bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-149. Clinical Profile and Antimicrobial Resistance Patterns of Salmonella Infection in Guatemala City
Authors: Elisa Rosales Ana , Barrios Andrea , Orozco Jarleny , Valenzuela Laura , Rodriguez Luis , Erdmenger Diego 
Published: January 2025

Abstract

Background
Salmonella infection is the second most common food-borne disease worldwide, causing over 155,000 deaths per year. Infection rates in low- and middle-income countries surpass those of high-income countries.
Several risk factors have been associated with higher mortality rates due to Salmonella infection, such as age, HIV infection, and antimicrobial resistance.
Although frequent in Central America, few data on risk factors associated to invasive Salmonellosis and mortality are available in the region.
Population General Characteristics

Methods
A retrospective cohort study was conducted at a third-level reference hospital in Guatemala City from 2022 to 2023. All cases of Salmonella infection identified through blood and stool cultures were included and evaluated for clinical factors and interest outcomes. Antimicrobial resistance patterns were identified according to the Clinical and Laboratory Standard Institute (CLSI) guidelines.
Clinical characteristics associated with mortality

Results
A total of 15 confirmed cases of Salmonella infection were identified. The mean age of the patients was 37.8 years (SD = 17.8). The majority of were male (86.6%). Over 73% had at least one comorbidity, with HIV being the most frequent, followed by chronic alcohol consumption.
The most common presentation included fever, diarrhea, and abdominal cramps. Only 6.6% of patients reported constipation. Over 46% of strains exhibited at least one mechanism of resistance, with 40% of showing resistance to fluoroquinolones, suggesting the presence of a GyrA-ParC phenotype.
The most common complication identified was Acute Kidney Injury in 46.6% of cases, with Hemolytic Uremic Syndrome present in 13.3% of cases. The overall mortality rate due to salmonellosis was 26.6% (Table 1).
Age over 50 years, sex, HIV infection, and ESBL resistance were significantly associated with in-hospital mortality, after adjusting for other clinical variables (Table 3).
Adjusted variables associated with mortality

Conclusion
The study identified a higher resistance to fluoroquinolones and case-mortality compared to other reports in the region. Although ESBL-producing strains were rare in the study, this resistance pattern was significantly associated with mortality due to salmonella infection. The uncontrolled use of antibiotics in the country may present as a major concern in the future treatment and management of salmonellosis.

Disclosures
All Authors: No reported disclosures
P-154. Malaria In Tunisia : Eradicated Or Still Endemic ?
Authors: Hammami Fatma , Rekik Khaoula , Smaoui Fatma , Chakroun Amal , Marrakchi Chakib , Koubaa Makram , Ben Jemaa Mounir 
Published: January 2025

Abstract

Background
Although malaria has been eradicated in Tunisia since 1979, our country remains exposed to the potential risk of resurgence. We aimed to study clinical, laboratory and therapeutic features of malaria.

Methods
We conducted a retrospective study including all patients hospitalized in the infectious disease department for malaria between 2000 and 2022.

Results
We encountered 92 cases, among whom 85 were males (92.4%). The mean age was 30±11 years. Fifteen patients received malaria chemoprophylaxis (16.3%). Returned travellers developed symoptoms after 10[5-25] days of returning home. Countries involved in importation were Ivory Coast (31.5%), Mauritania (8.9%) and Senegal (6.5%). The revealing symptoms included fever (90.2%), chills (87%), cephalalgia (79.3%) and diarrhea (26.1%). Arthromyalgia and vomiting were noted 46 cases (50%), each. Thrombopenia (65.2%), elevated C-reactive protein levels (43.5%), lymphopenia (39.1%), anemia (31.5%) and hepatic cytolysis (27.1%) were reported. There were 23 cases of severe malaria (25%). Palsmodium falciparum was identified in 68 cases (74%) and Plasmodium vivax in 8 cases (8.9%). Gametocytes were detected in 8.9% of the cases. Patients were treated with artemether/lumefantrine (71.7%) or quinine (19.6%). The disease evolution was favorable in 90 cases (97.8%). Apyrexia was noted after 2±1 days of treatment. Two patients were dead (2.2%).

Conclusion
Travellers to malaria endemic countries should be aware of the risk of malaria in order to follow preventive measures and to promptly consult in case of symptoms. An early diagnosis followed by the adequate treatment might prevent severe forms and death.

