bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-829. Determination of novel clinical phenotypes among sepsis patients from an Indian sepsis registry
Authors: Edathadathil Fabia , Gutajhr Georg , Dipu T S , Singh Sanjeev 
Published: January 2025

Abstract

Background
Sepsis is a dysregulated host immune response with heterogenous clinical presentation reflected in its high dimensional data and with distinct epidemiological profile endemic to LMICs such as India. The study aims to identify and estimate the prevalence of clinical phenotypes from retrospective data of sepsis patients from a South Indian registry.
Characteristics of the identified clusters and outcomes

Methods
The registry enrolled all adult patients admitted through the emergency department with a presumed diagnosis of sepsis following Surviving Sepsis Guidelines(SSG) criteria(Edathadathil F, 2022)1. Following Ordering points to identify the clustering structure(OPTICS) assessment, k-means clustering was identified and employed as unsupervised clustering method for deriving clusters. The association of focus of infection and outcomes among the clusters was assessed. The identified Indian clusters were compared to the phenotypic clusters derived by Seymour et al using distance matching2(Seymour et al, 2019).
Distribution of focus of infection and causative pthogens among the clusters

Results
Of the 1009 patients enrolled in the registry, four clusters were identified with Cluster 1 exhibiting the highest prevalence and comprising 389 patients (39%), followed by Cluster 3 (254, 25%), Cluster 4 (225, 22.3%), and Cluster 2 (141, 14%). Age(p=0.024) and gender(p=0.04) significantly differed among the four clusters with septic shock (p&lt; 0.001) and inhospital mortality (p&lt; 0.001) significantly higher in Cluster 3 (septic shock at 19%, in hospital mortality at 32%)(Table 1). Among focus of infection, the prevalence of pneumonia (p=0.018), SSI(p=0.011) and bacteremia(p=0.004) significantly differed among the clusters (Fig 1). The proportion of bacteremia(29%) and pneumonia(28%) were observed to be significantly high in cluster 2. UTI(139, 38%) and SSI (57, 15%) were found to be significantly high in cluster 1. Pseudomonas (p=0.008) and staphylococcus aureus (p=0.02) were observed to be significantly different among the clusters. Clusters 1,2,3 and 4 exhibited close association to the gamma, beta, alpha and delta clusters respectively among the phenotypes derived by Seymour et al.

Conclusion
Our study has been one of the pioneer initiative in demonstrating inherent subgroups among sepsis patients within an Indian cohort data that significantly differed in outcomes and epidemiology.

Disclosures
All Authors: No reported disclosures
P-852. Not High Enough? Treatment Outcome Comparing High Dose Daptomycin vs. Linezolid in VRE Bacteremia: Implications of Daptomycin PD Target
Authors: Hwang Liang-En , Chuang Yu-Chung , Chen Yee-Chun , Wang Jann-Tay , Chang Shan-Chwen 
Published: January 2025

Abstract

Background
The best treatment for vancomycin-resistant enterococcus (VRE) bloodstream infection (BSI) remains controversial. In 2020, the CLSI revised the daptomycin breakpoints for E. faecium and recommended a high-dose daptomycin of 8-12 mg/kg/day. However, the effectiveness of high-dose daptomycin versus linezolid remains unanswered. The most effective PD parameter for daptomycin’s effectiveness is the free drug area under the curve to minimum inhibitory concentration ratio (fAUC/MIC). This study compares the clinical outcomes of VRE BSI between patients treated with linezolid and daptomycin within recommended dose. Additionally, we examined whether achieving the fAUC/MIC target influences the outcomes between these two groups.Figure 1.Flow diagram illustrating the selection of patients for the study.

Methods
An observational cohort study was conducted within National Taiwan University Hospital and its branches. From January 2010 to December 2021, patients treated with more than 8 mg/kg of daptomycin or linezolid for VRE BSI were included. The estimated fAUC was calculated, and the fAUC/MIC target was chosen based on the MIC determined using broth microdilution. The primary outcome was in-hospital mortality.Table 1.Demographics, clinical characteristics and univariable logistic regression analysis of mortality among patients with VRE BSI

Results
There were 1425 VRE BSI episodes, and 795 met inclusion criteria. The mean age was 67.7 years (SD 14.6), with 57.5% males. The mortality was 59.3%. Of 625 daptomycin-treated patients, 528 had estimated fAUC/MIC available. 114 had estimated fAUC/MIC above target. Mortality was 49.1% for daptomycin-treated patients with the PD above target, 66.2% for those below it, and 44.1% for linezolid-treated patients. Multivariable logistic regression showed Charlson comorbidity index (aOR 1.90, P=0.05), platelet count (aOR 0.96, P&lt; 0.001), and Pitt bacteremia score (aOR 1.31, P&lt; 0.001) to be associated with mortality. Daptomycin below PD target was associated with worse outcome than linezolid (aOR 2.52, P&lt; 0.001), while daptomycin above PD target was not (aOR 1.00, P=0.99).Figure 2.Comparison of Kaplan–Meier survival curves between daptomycin and linezolid in patients with VRE BSI

