bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-786. Rates of Treatment Discontinuation over Time with Rifampin versus Isoniazid for Latent Tuberculosis Infection: A 6-year Experience at a Large Safety-Net Clinic
Authors: Martins Maria F , Teran Plasencia Juan M , Sinha Pranay , Acuña-Villaorduña Carlos 
Published: January 2025

Abstract

Background
Treatment of latent tuberculosis infection (LTBI) is a crucial component of tuberculosis (TB) eradication plans in the United States (US). It is estimated that 80% of active TB cases arise from LTBI reactivation. Numerous gaps have been identified in the LTBI care cascade, leading to low rates of treatment initiation and completion. Treatment duration has shown to be a significant factor influencing completion rates for LTBI treatment. Since 2020, the Center for Disease Control and Prevention (CDC) recommends 4 months of daily rifampin (4R) as the preferred regimen for LTBI, while 6 to 9 months of isoniazid (9H) is now considered an alternative regimen.Table 1.Characteristics of the Patients by Drug Used

Methods
We conducted a retrospective cohort analysis including all patients treated for LTBI with 4R or 9H (May 2015 - September 2021) at the Boston Medical Center/Boston Public Health Commission TB Clinic. The primary objective was to compare completion rates between patients with LTBI treated with 4R versus 9H. For this, completion of 95% of the planned course was considered sufficient. We also compared rates of treatment discontinuation by plotting a survival curve. Data analysis was performed with R statistical software (version 4.3.2). The study was approved by the Institutional Review Board (IRB) of Boston University.Figure 1.Rates of Treatment Discontinuation over Time for Rifampin versus Isoniazid

Results
A total of 2178 patients with a median age of 40 years-old were treated for LTBI during the study period, 958 (43.99%) with 4R and 1220 (56.01%) with 9H (Table 1). The completion rates differed significantly, with 652 (68.1%) completing 4R compared to 550 (45.1%) completing 9H (p &lt; 0.001). A Kaplan-Meier curve showed similar rates of discontinuation over time between the 2 regimens (Figure 1). After adjusting for key confounders using multivariable logistic regression model, the sole variable significantly associated with LTBI treatment completion was the use of 4R with an odds ratio of 2.805 (95% CI: 2.313 - 3.406) (p &lt; 0.001) (Table 2).Table 2.Factor's Association with Treatment CompletionOR: odds ratio; CI: confidence interval

Conclusion
Our findings confirm that 4R has better completion rates than 9H. Importantly, treatment completion on the survival curve was similar in the first 4 months of therapy, supporting the notion that treatment duration is a key factor determining LTBI treatment completion rate regardless of the drug used.

Disclosures
All Authors: No reported disclosures
P-791. Contribution of tuberculin skin test for diagnosing tuberculosis disease in pediatric patients in Bangladesh
Authors: Sosa Soto Giordano , Hossain Farzana , Rahman Toufiq , Rahman Mahfuzur , Kulkarni Suchitra , Roy Tapash , Malik Amyn , Brooks Meredith 
Published: January 2025

Abstract

Background
Bangladesh has a high tuberculosis (TB) burden, accounting for 4% of pediatric patients estimated to have TB globally. Obtaining microbiological confirmation of disease in children is challenging; in lieu of this, diagnosis often relies on the presence of symptoms, exposure history, physical examination, and a variety of other test results, such as chest x-rays and tuberculin skin tests (TST). We evaluate the contribution of TST to pediatric TB diagnoses.

Methods
An enhanced patient-finding initiative was implemented across 109 facilities in Mymensingh division, Bangladesh (2018-2021) to improve pediatric TB detection. Among children who screened positive on systematic verbal symptom screening and whose subsequent evaluation for TB disease included TST, we report the discriminatory properties of TST for TB diagnosis. We compare patient characteristics between children with positive and negative TST results using chi-squared/Fisher’s exact test.

