bluuebunny/crossref_metadata_2025_split huggingface dataset:
383. VA SHIELD: Building an Interactive Dashboard for Surveillance of Infectious Diseases across the Veterans Health Administration, 2000 – 2023
Authors: Epstein Lauren , Paredes-Vincent Ariana , Ogston Christopher , Rodriguez-Barradas Maria C , Bonomo Robert A , Woods Christopher , Brown Sheldon T 
Published: January 2025

Abstract

Background
The Veterans Health Administration (VA) utilizes a comprehensive data system that can be updated in real time to help detect emerging diseases across the United States. We describe a novel interactive dashboard that was developed to track emerging infections across the VA system.Figure 1.Comparison of trends of selected Infectious Diseases, VA system vs. U.S. population (2000 – 2023).

Methods
This project was developed as part of VA Science and Health Initiative to Combat Infectious and Life-Threatening Diseases (VA SHIELD), a comprehensive biorepository of specimens and clinical data that was developed in 2020 to address national health threats across the VA system to improve diagnostic and therapeutic capabilities.
We compiled a list of rare and emerging infectious diseases and identified appropriate ICD-9 and ICD-10 codes for each infectious disease based on expert opinion. All unique persons that received care at any type of VA facility (inpatient, outpatient) were eligible to be included in the analysis. We calculated incidence rates (per 100,000 VA population) based on the number of unique patients that received care at VA facilities annually from 2000 – 2023. We compared VA rates of selected infectious diseases with national rates using publicly available data from CDC’s WONDER database, where available.Figure 2.Incidence of rare Infectious Diseases detected across the VA system (no CDC comparison), 2000 – 2023.Rate per 100,000 VA patients.

Results
We included 47 unique infectious diseases in our assessment; 16 (34%) were also included in CDC’s WONDER database. Compared to CDC’s WONDER database, incidence rates and geographic trends of Coccidioides, Babesiosis, Dengue, Lyme disease and West Nile in VA population were similar to trends across the U.S. population (Figure 1). Among diseases that are not reported in CDC’s WONDER database, the incidence of Leishmaniasis increased in 2005 across the VA population while Bartonellosis, Q fever, and Tick-borne relapsing fever incidence increased in 2015 (Figure 2).

Conclusion
We illustrate how a VA dashboard demonstrates infectious disease trends across the U.S. Although some infections may be Veteran specific and related to deployment by military Reservists, others reflect overall population trends. Linkage of the dashboard to a structured surveillance program can serve as a powerful investigational tool to evaluate emerging outbreaks and trends due to environmental exposures across the U.S.

Disclosures
All Authors: No reported disclosures
P-1002. Congenital Syphilis: Are We Doing Too Much?
Authors: Palaganas Haley Anne , Iacob Alexandra , Batra Jagmohan S , Tay Ching Ching , Soliman Antoine , Guajardo Leonel F 
Published: January 2025

Abstract

Background
The resurgence of syphilis and its risks to neonates has been reported nationally. Sixty to ninety percent of infected infants can be asymptomatic at birth. Effective early identification and treatment of congenital syphilis is paramount. The American Academy of Pediatrics (AAP) offers guidelines for categorizing risk of congenital syphilis and outlines recommended and optional testing for completed workup. Literature on adherence to these guidelines is limited. We hypothesized that unnecessary imaging and labs were obtained on infants without an impact in their management.
Number of congenital syphilis cases per year and divided by diagnostic category.

Methods
We conducted a retrospective study of all infants with a diagnosis of congenital syphilis admitted at MemorialCare Miller Children’s and Women’s Hospital, an urban tertiary referral center, from Jan 2017 – Dec 2023 (IRB # MHS 361-23). Infants were subdivided by congenital syphilis diagnostic category. Data collected for infants included completion of long bone X-ray, head ultrasound, MRI brain, ophthalmologic exams, and lumbar puncture with CSF analysis, as well as if management changes were made based off study results and if any of the studies were abnormal.
Number of ophthalmology exams ordered for each congenital syphilis diagnostic category. The black checkmark indicates if this study was recommended by the AAP.

