bluuebunny/crossref_metadata_2025_split huggingface dataset:
1788. High Ferritin Levels in Hospitalized Patients with Acute Babesiosis in a Tertiary Medical Center in Long Island, NY (2014-2022)
Authors: Marcos Luis A , Gary Evan , Lamba Pooja , Saldivar Miguel A , Kalogeropoulos Andreas , Spitzer Eric 
Published: November 2023

Abstract

Background
Babesiosis, an intra-erythrocytic protozoan disease caused by Babesia spp, is an emerging zoonotic parasitic disease worldwide. Our group have recently described the utility of biomarkers such as lipid profile and procalcitonin levels in acute babesiosis caused by B. microti. Ferritin is a nonspecific marker, but serum levels can be seen with severe infections including bacterial and viral processes. Anecdotal reports suggest that elevated ferritin levels were elevated in a series of cases of acute babesiosis. Our aim is to investigate any association between ferritin levels and severity of infection and other biomarkers in patients diagnosed with acute babesiosis in Long Island, New York.
Correlation between Ferritin and LDH levels in hospitalized patients with acute babesiosis (r=0.565, P=0.0004).

Methods
We conducted a retrospective chart review of adult patients who had a positive peripheral blood thin smear for intra-erythrocyte B. microti parasites at Stony Brook University and Southampton Hospitals (Stony Brook Medicine) between 2014 and 2022. All cases were confirmed by PCR analysis which was performed by the NY State Department of Health. Only patients who had a ferritin level drawn during acute presentation were included in the analysis.

Results
A total of 36 patients (n=6, 16.6% female) met criteria for acute Babesia infection and had ferritin level drawn on admission during 2014-2022. Average age was 64 years-old (range: 42–90). Four patients (11.1%) were asplenic and 10 (27.7%) required ICU level of care. Parasitemia median was 1.6% (range: 0.1%-19.5%), eight cases (22.2%) required RBC exchange transfusion. Ferritin level median was 2297 ng/mL (range: 275-17,684). All cases had ferritin levels above 600ng/mL except one. Ferritin levels were higher on the group of patients who were not admitted to ICU (median: 2301ng/mL) than those admitted to ICU (median: 1894ng/mL) (p=0.25). In linear regression analysis, there was a correlation between ferritin and lactate dehydrogenase (LDH) levels (r=0.565, P=0.0004; Fig 1).

Conclusion
Ferritin was found strongly correlated with LDH levels. However, clinical severity of babesiosis is difficult to predict from inflammatory markers since low levels of ferritin and LDH were seen in ICU patients (Fig. 1). High ferritin levels were seen in almost all patients on this study.

Disclosures
All Authors: No reported disclosures
1793. Pipes as a Harm Reduction Tool: Insights from People Who Use Methamphetamine in Rural Illinois
Authors: Rains Alex , Augustine Erin , Bresett John , Fletcher Scott , Miller Kyle , Bolinski Rebecca , Jenkins Wiley D , Pho Mai T , Ezell Jerel 
Published: November 2023

Abstract

Background
Methamphetamine (meth) use is disproportionately high in rural settings and increased during COVID-19. While sterile syringes services are an evidence-based measure to reduce infectious disease transmission, little research exists around the value of smoking equipment, specifically pipes, in minimizing harms associated with rural drug use in the US.

Methods
Between March and June 2022, we conducted structured interviews with people who use methamphetamine (PWUM) living in rural Illinois who were at least 15 years old and used meth by any route in the past 30 days. Interview guides explored attitudes and behaviors regarding meth use routes, meth pipe use practice, and pipe access, and were refined by a peer-led Community Advisory Board. Interviews were audio recorded, transcribed, and coded in MAXQDA. The data were then analyzed for emergent themes using modified grounded theory.

Results
Nineteen participants, average age 37.1 (SD+8.7), were interviewed. Of these, 53% were women, and 89% were white. All reported smoking meth, and 84% injected meth. Participants reported that they often chose to smoke rather than inject to mitigate health concerns like wounds, pain, and infections. Smoking enabled them to use around others as opposed to using alone (as was typical when they injected). Participants expressed interest in pipe distribution through a harm reduction agency, e.g. according to one participant (a 31-year-old white male), “I’ve asked specifically if they had a pipe because I was trying to lay off the syringes.” They related that access to a harm reduction agency distributing pipes would connect people to other services such as HIV testing, naloxone, and safer sex supplies.