Results
Of 20,209 children who screened positive on verbal symptom assessment and were further evaluated for disease, 7,318 (36.2%) patients had TST, of which 1598 (21.8%) were diagnosed with TB disease. Discriminatory properties of TST were: sensitivity of 42.2% (95% Confidence Interval: 39.8-44.7%), specificity of 92.4% (91.7-93.1%), PPV of 60.9% (58.3-63.4%), and NPV of 85.1% (84.6-85.7%) (Table 1). A total of 648 (40.6%) children with TB and 364 (6.4%) children without TB had an induration diameter of &gt;10mm (Table 2). Among children diagnosed with TB, fewer males (p=0.01) and children aged 5-9 years (p&lt; 0.01), and more children aged 10-14 years (p&lt; 0.01), underweight (p&lt; 0.01), presenting with night sweats (p=0.02) and decreased appetite (p=0.04), and had a chest x-ray (p&lt; 0.01) or smear (p=0.01) suggestive of TB disease had a positive-TST result compared to children with negative-TST results. Among children with a negative TST result, those who were underweight were diagnosed with TB more often than those not underweight (p&lt; 0.01) (Table 3).

Conclusion
TST can be a clinically helpful part of diagnostic algorithms for children. Given its high specificity and NPV, TST can be combined with an evaluation of clinical symptoms and diagnostic studies to help diagnose or rule out disease in children at risk of TB.

Disclosures
Amyn Malik, MBBS, MPH, PhD, Analysis Group, Inc: Former Employee. Worked as a consultant with Pharma and Biotech for research studies
P-792. Evaluation of the efficacy and safety of a short-course, daily, 4-month regimen including isoniazid, pyrazinamide, rifapentine and moxifloxacin (2HZPM/2HPM) for the treatment of drug-susceptible pulmonary tuberculosis in Taiwan (ESCAPE-TB): A multicenter study
Authors: Feng Jia-Yih , Shu Chin-Chung , Lin Shu-Min , Weng Ya-Wei , Chen Jui-Kuang , Wu Kuan-Sheng , Tsai Hung-Chin , Chen Yao-Shen , Lin Hsi-Hsun , Shin-Jung Lee Susan 
Published: January 2025

Abstract

Background
The world is not on track to end the TB epidemic by 2030. Efficacious, safe, and shorter treatment regimens may significantly improve treatment success rates, and reduce TB incidence and mortality. The aim of this study is to evaluate the efficacy and safety of a short-course, 4-month regimen (2HZPM/2HPM) in the Asian population.

Methods
A prospective, 3-year, interventional study (Jan 2021-Dec 2023) enrolled adults with pulmonary TB, compared to historical controls (1:2 ratio) matched by age and sex, receiving standard 6-months treatment. The primary outcome was TB disease-free survival at 12 months after treatment assignment and proportion of grade 3 or 4 adverse events. A short-course regimen included a 2-months daily isoniazid(H), pyrazinamide(Z), rifapentine(P), and moxifloxacin(M), and 2 months of HPM. Sputum cultures were collected to assess early bactericidal effect at 2 months and to detect relapse at 12 months post-treatment.Fig 2.Treatment Duration of short-course, 4-months vs standard 6 months anti-tuberculous treatment: intent-to-treat analysis

Results
109 subjects received short-course therapy, (80 males), with a mean age of 63.4 +/- 15.9 years; and 218 controls. Rates of adverse events were higher in the treatment group but were mostly Grade 1 (54.3% vs 28.7%, p &lt; 0.001), and not significant for Grade 2 (p=0.28), Grade 3 (p=0.59) or Grade 4 (p=0.39). A higher discontinuation rate was found in the treatment group (65.7% vs 35.7%, p &lt; 0.001). Reasons for discontinuation included: hyperbilirubinemia, GI upset, dizziness and others. Currently, 74.1% of the treatment group has completed treatment, 14.8% are under treatment, and 3.7% died, not related to TB. 2-months sputum culture conversion was 86.5 vs 93.4% (p=0.15), in the treatment versus control group, respectively. Survival at 12 months post-treatment was not significantly different between the treatment versus control group (91.7% vs 90.6%, p=0.17). Significant risk factor for treatment discontinuation included age &gt;=55 years (adjusted HR 3.23, 95% CI: 1.27-8.19, p=0.01).

Conclusion
A short-course, 4 months regimen containing HPZM may be as efficacious as current standard, 6-month, anti-TB treatment regimens in Asian patients. Our study demonstrated a high rate of treatment discontinuation in Asian patients. This may be due to the older age of subjects with lower tolerability to adverse events.

