bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1446. Impact of Social Determinants of Health on Infectious Outcomes in Patients Undergoing Amputation
Authors: Passarelli Patrick , Sportiello Mike , Geiger Joshua , Tonozzi Theresa , Newhall Karina , Yamshchikov Alexandra 
Published: January 2025

Abstract

Background
Studies have demonstrated the impact of SDOH on outcomes following vascular surgery, but few have focused on risk factors for infectious complications following major amputation.
Odds Ratios (Confidence Intervals) for Infectious Outcomes Based on Social Determinants of Health

Methods
Local data for the Society Vascular Surgery Vascular Quality Initiative, a multicenter registry of quality improvement, were queried for demographics, clinical, procedure, and outcomes of 371 patients with amputation as index procedure 6/1/2015 to 7/31/2023. Zip codes were used to derive CDC/ATSDR Social Vulnerability Index (SVI). The impact of SDOH and SVI on surgical outcomes with a focus on infection was evaluated by logistical regression with R v4.3.2. Primary outcomes for univariate analysis included surgical site infection (SSI), readmission for infection, composite infection-related outcome, organ system complications during index admission, mortality at 30 days, 1 year, 2 years, and 5 years, and composite surgical adverse outcome inclusive of infectious and non-infectious complications. Significant variables were selected for multivariate regression.
Odds Ratios (Confidence Intervals) Additional Factors and Surgical Outcomes Based on Social Determinants of Health

Results
SDOH correlated with multiple parameters in univariate analysis (Fig 1, 2). Male patients had higher ASA score and uncontrolled infection as indication for amputation but were less likely to incur an SSI, or require above trans-metatarsal amputation. Publicly insured patients were more likely to be wheelchair bound or bedridden, or residing in a facility preoperatively, and had the highest risk of readmission for infection (OR=8.09), along with a higher risk of 2 year mortality. Patients with ongoing tobacco use had increased mortality at 1 (OR=1.9) and 2 years (OR=1.7). In multivariate analysis, male gender was associated with SSI (OR 0.25 CI 0.06-0.96). Composite infectious complication was associated with emergent procedure status (OR 2.96 CI 1.22-6.97). There was no significant difference in survival for SDOH derived subgroups (Fig 1) or composite surgical adverse outcome.
Kaplan-Meier Survival Analysis for subgroups based on SDOH parameters

Conclusion
Association between demographic, clinical, and peri-operative complications, with focus on infection, provides opportunity to identify high-risk patients, and serves as a framework for additional interventions, such as close post-operative follow up, and robust involvement of social work and care management teams.

Disclosures
All Authors: No reported disclosures
P-1447. Does Race or Social Vulnerability Play a Role in Antimicrobial Utilization for Admitted Patients? A Retrospective Analysis in a Large Healthcare System
Authors: Cosimi Reese , Mupanomunda Maria , Garrett-Ray Stacy D , Daragjati Florian , Kimathi Moyo , masoudi frederick , Aloia Thomas , Fogel Richard , Fakih Mohamad G , Bollinger Allison 
Published: January 2025

Abstract

Background
Rising antibiotic resistance is a major public health threat. In 2015 our organization responded by establishing antimicrobial stewardship programs in all acute care facilities. A review of the literature has shown concerning disparities in antibiotic use across different populations, potentially contributing to unequal health outcomes. Our organization has an expansive geographic footprint that encompasses diverse patient populations which precipitates the need to evaluate care across the system.Table 1.Antimicrobial Utilization by Race and SVIDOT - Days of Therapy per 1000 Days Present

Methods
Retrospective analysis of 103 hospitals across a large healthcare system of all admitted patients who received a target antibiotic between January 1, 2023 to December 31, 2023. The primary clinical outcome was antimicrobial utilization defined as duration of therapy (DOT) per 1000 days present for four antibiotic groups (total systemic, 3rd generation cephalosporins, broad-spectrum beta-lactams, vancomycin). Data were stratified across patient race and social vulnerability index (SVI) to identify factors that may be contributing to gaps in equitable care.

Results
A total of 665,312 patients were included in the analysis (70.5% White, 17.6% Black/African American (AA)). A greater proportion of White patients were 65 years and older compared with the Black/AA population which were primarily 18 to 64 years. Infectious disease diagnoses accounted for 14.6% of all encounters. Antibiotic utilization for White patients was 13% higher than Black/AA in Total Systemic antibiotics (p&lt; 0.001), and persisted when examined for infectious and non-infectious disease diagnoses (5% and 11.3% higher in White patients, respectively). Minimal differences were found when stratified by SVI.