Conclusion
Our findings suggest that daptomycin, even within the recommended dosage range, leads to poorer outcomes when it does not reach the estimated PD target compared to linezolid in treating VRE BSI. However, the outcomes are comparable with linezolid when PD target is reached.Table 2.Multivariate logistic regression analysis of the factors associated with in-hospital mortality (N=695)

Disclosures
All Authors: No reported disclosures
P-855. Epidemiology and Clinical Pattern of Bacteremia in a Referral Hospital in Nicaragua: a Three Year Cohort Study
Authors: Solís-Altamirano Anielka , Colomer-Sánchez Karina , Gavarrete-Rivas Kevin , Porras-Cortés Guillermo D 
Published: January 2025

Abstract

Background
In recent years, some institutions have described changes in the epidemiological, microbiological, and clinical profiles of bacteremias. The Dr. Fernando Vélez Paiz Hospital (HFVP) is a teaching and referral hospital in Nicaragua, which opened its services 5 years ago. The aim of this study is to describe and analyze the epidemiological, microbiological, and clinical characteristics as well as risk factors for mortality of patients with bacteremia.Table 1.Medical History in Patients with Bacteremia

Methods
This is a bidirectional, observational, analytical cohort study. Conducted with 467 patients from the Internal Medicine, Surgery, Orthopedics, Burn Unit, and Intensive Care Unit services of the HFVP who presented bacteremia between January 2021 to December 2023. After filtering the data, the patients included for analysis were 374. Different variables were analyzed, and mortality was analyzed with some factors including SOFA, NEWS2, and Pitt scores.Table 2.Microbiology of Bacteremia in Hospital Dr. Fernando Vélez Paiz

Results
The mean age of the patients was 50.2 ± 19.9 years, and 63.7% had a comorbidity. The most frequent comorbidities were hypertension (54%), diabetes (45.1%), and chronic kidney disease (15.7%). Most of the patients were from the surgery (31.8%), internal medicine (31.8%), and intensive care unit (28.6%) departments. In the medical history were relevant factors: use of antibiotics in the last 30 days (47.3%), surgery in the last 3 months (40.1%), presence or history of central vascular catheter (38.8%) (Table 1). The most common sites of infection that were documented were respiratory (29.9%), intra-abdominal (27.8%), and urinary (22.5%). At the time of bacteremia, patients had a mean of leukocytes/mm3 of 15,590 ± 9,540, C-reactive protein (mg/L) of 123.0 ± 65.8, and procalcitonin (ng/mL) of 16.6 ± 19.2. The most frequent bacteria were E. coli (17.1%), S. aureus (12.8%), and A. baumannii (9.1%) (Table 2). 62.6% of Gram-negative were multidrug-resistant. Factors associated with mortality were recent steroid use, associated chronic disease, and multidrug-resistance (Table 3). SOFA, NEWS2, and Pitt scores correlated with the probability of survival (Figure 1).Table 3.Risk Factors for Mortality in Patients with Bacteremia.

Conclusion
This is the first study to characterize bacteremias in Nicaragua, finding independent risk factors for mortality and validating severity scales to predict probability of survival.Figure 1.ROC Curve for SOFA, NEWS2, and PITT Score for Mortality Prediction in Patients with Bacteremia

Disclosures
All Authors: No reported disclosures
P-856. Beta Lactams as Oral Step Down Therapy in the Treatment of Uncomplicated Gram Negative Bacteremia: A Systematic Review and Meta Analysis
Authors: Dore Michael , Duffy Ryan , Huang Lily , Caputo Laura , Cantrell Sarah , Glasgo Blair 
Published: January 2025

Abstract

Background
Gram-negative bacteremia (GNB) treatment is initially intravenous but is often transitioned to oral antibiotics once stable. This decision is based on culture sensitivity, antibiotic bioavailability, and antibiotic side effect profile. Historically, fluoroquinolones (FQ) or trimethoprim-sulfamethoxazole (TMP-SMX) are selected over beta-lactams (BL) due to concerns about pharmacokinetics and bioavailability. In 2019, a systematic review and meta-analysis compared the use of BL for step-down therapy vs FQ and TMP-SMX was inconclusive, and the implementation of BL has not been widely adopted. Since then, several moderate-sized studies have evaluated this question but are limited by sample size. We performed a systematic review with meta-analysis evaluating BL in the treatment of uncomplicated GNB.Figure 1:30 Day Mortality
Forest plot illustrating the 30 day mortality comparison between beta lactams and FQ/TMP-SMX