Disclosures
All Authors: No reported disclosures
P-795. Unravelling the Enigma: Evaluating False Positive and Invalid Results in Urinary TB LAM Test among HIV Patients with Opportunistic Infections
Authors: Sharma Shivang , Kumar Deepak 
Published: January 2025

Abstract

Background
Various studies suggested that successful implementation of urine Lateral Flow –Lipoarabinomannan (LF LAM) testing could greatly improve TB diagnosis and treatment in HIV patients.Studies from India are scarce regarding urine LF-LAM testing. One should be careful while interpreting the positive test as this test can be positive in NTM, or nocardiasis. This case study highlights the false positive test result of LF-LAM testing and its impact on clinical decision-making in HIV TB co-infection.

Methods
In,this prospective observational hospital based study total 95 adult patients had been included consecutively regardless of their presenting symptoms or CD4 count.During this study, all recruited patients were underwent for relevant investigation for diagnosing opportunistic infections including TB and simultaneously urine LF-LAM assay tests were performed during hospitalisation.Urine LF- LAM testing had been conducted using the Determine Ag assay and interpreted using the 4-grade scale provided by the manufacturer.

Results
Out of total 95 patients, 31 were diagnosed with TB, and 25 tested positive for LAM. However, among the 25 LAM-positive patients, five were found to have false-positive results, while two patients received invalid results. Among the six cases of false-positive TB LAM results, three patients had confirmed NTM (Non-tuberculous mycobacterial) infections, one case was culture-positive for nocardiosis, and another had Cryptococcal infection. One case involved urosepsis with Diabetic Ketoacidosis. All five cases were negative for ZN stain, GeneXpert, and TB culture, and no ATT was administered. Tragically, two patients among these five expired. Additionally, both patients with invalid results had chronic kidney disease.

Conclusion
There can be false-positive TB LAM results with several clinical conditions like NTM infections,Nocardiosis,cryptococosis.These clinical conditions are close differential diagnosis of TB and requires invasive or advance testing methods. While urinary TB LAM testing demonstrates promising sensitivity in diagnosing tuberculosis among hospitalized HIV patients, the occurrence of false-positive results and invalid result outcomes alert clinicians and one should exercise caution in interpreting TB LAM results.

Disclosures
All Authors: No reported disclosures
P-801. Epidemiology and Clinical features of 101 Patients with Aeromonas Bacteremia
Authors: Masuda Daisuke , Furukawa Keiichi 
Published: January 2025

Abstract

Background
Recently pts with Aeromonas bacteremia have been increasingly recognized at our hospital. We investigated epidemiology and clinical features of pts with Aeromonas bacteremia at Asahi General Hospital (980 beds, acute care general hosp. Japan).

Methods
We retrospectively reviewed the medical records of all pts with positive blood cultures for Aeromonas from Jan1, 2018 to Sept30, 2023. We investigated characteristics of the pts , history of well water use , focus of infections, species , antimicrobial susceptibility, therapy, and 30-day mortality.

Results
Total 101 pts with Aeromonas bacteremia were included. We had average 20 A. bacteremia cases per a year and the number was much higher than other reports. Well water was used at home in 66%(21/32) of the pts. Male 69%(p=0.23),Median age 79 (42-97), Almost all pts(98%) had baseline diseases : malignancy 54%, cancer of biliary tract or liver 36%, diabetes mellitus 26%,steroid or immunosuppressant use 5%chr. renal diseases 5%, chr. liver disease 3%. Community acquired infect. was 81%. Hepatobiliary tract infect. was the most common 77%, (cholangitis 67%, cholecystitis7%, liver abscess 2%), septic shock unknown focus 6%, urinary infect. 3%, peritonitis 2%, skin soft tissue infect. 2% , others 11%. A.caviae was predominant 63%, A.veronii 20%, A.hydrophila17%. Mixed bacterial infect. 58%. Antimicro. suscept.(%) : PIPC/TAZ97, CMZ78, CTX89, CFPM100, MEPM97, LVFX100. The 30-days mortality rate(%) was 20 (21/101) in total and was relatively high in PIPC/TAZ therapy 34(15/44), followed by CTX 17, CTRX17, MEPM17, CMZ8,and CFPM0, LVFX0, CPFX0. The 30-days mortality rates by species(%): A.hydrophila 29, A.veronii25, A.caviae 17, Mixed infect. 22.

