bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-735. Acute Bacterial Skin and Skin Structure Infections: A Comparison of Outpatient One-Hour Infusion Oritavancin and Inpatient Vancomycin Use
Authors: Lindley William , Whittaker Cristen , Szymborski Shana , Reilly Joseph , Trivedi Manish 
Published: January 2025

Abstract

Background
Patients with acute bacterial skin and skin structure infections (ABSSSI) who present to the emergency department (ED) are commonly admitted for intravenous (IV) antibiotic treatment. At AtlantiCare Regional Medical Center (ARMC), oritavancin is utilized in the ED as a single 1200 mg dose to prevent ABSSSI admissions. The purpose of this study is to compare 30-day ABSSSI readmission rates between one-hour ED oritavancin infusion and inpatient vancomycin therapy transitioned to oral antibiotics. A financial assessment of both groups will also be presented.Table 1.Patient characteristics and outcomes analyzed via Student’s t-test or χ2 test.

Methods
Subjects with ABSSSI were included in this retrospective study if they were administered oritavancin in the ARMC ED between November 2022 and August 2023, or given IV vancomycin as an inpatient between January and August 2023. Data collection included patient demographics, history of ABSSSI, injection drug use, and length of stay (LOS). A financial analysis was performed based on diagnosis-related group (DRG) reimbursement and hospital-specific expenditures. Collected data were analyzed using a Student’s t-test or χ2 test as appropriate.

Results
A total of 191 patients were included in this study with 140 and 51 in the oritavancin and vancomycin arms, respectively (Table 1). The 30-day ABSSSI readmission rates were significantly lower in the oritavancin arm (n=8, 5.7%) compared to the vancomycin arm (n=10, 19.6%), p=.004. Amongst the 8 oritavancin readmissions, only 4 (2.9%) were considered oritavancin candidates based on our hospital protocol criteria which defines appropriate patients. The estimated cost after DRG-based reimbursement for a single patient in the vancomycin arm was approximately $10,300. The estimated cost avoidance for each oritavancin patient, not accounting for drug reimbursement or the subsequent decrease in readmissions, was approximately $7,240.

Conclusion
Oritavancin as a one-hour infusion in our ED appears to be an effective treatment option in preventing admissions and significantly decreasing 30-day ABSSSI readmissions. The financial benefits of preventing hospital admissions with single-dose oritavancin should be considered when treating ABSSSI patients in the ED setting.

Disclosures
Joseph Reilly, B.S., Pharm.D., Melinta Therapeutics: Advisor/Consultant
P-746. Characterizing Deep Neck Infections (DNI) at a Tertiary Care Center in Philadelphia with a High Population of People Who Inject Drugs (PWID)
Authors: Patel Kaya , Spivack Stephanie , Yan Flora , Thorntan Noah , Whitley Karl , Soliman Ahmed , Schultz Sara K 
Published: January 2025

Abstract

Background
Acute bacterial skin and skin structure infections (ABSSSI) including cellulitis and abscess are common complications of intravenous drug use (IVDU). With the widespread introduction of xylazine in the Philadelphia drug supply since 2019, more patients are injecting into their neck due to limited peripheral access from vein sclerosis or xylazine wounds. Herein, we have characterized DNI in PWID and their outcomes.
Figure 1
Injection behavior

Methods
The IRB approved this study. We conducted a retrospective chart review of patients with documented opioid use disorder (OUD) with injection behavior and a diagnosis of DNI from January 2016 through December 2022. We collected data on demographics, microbiology, drug use and treatment to characterize infection, surgical intervention, and outcomes.Figure 2.Substances used

Results
We identified 153 patients with OUD and injection behavior who were diagnosed with DNI. 80 (52%) patients were male and 73 (48%) were female. 101 (66%) were experiencing homelessness. 139 (91%) patients reported injecting into their neck and 25 (16%) patients reported using their neck as the only site of injection due to limited peripheral access. Figure 1. 83 (54%) endorsed polysubstance drug use with cocaine or amphetamines. Figure 2. Types of infection include: 131 (86%) neck abscess, 22 (14%) neck phlegmon, 14 (9%) internal jugular (IJ) septic thrombophlebitis, 3 (2%) sternoclavicular septic arthritis, 3 (2%) with mediastinal involvement, and 2 (1%) osteomyelitis (OM) of clavicle or mandible.
124 (81%) patients underwent drainage. 103 (83%) of these patients had cultures sent from the abscess. The predominant organisms were MRSA (47, 46%), MSSA (15, 15%), GAS (23, 22%), and alpha-hemolytic Strep (26, 25%). Figure 3. 137 (90%) patients had blood cultures sent, 115 (84%) without growth, 10 (7%) MRSA, 10 (7%) GAS, and 3 (2%) MSSA. 21 (17%) required repeat intervention. Within 30 days there were 48 (31%) readmissions and 1 (0.5%) death.Figure 3.Microbiologic data from abscess cultures