Results
81 infants were identified in this period. 11 (13.6%) had proven or highly likely, 50 (61.7%) had possible, 14 (17.3%) had likely, and 6 (7.4%) had less likely congenital syphilis. 46 (56.8%) received ophthalmologic exams, all of which did not lead to changes in management. 36 of the 46 ophthalmologic exams (78.3%) were conducted without recommendations from the AAP. 10 out of 19 (52.6%) brain MRIs were ordered without AAP recommendations and did not result in changes in management. 4 out of 62 (7%) long bone x-rays were performed without either AAP recommendation or subsequent changes in management. Similarly, 5 out of 66 (7.6%) lumbar punctures were carried out without adherence to AAP recommendations and did not result in changes in management. 12 out of 15 (80%) head ultrasounds were conducted without AAP recommendation.
Number of brain MRIs ordered for each congenital syphilis diagnostic category. The black checkmark indicates if this study was recommended by the AAP.

Conclusion
Unnecessary labs and imaging were frequently ordered for congenital syphilis work up. Our unit has now undertaken a multi-disciplinary quality improvement project to ensure timely and proper categorization of congenital syphilis risk to ensure appropriate imaging and labs are obtained.

Disclosures
All Authors: No reported disclosures
P-1026. Predictors of Consolidations, Such as Non-Round Image Pattern, in CT Findings in Patients with Invasive Mold Pneumonia
Authors: Jang Hyeon Mu , Chang Euijin , Bae Seongman , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Kim Sung-Han 
Published: January 2025

Abstract

Background
CT is important to diagnose pulmonary invasive mold infection (PIMI). According to 2008 European Organization for Research and Treatment of Cancer (EORTC) criteria, dense, well-circumscribed lesion(s) was listed, but the recent 2020 EORTC criteria further categorized into wedge-shaped and segmental or lobar consolidation in addition to the dense, well-circumscribed lesion(s). However, there are limited data on the different clinical characteristics between these two CT findings. We thus evaluated the frequency of the newly added criterion (consolidation) depending on the underlying diseases.

Methods
We reviewed all adult patients, at a 2700-bed tertiary hospital, Seoul, South Korea, between June 2007 and December 2023, who were diagnosed with proven PIMI, based on 2020 EORTC criteria. CT findings were classified as “round lesion” if those had well-circumscribed lesions such as nodule, mass or cavity and “consolidation” if those had wedge-shaped and segmental or lobar consolidation.

Results
A total of 63 patients with proven PIMIs: 38 (60.3%) aspergillosis and 25 (39.7%) mucormycosis. Of these 63 patients, 19 (30.2%) had a solid malignancy (SM), 18 (28.6%) underwent solid organ transplant and 23 (36.5%) had a hematologic malignancy (HM) including 10 hematopoietic stem cell transplant recipients. Of these, 27 (43%) patients had consolidations in CT findings, and the remaining had “round lesion”. Consolidation was significantly more frequent in patients with neutropenia (&lt; 1500 neutrophils/mm3) (33.3% [5/15] vs 66.7% [10/15]; p 0.03). It was also significantly more common in HM (34.8% [8/23] vs 65.2% [15/23]; p 0.0007) but less in SM (89.5% [17/19] vs 10.5% [2/19]; p 0.006).

Conclusion
More than 40% of proven PIMI showed lung consolidation, which is more frequent in neutropenia and HM but less common in SM.

Disclosures
All Authors: No reported disclosures
P-1028. A Shifting Baseline: Epidemiology and Mortality of Invasive Candidiasis caused by Candida Species Recovered at a Single Tertiary Care Center
Authors: Dickey James , Fowler Michael , Toth Eszter , Raposa Jesse , Vazquez Jose A 
Published: January 2025

Abstract

Background
Invasive candidiasis (IC) refers to a range of infections caused by the fungus Candida. Mortality rates from IC are as high as 40% despite antifungal therapy. Candidemia is the most common manifestation and ranks within the top 4 hospital-associated bloodstream infections in the US. In the past, most cases of IC were historically caused by Candida albicans. Recently there have been corresponding increases in non-albicans Candida species (NAC). This trend is concerning given the observed increases in antifungal resistance among the NAC, such as C. glabrata, C. parapsilosis, and C. auris. Given the high rate of mortality due to IC and increasing rates of antifungal-resistance among the NAC spp., it is critical to provide up-to-date information describing the shift in Candida spp.
Non-albicans Candida comprised the majority of cases of candidemia, with C. glabrata accounting for the majority of these infections. There was no discernable shift in species distribution across the study period.

Methods
A registry of all Candida clinical specimens recovered from anatomically sterile sites at our tertiary care center in Augusta, GA, was developed. Data over a 27-month period was evaluated through a retrospective chart review of all patients with IC. In addition to patient demographics, risk factors, and treatment courses, we analyzed the incidence and the 30 day all-cause mortality of subjects with either C. albicans or NAC causing IC.
Candida albicans comprised the majority of deep-tissue infections with no discernable shift in species distribution across the study period.