Conclusion
Large differences in antibiotic utilization were observed by race but were not as pronounced by SVI. Additional factors such as age, diagnosis, and regional variability may need to be further examined in future analyses. Although these disparities were observed, our internal mortality data for infectious diseases shows no differences by race. Additional investigation is warranted to determine appropriateness of antibiotic use in each population to further elucidate on the disparities identified in this study.

Disclosures
All Authors: No reported disclosures
P-1449. An Educational Initiative to Improve Engagement in HIV Services within Substance Use Disorder Clinics
Authors: Zawitz Chad J , Pillinger Kelly E , Vincent Shaina Y , Simone Laura , Napolitan Chris , Carter Jeffrey D , Meza Jimenez Jenniffer A , Molloy Leah 
Published: January 2025

Abstract

Background
Substance use disorder (SUD) clinics are uniquely positioned to link patients with SUD to HIV services. This project aimed to bridge gaps in HIV care within SUD clinics.

Methods
From 6/2023-10/2023, healthcare professionals (HCPs) led 5 education sessions on HIV testing, prevention, and management at SUD clinics in West Virginia and Delaware. Surveys were administered pre- and post-sessions and again 4-6 weeks later. Results informed a workshop for HCPs and policy makers and an online toolkit for HCPs nationwide.

Results
Surveys were completed by 67 SUD clinic patients (mean age: 48 years; 66% female; 76% Caucasian; 61% previously incarcerated; 78% previously tested for HIV, 7% living with HIV) and 35 HCPs. After the sessions, significant improvements were seen in patient knowledge of “undetectable = untransmittable” (27% vs 63%; P &lt; .001), PrEP awareness (62% vs 88%; P = .001), SUD support resources (73% vs 91%; P = .008) and HIV care resources (43% vs 70%; P = .003). Pre-session, 64% of patients did not perceive the need for HIV testing. Of the patients who did (n = 24), anxiety (63%) was the top barrier, while HCPs perceived it was patients’ lack of HIV awareness (63%). Regarding PrEP, HCPs most frequently perceived keeping up with appointments (54%) and remembering doses (51%) as the greatest challenges their patients face, but patients more frequently identified not knowing enough about the medication (39%) and concerns about side effects (31%). Patients’ self-reported likelihood of getting tested for HIV was 18% before the education and was 28% afterwards (P = .147), and 1 month later participating HCPs reported having helped &gt; 250 patients with SUD get HIV testing. On follow-up, HCPs also described continued use of the education materials with 80% planning to lead another group session. After attending the live workshop, HCPs and policy makers (N = 103) committed to improving HIV services for patients with SUD with 77% identifying single site services for both HIV and SUD care as a high priority. As of 3/2024, the online toolkit was accessed by 1,347 HCPs.

Conclusion
Patient knowledge of HIV testing, prevention, and management increased following the program which also offered insights into community-level awareness and barriers to engaging in HIV services.

Disclosures
Chad J. Zawitz, MD, Gilead Sciences: Honoraria Kelly E. Pillinger, PharmD, AHFS: Contractor
P-1461. Influenza Vaccine Amongst Persons Experiencing Homelessness: Evaluating Attitudes, Barriers, and Trust
Authors: Mann Yasmeen , Ishak Angela , Ogbenna Ugonna K , Kasmikha Lauren , Cherabuddi Medha R , Joyce Katherine , Harris Charlalynn , Numi Mariia , Santana-Garcés Maria , Rehman Najibah K , Bryce Richard , Joshi Seema , Zervos Marcus 
Published: January 2025

Abstract

Background
In Detroit, persons experiencing homelessness (PEH) have been a vulnerable part of society due to their comorbidities and unique barriers in access to care. Despite PEH experiencing higher rates of vaccine-preventable diseases, there is a lack of information on strategies to improve vaccine rates. The objective of this project is to obtain an understanding of enablers and barriers in influenza vaccine uptake amongst PEH, to inform future work to increase vaccine uptake.

Methods
This is a cross-sectional study of survey data from adult PEH encountered during Street Medicine (SM) outreach in Detroit to assess enablers and barriers in influenza vaccination. Respondents were provided a complimentary bus pass for participation. Descriptive statistics were conducted on sociodemographic variables with analysis of variables related to level of homelessness, vaccine concerns, vaccination status, and underlying health problems.

