bluuebunny/crossref_metadata_2025_split huggingface dataset:
822. Is the Juice Worth the Squeeze: Ophthalmologist Examination for All Hospitalized Patients with Candidemia in a Rural Community
Authors: Kim Hyun Sue , Baffoe-Bonnie Anthony 
Published: November 2023

Abstract

Background
Candidemia is a common cause of bloodstream infections in hospitalized patients in the United States. Ocular manifestations of candidemia include chorioretinitis and endophthalmitis, which can lead to the loss of vision. Currently, there are opposing recommendations on whether all patients with candidemia should have a dilated ophthalmologic examination. We describe a rural patient population with candidemia who underwent an ophthalmology consultation and the associated clinical features and risk factors for an abnormal eye exam. We analyze the impact of ophthalmology consults on the treatment, management, and outcome.

Methods
We conducted a retrospective cross-sectional study of consecutive candidemia cases from 2015 to 2023. We abstracted patient demographics, clinical, and microbiologic data.

Results
We found that 218 candidemia patients with an average age of 54 years (range, 5-94) underwent an ophthalmologic evaluation. The average duration between hospital admission and consultation was 12 days. 24% of patients reported visual symptoms at the time of the consult and of those, 49% reported decreased visual acuity. Age, insurance status, and the number of days between hospital admission and consultation were strongly associated with positive findings.

Conclusion
Abnormal eye findings were not uncommon and were seen more frequently in certain demographic groups. In resource-limited settings, a more nuanced consultation strategy informed by local data may be reasonable.

Disclosures
All Authors: No reported disclosures
823. Clinical Outcomes of Coccidioidomycosis in Patients Requiring Intensive Care Unit Hospitalization
Authors: Lim James Ray M , Scott Ashley , Wig Rebecca , Tan Rachel V , Harnois Emily R , Zangeneh Tirdad , Al-Obaidi Mohanad 
Published: November 2023

Abstract

Background
Coccidioidomycosis is an endemic mycosis in the southwestern United States. While most infections are mild or asymptomatic, severe cases are associated with high morbidity and mortality. We aimed to evaluate the clinical outcomes of patients admitted to the intensive care unit (ICU) with proven culture-positive coccidioidomycosis.

Methods
After institutional review board approval, we retrospectively included ICU patients with positive Coccidioides spp. culture within a multi-healthcare system between 10/01/2017 – 07/01/2022. Clinical information was collected by chart review.

Results
Of the 392 hospital encounters with positive Coccidioides spp. culture, 145 patients required ICU stay. The median age was 51 (32-62), with 100 (68.9%) male, 56 (38.6%) White non-Hispanics, and 25 (17.2%) Blacks. Fifty-seven (39.3%) received azole antifungals before hospitalization. Seventy-two (49.7%) had another fungal, bacterial, or viral infection during their hospitalization, and 41 (28.3%) had extrapulmonary coccidioidomycosis. The majority, 131 (90.3%), received antifungal therapy during their hospital stay. The median hospital length of stay was 18 days (10-37). Almost half (48.3%) died during the study period, with liver cirrhosis and age ( &gt;60 years) resulting in statistically significant mortality, 12/13 (92.3%), p-value &lt; 0.001, and 31/43 (72.1%) p-value =0.001, respectively. Mechanical ventilation and/or intravenous vasopressor support was associated with a high risk of mortality 66/113 (58.4%, p-value=&lt; 0.001). Failure to receive antifungal therapy before ICU admission was associated with increased mortality, 46/70 (65.7%, p-value=0.002).

Conclusion
Patients with coccidioidomycosis admitted to the ICU face an increased risk of mortality. Risk factors associated with ICU mortality include advanced age, cirrhosis, and delay in the administration of antifungal therapy. Future studies are needed to evaluate these risks further.

Disclosures
Tirdad Zangeneh, DO, AiCuris: Grant/Research Support Mohanad Al-Obaidi, MD, MPH, La Jolla Pharmaceuticals: Honoraria
825. Cryptococcosis in the Immunocompetent Patient: Incidence and Outcomes
Authors: Mani Valli , Zimilover Adam , Hsieh Ji-Cheng , Ghani Maham , Kashfi Simon , Chen Richie , Islam Iffath , Donaghy Henry 
Published: November 2023

Abstract

Background
Cryptococcosis is a fungal infection that can cause pulmonary, central nervous system, or disseminated disease in immunosuppressed individuals. Although pulmonary cryptococcosis is known to rarely affect immunocompetent patients, there is limited research comparing the incidence and clinical outcomes of cryptococcosis in immunocompetent versus immunocompromised patients.

