bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1120. Antibiotics use among premature infants in three neonatal care Units in Brazzaville, Republic of Congo
Authors: Ekat Martin Herbas , Ibara Rolland Bienvenu Ossibi 
Published: January 2025

Abstract

Background
To evaluate the use of antibiotics in Congolese premature infants based on WHO recommendations in three neonatal care units in Brazzaville.

Methods
This was a cross-sectional study, premature infants admitted 72 hours after birth in three neonatals care units in Brazzaville, between January 2019 and November 2020, were included. Taking into account WHO recommendations, we grouped premature infants according to the presence or absence of maternal risk factors for neonatal infection (3 items), and each factor was rated 1. Risk factors for neonatal infection, such as early onset sepsis (EOS) specific to the newborn (7 items), were also used and rated 1 or 0 depending on whether it was present or not. Maternal risk had 4 categories (0, 1, 2 and 3) and EOS risk had 8 categories (0, 1, 2, 3, 4, 5, 6 and 7). Premature newborns were first classified according to maternal risk followed by EOS risk for each maternal risk category, then the proportion of premature infants placed on antibiotics was determined.

Results
Aa total of 448 premature newborns were included. The proportion of antibiotic therapy depending on the categories was as follows: maternal risk 3 (EOS risk 2, 3 and 5 were 100% and INBP risk 4 67%), maternal risk 2 (INBP risk 1, 2, 3, 4 and 5: 0%, 64%, 92%, 91% and 100% respectively), maternal risk 1 (EOS risk 1, 2, 3, 4, 5 and 6: 88%, 66%, 88%, 93%, 100% and 100% respectively), maternal risk 0 (INBP risk 1, 2, 3, 4, 5 and 6: 29%, 57%, 76%, 82%, 96% and 100% respectively). In multivariate analysis, the factors associated with the use of antibiotic therapy outside the WHO recommendations were: being born in a health structure different from that of hospitalization (OR: 0.16; 95%CI: 0.03 – 0.94 ), be born in an integrated health center (OR: 23; 95%CI: 2.9 – 190).

Conclusion
The Use of antibiotic therapy is only effective when all the maternal or premature newborn risk factors are present, contrasting with WHO recommendations. Other factors are involved in the use of antibiotics, such as being born in primary healthcare facility. The implementation of an antibiotic management program is a necessity.

Disclosures
All Authors: No reported disclosures
P-1129. Exploring Cost Savings through Reduced Sedation for Magnetic Resonance Imaging in Pediatric Osteomyelitis Diagnosis
Authors: Sumner Lauren , Downey Rachel , Hauger Sarmistha Bhaduri , Thoreson Lynn , Williams John , Kaufman Brian 
Published: January 2025

Abstract

Background
Magnetic resonance imaging (MRI) is essential for the diagnostic workup of pediatric osteoarticular infection. In the pediatric population, sedation is often required to mitigate motion artifact and improve imaging quality, which contributes to cost, resource utilization, and risk to the patient. In 2021, our hospital implemented an evidence-based update to the pediatric osteomyelitis guideline adjusting MRI imaging sequences, which reduced sedation age requirements from 8 years to 3 years of age. This change was initiated in September 2021. This study evaluates economic implications of sedation reduction strategies in pediatric osteomyelitis imaging.
Figure 1. Pre vs Post Guideline Sedation Rates.

Methods
This is a retrospective chart review study of pediatric patients evaluated for bone and joint infection by MRI at a free standing 299 bed hospital in Central Texas. Cases were pulled by MRI indication according to the hospital’s osteomyelitis guideline inclusion criteria between January 1, 2020 and December 31, 2023. Previously healthy children age 6 months to 18 years with physical exam suggestive of acute hematogenous osteomyelitis or septic joint and less than 14 days of symptoms were included. Cases were compared by year pre-guideline (2020-2021) and post-guideline (2022-2023) and reviewed for age, sex, need for sedation, and diagnosis after MRI. Cost savings estimates were based on an average per case cost of sedation. The cost of sedation was determined by hospital charges.
Figure 2. Pre & Post Guideline Sedated vs Non-Sedated Patients.

Results
279 patients were included, (98 pre guideline change; 181 post guideline change). 61.3% male, 38.7% female, median age 6, IQR 6.5. A statistically significant reduction in sedation usage was observed after guideline implementation (50%-33%, p=0.0087) (fig 1). Among patients 3-8 years of age, 21 of 34 patients (62%) pre-guideline and 15 of 78 patients (19%) post- guideline received sedation (p&lt; 0.001) (fig 2). An average estimated cost savings of $270,215 per year was found. There was no increase in repeat MRI rates seen with the implementation of the age requirement change.

