bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-722. Troponin I Levels on Admission as a Predictor of Clinical Outcomes in Respiratory Viral Infection
Authors: Sherchan Robin , Morones Rosalba Gomez , Covarrubias Gonzalez Miguel A , Morales-Aseff Daniela , Aguayo-Millan Claudia , Arellano Lopez Alonso Benjamin , Martinez Felipe Salinas , Goldin Evan , Beenhouwer David , Rodriguez-Barradas Maria C 
Published: January 2025

Abstract

Background
Cardiac troponin I (Tn) is a biomarker for myocardial injury, often elevated in acute coronary syndrome (ACS), sepsis, and acute respiratory viral infection (ARI). The significance of elevated Tn in patients admitted with ARI is not clear. We evaluated readmission due to cardiovascular (CV) events (ACS, heart failure (HF), or stroke) and all-cause mortality in hospitalized ARI patients with elevated Tn on admission.

Methods
This is a 2-VA site sub-study of SUPERNOVA (Surveillance Platform for Enteric and Respiratory Infectious Organisms in the VA), that included patients with positive nasopharyngeal viral polymerase chain reaction and Tn obtained within 48 hours of admission during 3 ARI seasons (S): S1, 10/2016-9/2017; S2, 10/2017-9/2018; and S3 11/2021-1/2022. Outcomes assessed were 30, 90, and 365-day all-cause mortality and 365-day readmissions due to CV events.

Results
450 patients were included with &gt;90% males. The mean age (years) and Charlson Comorbidity Index (CCI) for elevated Tn and normal Tn groups were 71 and 67, and 6.5 and 5.1, respectively. Rhinovirus (22%) and Influenza A (20%) were the predominant viruses in the first two seasons. All S3 patients had SARS-CoV-2 (34%) (Table 1). The elevated Tn group had significantly higher 90-day mortality in S1 and S3, and 365-day mortality in S3 (Table 2). For all seasons combined, the elevated Tn group had significantly higher 90-day mortality (17% vs 6%), 365-day mortality (26% vs 16%), and higher HF readmissions (18% vs 7%) than the normal Tn group (Table 3). When adjusted for CCI, the difference was not significant for 365-day mortality (p=0.29), but the composite outcome for 365-day mortality and readmission for HF (40% vs 22%) remained significant (p=0.02). The 365-day mortality was not significantly different for the elevated Tn group across seasons.

Conclusion
ARI patients with elevated Tn had a higher risk of all-cause mortality and HF readmission within one year, which remained statistically significant after adjustment for comorbidities for the 90-day mortality and HF readmission. The composite outcome of 365-day mortality and HF readmission was significantly higher in the elevated Tn group. These findings underscore the prognostic value of Tn in predicting CV and mortality outcomes in hospitalized patients with ARI.

Disclosures
All Authors: No reported disclosures
P-736. No Air Don’t Care: Lack of gas on imaging is associated with a longer time to surgical intervention in patients with necrotizing fasciitis
Authors: Stevens Amanda , Salar Aveen , Silva America , Huang Alex , Touleyrou Lauren , Dhar Sorabh , Monday Lea 
Published: January 2025

Abstract

Background
Although necrotizing fasciitis is a life-threatening infection, initial symptoms may be non-specific. The presence of gas on plain X-ray or computed tomography scan can be diagnostic, but is missing in up to 1/4 of cases.Figure 1.Stratification of patients with necrotizing fasciitis

Methods
We performed a retrospective cohort study of adult patients admitted in 2022-2023 with necrotizing fasciitis (diagnosis code M72.6) at an urban level 1 trauma center, who received surgical intervention, and at least 1 dose of linezolid or clindamycin in addition to other antibiotics. Patients transferred from an outside hospital, who had no imaging results, or no surgical intervention were excluded. Patients with and without gas on initial imaging result were compared (Fig1). Primary outcome was whether a lack of gas on imaging correlated with longer time to surgical intervention. Time 1 was defined as the time radiographic images were attested, or the time of surgery consult (whichever was later). Time 2 was the documented operating room (OR) surgical start time. Clinical and microbiologic outcomes were also recorded.Table 1:Characteristics of patients with necrotizing soft-tissue infection with and without gas on initial imaging

Results
79 patients were included in the analysis (60 and 19 patients with and without gas on imaging, respectively). Cohorts were evenly matched in terms of illness severity and comorbidities, except that patients without gas on imaging were more often female (P=0.014) with higher rates of CPK elevation (P=0.033) (Table 1). Site of infection did not differ between groups (Fig2), nor did microbiologic OR culture results (figure not included, P=0.105). Patients without gas on imaging had significantly longer time to OR compared to those with gas (median 15.7 verses 4.3 hours, respectively, P=0.0128) (Figure 3a). Length of stay, repeat trips to OR, and mortality did not differ between groups, however, patients without gas had high rates of readmission (P=0.041) (Fig3b).

