bluuebunny/crossref_metadata_2025_split huggingface dataset:
1677. Trends in Antibiotic Resistance Among Uropathogens in the Pediatric Population: A Multicenter Experience in the US
Authors: Mithal Leena B , Chu David , Forster Catherine , Kalu Ibukun , Wiener John , Sun Shan , Fishbein Joseph , Arshad Mehreen 
Published: November 2023

Abstract

Background
Urinary tract infections (UTIs) are common infections in children. Overuse of antibiotics has led to increasing antibiotic resistance among uropathogens in adults; however, data on pediatric trends have not been previously reported. Our objective was to characterize antibiotic resistance trends in uropathogens among children at three tertiary care hospitals across the US.

Methods
Microbiologic data from positive urine cultures ( &gt;20,000 CFU/ml) in children 0 – 18 yrs of age between 1/1/2010 and 12/31/2020 were obtained from electronic medical records. Yearly antibiotic agent-specific resistance rates were calculated based on culture, patient, and organism level data.

Results
A total of 17,747 positive individual urine cultures were analyzed. E. coli was the most common organism isolated. Across all three institutions, rates of resistance against ampicillin/sulbactam (average rate 24%, IQR 3.21%) and trimethoprim/sulfamethoxazole (average rate 30%, IQR 6.42%) among E. coli remained high but stable over the study period. However, resistance against levofloxacin as well as third and fourth generation cephalosporins generally increased over this period across all institutions (Figure 1) and age groups (Figure 2). Combined antibiograms of all three institutions for 2019 and 2020 showed high rates of resistance against ampicillin/sulbactam and trimethoprim/sulfamethoxazole among Enterobacterales in general and variable resistance against ceftriaxone.

Conclusion
Over the last 10 years, there have been rising rates of resistance to broad spectrum antibiotics, including beta-lactams and quinolones, among uropathogens collected from a pediatric cohort with an increasing trend starting in 2015-2016. While we were not able to distinguish patients with community acquired UTI from hospital acquired UTIs, we noted with interest that the prevalence of resistant uropathogens even among the youngest age groups (&lt; 30 days and &lt; 1 year) trends along with the older children. This suggests a likely community reservoir of multi-drug resistant gram-negative bacteria. Colonization by resistant uropathogens has implications for empiric antibiotic choice, limited oral therapy options, and clinical outcomes which necessitate further study.

Disclosures
Ibukun Kalu, MD, Pfizer: Institutional support for clinical trial
1683. Severe Group A Streptococcus Infections Amongst Pediatric Patients in the Lehigh Valley, Pennsylvania Following the COVID-19 Pandemic
Authors: Gough Stormie , Berback Jonathan , Villalobos Tibisay 
Published: November 2023

Abstract

Background
In December 2022 the CDC issued an alert about possible increase of invasive group A Streptococcus infections (iGAS) among children in the United States. Colorado and Minnesota observed an increase in the number of cases in the Fall 2022. Similarly, the Pennsylvania Department of Health issued a health alert that was then lifted in February 2023. Preliminary CDC data showed that iGAS infections were higher in some areas of the country compared to pre-pandemic levels. Lehigh Valley Reilly Children’s Hospital is a community teaching hospital in Allentown, Pennsylvania. A rise in the number of children admitted with GAS infections was noted in the same period compared to previous years. The aim of our study was to determine the clinical characteristics of patients admitted with iGAS and non-iGAS infections during fall and winter 2022-2023.

Methods
Retrospective chart review of patients 18 years and younger admitted to Reilly Children’s Hospital between September 1st 2022 through March 31st 2023 and diagnosed with GAS infection plus those admitted with the same diagnosis between 2018 and 2022.

Results
There were 19 children admitted to the hospital with GAS infection: 6 (32%) with iGAS and 13 (68 %) with non-iGAS infections. The iGAS infections included bacteremia without source (2), myositis (1), pneumonia (2), and vascular infection (1). Non-iGAS infections included retropharyngeal abscess (3), peritonsillar abscess (2), parotid abscess (1), submandibular abscess (1), lymphadenitis (2), mastoiditis (1), cellulitis (1), pharyngitis (1), and erythema nodosum (1). Six children required intensive care and two were transferred to higher level care. Median age was 2.2 year for iGAS infections and 4.8 years for non-iGAS. All but one patient had no underlying medical conditions. There were no patient deaths. In 2018 there were zero cases of iGAS infection; in 2019: two cases; 2020: two cases; 2021: zero cases. There were no admissions between May 2020 and April 2022 for either iGAS or non-iGAS.