Conclusion
Distribution of meth pipes through harm reduction agencies represents a means for decreasing harm through circumvention of injection, decreased solitary drug use, and linkage to additional services related to overdose and disease prevention. Given increased rates of meth use in rural regions, this intervention could specifically address drug-related harms that impact rural PWUM. Future work should quantitatively explore the health impacts of pipe use as a harm reduction intervention.

Disclosures
All Authors: No reported disclosures
1794. Analysis of Antimicrobial Resistance Patterns in a Large Sample of US Hospitals Before and After COVID-19
Authors: Ranade Tarjani M , Griffin Meggie , Schwei Rebecca , Pulia Michael 
Published: November 2023

Abstract

Background
Significant concerns have been raised about a potential acceleration of trends in antimicrobial resistance (AMR) due to the COVID-19 pandemic. The pandemic disrupted infection control and antimicrobial stewardship processes and introduced a novel respiratory infection that mimics bacterial pneumonia, resulting in increases in hospital acquired infections and overall antibiotic prescribing. The objective of this study is to compare AMR of key bacterial pathogens before and during the pandemic to identify any concerning trends.

Methods
We used bacterial culture data (blood, respiratory, urine, and wound) from 313 U.S. hospitals in the Premier Healthcare Database to compare AMR patterns pre-COVID and during-COVID, defined as Jan. 2019 to Feb. 2020 and Mar. 2020 to Mar. 2022, respectively. We characterized % resistant cultures for three organisms identified as major threats to public health: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) and extended-spectrum beta-lactamase (ESBL). In addition to descriptive results, we assessed for statistically significant changes between pre and during-COVID using chi-square tests.

Results
There were 141,027 cultures analyzed for MRSA, 104,770 for VRE and 655,240 for ESBL. Wound was the most common culture type for MRSA (51.20%), while urine was most common for VRE and ESBL (75.84% and 86.21%, respectively). Between pre and during-COVID, the percent of MRSA isolates decreased (48.74% to 46.66% , p &lt; 0.001), VRE isolates increased (11.45% to 12.06%, p = 0.004), and ESBL infections decreased (8.22% to 8.04%, p = 0.009) (Table 1). There were differences in AMR across all pathogens by race (p &lt; 0.001) and ethnicity (p &lt; 0.001) both pre and during-COVID. Risk of AMR infections increased among Black and Hispanic patients during COVID (Table 2).

Conclusion
Unexpectedly, we observed a statistically significant decrease in AMR for MRSA and ESBL during-COVID. AMR risk among racial and ethnic minority groups further increased during-COVID, raising concern about this as an additional area of disparity. The clinical significance of these results remains unclear and further research is needed to characterize the short and long term impact of COVID on AMR.

Disclosures
All Authors: No reported disclosures
1806. Community Spread of Highly Resistant Enterobacterales
Authors: Xiao Jamie , Brown Dylan , Chen Liang , Holowka Thomas , Ruegsegger Laura , Liccione Mera F , Bonomo Robert A , Marshall Steven , Rudin Susan D , Bartelt Luther A , van Duin David 
Published: November 2023

Abstract

Background
Highly Resistant (including ceftriaxone-resistant and carbapenem-resistant) Enterobacterales (HRE) are a major and growing public health threat. Community spread of HRE is poorly understood.

Methods
Monthly stool samples were obtained from patients who were discharged home after a hospitalization at one of 6 participating US medical centers with a clinical culture positive for HRE based on local laboratory antimicrobial susceptibility testing. Stool samples were also collected from community and household contacts they referred, and any contacts referred by those contacts. Samples were screened by culture on selective media for HRE, and with PCR for presence of extended-spectrum β-lactamase (ESBL), AmpC, and carbapenemase genes. Whole genome sequencing was performed on selected isolates.

