bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1394. Scenario Projections of Congenital Syphilis Cases in California, 2023–2030
Authors: Linton Natalie , Burghardt Nicole , de Guzman Natalie , Snyder Robert , León Tomás M , Jain Seema , Jacobson Kathleen 
Published: January 2025

Abstract

Background
The yearly number of congenital syphilis (CS) cases in California is at its highest point since 1950. We explored how efforts in California to 1) reduce syphilis cases; and 2) increase adequate syphilis treatment among infected pregnant persons could impact CS case projections through 2030.
Yearly projected incidence by scenario comparing the baseline scenario to a 10% reduction in infections, 10% increase in treatment adequacy, and both interventions combined

Methods
We developed a scenario modeling framework to project CS incidence between 2023–2030 using California 2015–2022 surveillance data on CS cases and female syphilis cases of childbearing age (15–44 years). We compared a baseline scenario where existing trends continued without additional interventions to scenarios that considered 1) the impact of an absolute reduction of 2–10% in the rate of female syphilis cases per year; and 2) a 2–10% increase in the proportion of pregnant persons adequately treated for syphilis.

Results
A reduction in the absolute rate of female syphilis cases by 2–10% led to an 8–31% decrease in cumulative CS cases between 2023–2030. Increasing the proportion of pregnant persons adequately treated for syphilis by 2–10% over baseline led to a 1–8% decrease in cumulative CS cases. Combining both scenarios resulted in an 8–37% reduction in cumulative cases.

Conclusion
This model shows that to reduce CS case incidence in California, the most important upstream intervention is to reduce the rate of syphilis among females. To this end, syphilis screening and treatment among those who infect females must be improved. Additionally, even assuming no changes in syphilis incidence in females, CS cases could be reduced to a lesser extent by increasing the proportion of pregnant persons with syphilis who are adequately treated above current rates. The results of this study can inform syphilis screening and treatment recommendations, and the magnitude of future CS case reduction will depend on intervention scope and implementation.

Disclosures
All Authors: No reported disclosures
P-1413. Association of Electronic Patient Portal Use and HIV Viral Suppression and Retention in Care among People Living with HIV at an Urban Academic Medical Center
Authors: Zimmer Daniela , Laiteerapong Neda , Shetty Raj , Ridgway Jessica 
Published: January 2025

Abstract

Background
Electronic patient portals are secure websites that give patients access to health information and allow for secure messaging with providers. Portal use has been associated with improved patient engagement in care, better patient-provider communication, and improved health outcomes in non-HIV patient populations, but portal use is under-studied among PLWH. We sought to assess the relationship between patient portal (MyChart) utilization and HIV-related outcomes among PLWH.

Methods
We collected electronic health record data for PLWH who attended an HIV care visit at an urban academic medical center over 2 years, including demographics, laboratory results, medical encounters, and MyChart status. We compared the demographic characteristics of PLWH with and without an active MyChart account using chi-square. We used logistic regression to assess if MyChart status was associated with outcomes of viral suppression (&lt; 200 copies/mL), retention in care (using the six-month gap definition, i.e., PLWH who attended an HIV care appointment in the prior 6 months are retained), and CD4 count &gt;200 cells/mm3, after controlling for age, race, and sex.

Results
Among 785 PLWH, the mean age was 47 years (SD=14.9), 70% were male, and 83% were Black/African-American. Black PLWH were significantly less likely than White PLWH to have an active MyChart account (83.6% (543/649) vs. 95.8% (91/95), p&lt; 0.01). PLWH with an active MyChart had increased odds of HIV viral suppression (Odds Ratio [OR]: 2.02, 95% CI [1.3 - 3.7]); retention in care (OR: 2.2 95% CI [1.4 -3.4]); and CD4 &gt;200 (OR: 3.3, 95% CI [1.8 to 6.0].

Conclusion
MyChart utilization at the urban academic HIV clinic is associated with positive health outcomes. However, Black PLWH are less likely to utilize MyChart than White PLWH. Additional work is needed to increase MyChart access for non-white patients PLWH, to decrease the digital divide, improve engagement in care and other health outcomes.