Conclusion
Since 2016, there has been a sixfold increase in incidence of DNI in PWID. Figure 4. The complications of neck infection can be catastrophic with extension into mediastinum, septic thrombophlebitis, bloodstream infections, or bone and joint infections. It is important to recognize neck infections early and intervene as soon as possible before further complications occur.
Figure 4. Neck abscess incidence

Disclosures
Sara K. Schultz, MD FACP FIDSA, AbbVie: Advisor/Consultant
P-748. Evaluation of Risk Factors for Short Inpatient Hospital Stays for the Treatment of Cellulitis
Authors: Orlikowski Cole , Schmidt Kyle , Jameson Andrew , Dumkow Lisa E 
Published: January 2025

Abstract

Background
Cellulitis is a common cause of hospitalization and imposes significant financial burden on healthcare systems. This study aimed to identify patient risk factors associated with short-stay hospitalizations for cellulitis with a goal to develop a dalbavancin protocol for use in the emergency department (ED) to mitigate short hospital stays.

Methods
A retrospective cohort study was conducted at a 350-bed community teaching hospital in Michigan evaluating adult patients diagnosed with cellulitis February 1, 2020 - August 1, 2023, who received initial treatment with monotherapy targeting beta-hemolytic streptococci or Staphylococcus aureus. Three cohorts were identified based on length of hospitalization or ED discharge. The primary outcome was to identify risk factors associated with short-stay (&lt; 72 hour) hospitalizations. Multivariate logistic regression was used to identify independent patient factors associated with short-stay hospitalization in contrast to long-stay (≥ 72 hours) or ED discharge. Patients were excluded if they required surgical intervention, received polymicrobial therapy, required ICU admission, received cellulitis treatment in the past 90 days, or were being treated for multiple infections.

Results
A total of 161 patients were included (ED discharge, n = 75; Short-stay, n = 46; and Long-stay, n = 40). Patient and treatment characteristics are summarized in Table 1. Logistic regression demonstrated that need for incision and drainage (I&D) (OR 7.23; 95% CI 1.69-38.04), Charlson Comorbidity Index ≥ 3 (OR 1.23; 95% CI 1.04-1.46), or presenting with fever (OR 31.62; 95% CI 5.67 – 596.30) were independent risk factors for short-stay hospitalization compared to ED discharge. Charlson Comorbidity Index &gt; 3 (OR 1.25, 95% CI 1.06-1.48) and purulent cellulitis (OR 4.29, 95% CI 1.22-15.38) were predictive of long-stay hospitalizations. Characteristics such as fever, recurrent cellulitis, history of MRSA, and BMI were not associated with longer hospital stays.

Conclusion
A protocol to evaluate ED patients with cellulitis for dalbavancin use could reduce unnecessary hospitalizations and healthcare cost. Patients with more comorbidities, purulent cellulitis needing I&D, and those with unstable vital signs may be less ideal candidates for ED dalbavancin use.

Disclosures
All Authors: No reported disclosures
P-769. A chromosome 4p14 locus associates with higher protection from Leprosy in close family contacts of Lepromatous Leprosy cases in endemic regions
Authors: Mitra Debdeep 
Published: January 2025

Abstract

Background
Leprosy presents as an infectious disease with intricate genetic and immunological underpinnings. Genetic variations affecting cytokine genes and immune receptors, such as Toll-like receptor 1 (TLR1), may influence disease susceptibility. Close family contacts of individuals with slit skin positive lepromatous leprosy face a notably heightened risk of transmission. It is crucial to implement rigorous screening and early intervention protocols to promptly identify and manage latent infections, thereby curtailing potential disease dissemination within households and communities.

Methods
We conducted a genome-wide association study involving close family contacts of individuals with positive slit skin smears for Mycobacterium leprae. Our study comprised 131 lepromatous leprosy patients from prospective cohorts in an endemic region. Genotyping was performed using real-time polymerase chain reaction (RT-PCR) on the 7500 Real Time PCR System, employing SNP genotyping assays for pre-selected SNPs (rs7842033 and rs4167826) with specific primers and probes corresponding to the SNP of interest.