Methods
A retrospective analysis was performed on patients with confirmed positive CSF PCR, CSF antigen, or serum cryptococcal antigen tests from 8 hospitals in New York from 2017-2022. Patients were classified as immunocompromised if they had HIV, an organ transplant, active cancer, or were on immunosuppressive medications at the time of diagnosis. Baseline demographic information, comorbidities, and clinical outcomes were recorded. Statistical methods performed include t-test, Chi-square, and Fisher exact test.

Results
37 cases were identified with 9 cases (24%) in immunocompetent patients. There were no significant differences in age (p=0.82), gender (p=0.61), or BMI (p=0.15) amongst immunocompetent vs immunocompromised patients. Immunocompetent patients were more likely to have diabetes compared to immunocompromised patients (44% vs 21%, p = 0.04). Immunocompetent patients presented with meningitis more frequently (78% vs 41%, p = 0.05) with decreased mortality (11% vs 18%, p = 0.04) and no significant differences in rates of fungemia (21% vs 22%, p = 0.28). The majority of immunocompetent patients were treated inpatient and discharged on fluconazole without documented relapsed infection (77%). When assessing patients before and after 3/30/2020, the midpoint of our data timeline and beginning of the COVID pandemic, the proportion of immunocompetent cases increased (12% vs 35%, p = 0.03) while the total number of cases was relatively unchanged.

Conclusion
Meningitis was a more common presentation than pulmonary disease in immunocompetent patients. Immunocompetent patients also had better outcomes with decreased mortality. Overall, the number of immunocompetent patients increased over the study period. Additional information about cryptococcosis in immunocompetent patients, as well as the role of diabetes and COVID infection as potential risk factors, warrants further study.

Disclosures
All Authors: No reported disclosures
832. Epidemiology, Clinical Characteristics, Treatment and Outcome of Mucormycosis during COVID-19 Pandemic in the VA Health System
Authors: Muthukumarasamy Nirmal , Suzuki Hiroyuki 
Published: November 2023

Abstract

Background
Mucormycosis is associated with high mortality rates, ranging between 40 to 90%. COVID-19 associated mucormycosis (CAM) has garnered much attention during the COVID-19 pandemic. As most of the reports of CAM are case reports, it is difficult to estimate the true incidence and characteristics of CAM compared to non-CAM cases. Our study aims to describe and compare CAM and non-CAM cases during the COVID-19 pandemic within the Veterans Health Administration (VHA) system.

Methods
A retrospective chart review was conducted of all inpatients with a diagnostic code of mucormycosis (ICD-10: B46) among VHA hospitals from 1/1/2020 to 12/31/2022. We classified CAM as mucormycosis with a preceding COVID-19 diagnosis within 3 months. Data collected include demographics, comorbidities, COVID-19 diagnosis within 3 months, type of mucormycosis, surgical treatment and 90-day mortality.

Results
During the study period, 61 patients were identified, and after a manual chart review a total of 47 patients from 29 hospitals were included in the descriptive analysis. The median age of patients was 68 years, with 46/47 (97.9%) being male. 33/46 (70.2%) were White. Most common comorbidities were diabetes mellitus (72.3%), chronic obstructive pulmonary disease (57.5%), and chronic kidney disease (40.4%). Pulmonary mucormycosis was the most common manifestation in 20 (42.6%), followed by rhino-cerebral in 15 (31.9%), cutaneous in 7 (14.9%) and musculoskeletal in 4 (8.5%) of patients.
There were 11 (23.4%) patients with CAM. Most of these cases occurred in the second half of 2021 during the Delta variant wave (8 patients), followed by 2 cases in 2022 (during the Omicron variant wave) and 1 case in 2020. More than half of patients with CAM had pulmonary disease compared with about one-third in non-CAM cases (63.6% versus 36.1%, p=0.16). CAM cases were significantly less likely to be confirmed with a biopsy (45.5% versus 80.6%, p=0.02). Mortality was higher in CAM cases (54.6% versus 30.6%, p=0.17) although the difference was not statistically significant.
Comparison of CAM and Non-CAM cases during the study period

Conclusion
CAM cases seemed to be quite different from non-CAM cases in clinical characteristics, treatment and outcome in our VHA cohort although a definitive conclusion cannot be made due to the limited number of cases.