Disclosures
Jessica Ridgway, MD, Gilead Sciences: Expert Testimony
P-1422. Low Use of Oral Antibiotics for People Hospitalized with Serious Injection-Related Infections: the CHOICE+ Cohort
Authors: Flores Hannah E , Omari Habib , Derenoncourt Meghan , Stevens Jasmine , Vaish Ishan Kumar , Raman Sumitha , Fujita Ayako Wendy , Carpenter Joseph E , Catalanotti Jillian S , Kattakuzhy Sarah , Steck Alaina , Kuo Irene , Reece Becky , Rosenthal Elana S , Traver Edward C 
Published: January 2025

Abstract

Background
Oral (PO) antibiotics are a convenient alternative to parenteral antibiotics and decrease the need for inpatient care. Increasing evidence shows PO antibiotics are effective even in severe infections. We aim to assess PO antibiotic use among hospitalized people who inject drugs (PWID).

Methods
CHOICE+ is a multisite retrospective cohort study of adults hospitalized at four healthcare systems with infections resulting from injection opioid use between 1/1/2018 and 3/31/2022. Data were collected by abstraction of the electronic medical record. Patients were categorized by intended route of the antibiotic course. Data were analyzed by the chi-square test, Fisher’s exact test, and multivariate logistic regression.

PO, oral; SSTI, skin and soft tissue infection.

Results
1631 patients had an intended treatment plan with either PO (17%) or parenteral (83%) (intravenous, long-acting infusion, or other) antibiotics (Table 1). There was no difference in PO antibiotic use based on gender or unstable housing. PO antibiotics were more likely to be used when planned antibiotic duration was ≤2 weeks (p&lt; 0.0001) and when only skin and soft tissue infection (SSTI) was present (p&lt; 0.0001, Table 2). Alternatively, infectious disease consultation was associated with lower use of PO antibiotics (p&lt; 0.0001). From 2018 to 2022, PO antibiotic use decreased (p&lt; 0.0001, chi-square for trend, Figure 1). Those treated with PO antibiotics were less likely to have ID follow-up scheduled (p=0.0002) and less likely to attend ID follow up (p=0.0024, Figure 2).

PO, oral.

Conclusion
PO antibiotics were rarely used in this large multisite cohort of PWID, especially for infections other than SSTI. Surprisingly, use decreased over the study period, despite emerging evidence for PO antibiotics in complex infections for people who do not inject drugs. PWID with complex infections require long courses of antibiotics, but face barriers to prolonged hospitalization and outpatient infusions due to underinsurance, unstable housing, and untreated addiction. PO antibiotics may facilitate antibiotic completion while reducing patient-directed discharge, and therefore are likely underutilized for PWID.

PO, oral.

Disclosures
Elana S. Rosenthal, MD, Gilead Sciences: Grant/Research Support|Merck: Grant/Research Support
P-1519. Susceptibility of Clinical Non-Morganellaceae Enterobacterales Isolates from Bloodstream and Respiratory Tract Infections to Imipenem/Relebactam and Comparators: SMART United States 2020-2022
Authors: Wise Mark G , Andrew DeRyke C , Esterly John , Bauer Karri A A , Siddiqui Fakhar , Young Katherine , Motyl Mary , Sahm Daniel F 
Published: January 2025

Abstract

Background
Enterobacterales with multidrug-resistance (MDR) or difficult-to-treat resistance (DTR) present clinicians with limited treatment options. Imipenem/relebactam (IMR) is a combination of imipenem with relebactam, a β-lactamase inhibitor of class A and C β-lactamases. We examined the activity of IMR and comparators against isolates of non-Morganellaceae Enterobacterales that were the etiological agents of bloodstream and respiratory infections in the United States.

Methods
In 2020-2022, 26 clinical labs in the U.S. participated in the global SMART surveillance program each collecting up to 250 consecutive gram-negative pathogens per year. Only isolates from patients with bloodstream and respiratory tract infections were included in this study. MICs were determined using CLSI broth microdilution and interpreted with 2024 CLSI breakpoints. MDR was defined as resistance to ≥3 sentinel agents (amikacin, aztreonam, cefepime, ceftazidime, colistin, imipenem, levofloxacin, and piperacillin/tazobactam). DTR phenotypes were defined by isolates nonsusceptible (intermediate or resistant) to all β-lactams (including aztreonam, ceftazidime, cefepime, imipenem, meropenem, piperacillin-tazobactam), as well as fluoroquinolones (levofloxacin).

