bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1557. Using cefazolin and ceftriaxone via automated susceptibility predicts susceptibility to oral cefpodoxime but not cefuroxime in Enterobacterales
Authors: Sassine Joseph , McCloskey Cindy B , White Bryan , Ibragimova Nayle , Robison Denise , Pan Steven , Alkozah Maria , Siegrist Emily A 
Published: January 2025

Abstract

Background
Current CLSI recommendations suggest using cefazolin to predict susceptibilities of oral cephalosporins for uncomplicated UTI (uUTI) due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis. Most laboratories do not conduct routine susceptibility testing of oral cephalosporins as they are not available on many automated panels. However, there are limited data which evaluate ceftriaxone and cefazolin categorical agreement with oral cefpodoxime and cefuroxime. This study assessed agreement between ceftriaxone or cefazolin via MicroScan with cefuroxime or cefpodoxime via disk diffusion.

Methods
We collected E. coli, K. pneumoniae, or P. mirabilis isolates from urine cultures in a single center between 2/2024 and 3/2024. Identification was performed using MALDI-TOF and susceptibility testing was conducted overnight broth dilution panels (MicroScan, Beckman Coulter) and disk diffusion for cefazolin and ceftriaxone and by disk diffusion for cefuroxime and cefpodoxime. The primary outcome was categorical agreement assessed by Fleiss’ kappa of automated panel susceptibility for cefazolin and ceftriaxone with cefpodoxime and cefuroxime. Secondary outcomes included disk diffusion categorical agreement and rates of very major, major, and minor errors.

Results
We included 132 isolates, 105 (79.5%) E. coli, 16 (12.1%) K. pneumoniae, and 11 (8.3%) P. mirabilis. Ceftriaxone had slightly lower categorical agreement with cefpodoxime than cefazolin (98% vs 100%). Furthermore, very major errors were more common when using ceftriaxone to predict susceptibility (7% vs 0%). Ceftriaxone and cefazolin both were poor predictors of cefuroxime susceptibility (80% vs 80%).

Conclusion
In this sample, both cefazolin and ceftriaxone had high categorical agreement with cefpodoxime; however, cefazolin resulted in fewer very major errors. On the other hand, cefazolin and ceftriaxone had much lower categorical agreement with cefuroxime, mostly driven by isolates intermediate to cefuroxime but susceptible to cefazolin and ceftriaxone. Our data support the CLSI recommendations to use cefazolin over ceftriaxone to predict susceptibility of cefpodoxime but do not support the use of cefazolin to predict activity of oral cefuroxime for uUTI.

Disclosures
Joseph Sassine, MD, Ansun BioPharma: Grant/Research Support|Cidara Therapeutics: Grant/Research Support|Community Infusion Solutions: Grant/Research Support|F2G: Grant/Research Support|Shionogi: Grant/Research Support Bryan White, PharmD, BCPS, BCIDP, Melinta: Advisor/Consultant|Shionogi: Grant/Research Support
P-1572. Epidemiology and Risk Factors for Altered Mental Status Induced by Urinary Tract Infections Amongst Elderly Hospitalized Patients
Authors: Cino Rebecca , Lindley William , Reilly Joseph , Lodise Thomas , Trivedi Manish 
Published: January 2025

Abstract

Background
Elderly patients with urinary tract infections (UTIs) often present with atypical symptoms including altered mental status (AMS). Although UTI-induced AMS is typically reversible, these patients often experience complications and a longer hospital stay. There is a paucity of data on the incidence and risk factors for UTI-induced AMS in elderly patients. The purpose of this study was to describe the epidemiology and risk factors for AMS in elderly patients hospitalized with UTIs.Table 1.Bivariate Comparison of Baseline Characteristics between Patients with and without UTI-induced Altered Mental Status (AMS)
χ2 test, Student’s t-test, or Fisher’s exact test for variable comparisons.