Disclosures
All Authors: No reported disclosures
834. A Single-center Experience of Cardiovascular Histoplasmosis: An Emerging Complication of Histoplasmosis
Authors: Ordaya Eloy E , Lawrence Sarah A , Conley Elyse L , Padang Ratnasari , Enzler Mark 
Published: November 2023

Abstract

Background
Histoplasmosis is an endemic mycosis associated with a wide range of clinical presentations. Cardiovascular histoplasmosis (CVH) was rarely seen at our center before 2007 but has increased in frequency over the last 15 years. Herein, we describe the clinical characteristics of our recent CVH cases.

Methods
We identified all adults diagnosed with CVH at Mayo Clinic in Rochester, MN, between May 2007 and February 2023.

Results
Ten cases of CVH were identified, all of whom resided in the Midwest (Table). The majority were male, with a median age of 72 years. Five patients had prosthetic valves, two endovascular grafts, one a prosthetic valve and aortic graft, and one was a heart-kidney transplant recipient. Patients most frequently presented with prolonged night sweats, fever, and dyspnea. Cytopenias, pulmonary nodules, and splenomegaly were common laboratory and imaging findings. The diagnosis was suspected based on a positive Histoplasma antibody (100%) and/or antigen (80%) testing and confirmed by positive culture (blood 60%, explanted valve/graft 20%) and/or histopathology (60%). Identified clinical syndromes included: prosthetic valve endocarditis (PVE; 50%), native valve endocarditis (10%), mycotic aortic aneurysm (10%), aortic graft infection (10%), PVE and aortic graft infection (10%), and myocarditis (10%). Most patients received combined medical and surgical treatment (50%). Three patients (30%) received medical treatment only, including one patient with myocarditis. Two patients (20%) presented progressive clinical decline and were not considered antifungal treatment or surgical candidates. The overall mortality within one year of diagnosis was 50%. Patients with endocarditis and/or graft infection who received only medical treatment had higher mortality than those who received combined medical and surgical treatment (100% vs 20%, respectively).Table.Clinical characteristics of patients presenting with cardiovascular histoplasmosis (N=10)
*Patient frequently had more than one comorbidity, symptom, laboratory or imaging finding, positive histoplasmosis testing, or affected valve. **Two patients did not receive treatment given their critical status, and were transitioned to comfort care.

Conclusion
CVH is being seen more frequently at our institution. One-year mortality of CVH was high, but combined medical and surgical management conferred better outcomes than medical treatment alone. We suggest a high index of suspicion of CVH in patients residing in Histoplasma endemic regions with a history of prior cardiac or vascular surgery presenting with prolonged fevers and/or new cardiomyopathy.

Disclosures
All Authors: No reported disclosures
837. Isavuconazole in the Treatment of Chronic Forms of Coccidioidomycosis
Authors: Heidari Arash , Sharma Rupam , Shakir Qusai , Shah Madiha , Donnelly Monica , Reynolds Trina , Trigg Kate , Joliff Jeff , Kuran Rasha , Johnson Royce H , Thompson George R 
Published: November 2023

Abstract

Background
Coccidioidomycosis is a fungal infection with a range of clinical manifestations. Currently used antifungal agents exhibit variable efficacy and toxicity profiles necessitating evaluation of additional therapeutic options.

Methods
Patients with coccidioidomycosis who received Isavuconazole were identified by cross-indexing ICD-9 and ICD-10 codes from patients and data abstracted. Responses to Isavuconazole therapy were measured using a modified Mycoses Study Group Coccidioidomycosis Scoring system as described previously.

Results
82 patients met the criteria for inclusion. Over half of the patient exhibited pulmonary involvement 45/82 (55%), although meningitis 32/82 (39%), bone and joint disease 14/82 (17%) and skin/soft tissue infection 7/82 (9%) were also seen. The majority of patients experienced a decrease in their MSG score following initiation of Isavuconazole therapy (median MSG score change across all patient groups 7 → 2, p&lt; 0.0001). Overall improvement was noted in 58/82 (71%) patients, while no change was observed in 19/82 (23%) and 5/82 (6%) who were unresponsive to antifungal changes.

Conclusion
Isavuconazole demonstrated efficacy in the majority of patients treated, with failures observed only in a subgroup of patients with coccidioidal meningitis.