Conclusion
Almost a quarter of necrotizing fasciitis patients presented without gas on initial imaging result. Despite having a similar degree of illness and poor prognostic laboratory parameters, these patients had a significantly longer time to OR compared to those with gas on initial imaging. Infectious diseases physicians should strive to provide valuable insight to our surgical colleagues for a syndromic approach to this illness regardless of the imaging results.

Disclosures
All Authors: No reported disclosures
P-740. Prevalence of Methicillin-Resistant Staphylococcus Aureus and Pseudomonas in Wounds of Patients with Substance Use Disorder
Authors: Yang Jerry , Traver Edward C , Tung Chih Chun , Harris Anthony , Baghdadi Jonathan 
Published: January 2025

Abstract

Background
Wound infections among patients with substance use disorder are frequently treated with empiric antibiotic coverage for Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. To guide appropriate empiric antibiotics, we evaluated the prevalence of these pathogens in the wounds of patients with substance use disorder using a large database.Table 1.Prevalence of Pathogens in Wound and Non-Wound Clinical Cultures from Patients with Substance Use Disorder in a Large Administrative Database

Methods
Encounters between January 2019 and March 2021 for patients with substance use disorder in the Premier Healthcare Database were identified by current or previous diagnosis code for opioid use, current or previous prescription of medications for opioid use disorder, or a diagnosis of Hepatitis C under the age of 55. Clinical cultures from any specimen besides stool were included.

Results
Overall, 18,797 clinical cultures were collected during 10,720 encounters for patients with substance use disorder at 119 hospitals. 516 cultures from 378 encounters at 23 hospitals were explicitly labeled as being collected from wounds. Results from wound and non-wound clinical cultures are provided in Table 1. 426 wound cultures (83% of 516) demonstrated Gram-positive organisms, 230 (45%) demonstrated Gram-negative organisms, and 278 (54%) were polymicrobial. The most common organism identified was Staphylococcus aureus (n=252, 49% of wound cultures), 64% of which was MRSA. Pseudomonas was identified in 35 wound cultures (7%).

Conclusion
Wound cultures from patients with substance use disorder are frequently polymicrobial. Though MRSA is extremely common, Pseudomonas is rare. Empiric antibiotic coverage of Pseudomonas should not be automatic.

Disclosures
Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor
P-743. Correlating Climate Conditions with Pseudomonas aeruginosa Prevalence in Diabetic Foot Infections within the United States
Authors: Winski Rebecca , Mergenhagen Kari A , Chan Arthur , Xu Jiachen , Wattengel Bethany A 
Published: January 2025

Abstract

Background
Diabetes-related foot infections (DFIs) are often difficult to treat and can result in amputation or even death if allowed to progress. The 2023 ‘International Working Group on the Diabetic Foot (IWGDF)/Infectious Disease Society of America (IDSA) Guidelines on the Diagnosis and Treatment of Diabetes-Related Foot Infections’ provides recommendations on which pathogens to target with empiric antibiotic therapy depending on which solar climate region a patient is from. The United States (US) has numerous different climate zones that can be classified using the US Department of Energy International Energy Conservation Code (IECC), which utilizes annual temperature and precipitation data to assign a climate designation to each county within the US.
IECC Climate Map

Methods
This study was a retrospective national cohort study of all Veterans aged 18 years of age or older between 1/1/2010 – 3/23/2024 with diabetes mellitus and a cultured lower extremity wound. National Veteran data was obtained from the VA Corporate Data Warehouse (CDW) via Structured Query Language (SQL) Server Management Studio. SQL coding was used to acquire demographic information, ICD diagnoses, lower extremity culture results, and Charlson Comorbidity Index for all patients who met inclusion criteria.
Pseudomonas Prevalence

Results
The prevalence of Pseudomonas significantly varied between US climates. Pseudomonas was most prevalent within the Hot Humid climate, where it was isolated in 13.2% of DFI cultures. Pseudomonas was least prevalent within the Cool Dry climate, where it was only isolated in 7.2% of cultures.