Results
Of 1,923 patients with positive HRE cultures from healthcare settings, 943/1,923 (49%) were discharged home. 65/943 (7%) were consented into the study, and 31/65 (48%) returned at least one sample (median of 6 samples; IQR 5-10). The index HRE species was isolated from stool samples from 19/31 (61%) participants; the median duration of detected carriage was 391 days (range 84-662 days). Screening for resistance genes was performed on 477 sample-derived isolates (Table 1); ESBL/AmpC and carbapenemase genes were present in 221/447 (49%) and 17/447 (4%), respectively. Stool samples (median of 7 samples; IQR 5-11) were collected from 11 contacts of 9 participants, and 1 contact of a contact. Index HRE were isolated from samples from 10/12 contacts (83%); the median duration from date of positive index culture to last positive sample in a contact was 400 days (range 146-588). Whole genome analysis confirmed genetic similarity (&lt; 21 single nucleotide polymorphism difference) between ceftriaxone-resistant blaSHV and blaCTX-M-15 carrying K. pneumoniae isolates in a cluster of 4 participants, which included secondary transmission between a contact of the index patient and one of their contacts over a period of 555 days.Table.Resistance genes

Conclusion
Patients with a clinical culture positive for HRE are at risk for prolonged intestinal HRE carriage after hospitalization. Upon returning home, community spread of HRE was very common in this cohort.

Disclosures
Robert A. Bonomo, MD, Entasis: Grant/Research Support|Merck: Grant/Research Support|venatorax: Grant/Research Support|Wockhardt: Grant/Research Support David van Duin, MD, PhD, Entasis: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Qpex: Advisor/Consultant|Roche: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Union: Advisor/Consultant|Utility: Advisor/Consultant
2887. Implication of genotypes for prognosis of Candida glabrata bloodstream infections
Authors: Chen Pao-Yu , Huang Yu-Shan , Chuang Yu-Chung , Wang Jann-Tay , Sheng Wang-Huei , Chen Yee-Chun , Chang Shan-Chwen 
Published: November 2023

Abstract

Background
Genotyping a specific pathogen may demonstrate unique patterns of antimicrobial resistance and/or interaction between pathogen and host, which subsequently lead to miserable consequence. Herein, we conducted a retrospective single-center study to analyze the association between genotypes and clinical outcomes among Candida glabrata bloodstream infections (BSIs).

Methods
A standard case report form was used to collect the clinical data of hospitalized adults with C. glabrata BSIs in 2017. Antifungal susceptibility testing was performed by using the Sensititre YeastOne SYO-10 panel, and minimum inhibitory concentrations (MICs) were interpretated according to the Clinical and Laboratory Standard Institute. Genotyping was performed by using a multilocus sequence typing scheme, and further analyzed by the unweighted pair group method with arithmetic averages (UPGMA) method.

Results
Among 48 patients, clonal complex 7 (CC7, defined by UPGMA similarities &gt;80%) was the most common CC (n=14, 29.2%). The rates of fluconazole and candin resistance were low (6.6% and 0%, respectively) without specific distributions among genotypes Charlson comorbidity index (adjusted odd ratio [aOR], 1.49; 95% CI, 1.05-3.11) was the only risk factor for CC7 C. glabrata BSIs. CC7 was independently associated with 28-day mortality (aOR, 5.88; 98% CI, 1.06-32.47) in addition to a APACHE II score of &gt;18 (aOR, 5.84; 98% CI, 1.16-29.46). The Kaplan–Meier survival analysis also showed greater mortality in CC7 (Figure). Fluconazole resistance or candin therapy had no significant impact on mortality.Figure.Comparison of Kaplan–Meier survival curves between cloncal complex 7 (CC7) and non-cloncal complex 7 (non-CC7) at 28 days in patients with Candida glabrata bloodstream infections

Conclusion
Our data shed light on the impact of genotypes on clinical outcomes in C. glabrata BSIs. Further virulence characterization of CC7 is warranted.

Disclosures
All Authors: No reported disclosures
1811. Impact of a one-time oritavancin infusion on hospital length of stay for uncomplicated skin and soft tissue infections
Authors: Bremmer Derek N , Alvarez Gabriela , Buchanan Carley , Carr Dustin R , Shively Nathan R , Moffa Matthew A , Trienski Tamara , Walsh Thomas L 
Published: November 2023

Abstract

Background
Oritavancin is a lipoglycopeptide antibiotic approved in the United States for the treatment of adults with skin and soft tissue infections (SSTIs). Given the extended half-life of this agent, a one-time intravenous (IV) infusion is adequate to treat SSTIs. This single IV dose provides a convenient outpatient alternative to a traditionally dosed inpatient vancomycin regimen, which may cause a prolonged hospital length of stay (LOS). Previous studies have demonstrated oritavancin to be non-inferior to vancomycin in clinical measures of SSTI resolution. Our antimicrobial stewardship program proactively identified oritavancin eligibility to potentially decrease hospital LOS for patients with SSTIs admitted to the hospital when the primary team preferred continued IV therapy.

