bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1414. An Analysis of Social and Clinical Characteristics of Individuals who Acquired a Central Line Associated Bloodstream Infection (CLABSI)
Authors: Schocken Derek D , Kim Mindy , Gettler Erin , Okeke Nwora Lance , Turner Nicholas A , Anderson Deverick J 
Published: January 2025

Abstract

Background
A previous exploratory analysis of surveillance data at our large academic medical center identified higher CLABSI rates among non-Hispanic Black patients compared to White patients. In the context of a growing understanding of the importance of social determinants of health (SDOH), we sought to better describe those patients who acquired a CLABSI.

Methods
We conducted a retrospective analysis of patients with CLABSI who were admitted to one of 3 hospitals in our health system in 2022 (1 large academic and 2 community hospitals). CLABSI was defined using standard NHSN criteria. We compared demographic, admission, clinical and SDOH data between patients identifying as White or non-Hispanic Black. These groups were selected due to sample size limitations. Race was defined based on information from the EHR. To identify variables associated with race that may mediate differences in acquiring CLABSI, we created a logistic regression model using stepwise backwards selection.

Results
Among 167 patients with CLABSI, 86 (52%) identified as White and 67 (40%) identified as Black. Social and clinical characteristics of the cohort are included in Table 1. Data on central lines in place at diagnosis are included in Table 2. The 3 most common organisms were Staphylococcus epidermidis, S. aureus, and Pseudomonas aeruginosa. Median Elixhauser scores were not different between groups (9 v. 10, p = 0.2). Median Social Deprivation Index also did not differ between groups (64 v. 66, p = 0.4). Clinical and social characteristics identified via logistic regression as independently associated with race are described in Table 3.

Conclusion
Black patients with CLABSI more frequently required assistance in their ADLs, more frequently had a line dedicated to dialysis, and were less likely to have psychosocial concerns identified or documented. The results of this analysis support the complex interrelated nature of biopsychosocial factors that may predispose to disparate needs for central venous catheters and therefore inequities in the risk of CLABSI. Additionally, disparities in screening and documentation of SDOH exist in this cohort. Future studies should aim to quantify the risk of acquiring a CLABSI conferred by race.

Disclosures
Nicholas A. Turner, MD, MHSc, PDI: Research contract|Purio Labs: Research contract
P-1418. Risk for Early and Late Readmission for Serious Injection-Related Infections: the CHOICE+ Cohort
Authors: Traver Edward C , Omari Habib , Stevens Jasmine , Derenoncourt Meghan , Flores Hannah E , Vaish Ishan Kumar , Raman Sumitha , Fujita Ayako Wendy , Reece Becky , Kuo Irene , Steck Alaina , Catalanotti Jillian S , Carpenter Joseph E , Kattakuzhy Sarah , Rosenthal Elana S 
Published: January 2025

Abstract

Background
People who inject drugs hospitalized with severe injection-related infections (SIRI) face barriers to antibiotic treatment completion and remain at risk for new infections due to ongoing injection drug use. We explored risk factors for SIRI readmission and whether readmissions were caused by the index SIRI or a new SIRI.

Methods
CHOICE+ is a retrospective cohort study of adults hospitalized with SIRI due to injection opioid use at 4 hospital systems between 1/1/2018 and 3/31/2022. Data were collected by abstraction of the medical record. Primary outcomes were readmission for SIRI within 1 year and time to readmission. Categorical variables were analyzed by chi-square, Fischer exact test, and multivariate logistic regression. Time to readmission was compared by the Mann-Whitney test.