Results
43 participants' surveys were analyzed. Participant vaccine status and level of homelessness varied with majority (35%) reporting spending at least 1 night in a tent or other dwelling. Regarding participant demographics, 86% (n=37) were male and 81% (n=35) were Black or African American (AA) (Table 1). Amongst survey respondents, the highest sources of trust for information regarding influenza vaccine was found amongst: ‘Social Services Agencies or Other Services’ 95.2% (n=20) and ‘Experts and Scientists’ 93.8% (n=15) (Figures 1 and 2). Variables regarding sources of information trusted were analyzed via chi-square analysis to evaluate for statistical significance (p-value &lt; 0.05) amongst demographic variables (Figure 3).

Conclusion
Previous literature regarding attitudes towards vaccines amongst PEH has demonstrated distrust in healthcare. Results of this study are unique in identifying healthcare members as resources trusted by most participants in providing information on vaccines. This emphasizes the importance of SM outreach in Detroit in building trusting relationships with PEH in addition to decreasing barriers in access to care, to help target future vaccination initiatives.Table 1:Participant Demographics and Influenza Vaccination Status

Disclosures
Seema Joshi, MD, AbbVie: Grant/Research Support Marcus Zervos, MD, Johnson and johnson: Grant/Research Support|Moderna: Grant/Research Support
P-1471. Mortality Analysis of Antimicrobial Regimens Selection in Acinetobacter baumannii Ventilator-Associated Pneumonia
Authors: Lozano Axel , Rondan Paola L , Martínez Jaime T , Taype-Rondan Alvaro 
Published: January 2025

Abstract

Background
Ventilator-associated pneumonia from Acinetobacter baumannii is one of the most severe healthcare-associated infections. Its increased antimicrobial resistance presents challenges in treatment and is associated with high mortality rates. The objective of this study was to determine the association between high dose ampicillin-sulbactam and mortality in patients with ventilator-associated pneumonia from Acinetobacter baumannii (AB-VAP).
Clinical epidemiological characterization of patients with AB-VAP
*Median
**Interquartile range

Methods
We performed a retrospective cross-sectional study reviewing electronic medical records of patients from the Intensive Care Unit of a referral hospital for COVID-19 between April 2020 and May 2021.
Characterization according to antibiotic therapy in patients with AB-VAP

Results
We reviewed a total of 311 medical records. 48 patients with AB-VAP were selected according to inclusion and exclusion criteria. The study population was 81.25% male and the median age was 54.9 years [IQR: 22-74]. The most common comorbidities were obesity (43.75%) and hypertension (10.4%). Patients requiring mechanical ventilation for more than 30 days had higher mortality rates compared to patients requiring less than or equal to 30 days (73.68% vs. 44.83%, p=0.049). The most commonly used antibiotic regimens were meropenem plus colistin (41.67%) and colistin plus ampicillin-sulbactam (25.0%). The non-sulbactam antibiotic regimens had a higher 14-day mortality than the sulbactam regimens (60.71% vs 20%, p=0.005). The mortality risk was 2.99 (CI: 1.19 - 7.49, p=0.019) times higher when using regimens without sulbactam, adjusted for sex, SAPS II score and days in the ICU.
Bivariate analysis of antibiotic regimens and mortality in patients with AB-VAP

Conclusion
The mortality risk with non-sulbactam antibiotic regimens was 3 times higher compared to sulbactam antibiotic regimens in patients with AB-VAP.
Multivariate Poisson Regression Analysis of antibiotic therapy and mortality in patients with AB-VAP

Disclosures
All Authors: No reported disclosures
P-1477. In vitro efficacy of Minocycline on Skin, Soft Tissue and Musculoskeletal Gram Negative bacterial isolates
Authors: Crowley Patrick , Streck Nicholas , Challener Douglas , Abu Saleh Omar M 
Published: January 2025

Abstract

Background
Minocycline is a second-generation tetracycline with a broad antimicrobial spectrum. It is often used in chronic suppression of musculoskeletal infections, given activity against gram positive organisms. Efficacy of Minocycline against gram negative skin and soft tissue infection has not previously been defined. In this study, we review in vitro minocycline efficacy against isolates from skin, muscle, and bone sources.Fig 1.Organisms isolated