Disclosures
All Authors: No reported disclosures
P-168. Antimicrobial Resistance Patterns at a Private Referral Hospital in Blantyre, Malawi
Authors: Cappiello Matthew , Lim Lindsay S , Rambiki Tadala , Chala Dosso Kalkidan , Felix Mandala Freedom , Infante Juan , Liu Eugene W 
Published: January 2025

Abstract

Background
Antimicrobial resistance (AMR) is expected to be a global health security risk in Africa in coming decades. While AMR data is available from Malawi public hospitals, data from Malawi’s burgeoning private hospital sector is limited.
Initial Hospital Antibiogram Data, Fall 2021 - Spring 2022

Methods
An antibiogram was obtained for clinical blood and urine cultures from October 2021 through April 2022 at a private referral hospital in southern Malawi (n=684). Logistic regression was used to assess for patient-related determinants of AMR, as well as effects on patient outcomes.
Tests of Association for AMR Determinants

Results
High AMR rates were seen in E. coli (37.4% ceftriaxone, 35.8% ciprofloxacin, 32.5% trimethoprim), as well as unexpected carbapenem resistance (7.4% of tested isolates). Statistically significant tests of association linked both fluoroquinolone (X2 = 4.91, p=0.027) and third-generation cephalosporin resistance (X2 = 3.67, p=0.05) to patients who had increased numbers of antecedent hospital encounters. Fluoroquinolone resistance was associated with increased risk for acute-care follow up within 30 days of antibiotic prescription (X2 = 4.73, p=0.03). Third-generation cephalosporin resistance (suggestive of ESBL production) showed association with older age (X2 = 20.009, p=&lt; 0.001) and female gender (X2 = 5.58, p=0.018) A multiple logistic regression model examining variables associated with ceftriaxone-resistant Enterobacterales showed increased risk of patient death (OR 5.99, CI 1.37–26.17, p=0.017), as well as higher Charlson comorbidity index (OR 1.14, CI 1.02-1.28, p=0.024).
Over 40% of patients with culture-positive results were treated empirically, without follow up for review of sensitivities. Choice of empiric antibiotic differed from national guidelines, with only 32% UTI patients and 8.4% pharyngitis patients receiving recommended first-line regimens. Local point-prevalence data sometimes appeared to be discordant with national data. As one example, all three recommended cystitis regimens on national formulary guidelines displayed &gt;=30% resistance rates on local antibiogram data, including ciprofloxacin, nitrofurantoin, and cefuroxime.
Logistic Regression for Determinants of ESBL Enterobacterales
Multiple logistic regression model

Conclusion
Further research needs to assess best practices for stewardship in regional private hospitals, as well as determinants for AMR that encompass markers of healthcare utilization.
Demographic Descriptive Statistics

Disclosures
All Authors: No reported disclosures
P-171. Epidemiology of Carbapenem-Resistant Gram-Negative Organisms across sites participating in CDC’s Global Action in Healthcare Network-Antimicrobial Resistance Module — Ethiopia, Greece, and India, October 2022-February 2024
Authors: Robinson Matthew 
Published: January 2025

Abstract

Background
A rising burden of carbapenem-resistant Enterobacterales (CRE) worldwide, in particular CRE producing plasmid-encoded carbapenemases (CPOs), has prompted global concern for rapid spread of resistance and difficult to treat infections. Data from low- and middle-income countries characterizing CRE is limited. CDC’s Global Action in Healthcare Network – Antimicrobial Resistance Module aims to prevent, detect, and respond to CP-CRE in healthcare settings.

Methods
CRE clinical isolates identified by antimicrobial susceptibility testing across select high-risk, inpatient, and outpatient settings in 8 hospitals in Ethiopia, Greece, and India were tested for carbapenemase production with modified carbapenem inactivation method and/or identification of KPC, NDM, VIM, IMP, and OXA-48-like carbapenemases using lateral flow assays (Greece and India) or KPC, NDM, VIM, and OXA-48-like using real-time polymerase chain reaction (Ethiopia).
Distribution of carbapenemase detection by country, Enterobacterales (N = 3,497) — Ethiopia, Greece, and India, October 2022-February 2024

Results
During October 2022– February 2024, 14,078 Enterobacterales isolates in 3 countries were evaluated for carbapenem resistance; 3,060 (22%) were carbapenem resistant (Table). Carbapenem resistance was common across settings for Klebsiella pneumoniae (42-54%) but was lower and more variable for Escherichia coli (1-27%) and Enterobacter cloacae complex (7-31%). Testing for carbapenemase production and/or mechanism was performed for 3,497 CRE isolates, which identified carbapenemase production or a mechanism in 3,239 (93%) of CRE isolates. Among CRE tested for carbapenemases, the most common carbapenemases identified were KPC in Greece and NDM in India and Ethiopia; multiple carbapenemases were identified in 793 (24%) of carbapenemase producers (Figure).