Disclosures
Rupam Sharma, PGY-1/MD, Astellas: Grant/Research Support George R. Thompson, III, MD, Astellas: Advisor/Consultant|Astellas: Grant/Research Support|Cidara: Advisor/Consultant|Cidara: Grant/Research Support|F2G: Advisor/Consultant|F2G: Grant/Research Support|Mayne: Advisor/Consultant|Mayne: Grant/Research Support|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support
839. Insights into Histoplasmosis in India: A Tertiary Care Centre Experience
Authors: SONI J I N A L , Jindal Anmol , Aggarwal Anivita , Batra Tanvi , GOGIA A T U L 
Published: November 2023

Abstract

Background
Serious fungal infections have a significant global impact, affecting millions of lives. Histoplasmosis, commonly reported from the Gangetic Plains of India, presents as a spectrum of varied clinical courses ranging from an acute pulmonary illness to a progressive disseminated histoplasmosis. It is probably underreported due to low index of suspicion, expensive and invasive tests, especially in resource-limited settings like India. In a high tuberculosis burden country, its clinico- radiological resemblance often makes the diagnosis and treatment further challenging for clinicians.This study was conducted to provide deeper insights into the varied clinical presentation and outcomes of Histoplasmosis from a tertiary centre in India.

Methods
We conducted a retrospective observational study including all adult patients who were diagnosed with Histoplasmosis between July 2019 and March 2023 admitted in the Department of Internal Medicine at Sir Ganga Ram Hospital, New Delhi. Their details were collected using electronic records and analysed. They were followed up till the completion of treatment or recent follow up.

Results
We found 8 patients with confirmed histoplasmosis. Majority of the cases were males (87.5%), farmers (37.5%) and belonged to Uttar Pradesh (37.5%),Table 1, Figure 1. Only one patient did not have any attributable underlying risk factor. Fever (100%) and weight loss (50%) were the most common symptoms, Table 2. Anemia, leucopenia and splenomegaly were among the common abnormalities detected, Table 3. Organ-specific involvements were identified by histopathological examination on specific biopsy, Figure 2. Most of the patients (75%) received an initial intravenous course of Liposomal Amphotericin B for 2-3 weeks followed by oral Itraconazole therapy. There were two in-hospital mortalities, out of which one patient expired before the initiation of treatment. Rest of the patients (75%) had clinical recovery on follow up.
Abbreviations: HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome
Abbreviations: MODS, multiorgan dysfunction syndrome; HLH, hemophagocytic histiocytosis
Abbreviations: FDG, fluorodeoxyglucose

Conclusion
Majority of the cases depicted in our study had peculiar diagnostic dilemmas and required a strong clinical suspicion with subsequent invasive procedures to establish the diagnosis. Our study adds to the paucity of data on histoplasmosis and improves the understanding of the disease course among the Indian population.
Distribution of 8 cases of histoplasmosis reported from different states of India

Disclosures
All Authors: No reported disclosures
855. Distinguishing between drug-susceptible and resistant Neisseria gonorrhoeae from urine samples by image recognition AI.
Authors: Ariizumi Reiichi , Inagaki Tsubasa , Ozaki Hiroaki , Nakada Mitsutaka , Maeta Shogo , Nakajima Masakazu , Taketani Makoto 
Published: November 2023

Abstract

Background
Gonorrhea is a major public health concern because it causes complications that can seriously affect maternal and newborn health, including infertility and neonatal eye infections leading to blindness. Antimicrobial resistance (AMR) of the causative pathogen, Neisseria gonorrhoeae (Ng), emerged shortly after the introduction of antimicrobial agents. This has continued to grow over the past 80 years, culminating in the current outbreak of the gonorrhea superbugs, a broad spectrum of drug-resistant strains of Ng. Gonorrhea superbugs can be a major challenge inducing prolonged complications of gonococcal infection and increasing the number of patients with complications.
Here, we demonstrated whether resistant Ng can be morphologically distinguished from susceptible Ng using our artificial intelligence (AI) assisted image recognition of Gram-stained specimens, which are inexpensive and can be diagnosed in the clinical setting.