Results
184 cases of IC were identified during this period. NAC spp. comprised the majority of cases of candidemia (64.8%, n=84) while the majority of the deep-tissue infections were caused by C. albicans (60%, n=110; Chi-squared, p &lt; 0.001). We identified a notable, non-statistically significant difference in 30-day all-cause mortality between C. albicans and all NAC infections. When compared directly, we found a higher 30-day all-cause mortality in infections caused by C. glabrata (30.6%, n=49) than C. albicans (14.6%, n=89; Chi-squared, p=0.026).

Conclusion
We describe a significant increase in candidemia due to NAC (65%), especially due to C. glabrata. Moreover, there was a slightly higher 30-day mortality due to C. glabrata when compared to C. albicans across all cases of IC. This study establishes a framework to maintain detailed and current, longitudinal evaluations of the epidemiological trends of IC. In addition, knowledge of the shifting epidemiology of IC would also help with the appropriate selection of empiric antifungals and adequate antifungal stewardship.

Disclosures
All Authors: No reported disclosures
P-1041. Contemporary Increase in Candidemia Mortality Is Associated with Antifungal Resistance and Patient Demographics
Authors: Adelman Max W , Nigo Masayuki , Connor Ashton , Casarin Stefano , Hsu Enshuo , Arias Cesar A 
Published: January 2025

Abstract

Background
Candida spp. commonly cause bloodstream infections (BSI) in chronically ill patients, and Candida BSI is increasingly due to antifungal-resistant species. This retrospective cohort study examined temporal trends in candidemia epidemiology and associations between epidemiologic changes and mortality.Table 1.Characteristics of patients with different bloodstream infection types.

Methods
We included patients in a large healthcare system with a first BSI due to Escherichia coli or Klebsiella pneumonia (gram-negative bacteremia [GNB]), Staphylococcus aureus (SAB), or Candida spp. (candidemia) from 6/2016-6/2023. We compared 30-day mortality and demographics between BSI types. We examined changes in candidemia demographics, mortality, and causative species, both by individual year and by period (period 1, 2016-2019 vs. period 2, 2020-2023).Figure 1.Changes in mortality due to bloodstream infection types examined.

Results
Of 12057 patients, 7801 (64.7%) had GNB, 3602 (29.9%) SAB, and 654 (5.4%) candidemia (baseline characteristics in Table 1). Thirty-day mortality was highest for candidemia (30.9% vs. 13.4% for SAB and 8.0% for GNB, p&lt; .01 by χ2). There was a trend toward increased mortality for patients with candidemia (p=0.06 by Mann-Kendall test, Figure 1). Candidemia mortality was significantly higher in period 2 vs. 1 (36.8% vs. 22.7%, p&lt; .01 by χ2). Candidemia patients in period 2 tended to be older (mean age 66.3±14.3 vs. 63.8±16.2, p=0.04 by t-test); age was associated with mortality among patients with candidemia (OR 1.02, 95% CI 1.01-1.04 per year increase). Of species examined, only the incidence of C. auris increased (p&lt; 0.01 by Mann-Kendall test, Figure 2). C. glabrata was associated with the highest 30-day mortality (36.3%) among common species; C. auris mortality was 17.4%. While the proportion of candidemia cases due to antifungal-resistant species (C. auris, glabrata, krusei, lusitaniae, parapsilosis) did not change between periods (p=0.79), mortality from these species was significantly higher in period 2 vs. 1 (36.1% vs. 21.5%, p&lt; 0.01).Figure 2.Increasing prevalence of candidemia due to C. auris, 2016-2023.

Conclusion
Candidemia mortality increased significantly starting in 2020, at least in part due to increasing patient age and increased mortality associated with antifungal-resistant candidemia. Urgent efforts are needed to combat candidemia in an ageing population prone to antifungal-resistant Candida infections.

Disclosures
All Authors: No reported disclosures
P-1052. Identifying Facility and Specimen Type Associated with Screening-to-Clinical Candida auris Patients in the United States, 2013–2022
Authors: Baker Anna D , Jones Sophie , Rajeev Malavika , Lyman Meghan 
Published: January 2025

Abstract

Background
Candida auris (C. auris) is an emerging healthcare-associated fungal pathogen associated with high mortality and antifungal resistance. Targeted screening based on patient risk factors and facility type is important for identifying colonized patients and implementing recommended infection prevention and control (IPC) precautions. Understanding the epidemiology of C. auris colonized patients who subsequently have positive clinical specimens (screening-to-clinical patients (STC)) can help us understand the clinical course and impact of colonization.