Conclusion
We had many pts with Aeromonas bacteremia , which might be related to well water use of many pts in our district. Most of the pts were elderly, having baseline diseases including cancer(54%) and hepatobiliary tract infect. was most common. The 30-day mortality rate was lowest in the therapy group with CFPM or LVFX .

Disclosures
All Authors: No reported disclosures
P-805. Factors associated with mortality and morbidity of patients with methicillin-resistant Staphylococcus aureus bacteremia in a regional hospital
Authors: Choy Annabel K T , Tang Tommy H C , Wu T C , Leung W S 
Published: January 2025

Abstract

Background
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is a critical health issue. This retrospective study aimed at identifying factors associated with adverse clinical outcomes in MRSA bacteremic patients admitted to Kwong Wah Hospital, an 800-bed regional hospital in Hong Kong, China. It was approved by the Kowloon Central/Kowloon East Cluster Research Ethics Committee, Hospital Authority (KC/KE-23-0107/ER-4).

Methods
Patients aged 18 years or above with MRSA bacteremia between 2020 and 2022 were identified. Their demographics and clinical background were summarized in Table 1. The primary and secondary outcomes were 30-day all-cause mortality and intensive care unit (ICU) admission, respectively.

Results
Of the 115 patients included, 112 (97.4%) received intravenous vancomycin as the first line antibiotic, 59 (51.3%) developed complicated bacteremia and 17 (14.8%) necessitated second line antibiotics (Figure 1). Thirty-six (31.3%) died within 30 days of positive blood culture for the first time and 14 (12.2%) needed ICU care.
Among the 44 (38.3%) patients attended by an infectious disease (ID) doctor, there was a higher chance to receive echocardiogram (77.3% vs 56.3%), computed tomography (52.3% vs 8.45%), surgical removal of infective foci (43.2% vs 12.7%), and numerically lower deaths (20.5% vs 38.0%) compared to those who were not.
ID consultation, along with younger age, lower Charlson comorbidity index, longer duration of antibiotics, and those without altered mental status or hypothermia, were noted to favor survival in univariate analysis (Table 2). By multivariate logistic regression, older age, higher C-reactive protein, altered mental states, and shorter antibiotic duration were significantly associated with mortality while ID consultation, vancomycin MIC &gt;= 1 μg/mL, and congestive heart failure were associated with ICU admission (Table 3).

Conclusion
MRSA bacteremia resulted in high mortality. ID consultation might have contributed to a greater effort in searching for surgically removable infective foci and a numerically lower death rate. Its association with ICU admission might suggest that sicker patients require greater expertise from ID doctors.

Disclosures
All Authors: No reported disclosures
P-806. How close are we to achieving the trifecta of optimal treatment duration, route of therapy, and repeat blood culture testing for uncomplicated gram-negative bacteremia?
Authors: Son Andrea H , Morelli Morgan K , Hecker Michelle T 
Published: January 2025

Abstract

Background
A 2021 consensus document outlined recommendations for treatment duration, oral antibiotic use, and need for repeat blood cultures in patients with uncomplicated gram-negative bacteremia. Data support 7 days of effective therapy and oral step-down therapy in clinically stable patients. Repeat blood cultures were not recommended except for patients with concern for endovascular infection. We sought to evaluate the percentage of our gram-negative bacteremia cases that would be defined as uncomplicated and how well our practices for these cases aligned with the 2021 recommendationsTable 1.Antibiotic days of therapy

Methods
This retrospective cohort study included adult patients hospitalized between 1/1/2022 and 12/31/22 who had a blood culture with growth of a gram-negative organism and who received ≥ 4 days of antibiotics for the bacteremia. Effective therapy required both use of an antibiotic to which the organism was susceptible and source control. Unnecessary IV therapy was defined as continuation of IV therapy in patients with clinical stability for ≥ 24 hours who had an oral treatment option available.Table 2.Repeat blood cultures