Conclusion
The prevalence of DFI organisms varies within different US climates. Utilization of local climate information may allow for more accurate and targeted empiric antibiotic selection when treating DFIs.

Disclosures
All Authors: No reported disclosures
P-747. Surgical Site Infections Following Cesarean Sections Across a Large Safety Net Public Hospital System
Authors: Akter Khaleda , Folks Megan A , Bakare Temilola-Azeezat , Episcopia Briana , Fornek Mary , Abdallah Marie , Quale John 
Published: January 2025

Abstract

Background
Surgical site infections (SSIs) following Cesarean section (CSEC) can be associated with serious adverse outcomes. Pre-operative and intra-operative protocols have been established to minimize the risk of developing SSIs.

Methods
Patients undergoing CSEC in an 11-hospital public health system in New York City in 2023 were reviewed. SSIs were defined according to National Healthcare Safety Network criteria. Propensity score matching, using six variables (age, body mass index, diabetes mellitus, surgery duration, American Society of Anesthesiology score, and wound class), was used to create a control group for the patients with SSIs.

Results
Among the 4643 CSEC surgeries, 73 SSIs were recorded, including 49 superficial incisional, 6 deep incisional, and 18 deep/organ space SSIs. SSIs were detected during the initial admission in 7 cases, repeat hospitalizations in 33 cases, and in outpatient settings in 33 cases. A higher rate of SSIs was observed from four hospitals; zip codes for these patients had higher poverty levels than for those patients from the four hospitals with the lowest infection rates (23.4±8.6 vs. 17.7±9.7 per cent, P=.08).
Comparing the SSI and control groups, no differences were found in race, ethnicity, blood loss, or surgical team composition. Although both groups had a similar proportion of patients residing in shelters, the SSI group had more recent immigrants than the control group (15 vs. 3, P=.004). Notably, recent immigrants with SSIs had fewer prenatal visits compared to the rest of the SSI group (5.53±3.44 vs. 7.72±3.98, P=.04), and 14 of the 15 SSIs in the recent immigrants were detected post-discharge from CSEC.

Conclusion
In a large public healthcare system, overall rates of SSIs following CSEC were low. Most infections were detected following discharge; living in neighborhoods of high poverty and being a recent immigrant appear to be risk factors for SSIs. While pre- and intra- operative protocols have been established to prevent SSIs, it appears postoperative factors (including wound care following discharge) warrant emphasis as well.

Disclosures
All Authors: No reported disclosures
P-757. Microbiological and clinical characteristics of extrapulmonary nontuberculous mycobacterial disease in a Chinese general hospital
Authors: Yao Yumeng , Bao Rong , Pan Jue , Hu Bijie 
Published: January 2025

Abstract

Background
Data on extrapulmonary nontuberculous mycobacterial disease (ENTM) in China is lacking. We aim to explore the microbiological and clinical characteristics of ENTM in a general hospital.

Methods
Laboratory extrapulmonary samples positive for nontuberculous mycobacteria in Zhongshan Hospital, Fudan University between Jan. 2017 and Dec. 2021 were retrospectively searched. The respective patient data were reviewed and followed until Dec. 2022. Thirty-three confirmed ENTM cases were included. Demographic, microbiological, clinical characteristics, as well as treatment and prognosis were analyzed.

Results
A total of 33 confirmed ENTM cases were included. The average age was (49±16.3) years. Twenty-three cases (69.7%) were female and one third of the patients were immunocompromised. Skin and soft tissue infection, bone and joint infection, and disseminated NTM disease were the most common types (57.6%, 18.2%, and 15.6%). Healthcare-associated infections accounted for 51.5% (17/33) of the cases. Mycobacterium abscessus complex (42.4%) among rapidly growing mycobacteria (RGM) was the most common causative species. Patients received combination therapy with an average of (3.5±0.8) drugs for 6.3 (4.3,9.6) months. Most cases recovered (69.7%) or improved clinically (18.2%). Compared with RGM, infections with slowly growing mycobacteria (SGM) were seen in older individuals (60.2±15.0 vs 42.6±14.0, P&lt;0.05) and were more often community-acquired (83.3% vs 28.6%, P&lt;0.05).

Conclusion
Skin and soft tissue infection is the most common type of ENTM, with Mycobacterium abscessus complex being the most important causative species. SGM infections affect older population and are more often community-acquired. Treatment of ENTM is challenging and lacks standardized protocol, future researches are warranted.