Methods
This was a retrospective, cohort study of adult patients with uncomplicated SSTI admitted to the hospital. All patients who received oritavancin that met these criteria were included and a comparator standard of care arm (SOC) was matched based on age, Charlson score, SOFA score, location of cellulitis, and organism if available. The primary outcome was hospital LOS. Secondary outcomes included documented adverse drug events (ADEs) and 30-day emergency department (ED) visit, hospital readmission, and a composite re-evaluation in outpatient setting, ED, or hospital for continued or worsening infection.

Results
A total of 57 oritavancin patients were included with 35 able to be matched to a SOC comparator. The only difference in baseline demographics was patients in the oritavancin arm were more likely to have failed outpatient antibiotics (49% vs 26%; p = 0. 048). There was no difference in hospital LOS between the oritavancin arm and SOC (2.02 vs 2.56; p = 0.250). There were similar rates of ADEs (2.8% vs 0%; p = 1.00), 30-day ED visits (11.4% vs 14.3%; p = 1.00), hospital readmissions (11.4% vs 5.7%; p = 0.673), and composite re-evaluation for continued or worsening infection (8.6% vs 17.1%; p = 0.477) in the oritavancin arm compared to SOC, respectively.

Conclusion
This analysis found that patients given oritavancin for SSTIs had a numerically shorter hospital LOS, but was underpowered to detect significance. Oritavancin is a reasonable alternative when oral therapy is not an option.

Disclosures
Derek N. Bremmer, PharmD, BCIDP, Thermo Fisher Scientific: Advisor/Consultant Dustin R. Carr, PharmD, BCPS, BCIDP, Merck: Advisor/Consultant Thomas L. Walsh, MD, Accelerate Diagnostics: Advisor/Consultant
1815. Clinical Characteristics of Infections due to Staphylococcus Lugdunensis Compared to Other Staphylococcal Infections
Authors: Harb Souad Bou , Zougheib Youssef , Matar Ayah , Mansour Reem , Kanafani Zeina 
Published: November 2023

Abstract

Background
Staphylococcus lugdunensis (SL) belongs to the group of coagulase negative Staphylococci (CoNS). SL infections may have a more virulent course compared to other CoNS, bearing resemblance to infections caused by S. aureus (SA). This study aims to investigate the clinical characteristics of SL infections at a tertiary care center in Lebanon.

Methods
We enrolled all patients presenting from 2017 to 2021 with positive cultures for SL from four clinical sites (urine, respiratory, wound, and blood). We then selected controls with SA matched 1:1 by site of infection. Since CoNS is not a well-described respiratory pathogen, CoNS were only matched to urine, wound, and blood. Patients who were deemed to have colonization were excluded. We determined the risk factors and outcomes associated with SL infections compared to SA and CoNS infections. We then identified predictors of mortality in the SL cohort.

Results
We identified 101 patients with SL infection, who were matched to 103 patients with SA and 97 patients with CoNS. Most SL isolates were obtained from wound samples (72%), followed by urine (16%), blood (8%) and sputum (4%). Compared to SA, SL patients were less likely to be admitted to the hospital for more than 6 days within the past 30 days (8% vs. 31%; p&lt; 0.01). On the other hand, compared to CoNS, patients in the SL cohort were more likely to have a history of endocarditis (6% vs. 0%; p=0.01). There were no other significant differences between baseline characteristics of SL, SA, and CoNS patients. As far as outcomes, compared to the SA group, patients with SL were more likely to develop renal insufficiency (odds ratio [OR] 4.9; 95% confidence interval [CI] 1.0-23.5) and less likely to have persistent bacteremia (OR 0.5; 95% CI 0.4-0.6). No difference in outcomes was observed between the SL and CoNS cohorts. The mortality rate among SL patients was 8%. The predictors of mortality in this cohort are found in the table.
Bivariable and multivariable analysis of predictors of mortality among patients with SL infections

Conclusion
SL appears to be more associated with patients in the community rather than the hospital setting and may be more likely to occur in patients with damaged heart valves. Chronic pulmonary disease and a blood source of infection are associated with a fatal outcome in SL patients.