Conclusion
Lowering the required age for sedation allows for individualized assessment of sedation needs in the 3-8 age group. This leads to improved patient care through decreased patient risk, reduction in overall rate of sedation and results in cost savings.

Disclosures
Brian Kaufman, MD, Johnson & Johnson: Advisor/Consultant
P-1156. Procalcitonin Assay in Predicting Etiology in Young Febrile Infants Visiting the Emergency Department in Korea
Authors: Kim Haemin , Kim Min Young , Baek Jee Yeon , Lee Ji Young , Yoon Seo Hee , Kim Heeyeon , Kang Ji-Man 
Published: January 2025

Abstract

Background
There have been no studies conducted in Korea on the role of procalcitonin as a predictive factor for serious bacterial infection (SBI) in young febrile infants under 90 days of age, and it is not included in insurance reimbursement criteria despite its potential clinical utility. Our aim was to assess the role of the procalcitonin assay in distinguishing the etiology of fever, including SBI and simple urinary tract infection (sUTI), in young febrile infants in Korea.
The sensitivity and the specificity of procalcitonin (≥0.5 ng/mL) for SBI and sUTI
A. The sensitivity and the specificity of procalcitonin for SBI
B. The sensitivity of the specificity procalcitonin for sUTI

Methods
This retrospective study was conducted on patients under 90 days of age who visited the pediatric emergency department (ED) at Severance Children's Hospital and underwent procalcitonin assay from January 2019 to February 2024. Patients who visited the ED for reasons other than fever or were under 29 days of age were excluded. The SBIs were defined as cases of the identification of pathogens in sterile fluids such as blood and cerebrospinal fluid, while sUTIs were defined as UTIs without bacteremia. Viral infections were defined as cases where a virus was identified through testing or when symptoms or contact history clearly indicated viral infection; otherwise, they were classified as unknown. The cut-off value for procalcitonin was set at 0.5 ng/mL.

Results
A total of 633 patients were collected, of whom 131 were excluded, resulting in 502 individuals included in the analysis. Among them, half were aged between 29-60 days and the other half between 61-90 days, with six admissions to the intensive care unit and no fatalities. By etiology, there were 22 cases of SBI (4.4%), 161 cases of sUTI (32.1%), 147 cases of viral infection (29.3%), and 172 cases classified as unknown (34.3%). The median values of procalcitonin were 5.03 (range, 0.08-100) for SBI, 0.35 (range, 0.05-52.2) for sUTI, 0.13 (range, 0.04-53.3) for viral infection, and 0.15 (range, 0.04-100) for unknown. The sensitivity of procalcitonin (≥0.5 ng/mL) for SBI and sUTI was 81.8% and 42.2% respectively, while the specificity was 77.8% and 88.3% respectively. (see Figure)

Conclusion
In febrile young infants in Korea, the utility of procalcitonin as a predictor of SBI is significant, warranting consideration for its proactive integration into clinical practice.

Disclosures
All Authors: No reported disclosures
P-1158. Surgical Outcomes Following Paenibacillus Infant Infectious Hydrocephalus
Authors: Ericson Jessica E , Natukwatsa Davis , Ssenyonga Peter , Onen Justin , Mugamba John , Mulondo Ronald , Morton Sarah , Templeton Kelsey , Hehnly Christine , Mbabazi-Kabachelor Edith , Kulkarni Abhaya , Warf Benjamin , Broach James , Paulson Joseph , Schiff Steven 
Published: January 2025

Abstract

Background
We previously identified Paenibacillus species in the cerebrospinal fluid of 44% of infants presenting for neurosurgical evaluation with findings consistent with postinfectious hydrocephalus (PIH) in Eastern Uganda. Here we sought to compare outcomes among hydrocephalic infants with and without Paenibacillus detection at the time of hydrocephalus surgery.

Methods
In a prospective observational trial, 78 infants with PIH who underwent a cerebrospinal fluid (CSF) diversion had a positive CSF polymerase chain reaction result for Paenibacillus species (PP), and 111 had a negative result (PN). The primary outcome was diversion failure-free survival defined as being alive without diversion failure at the end of the observation period adjusted for age at the time of diversion and surgery type. Secondary outcomes included overall survival and diversion success.

