bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-120. Treatment of Acute Uncomplicated Diverticulitis among Hospitalized Patients: Clinical Practices and Outcomes
Authors: Tehaili Hussein , Shams Zainab , Malviya Meenal , Szpunar Susan M , Johnson Leonard B 
Published: January 2025

Abstract

Background
There are limited data comparing the outcomes of different antibiotic regimens for uncomplicated diverticulitis among hospitalized patients. We evaluated physician prescribing and outcomes based on discharge antibiotic regimens among hospitalized patients with acute uncomplicated diverticulitis.

Methods
We performed a retrospective chart review on adult patients at a tertiary care hospital between July 2018 and June 2023 diagnosed with acute uncomplicated diverticulitis. Uncomplicated diverticulitis was defined as patients without perforation, peritonitis, abscess, or strictures. We collected data on demographics, comorbid medical conditions, Charlson score, imaging findings and antibiotic treatment regimens as inpatient and outpatient. Ninety-day outcome measures included readmissions for relapse of diverticulitis, intervention for complications (operative or by interventional radiology) and episodes of Clostridioides difficile infection (CDI). Data were analyzed using Student’s t-test, the chi squared test, and the Mann-Whitney U test.

Results
Among 108 evaluable patients, 91.7% (99) received inpatient beta-lactam (BL) based therapies. Upon discharge, 44.4% (48) received fluoroquinolones (FQ) and 55.5 % (60) got BL based therapies. The groups were similar in demographics and clinical conditions; however, the median Charlson score was significantly higher in the BL group than the FQ group (1.0 (range 0-11) vs. 0.0 (range 0-7)), respectively. There were no differences in length of treatment as inpatient (3.3 days ±1.6 BL vs 3 days ± 1.3 FQ, p = 0.24) or outpatient (7.5 ± 4.6 BL vs. 7.0 ± 2.1 FQ, p = 0.51). Patients with a recurrence had a higher prevalence of rheumatologic disease than those without a recurrence, 28.6% vs. 9.6%, respectively, p=0.04), There was no significant difference in recurrence or readmission by outpatient regimen (57.1% BL vs 55.3% FQ, p = 0.9). There were two patients in the BL group who subsequently needed intervention and drainage on readmission and two episodes of CDI, one in each group.

Conclusion
In our study, there was no overall difference in 90-day outcomes for patients with acute uncomplicated diverticulitis who received FQ or BL therapy on discharge. Further studies should be performed to confirm this observation.

Disclosures
All Authors: No reported disclosures
P-157. Molecular epidemiology of carbapenemase genes among carbapenem-resistant Klebsiella pneumoniae (CR-Kp) from the Philippines: implications for surveillance and treatment
Authors: Maurice Salvana Edsel , Poblete Jonnel B , Francisco Christian , Geganzo Stessi , Luzentales Vivienne , Grace Hernaez Ma , dela Tonga Angelo , Perez Federico , Paterson David , Bonomo Robert A 
Published: January 2025

Abstract

Background
In the Philippines, the proportion of carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has doubled in the past decade and now exceeds 15%. However, the prevalence of different carbapenemase genes remains unknown. Unlike the United States and China where blaKPC predominates, blaOXA-48-like serine carbapenemases and metallo-β-lactamases (MBL) blaNDM, -IMP, and -VIM frequently occur among CR-Kp in the Asia-Pacific region. In order to better inform empiric treatment strategies and assist with infection prevention, we investigated the carbapenemases present in CR-Kp from the Philippine General Hospital (PGH), a 1,500-bed tertiary care national referral center in Manila, Philippines.Table 1.Carbapenemase genes detected with Xpert® Carba-R among carbapenem-resistant Klebsiella pneumoniae isolates from the Philippine General Hospital in Manila, Philippines.

Methods
CR-Kp from clinical samples were identified in the clinical microbiology laboratory at PGH using the VITEK® 2 platform (bioMerieux, USA). These isolates were collected and underwent rapid molecular testing with Xpert® Carba-R (Cepheid, USA) at the central laboratory of the Philippine National Institutes of Health. Molecular test results were typically available within 24 hours from the time of identification. These results were relayed to the treating physicians to guide clinical decision-making.

Results
A total of 81 CR-Kp isolates were collected from February to May 2024. Isolates were obtained from respiratory (n=44, 54.3%), blood (n=24, 29.6%), urine (n=9, 11.1%), and tissue/wound (n=4, 4.9%) samples. Table 1 summarizes the carbapenemase genes detected with Xpert® Carba-R among CR-Kp isolates from PGH, including multiple genes present in some samples.

