bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-944. Usefulness of PCR and Culture of Specimens Obtained at Surgery in Patients with Infective Endocarditis
Authors: Shrestha Nabin K , Nagam Meghna , Wang Hannah , Gordon Steven M 
Published: January 2025

Abstract

Background
By 2016 it was standard protocol at Cleveland Clinic that patients undergoing surgery for confirmed or suspected infective endocarditis (IE) had cardiac specimens tested by both culture and 16s rRNA PCR and amplicon sequencing (PCR) to verify or accurately identify the causative pathogen. The purpose of this study was to compare the sensitivities and false positive rates, of PCR and culture of cardiac specimens obtained at surgery, among patients with infective endocarditis.

Methods
This was a retrospective cohort study. Episodes of pathologically-proven bacterial endocarditis with a single causative pathogen, among patients who underwent surgery for IE from January 1, 2016, to January 1, 2021 were identified from the Cleveland Clinic Infective Endocarditis Registry. The causative pathogen in the registry is determined by criteria that consider blood culture, histopathological findings, and culture and PCR of surgical specimens. Sensitivities of culture and PCR were compared, as were the false positive rates for PCR and culture among tests that were positive.

Results
Microbiological testing was done on 1326 fresh tissue specimens from 731 episodes of IE among 706 unique patients during the 5-year study period. PCR was significantly more sensitive than culture in detecting the pathogen (79.6% vs. 31.6%, p-value &lt; 0.001). After adjusting for the number of specimens tested per IE episode, the odds of detecting the pathogen were significantly higher for PCR than for culture (OR 10.60, 95% C.I. 8.23 – 13.74, p-value &lt; 0.001). Specimens that tested positive were false positives 1.6% and 10.1% of the time, for PCR and culture, respectively. Among specimens that tested positive, the odds of a positive test result being a false positive were significantly lower for PCR than for culture (13/795 vs 35/313, OR 0.15, 95% C.I. 0.07 – 0.27, p-value &lt; 0.001).

Conclusion
The causative pathogen for IE is much more likely to be identified by PCR of surgical specimens than by culture. Conversely, a positive culture from a surgical specimen is much more likely to be a contaminant than a positive PCR.

Disclosures
Hannah Wang, MD, Hologic: Advisor/Consultant
P-948. Three Drugs, Two Pills, One Algorithm: HIV PrEP, PEP, and Treatment Initiation Consolidated Guidelines for Resource Limited and Non-Specialty Settings
Authors: Boney Colton P , Park Erin G , Hill Samantha V , Parker Robert W , Jergel Andrew , Davis Nicholas S , Yap Austin 
Published: January 2025

Abstract

Background
Accessing HIV prevention and treatment remains difficult throughout the United States (US). With the shortage of infectious disease physicians and other providers offering HIV prevention and treatment services, increasing the number of clinicians offering HIV Pre-Exposure Prophylaxis (PrEP), HIV Post-Exposure Prophylaxis (PEP), and Test & Treat (T&T) (where individuals testing positive for HIV are rapidly engaged in HIV treatment) is imperative. This project’s goal is to create a consolidated algorithm for HIV treatment and prevention that simplifies care for providers with few resources or limited experience.
The 3-2-1 Algorithm
The algorithm includes the necessary steps, testing, and result interpretation to provide PrEP, PEP, and T&T services. Guidelines referenced in the making of this algorithm include those published the International Antiviral Society (IAS), the National Institutes of Health (NIH), and The New York State Department of Health AIDS Institute (NYSDOH AI).

Methods
The algorithm was designed using published HIV care guidelines from multiple clinical bodies and includes PrEP, PEP, and T&T. Only three medications are offered in the algorithm to reduce cost of implementation. The combination of tenofovir disoproxil fumarate with emtricitabine provides low-cost, generic PrEP regardless of gender, pregnancy, or intravenous drug use while also providing the backbone needed for PEP and T&T. Dolutegravir, the third medicine, was chosen for PEP and T&T because of its once daily dosing and approval in pregnancy. The algorithm was tested with US medical students. Students completed an eight-question test unassisted then immediately repeated those questions with the algorithm. Questions included clinical scenarios related to HIV testing, PrEP, PEP, and T&T. Students were recruited by email for the online test. Pearson’s chi-squared compared pre vs post test scores; total score (number of items correct) used Paired Wilcoxon signed rank test.