Disclosures
All Authors: No reported disclosures
P-771. Demographic and Clinical Characteristics of Adverse Reactions to anti-Tuberculosis Therapy: A Retrospective Analysis
Authors: Zaçe Drieda , Benedetta Rossi , Minardi Maria Letizia , Alessio Grazia , Alborghetti Leonardo , Muratore Gianmarco , Moccione Martina , Coppola Luigi , Compagno Mirko , Campogiani Laura , Marco Iannetta , Sarmati Loredana 
Published: January 2025

Abstract

Background
Adverse reactions (AR) to anti-tuberculosis (anti-TB) therapy pose a significant challenge, leading to decreased treatment compliance, increased morbidity and mortality rates, and prolonged hospital length-of-stay.

Methods
This study examines the demographic, clinical, and laboratory profiles of patients diagnosed with tuberculosis and hospitalized at the Tor Vergata Policlinic in Rome between 2013-2023, who experienced adverse reactions requiring the interruption, suspension, or modification of anti-tuberculosis therapy, in the period 2013-2023.

Results
Out of 242 patients receiving treatment for tuberculosis, data regarding AR were available for 136 cases. Of these, 35.3% (48/136) experienced an AR attributable to anti-tuberculosis therapy, median age of 39 years (IQR 26.5-57), 72.9% male, 60.4% non-italians, and 41.6% undergoing treatment for pulmonary TB. The most common AR were hypertransaminasemia (52.2%), allergic reaction (25%), and cholestasis (8.3%).
Patients with AR characterized by hypertransaminasemia/cholestasis compared to those with allergic reactions were younger (31 years (IQR 25-45) vs. 60.5 (IQR 36-69.5); p=0.012), more frequently of non-italian nationality (74.2% vs. 25.8%; p= 0.013), and had more frequently a negative Quantiferon test (41.9% vs. 8.3%; p= 0.03).
Pirazinamide emerged as the drug most frequently linked to AR, being suspended in 62.5% of cases (20/29 due to hypertransaminasemia; 8/12 due to allergic reaction). In 76.2% of cases, the drug responsible for the AR was discontinued in favor of a fluoroquinolone. All ARs resolved upon suspension of the implicated drug.
Among patients with AR, 65.3% recovered, and 13% died. Patients with AR had a lower lymphocyte count at treatment initiation compared to patients without AR (median 1150 (IQR 780-1940) vs 1460 (IQR 1035-2020), p=0.04) and had more frequently a negative Quantiferon test (29.2% vs 10.2%; p=0.012).

Conclusion
AR during TB therapy affected 35% of patients in our sample. Pyrazinamide was the most commonly implicated drug, and the reactions resolved upon discontinuation. A lower lymphocyte count at TB diagnosis in patients with AR might indicate an immune component, similar to IRIS, in their onset. However, further studies are warranted to explore this aspect.

Disclosures
All Authors: No reported disclosures
P-773. Mycobacterium Tuberculosis Liver Abscess in Kidney Transplant Recipients
Authors: Dyal Natasha , Vikram Holenarasipur R , Venkatachalam Thilagavathi , Kodali Lavanya 
Published: January 2025

Abstract

Background
Recipients of solid organ transplant (SOT) have higher risk for infections, and the prevalence of mycobacterium tuberculosis liver abscess (MTB-LA) without pulmonary/disseminated MTB is 0.34%. However, there is little research on MTB-LA in SOT recipients.
Mycobacterium tuberculosis Liver Abscess Cases
Upon extensive literature review, this chart details all published, English-language cases of mycobacterium tuberculosis liver abscess in solid organ transplant recipients.

Methods
We conducted an extensive literature review of MTB-LA in adult SOT recipients.