Results
Of 1618 patients discharged alive, 439 (27%) had ≥1 readmission for SIRI. Unstable housing, patient-directed discharge, and not finishing planned intravenous antibiotics in the hospital were associated with increased risk for SIRI readmission (Table 2). Risk of SIRI readmission was not associated with addiction or psychiatry consultation, discharge on medication for opioid use disorder (MOUD), or type of MOUD. The cause of readmission in 238 (54%) was the index SIRI and in 201 (46%) was a new SIRI. Median time to readmission was shorter for those readmitted with index SIRI compared to a new SIRI (10 v. 126 days, p &lt; 0.0001, Figure 1) and for those who did not complete treatment for the index SIRI compared to those who completed treatment (7 v. 78 days, p &lt; 0.0001, Figure 2).

Conclusion
In this large, representative study, readmission for SIRI occurred frequently for both problems related to the index SIRI as well as development of new SIRI. Readmission for index SIRI occurred earlier than for new SIRI, especially for those who did not complete antibiotic treatment. Notably, readmission for SIRI was not associated with inpatient interventions to address addiction during the index hospitalization. Therefore, prioritizing completion of treatment of the index SIRI may be critical for reducing early readmissions. In contrast, prevention of new SIRI, by longitudinally addressing addiction, social determinants of health, and harm reduction, may be necessary to reduce later readmissions.

Disclosures
Elana S. Rosenthal, MD, Gilead Sciences: Grant/Research Support|Merck: Grant/Research Support
P-1427. Continuation of HIV and hepatitis C care among refugees migrating from Ukraine - Five Times Ninety project
Authors: Kowalska Justyna , Antoniak Sergii , Samsonova Olena 
Published: January 2025

Abstract

Background
Five Times Ninety project investigates linkage to care among war refugees living with HIV displaced from Ukraine to Poland.Figure 1.Gender and mode of HIV infection of Ukrainian refugees stratified by time of registering to care in Warsaw

Methods
Refugees who registered to HIV care in Warsaw were followed according to “Standardized protocol for clinical management and medical data sharing for PLHIV among refugees from Ukraine” developed by WHO/CHIP,EACS, ECEE and ECDC (https://iris.who.int/handle/10665/353083). For each patient who signed informed request data were linked to database at the Public Health Center (PHC) Ministry of Health Ukraine, and sent back on standardized form.Figure 2.Cascade of HIV care of Ukrainian refugees registered to care in Warsaw

Results
Among 205 refugees who registered to HIV care in Warsaw (5 Mar2022 - 31Aug2023) 202 (98.7%) were linked with PHC database, 121 (59.9%) were female, median age 40.0 (range 18-69, IQR 36.0-46.0), migrating from Central (67; 33.2%), South (65; 32.2%), East (39; 19.3%), West (27; 13.4%) and North (4; 2.0%) Ukraine. Mode of HIV infection was heterosexual in 113 (55.9%), other/unknown in 51 (25.2%), injecting drug use in 28 (13.9%) and MSM in 10 (4.9%) persons. Women and persons who acquired HIV through heterosexual contacts were more likely to migrate earlier, but age structure did not significantly change over time (Figure 1). On 31Dec2023 in total 128 (63.4%) patients remained in care in Warsaw.
189 patients (93.1%) had HIV viral load measured both in Ukraine and Poland, 173 (91.5%) and 155 (82.0%) were undetectable, respectively. This translates into 9.5% loss of ART efficacy during a transition period. These improved over time (Figure 1). Switching of antiretroviral therapy occurred often, yet majority remained on integrase inhibitor (194; 98.0%) and tenofovir (176; 88.9%), Figure 4.
148 persons (73.6%) were tested with HCV serology in Ukraine and 187 (93.0%) in Poland. Of 59 (31.5%) tested positive in Poland, 24 were post-DAA therapy in Ukraine. Of 35 who were tested with PCR in Poland, 10 had undetectable HCV RNA, 25 had detectable HCV RNA of whom 10 already went through DAA therapy, Figure 3.Figure 3.HCV testing and treatment for Ukrainian refugees registered to care in Warsaw

Conclusion
Standardized protocol proved to be an efficient for medical data exchange. Viral suppression among Ukrainian refugees on ART decreased slightly, but in general remained high and improved with time. Routine HCV screening is a necessity, especially because there are no restrains to DAA treatment access in Poland.Figure 4.Antiretroviral therapy switches among refugees registered to care in Warsaw