Conclusion
Among CR-Kp from PGH, blaNDM was the predominant carbapenemase, followed by blaOXA-48-like and blaKPC genes. A third of the isolates co-harbored blaNDM and a serine carbapenemase, usually blaOXA-48-like. These findings suggest that there is molecular heterogeneity and likely plasmid spread among CR-Kp in the Philippines. These findings also underscore the importance of molecular surveillance programs that can rapidly characterize resistant strains, highlight the emergence of novel genotypes, and inform empiric and definitive therapy for CR-Kp.

Disclosures
Federico Perez, MD, MS, Merck: Grant/Research Support David Paterson, Infectious Diseases Physician, AMR Action Fund: Board Member|Aurobac: Advisor/Consultant|bioMerieux: Grant/Research Support|bioMerieux: Honoraria|CARB-X: Advisor/Consultant|Entasis: Expert Testimony|Menarini: Honoraria|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support|Shionogi: Honoraria
P-161. Assessing Antibiotic Usage Patterns, Knowledge Gaps, and Influencing Factors Among Poultry Producers, Veterinarians, and Farmers in Kerala, India
Authors: Kochuparambil Jose J 
Published: January 2025

Abstract

Background
Antibiotic resistance is a pressing global concern exacerbated by widespread antibiotic use in livestock farming. This study aims to assess antibiotic consumption patterns and knowledge gaps among poultry producers, veterinarians, and farmers in Kerala, India, crucial for implementing effective antimicrobial stewardship strategies.

Methods
A cross-sectional survey was conducted across Kerala, India, involving poultry producers, veterinarians, and farmers. Data were collected through structured interviews, focusing on antibiotic usage, knowledge, feeding practices, and biosecurity measures on poultry farms. Statistical analysis, including descriptive statistics, inferential tests, and regression analysis, was conducted to assess associations between variables and demographic factors.

Results
Among the participants, 37% of poultry producers were from urban areas, while 63% were from rural areas. The majority of veterinarians (65%) had over five years of experience in poultry farming. Tetracyclines, aminoglycosides, and cephalexin were the most commonly used antibiotics, with 35% of producers reporting their frequent use. Regression analysis revealed that farm size and educational level significantly influenced antibiotic usage patterns, with larger farms and producers with higher education levels more likely to use antibiotics regularly (p &lt; 0.001). Despite high antibiotic usage, there were significant knowledge gaps among stakeholders regarding antibiotic resistance. Only 37% of farmers were aware of the link between antibiotic use and antimicrobial resistance. A significant association between knowledge of antibiotic resistance and age was observed, with older farmers demonstrating higher levels of awareness. 57% of farmers above the age of 50 were aware of antibiotic resistance compared to 23% of farmers below the age of 30 (χ² = 15.6, p &lt; 0.001). Additionally, farmers who had attended training programs on antibiotic stewardship were significantly more knowledgeable about antimicrobial resistance compared to those who had not received training (p &lt; 0.01).

Conclusion
The study highlights the need for targeted interventions to promote responsible antibiotic use and combat antimicrobial resistance.

Disclosures
All Authors: No reported disclosures
P-204. Contemporary Economic and Healthcare Burden Associated with Clostridiodes difficle Infections (CDI) in the United States
Authors: Thapaliya Dipendra , Krishnan Vidya , Hill Hannah 
Published: January 2025

Abstract

Background
Centers for Disease Control and Prevention (CDC) estimated that in 2017, there were 223,900 cases of CDI in hospitalized patients and 12,800 deaths in the United States. CDI is the most common health care-associated infection, and a leading cause of diarrhea in the hospitalized patients (Magill et. al., 2015). Incidence of Community-associated CDI is rising in recent years (Chitnis et. al., 2013; Gerding & Lessa 2015).

Methods
The National Inpatient Samples (NIS) datasets include de-identified patient-specific and hospital-specific information for hospitalized patients across the U.S. We utilized these datasets to study the economic and healthcare burden associated with CDI. Data were downloaded and SAS software was used for analyses. Continuous variables were summarized by means and standard deviations and compared using Student’s t-tests. Categorical variables were summarized by percentages and compared using Chi-squared or Fisher’s tests, as appropriate. Bivariate and multivariable logistic regression models were created to determine factors that are associated with the primary outcome.Table 1:Patient Characteristics

Results
A total of 10,806 cases of CDI were identified among in-patient samples of 1818,090 patients during 2017-2019 in 9 geographic regions across the United States. This constitutes 10% sample of the NIS dataset. Compared to 2017, significant increase in CDI was observed in 2018 and 2019 (12% vs 46 and 41% respectively). Of the patient population, mean age at admission was 66 years; white had the highest cases of CDI compared to any other race (p &lt; 0.001). Majority of the CDI cases were observed in teaching hospitals compared to community hospitals (71% vs 9.3%; p=&lt; 0.001). South Atlantic region had the highest CDI burden (20%) followed by East North Central region (18%). Large hospitals based on bed size observed significantly higher cases of CDI (51%, p = 0.017). Hospitalization charges was significantly higher among CDI patients (mean $ 109,798 vs $56,530; p = &lt; 0.001).