Conclusion
In this global cohort, the majority of CRE tested for carbapenemase production were identified as carbapenemase-producing and the dominant carbapenemase detected by species varied by country. Collaboration, coordinated action, and innovative strategies are needed to both reduce spread of these highly resistant organisms in endemic settings and increase preparedness to prevent emergence and spread of novel carbapenem resistance mechanisms in the future.

Disclosures
All Authors: No reported disclosures
P-217. Risk Factors Associated with Clostridioides difficile Infection and Mortality in a Referral Hospital in Nicaragua
Authors: Balitán-Amoreti Carlos , Marenco-Avilés Sunaya , Porras-Cortés Guillermo D 
Published: January 2025

Abstract

Background
Clostridioides difficile infection (CDI) is one of the main problems among healthcare-associated infections. Some studies report an increase in the incidence of this infection causing enterocolitis in hospitalized patients and eventually being associated with various complications, mortality, and increased hospital costs. The data about the epidemiology and outcomes of CDI in Nicaragua are insufficient. The aim of this study was to determine risk factors associated with CDI infection and mortality in patients admitted to a referral hospital (Dr. Fernando Vélez Paiz Hospital) in Managua, Nicaragua.Table 1.Clinical Factors Associated in Patients with and without Clostridioides difficile Infection

Methods
It is an analytical nested cohort study. A total of 150 patients hospitalized in different services of the hospital between January 2020 and December 2022 and who started with in-hospital diarrhea (defined as the absence of pre-existing diarrhea prior to hospitalization and onset 72 hours after admission to the hospital) were included. Of the150 patients, 50 were defined as CDI cases and 100 as controls without CDI. The diagnosis of CDI was made by molecular method (real-time RT-PCR) using Xpert C. difficile®. Differences between cases and controls were analyzed.Figure 1.Comparative Mortality Rate in Patients with and without Clostridioides difficile Infection

Results
The mean age of the patients was 52.8±18.7 years-old, 52% were men, and 50% had an associated chronic disease. A higher proportion of patients with CDI had a history of antibiotic use (98% vs 52%, p&lt; 0.001), use of proton pump inhibitors (46% vs 25%, p=0.009), previous hospitalization (94% vs 46%, p&lt; 0.001), and previous surgery (64% vs 25%, p&lt; 0.001) (Table 1). Mortality in patients with CDI was 20% vs. 11% in controls (Figure 1). In the univariate analysis, the risk factors for CDI were the classic ones, such as previous use of antibiotics (ceftriaxone, quinolones, clindamycin), previous hospitalization, previous surgery, and use of proton pump inhibitors. The multivariate analysis found that previous use of ceftriaxone (OR: 6.40; 95%CI: 2.09–19.59) and clindamycin (OR: 3.0; 95%CI: 1.01–8.92) were significantly associated with CDI (Table 2). Regarding mortality, a significant association was found with age over 60 years-old (OR: 4.33; 95%CI: 1.02-18.41).Table 2.Risk Factors in Multivariate Analysis for Clostridioides difficile Infection and Mortality

Conclusion
Prior use of ceftriaxone and clindamycin are independent risk factors for CDI. Patients with CDI over 60 years-old have a higher risk of mortality.

Disclosures
All Authors: No reported disclosures
P-224. Accurate Clostridioides difficile Ribotype Prediction from Whole Genome Sequencing Data Using Machine Learning
Authors: Qi Peng , McKay Susannah , Paulick Ashley , Vlachos Nick , Adamczyk Michelle , Friedman Bree E , Weber Bonnie , Gargis Amy , Halpin Alison L 
Published: January 2025

Abstract

Background
Clostridioides difficile is a healthcare-associated pathogen recognized as the most common cause of infectious diarrhea in healthcare settings. PCR-based ribotyping, which employs heterogeneity of the ribosomal intergenic spacer region for discrimination, has historically been the preferred method for C. difficile typing. However, ribotyping is laborious and exhibits inter-laboratory variation which significantly limits its utility as a universal typing scheme.
The increasing adoption of whole genome sequencing (WGS) provides the opportunity for universal prediction of ribotypes (RTs) from WGS data. Machine learning (ML) offers the opportunity to predict RTs from genomic features which are more amenable to reliable resolution by WGS analysis than the repetitive sequences which define RTs.