Results
After a median follow-up period of 35.7 months, the primary outcome had occurred in 42 PP patients (54%) and in 76 PN patients (68%) (adjusted hazard ratio (aHR), 2.45; 95% confidence interval [CI], 1.42 to 4.22; P=0.001). PP patients who underwent endoscopic diversion had the worst primary event rate (aHR, 6.47; 95% CI, 2.40 to 17.42; P&lt; 0.001). Death from any cause occurred in 16 PP patients (20%) and 9 PN patients (8%) (aHR, 3.47; 95% CI, 1.44 to 8.37; P=0.006). Diversion failure occurred in 28 PP patients (36%) and in 29 PN patients (26%) (aHR, 2.24; 95% CI, 1.31 to 3.85; P=0.003).

Conclusion
Paenibacillus detection in the CSF at the time of hydrocephalus surgery was associated with a significantly increased rate of the composite of diversion failure or death, death, and diversion failure, and was particularly increased for patients who had an endoscopic diversion. Preoperative testing and treatment of Paenibacillus infections may improve outcomes for surgical management of PIH.

Disclosures
Jessica E. Ericson, MD, MPH, Abbvie: Advisor/Consultant
P-1169. Disseminated Pediatric Coccidioidomycosis at an Academic Center in Southern Arizona (2013 - 2023)
Authors: Lacy Marian , Gotwalt Jordan , Ampel Neil M , Shehab Kareem W 
Published: January 2025

Abstract

Background
There have been few reviews of pediatric disseminated coccidioidomycosis, particularly regarding presentation. A better understanding of this may enable more timely diagnosis and improve management in children.

Methods
We identified 157 children with coccidioidomycosis seen in the pediatric infectious diseases practice at University of Arizona – Banner University Medical Center in Tucson, AZ, between 2013 – 2023. Criteria included: age under 18, seen by a pediatric infectious diseases specialist, with a diagnosis of coccidioidomycosis in the consultation note. This study includes the subset of children with a diagnosis of disseminated coccidioidomycosis. Cases were excluded if the electronic medical record did not document at least one of the following supporting diagnostics: positive coccidioidal IgM or IgG by EIA, culture positive for Coccidioides, or histopathological findings characteristic of coccidioidomycosis. Demographic, laboratory, and radiologic data as well as clinical characteristics were collected from review of the electronic medical record.

Results
Among 157 patients, 28 (17.8%) had disseminated disease. Median age at diagnosis was 11.7 years (range 7 months to 17 years of age). 64% were male. Musculoskeletal disease was the most common extrapulmonary organ system involved (15 patients), followed by skin (11), central nervous system (4), abdominal organs and viscera (2), pericardium (1) and bloodstream (1). Sixteen (57%) had no comorbidities. The chest radiograph was normal in 10 of 26 (38%) where it was performed. Seventeen (61%) had a negative coccidioidal EIA IgG serology, and 3 patients (11%) had negative IgM and IgG serologies on presentation. Only 3 (11%) had an elevated absolute eosinophil count (above 600/µL).

Conclusion
Disseminated coccidioidomycosis affects children of all ages and can involve many different organ systems, particularly musculoskeletal, skin, and central nervous system. It should be considered in the appropriate clinical setting even in patients with negative coccidioidal serologies, normal chest x-rays, normal eosinophil counts, or no underlying illness.

Disclosures
All Authors: No reported disclosures
P-1185. Targeting and Universal Congenital Cytomegalovirus Screening in a Neonatal Intensive Care Unit
Authors: Torriente Adriana Gonzalez , Randis Tara , Espinosa Claudia M 
Published: January 2025

Abstract

Background
Congenital cytomegalovirus (cCMV) infection, confirmed by urine or saliva CMV PCR within 3 weeks of life, affects 0.5 % of live births in the United States. This number varies in different populations, and it is affected by socio-demographic characteristics. In Neonatal Intensive Care Units (NICUs), higher prevalence has been reported in preterm and low birth weight infants, but timing of screening remains a challenge without universal screening because only 10% of cCMV are symptomatic. Regardless of symptoms, infected infants are at increased risk of adverse outcomes such as hearing loss. Thus, we sought to determine the incidence and associated characteristics of cCMV infection using targeting and subsequently universal screening in our NICU population

Methods
From Feb 1, 2023 to Apr 30, 2024, infants who were admitted at Tampa General Hospital (TGH) NICU and had a CMV PCR testing performed during admission were followed prospectively. Before Feb 28, 2024, cCMV screening was performed only in infants who were symptomatic (IUGR, microcephaly, thrombocytopenia) or failed hearing screen. After that, all infants born preterm &lt; 33 weeks gestational age (GA) and all infants with anticipated NICU stay &gt; 3 weeks were screened for cCMV at admission. Characteristics such as GA, birth weight, and race and ethnicity are recorded in a RedCap database. Descriptive statistics were used