Conclusion
The number of children admitted for iGAS and non-iGAS infections in the fall and winter of 2022-2023 surpassed the preceding 4 years combined. This is reflective of what was happening in some other areas of the country as a result of reduced exposure and lack of immunity due to pandemic restrictions.

Disclosures
All Authors: No reported disclosures
1687. Unprecedented Outbreak of Invasive group A Streptococcus Infections in Children - Colorado, October 2022 to March 2023
Authors: Ho Erin C , Silveira Lori , Birkholz Meghan C , Cataldi Jessica R , Dominguez Samuel R 
Published: November 2023

Abstract

Background
Since the fall of 2022, we have observed a sharp rise in pediatric invasive group A Streptococcus (iGAS) hospitalizations in Colorado, similar to trends reported in other countries.

Methods
From October 2022 – March 2023, iGAS cases were prospectively identified in patients hospitalized at Children’s Hospital Colorado and medical charts were systematically reviewed. iGAS was defined as isolation of GAS from a sterile site (confirmed case) or a non-sterile site with clinically consistent disease (probable). Using laboratory specimen records, we compared the number of patients with sterile site GAS-positive cultures across three time periods: Pre-COVID-19 (Jan 2015 – Mar 2020), COVID-19 pandemic (Apr 2020 – Sep 2022), and Outbreak (Oct 2022 – Mar 2023).

Results
Among the 81 iGAS cases identified during the outbreak (Table 1), median age was 6 years old; 64% of patients were male and 69% were previously healthy. 33% of patients required pediatric intensive care unit (PICU) admission, and two patients died. iGAS was more commonly associated with upper respiratory infection (URI) symptoms (63%) than isolated sore throat (5%) or trauma/skin findings (15%). The most common clinical manifestations were head and neck infections (37%), musculoskeletal infections (32%) and pneumonia (20%). 11% had toxic shock syndrome and 4% had necrotizing fasciitis. Lab findings associated with PICU admission were bandemia, leukopenia and higher CRP values. Disease severity and treatment varied by clinical manifestation (Table 2). There were more iGAS cases during the outbreak (average 10.0/month) compared to pre-pandemic years (3.8/month over the same period) and during the pandemic (1.2/month over the same period) (Figure 1).

Conclusion
We report an unprecedented outbreak of iGAS in pediatric patients in Colorado, with case numbers close to triple the pre-pandemic baseline at our hospital. The timing and high proportion of cases with associated URI symptoms suggest a link to the recent surges in respiratory viruses, although iGAS cases have continued to persist past the peak of respiratory season. Invasive GAS can be severe and evolve rapidly; there are important clinical and laboratory features that may help in earlier identification of children who are critically ill.

Disclosures
Samuel R. Dominguez, MD, PhD, Biofire Diagnostics: Advisor/Consultant|Biofire Diagnostics: Grant/Research Support|Cobio Diagnostics: Board Member|Karius: Advisor/Consultant|Pfizer: Grant/Research Support
1694. Joint Fluid Cell Count of Septic Arthritis Patients Diagnosed with Positive Culture in Children
Authors: Otsubo Yuto , Shibata Meiwa , Ota Norikazu , Hataya Hiroshi , Horikoshi Yuho 
Published: November 2023

Abstract

Background
Septic arthritis is one of serious pediatric infections that could result motor comorbidities. Historically, joint fluid cell count of 50,000 and over cells/mm3 has been used for presumptive diagnosis of septic arthritis while awaiting for culture result. Our aim of study was to evaluate joint fluid cell count for diagnosis among septic arthritis patients confirmed with positive culture in children.

Methods
Patients with septic arthritis were included at Tokyo Metropolitan Children's Medical Center from March 2010 to March 2023. Septic arthritis was confirmed with positive joint fluid culture for a pathogenic organism. Patients with negative joint fluid culture and patients without joint fluid cell count were excluded. Electrical charts were retrospectively reviewed for demographic data, timing of arthrocentesis, culture result and joint fluid cell count.