Methods
As shown in Figure1, three groups of standard bacterial strains were used for the study; (1) a drug-susceptible Ng (ATCC 49226), (2) two drug-resistant Ng (NCTC13480 and NCTC13821), and (3) other GNC (ATCC13120: Neisseria flavescens and ATCC49143: Moraxella catarrhalis). Each bacterial strain was dissolved in female human urine and Gram stained. Image data were collected using a Nikon Eclipse Si microscope at 1000x magnification and iPhone 11.
In total, approximately 600 images were collected, with 60% used for training and 20% for validation. As a final test, 20% of the images were used to test accuracy.

Results
As shown in Table 1, our preliminary AI model achieved 95.3% sensitivity and 96.5% specificity. Since we use Gram-staining, its limit of detection is in theory 1 × 10^5 cells/ml and we confirmed it experimentally.
The classification prediction results.
The trained AI was tested on 139 images divided into three groups; (1)Drug-resistant Neisseria gonorrhoeae(DR-Ng), (2)Drug-susceptible Ng (DS-Ng) and (3)other commensal gram-negative cocci (other GNC)

Conclusion
Our preliminary AI model was able to distinguish not only drug-resistant Ng from drug-susceptible Ng, but also other commensal GNC with Gram-stained specimens, demonstrating the potential for low-cost point-of-care diagnosis of Ng. Such a diagnosis will promote the proper use of antimicrobial agents, which can help to prevent the spread of drug-resistant Ng.

Disclosures
Masakazu Nakajima, B. Engineering, Soiken Holdings: Board Member|Welby Inc.: Board Member|Welby Inc.: Ownership Interest|Welby Inc.: Stocks/Bonds
859. The Role of Procalcitonin in Antimicrobial De-escalation and Stewardship Program in Febrile Neutropenic Cancer Patients
Authors: Dagher Hiba , Chaftari Anne-Marie , Hachem Ray Y , Jiang Ying , Philip Ann , Mulanovich Patricia , Haddad Andrea , Lamie Peter , Dib Rita Wilson , John Teny , Garnes Natalie J Dailey , Chaftari Patrick , Raad Issam I 
Published: November 2023

Abstract

Background
Serial procalcitonin (PCT) measurement has been adopted as an adjunct to clinical judgement to guide antibiotic therapy, prevent antibiotics overuse and endorse antimicrobial stewardship programs. PCT peaks at 24 to 48 hours, and declines with infection resolution. In this prospective study we explored the role of PCT used as a biomarker in adjunct to the clinical judgment to guide antibiotic course.

Methods
We prospectively enrolled cancer patients with febrile neutropenia (FN) to receive empiric intravenous broad-spectrum antibiotics (IV-BSA) for at least 48 hours. PCT was measured at baseline and 48-72 hours after initiation of study drug. A PCT drop at 48-72 hours after study drug initiation was defined as a drop by ≥30 % from baseline (start of therapy) or a level of &lt; 0.25 ng/ml. De-escalation was defined as a switch of IV-BSA to oral or simplified once a day IV therapy.

Results
A total of 80 patients were enrolled between October 2021 and April 2023, of whom 74 had serial PCT measurements. Median age was 59 years, 57% were male, and 66% had hematological malignancies. A PCT drop at 48-72 hours was observed in 68% of patients who de-escalated to oral or IV therapy. In this PCT guided study, the median time to de-escalation was 62 hours (&lt; 3 days). Furthermore, 64% of these patients de-escalated within 3 days after initiation of therapy, 79% de-escalated by day 4, 85% by day 5 and 92% by day 7. Patients with PCT drop had a shorter median duration of antibiotic compared to those without PCT drop (54.8 hours vs 106.4 hours; p=0.003). Furthermore, the antibiotic therapy de-escalation occurred sooner in patients with PCT drop (75% occurred prior or at 72 hours in the PCT drop group vs 41% in the non-PCT drop group; p=0.017). Patients who had a documented bacteremia had a significantly higher median PCT level at baseline than those without bacteremia (3.92 ng/ml vs 0.37 ng/ml; p=0.001).

Conclusion
In this PCT guided study, the median time to de-escalation of IV-BSA was &lt; 3 days and most of the cancer patients with FN who de-escalated had a PCT drop within 3 days of initiating therapy. Patients with a PCT drop had an earlier de-escalation and a shorter course of antibiotic therapy.

Disclosures
Natalie J Dailey Garnes, MD, MPH, AlloVir: Grant/Research Support Issam I. Raad, Distinguished Professor, Novel Anti-Infective Technologies, LLC: Technology License