Conclusion
These results highlight the significant disease morbidity and mortality as well as economic burden caused by CDI and warrants effective mitigation strategies to address the risk factors to minimize CDI.

Disclosures
All Authors: No reported disclosures
P-211. Implications of Skilled Nursing Facility Origin on Clostridioides difficile Infection Hospitalizations in the United States
Authors: Reveles Kelly , Strey Kelsey , Evans Cory T , Tillotson Glenn S 
Published: January 2025

Abstract

Background
Clostridioides difficile infection (CDI) occurs in nearly half a million Americans annually. Skilled nursing facility (SNF) residents are at increased CDI risk due to older age, underlying comorbidities, and frequent healthcare exposure. The study sought to describe the implications of CDI originating in SNFs, including CDI acuity, health outcomes, transitions of care, and economics.

Methods
This was a retrospective cohort study using the Premier Healthcare Database, which represents approximately one-quarter of United States healthcare systems. Older adult (65+ years) patients were included if they had an index, non-recurrent CDI hospitalization (ICD-10 code A04.72) between July 1, 2019 and December 31, 2022. Patient and CDI characteristics, health outcomes (inpatient mortality, hospital length of stay [LOS], readmission for recurrent CDI [rCDI]), and hospital costs were compared between patients admitted from a SNF compared to a non-SNF point of origin.

Results
A total of 94,330 index CDI hospitalizations were included. Patients were predominantly female (58.4%), White race (81.6%), and treated in urban settings (86.5%). Only 5.3% (n=5,003) of CDI patients were admitted from a SNF; however, 28.4% (n=26,891) were discharged to a SNF. One-third (31.0%) of patients admitted from a non-healthcare location were discharged to a SNF. Patients admitted from a SNF were older (median age 79 vs. 76 years) and more likely to have a secondary CDI diagnosis (85.0% vs. 74.4%) and emergent admission (90.2% vs. 82.1%) compared to non-SNF patients. Patients admitted from SNFs were also more likely to experience poor CDI health outcomes, including higher inpatient mortality (12.8% vs. 8.2%), readmissions for rCDI (14.8% vs. 13.8%), median hospital costs ($17,728 vs. $14,832), and longer median hospital LOS (8 vs. 7 days) (p&lt; 0.05 for all). Median costs were significantly higher for patients discharged to a SNF compared to a non-SNF location ($19,560 vs. $11,481).

Conclusion
Older, hospitalized CDI patients originating from SNFs disproportionately experience poor outcomes in health and financial burden. Over one-quarter of CDI patients were discharged to a SNF suggesting a major impact on physical function, quality of life, and associated risk.

Disclosures
Kelly Reveles, PharmD, PhD, AstraZeneca: Grant/Research Support|Ferring Pharmaceuticals: Advisor/Consultant
P-262. Hydrogen Peroxide Fogging: Feasibility and CLABSI Impact in a Pediatric Hematology/Oncology Unit
Authors: Bigham Michael T , Cirese Jill , Hord Jeffrey D , Williams Stephanie , Carr Beth A , Haydar Hanan , Pangonis Evelyn , Bair Tina 
Published: January 2025

Abstract

Background
Hospital acquired infections, including central line infections (CLABSIs), increase morbidity and mortality in immunocompromised patients. Environmental decontamination with HHP fogging reduces bacterial growth and bioburden in the hospital setting. The investigators sought to test the feasibility of an oncology unit-based hybrid hydrogen peroxide (HHP) fogging program and assess the impact on CLABSIs.

Methods
At a large Midwest freestanding children's hospital, this study evaluated the implementation of a HHP fogging program in a 20-room hematology/oncology inpatient unit and measured three endpoints:
1) the impact of fogging on aerobic colony counts (ACC) in a cohort of patient rooms cleaned using HHP Fogging (terminal clean + ultraviolet light + HHP fogging) compared to control rooms receiving standard cleaning (terminal clean + ultraviolet light);
2) the frequency, feasibility, and safety of fogging in a busy clinical unit; and
3) the important patient safety outcome, CLABSI rate, measured as rate per 1000 central line (CL) days of both mucosal-barrier infections (MBI) and non-MBI infections.