Results
76 students from 13 medical schools completed pre and posttest questions. Correctness increased from 3 of 8 (pretest) to 6 of 8 (posttest) (p=&lt; 0.001). All questions increased in percentage correct with the algorithm. Change in correct responses on PEP, PrEP lab work, need for quantitative RNA with prior injectable PrEP use, and selecting a T&T regimen were all statistically significant. (p=&lt; 0.001)

Conclusion
This algorithm significantly improved medical students’ ability to accurately answer HIV clinical care questions and has the potential to expand access to HIV prevention and treatment. Further studies are needed to understand the algorithms’ effect in a clinical setting.

Disclosures
All Authors: No reported disclosures
P-950. Pre-Exposure Prophylaxis Education for Internal Medicine Residents (PRIMER)
Authors: Nash Brenton , Abrantes-Figueiredo Jessica , Godshall Casey 
Published: January 2025

Abstract

Background
Pre-exposure prophylaxis (PrEP) for HIV is a safe and effective strategy for HIV prevention among high-risk patient groups. Despite consistent experimental and real-world data showing benefit, PrEP is underutilized. There is a dearth of non-specialized providers engaging in PrEP services. The purpose of this project is to increase knowledge and prescribing of PrEP among a cohort of internal medicine (IM) residents.

Methods
A 3 hour interactive education session was provided to the IM residents of the University of Connecticut Categorical Internal Medicine Residency. Baseline knowledge was assessed with a pre-training survey. This survey was repeated up within six months to assess for a change in PrEP knowledge and prescribing.

Results
The pre-intervention (pre) survey was completed by 39 IM residents. The post-intervention (post) survey was completed by 25 IM residents from the same cohort. 4 participants from the post group were excluded as they had not completed a pre survey. Similar proportions indicated PrEP awareness pre- and post-intervention 97.4% and 100%, respectively. There was a numeric increase in the proportion of respondents reporting knowledge of PrEP indications from 69.2% pre to 85.7% post. Similar proportions reported prescribing PrEP 15.4% pre and 14.3% post. Those who had prescribed PrEP reported providing it to only 1-5 patients. When assessing for paired differences among a sub-set of participants who had both pre- and post scores, general knowledge of PrEP significantly improved. General knowledge scores averaged 8.6% pre and 22.6% post (p-value 0.001). Of the five general knowledge questions – testing individual domains -- the mean differences between pre and post scores were: 0.6 (95% CI 0.3-1.0), 0.2 (0.04-0.4), 0.05 (-0.1-0.2), 0.2 (0.007-0.4), 0.05 (-0.05-0.1), and 0.3 (0.08-0.5), respectively. Indicating that in all but 2 domains the 95% confidence interval did not include 0.

Conclusion
Among a cohort of IM residents from a mid-sized, university-based program, general PrEP knowledge was low despite widespread awareness. Knowledge was improved following an educational session; however, prescribing did not increase. Other barriers besides knowledge likely impact the likelihood of generalists, and in particular learners, to prescribe PrEP.

Disclosures
All Authors: No reported disclosures
P-951. Delphi Study of a Fungal Curriculum for Infectious Diseases Fellows
Authors: Bryan Karen , Linder Kathleen A , Miceli Marisa H , Abdoler Emily 
Published: January 2025

Abstract

Background
Infectious Diseases (ID) clinicians must be proficient in diagnosis and management of fungal diseases. Though certain fungal diseases have geographic distributions, those distributions are shifting, and ID fellows need to be prepared to practice in diverse environments. We aimed to reach consensus from experts on the critical topics to include in fungal diseases curricula for ID fellows, focusing on North and South America.Figure 1:Delphi Methodology