Methods
The MEDLINE, Embase, and Web of Science databases were searched from inception to August 2023 for published articles related to bacteremia, BL antibiotics, and FQ or TMP-SMX antibiotics. Inclusion criteria included adults aged 18 years or older with uncomplicated GNB treated with IV antibiotics initially and transitioned to appropriate oral antibiotics based on sensitivity testing. Uncomplicated infections were defined as having definitive source control within 48 hours.Figure 2:Antibiotic Failure Rate
Forest plot illustrating the antibiotic failure rate between beta lactams and FQ/TMP-SMX

Results
The search yielded a total of 5029 citations. 1598 were removed as duplicates. 3431 titles and abstracts were screened with 3411 excluded. 20 full texts were retrieved and evaluated for eligibility; 13 were excluded and 7 were reviewed. A total of 7306 patients were included in the study with twice as many as the FQ/TMP-SMX vs BL group (4879 vs 2407). The average age (69 vs 71), percent male (51 vs 52%), percent urinary source (75 vs 77%), duration of IV antibiotics (4.2 vs 4.6), Pitt bacteremia score (1.1 vs 1.4) and Charleston comorbid index (2 v 2.2) were similar in each group. There was no statistical difference between the 30-day mortality -0.01 (95% CI -1.31 to 1.28) or antibiotic failure: 0.06 (95% CI -0.42 to 0.53)

Conclusion
BL are non-inferior to FQ or TMP-SMX as oral step-down therapy in the treatment of uncomplicated GNB . The individual decision to use a FQ, TMP-SMX or BL should be based on the patients' comorbid conditions, potential drug-drug interactions, cost, and potential for adverse events.

Disclosures
All Authors: No reported disclosures
P-868. Evaluating the Clinical Impact of Rapid Diagnostic Testing on Antimicrobial Stewardship Interventions
Authors: Huynh-Phan Ricky , Le Kevin , Lasco Todd M , Zidaru Andrei , Tam Vincent , Phe Kady 
Published: January 2025

Abstract

Background
The management of bloodstream infections (BSIs) may be improved with rapid diagnostic identification. The updated Biofire FilmArray blood culture identification (BCID) 2 panel is able to detect extended-spectrum beta-lactamase and additional carbapenemase encoding genes amongst other resistance markers, allowing for earlier antimicrobial stewardship interventions. The purpose of this study was to evaluate the time to optimal antimicrobial therapy.

Methods
This was a single-center retrospective chart review of patients before and after the implementation of the updated BCID panel (BCID1 vs. BCID2, respectively). Adult patients were eligible for inclusion if they had a positive blood culture with an accompanying BCID panel result. Patients were excluded if they received concomitant treatment for an unrelated infection or had monomicrobial BSI with Staphylococcus species. The primary endpoint was time to initiation of optimal antimicrobial therapy from index blood culture, defined as pathogen and resistance gene directed therapy per hospital treatment algorithm. Secondary endpoints included time to active antimicrobial therapy, defined as empiric therapy shown to be active against index isolate(s) with an antimicrobial susceptibility report, and 30-day mortality.

Results
Overall, 143 patients were included in the BCID1 group and 175 patients in the BCID2 group. Time to optimal antimicrobial therapy was shorter in the BCID2 group compared to the BCID1 group (17.1 hours vs. 29.3 hours; p &lt; 0.05). Time to active therapy was shorter in the BCID2 group compared to the BCID1 group (3.1 hours vs. 5.9 hours; p=0.03). Thirty-day mortality rate was lower in the BCID2 group compared to the BCID1 group (9.7% vs. 20.9%; p &lt; 0.05).

Conclusion
Time to optimal and active antimicrobial therapy were significantly shorter after the implementation of the BCID2 panel. Furthermore, 30-day mortality was lower, indicating that optimized therapy per local hospital treatment algorithms may improve outcomes.