Results
A total of 95 patients with septic arthritis were identified. After excluding patients with negative culture and without joint fluid cell count, 22 patients were included for our study. Median age was 5 (IQR: 2-10) years old. Girl ratio was 45%. The median joint fluid cell count was 19,575 (IQR: 6,806-47,388) cells/mm3. Patients with 50,000 and over cells/mm3 was 23%. The median time from onset to arthrocentesis was 3 (IQR: 2-5) days. The isolated organisms were methicillin-susceptible Staphylococcus aureus (50%), methicillin-resistant S. aureus (9%) and Streptococcus pyogenes (27%), Streptococcus pneumoniae (5%), Klebsiella pneumoniae (5%) and Salmonella spp (5%). The infected joints were hip (59%), knee (23%), ankle (14%), elbow (5%) and shoulder (5%). One patient had hip and ankle arthritis. Nine patients were complicated with septic osteomyelitis. The Pearson correlation coefficient between days from onset of symptoms to puncture and the number of joint cells was 0.093 (p=0.681). (Figure 1)

Conclusion
Majority of patients with septic arthritis confirmed with joint fluid culture did not exceed joint fluid cell 50,000 cells/mm3.

Disclosures
All Authors: No reported disclosures
1701. Trends in Invasive Candidiasis in Children with Hematologic Malignancies: Increased Risk of Dissemination with Non-albicans Candida
Authors: Said Amira , Afridi Faraz , Daignault Chelsea , O’Farrell Candelaria , Scheurer Michael E , Redell Michele S , Garnes Natalie J Dailey , Gramatges Maria , Dutta Ankhi 
Published: November 2023

Abstract

Background
Candida species are the most common cause of invasive fungal infections in hospitalized patients. Children with hematological malignancies are at increased risk. The epidemiology of species implicated in invasive candidiasis (IC) has changed over the past 25 years with non-albicans Candida (NAC) species now prevailing. These changes have therapeutic and prophylactic implications as some species carry intrinsic resistance to widely-used antifungal medications.

Methods
Patients ages 0-18 with hematologic malignancy and at least one episode of IC from 2011-2022 from two institutions were included. Patients who had received a bone marrow transplant were excluded. Information related to demographics, host factors, clinical risk factors, Candida species and antifungal minimum inhibitory concentrations (MICs), treatment and outcomes was collected via retrospective chart review.

Results
53 cases of IC were identified. Sixty percent were males. Thirty (57%) were of Hispanic ethnicity. The median age at diagnosis was 9 years (range 2 months-18 years). Seventy percent (37/53) had B-cell acute lymphoblastic leukemia. The median time to IC from diagnosis of cancer was 95 days (IQR 20-277). C. tropicalis (n=17; 32%) and C. albicans (n=14; 26%) were the most common species followed by C. glabrata and C. parapsilosis. Thirty-five percent (18/53) had concurrent bacteremia. The most common sites of dissemination were the lungs (n=24, 45%), kidneys (n=17; 32%), liver (n=15, 28%) and spleen (n=14; 27%). Of the 35 patients who underwent dilated eye exams, 23% (n=8) had ophthalmologic involvement. NAC were more likely to disseminate to the eyes, skin and spleen than C. albicans (p&lt; 0.05). Fourteen isolates (26%) demonstrated increased MICs to fluconazole and six demonstrated increased MICs to voriconazole. Most (59%) required more than 6 weeks of antifungals. Sixteen patients died, of which six were attributed to IC.

Conclusion
NAC accounted for most of the IC in hematological malignancies with C.tropicalis being the most common. The implications of NAC being predominant in this high-risk group is concerning due to the higher MIC to azoles and the potential for azole resistance in the future. Antifungal prophylaxis and treatment both need to be reevaluated periodically based on these findings.

Disclosures
Natalie J Dailey Garnes, MD, MPH, AlloVir: Grant/Research Support
1703. Pseudo-Outbreak of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit: Implications for Surveillance
Authors: Dauphin Ashley , Gordon Patrick S , Story Gina L , Gupta Munish , Schultz Jordan , Doucette Matthew , Cumming Melissa , Longhi Lorinda , Kirby James , Mehrotra Preeti 
Published: November 2023

Abstract

Background
We conduct weekly surveillance screening for methicillin-resistant Staphylococcus aureus (MRSA) in our neonatal intensive care unit (NICU). In September 2021, we noted an increase in positive MRSA screening results and identified 2 patients with MRSA wound infection. We conducted an investigation to explore the possibility of in-unit transmission.

