bluuebunny/crossref_metadata_2025_split huggingface dataset:
308. Development and Validation of a LASSO-based Score to Predict 1-year Mortality After Discharge in Patients with Severe Pneumonia Admitted to the Intensive Care Unit
Authors: Garcia-Gallo Esteban , Duque-Vallejo Sara , Sanabria-Herrera Natalia , Viñán Garcés André Emilio , Narváez - Ramírez Oriana , Ramirez Valbuena Paula Camila , Reyes Luis Felipe F 
Published: January 2025

Abstract

Background
Severe community acquired pneumonia(sCAP) is the leading cause of ICU admission around the globe and is responsible for more than 3.5 million deaths yearly. Up to 40% require ICU admission and present a mortality rate up to 50%. Many risk factors for long-term mortality have been previously identified; however, current CAP severity scores do not discriminate patients at higher risk to die 1-year after the sCAP episode.
Figure 1. Comparative Analysis of Severity Score AUCs: Evaluating Discriminatory Power Across Metrics. A) Training B) Validation C) SAPS II D) Charlson Comorbidity Index E) SOFA F) CURB-65

Methods
In this retrospective cohort study, data of 4748 adult patients with sCAP were obtained from the Medical Information Mart for Intensive Care IV(MIMIC-IV) 2001-2012 database. Univariate logistic regression analysis was used to identify those variables that tend to have a significant impact on 1-year mortality. Then a multivariate analysis was carried out to identify variables associated with one-year mortality in SCAP patients. Finally, a predictive model was developed and compared with the widely used severity of disease classification system SAPS-II. 10-fold cross-validation method was used to assess the performance metrics. The data were divided into training and validation sets in a 4:1 ratio. The least absolute shrinkage and selection operator (LASSO) regression method was used to screen the variables and to test the accuracy of the risk prediction model.

Results
17 key factors were used as independent risk factors for 1-year mortality to construct the prediction model, including age, heart rate, temperature, Glasgow coma scale, malignant cancer, severe liver disease, ARDS, BUN, INR, Prothrombin Time, bilirubin, hemoglobin, urine output, supplementary oxygen, vasopressors, piperacillin tazobactam and ceftriaxone prescription. The AUC values of the prediction training and validating model were superior to the SAPS II, Charlson Comorbiditiy index, the SOFA, and CURB-65 scores [0.79, 0.80, 0.71, 0.69, 0.62, and 0.64, respectively] (Figure 1).

Conclusion
Our prediction model could effectively predict 1-year mortality in patients with sCAP; additionally, it exhibits commendable classification accuracy within the ICU patient population underscoring its potential utility as a valuable prognostic tool for clinical decision-making in critically ill individuals.

Disclosures
All Authors: No reported disclosures
P-840. Is Staphylococcus lugdunensis just another coagulase-negative Staphylococcus? A Comparative Study of community-acquired Staphylococcus lugdunensis and methicillin-susceptible Staphylococcus aureus Bacteremia
Authors: Chung Jessica , Wathan Khin , Aung Aye Honey , Maung Aye Cherry Maung , Liu Franklin , Ghitan Monica , Chapnick Edward , Shia Lin Yu 
Published: January 2025

Abstract

Background
Staphylococcus lugdunensis (SL), a coagulase-negative staphylococcus (CoNS), usually a skin commensal, has demonstrated similar virulence to Staphylococcus aureus. Current studies have compared SL bacteremia (SLB) to S. aureus bacteremia, primarily hospital-onset methicillin-resistant Staphylococcus aureus bacteremia. Our study is the first to compare the clinical characteristics and outcomes between community-acquired SL bacteremia (SLB) and MSSA bacteremia (SAB).Table 1:Patient Demographics

Methods
This retrospective cohort study evaluated hospitalized adults with SLB and SAB at an urban tertiary care center from January 1, 2017 to December 31, 2022. CA-BSI was defined as at least one positive blood culture with SL or methicillin-susceptible Staphylococcus aureus (MSSA) within 72 hours of admission. Patients previously hospitalized within 30 days, on chemotherapy, or transferred from another facility were excluded. The primary outcome was in-hospital mortality rate with a secondary outcome of hospital length of stay (LOS). The Whitney Mann U test and chi-square test were used for the analysis.
Figure 2