Disclosures
All Authors: No reported disclosures
1819. The Impact of Vascularized Lymph Node Transplant in Reducing the Rate of Cellulitis in Patients with Breast Cancer–Related Lymphedema
Authors: Perez Alejandro , Schaverien Mark , George-Palop Monica , Barcenas Carlos , Viola George M 
Published: November 2023

Abstract

Background
Lymphedema following breast cancer surgery is a chronic and disabling complication that may lead to recurrent cellulitis. Innovative advances in treatment of breast cancer–related lymphedema have evolved beyond conservative management to include vascularized lymph node transplant (VLNT). Herein, we analyzed the impact of VLNT in reducing the rate of upper extremity cellulitis in breast cancer survivors.

Methods
The charts of all patients who had breast cancer and mastectomy, whose course was complicated by upper extremity lymphedema, and who ultimately underwent VLNT at our comprehensive cancer center from 2017 to 2021 were reviewed. Patients who had at least one episode of cellulitis within the year prior to VLNT and were followed for 24 months were included. Thereafter, we reviewed patients’ demographics, cancer management, breast reconstructive procedures, VLNT surgeries, and infectious complications.

Results
We included 66 patients in our study. Their median age was 57 years (IQR, 23-76 years) (Table 1). The majority were White (88%), with a mean (± SD) body mass index of 29.4 ± 6.7 kg/m2. Most patients had invasive ductal carcinoma (82%) and received chemotherapy (94%), including taxane-based regimens (85%), which increases the risk for lymphedema. Also, most patients received radiation therapy (86%), including to the axillary nodal basin (92%). Furthermore, most underwent unilateral mastectomy (74%) with axillary lymph node dissection (95%) followed by autologous or implant-based reconstruction (both 42%) (Table 2). VLNT was performed at a median of 92 months (IQR, 32-156 months) after mastectomy and were mainly harvested from the inguinal and gastroepiploic regions (both 32%). After VLNT, 58 (88%) patients remained infection-free throughout the 24-month follow-up period. The only factor associated with recurrent cellulitis was the need for a second lymph node transfer or lymphovenous bypass surgery, likely owing to a significant lack of lymphedema reduction (p=0.006).

Conclusion
The novel approach of VLNT in the management of breast cancer–related lymphedema is associated with significantly decreased recurrent cellulitis rates and should be considered as part of the infectious diseases treatment armamentarium.

Disclosures
All Authors: No reported disclosures
1820. Source Control and Odontogenic Infections in an Urban Safety Net Hospital: What, When and How?
Authors: Pollock Erin , Elbathani Mohamed , Damughatla Anirudh , Monday Lea M 
Published: November 2023

Abstract

Background
Odontogenic infections cause 2.2 million emergency department (ED) visits annually. Infectious diseases (ID) physicians are frequently consulted and recommend source control procedures by oral and maxillofacial surgery (OMFS). However, patients are often instructed to follow-up outpatient which may be difficult due to social determinants of health. Despite this common occurrence, almost no studies exist in the ID literature on follow-up rates or outcomes of these management strategies. We aim to identify and characterize patients with odontogenic infections, and determine whether definitive source control (SC) impacts outcomes.

Methods
An observational cohort study analyzing patients seen by OMFS for odontogenic infection over 14 months (1/2022-2/2023) at a safety net hospital system in Detroit, MI. Odontogenic infection was defined as that of the jaw, neck, or face originating from a tooth or its supporting structures. Non-infectious consults were excluded (Fig 1). Characteristics and outcomes were compared between patients with and without SC. Primary outcome was incidence of 30-day readmission. Mortality and microbiologic data were also collected.

Results
78 patients were evaluated by OMFS; 44 (56%) were admitted and 34 (44%) were discharged from the ED. SC occurred in 60 patients, 50 of which had SC on the index admission or ED visit (29 of 44 admitted and 21 of 34 ED patients, respectively) (Fig 1). SC was deferred in 28 patients, 10 of whom did later receive it. Follow up rates for ED patients who SC deferred were high (8 of 13 patients). Only 2 of 15 deferred inpatients were seen (Fig 1). No documented SC occurred in 18 patients. Groups did not differ significantly in clinical characteristics, antibiotics, or rates of ID consultation (Table 1). There was a trend for SC patients to be male (p=0.057) and require intensive care unit support (p=0.081) (Table 1). Readmission rates were higher in those without source control (28% versus 3%, p=0.001). Common pathogens isolated included oral Streptococci and gram-positive rods (Fig 2).

Conclusion
Odontogenic infection patients without source control had high rates of readmission despite being less critically ill. The ID community should take a more active role in studying the optimal management strategy for this common occurrence.

Disclosures
All Authors: No reported disclosures