Methods
We conducted a modified Delphi survey (See Figure 1) of ID faculty in North and South America who are members of the Mycoses Study Group Education and Research Consortium (MSGERC). Authors selected the initial list of 78 topics based on a previous single institution modified Delphi, as well as fellow and expert faculty member input. Respondents rated each topic’s importance from 1 (Do Not Include) to 5 (Very Important to Include), over two survey rounds. Consensus to prioritize a topic in the curricular list was defined as ≥80% of participants rating the topic ≥ 4 (Important to Include).Table 1:List of Topics that Met Consensus Criteria

Results
Of eligible MSGERC members, 24% (33/139) responded to the first round survey and 73% of initial respondents (24/33) completed the second round. Six new topics were proposed after round 1 and were included in round 2. Fifty topics (50/84, 60%) met consensus criteria after round 2. Topics that met consensus criteria included endemic fungi and highly morbid fungal diseases, as well as specific topics regarding diagnostics and therapeutics for fungal diseases (Table 1). Some common but often less serious fungal diseases did not meet consensus, along with several rare conditions (Table 2).Table 2:List of Topics that Did Not Meet Consensus Criteria

Conclusion
The scope of fungal diseases is broad and varies geographically, which necessitates intentional prioritization of certain topics in designing curricula for ID fellows. Our survey identifies topics of particular importance in the North and South American regions. These findings, along with additional input from broad representation of ID fellowship program leaders and educational experts, can be used in the development of a standardized fungal diseases curriculum for ID fellows, regardless of the location of training.

Disclosures
Marisa H. Miceli, MD, AN2: PI in clinical trial|F2G: PI in clinical trial|Pulmocide: PI in clinical trial|Scynexis: Advisor/Consultant|Scynexis: PI in clinical trial
P-955. Single vs. Multiple-Fellow Triaging Systems in a Large Academic Infectious Disease Service – A Quality Improvement Project
Authors: Machiavello Roman Francisco J , Azar Marwan M 
Published: January 2025

Abstract

Background
The Yale New Haven Hospital (YNHH) is a large academic center with 3 Infectious Diseases (ID) consult services (General, Heme-Onc, and Transplant ID), each staffed by 1 fellow and attending physician. In the traditional consult triaging system, one fellow receives all the consults, often ≥15/day, and assigns them to each ID service. Fellows alternate the triaging duty during the week, resulting in 2-3 triaging days/week/fellow. Our program review identified that this system was a significant source of burnout and contributed to prolonged work hours, which prompted a QI project to address these concerns.
Traditional and New Proposed Triaging Systems at YNHH

Methods
We designed an 8-question survey to assess the effect of triaging on the fellows’ workload, performance and mental health (anxiety and burnout). 2 interventions changed the consult triage workflow: i) The ID consult order on the electronic medical record was reformatted to require that primary providers select an ID subspecialty service, and ii) We eliminated the traditional triage role by asking the YNHH call center to route service-specific consults to the appropriate ID fellow (Figure 1). We conducted the pre-intervention survey in November 2023. The interventions took place in December 2023. The survey was repeated in February 2024.
Pre and post-intervention surveys

Results
7 (100%) and 6 fellows (86%) completed the pre and post-intervention surveys (Figure 2). In the pre-intervention survey, 57% reported frequently experiencing interruptions, and 57% reported an average of 15-25 interruptions/day. 86% stated that the traditional system contributed to a little or some anxiety, and 100% that it caused some or a lot of burnout. 57% replied that it contributed to some or a lot of impaired patient care.
In the post-intervention survey, 17% reported frequently experiencing interruptions, and 67% reported an average of &lt; 5 interruptions/day. 50% stated that the new system contributed to a little or some anxiety, and 50% said that it caused some or a lot of burnout. 17% replied that it contributed to some or a lot of impaired patient care.

Conclusion
A switch from a single-fellow to a multiple-fellow triaging system in our ID division led to decreased interruptions, decreased feelings of anxiety and burnout, and reduced perceptions of impaired patient care.

Disclosures
All Authors: No reported disclosures
P-970. Impressions of the Pediatric Infectious Diseases Subspecialty by Pediatric Resident Physicians and Medical Students Following a Peds ID Elective Rotation
Authors: Watson Michael E 
Published: January 2025

Abstract

Background
The subspecialty of Pediatric Infectious Diseases continues to struggle with a low number of applicants seeking training relative to the number of fellowship programs and open training positions. We explored the impressions that medical students and pediatric residents gathered about the subspecialty after completion of a Peds ID elective as a Quality Improvement initiative.