Results
The pre-/post-cleaning ACC measured in the control rooms resulted in no decrease in average ACC while the HHP fogging intervention rooms demonstrated a 99.9% decrease in ACC. The observed fogging interval for each room did not deviate significantly from plan [plan = 19 days versus actual = 18.2 days (SD±4.7)]; with fogging scheduled for 2 days per week and with no unplanned patient room changes. There were no safety events associated with fogging. There was 100% chemical and biologic indicators passage rate affirming successful fogging cycle completion. Baseline CLABSI rate was 2.8 per 1000 CL days (non-MBI=1.3 per 1000 CL days). Since fogging began, there has been only 1 CLABSI, yielding a rate of 0.9 per 1000 CL days (non-MBI=0 per 1000 CL days). Days between CLABSI events averaged 35.4 days at baseline and only 1 MBI event since implementation (103 days after previous event).

Conclusion
Hybrid hydrogen peroxide fogging is a safe, feasible, and effective method for reducing aerobic colony count in a busy hematology/oncology clinical unit and may reduce the CLABSI rate in an immunocompromised patient population.

Disclosures
Michael T. Bigham, MD, MBA, ForTec Medical: Advisor/Consultant
P-304. Vancomycin Resistant Enterococcus faecium Minimum Inhibitory Concentration Trends from 2019-2024: Have We Killed Daptomycin?
Authors: Arena Christen J , Mulbah Jessica L , Kenney Rachel M , Shallal Anita , Davis Susan L , Veve Michael 
Published: January 2025

Abstract

Background
Vancomycin resistant Enterococcus faecium (VRE) has been categorized as a bacterium with serious antibiotic resistance threats in the United States, where daptomycin (DAP) has been a drug of choice. In 2019, the Clinical and Laboratory Standard Institute M100S 29th edition revised DAP breakpoints for VRE to susceptible dose dependent with a minimum inhibitory concentration (MIC) of ≤ 4 mcg/mL. Higher MICs are associated with resistant mechanisms and increased microbiological failure is seen with MICs of 3-4 mcg/L. Linezolid (LZD) is an VRE treatment option that has favorable clinical outcomes and microbiological eradication with less emerging resistance, but LZD use can be controversial due to outdated dogma of using a bacteriostatic agent. The purpose of this study was to evaluate MIC trends for DAP and LZD in patients with VRE bloodstream infections (BSI) at a large academic medical center.
Bloodstream Infection VRE Comment within the Electronic Health Record: Current and Proposed

Methods
IRB-exempt, cross-sectional study of adult patients with VRE BSI and a healthcare encounter from 2019-2024 at a 5-hospital health-system in southeast Michigan. Patients were identified using Microsoft SQL Server queries based on microbiology results. The primary outcome was the proportion of patients with a DAP MIC &gt; 1 mcg/mL with corresponding LZD MICs. Our health-system currently recommends DAP or LZD for VRE BSI until susceptibilities are available via blood culture comment (Figure 1).
Measured MICs of daptomycin and linezolid, 2019-2024
*Daptomycin MIC Breakpoints: Susceptible Dose Dependent = ≤ 4 mcg/mL, Resistant = ≥8 mcg/mL. Linezolid MIC Breakpoints: Susceptible = ≤4 mcg/mL, Intermediate = 4 mcg/L, Resistant ≥8 mcg/L

Results
555 LZD and 491 DAP unique MICs from VRE BSI were evaluated. Figure 2 represents the average MICs by month and year for DAP and LZD from 2019-2024. The majority of DAP MICs were measured at 2 (30%), 3 (56%), and 4 (18%) mcg/mL. DAP MIC50 and MIC90 values were calculated at 3 mcg/mL and 4 mcg/mL, respectively. 98.7% of LZD MICs were measured at ≤2 mcg/mL (Table 1). LZD MIC50 and MIC90 values were calculated at 2 mcg/mL.
Average daptomycin and linezolid MIC per month and year, 2019-2024

Conclusion
While the VRE MICs for DAP are increasing, LZD has remained stable over the past 5 years. A possible stewardship opportunity is to modify the health-system's current blood culture comment could suggest LZD as the VRE drug of choice and high-dose DAP as an alternative in patients until susceptibilities are available (Figure 1).