Disclosures
All Authors: No reported disclosures
P-1429. Racial Disparities in Childhood Vaccination Rates and Their Association with State-Level Structural Racism
Authors: Han Jin-Young , Wu Yiyuan , Abramson Erika 
Published: January 2025

Abstract

Background
Racial disparities in childhood vaccination rates are well-documented nationally. These disparities may vary across states due to multiple reasons, including vaccine exemptions. A structural racism score is a measure developed to quantify systemic racial disparities across various domains, including segregation, economic status, and incarceration. Notably, structural racism is more pronounced in Northeastern and Midwestern states of the United States. Leveraging recently published Black structural racism scores at the state level, we examined the relationship between structural racism and childhood vaccination rates among non-Hispanic Black and non-Hispanic White children.

Methods
We analyzed 5-year aggregate vaccination rates (2017-2022) for children aged 19-35 months using data from the US Centers for Disease Control and Prevention National Immunization Survey-Child (NIS-Child). The main outcome was the difference in percentage points between non-Hispanic Black and non-Hispanic White childhood vaccination rates for each state. The childhood vaccination rate was defined by whether children received all recommended vaccines (4+ DTaP/DTP/DT; 3+ polio; 1+ measles-containing vaccine; full series Hib; 3+ Hep B; 1+ varicella at or after 12 months of age; and 4+ PCV). Eleven states were excluded from analysis due to fewer than 30 non-Hispanic Black respondents. We investigated the relationship between state-level structural racism scores for non-Hispanic Black individuals and calculated vaccination rate differences by linear regression analyses. Additionally, we examined the relationship in states that allowed religious exemptions for childhood vaccinations.

Results
At the state level, higher structural racism scores were associated with greater disparities in childhood vaccination rates between non-Hispanic Black and non-Hispanic White children (Figure 1). Importantly, these associations were significant only in states that allowed religious exemptions for childhood vaccinations (Figure 2, p = 0.046).

Conclusion
When childhood vaccination exemptions are permitted, state-level structural racism may significantly contribute to the observed racial disparities in vaccination rates among non-Hispanic Black children.

Disclosures
All Authors: No reported disclosures
509. Pseudomonas aeruginosa-specific CRISPR-Cas3 bacteriophage cocktail developed to treat respiratory and bloodstream infections
Authors: McMillan Lana , Penke Taylor , Tuson Hannah , McKee Robert , Baker Ethan , Trama Ashley 
Published: January 2025

Abstract

Background
New strategies are needed to combat infections due to multidrug-resistant (MDR) Pseudomonas aeruginosa. Bacteriophage therapy offers an effective, pathogen-specific, microbiome-sparing treatment with an orthogonal mechanism of action to that of small-molecule antibiotics. Here we describe the development and characterization of the P. aeruginosa-targeting 6-phage cocktail LBP-PA01.

Methods
High-throughput automated methods were used to isolate and characterize wild-type phages. Proprietary Locus-developed software was used to predict the most efficacious combinations of bacteriophages. Selected phages were engineered to express CRISPR-Cas3, and phages were combined into an optimal cocktail and subjected to in vitro antibacterial activity characterization including assessments of bacteriophage and cocktail host range by liquid growth curve assay and by plaque assay, bactericidal activity in the presence of mucin matrices using EpiAirwayTM human airway epithelium tissues, biofilm degradation and inhibition. In vivo efficacy was tested in immuno- compentent mouse models of lower respiratory tract infection with LBP-PA01 administered intranasally and intravenously as well as in a rat model of blood stream infection with intravenous administration.