Results
A total of 715 infants were screened for CMV while hospitalized in the TGH NICU during the study period. Most of the infants (68.2%) were screened after failing newborn hearing screen and only four (0.6%) were screened because of their symptoms. The characteristics of the infants with positive and negative saliva or urine CMV PCR are described in Table 1. Only three (0.4%) infants tested positive for CMV and were confirmed to have cCMV. Two infants with cCMV infection were screened because they were symptomatic

Conclusion
At TGH NICU, the incidence of cCMV using targeting and universal screening was comparable with the U.S. general population and lower than reported in other NICUs. We plan to perform association when statistically feasible, and compare incidence of cCMV between the targeting and universal screening periods

Disclosures
Claudia M. Espinosa, MD, MSc, AstraZeneca: Grant/Research Support|Clinetics: Grant/Research Support|Enanta: Grant/Research Support|Gilead: Advisor/Consultant|Jansen & Jansen: Advisor/Consultant|Kentucky Health Rural Association: Honoraria|Medimmune: Grant/Research Support|Melinta: Grant/Research Support|Merck: Grant/Research Support|Sanofi: Advisor/Consultant|Sanofi: Honoraria
425. Revealing Seasonal Patterns in the Post-Pandemic Era: A Comparative Analysis of Burden and Seasonality of Influenza and COVID-19 in Europe and the US
Authors: Shaikh Nabila , van Aalst Robertus , Harris Rebecca C , El Guerche-Séblain Clotilde 
Published: January 2025

Abstract

Background
The emergence of SARS-CoV-2 has profoundly impacted global healthcare systems, raising concerns about its interaction with seasonal influenza and the appropriateness of concomitant vaccination campaigns. This study aims to compare the burden and timing of COVID-19 and influenza-associated hospitalizations during the post-pandemic period.Figure 1:Evolution of Influenza and Covid-19 activity by season over 2022-2023 and 2023-2024

Methods
We retrospectively analyzed laboratory-confirmed hospitalization data from sentinel surveillance systems for influenza and COVID-19 across two seasons (2022-2023 to 2023-2024) in England, the US, and four European countries (France, Germany, Italy, Spain). We examined absolute hospitalization numbers in the EU, weekly rates in England, and both rates and numbers in the US to identify seasonal peaks and describe epidemiological trends.
Annual cumulative number of laboratory-confirmed hospitalizations in Germany, Spain and US by season (annual period defined as epi week 27 – epi week 26)

Results
Peak laboratory-confirmed hospitalizations in EU countries for COVID were higher than for influenza, ranging from 0 to 1,427 per week and 0 to 366 per week, respectively. Similarly in the US, hospitalizations for COVID-19 and influenza varied from 44,760 to 319,445 and 3,301 to 172,784, respectively. England had higher peak weekly rates for both influenza (18.1 per 100,000) and COVID (18.3 per 100,000) compared to the US (7.4 per 100,000 for influenza and 13.7 per 100,000 for COVID).
Across the EU, England, and the US, peak influenza activity occurred between Week 47 and Week 6 in both 2022-2023 and 2023-2024 seasons. While COVID-19 activity peaked alongside influenza, activity remained high beyond the winter seasons.
Annual cumulative hospitalizations for COVID-19 were 4, 5, and 12 times higher than influenza in the US, Germany, and Spain, respectively. Cumulative hospitalizations for other countries were not assessed due to missing data.

Conclusion
COVID-19 and influenza continue to pose a significant burden on healthcare systems. While differing testing practices between viruses and between countries introduces limitations to this analysis, our findings confirm that COVID-19 circulation is not restricted to winter seasonality, and surveillance and prevention measures should be reinforced year-round. Further research is also required to properly inform the validity of concomitant vaccination policy.

Disclosures
Nabila Shaikh, MSc, Sanofi: Stocks/Bonds (Public Company) Robertus van Aalst, PhD, MSc, Sanofi: Employee|Sanofi: Stocks/Bonds (Public Company) Rebecca C Harris, MBioch, MSc, PhD, Sanofi vaccines: Stocks/Bonds (Private Company) Clotilde El Guerche-Séblain, PhD, Sanofi vaccines: Stocks/Bonds (Private Company)
P-1228. Predictive Performance of Population Pharmacokinetic (Pop PK) Models in InsightRX® for Model-Informed Precision Dosing (MIPD) for Cefepime
Authors: Konig Christina , Kuti Joseph L , Fratoni Andrew J 
Published: January 2025

Abstract

Background
MIPD is a promising Bayesian tool to ensure therapeutic antimicrobial concentrations, with multiple models often available. Model selection and sampling strategy might generate different estimates for different populations. Herein, we assess performance of two models in InsightRX® to predict cefepime PK and exposure through differing sampling approaches.