Methods
Resident physicians and medical students at the University of Michigan, from July 2022 to present, were surveyed after their Peds ID elective experience. Participation was voluntary and only anonymous responses in aggregate form were reported.

Results
The survey response rate was 56.3% (27 of 48 learners invited; 79% resident physicians and 21% medical students). 100% of learners reported a high educational value in participating in a Peds ID elective. Despite only 7.4% of learners considering Peds ID as a career before the elective, 18.5% of learners reported considering Peds ID fellowship training after their elective experience. Respondents indicated that 1) expertise in the subject matter of infectious diseases, 2) a mixture of inpatient and outpatient clinical experiences, and 3) opportunities to participate in Infection Prevention and Public/Global Health, were the top three most attractive aspects of the Peds ID subspecialty. In contrast, respondents indicated that 1) salary and compensation, 2) antimicrobial stewardship responsibilities, and 3) patient volume and workload, were the three least attractive aspects of the Peds ID subspecialty.

Conclusion
Peds ID remains a popular elective among learners who praise the educational content and teaching. Relatively low compensation, a heavy workload, and displeasure with antimicrobial stewardship duties were some of the main negative impressions by learners. Despite these impressions, participation in a Peds ID elective did lead to over twice as many learners considering Peds ID for their future careers. A mandatory Peds ID experience should be considered for the educational benefit of all learners and may improve fellowship recruitment. We identified issues for our subspecialty to address through advocacy to improve working conditions and compensation, thereby helping train and sustain an appropriate Peds ID workforce for the future.

Disclosures
All Authors: No reported disclosures
P-971. Chogoria Rounds: A Novel Clinical Reasoning Tool for Residents
Authors: Leonard Michael , Kooken Banks , Barrier Charles , smith Will 
Published: January 2025

Abstract

Background
Teaching clinical reasoning requires a clinician being able to demonstrate their thought process when approaching a case, and a large volume of case exposure during residency to gain a basis of understanding. Training programs have observed improved application of clinical reasoning skills by internal medicine (IM) residents when a case-based reasoning curriculum is introduced. We present a novel educational tool for IM residents involving a series of case presentations (Chogoria Rounds, CR) from a physician partner in Kenya to general IM and Infectious Disease attendings, along with IM residents at different stages of training.

Methods
Over an 18-month period, 30 cases were presented virtually, de novo, allowing attendings to discuss their clinical assessment of these cases in real time with the residents in attendance. A survey with Likert scale response (1 strongly disagree, 5 strongly agree) was distributed to residents to assess CR as an effective clinical reasoning teaching tool

Results
Of the 30 presented cases, 11 were related to tuberculosis (pulmonary, miliary, meningitis), 10 to other infections (severe malaria, leishmaniasis) and other interesting cases such as African night shade ingestion. Thirteen residents were surveyed with 10 respondents. All 10 strongly agreed or agreed that CR was a useful clinical reasoning teaching tool (50% strongly agreed, 50% agreed), and 90% felt it impacted patient care. 80% reported CR drove them to read more about a particular disease process that was discussed. 50% of residents did not feel CR impacted their practice regarding high value care, but 90% felt it generated meaningful discussion surrounding resource utilization. All residents expressed interest in participating in a global medicine experience in the future, and 90% became more interested in global medicine.

Conclusion
CR showed to be an effective clinical teaching tool for IM residents by giving them insight into clinical reasoning from expert attendings as well as rapid fire case conferences to provide increased volume of exposure.This virtual case conference model can easily be replicated for the benefit of residents and other learners at the US-based institution while at the same time benefiting those at the partnering international institution.