Results
&gt;2800 individual bacteriophage were discovered through high throughput methods. Cocktail prediction and optimization resulted in the final combination of 6 unique bacteriophage, LBP-PA01, which was tested against 570 diverse contemporary P. aeruginosa clinical isolates from patients with respiratory or bloodstream infections. The cocktail showed a host range of 97.3% and efficacy against biofilms and in the presence of mucin. In mouse models of acute lower respiratory tract infection and disseminating pulmonary infection and a rat model of bloodstream infection, LBP-PA01 produced multiple log reductions in CFU levels relative to vehicle treatment and superiority to standard-of-care antibiotics.

Conclusion
Based on the in vitro and mouse model data, LBP-PA01 is a strong candidate for advancement into the clinic for treatment for P. aeruginosa infections.

Disclosures
All Authors: No reported disclosures
512. Efficacy of Gepotidacin versus Nitrofurantoin in a Nitrofurantoin Not Susceptible Population: A Pooled Analysis of the EAGLE-2 and EAGLE-3 Randomized Controlled Trials in Uncomplicated Urinary Tract Infection
Authors: Dennison Jeremy , Sheets Amanda , Watts Sarah , Scangarella-Oman Nicole E , Butler Deborah , Breton John , Janmohamed Salim 
Published: January 2025

Abstract

Background
Two Phase 3 trials (EAGLE-2 [NCT04020341]/EAGLE-3 [NCT04187144]) showed that gepotidacin, a first-in-class triazaacenaphthylene antibacterial, was non-inferior to nitrofurantoin (NTF) in treating uncomplicated urinary tract infection (uUTI) caused by NTF-susceptible (NTF-S) qualifying uropathogens (≥ 105 CFU/mL).1 This study evaluates gepotidacin efficacy in the pooled EAGLE-2/3 microbiological intent-to-treat (micro-ITT) NTF not susceptible (NTF-NS) population.

Methods
In EAGLE-2/3, female patients aged ≥ 12 years with ≥ 2 uUTI symptoms received oral gepotidacin (1500mg) or NTF (100mg) twice-daily for 5 days.1 In this study, therapeutic, clinical and microbiological response (defined in tables) at test-of-cure (Day 10–13) were assessed in the pooled EAGLE-2/3 micro-ITT NTF-NS and NTF-S populations and across patient subgroups.

Results
Of the 1421 micro-ITT patients, 220 (15%) had NTF-NS uropathogens and 1201 (85%) had NTF-S uropathogens. The most common baseline uropathogens were Escherichia coli (90%) in the NTF-S population, and Klebsiella pneumoniae (31%), Proteus mirabilis (26%), and E. coli (24%) in the NTF-NS population (Table 1). Across key subgroups, the proportion of patients with NTF-NS uropathogens was broadly similar to the overall population (except Hispanic/Latinx, Black race and US subgroups which were numerically higher; Figure 1). For efficacy outcomes, treatment differences were higher in the NTF-NS vs the NTF-S population, and, as expected, favored gepotidacin vs NTF (Table 2). Treatment differences in therapeutic success were numerically higher across key subgroups in the NTF-NS vs the NTF-S population (Figure 2).

Conclusion
Gepotidacin was efficacious in both populations, and across subgroups, with a higher therapeutic treatment difference in the NTF-NS vs the NTF-S population. Gepotidacin could offer benefit in patients with uUTI, including those with NTF-NS uropathogens.
1. Wagenlehner F, et al. Lancet 2024;403:741–55.
Funding: EAGLE-2 was funded in part by GSK and in part with Federal funds from the US Office of the Assistant Secretary for Preparedness and Response, Biomedical Advanced Research and Development Authority (HHSO100201300011C). EAGLE-3 was funded by GSK.