Methods
Here we employed 8 different ML models using a dataset of 2,283 C. difficile isolates collected through surveillance activities (2012-2018) with both CDC’s capillary-based PCR-ribotyping and whole genome multi-locus sequence type data (6,786 loci; BioNumerics v7.6). The dataset was divided into training (75%) and testing (25%) sets to train and test each model. Models were improved with hyperparameter tuning. Accuracy was calculated from the predicted RTs compared to the PCR-based RTs of the test set. We combined the top three models based on probability distribution of correct/incorrect predictions to enhance performance. The final model was applied on WGS data for 2,194 isolates collected during 2019-2020.

Results
The top performing models were Support Vector Machine (linear kernel) (93.2% accuracy), Xgboost (92.6%), and Logistic Regression (92.6%). The final combined model achieved 94.3% accuracy overall with 44/51 RTs reliably predicted (99.2%). Three RTs could not be reliably predicted (64.0%); one RT could not be predicted due to the insufficient number of isolates available in the dataset. Application of the final model on the 2019-2020 dataset reliably predicted 93.2% (1816/1948) of RTs called; 11% of isolates lacked a RT call.

Conclusion
Use of ML on WGS data shows promise as a universal method for accurate C. difficile RT prediction and thus for identifying clinically important strains while providing an important bridge to connect WGS with historical RT trends.

Disclosures
All Authors: No reported disclosures
P-226. Assessing the Risk Factors for Catheter Related Bloodstream Infections (CRBSI) among Cancer Patients with Long Term Central Venous Catheters (LCVC) for Implementing Preventive Interventions
Authors: Haddad Andrea , Wilson Dib Rita , Chaftari Anne-Marie , Jiang Ying , Moussa Mohammad , Dagher Hiba , Philip Ann , Hachem Ray Y , Raad Issam I 
Published: January 2025

Abstract

Background
Catheter Related Bloodstream Infection (CRBSI) remains a leading cause of morbidity, mortality, and escalating costs in cancer patients with LCVC despite advancements in medical care and the implementation of BSI bundle. Several risk related studies have been published in cancer patients but did not include strict definition of CRBSI and relied on Central Line-Associated Blood Stream Infections (CLABSI) definitions in the setting of Mucosal Barrier Injuries (MBI) which might be emerging from the gut rather than the catheter. Our study aims at determining specific subgroups of cancer patients who are most susceptible for CRBSIs to determine the potential effectiveness of preventive interventions such as catheter locks.
Independent predictors of CRBSI by multivariate logistic regression analysis

Methods
We retrospectively reviewed cancer patients with indwelling LCVC that remained in place for at least 3 weeks between 2018 and 2022. By simple random sampling, we compared 200 patients who developed a definite CRBSI to 400 patients who did not. A definite CRBSI was defined according to the stringent criteria by the Infectious Diseases Society of America.

Results
Among cancer patients with CRBSI, 82% had hematological malignancy. Over 50% of the catheters had 2 lumens. Patients with CRBSI were more likely to receive blood products through the catheter (81% vs 45%, p&lt; 0.0001). The median time from catheter insertion to CRBSI was 51 days. Of the identified pathogens causing CRBSI, 62% were gram positive bacteria, 37% gram negative bacteria and 2% candida. By multivariate logistic regression analysis, the leading independent significant risk factors were the presence of multiple catheters in place, neutropenia, allogeneic transplants, followed by blood product administration, multiple catheters inserted within the past year, and basilic site insertion (table 1).

Conclusion
Cancer patients with LCVC are susceptible to CRBSI, particularly those who are neutropenic, had allogeneic transplants, have multiple catheters, received blood products, or had basilic site insertion. Effective preventive interventions such as antimicrobial locks and antimicrobial catheters with prolonged activity should be primarily implemented in these highest risk populations.