Disclosures
All Authors: No reported disclosures
P-973. Pediatric Infectious Diseases rotation for general pediatric residents in Washington DC: impact, benefits and pitfalls
Authors: Shieb Mohamad , Stern Eric J , Gaviria Susana , AlSayeb Badr , Ristagno Elizabeth H , Li Guyu 
Published: January 2025

Abstract

Background
Although infectious diseases present significant challenges in pediatric care, formal training in pediatric infectious diseases is not mandated in categorical pediatric residency training. This research seeks to examine the self-assessed confidence levels of general pediatric residents in Washington DC in managing common infectious diseases. The study specifically compares the confidence levels of residents who have undergone elective infectious diseases training with those who have not.
Subjective Confidence in the Management of Common Infectious Diseases Encounters

Methods
A cross-sectional study was conducted using voluntary surveys distributed among pediatric residents from various programs in Washington DC. The surveys aimed to assess subjective confidence levels in managing common infectious disease conditions and to explore motivation to pursue infectious disease training.
Effect of infectious diseases elective rotation on interest in infectious diseases as a career.
Are you more or less likely to pursue infectious diseases fellowship?

Results
Analysis of 20 completed surveys revealed that residents who completed infectious diseases rotations demonstrated significantly higher confidence levels in managing infectious disease conditions compared to their counterparts (P: &lt; 0.001). Notably, residents with specialized training showed increased confidence in antibiotic selection and in their diagnostic abilities. Additionally, they exhibited enhanced confidence in managing specific presentations such as sexually transmitted diseases, fever of unknown origin, and central nervous system infections (all with P &lt; 0.05). Finally, 22% of respondents expressed an increased likelihood of pursuing a career in infectious diseases following their rotation.
Effect of infectious diseases rotation on the confidence in the management of inpatient and outpatient infectious diseases encounters

Conclusion
These findings underscore the potential benefits of incorporating infectious diseases rotations into pediatric residency programs, as evidenced by improved skills in antibiotic selection, diagnosis, and management of specific infectious disease scenarios. Additionally, the observed increased interest in pursuing a career in infectious diseases among a subset of residents highlights the positive impact of such training on career trajectory and specialty choice. Investigators plan to distribute the questionnaire more broadly across the US to see if these results are more widespread.

Disclosures
All Authors: No reported disclosures
P-974. An Embedded Transplant Infectious Diseases Fellowship Track Is Appealing to Clinical and Research-Focused Fellows
Authors: Fung Monica , Schwartz Brian S , Babik Jennifer M 
Published: January 2025

Abstract

Background
Transplant Infectious Diseases (TID) training is commonly completed as a separate fellowship following ACGME ID fellowship. There is limited evidence on the impact of an embedded TID training track within ID fellowship.
Fellow Interest and Preferences for Transplant Infectious Disease Training by Career Focus

Methods
Our TID track, created in 2016, aligns with existing standards for TID training. Fellows may complete the track within a 2-year ACGME fellowship or as part of a longer research track. Current and prior fellows of our TID track were anonymously surveyed about TID track interest/impact and career goals.

Results
All 11 prior and current track fellows completed the survey. 64% of fellows (n=7) have or plan to pursue careers in clinical medicine, with a secondary focus on medical education (73%, n=8) and/or research (73%, n=8). 36% (n=4) have or plan to pursue primary careers in basic/translational research with a secondary focus in clinical medicine (Figure 1). Only 3 (26%) fellows were committed to TID prior to fellowship, with most (73%) developing an interest in TID during fellowship. Trainees cited interesting clinical cases (100%), mentorship/role models (73%), and research opportunities (55%) as reasons for their interest in TID training.
If an embedded TID fellowship were not offered, 18% (n=2, both with primary clinical focus) of fellows would have pursued a discrete TID year. All fellows cited the ability to stay at the same institution and patient population as factors for participating in our track, with 91% selecting quality of mentors and 73% level of clinical training. 55% of all fellows, and 100% of fellows pursuing careers in basic/translational science, specified the ability to tailor training path as a reason for participating in our track.
Since 2022, we have had 41% (7/17) of the fellows in our ID fellowship participate in the TID track. All track graduates (n=6) are currently in academic positions specializing in TID.

Conclusion
Among ID training programs with adequate patient population and clinical expertise/mentors to provide specialized training in TID, an embedded TID Track within ID fellowship may increase recruitment into TID, particularly among fellows pursuing a career in basic/translational research and not initially interested in TID prior to fellowship. Results are limited by our single-center experience.

Disclosures
All Authors: No reported disclosures