Disclosures
All Authors: No reported disclosures
P-876. Factors Influencing Outcome in Patients Admitted with Melioidosis- A Single Centre Retrospective Study
Authors: Desai Raghavendra P , Ramachandra Koushik , Vidyalakshmi K , Srinivas Samyuktha 
Published: January 2025

Abstract

Background
Melioidosis is largely under-reported in the Indian subcontinent. This region is believed to account for 44% of total cases, with an estimated annual incidence of 52,500 cases. This retrospective study of 50 patients aimed at determining association between factors like diabetes mellitus, hypertension, existing heart disease, lung disease, liver disease, alcohol abuse, immunosuppression, symptoms at admission to the hospital, and time from symptom onset to isolation of the bacterium, on in-hospital mortality, development of acute kidney injury (AKI), need for renal replacement therapy (RRT), intensive care unit (ICU) stay and recurrence.

Objectives
To study the risk factors influencing in-hospital mortality in patients admitted with melioidosis. To study the association between risk factors identified and developemenet of Acute Kidney Injury, the need for Renal Replacement Therapy, ICU stay and recurrence of the disease.

Methods
Study setting: Teaching hospitals affiliated with Kasturba Medical College, Mangalore
Study design: Retrospective Cross Sectional Study
Inclusion Criteria: Patients admitted and diagnosed with Melioidosis, Age &gt;18 years
Exclusion Criteria: Pre-existing kidney disease

Results
Data analysis showed that diabetes, hypertension, pre-existing heart disease, lung disease, liver disease, alcohol abuse, immunosuppression, symptom complex, time from symptom onset to isolation of organism, and development of AKI had no significant associations with in-hospital mortality. Hypertension, pre-existing heart disease, hyponatremia, and advanced age was noted to have statistically significant associations with development of AKI. Hypertension, pre-existing heart disease, and advanced age was noted have statistically significant associations with need for RRT. Pre-existing heart disease, and longer ICU stay had statistically significant associations with recurrence of the disease. Further analysis, with respect to geographic influences is ongoing.

Conclusion
In patients with Melioidosis, hypertension, pre-existing cardiac disease, hyponatremia, and advanced age were noted to have significant association with development of AKI while pre-existing cardiac disease and longer ICU stay were associated with recurrence.

Disclosures
All Authors: No reported disclosures
P-882. Comparison of Epidemiology, Risk factors, Antimicrobial susceptibility and Outcome of Anaerobic Bacteremia: 2011-2013 and 2020- 2022
Authors: Palanivetpillai Sivanthini , Lee Mao-Cheng , Naidu Prenilla 
Published: January 2025

Abstract

Background
Anaerobes are again entering the spotlight as patients become more complex and antimicrobial resistances continue to mount as a result of their widespread use. The aim of our study was to compare the incidence, risk factors and susceptibility patterns of anaerobic bacteremia during 1st Jan 2011-31st Dec 2013 (period 1) and 1st Jan 2020-31st Dec 2022 (period 2) in community hospitals and acute care centres in Edmonton and the North Zone in Alberta.
The percentages of anaerobic organisms isolated in 2011-2013 and 2020-2022

Methods
• Microbiologic data extracted from laboratory information system
• Demographic and clinical data extracted from the EMR system
• Blood cultures were incubated on the BD BACTEC 9240™ system or the BD BACTEC™ FX Blood Culture System
• Organism identification was performed by Vitek® 2 ANC ID card, traditional phenotypic methods, Vitek® MALDI-TOF and, failing these, genomic sequencing
• Susceptibility testing by E-test; interpretation as per CLSI or EUCAST guidelines
The percentages of susceptible Bacteroides species to different antimicrobials in 2011-2013 and 2020-2022

Results
Period 1:
319 anaerobic bacteremia were identified. 247 were included in the study after exclusion of repeat positives (within the first 2 weeks of the first positive culture) and contamination. Total number of isolates were 279 and susceptibilities were available on 252 during this period.
Period 2:
830 anaerobic bacteremia were identified. 467 anaerobic bacteremia were included in the study after exclusion of repeat positives and contamination. The total number of isolates were 539 and susceptibilities were available on 417 isolates during this study period.
The total number of anaerobic bacteremia almost doubled from 82 cases per year to 156 cases per year during the study decade. The majority were monomicrobial bacteremia (71% and 85%) with the gastrointestinal tract identified as the commonest source. The most common isolated anaerobe was Bacteroides species. Metronidazole susceptibilities for all anaerobes were above 90%. The crude 30-day mortality rates were 22.7% and 25.8% in period 1 and 2 respectively.

Conclusion
The total number of anaerobic bacteremia increased significantly in the 9-year interval. No significant changes in metronidazole susceptibility were observed between both periods of time.