Results
During 2022, 251 unique patients were hospitalized with gram-negative bacteremia and received ≥ 4 days of antibiotics, 130 (52%) of whom were classified as having uncomplicated bacteremia. The average duration of effective therapy was 11.8 days and 74.6% of patients received ≥ 10 days. Unnecessary IV therapy was continued for an average of 3.8 days and 33 (34%) were not transitioned to an orally available option by day 4 of clinical stability. Repeat blood cultures were done in 86 (66%) patients but were indicated in only 18 (14%). Twenty-two (26%) repeat blood cultures were collected &lt; 48 hours after the initial positive blood culture

Conclusion
Using the 2021 consensus recommendations as a guide, more than half of patients with uncomplicated gram-negative bacteremia at our institution received longer than recommended durations of therapy, were not transitioned to an oral option when clinically stable and had repeat blood cultures done when not indicated. A multifaceted intervention to achieve the trifecta of optimal treatment duration, route of therapy, and repeat blood culture testing for uncomplicated gram-negative bacteremia is planned.

Disclosures
All Authors: No reported disclosures
P-807. Evaluation of Risk Factors for Carbapenem-Discordant Enterobacterales Bacteremia at a Large Academic Cancer Institution
Authors: Stabler Alex , Vuong Nancy , Borjan Jovan , Hwang Hyunsoo , Feng Chun 
Published: January 2025

Abstract

Background
Carbapenem resistance in non-carbapenemase producing Enterobacterales is thought to be mediated by increased beta-lactamase production and outer membrane porin mutations. Cases of phenotypic discordance of carbapenem susceptibility (ertapenem-nonsusceptible, meropenem-susceptible) are documented. Given limited clinical data in immunocompromised patients, we aim to characterize risk factors that may lead to carbapenem-discordant Enterobacterales (CD-E) bloodstream infection (BSI) in patients with cancer.

Methods
This is a retrospective, single-center study comparing adults &gt; 18 years of age from January 2016 through November 2023 with a history of a ceftriaxone-resistant Enterobacterales (CRO-R-E) BSI subsequently having either a CRO-R-E or CD-E BSI of the same index organism within one year. Fisher’s exact test was used to compare categorical variables. Wilcoxon rank-sum test was used for continuous variables. Univariate logistic regression models were used to evaluate risk factors associated with CD-E BSI development.

Results
We evaluated 829 patients with CRO-R-E BSI. 9.4% had a subsequent CRO-R-E BSI and 1.6% developed CD-E BSI with the same index organism. The most common organisms identified were Escherichia coli (n=70, 76.9%) and Klebsiella species (n=16, 17.6%). There was no difference in age and most patients had a hematologic malignancy (n=83, 91.2%). Subsequent CRO-R-E or CD-E BSI occurred most often within 90 days of the index BSI (n=61, 78% and n=11, 85%, respectively). Ceftazidime-avibactam (CZA) and latter generation cephalosporin exposure were each significantly associated with CD-E BSI (OR 10.29; p&lt; 0.001 and OR 1.05; p=0.03, respectively). Severe neutropenia (absolute neutrophil count &lt; 500 K/µL) trended towards significance for CD-E BSI development (OR 3.41, p=0.06). Of the 13 CD-E BSI, development of nonsusceptible carbapenem-concordant phenotype with the same organism in the following year occurred in 5 patients (38.5%).

Conclusion
These data suggest that risk factors associated with CD-E BSI development include exposure to CZA or latter generation cephalosporins. Severe neutropenia may also be an indicator, but further studies are warranted to validate this and other CD-E BSI risk factors.

Disclosures
All Authors: No reported disclosures
Mock Court simulations—what is their influence on preparing police officers for the reality of presenting testimony in a court case?
Authors: Davies Amanda , McCarthy Catherine 
Published: January 2025

Abstract
The preparation of police recruit officers as police witnesses in judicial hearings is critical in contributing to the accuracy and completeness of information in the prosecution of alleged offenders and ultimately to judicial decisions. There is a paucity of studies focused on strategies for preparing police officers for their role in court hearings. This article presents the evaluation of the design and delivery of a Mock Court simulation exercise in preparing police recruits for the reality of this future operational role. The findings from participant surveys and interviews indicate the Mock Court simulation exercises enable participants to more adequately transition theory to practice and is an essential experience for building competence and confidence for their future policing duties. The key elements of the Mock Court simulation design and environment that evoke engagement, presence, and immersion in the simulation are discussed to contribute to the wider police education community endeavours.