Results
Two-locus analyses of association of variants near rs7842033 showed a haplotype comprised of rs977477 and an IL9 missense variant, rs943138945, had the most significant association (p = 1.26x10-12).Our results showed no association between the SNP rs4052176 in NOD2 and leprosy in this population.

Conclusion
Situated on chromosome four (4p14), the TLR1 gene encodes a receptor that identifies glycolipids and lipopolysaccharides of M. leprae, stimulating the transcription factor nuclear factor-kappa B (NF-kβ) and enhancing the expression of pro-inflammatory genes. This gene may confer a degree of protection to close contacts against Leprosy.

Disclosures
All Authors: No reported disclosures
P-799. Eravacycline in the Management of Nontuberculous Mycobacteria (NTM) Infections: A Single-Centre Experience
Authors: Koomanan Narendran , Yvonne Zhou Peijun , Andrea Kwa Lay Hoon , Chung Shimin Jasmine 
Published: January 2025

Abstract

Background
Ubiquitous in nature, nontuberculous mycobacteria (NTM) have been associated with a wide spectrum of clinical infections. Treatment often requires the use of multiple antibiotics for a prolonged course. However, due to inherent drug resistance & treatment-limiting adverse events (AE), clinical outcomes are often suboptimal. In vitro studies have suggested that eravacycline (ERV) might be an effective component of NTM treatment regimens. However, clinical studies showing its safety & efficacy are limited. Hence, this study aims to assess the safety & efficacy of ERV treatment in NTM infections.Table 1:Clinical Characteristics of Patients Receiving Eravacycline (ERV) for the Treatment of NTM Infections

Methods
A retrospective, single-centre observation study reviewing the electronic medical records of all patients prescribed at least 48 hours of ERV from May 22 to April 23 for the treatment of NTM infections was conducted. For each course of ERV, demographic, microbiological & clinical outcome data was collected. Efficacy outcomes included treatment outcome at end of therapy. Safety outcomes included presence of any AE that led to discontinuation of ERV.

Results
During the study period, 16 patients received ERV containing regimens for the treatment of NTM infections (Table 1). A majority (75%) were being treated for pulmonary NTM infections & M. abscessus was the most isolated mycobacterium (87.5%). Treatment consisted of ERV, in combination with 2-3 antibiotics, for a median duration of 30 days (IQR: 20.3-35.5 days). To facilitate outpatient antimicrobial therapy (OPAT), most patients were transitioned from 1mg/kg q12h to 1.5mg/kg q24h dosing, with half (50%) eventually completing treatments via OPAT. At the end of ERV therapy, all patients demonstrated clinical improvement. AE led to discontinuation of ERV in 7 (43.8%) patients & dose reduction in 2 (12.5%) patients. Gastrointestinal (GI) AE was most prevalent (8/9, 88.9%) with improvements observed in both patients with dose reductions. Despite the truncated therapy, clinical improvement was still observed amongst patients with AE.

Conclusion
ERV would bolster the armamentarium of antibiotics against NTM infections, especially with its OPAT compatibility. However, in our population, a considerable proportion could not tolerate ERV. Dose reduction maybe be considered to improve ERV tolerability.

Disclosures
All Authors: No reported disclosures
P-800. High prevalence of treatment initiation delays among people diagnosed with multidrug-resistant tuberculosis-Dushanbe, Tajikistan—2019-2021
Authors: Tilloeva Zulfiya H , Horth Roberta , Mirzoev Azamdjon , Sharifov Rajabali , Nabirova Dilyara , Pirmahmadzoda Bobochon 
Published: January 2025

Abstract

Background
Multidrug resistant TB (MDR-TB) incidence is increasing in Central Asia, especially in Tajikistan, which is among the top 30 high-burden countries. Delays in treatment initiation are associated with increased transmission and poor health outcomes. In Dushanbe, the capital, the numbers and characteristics of people experiencing treatment delays are unknown. This information was needed to improve treatment programs and reduce transmission.Table 1.Characteristics of people with confirmed pulmonary MDR-TB experiencing treatment delays, Dushanbe, Tajikistan, 2019-2021

Methods
We conducted a cross-sectional study of all persons, ages ≥15 years old, diagnosed with pulmonary MDR-TB in 2019-2021. We abstracted data in 2022 from the national electronic TB database OpenMRS. Treatment delay was defined as &gt;3 days from MDR-TB diagnosis to treatment initiation. MDR-TB confirmation was based on molecular tests (including line probe assay and GeneXpert) and phenotypic drug sensitivity tests. We calculated treatment delay percentage by group and percent difference and prevalence ratio; statistical testing is not applicable in our study, which captures the entire population.