Disclosures
All Authors: No reported disclosures
P-905. Post One-year Outcomes for Corticosteroid Use in Non-HIV Cryptococcal Meningoencephalitis
Authors: Chang Bickey , Anjum Seher , Joseph Snow , Hammoud Dima A , Williamson Peter 
Published: January 2025

Abstract

Background
Cryptococcal meningoencephalitis (CM) is a major cause of mortality in HIV/AIDS, transplant recipients and previously healthy individuals. In the latter, a post-infectious inflammatory response syndrome (PIIRS) has been noted to have a favorable response to corticosteroids although long-term responses have not been studied.

Methods
In addition to standard antifungal therapy, 15 patients admitted with CM/PIIRS from 2015-2020 were treated with standard pulse – taper corticosteroid therapy (PCT) consisting of intravenous methylprednisolone 1 gm daily for 1 week followed by oral prednisone 1 mg/kg/d, tapered based on clinical and radiological response. One patient was excluded from the study due to death from an unrelated cause within 6 months of diagnosis. Comprehensive neurocognitive testing and MRI brain scans were performed one year after diagnosis to assess clinical status.

Results
80% of patients were male, median age 51 years. Median time from antifungal treatment to steroid initiation was 6 weeks. Eleven of 14 patients were neuropsychologically evaluated using performance-based neurocognitive tests. A one-sample T- test showed that the cohort obtained significantly lower scores in memory, learning, language, and information processing/psychomotor speed test in comparison to a normative sample. Also, the mean memory, learning, psychomotor, and information processing speed scores were in the low average range. These findings suggest very mild cognitive deficits in this cohort one year post diagnosis. With the exception of one patient whose MRI brain showed worsened findings at the one-year mark due to a neuro-inflammatory flare, radiological findings suggested stability or improvement for the remaining 13 patients. CSF cultures remained negative.

Conclusion
Neurocognitive testing performed in a small cohort of previously healthy patients with CM-PIIRS showed an absence of moderate or major neurocognitive deficits one year post diagnosis with minimal adverse effects and no reoccurrence of infection. Brain MRI findings were also stable or improved for the majority.

Disclosures
All Authors: No reported disclosures
P-914. Clinical Outcomes and Predictors of Mortality among Hospitalized HIV/ AIDS Adult Patients Diagnosed with Central Nervous System Infections in a National Tertiary Referral Hospital in the Philippines: A 5-year Retrospective Study
Authors: Linsao Ma Jean Capulong , Bornales Dante P , Solante Rontgene M , Edrada Edna 
Published: January 2025

Abstract

Background
HIV infection remains a significant global health concern despite the major advances in its understanding and treatment. Central nervous system (CNS) infections are common complications among HIV-infected patients. In the Philippines, limited local data on the clinical profile and outcome among HIV-infected patients with CNS infections is available.
Case Distribution of CNS Infections among HIV-infected patients in the Philippines

Methods
This is a 5-year retrospective study of confirmed HIV-infected patients hospitalized and managed as CNS Infections at San Lazaro Hospital, Manila Philippines between 2018 and 2022. Demographics and clinical data were extracted from medical records and the association with clinical outcome and length of hospital stay were analyzed.
Incidence and Case Fatality Rate of CNS Infections among HIV-infected patients in the Philippines

Results
One hundred twenty-eight (128) HIV-infected patients, mostly male (95%), were included, with a mean age of 31 years, and a mean CD4 lymphocyte count of 56.8 (0-282) cells/mm3. Forty-one patients (32%) were newly diagnosed with HIV, and 51% (n=65) were not on antiretroviral therapy (ART). The mean duration of HIV diagnosis among those known to have HIV before admission was 1.4 years. The most common CNS infection was Tuberculous Meningitis (TBM) (35%), followed by Cryptococcal Meningitis (CM) (29%), and Toxoplasma Encephalitis (TE) (17%). The presence of dual CNS Infection was diagnosed among 20 patients (15.6%), of which a total of 16 (12.5%) had co-infection of TBM and TE, while 4 (3.1%) had co-infection of TBM and CM. The most common clinical manifestations were headache (87.5%), fever (61%), and sensorial changes (60%). The overall in-hospital mortality rate was 30.4% (n=39), with the highest case-fatality rate among those infected with Cryptococcal Meningitis at 53% (n=19). Among those diagnosed with CM, 23 patients (62%) had concomitant Cryptococcal Fungaemia. Those with CM and dual CNS infection had a longer hospital stay of &gt;31 days ( &gt;1 month).

Conclusion
In the Philippines, the most common CNS infection among HIV-infected patients was Tuberculous Meningitis, followed by Cryptococcal Meningitis, and Toxoplasma Encephalitis. Early diagnosis of HIV infection with timely initiation of ART, together with an effective diagnostic and management approach to these conditions is needed to decrease the risk of further complications and death.

Disclosures
All Authors: No reported disclosures