Disclosures
Rachel M. Kenney, PharmD, BCIDP, Medtronic Inc: Spouse is an employee, stockholder
P-305. Empirical Treatment with vancomycin-resistant enterococcus (VRE) Effective Antibiotics versus Glycopeptides: Impact on Survival Outcomes in VRE Bloodstream Infections
Authors: Hung Ou Tao , Chuang Yu-Chung , Wang Jann-Tay , Chen Yee-Chun , Chang Shan-Chwen 
Published: January 2025

Abstract

Background
Vancomycin-Resistant Enterococcus (VRE) is a predominant pathogen in nosocomial bacteremia (BSI) in Taiwan. Although glycopeptides are traditionally recommended for empiric treatment of suspected Gram-positive infections, this study evaluates whether empiric anti-VRE antibiotics improves survival compared to glycopeptides following definitive VRE treatment confirmed by blood culture.

Methods
This retrospective cohort study was conducted at the National Taiwan University Hospital and its branches from January 2010 to July 2023. It included patients aged 18 or older diagnosed with VRE BSI who received definitive treatment with linezolid or daptomycin (defined anti-VRE antibiotics). Patients were categorized into two groups based on the initial treatment received on the onset day of VRE BSI: empiric anti-VRE and empiric glycopeptide. The primary outcome was 28-day mortality.

Results
Of 2,067 VRE BSI episodes recorded, 138 met the inclusion criteria. The average age was 64.1 years, with a male majority of 64.5%. The overall mortality rate was 55.1%. The empiric anti-VRE group included 50 patients, while the empiric glycopeptide group comprised 88 patients. Time to definitive treatment was significantly shorter for the empiric anti-VRE group (0 days) compared to the empiric glycopeptide group (2.2 days; P &lt; 0.001). Mortality was lower in the empiric anti-VRE group at 42% versus 62.5% in the empiric glycopeptide group (P = 0.02). Multivariable logistic regression showed empiric anti-VRE treatment as a significant predictor of lower mortality (adjusted odds ratio [aOR] = 0.38, 95% CI: 0.17–0.85; P &lt; 0.05), independent of the Charlson comorbidity index (aOR = 1.23; P = 0.008), steroid use (aOR = 2.61; P = 0.03), and the Pitt bacteremia score (aOR = 1.43; P &lt; 0.001).

Conclusion
Among patients who received definitive treatment for VRE, those treated with empiric anti-VRE demonstrated superior survival outcomes compared to those given empiric glycopeptides. This study underscores the importance of timely and appropriate antimicrobial therapy in managing VRE infections. While our data do not advocate for the universal use of empiric anti-VRE treatment, they suggest that such therapy should be considered when VRE infection is highly suspected to potentially improve outcomes.

Disclosures
All Authors: No reported disclosures
P-321. Risk Factors for Methicillin-Resistant Staphylococcus aureus Carriers in the Intensive Care Unit: A Single-Center, Retrospective Cohort Study in Japan
Authors: Yoshida Hisato , Nigo Masayuki , Iwasaki Hiromichi 
Published: January 2025

Abstract

Background
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common pathogens in the intensive care unit (ICU). Active surveillance cultures (ASCs) for MRSA often performed in ICUs may not be optimal in ICU settings with low prevalence of MRSA. This study aims to determine the risk factors of MRSA carriage in the ICU and develop a clinical predictive model to optimize the screening process.

Methods
All patients screened for MRSA by nasal ASC at the time of ICU admission between April 2015 and August 2022 were retrospectively included and divided into MRSA-positive and MRSA-negative groups. Patients’ characteristics were evaluated to determine the prevalence of MRSA and the risk factors. Cost analysis was conducted based on the risk factors identified by our analysis.

Results
Of the 3,927 ICU patients included, 133 (3.4%) were MRSA-positive. Multivariate analyses showed that risk factors for MRSA carriage were age ≥60 years (odds ratio [OR]: 1.60), history of hospitalization within a year (OR: 1.51), admission under departments dealing with skin and soft tissues (OR: 3.00), and ICD-10 codes classification I (OR: 3.44). Screening patients based on at least one of the risk factors exhibited high sensitivity (93.2%) to identifying MRSA carriage and could reduce ASC overall costs by 86.9%.

Conclusion
This study suggests that universal ASCs to detect MRSA may not be optimal in ICU settings with low prevalence of MRSA. Targeted screening based on risk factors may reduce the volume and cost of MRSA screening. Prospective studies are warranted to confirm these findings.

Disclosures
All Authors: No reported disclosures