Methods
Historic cefepime PK data were sourced from prospective-observational studies that used robust sampling to develop pop PK models in patients with diabetic foot infection (n=5), VAP (n=15), and supported on ECMO (n=6, 2 on CRRT) or CRRT only (n=4). Historic individual Bayesian estimates served as the reference standard. Two pop PK models (A; B) in InsightRX® were evaluated using four sampling scenarios 1) trough, 2) midpoint, 3) trough and midpoint and 4) peak, midpoint and trough. The median percentage error (MPE) and median absolute percentage error (MAPE) with acceptable defined as &lt; ±20 and &lt; 30%, respectively, were calculated as measures of bias and imprecision for clearance (CL) and volume of central compartment (Vc). Predicted categorical achievement of ≥ 70% fT &gt; 8 mg/L was compared.

Results
Imprecision and bias for CL and Vc showed variability dependent on model and sampling strategy (Table 1). MAPE/MPECL for all models and sampling strategies were acceptable. Both models showed the lowest bias on CL for sampling scenario 4. In the full patient cohort, MAPE/MPEVc were &gt;30 and &gt; ± 20% for most tested scenarios. When excluding patients with extracorporeal support (i.e. ECMO or CRRT), bias and imprecision for Vc improved, with best prediction in model A using sampling scheme 4 and sampling 1 in model B. Using each model and sampling scheme, only 1 patient had discordant predicted categorical achievement of ≥ 70% fT &gt;8 mg/L.

Conclusion
Among patient populations representative of the two studied PopPK models in InsightRX®, predicted PK parameters and achievement of relevant exposures demonstrated acceptable performance for clinical care. While all sampling scenarios were acceptable in predicting CL, increasing the number of samples up to three generally improved performance. Appropriate model selection for special populations such as ECMO and CRRT remains paramount as Vc was poorly predicted among this subgroup.

Disclosures
Christina Konig, PhD, Gilead Inc.: Honoraria|Pfizer Inc.: Honoraria|Shionogi Inc.: Honoraria Joseph L. Kuti, PharmD, Abbvie: Advisor/Consultant|bioMerieux: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi Inc: Advisor/Consultant|Shionogi Inc: Grant/Research Support|Shionogi Inc: Honoraria|Venatorx: Grant/Research Support Andrew J. Fratoni, PharmD, InsightRX: Grant/Research Support
P-1231. Optimal vancomycin AUC target in children with MRSA bacteremia: based on Bayesian-guided dosing
Authors: Lee Yonghee , Kim Gahee , Lee Jina 
Published: January 2025

Abstract

Background
Despite the widespread use of vancomycin in methicillin-resistant Staphylococcus aures (MRSA) infections, there is still a lack of clinical data elucidating the optimal target concentration of vancomycin in the pediatric population.

Methods
From September 2013 to December 2021, a retrospective analysis was conducted on pediatric patients (3 months- 18 years of age) with MRSA bacteremia. Vancomycin area under the concentration-time curve (AUC) was estimated by Bayesian software.

Results
A total of 56 patients with MRSA bacteremia were included, with median age of 2.4 years. 92.9% had underlying medical conditions, most of which were associated with catheter-associated infections. Persistent bacteremia ≥ 48 hours, recurrent bacteremia, 30-day all-cause mortality, and acute kidney injury (AKI) were observed in 17.9%, 14.8%, 3.7%, and 7.1%, respectively. AUC24-48 ≥ 400 did not demonstrate clinical benefit in the above outcomes. Persistent bacteremia was associated with source control, 30-day all-cause mortality, and AKI. As an AUC target, AUC24-48 ≥ 528.2 mg·h/L was associated with persistent bacteremia (P &lt; 0.01), and AUC24-48 ≥ 536.8 mg·h/L was associated with AKI (P = 0.01). No significant factors associated with 30-day mortality and recurrence were identified.

Conclusion
We suggest an AUC24-48 &lt; 528.2 mg·h/L as the optimal target for children aged ≥ 3 months with MRSA bacteremia. The lower bound of the target range was not identified.

Disclosures
All Authors: No reported disclosures