Results
Of 100 people diagnosed with MDR-TB in 2019-2021, 6% had extensively drug-resistant (XDR) and 14% pre-XDR TB (Table 1). Also, 16% had diabetes, 8% had HIV, and 4% had hepatitis B and C. The median number of days from MDR-TB diagnosis to treatment initiation was 3 days (IQR: 1-7 days, Max: 225 days). Half (49%) experienced treatment delays. Proportion with delay was highest in 2020 (55%), the 1st year of the COVID-19 pandemic. Also, 2 of 6 people with XDR-TB, had delayed treatment. The proportion experiencing delay was 11% greater for males than females, 12% greater for older populations than younger, 15% greater for larger households ( &gt;7 people) compared to smaller (3 or less), and 17% greater for those primary/secondary compared university education. There was a 42% difference in the proportion of patients with delays between the district with the highest and lowest proportion of delay (60% and 18%, respectively).

Conclusion
Half of people diagnosed with MDR-TB had treatment delays, including people with XDR-TB. Our findings highlight the need for immediate interventions that reduce time from diagnosis to treatment initiation, especially in districts and population groups with highest proportion of delayed treatment.

Disclosures
All Authors: No reported disclosures
P-802. The Predictive Accuracy of Clinical Covariates in Differentiating Staphylococcus aureus Bacteremia with and without Deep-Seated Foci of Infection via Application of Different Variable Selection Methodologies
Authors: Brunton Amanda E , Strnad Luke 
Published: January 2025

Abstract

Background
Staphylococcus aureus bacteremia (SAB) is a common bloodstream infection with a mortality rate of 20-30%. SAB is frequently associated with deep-seated foci of infection (DSFI) for which IDSA/ESCMID draft guidelines propose using clinical features early in evaluation to risk stratify for DSFI. However, literature for using combinations of clinical features to identify DSFI is limited, and the best process of variable selection is not defined. We explored variable selection methods to identify a combination of clinical features with the best predictive accuracy for identifying SAB with DSFI.

Methods
242 adults admitted to a 500-bed teaching hospital in Portland, Oregon with incident SAB between January 1, 2016 and December 31, 2017 were included. Patients who died, transitioned to comfort or discharged before medically advised within 7 days, or without an infectious disease consultation were excluded. Clinical information was abstracted from electronic medical records. We performed four variable selection methods: best subset, forward and backward stepwise regression, and the LASSO. Variables were selected using 5-fold cross-validation. We estimated the area under the receiver operating curve (AUC) and fit a multivariable logistic regression model to evaluate the expected performance of the predictor combinations.

Results
The cohort is described in Table 1 and 2. SAB with one or more DSFI was diagnosed in 65% (n=158). Predictors selected by the four methods are described in Table 3. The combination of bacteremia duration, hospital acquired SAB (haSAB), central venous catheter (CVC), skin and soft tissue infection (SSTI), and any cardiac device had the highest predictive accuracy with an AUC of 82%. The odds of DSFI is estimated to increase by 32% (95% CI; 15% to 53%) for every 1 day increase in bacteremia after adjusting for haSAB, CVC, SSTI and any cardiac device (Table 4).

Conclusion
Duration of bacteremia, haSAB, and CVC were included regardless of the variable selection method. Our model shows that combinations of clinical features are more predictive of DSFI than any single feature. Larger studies in different cohorts are needed to verify the predictive accuracy of these variables used in combinations to risk stratify for SAB with DSFI.

Disclosures
All Authors: No reported disclosures
P-803. A 10-year Retrospective Analysis of Staphylococcus aureus Bacteremia in a Philippine Tertiary Hospital
Authors: Navarro Alfred Daniel M , Henson Karl Evans R , Abad Cybele Lara R 
Published: January 2025

Abstract

Background
Staphylococcus aureus is a frequent cause of bacteremia in community and health care settings. There is limited data on S. aureus bacteremia (SAB) in the Philippines. This study describes the demographic profile and clinical characteristics of adult patients with SAB and their association with in-hospital mortality.