Results
33 SLB patients and 66 SLB patients were included. The demographics of both groups are seen in Table 1. The SLB group was older and had a higher Charlson Comorbidity Index score compared to the SAB group. The incidence of SLB increased during the study period while the incidence of SAB remained the same (Figure 1). Two-thirds of the patients in both groups met sepsis criteria on presentation. 33% of SLB and 18% of SAB had a Pitt bacteremia score of ≥4 points. Endocarditis, skin and soft tissue infections, osteoarticular, line-related, and pneumonia are the primary sources of infections in SLB and SAB. There was no statistical difference in rates of ICU admission, need for ventilator support, need for renal replacement therapy, and length of stay between the two groups. In-hospital mortality was 15% for both groups.

Conclusion
SL is a CoNS recognized as an emerging pathogen. The incidence of CA-SLB is increasing, particularly in older individuals with underlying comorbid conditions. The in-hospital mortality rate associated with SLB is as high as CA-SAB. Clinicians must recognize the high pathogenicity of SLB and implement comprehensive strategies to prevent morbidity and mortality.

Disclosures
All Authors: No reported disclosures
P-848. Proactive Pharmacy-led Transition of Care Protocol to Increase Appropriate Oral Antibiotic Use in Uncomplicated Gram-Negative Bacteremia
Authors: Kufel Julia , McFadden Cadhan , Avery Lisa 
Published: January 2025

Abstract

Background
Limited data are available to describe a pharmacist-driven Gram-negative bacteremia (GNB) protocol on treatment optimization and outcomes. The primary outcome was a composite of the percentage of patients on a pharmacist-driven antibiotic protocol. Secondary outcomes evaluated 30-day all-cause mortality and infection-related readmission.

Methods
This was a single-center, quasi-experimental study conducted in a 451-bed community teaching hospital. The pre- and post-intervention cohorts included patients from 8/1/22-9/30/23 and 10/1/23-4/31/24, respectively. Patients aged &gt;18 years with GNB were included. Patients who are immunocompromised, had a non-functional gastrointestinal tract, were enrolled in hospice, expired during hospitalization, pregnant, left against medical advice, had a polymicrobial infection, bacteria resistant to all PO agents, inadequate source control, or those with infectious disease consultations were excluded. For the intervention, a pharmacist-driven GNB protocol was developed to include the definition of uncomplicated GNB, clinical improvement criteria, ranked order of preferred PO antibiotics with appropriate dosing and duration of therapy. These recommendations were communicated to providers by pharmacists. The Chi-square test and student t-test were used for nominal and continuous data, respectively. A p-value of &lt; 0.05 was considered statistically significant.

Results
There were 61 and 41 patients in the pre- and post-intervention cohorts, respectively. Demographics were similar. The primary outcome was achieved in 59% and 81% of patients, respectively (p=0.02). Urinary source was most common, including 75% in the pre and 85% in the post-intervention group (p=0.22). Trimethoprim-sulfamethoxazole use increased from 6% to 29% (p=0.002). No difference in 30-day all-cause (p=0.51) and infection related readmission (p=0.82) was identified.

Conclusion
Implementation of a proactive pharmacy-led GNB protocol increased the use of appropriate PO transition regimens in uncomplicated GNB.

Disclosures
All Authors: No reported disclosures
P-853. Prevalence, Clinical Data and Associated Risk Factors of Third Generation Cephalosporin Resistance in Salmonella spp. Septicemia in Northeast of Thailand
Authors: Thivakorakot Kunakorn , Meesing Atibordee , Phanthanawiboon Supranee 
Published: January 2025

Abstract

Background
The increase of antimicrobial resistance bacteria among foodborne pathogens including Salmonella spp. has been associated with poor outcomes. The studies of prevalence and risk factors of Salmonella spp. resistance in Thailand is limited. Hence, this study was conducted to study the prevalence and risk factors of third-generation cephalosporin resistance in Salmonella septicemic patients.
Heat map showing the proportion of antimicrobial resistance in Salmonella spp.