Methods
We launched a multi-pronged investigation that included additional patient screening. Surveillance isolates were assessed for the presence of MRSA using chromogenic agar. Additional antimicrobial sensitivity testing was performed on an automated bacterial identification system if chromogenic agar results were inconclusive, fig 1 & 2. We also conducted audits of staff hand hygiene, enhanced cleaning and disinfection of shared patient-care equipment, implemented standardized chlorhexidine gluconate (CHG) scrub use for NICU staff upon unit entry, and added new CHG bathing for certain patients.
Positive control chromogenic agar plate
Ambiguous chromogenic agar results

Results
Over the course of a 6-week long investigation, 18 neonates were found to be MRSA-positive on surveillance swabs using chromogenic agar. In the first 2 weeks of the investigation, PFGE showed that 9 MRSA isolates were genetically distinct. Over the next weeks, additional MRSA-positive surveillance swabs were collected and ultimately 15 isolates underwent whole genome sequencing at the Mass. State Public Health Laboratory. Only 2 pairs of isolates appeared related. Antimicrobial resistance genes were identified and revealed only 6 of the 15 isolates contained the mecA gene consistent with MRSA. As a result, all 18 positive surveillance swabs obtained during the investigation underwent full identification and sensitivity testing confirming only 6 samples contained MRSA and 12 contained methicillin-sensitive Staphylococcus aureus (MSSA). Testing discordance with breakthrough MSSA growth was reported to the chromogenic agar manufacturer.

Conclusion
Our investigation identified that an increase in MRSA-positive surveillance swabs was a pseudo-outbreak due to false-positive MSSA growth on MRSA selective media. At the conclusion of this investigation, the need for ongoing surveillance swabs was re-evaluated and ultimately discontinued. Clinical NICU specimens are now monitored in real-time by Infection Control.

Disclosures
James Kirby, MD, D(ABMM), Abbott Molecular: Educational Grant
2877. Influence of vancomycin AUC monitoring on acute kidney injury in a large quasi-experimental study of over 3000 patients
Authors: Gregory Eric , Schadler Aric , Burgess David , Burgess Donna R , Cotner Sarah , VanHoose Jeremy , Wallace Katie L 
Published: November 2023

Abstract

Background
Due to the inconsistent correlation of vancomycin trough concentrations with area under the curve (AUC) and increased rates of vancomycin-induced kidney injury (VIKI), an institutional practice change was implemented in 2017 to use 2-level AUC monitoring. The objective of the present study was to evaluate VIKI outcomes in a large quasi-experimental study.

Methods
A 4-year quasi-experimental study was performed at an academic medical center and included patients who received parenteral vancomycin for ≥ 72 hours. The primary outcome was the incidence of VIKI defined using KDIGO criteria. Secondary outcomes included inpatient all-cause mortality, median length of stay (LOS), median intensive care unit LOS, and median vancomycin trough concentration. Multivariable logistic regression analyses were used to identify primary predictors of VIKI and all-cause inpatient mortality while controlling for other significant covariates.

Results
The study included 3207 patients, with 1964 and 1243 in the trough and AUC groups, respectively. Similar baseline demographics (i.e., age, sex, race, weight, BMI, CrCl, Charlson Comorbidity Index) were noted between the groups. Patients in the AUC group were more likely to receive a vancomycin loading dose (32% vs 49%; p&lt; 0.001) and have greater median trough concentrations (11.5 mg/L [8.1-16.0] vs 11.8 mg/L [8.9-16.2]; p=0.008). However, they also had lower median day 3 vancomycin exposures (3500 mg [2250-5000] vs 3250 mg [2500-4500]; p=0.008). Median AUC was 488 (396-607) in the AUC group. No significant differences were noted in the bivariate analysis of VIKI, defined as meeting criteria of any of the 3 KDIGO stages (20.5% vs 19.6%; p=0.112). The multivariable logistic regression suggested AUC monitoring was associated with a 23% decrease in VIKI (OR 0.767; 95% CI 0.621-0.947). All-cause inpatient mortality was significantly decreased in the AUC group (8.1% vs 6.3%; p=0.049).

Conclusion
VIKI was significantly reduced when AUC monitoring was employed in a large quasi-experimental study comprising over 3000 patients, one of the largest evaluations to date. This further strengthens the recommendation to transition to AUC monitoring for most patients receiving vancomycin for ≥ 72 hours.

Disclosures
All Authors: No reported disclosures
1709. Shifting Infection Spectrum in Febrile Neutropenic Pediatric Cancer Patients During the COVID-19 Pandemic: An Impact Assessment
Authors: Dabas Aditya , Sharma Vagisha , Singh Amitabh , Kriplani Kushal , Gaind Rajni , Gera Rani 
Published: November 2023

Abstract

Background
Febrile neutropenia (FN), which is the most common reason for hospital admission among pediatric oncology patients recieving chemotherapy, has seen changes in the epidemiology of infectious pathogens over the past few decades. This is attributable to shifts in hospital flora, antibiotics usage, and resistance patterns. Previously, bacterial infections were more common in this population, with mycobacterial, viral, and protozoal organisms being less frequent. Gram-negative bacteria such as E. coli, Klebsiella, and Pseudomonas were the most common causative agents. However, with the onset of the COVID-19 pandemic, the implementation of nationwide lockdowns, reduced healthcare visits, and strict interpersonal preventive measures are anticipated to impact the previous trends.