Methods
Patients aged ≥ 18 years with SAB from 1/1/2013 to 12/31/2023 were reviewed for study inclusion. SAB was defined as at least one blood culture result positive for S. aureus. Clinical characteristics, comorbidities, sources of infection, and clinical outcomes were recorded. Stepwise regression analysis was performed using STATA 13.1.

Results
314 patients with SAB were included; over half were male (185/314, 59%) and majority (62.5%) had Methicillin Susceptible Staphylococcus aureus (MSSA) bacteremia. The most common comorbidities were diabetes mellitus (146/314, 46.5%) and end stage renal disease (92/314, 29.3%). Mortality was high at 24.5% (77/314). Deceased patients were significantly older than survivors (65.7 years vs 59.0 years, p = 0.004). Among deceased patients, pleuropulmonary and intravascular catheter-related infections were the most common sources of infection comprising 29/77 (37.7%) and 12/77 (15.6%), respectively. Most patients (252/314, 80.3%) were referred to infectious diseases (ID) specialists. Clinical factors significantly associated with in-hospital mortality in the bivariate analysis included older age (OR=1.02, 95% CI 1.01-1.04), active malignancy (OR=3.25, 95% CI 1.68-6.26), hepatic failure (OR=3.25, 95% CI 1.01-10.51), hospital-acquired SAB (OR=3.97, 95% CI 2.09-7.53), septic shock (OR=54.0, 95% CI 7.2-404), and ICU admission (OR=22.17, 95% CI 9.16-53.69). In the multivariate regression model, hospital-acquired SAB (OR = 3.79, 95% CI 1.05 – 13.72, p = 0.002) and septic shock (OR = 1972.07, 95% CI 120.25 – 32339.3, p = &lt; 0.001) increased the odds of in-hospital mortality, while referral to ID was protective (OR=0.11, 95% CI 0.01 – 0.90, p = 0.40).

Conclusion
The high mortality rate of SAB in this study is comparable to published data. Hospital-acquired SAB and the presence of septic shock significantly affect in-hospital mortality. Referral to ID specialist is associated with improved survival.

Disclosures
Karl Evans R. Henson, MD, FIDSA, BSV Biosciences: Honoraria|Cathay Drug Company, Inc: Grant/Research Support|MSD: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria
P-804. Shorter vs. Longer Duration of Antibiotics in Pediatric Uncomplicated Gram Negative Bacteremia
Authors: Wesolowski Alec , Fernandez Marisol , Gilroy Kavitha 
Published: January 2025

Abstract

Background
Guidelines for uncomplicated gram negative bacteremia recommend 7-14 days of antibiotics; however there is limited pediatric evidence on duration of therapy. Studies in adult patients support a shorter duration of treatment and earlier transition to oral antibiotics. The primary objective of this study was to describe the local practice of a free standing children’s hospital in treating uncomplicated gram negative bacteremia in pediatric patients.

Methods
This single-center, retrospective study included pediatric patients from January 2022 to December 2023 with uncomplicated gram negative bacteremia. Those with chronic medical conditions, immunocompromised status, and polymicrobial bacteremia with mixed gram positive and gram negative organisms were excluded. Short-course antibiotic duration was defined as 7-10 days and long-course antibiotic duration was defined as &gt; 10 days. Outcomes assessed included recurrent infection, readmission, length of stay, and adverse events between the two groups.

Results
156 positive blood cultures were identified and 31 patients met inclusion criteria. 16 patients had a total antibiotic duration of 7-10 days (mean 7.8 days) compared to 15 patients with an antibiotic duration &gt;10 days (mean 14.6 days). The average length of hospitalization was 6.8 days in the 7-10 day group and 14.2 days in the &gt;10 day group. The primary organism identified was E. coli (64.5%) from a urinary source (77.4%) with a majority of patients transitioning to oral antibiotics (61.3%) to complete therapy. Neither group developed a recurrent infection within 30 days; however, 3 patients in the &gt;10 day group had a readmission within 30 days. More adverse events occurred in patients that received a longer duration of therapy (20%) vs those that received a shorter duration of therapy (6.3%).

Conclusion
7-10 days of total antibiotics may be appropriate in immunocompetent pediatric patients with uncomplicated gram negative bacteremia. Shorter duration of antimicrobial therapy is associated with decreased length of hospitalization and fewer adverse reactions without increased risk of recurrent infection.

Disclosures
All Authors: No reported disclosures