Methods
A retrospective study was conducted between January 1st, 2016, to June 30th, 2023, in Srinagarind Hospital Khon Kaen, Thailand. All patients with hemoculture positive for Salmonella spp. who aged ≥ 18 years were included for analysis.
Subgroup analysis

Results
A total of 139 patients with Salmonella septicemia were included in this study, The mean age was 56.54 years and males were 51.8%. The prevalence of third-generation cephalosporin resistance Salmonella spp. was 8.8%. The most common primary infection site was primary bacteremia (66.9%), gastrointestinal tract (12.9%), Urinary tract (7.2%), bone and joint (3.6%), and arteritis (3.6%) respectively. Mortality was 7.1% (1 patient died from resistant strain). Carbapenem, piperacillin/tazobactam, and ciprofloxacin were an alternative treatment in the resistant group. There are no statistically significant among previously known factors associated with third-generation cephalosporin resistance in Salmonella septicemic patients.
Vital signs and laboratory investigations

Conclusion
The prevalence of third-generation cephalosporin resistance in Salmonella septicemic patients in this study was higher than overall in Thailand but lower than in tertiary care hospitals in Bangkok. Mortality was not higher in the resistant group. The mortality rate is not associated with ceftriaxone resistance in Salmonella spp. septicemia.
Empirical antibiotic of choice

Disclosures
All Authors: No reported disclosures
P-859. Shorter versus Longer Duration of Antibiotic Therapy for Gram-Negative Bacteremia (GNB) in Immunocompromised Patients
Authors: Slain Nicole , Randazza Olivia , Taylor Alex D , Williamson John C , Hartis Charles , DeWitt Michael E , Palavecino Elizabeth , Ohl Christopher , Luther Vera P , Maves Ryan C , Banoub Mary 
Published: January 2025

Abstract

Background
Although there is no standard duration of therapy for GNB, 14 days has been commonly used. In recent years, studies have evaluated shorter durations of antibiotics (abxs) specifically for uncomplicated GNB in immunocompetent patients. The purpose of this study was to determine whether a shorter duration of abx therapy for GNB in immunocompromised patients had an impact on clinical outcomes compared to a longer abx duration.

Methods
This was a single-center, retrospective, matched pairs study from July 2021 to August 2023. Patients were included if they were ≥ 18 years old, hospitalized with GNB, and met immunocompromising criteria. A blood culture report was obtained and cross referenced with ICD-10 codes to identify patients. Short durations of abxs were considered ≤ 8 days, while a long duration was ≥ 10 days. The primary outcomes were all-cause mortality and abx failure at 90 days (defined as a relapsed blood stream infection, new local suppurative complication, or a new distant complication). Secondary outcomes consisted of 30 day infection related hospital readmission, length of stay, Clostridioides difficile infections, total active days of therapy, and development of resistance. Patients were matched in a 1:1 ratio based on type of GNB (Enterobacterales vs non-Enterobacterales), age (+/- 10 years) and Pitt Bacteremia Score (+/- 1).

Results
29 matched pairs were included (Figure 1). The majority of matched pairs (96.6%) had Enterobacterales infections. The most common immunocompromising conditions were diabetes (21/29 and 19/29) and solid tumors (12/29 and 8/29) in the short and long groups, respectively. Most infections originated from the urinary tract, 16 (55.2%) in the short group and 20 (69.0%) in long group (Table 1). All-cause mortality within 90 days occurred in 2 (6.9%) patients in both the short and long groups (P value &gt;0.9). Abx failure occurred in 1 (3.4%) patient in the short group and 2 (6.9%) in the long group (P value &gt;0.9) (Table 2).

Conclusion
Shorter durations of abx therapy for GNB in immunocompromised patients showed similar clinical outcomes compared to longer durations of therapy. These findings support further investigation with an appropriately powered randomized prospective trial.

Disclosures
John C. Williamson, PharmD, Armata Pharmaceuticals: Grant/Research Support|Blue Collar Vaccines and Therapeutics: Board Member|Blue Collar Vaccines and Therapeutics: Ownership Interest|Paratek Pharmaceuticals: Grant/Research Support|ST Pharm Co, Ltd: Grant/Research Support Ryan C. Maves, MD, AiCuris: Grant/Research Support|Biotest: Grant/Research Support|GeoVax: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria|Sound Pharmaceuticals: Grant/Research Support
P-906. Diagnosis, Treatment, and Outcomes in Patients with Central Nervous System Blastomycosis
Authors: Biggs Megan 
Published: January 2025