Methods
Using national case surveillance data from 34 states and Washington DC, we described C. auris adult patients, as defined by Council of State and Territorial Epidemiologists, during 2013–2022. We analyzed facility and specimen source for STC patients and compared with screening or clinical only patients using chi-squared tests.

Results
Among 13,341 screening patients, 1,151 (9%) were STC. STC patients were more likely than screening only patients to be screened at long-term acute-care hospitals (LTACH) (48% vs 40%; p&lt; 0.001) and were more likely than clinical only patients to have positive clinical specimens taken at LTACHs (35% vs 10%; p&lt; 0.001). While blood was the most frequent clinical specimen source for STC and clinical only patients (39% and 35% respectively), respiratory specimens were more likely to be taken from STC patients than clinical only patients (12% vs 8%; p&lt; 0.001). The median time between STC specimen collection was 47 days [interquartile range (IQR) 19-111] and was shorter for patients in LTACHs (median 37 days [IQR 17–78]) than ACHs (median 53 days [IQR 21–116]).

Conclusion
About half of STC patients were screened at LTACHs and over half of STC clinical specimens were collected at LTACHs. While blood specimens were most frequent clinical specimen source among STC, respiratory sources were more likely to be taken from STC patients than clinical only patients. As high-risk respiratory devices (e.g., mechanical ventilation) are associated with invasive infections, our findings emphasize the importance of timely diagnosis and monitoring STC patients with clinical respiratory sources in LTACHs to reduce risk of invasive infection.

Disclosures
All Authors: No reported disclosures
P-1070. Safety and Efficacy of Replacement with Contezolid-Containing Regimens in Patients with Multidrug-Resistant/Rifampicin-Resistant Tuberculosis Who are Intolerant to Linezolid-Containing Regimens: a Retrospective Case Analysis
Authors: Chang Tingting , Zhang Yuxia , Sun Yanming , Zhao Zhiyuan , Liu Fengxia , Xiong Yu 
Published: January 2025

Abstract

Background
Linezolid, commonly used in the treatment of multidrug-resistant tuberculosis (MDR-TB), has limitations due to adverse effects such as myelosuppression, optic neuropathy. Contezolid, a new oxazolidinone, was developed to reduce toxicity. This preliminary study focused on the potential utility of contezolid in the treatment of MDR-TB.

Methods
This is a retrospective case analysis, thirteen MDR/rifampicin-resistant(RR) TB patients who were switched to contezolid-containing regimens due to adverse reactions during treatment with linezolid-containing regimens were included. Linezolid was administered 600mg once daily for 6-24 weeks, contezolid was given 400mg twice daily for 4 months to 1 year. The results of drug sensitivity test (DST), regimens containing linezolid or contezolid and treatment duration, occurrence of adverse reactions, timing of treatment adjustment, adverse reactions and efficacy are described.

Results
The basic information and treatment related results were shown in Table 1. All of 13 patients experienced adverse reactions during the treatment of linezolid-containing regimens, of which 9 (69.2%) were severe. The time to myelosuppression after linezolid initiation was approximately 8 weeks, and 16 weeks for neurotoxicity. After at least 4 weeks of switching to regimens containing contezolid, 95% of patients with linezolid-related adverse reactions were alleviated or improved. At the end of the third month after treatment adjustment, the WBC, PLT and hemoglobin level of 13 patients returned to pre-treatment level, and the lower limb numbness of 2 patients were improved. Sputum mycobacterium tuberculosis culture and sputum smears acid fast stain of 13 patients turned negative or continued negative, and no case of positive recurrence. Follow-up chest computed tomography showed no evidence of disease progression.

Conclusion
This study showed that contezolid were not only safer than linezolid but also demonstrated clinical improvement in all included patients with MDR-TB. This study supports the hypothesis that contezolid may provide an effective and safe alternative to linezolid in the management of MDR-TB in the future.

Disclosures
All Authors: No reported disclosures
P-1071. In Vitro Susceptibility of the syphilis spirochete, Treponema pallidum, to Linezolid
Authors: Stafylis Chrysovalantis , De Lay Bridget D , Norris Steven , Nguyen Ryan M , Konda Kelika , Reyes-Diaz Michael , Klausner Jeffrey , Edmondson Diane 
Published: January 2025

Abstract

Background
Benzathine penicillin is the antimicrobial treatment of choice for syphilis, but worldwide shortages have caused disruptions in patient care. Therefore, the is a need for new antimicrobial compounds that are effective at curing Treponema pallidum subsp. pallidum (Tp) infections that are not subject to the same supply chain issues currently effecting benzathine penicillin availability. To this end, we tested the in vitro susceptibility of four different strains of Tp (Nichols, Mexico A, UW231B, and UW249B) to linezolid.