Results
Among 4,763 collected NME isolates, 575 (12.1%) were MDR and 33 (0.7%) were DTR. Escherichia coli (n=1695) and Klebsiella pneumoniae (n=958) were the most common species collected and their MDR rate was 12.2% and 13.5%, respectively, while their DTR rate was 0.1% and 1.8%, respectively. Against the full collection, IMR and meropenem were the most active agents, each inhibiting 98.7% of the population (Figure). Ertapenem, amikacin and imipenem alone were also active, inhibiting &gt;93%. IMR retained its activity versus the MDR subset, as 97.0 were interpreted as susceptible, the highest percentage among comparator drugs. IMR also showed activity against the challenging DTR subsets with 81.8% susceptible, approximately 30 percentage points higher than amikacin.

Conclusion
Based on these in vitro data, IMR appears to be an excellent therapeutic choice for use against NME infections from blood and respiratory tract sources, including those identified as MDR and DTR.

Disclosures
Daniel F. Sahm, PhD, Pfizer, Inc.: Advisor/Consultant
P-1567. Urinary Tract Infections Broadly Impact Quality of Life Among People with Neurogenic Bladder
Authors: Fitzpatrick Margaret A , Wirth Marissa , Solanki Pooja , Suda Katie J , Burns Stephen , Weaver Frances , Collins Eileen , Safdar Nasia , Evans Charlesnika T 
Published: January 2025

Abstract

Background
Although recurrent urinary tract infections (UTI) are common complications in people with neurogenic bladder (NB), limited data exist on the specific ways UTIs impact quality of life (QoL) in this population. These data could help tailor patient-centered approaches to improving UTI care in people with NB.
UTI Impacts on Feelings and Emotional Well-being

Methods
We mailed surveys to 289 Veterans with NB due to spinal cord injury/disorder (SCI/D), multiple sclerosis, or Parkinson’s Disease who had at least one in-person encounter associated with a UTI diagnosis at four Veterans Affairs Medical Centers between May 2022-May 2023. The survey was adapted from existing instruments and previously collected qualitative data. An expert panel refined the survey using a Delphi process, followed by cognitive interviews with Veterans with NB (n=8). The QoL section contained 15 survey items with 5-point Likert scale response options (higher values = greater QoL impact) which assessed how UTIs affect feelings, emotional well-being, daily activities, sex life, and social participation. To account for missing and ‘not applicable’ responses, scaled QoL scores were calculated by multiplying total survey score by the ratio of 15 / the number of items answered. Descriptive statistics summarized respondent characteristics and QoL scores.
UTI Impacts on Activities

Results
Respondents (n=71) were older [median age (range) = 72 (36-88)], male (92%), and white (79%). Most had SCI/D (77%) and used urinary catheters (77%). 85% of respondents answered at least 13 items. Other than feeling often or always frustrated or bothered by UTIs (n=22; 31%), most respondents did not report that UTIs frequently impact feelings or emotional well-being (Figure 1). In contrast, UTIs had a strong impact on activities (Figure 2), with many respondents agreeing their UTIs have impacted diet (n=35; 50%), travel (n=37; 53%), and sex life (n=24/40 responses; 60%). Mean [standard deviation (SD)] scaled total QoL score was 40.8 (15.3) out of a possible maximum score of 75, with a mean (SD) per item score of 2.7 (1.0) out of 5.

Conclusion
People with NB experience substantial QoL impacts from UTIs, particularly on their daily and social activities. Patient-centered interventions focused on reducing negative impacts on QoL from UTIs are urgently needed for this population.

Disclosures
All Authors: No reported disclosures
574. Early Post-Marketing Safety Surveillance for the Respiratory Syncytial Virus Prefusion F Protein Vaccine (RSVPreF3 OA)
Authors: Verheust Céline , Deraedt Quentin , Bryan Philip 
Published: January 2025

Abstract

Background
RSVPreF3 OA (GSK) received its first approval on 3 May 2023 in the United States (US), for the prevention of lower respiratory tract disease caused by respiratory syncytial virus (RSV) in ≥ 60-year-olds. By 15 March 2024 (data lock point [DLP] of this analysis), RSVPreF3 OA was also approved in all European Economic Area countries, and &gt; 10 additional countries across both hemispheres. We summarized the post-marketing safety surveillance data following vaccination with RSVPreF3 OA.

Methods
Exposure was based on RSVPreF3 OA doses distributed and administered. The spontaneous adverse events (AEs) reported from 3 May 2023 up to DLP were retrieved from GSK’s Global Safety Database. Observed-to-expected (O/E) analyses were performed for reports of Guillain-Barré syndrome (GBS) and transverse myelitis.

Results
Up to DLP, &gt; 9.1 million RSVPreF3 OA doses were distributed globally, of which &gt; 7.8 million doses were administered to adults in the US. There were 1,301 reports including 3,278 AEs following RSVPreF3 OA administration, of which 91.34% were considered non-serious (Table). Most reported AEs were consistent with the expected reactogenicity profile, as observed in clinical trials and listed in the prescribing information. O/E analysis of GBS (N=9) and transverse myelitis (N=1) found that the reporting rates did not exceed the expected background incidence (16 and 6 expected cases, respectively); no other neuroinflammatory events were reported. Nineteen reports of atrial fibrillation were reported and more plausibly reflect the epidemiology of the older adult population being vaccinated. Of all reports, 539 (41.43%) described medication errors, of which 85.34% were without associated symptoms. Although RSVPreF3 OA is not indicated for pregnant women, 263 cases of exposure during pregnancy (48.79% of the medication errors) were reported.

Conclusion
Based on the data from the first 10 months of post-marketing surveillance, the safety profile of RSVPreF3 OA was shown to be consistent with that observed in clinical trials. The available evidence does not suggest a causal association between RSVPreF3 OA and neuroinflammatory events or atrial fibrillation. Along with the vaccine efficacy shown in clinical trials, the data supports a favorable benefit-risk profile.
Funding: GSK

Disclosures
Céline Verheust, PhD, GSK: Salary as GSK employee, with stock options included|GSK: Stocks/Bonds (Public Company) Quentin Deraedt, PhD, GSK: Salary as GSK employee, with stock options included|GSK: Stocks/Bonds (Public Company) Philip Bryan, PhD, GSK: Salary as GSK employee, with stock options included in salary|GSK: Stocks/Bonds (Public Company)
P-1598. Evaluating the Utility of MRSA Nares Testing as an Antimicrobial Stewardship Tool
Authors: Morado Faiza , Nanda Neha , Lee Rebecca 
Published: January 2025

Abstract

Background
A common challenge for antimicrobial stewardship programs is limiting vancomycin usage as overuse is linked with significant clinical consequences such as nosocomial infections. While Methicillin-resistant Staphylococcus aureus (MRSA) nasal screens are widely used to rule out MRSA in lower respiratory tract infections, studies evaluating its use in non-pneumonic processes are limited. The purpose of this study was to evaluate the utility of MRSA nasal screens by estimating its predictive value for various clinical cultures.

Methods
This retrospective cohort study was conducted at an academic medical hospital from October 1, 2021 to January 31, 2024. Patients with an MRSA nasal swab collected within 48 hours of admission and a clinical culture within 14 days of the nasal swab were included. Chromogenic media was used for detection of MRSA colonization. Clinical cultures were defined as blood, body fluid, respiratory, wound, and tissue cultures. Patients with a history of an MRSA infection within prior 90 days or received 10 or more days of an anti-MRSA antibiotic prior to nasal swab collection were excluded. Microbiological and clinical data were collected for included patients. The primary endpoint was to determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for a positive MRSA clinical culture.

Results
A total of 11391 clinical cultures collected from various anatomical sites were included in this study. The distribution of clinical cultures were as follows: 55.4% blood, 11.9% wound, 11.9% body fluid, 15.7% respiratory, and 5.1% tissue. The total MRSA prevalence for any clinical culture was 1.3%. The sensitivity, specificity, PPV, and NPV for all clinical cultures were 55%, 96.8%, 18.5%, and 99.4%, respectively. Results for each clinical culture site are listed in table 1.

Conclusion
The results of an MRSA nasal screen via chromogenic media had a high NPV for MRSA growth in blood, body fluid, respiratory, wound, and tissue cultures up to 14 days after MRSA nasal swab collection.

Disclosures
All Authors: No reported disclosures
P-1607. Comparison of In-House Versus Reference Laboratory Antifungal Susceptibility Testing on De-Escalation Rates of Echinocandin Therapy for Candidemia
Authors: Webb Joseph , Mondy Kristin , Jaso Theresa , Rose Dusten T T 
Published: January 2025

Abstract

Background
The Mycoses Study Group Education and Research Consortium recommends healthcare facilities who routinely manage invasive fungal infections have access to “timely antifungal susceptibility testing,” and the Infectious Disease Society of America recommends antifungal de-escalation in candidemia within seven days to mitigate excessive drug costs and fungal resistance. In 2020, Ascension Seton hospital network converted from in-house (INH) antifungal susceptibility testing (AFST) to reference laboratory (RFL) testing.