Abstract

Background
Blastomyces is a dimorphic fungus found in the soil and is endemic to regions of the Ohio River basin and Southeastern United States. It can cause both local and systemic infections in several organs regardless of immunity status. Infection occurs through inhalation of aerosolized conidia. Blastomycoses most commonly affects the lungs and infection of the central nervous system (CNS) is rarely found representing approximately 5-10% of individuals with extra-pulmonary blastomycosis.
Demographics of Patients with CNS Blastomycosis

Methods
Given the limited information on this rare form of blastomycoses, a retrospective review was conducted at a major tertiary center in Minnesota of adult inpatients diagnosed with proven or probable CNS blastomycoses between 2005 and 2020. Institutional Review Board approval at the Mayo Clinic was obtained. Data pertaining to diagnostic evaluation, treatment and outcomes were collected from eight medical charts found to meet criteria for proven or probable CNS Blastomycosis.
Diagnosis, Treatment, and Outcomes in Patients with CNS Blastomycosis

Results
As seen in prior studies, most patients were male. The most common CNS related symptom on presentation was headache. Frequent comorbidities included diabetes, COPD, and alcohol use. Findings on MRI varied greatly. Blastomyces serum antibody was positive in only half of patients and urine antigen was frequently negative, however this test was not performed in one patient in this study. All but one patient survived to at least one year post diagnosis. All patients were treated with liposomal amphotericin B ranging from nine days to six weeks and voriconazole was the most frequently used azole. All patients treated with voriconazole survived at least one year following completion of treatment.
Diagnosis, Treatment, and Outcomes in Patients with CNS Blastomycosis (continued)

Conclusion
This study emphasizes the importance of having a high suspicion when CNS symptoms are present in a patient with evidence of Blastomyces. Additionally, patients can have proven CNS blastomycoses without Blastomyces positive antibodies and/or antigen in blood or urine as well as variable MRI findings.
Laboratory and Culture Results in Patients Found to Have CNS Blastomyces

Disclosures
All Authors: No reported disclosures
P-918. Rabies encephalitis: Spectrum of MRI findings and predicted probability of abnormality detection based on symptom duration
Authors: Mohata Madhav , Suri Vikas , Singh Paramjeet 
Published: January 2025

Abstract

Background
Rabies is a highly lethal infectious disease and is equivalent to a death sentence for the patient. With currently available tests, the ante-mortem diagnostic sensitivity is only ∼40%. Currently, there are only isolated case reports or small case series exploring the MRI features in rabies encephalitis.
T2 TSE showing hyperintensities in bilateral basal ganglia (caudate nucleus, putamen and globus pallidus) and thalamus and corresponding DWI and ADC images showing true diffusion restriction

Methods
A prospective observational study was designed to explore the patterns of MRI abnormalities in rabies patients. A total of 31 patients were enrolled in the study, out of which 21 underwent Contrast-Enhanced Magnetic Resonance Imaging of Brain and spinal cord.
FLAIR/T2 images showing hyperintensities in dorsal brainstem, cervical spinal cord

Results
Overall, MRI was normal in 10(47.6%) patients, whereas 11(52.4%) patients showed abnormalities. Abnormalities were detected in various brain regions with brainstem, spinal cord and basal ganglia being the most commonly affected regions. Other regions such as the cortex, sub-cortical white matter, limbic system, internal capsule, corona radiata, thalamus, and sub-thalamic region were also involved to varying degrees. Diffusion-weighted-imaging showed typical pattern of diffusion restriction in 6 cases (28.5%). No gadolinium contrast enhancement was observed in any patient. Overall, no significant difference in neuroimaging findings were observed between encephalitic and paralytic forms of rabies. In addition, univariate logistic regression analysis revealed that the likelihood of detecting abnormalities on MRI increases with the duration from the symptom onset.
T2 hyperintensity in conus medullaris with contrast enhancing cauda equina nerve roots

Conclusion
Till date this is the largest prospective study (21 cases) exploring the MRI findings in the patients of rabies encephalitis. The study demonstrated certain patterns of brain imaging in rabies which in the appropriate clinical context could significantly aid in establishing the ante-mortem diagnosis of rabies encephalitis. At the same time, the study also highlights the fact that a normal MRI brain does not rule out the diagnosis and that the probability of finding specific abnormalities on MRI increases as the disease progresses.
Univariable logistic regression to estimate predicted probability of appearance of MRI abnormality after appearance of 1st cardinal symptom