Results
Our review showed 4 cases of MTB-LA in SOT recipients (table below). We detail 1 additional case.
A 58-year-old male with ESRD due to type 2 diabetes mellitus, and latent MTB underwent kidney transplantation in March 2023. He completed a 6-month course of isoniazid and vitamin B6 for latent MTB 1 month before transplant. His post-operative course was uncomplicated; he was discharged to follow up with his nephrologist. He later developed norovirus illness with fever, which was conservatively managed. He developed new fevers 3 months post-transplant and CT of the abdomen/pelvis revealed a liver abscess, which was treated with empiric broad spectrum antibiotics, and was not amenable to aspiration. At his 4-month post-transplantation, he complained of fatigue, night sweats, poor appetite, and weight loss requiring hospitalization, wherein an MRI of the abdomen/pelvis identified a 3.6 x 3.2 x 6.2 cm liver abscess. The liver abscess aspirate was positive on acid fast bacilli smear and MTB polymerase chain reaction. He was initiated on antituberculosis therapy with isoniazid, rifabutin, pyrazinamide, and ethambutol. Susceptibilities identified pyrazinamide resistance, and led to substitution with levofloxacin. Labs, imaging and microbiology testing were negative for evidence of pulmonary/disseminated MTB. His donor’s information was reviewed; no obvious risk factors for active MTB were found. The recipient of the mate kidney is doing well without evidence of MTB infection. After 2 months of 4-drug antituberculosis therapy, ethambutol was discontinued. CT scan of the abdomen and pelvis at 4 months post anti-tuberculosus therapy revealed a 3 cm area of residual inflammation at the site of prior MTB-LA, in the setting of resolution of prior symptoms.

Conclusion
Early imaging and diagnostic aspiration of liver abscess with specific stains, culture and PCR testing can facilitate rapid diagnosis and initiation of antituberculosis therapy.

Disclosures
All Authors: No reported disclosures
The ‘crisis’ of antitrust economics
Authors: Padilla Jorge 
Published: January 2025

Abstract
The extant antitrust frameworks in the EU, UK, and US are being challenged conceptually, ideologically, and empirically. In particular, they are criticized for downplaying the economic and political cost of under-enforcement. In this article I accept, for the sake of the argument, that enforcement has been excessively lenient, though I believe the jury is still out, and focus on investigating whether the alleged under-enforcement of the competition laws is caused by the move towards a ‘more-economics approach’ to competition law enforcement. In my opinion, the evidence is mixed. Yet, the answer should not be less economics but better economics and greater scrutiny of both economic and non-economic evidence when they fail to point in the same direction.
Competition policy and labour market power: new evidence and open questions
Authors: Kariel Joel , Schneebacher Jakob , Walker Mike 
Published: January 2025

Abstract
Emerging evidence on pervasive and rising market power in US labour markets has led some competition agencies to wonder if the prevailing focus on product market power is too narrow. We survey existing competition enforcement in labour markets and the empirical evidence on the extent and impact of labour market power, with a particular focus on the UK. We find that in contrast to the US, labour market power in the UK has not risen substantially. Nonetheless, workers vary in their exposure and, for some, labour market power has significant economic costs. Labour market power also appears to interact in significant ways with other labour market policies. We argue these findings underscore the danger of making policy decisions based on evidence from other countries, or by analogy with product markets. We survey what these findings mean for existing tools available to competition agencies and conclude by laying out four types of open questions: theoretical, empirical, legal, and normative.
Towards an effective merger review policy: a defence of rebuttable structural presumptions
Authors: Lancieri Filippo , Valletti Tommaso 
Published: January 2025

Abstract
We discuss the design of an effective merger review policy for the twenty-first century. We argue that the practice of the past decades is inadequate and propose a move towards much stronger rebuttable structural presumptions. These presumptions establish that all mergers above certain thresholds are illegal unless the merging parties can prove that merger-specific efficiencies will be shared with consumers and yield tangible welfare gains. These presumptions are grounded on solid economics and also acknowledge the real-world limitations in enforcement resources and information asymmetries between companies and regulators. We outline how to establish such presumptions in practice, defending the implementation of an ex ante system that selects in advance (rather than per transaction) which companies and markets are subject to the presumption. Finally, we outline which merger-related efficiencies can rebut the presumption.
New directions in competition policy: an overview
Authors: Cowan Simon , Ormosi Peter , Perkins Joe 
Published: January 2025

Abstract
Competition policy has faced increasing scrutiny in recent years, with tension between traditional antitrust frameworks and contemporary critiques, including the ‘hipster antitrust’ movement. Some of the critics contend that competition policy has failed to address the growing market power of dominant firms, especially in the digital sector. This issue of the Oxford Review of Economic Policy explores the validity of these claims and their potential implications for the future of competition policy. It also examines how emerging methodologies, particularly those rooted in data science, can enhance our understanding both of how firms behave and how competition authorities and courts make decisions. This article summarizes a diverse range of contributions from academics, regulators, and practitioners in law and economics. It concludes with a discussion of how competition economics might adapt to the challenges posed by the hipster antitrust movement and the rapid changes in how firms compete.