Disclosures
All Authors: No reported disclosures
P-232. Reduction in Catheter-associated Urinary Tract Infections (CAUTIs) Post-Implementation of External Urethral Catheters (EUC) in the Intensive Care Units at a Quaternary Medical Center
Authors: Bchech George , Bangash Salman , Noonan Joseph , Gill Arshpal , Rothman Ryan , Abalos Charmaine Clarisse D , Betancourth Adriana C , Young Meilin , Bhanot Nitin 
Published: January 2025

Abstract

Background
Catheter associated urinary tract infections (CAUTIs) have significant clinical and financial impact on the US healthcare system. In a systematic review published in 2018, the attributable cost of a CAUTI was estimated to exceed $1000 (1). Indwelling urinary catheters increase risk for CAUTIs proportionate to the length of catheter use (figure 1). External Urethral Catheters (EUC) have the potential to reduce risk of CAUTIs. We conducted this quality improvement project to study the impact of EUC use on CAUTIs in the ICUs at our institution.
Figure 1. Length of Foley Catheter placement to CAUTI by organisms.

Methods
EUC use was introduced in female (F) and male (M) patients since July 2018 and November 2021, respectively at our hospital. In this retrospective review, cases of CAUTIs were reviewed pre and post implementation of EUCs; in F from Jan 2015 to Jan 2021 and in M from Nov 2019 to Nov 2023 in patients admitted to the ICUs. National Healthcare Safety Network (NHSN) definition for CAUTIs was utilized for this project. Additionally, information on pathogens implicated in these infections was obtained.
Figure 1: Distribution of organisms in Female population

Results
There were a total of 157 CAUTIs noted in the study period; of the 132 F cases, 95 cases occurred pre and 37 cases post EUC implementation (RR 2.5 & RRR 61%). Of the 25 M cases, 15 cases were in pre and 10 cases post (RR 1.5 & RRR 33%) EUC use. Overall, there was an absolute risk reduction of 0.402. E.coli was the most common pathogen in both males (24%) and females (47%). There was an overall higher incidence of Enterococcus spp in the male population (20%) when compared to the female population (11.4%) (Figure 2&3).
Figure 3: Distribution of organisms in male population

Conclusion
Nosocomial infections are well described as a burden for ICU patients, but the results of this study demonstrate that there are possible interventions to mitigate CAUTIs. Clinicians and nursing staff should evaluate the need for indwelling urinary catheters on a daily basis. Favoring placement of EUC over indwelling urinary catheter has the potential to significantly reduce the burden of this disease.

Figure 4: Total case pre and post implementation of EUC.

Disclosures
All Authors: No reported disclosures
P-245. Not in the Bundle: Mitigating Central Line-Associated Bloodstream Infections in the Trauma ICU through Central Line Access Restriction
Authors: Pustorino Thomas , Keller Marina , Palazzo Jamie , Mikaya Charmaine , Quinn Moira , Yezzo Phyllis , Prabhakaran Kartik , Chen Donald S , Kennedy Stephanie , Anekwe Chinwe 
Published: January 2025

Abstract

Background
Central line-associated blood stream infections (CLABSI) pose a significant threat in healthcare. The CDC CLABSI reduction bundle focuses primarily on optimizing line insertion and has few recommendations addressing line maintenance. This ignores most of the line’s lifespan and risk for infection.

Methods
The single center observation study sought to reduce risk for CLABSI by focusing on central line maintenance and access within a Trauma Intensive Care Unit (TICU). Nurse epidemiologists observed front line staff and noted that many central lines had a long dwell time and were accessed multiple times a day. In order to reduce the number of line accesses, a process was instituted where blood draws were preferentially obtained via peripheral blood draw or arterial line. Education regarding line maintenance and proper line access technique was reviewed and reinforced. Compliance with this process was prospectively monitored.

Results
From February 2021 to February 2022, the TICU experienced a surge of 9 CLABSIs with all the lines having an extended dwell time of 5-147 days (mean 69 days). Of these patients, 4 were receiving total parental nutrition and 4 were undergoing dialysis (Table 1). Over the summer of 2022, education was used to change practice in the TICU and stop bloodwork drawing from central lines. After the process change, no CLABSIs were reported for over 24 months, until March 2024 (Figure 1). To sustain progress, a line access audit and blood draw audit were developed to ensure vigilant hand hygiene and scrub-the-hub technique were implemented and to ensure that blood draws were not obtained from central lines. As of March 2024, &gt;95% of blood draws were not obtained from central lines decreasing line access. Job aid cards were developed to teach and reinforce how to critically evaluate blood draws (Figure 2).

Conclusion
The study underscores the likely connection between blood draw practices and risk for line contamination. Minimization of central line access can decrease the chance of line contamination; avoiding blood draws are an effective way to radically reduce line access and bring CLABSI rates to zero.

Disclosures
All Authors: No reported disclosures