Disclosures
All Authors: No reported disclosures
P-949. The Success of Rapid-Fire Journal Club in Achieving Doctor of Pharmacy Educational Outcomes
Authors: Bradley Nicole , Lee Yuman 
Published: January 2025

Abstract

Background
Rapid-fire journal club is an activity in the infectious diseases elective for pharmacy students in their third professional year. In small groups, students were tasked with completing a journal club on an assigned study evaluating new antibiotics for treatment of resistant gram-negative infections. Students were given 1 week to prepare their presentation, and 10 minutes deliver their presentation. The goal of rapid-fire journal club was to engage pharmacy students in primary literature relating to new antibiotic agents and differentiate how each of the agents is best used in practice. The purpose of this study was to assess the impact of rapid-fire journal club on achieving Curriculum Outcomes and Entrustable Professional Activities (COEPA) within a Doctor of Pharmacy Program.

Methods
Student feedback was anonymously collected via an electronic survey. Students evaluated the impact of rapid-fire journal club across the 3 domains of the American Association of Colleges of Pharmacy (AACP) COEPA educational outcomes (Knowledge, Skills, and Attitudes) on a Likert scale from strongly disagree (1) to strongly agree (5). Student perceptions and feedback on the activity were also collected.

Results
29 of the 38 students who participated responded. Majority strongly agreed or agreed that rapid-fire journal club allowed them to build foundational knowledge of antibiotics for resistant gram-negative infections (27/29, 93.1%), solve problems (21/29, 72.4%), improve communication among colleagues (24/29, 82.7%), understand the role of primary literature in improving antibiotic use (26/29, 89.7%), support shared goals on a team (25/29, 86.2%), and build and maintain trust among colleagues (25/29, 86.2%).
Majority of students rated the activity a 3 out of 5 in difficulty, found the activity engaging, and enjoyed participating.

Conclusion
Rapid-fire journal allowed pharmacy students to achieve key Doctor of Pharmacy educational outcomes across the 3 COEPA domains. The activity was positively received by students and provided them with a unique activity within the classroom.

Disclosures
All Authors: No reported disclosures
P-953. Infection prevention certificate exam performance: ChatGPT 4 vs ChatGPT 3.5
Authors: Saravanakumar Saujanya , Dorairajan Sureshkumar , Naveen Jenifer , Shobana S 
Published: January 2025

Abstract

Background
In recent times, AI models were utilized to evaluate competitive examinations such as the US medical licensing examination and clinical case conferences. However, there was limited data on their evaluation in infection control certificate examinations, known for their inclusion of complex questions. In this study, we aimed to assess the performances of ChatGPT-4 and ChatGPT-3.5 models in handling infection control certification examinations, providing insights into their efficacy in infection prevention.

Methods
This cross-sectional study, conducted by an infectious disease (ID) physician, involved an ENT resident, an ID physician assistant, and a Pharm D student. Questions were sourced from the International infection control certification examination and underwent complexity validation and answer approval by international infection prevention professionals. Each model, ChatGPT-4 and ChatGPT-3.5, received questions separately, and their answers were cross-checked with validated responses by the team. Statistical analysis employed the Chi-square test to assess performance differences. Data were collected in an excel sheet for subsequent analysis.

Results
In the evaluation of 96 infection control examination questions, ChatGPT-4 outperformed ChatGPT-3.5, achieving an accuracy of 82.3% (79 out of 96 questions answered correctly) compared to ChatGPT-3.5's accuracy of 65.6% (63 out of 96) as shown in table -1 below. Statistical analysis using a Chi-square test confirmed a significant difference between the two models (p &lt; 0.05), highlighting the advancements in ChatGPT-4's capabilities. ChatGPT-4 excelled in contextual comprehension, while ChatGPT-3.5 struggled with adaptability in managing complex queries.

Conclusion
In this study, ChatGPT-4's accuracy of 82.3% exceeded that of ChatGPT-3.5, which achieved 65.6%. Future research should compare other AI models and analyse each question for contextual understanding to enhance AI models performance in infection prevention.

Disclosures
All Authors: No reported disclosures