Disclosures
Jeremy Dennison, MD PhD, GSK: Employee|GSK: Stocks/Bonds (Public Company) Amanda Sheets, PhD, GSK: Employee|GSK: Stocks/Bonds (Public Company) Sarah Watts, MSc, GSK: Employee|GSK: Stocks/Bonds (Public Company) Nicole E. Scangarella-Oman, MS, GSK: Employee|GSK: Stocks/Bonds (Public Company) Deborah Butler, PharmD, GSK: Employee|GSK: Stocks/Bonds (Public Company) John Breton, MCM, GSK: Employee|GSK: Stocks/Bonds (Public Company) Salim Janmohamed, MD, GSK: Employee|GSK: Stocks/Bonds (Public Company)
516. Cytomegalovirus (CMV) Saliva Shedding Kinetics in Children with Congenital Cytomegalovirus Infection (cCMV)
Authors: Pinninti Swetha , Pati Sunil , Novak Zdenek , Fowler Karen , Boppana Suresh , Ross Shannon 
Published: January 2025

Abstract

Background
CMV is the most common cause of congenital viral infection worldwide and the leading cause of non-genetic sensorineural hearing loss (SNHL). Children with congenital CMV infection (cCMV) shed the virus in urine and saliva for prolonged but variable durations. However, data on CMV saliva shedding kinetics in cCMV is limited because of the lack of longitudinal virological follow-up. The objective of this study is to describe CMV shedding kinetics in saliva during early childhood in a cohort of children with cCMV identified through universal newborn screening.

Methods
As part of the CMV and Hearing Multicenter Screening study (CHIMES), &gt;100,000 newborns were screened for cCMV. Data from 211 children with ≥ 5 visits each with audiological follow-up and serial saliva samples collected every six months through four years of life was analyzed. Saliva CMV shedding duration and intermittent shedding according to presence of newborn symptoms, hearing status and antiviral treatment are described.

Results
Of the 211 children with cCMV, 14 received anti-viral treatment in early infancy. Most children shed CMV in saliva during infancy with a gradual decrease in frequency on follow-up (Figure 1). The median duration of shedding did not differ between children with asymptomatic and symptomatic cCMV (25 vs 26 months respectively; p = 0.61); children with SNHL and normal hearing (22 vs 26 months respectively; p = 0.26); and between those treated with antiviral agents and untreated children (23 vs 25 months; p = 0.9). Salivary CMV shedding was intermittent in about a third of the cohort (71/197 - 36%), mostly (91.5%) in those with asymptomatic cCMV. CMV shedding duration was significantly longer in children with intermittent shedding compared to those who did not (34 vs 17 months; p &lt; 0.0001).

Conclusion
In this large cohort of children with cCMV identified through newborn screening, children shed CMV DNA in saliva for a median of two years, irrespective of newborn symptoms, hearing status, and receipt of anti-viral therapy. A third of the cohort shed CMV intermittently. Based on these observations, we conclude that a negative saliva CMV PCR result during infancy in newborns with findings consistent with cCMV but not tested in the newborn period likely excludes a diagnosis of cCMV.

Disclosures
Swetha Pinninti, MD, Moderna: Grant/Research Support|Pfizer: Grant/Research Support Karen Fowler, DrPH, Moderna: Advisor/Consultant Suresh Boppana, MD, GSK: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support
P-1513. In Vitro Activity of Ceftaroline against Bacterial Pathogens from Pediatric Patients Collected During the ATLAS Global Surveillance Program in 2018-2022
Authors: Hackel Meredith , Stone Gregory , Sahm Daniel F 
Published: January 2025

Abstract

Background
The parenteral cephem ceftaroline fosamil is approved for treatment of adults and children with complicated skin and soft tissue infections (SSTI) and community-acquired bacterial pneumonia (CABP) caused by susceptible isolates of Staphylococcus aureus (methicillin-resistant [MRSA; SSTI] and methicillin-susceptible [MSSA; SSTI and CABP]), β-hemolytic streptococci (Streptococcus pyogenes and Streptococcus agalactiae [SSTI]); Streptococcus pneumoniae (CABP, including concurrent bacteremia), Haemophilus influenzae (CABP), and isolates of Escherichia coli, Klebsiella pneumoniae and Klebsiella oxytoca (SSTI and CABP). Several pathogens causing CABP are also frequently associated with bloodstream infections (BSI). This study examined the in vitro susceptibility to ceftaroline and comparator agents among pathogens isolated from pediatric patients with SSTI, respiratory tract infections (RTI), and BSI as part of the Antimicrobial Testing Leadership and Surveillance (ATLAS) surveillance program in 2018-2022.