Methods
We conducted a retrospective review of all minocycline susceptibility testing performed on musculoskeletal GNB isolates performed at the Mayo Clinic reference lab between 2013-2022. We describe the isolates broken down by site of culture and organism isolated. Then, we calculated the overall susceptibility of these isolates to Minocycline and susceptibility of the most common 6 organisms isolated.Fig 2.Sites of gram negative isolation

Results
During the study timeframe, we identified 13,567 gram negative isolates from musculoskeletal sites. Of 330 species identified, 19 were identified in at least 100 isolates (fig 1). Of 36 unique sites, 19 sites were each identified in at least 100 isolates (fig 2). 1920 isolates were tested for susceptibility to minocycline. Of these, 1584 (82.5%) were susceptible to minocycline. Of the most common organisms identified and tested for minocycline susceptibility, 99% of Stenotrophomonas maltophilia, 83% of Enterobacter cloacae, 80% of Escherichia coli, 68% of Acinetobacter baumanii, 1% of Proteus mirabilis, 53% of Klebsiella pneumoniae, 65% of Serratia marcescens isolates were susceptible to minocycline (fig 3). Pseudomonas aeruginosa isolates were not tested, due to innate resistance.Fig 3.Minocycline susceptibility compared to key organisms

Conclusion
A majority of skin and soft tissue cultures positive for Gram negative isolates were below the waist line. Of these, we reported organisms most commonly found. Minocycline showed in vitro activity against some commonly isolated gram negative organisms, especially E.coli, Acinetobacter, and Stenotrophomonas. Further research is needed into the efficacy of minocycline in gram negative skin and soft tissue infections, but it may represent a viable oral option, especially in the end of life.

Disclosures
All Authors: No reported disclosures
P-1485. Comparison of Eravacycline and Cefiderocol in the Treatment of Multidrug-resistant Acinetobacter baumannii Infections
Authors: Halim Justin , King Madeline , Nikolic Dejan , Palacios Carlo Foppiano 
Published: January 2025

Abstract

Background
A. baumannii is a common cause of drug-resistant hospital-associated infections. Eravacycline and cefiderocol were recently introduced as agents against drug-resistant A. baumannii. Data comparing these drugs against multi-drug resistant (MDR) A. baumannii is lacking. We compared clinical outcomes of patients with multi-drug resistant A. baumannii infections treated with either eravacycline or cefiderocol.

Methods
A retrospective chart review of patients with MDR A. baumannii infections from 2019-2023 at Cooper University Hospital who received either eravacycline or cefiderocol was performed. MDR infections were defined as isolates resistant or intermediate to meropenem or ampicillin-sulbactam. Patients were excluded if A. baumannii was deemed a colonizer rather than infection per infectious diseases evaluation, or non-MDR infections. We collected data on demographics, risk factors for MDR infection, and infection characteristics. Primary outcome was hospital mortality rate. Secondary outcomes assessed were mortality and readmission at 30 and 90 days, ICU admission, shock requiring vasopressors, mechanical intubation, and drug-related adverse events. Descriptive statistics and Fisher’s exact test were used.

Results
44 patients were included, median age was 61 years old, 80% were male, 59% identified as White, and 13.6% were Latino. Most common site of infection was pulmonary (59%). 31 patients received cefiderocol, 11 received eravacycline, and 2 received combination therapy with both agents. Higher hospital mortality rates were observed in the cefiderocol group (52% vs 18%), approaching significance (P=0.08). Hospital mortality, and 30 and 90-day mortality were not significant between both groups. Patients on cefiderocol were more likely to require mechanical intubation (74% vs 27%, P=0.01). ICU admission and use of vasopressors did not differ significantly between both groups. Liver function elevations more common among patients on cefiderocol compared to eravacycline (61% vs 9%, P=0.004).

Conclusion
In this retrospective study comparing eravacycline and cefiderocol for the treatment of MDR A. baumannii infections, mortality and readmission outcomes were comparable between both groups.