Methods
A retrospective study of hospitalized patients ≥ 70 years of age with a UTI at AtlantiCare Regional Medical Center between 1/2023-12/2023 was performed. Subjects with UTI were categorized in 2 groups, those with new onset UTI-induced AMS and those without AMS. Admitting providers determined the presence of AMS defined as new onset delirium or a significant change in mental status from baseline. Patients were excluded if they displayed evidence of AMS prior to their UTI or had a new comorbid condition at admission that could precipitate AMS. Data collection included patient demographics, body mass index, weight, admission source, comorbid conditions, presence of urinary instrumentation, and concurrent medications. Bivariate analyses were completed for baseline characteristics between patients with and without UTI-induced AMS. Log-binomial regression was performed to determine factors independently associated with the presence of UTI-induced AMS.Table 2.Baseline Characteristics Associated with UTI-induced Altered Mental Status (AMS) in the Log-Binomial Regression Analysis

Results
In total, 100 patients met the study criteria. The mean (SD) age was 74.8 (4.8) years, 54% were female, 15% were admitted from a long-term care facility, and 24% had an indwelling urinary catheter. Comparison of baseline characteristics between patients with and without UTI-induced AMS is shown in Table 1. In the log-binomial regression, female gender [risk ratio (RR) of 4.7, 95% CI: 1.6-13.8], presence of a urinary catheter (RR of 4.5, 95% CI: 1.6-13.0), and age ≥ 80 years (RR of 2.4, 95% CI: 1.1-5.1) were independently associated with UTI-induced AMS (Table 2).

Conclusion
Identified risk factors for UTI-induced AMS included female gender, presence of an indwelling urinary catheter, and age 80 years or greater. Further studies are warranted to determine the clinical implications and significance of these potential risk factors.

Disclosures
Joseph Reilly, B.S., Pharm.D., Melinta Therapeutics: Advisor/Consultant Thomas Lodise, Jr., Pharm.D., PhD, MERCK: Advisor/Consultant
P-1582. Comparing Contamination Rates in Single-Site vs Multi-Site Blood Culture Sampling
Authors: Borad Abhilasha , Azim Ahmed Abdul , Boruchoff Susan , Ibrahim Ali , Weinstein Melvin P , Kaye Keith S 
Published: January 2025

Abstract

Background
The utility of blood cultures relies on optimal sampling - two samples obtained from separate sites at different times. We noted repeated instances where, according to the electronic medical record (EMR), 2 sets of blood cultures were obtained in the emergency department (ED) with identical time stamps. When these cultures, presumed to be from a single site, return positive for commensal organisms in both sets, treatment might be initiated for a probable contaminant. This study aimed to compare the recovery rate of commensal organisms in both sets of blood cultures obtained from presumed single-site sampling (SSS) versus multi-site sampling (MSS).

Methods
This is a retrospective analysis utilizing data from microbiology and hospital administrative databases. The incidence rates of blood culture contaminants in patients who had two sets of blood cultures drawn with an identical time stamp for both sets (aka SSS) and in patients who had different time stamps within 1 hour of each other for each set (aka MSS) were compared. Rates from ED and selected non-ED inpatient locations were also compared.

Results
There were 1500 positive blood cultures from 720 patients, and 385 patients had 2 sets of blood cultures drawn with at least 1 positive culture for a commensal pathogen (Table). 312/385 patients (81.0%) had samples obtained via SSS and 73 (19.0%) via MSS. Of the 312 SSS patients, 99 (31.7%) had 2/2 sets positive for a commensal, while 15 of 73 MSS patients (20.5%) had 2/2 sets positive for a commensal (p=0.06). In the ED, 251 patients had samples obtained via SSS and 55 via MSS. 84/251 SSS patients (33.4%) had 2/2 sets positive for a commensal, while 12/55 MSS patients (21.8%) had 2/2 sets positive for a commensal (p=0.09).

Conclusion
Blood cultures obtained via SSS had higher rates of 2/2 set positivity for a commensal as compared to cultures obtained via MSS; however, this study was underpowered to demonstrate statistical significance. Other limitations include the assumption that EMR time stamp for collection of blood cultures accurately represents blood culture collection time. Diagnostic stewardship opportunities include potential EMR modifications and/or additional training related to documentation of timing of blood culture collection.

Disclosures
Melvin P. Weinstein, MD, Helixbind: Advisor/Consultant|Safeguard Biosystems: Advisor/Consultant|Selux Diagnostics: Advisor/Consultant Keith S. Kaye, MD, MPH, Allecra: Advisor/Consultant|CARB-X: Advisor/Consultant|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Shionogi: Advisor/Consultant|Spero: Advisor/Consultant
P-1590. Diagnostic Stewardship as a CAUTI Prevention Strategy: Implementation of a Urine Culture Wizard to Drive Institutional Change
Authors: Reisenauer Claire , Castillo Alyssa Y , Hansen Shane , Bovaird Jennifer , Moylan Keri , Robbins Emily , Pisney Larissa 
Published: January 2025

Abstract

Background
Standardized urine culture ordering is an essential practice in the prevention of catheter-associated urinary tract infections (CAUTI). Historically, the University of Colorado Hospital (UCH) offered a stand-alone urine culture order, which required documentation of the culture indication. Frequently, the attestation was incongruent with the clinical scenario, and a preceding urinalysis (UA) was not performed. As a result, cultures often resulted in the detection of asymptomatic bacteriuria, leading to inappropriate antibiotic prescribing. We hypothesized that the creation of a Urine Culture Wizard would decrease unnecessary urine cultures with downstream implications on antibiotic usage and CAUTI reporting.
Year-Over-Year % Change by Month and Fiscal YearFigure 1:Year-over-year Reduction in Urine Cultures Performed at UCH by Inpatient Teams

Methods
In 2021, key stakeholders across the UCHealth system began the development of a Urine Culture Wizard. This replaced all orders for urine cultures in inpatient settings. Multiple synonyms push providers to the wizard, which performs data mining to determine if a urine culture is appropriate. For most, it requires that a preceding UA showing pyuria has been performed. The wizard also allows the ordering of a urine culture without documentation of pyuria if unique patient characteristics are detected in the electronic medical record. These are identified by discrete fields that correspond to criteria as outlined by an institutional governance committee, including specific clinical diagnoses. Educational material was developed to support the launch of the wizard.
Year-Over-Year % Change by Month and Fiscal YearFigure 2:Year-over year Reduction in Urine Cultures Performed at UCH by Inpatient Teams

Results
The Urine Culture Wizard went live in November 2023. Results show a sustained decrease of more than 30% in the number of urine cultures ordered at UCH, and this change meets the criteria for special cause variation. (Figures 1, 2, and 3).
Urine Tests Per MonthFigure 3:Statistical Process Control Chart Demonstrating Special Cause Variation

Conclusion
It has been shown that inappropriate ordering of urine cultures leads to misclassification of colonization as infection and unnecessary prescribing of antibiotics. A standardized approach to ordering urine cultures based on clinical criteria was created for all UCHealth hospitals through the development of a Urine Culture Wizard. Since implementation there has been a continual significant reduction in the number of urine cultures performed, signaling the success of this diagnostic stewardship tool.

Disclosures
All Authors: No reported disclosures
584. Implementation and Evaluation of an Interactive Infectious Diseases Online Curriculum for Trainees on ID electives
Authors: Krishnan Gayathri , Mattar Caline , Kirmani Nigar , Lawrence Steven 
Published: January 2025

Abstract

Background
Infectious Diseases Online Curriculum (IDOC) is an online asynchronous interactive educational resource for trainees on ID electives to augment their ID knowledge and complement their clinical training. The curriculum mapping with details of modules and methods of assessment are elaborated in TABLE 1. A program evaluation of the IDOC with the aim to analyze program outcomes was done in 2023.Table 1:Curriculum mapping including goals, objectives, conceptual framework, educational strategies and assessments for Infectious Diseases Online Curriculum

Methods
IDOC was piloted with medical students and residents from August 2022 to December 2022 and assesses Kirkpatrick level 2 learning. The primary assessment was of Program Outcome, set up using a Pragmatism paradigm with Mixed Methods research methodology to assess quantitative and qualitative data. Following IRB approval, data collection was conducted through web-based surveys (Qualtrics). Each surveyor was asked to assign a unique alphanumeric number to their pre and post survey so these could be used for comparison. The primary outcome assessed was change in knowledge. Each question in the pre- and post-assessment was awarded 1 for correct answer and 0 for incorrect answer. A paired sample t test was used to compare pre and post cumulative scores and analyzed using SPSS v26.Table 2:Paired sample T test analysis of quantitative outcomes

Results
During the pilot phase 16 pre- and 20 post assessment surveys were received (8 phase-3 students, 4 phase-2, 3 phase-1, 3 interns, 2 with no level of training). 11 respondents had allotted the same alphanumeric number to both pre- and post-surveys and these were used for comparative analyses of knowledge change. Interest in pursuing ID as a career prior to and after revision of modules was sought on a 5-point Likert scale and received 12 responses. Paired t test showed significant improvement in knowledge and increase in interest of trainees to pursue ID as a career (TABLE 2). Majority of trainees also rated the modules to be extremely clear and relevant to clinical practice (TABLE 3). Qualitative feedback was overwhelmingly positive (TABLE 4).Table 3:Results of self-perceived clarity and self perceived relevance of the modules by the trainees

Conclusion
IDOC functions as a novel, accessible, quick, engaging, and effective way to improve ID related knowledge in trainees and is an adjunct to their clinical elective experience. Although this was a small study, the results are significant and transferable, and IDOC can be disseminated to smaller training programs where educators and ID learning resources are not available.Table 4:Qualitative feedback for Infectious Diseases Online Curriculum as well as individual interview response from trainee

Disclosures
All Authors: No reported disclosures
586. Let's Have a Chat: How Well Does an Artificial Intelligence Chatbot Answer Clinical Infectious Diseases Questions?
Authors: Hanrahan Kathleen , Steele Jeffrey , Seabury Robert , Parsels Katie A , MacDougall Conan , Britt Rachel S , Chahine Elias , Covington Elizabeth W , Gallagher Jason C , Kufel Wesley D 
Published: January 2025

Abstract

Background
ChatGPT is an artificial intelligence tool used by practitioners to answer clinical questions. It’s unknown whether ChatGPT provides quality responses to infectious diseases (ID)-specific questions. This study surveyed ID pharmacist subject matter experts (SMEs) to assess the quality of ChatGPT responses.

Methods
The primary outcome was percentage of ChatGPT responses considered useful. Secondary outcomes were SME’s ratings of correctness, completeness, and safety (C/C/S). One hundred clinically encountered questions by ID pharmacists were assembled and internally validated. Questions were entered into ChatGPT version 3.5 and responses were recorded. Definitions for useful and C/C/S were based on prior definitions and literature. A 0-10 rating scale for C/C/S was developed and validated for interrater reliability using a random sample. Questions with ChatGPT responses were sent to five SMEs for evaluation. Ordinal and categorical variables were assessed for interrater reliability using an average measures intraclass correlation coefficient (ICC) and Fleiss Multirater Kappa (FMK), respectively. SMEs’ responses were compared using the Kruskal-Wallis and Chi-square tests for ordinal and categorical variables, respectively. A post-hoc analysis was performed to identify the location of differences between SME ratings based on question difficulty and category for C/C/S using a Mann-Whitney U test with Bonferroni correction.

Results
SMEs considered 41.8% of responses useful. Median (IQR) ratings for C/C/S were 7 (IQR 4-9), 5 (IQR 3-8), and 8 (IQR 4-10), respectively. The FMK for useful was 0.379 (95% CI 0.317-0.441) indicating fair agreement, and ICC were 0.820 (95% CI 0.758-0.870), 0.745 (95% CI 0.656-0.816), and 0.833 (95% CI 0.775-0.880) for C/C/S, respectively, indicating substantial agreement. No significant difference was observed between SME responses for the percentage of responses considered useful. Neither question category nor difficulty resulted in a difference in SMEs’ ratings for C/C/S or percentage of responses considered useful.

Conclusion
Fewer than half of ChatGPT responses were considered useful by SMEs. However, responses were mostly considered correct and safe, but often deemed incomplete.

Disclosures
Conan MacDougall, PharmD, MAS, Merck: Grant/Research Support Elias Chahine, Pharm.D., Seqirus: Advisor/Consultant|Seqirus: Honoraria Wesley D. Kufel, Pharm.D., BCPS, BCIDP, Merck & Co.: Grant/Research Support|Shionogi, Inc: Grant/Research Support
P-1664. Shifting Susceptibilities and Clinical Outcomes of Oncology Patients with Streptococcus mitis/oralis Bacteremia
Authors: Handley Guy , Shah Shivan , Bruning Rebecca , Katzman Ju Hee , Greene John , Pasikhova Yanina 
Published: January 2025

Abstract

Background
Streptococcus mitis/oralis cause most viridans group infections in oncology patients and may cause more severe clinical disease. Antimicrobial resistance to beta-lactams is not uncommon, and patients, including those with severe neutropenia, may be at higher risk. We sought to describe changes in susceptibility patterns of S. mitis/oralis and clinical characteristics in these patients.

Methods
Patients at an NCI-designated comprehensive cancer center from 01/01/2022-03/15/2024 with S. mitis/oralis in blood cultures were identified. Clinical and laboratory data were evaluated to describe susceptibility patterns and clinical outcomes.

Results
There were 126 patients included in the study. 58 (46%) had AML and 59 (46.8%) had undergone bone marrow transplantation. Severe neutropenia at the onset of bacteremia was present in 107 (84.9%). The median time to clearance was 1 day (IQR 1-2). Antibacterial prophylaxis was prescribed in 105 (83.3%), most of which was fluoroquinolones (96.2%). Polymicrobial bacteremia occurred in 22 (17.5%) patients. Hypoxic respiratory failure developed in 34 (27%) and 13 (10.3%) required ICU admission. In-hospital mortality occurred in 15 (11.9%) patients. Non-susceptibility was common for penicillin (41.6%) and levofloxacin (54.9%) but rare for ceftriaxone (2.4%) and vancomycin (0%). Ceftriaxone non-susceptibility was associated with cefepime non-susceptibility in all cases (3/3, 100%), while 6 (8.2%) isolates susceptible to ceftriaxone were non-susceptible to cefepime (p=0.001). Of 98 patients receiving fluoroquinolone prophylaxis, levofloxacin prophylaxis had a greater association with levofloxacin non-susceptibility than ciprofloxacin prophylaxis (86.7% vs 54.4%; p=0.002). Patients receiving ciprofloxacin prophylaxis had similar rates of levofloxacin non-susceptibility to those not receiving ciprofloxacin prophylaxis (54.4% vs 55.6%; p=0.900). Beta-lactam non-susceptible rates rose over time and were statistically higher for ampicillin in 2023 compared to 2022 (41.7% vs 18.0%; p=0.007).

Conclusion
Beta-lactam non-susceptibility among S. mitis/oralis isolates may be increasing. Cefepime susceptibility cannot be inferred from ceftriaxone susceptibility.

Disclosures
All Authors: No reported disclosures
P-1669. Effect of Antimicrobial Stewardship Program on Antibiotic Prescribing for Veterans Affairs Nursing Homes
Authors: Jacob Matthew , Froehlich Morgan , Belanger Debra , Psevdos George 
Published: January 2025

Abstract

Background
The CDC strongly recommends nursing homes take resolute steps to improve antibiotic prescribing practices and reduce inappropriate use. This is because studies have shown that up to 70% residents of US nursing homes receive 1 or more courses of antibiotics in a year while 75% of these prescriptions may be unnecessary or inappropriate. Antibiotic stewardship programs (ASP) are committed to optimize treatment of infections and reduce adverse events by close monitoring, education, and preventing unsuitable use. We analyzed the effect of our ASP over antibiotic prescribing of four Veterans Affairs (VA) community living centers (CLC).
Table 1.

Methods
Retrospective review of ASP notes in the year 2023- the inaugural year for ASP reviewing CLCs- addressing requests for restricted antibiotics over 4 CLCs at Northport VA campus. The 4 CLCs are structured nursing homes with a 139 total bed capacity with two long term residential care units, one mental health, and one combined subacute rehab/hospice. We compared antibiotic use as days of therapy (DOT)/1000 days, for total antibiotics use, and analyzing cephalosporins, fluoroquinolones anti-MRSA, anti-MSSA, for years of pandemic 2020-2022 vs. 2023.
Figure 1a

Results
Comparing 2020-22 vs. 2023 there was a decrease in all antimicrobial use in the CLCs, from 142 DOT/1000 days to 88. In 2023 the ASP team reviewed 135 CLC requests for restricted antibiotics, and 56 E-advice requests for guidance. 10% of the requests were denied. See table 1. The most common request for E- advice was whether to treat asymptomatic bacteriuria with/or without presence of urinary catheter. Comparing 2020-22 vs. 2023 there was a decrease in cephalosporins use by DOT/1000 days, 29.3 vs. 10.8, P: 0.09. There was no difference in Fluoroquinolones 2.0 vs. 6.0 P: 0.953, anti-MRSA antibiotics, 7.02 vs. 4.04 P:0.348, anti MSSA 0.67 vs. 0.8 P: 0.574. See figures 1a/1b. Figure 2 shows a downward trend of C. difficile infections in our CLCs.
Figure 1b

Conclusion
Our ASP was overall successful in decreasing antibiotic use in our CLCs, notably for cephalosporins, while keeping FQ and other antibiotics use low. We were successful in education and preventing antibiotics especially for asymptomatic bacteriuria. An equally important achievement for our program was the decreasing rate of C. difficile infections.
Figure 2

Disclosures
All Authors: No reported disclosures