Methods
A 16-month prospective observational study was conducted on 131 eligible pediatric cancer patients (ages 1-12) admitted with febrile neutropenia from Dec 2019 to May 2021. Causative pathogens were identified through lab investigations upon admission, and on days 3 and 7.

Results
Out of the 131 children enrolled in the study, an etiological agent could be identified in 72. SARS-CoV-2, Acinetobacter, and Klebsiella accounted for over 50% of the infections. SARS-CoV-2 was the most common pathogen, and non-SARS-CoV-2 coronaviruses were also detected, even more than E. coli.Overall, gram-negative infectious agents comprised the most common pathogens (35.2%), similar to the pre-COVID era, followed by an appreciably increased respiratory viral burden (32.3%), a markedly decreased proportion of gram-positive infections (11.2%), and lastly, a largely unchanged fungal contribution (11.2%).

Major etiological agents in febrile neutropenia patients

Conclusion
Rigorous interpersonal precautions and hygiene practices that were reinforced during the pandemic are effective in preventing hospital-acquired and contact-transmitted infections caused by gram-positive bacteria. However, despite the strict preventive measures and travel restrictions, transmission of airborne infections between immunocompromised patients and their caregivers was not avoided and became the most prevalent infection in the group. The risk of infection from the overgrowth of endogenous gram-negative flora remains unchanged.

Disclosures
All Authors: No reported disclosures
1727. Household Vaccination Status and Attitudes towards Pediatric COVID-19 Vaccination: A survey at four New Jersey clinic-based pediatric practices
Authors: Katic Bozena J , Alvitres Jessica L , Hasan Uzma , Katragkou Aspasia , Friedman Stephen M , Schwab Joseph V , Weller Alan , Thomas Pauline , Kennedy Mary C , Li Charles , Gurumurthy Manisha , Rohan Claudia , Chu Dorothy , Hussein Mawada , Shaikh Mehek , Damania Bijal , Morisetty Harini , Godfrey Grayland W , Gaur Sunanda , Noor Hathija 
Published: November 2023

Abstract

Background
Although COVID-19 vaccination has been recommended for all children 6 months of age and older since August 2022, vaccine uptake among the pediatric population is low. Underlying caregiver attitudes towards pediatric COVID-19 vaccination have not been adequately classified or described. A better understanding of how caregiver attitudes influence household vaccination behavior can help tailor future vaccine interventions.

Methods
Unvaccinated children aged 18 months to 11 years underwent antibody testing and their caregivers were asked to complete an electronic survey at four clinic-based practices in Northern and Central NJ from September 2022 to April 2023. Information was collected on household exposures, vaccination status, COVID-19 infection, and caregiver beliefs about pediatric vaccination. Latent class analyses were conducted to group caregivers into four distinct profiles based on how safe, effective, useful and necessary they felt vaccination was.

Results
A total of 656 survey participants were grouped into a vaccine acceptance class based on their level of agreement on each attitudinal item, from low to high. Those in Class 1 had the most disagreement and lowest vaccine acceptance; those in Class 4 had the most agreement and highest vaccine acceptance. The majority of the sample fit into Class 2 (39%), indicating moderate disagreement and low COVID-19 vaccine acceptance.
Caregivers in the lowest vaccine acceptance classes (1 & 2) were significantly less likely to plan to vaccinate their children compared to those in higher classes (3 & 4); (9.8% and 5.5% vs. 31.9% and 61%).
Those in Class 2 were significantly less likely to have at least one adult household member fully vaccinated or boosted against COVID-19 than those in higher classes; and were significantly more likely to be from households where at least one adult was diagnosed with COVID in the past year than those in Class 3 (54.2% vs 37.7%).

Conclusion
Caregiver attitudes towards vaccination, and inclusion in vaccine acceptance classes, is closely associated with household vaccination status and COVID-19 infection history. Educational efforts and messaging should target the different aspects of caregiver profiles to address vaccine hesitancy and make future vaccine programming for children more successful.

Disclosures
Joseph V. Schwab, MD, MPH, Bristol-Myers Squibb: Stocks/Bonds|GE Healthcare: Stocks/Bonds|Johnson and Johnson: Stocks/Bonds