Methods
There are two genetically distinct subgroups of Tp: the Nichols group and the SS14 group. The SS14 group is currently predominant worldwide, so we tested three different strains from this group (Mexico A, UW231B, and UW249B). Tp cultured in TpCM2 medium were exposed to linezolid concentrations ranging from 0 to 4 µg/mL for 1 week, then the number of Tp per culture and motility were assessed by darkfield microscopy.

Results
Multiplication was completely inhibited (fold increase ≤1) in cultures treated with 0.5 - 4 µg/mL linezolid and motility was significantly decreased. In vitro MICs for linezolid ranged from 0.32 to 0.36 µg/mL in the four strains tested, with no difference between the Nichols strain (0.32 µg/mL) and the SS14 subgroup strains (0.34 - 0.36 µg/mL). The MIC range determined in vitro is compatible with the blood serum ranges reported in patients given therapeutic doses of linezolid.

Conclusion
Further studies are ongoing to determine if linezolid is an effective antimicrobial compound for the treatment of syphilis.

Disclosures
Jeffrey Klausner, MD MPH, Direct Diagnostics: Advisor/Consultant
P-1090. Rifaquizinone for the Treatment of Acute Bacterial Skin and Skin Structure Infections: A Multicenter, Double-Blind, Randomized, Active-Controlled, Phase 2 Trial
Authors: Scott Overcash J , Waters Michael , Wang Huan , Geng Guozhu , Ai Changlin , Ma Zhenkun , Chen Jing 
Published: January 2025

Abstract

Background
Rifaquizinone (RFQ, TNP-2092) is under development for the treatment of serious or life-threatening bacterial infections including those caused by gram-positive pathogens that have developed resistance to commonly used antibiotics. This study compared the safety, tolerability and efficacy of RFQ and vancomycin in patients with acute bacterial skin and skin structure infections (ABSSSIs).

Methods
A multi-center, randomized, double blind, positive controlled phase 2 clinical trial (NCT03964493) was conducted in adults with ABSSSIs in the USA. Eligible patients were randomized 2:1 to receive RFQ (300 mg) or vancomycin (1 g) IV q12h for 3 to 14 days. Patients who met the switching criteria may switch to commercially available oral antibiotics judged by the investigators. The total duration of the treatment was 7 to 14 days. The primary endpoint was safety and tolerability. The key secondary endpoint was the clinical response at early assessment (EA) visit.

Results
A total of 117 patients received at least 1 dose of study drugs. The incidences of adverse events (AEs) in RFQ and vancomycin groups were 46.2% (36/78) and 48.7% (19/39), respectively. The most of AEs were mild in severity. No drug-related serious AE was reported. The clinical response rate of RFQ at EA visit was higher than vancomycin in the ITT, modified ITT and Micro-ITT populations (Table 1). In patients infected with MRSA and fluoroquinolone-resistance (RF-Q) S. aureus, the clinical response rate of RFQ and vancomycin group were 78.1% (25/51) vs 57.9% (11/29), and 75.9% (22/51) vs 55.6% (10/29), respectively. Pharmacokinetic-pharmacodynamic (PK-PD) analysis indicated that more than 95% of patients achieved the systemic exposures required (AUC0-24h &gt; 50 µg·h/mL) for the treatment of medical device associated biofilm infections.

Conclusion
RFQ was safe and well tolerated in patients with ABSSSIs. The early clinical response rates of RFQ in ITT, mITT and micro-ITT populations were all higher than that of vancomycin. More importantly, RFQ demonstrated higher early clinical response rates than vancomycin in patients infected with MRSA and FQ-R S. aureus. The PK-PD analysis indicated that sufficient drug exposures were achieved for medical device associated biofilm infections.

Disclosures
Huan Wang, PhD, TenNor Therapeutics (Suzhou) Ltd: Employee Guozhu Geng, MD, TenNor Therapeutics (Suzhou) Ltd: Employee Changlin Ai, Master of Medicine, TenNor Therapeutics (Suzhou) Ltd: Employee Zhenkun Ma, PhD, TenNor Therapeutics (Suzhou) Ltd: Employee Jing Chen, Master of Science, TenNor Therapeutics (Suzhou) Ltd: Employee