Methods
16,533 non-duplicate, clinically relevant isolates of S. aureus, β-hemolytic streptococci, S. pneumoniae, H. influenzae, M. catarrhalis and Enterobacterales were collected from patients aged 0-17 years old with BSI, RTI and SSTI by 285 medical centres in 60 countries. In vitro susceptibility to ceftaroline was determined by CLSI broth microdilution and results were interpreted using CLSI 2024 breakpoints where available. Extended spectrum β-lactamase (ESBL) screening was performed using the CLSI M100 method.

Results
The in vitro activity of ceftaroline is summarized in the table. 100% of MSSA and β-hemolytic streptococci isolates, &gt;99% of S. pneumoniae, &gt;99% of H. influenzae, and &gt;92% of ESBL screen-negative E. coli, K. pneumoniae, K. oxytoca and P. mirabilis collected from all pediatric patients combined tested as susceptible to ceftaroline, as did &gt;97% of MRSA. M. catarrhalis ceftaroline MIC values ranged from ≤0.06 - 8 µg/mL, with an MIC90 of 0.25 mg/L. Susceptibility was consistant across each of the age groups.

Conclusion
Ceftaroline demonstrated potent in vitro activity against a global collection of clinically relevant pathogens collected from pediatric patients.

Disclosures
Daniel F. Sahm, PhD, Pfizer, Inc.: Advisor/Consultant
P-1524. Clinical Characteristics and Outcomes of Patients with Candida auris at RUHS
Authors: Chiu Chiao An , Hong Maily , Aravagiri-Do Arunmozhi , Nguyen Rebecca , Mulligan Nikki , Sutjita Made , Weng Bruce 
Published: January 2025

Abstract

Background
Invasive Candidiasis Clinical Associations
*: Immunocompromised status including patients on chemotherapy, status post organ transplant, HIV positive, etc.

Methods
We conducted a retrospective chart review of C. auris fungemia cases in adult hospitalized patients at RUHS between January 2022 to December 2023. Demographic data, clinical associations, antifungal susceptibility and clinical outcomes were noted using descriptive statistics.
Antifungal Susceptibility

Results
Nine patients (n = 9) were identified. 8/9 (89%) presented from a long-term care facility. 5/9 (56%) patients were male gender averaging 65 years old (range 45-86yo). Charlson comorbidity index was 8.11. Clinical associations: invasive devices (9/9, 100%), long-term care residence (8/9, 89%), hospitalization within 90 days (7/9, 78%), IV antibiotic within 90 days (8/9, 89%), and surgery (5/9, 56%). All patients were treated with micafungin. Despite 100% susceptibility to echinocandins, fungemia duration was long (mean 242.1 hours; range 39.13-1431.75 hours) and 4/9 (44%) patients required a dose increase of micafungin (mean dose 194 mg; range 100-300 mg). Cases were further characterized by prolonged ICU length of stay (LOS (mean 15d, range 3-41d)), prolonged hospital LOS (mean 39.3d, range 9-65d), and high mortality (4/9, 44%). 2/5 (40%) survivors versus 0/4 (0%) deceased patients had source control. The majority of survivors 4/5 (80%) had a primary line-associated fungemia. 2/5 survivors (40%) were readmitted within 6 months.
Mortality in Relation to Source Control

Conclusion
Patients from long-term care facility with additional clinical associations appear to have high risk for C. auris infection and complications. Consideration of higher initial dose echinocandins should be considered in management of patients presenting with C.auris fungemia. Aggressive source control of fungemia etiology should be pursued when possible.

Disclosures
All Authors: No reported disclosures