who inject drugs.

Disclosures
All Authors: No reported disclosures
P-937. Clinicomicrobiological Risk Factors for Infective Endocarditis in Viridans Group Streptococci Bacteremia
Authors: Bae Jiyeon , Park Jae Hyeon , Lee Minkyeong , Jo Hyeon Jae , Lee Chan Mi , Kang Chang Kyung , Choe Pyoeng Gyun , Park Wan Beom , Kim Nam Joong , Kim Inho , Oh Myoung-don 
Published: January 2025

Abstract

Background
Viridans group streptococci (VGS) persist as the dominant cause of community-acquired native-valve endocarditis, contributing to 20% of cases. The incidence of streptococcal infective endocarditis (IE) exceeds that of Staphylococcus aureus IE, notably in Asia. However, the risk factors that guide the decision to conduct echocardiography to rule out IE in patients with VGS bloodstream infections (BSIs) remain unclear. Therefore, our study aimed to identify independent risk factors for IE in patients with VGS BSIs.

Methods
This retrospective study conducted at Seoul National University Hospital from January 2013 to December 2022 involved patients with VGS and nutritionally variant streptococcal BSIs, excluding single positive blood cultures and polymicrobial BSI cases. Independent risk factors were identified by multivariate logistic regression and sensitivity analyses according to echocardiography results, VGS species, or the inclusion of possible IE cases.
Proportions of infective endocarditis by viridans group streptococci species.
VGS species belonging to the mitis group are represented by the orange-coloured dots, and those in the non-mitis group are represented by the green-coloured dots. Circle size correlates with the number of IE cases attributed to each VGS species.

Results
Of 845 VGS BSI cases, 349 were analyzed and 86 IE cases were identified (24.6%). In the multivariate analysis, heart valve disease (adjusted odds ratio [aOR], 14.14, 95% confidence interval [CI], 6.14–32.58; P &lt; 0.001), persistent bacteremia (aOR, 5.12, 95% CI, 2.03–12.94; P = 0.001), age (per year, aOR, 0.98; 95% CI, 0.96–1.00; P = 0.015), solid cancer (aOR, 0.26, 95% CI, 0.13–0.53; P &lt; 0.001), and hematologic malignancy (aOR, 0.04; 95% CI, 0.01–0.41; P = 0.006) were independently associated with IE. Sensitivity analyses yielded consistent results; also, infection by a member of the mitis group was independent risk factor for IE (aOR, 6.50; 95% CI, 2.87–14.68, P &lt; 0.001).

Conclusion
Younger age, heart valve disease, persistent bacteremia, absence of underlying hematologic malignancy or solid cancer, and BSI by a member of the mitis group were the independent risk factors for IE in VGS BSI patients. In conclusion, regular echocardiographic evaluation could be prudently considered based on these clinicomicrobiological risk factors.

Disclosures
All Authors: No reported disclosures