Methods
This was a multicenter, retrospective cohort study evaluating the stewardship, clinical, and financial impact of RFL use for AFST in patients with candidemia. AFST was performed INH for isolates from May 2017 to Jul 2020 and by RFL for isolates from Aug 2020 to Sep 2023. The primary outcome was rate of antifungal de-escalation from echinocandin to azole therapy by day 7. Secondary outcomes include cost of antifungal treatment, hospital and intensive care unit (ICU) length of stay, days to targeted therapy, turn around time of test (TAT), and all-cause hospital mortality. Inclusion criteria were candidemia diagnosis and empiric echinocandin treatment. Exclusion criteria were diagnoses of candidemia with ocular, meningeal, or cardiac involvement; candidemia due to C. auris; or death before susceptibility resulted. Outcomes were analyzed by Wilcoxon rank sum.

Results
This study included 85 patients (42 INH and 43 RFL). The most common infectious species were C. albicans (31% INH vs 35% RFL) and N. glabrata (36% INH vs 49% RFL).Rate of de-escalation by day 7 was higher in the INH than RFL group(, 67 vs 35%, p&lt; 0.01) . RFL use significantly increased days to targeted therapy (2 INH vs 6 RFL, p &lt; 0.01), turn around days of test (5 INH vs 12 RFL, p &lt; 0.01), echinocandin days (4 INH vs 9 RFL, p &lt; 0.01), and cost of antifungal treatment ($1145 INH vs $2290 RFL, p &lt; 0.01). There were no differences in additional secondary endpoints.

Conclusion
Reference laboratory use for AFST was associated with significantly decreased echinocandin de-escalation rate, leading to longer turn around time of test, time to targeted therapy, and cost of antifungal treatment. In-house AFST offered faster susceptibility results and possibly cost savings.

Disclosures
All Authors: No reported disclosures
P-1608. No Targets, No Problem: Evaluation of Patients with Bloodstream Infections without a Molecular Target Detected by a Rapid Diagnostic Assay
Authors: Shah Megan , Williamson Julie E , Davidson Lisa , Boger Michael S 
Published: January 2025

Abstract

Background
Early identification and management of sepsis is essential in improving patient outcomes. Blood culture rapid diagnostic testing (RDT) allows for early targeting of antimicrobial therapy, particularly when paired with antimicrobial stewardship (AMS) intervention. Hospitalized patients with positive blood cultures are reviewed daily by AMS pharmacists in our health-system, regardless of the RDT result. Limited data exist on the impact of AMS assessment in patients with a positive blood culture with an organism that is not a target identified by RDT. The objective of this study is to describe the microbiology and antimicrobial management of patients with a positive blood culture, but no molecular target detected (NMTD) on the BioFire® Blood Culture Identification 2 (BCID2) panel.

Methods
This retrospective review evaluated patients within the Atrium Health Greater Charlotte Market who had ≥ 1 positive blood culture with a BCID2 result of NMTD from January to May of 2023. The primary endpoint was to identify the most common organisms recovered by standard of care methods following a NMTD result. Secondary endpoints were evaluated in hospitalized patients and included change in antimicrobials in response to the Gram stain result and percentage of patients on active therapy at organism identification and/or susceptibility testing. Data were analyzed using descriptive statistics.

Results
160 organisms were identified in 149 patients with a BCID2 result of NMTD. The most common organisms identified were Micrococcus luteus (14.3%), Corynebacterium spp. (9.4%), non-fragilis Bacteroides spp. (8.1%), Clostridium spp. (7.5%), and Fusobacterium spp. (4.4%) (Table 1). Contamination was suspected in 34% of patients; however, when the organism was considered a true pathogen by the treating provider, the most common infection sources were intra-abdominal (26%) and skin/skin structure (12%). Antibiotics were modified after the Gram stain or NMTD results in 38% of patients, and 79/85 (93%) of patients were on active therapy at organism identification or susceptibility testing if considered a true infection.

Conclusion
Even when RDT fails to yield a molecular target, AMS review of patients with positive blood cultures may ensure adequate antimicrobial therapy

Disclosures
All Authors: No reported disclosures