Disclosures
Madeline King, PharmD, Innoviva: Advisor/Consultant
P-1486. Comprehensive Approach to Vibrio Vulnificus: Integrating Drug Therapy, Diagnostic Modalities, and Targeted Care for At-Risk Populations
Authors: Ebrahimi Hashem Haj , Ghneim Hiyam , Farid Tahsin 
Published: January 2025

Abstract

Background
Vibrio vulnificus (VV), is endemic to warm coastal waters where it causes significant foodborne and aquatic illnesses resulting in high mortality and morbidity. There are no FDA-approved treatments or standard management strategies. Here we explore the landscape of VV infections, their characteristics and treatment outcomes.Figure 1:Outcome of Vibrio Vulnificus Infections

Methods
Cases of VV from 2014 to 2024 were identified from PubMed and Embase databases, employing pertinent keywords, MeSH terms, and Emtree terms. Articles underwent screening using Rayyan.ai using PRISMA protocol. 72 cases that met inclusion criteria were entered to CURE ID and aggregated data was analyzed.Figure 2:Age Distribution of Vibrio Cases

Results
The outcome distribution of cases are in Figure 1. 46/72 patients recovered while 21 died. Age and gender of patients with VV infections are displayed in Figure 2 and 3 respectively. Most cases occurred in middle aged individuals while there was a male prevalence in cases. Figure 4 displays the countries where most infections occurred. China and the United States had the highest incidence of cases.Figure 3:Sex of Patients

Conclusion
The high mortality of VV underscores the importance of finding treatment options for this often-forgotten disease. The age and sex distribution in middle aged males is indicative of the correlation between aquatic activity such as fishing and VV. Males who engage in these activities are at highest risk of contracting VV infections. The geographic distribution of cases underscores countries with warm oceans is where most cases occur. In our data we noticed a prevalence of chronic liver diseases amongst VV patience. We aim to explore this correlation and most effective antimicrobials in a full manuscript.Figure 4:Geographic Distribution of Vibrio Vulnificus

Disclosures
All Authors: No reported disclosures
P-1490. Evaluating the Impact of Inadequate Empiric Gram-Negative Antibiotic Therapy on Clinical Outcomes
Authors: Baghdadi Jonathan , Goodman Katherine E , Magder Laurence S , Claeys Kimberly C , Sutherland Mark , Harris Anthony 
Published: January 2025

Abstract

Background
Many clinicians select broad-spectrum antibiotic therapy based on the concern that inadequate empiric coverage will be associated with a worse outcome. To explore this concern, we compared outcomes between patients started on empiric narrow-spectrum antibiotics and later escalated to broad-spectrum antibiotics v. patients started empirically on broad-spectrum antibiotics and then continued on broad-spectrum antibiotics.Figure 1.Antibiotic Classification

Methods
We conducted a retrospective observational cohort study of adult patients discharged in 2019 from 120 hospitals in the Premier Healthcare Database. Encounters for adult patients were included if associated with (1) initiation of narrow- or broad-spectrum Gram-negative antibiotics on hospital day 0-2 and (2) administration of a broad-spectrum Gram-negative antibiotic as definitive therapy (see Fig. 1 for classification of antibiotics as narrow v. broad). Patients who received empiric narrow-spectrum antibiotics were matched to patients who received empiric broad-spectrum antibiotics using propensity scores. A win ratio was estimated to compare a ranked composite outcome including mortality, readmission, and adverse drug events between the two groups (see Fig. 2 for outcome structure).Figure 2.Components of Overall Clinical Outcome including Desirability of Outcome Ranking (DOOR)

Results
81,826 patients who received empiric narrow-spectrum antibiotics were matched to 81,826 patients who received empiric broad-spectrum antibiotics (see Table 1 for patient characteristics). Mortality was lower (8.9% v. 9.2%, p = 0.022), readmission was less frequent (11.1% v. 12.7%, p &lt; 0.0001), and adverse events were more frequent (10.5% v. 9.0%, p &lt; 0.0001) after empiric narrow-spectrum antibiotics than empiric broad-spectrum antibiotics (see Table 2 for outcomes). Head-to-head comparison of ranked outcomes between the two groups suggested better clinical outcomes associated with empiric narrow-spectrum antibiotics (win ratio 1.04, p = 0.0007).Table 1.Characteristics of Patients in the Overall and Matched Cohorts

Conclusion
In a large propensity score-matched analysis of observational clinical data, starting empiric narrow-spectrum antibiotic therapy and needing to escalate to broad-spectrum antibiotic therapy later was not associated with worse clinical outcomes. Our findings challenge traditional guidance on how to select empiric antibiotic coverage.Table 2.Distribution of DOOR by Empiric Treatment Group in the Matched Cohort

Disclosures
Kimberly C. Claeys, PharmD, PhD, bioMérieux: Advisor/Consultant|bioMérieux: Honoraria Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor