bluuebunny/crossref_metadata_2025_split huggingface dataset:
1398. Successful Treatment of primary and refractory Echinococcus (Hydatid Cyst Disease) with Mefloquine and Mebendazole
Authors: Richardson James D , Skeen Venus 
Published: November 2023

Abstract

Background
Treatment regimens for relapsed or refractory Echinococcus (Hydatid cyst disease) are not well defined. Because seropositivity for Echinococcus disease is unpredictable, insurance coverage for expensive regimens are often denied. Improved, effective regimens are needed. Recent laboratory studies in rat model of Echinococcus showed that Mefloquine added to regimens of Mebendazole were effective.
Hydatid cyst pretreatment.
Post treatment liver
Post treatment CT, 2 years after Mefloquine and Mebendazole treatment.

Methods
Described herein, are three cases of patients treated with combination of Mefloquine and Mebendazole. The initial case was a 56 yo farmer who failed standard therapy with Mebendazole, then PAIRS therapy with Mebendazole. His case was determined to be refractory to therapy. Serologic Echinococcus testing was negative, but CT scan showed liver cyst full of Echinococcus progeny. He was placed on Mebendazole bid for one month with mefloquine 250 mg tiw for one month. He was monitored with weekly liver enzyme tests and baseline EKG. Repeat CT scan at 2 months and 2 years show 2 small stable cysts remaining. Since the first treatment, two other primary cases (one liver and one cerebral) were treated with equally effective results. Patients were informed that this regimen was using medicine that was used to treat parasites, but the combination of the two agents had not been studied extensively together.

Results
Three cases of Echinococcus have been treated with combination of Mebendazole and Mefloquine. All have shown clinical cure. Minor elevations of hepatic enzymes were observed with one case, but regimen was not discontinued. No arrhythmias were seen with the regimen. The refractory case is stable at 2 years. The 2 primary cases are stable at 6 months at follow up.

Conclusion
The combination of Mefloquine and Mebendazole was a well tolerated and effective therapy for both primary and refractory Echinococcus disease. It will be difficult to recruit and study this disease due to the paucity of cases in the US. More study of this disease is needed, but this limited study suggests that this combination regimen of mefloquine and Mebendazole has the potential to be a new standard of care. Moreover, this treatment regimen shortens therapy from 3 months to one month.

Disclosures
All Authors: No reported disclosures
1416. Walk a Mile in Someone Else’s Shoes: Navigating the Complexity of Daily Environmental Cleaning – A Quality Improvement Pilot Project
Authors: McKinley Linda , Keating Julie , Hoel Sydney , Parmasad Vishala , Safdar Nasia 
Published: November 2023

Abstract

Background
A major tenet of environmental cleaning is to focus on high-touch surfaces (HTS). HTS in the patient’s proximity have high rates of contamination, yet cleaning compliance of HTS remains low particularly when the patient is present. This quality improvement (QI) project aimed to use stakeholder input to modify a HTS cleaning checklist.

Methods
This pilot project used a Plan-Do-Check-Act cycle to modify and evaluate a daily cleaning checklist across acute and long-term care settings at one Midwestern VA Hospital (Figure 1).
PDCA

Results
Two pre-intervention focus groups (patients, N=8 and EMS, N=5) were conducted to understand stakeholder perspectives and barriers to daily cleaning to inform modifications to the cleaning checklist. Participants viewed the graphic and discussed patients’ and EMS’s possible notions upon EMS entering the patient room. The groups were then asked how these insights could be addressed during the cleaning process. Recurrent themes of stakeholder’s perceived barriers to cleaning are depicted in Figure 2. Integrating the stakeholder suggestions to overcome barriers, and the literature suggesting higher touch and contamination of surfaces within proximity to the patient, the QI team and EMS designed a paradigm shift for the checklist including modifying mental models for: a. cleaning patterns from clean-to-dirty to dirty-to-clean (Figure 3) and b. extent of surface cleaning (Figure 4).
Pre- and post-intervention observations of daily cleaning compliance of 10 HTS showed a significant improvement of 38% (pre, N=7) to 72% (post, N=10) (p = 0.011).
Two EMS interviews were conducted post-intervention to evaluate checklist usability. Emergent themes were discomfort with cleaning any surface near the patient while the patient was in the bed and with the use of the modified cleaning pattern due to discordance with previous training and practices
Graphic Exercise
Cleaning Pattern Mental Model
Modified Checklist
Modified Checklist

Conclusion
Current checklists do not address contextual factors of navigating the environment surrounding patients in bed. HTS cleaning rates may be improved by modifying checklists based on input from local stakeholders. Future research is needed to evaluate modified cleaning processes to facilitate daily cleaning of occupied patient rooms.

Disclosures
All Authors: No reported disclosures
1425. "Influence of outpatient antibiotic prescriptions in prevalence of ESBL producing Enterobacteriaceae in local hospitals"
Authors: Ponce Rafael , Kinsella Patrick , Campbell Darien 
Published: November 2023

Abstract

Background
The increase in antibiotic resistance has been linked to antibiotic exposure. However, initiatives of antibiotic stewardship programs have been associated with decrease in antibiotic utilization but without a clear decrease in antibiotic resistance. We hypothesized that outpatient antibiotic exposure in communities geographically close to hospitals contribute to their incidence of ESBL producing Enterobacteriaceae (ESBL-PE).
Outpatient antibiotic prescriptions per 1000 population by zip code
Total antibiotic prescriptions per zip code

Methods
From March 2022 to March 2023 we evaluated antibiotic utilization in the inpatient and outpatient setting of a healthcare system in central Georgia. Outpatient settings included urgent cares, emergency rooms, and primary care clinics. The incidence of ESBL-PE was obtained from each hospital’s antibiogram. We calculated the number of outpatient prescriptions per zip code. Nearest neighbor analysis was used to determine the closest hospital for each zip code, with each zip code having a unique "nearest" hospital. The number of antibiotic prescriptions for those zip codes were assigned to that hospital. To estimate the antibiotic “burden” for each hospital, we used days of therapy (DOT) per 1000 days present of inpatient antibiotic use, plus antibiotic prescriptions per zip code population. Percentage of ESBL-PE for each hospital was the independent variable. QGIS v3.8 was used for spatial analysis.
Inpatient antibiotic use and ESBL-PE percentage
Outpatient antibiotic use

Results
There were 61 070 outpatient antibiotic prescriptions and 500 092 DOT. Prescriptions were given to residents of over 1000 different zip codes of nearly 20 states. 60% of the prescriptions were from urgent care centers, 1 for every 2 encounters. Inpatient antibiotic use varied among hospitals, with no correlation between antibiotic use and percentage of ESBL-PE. Linear regression model had an R2 of over 0.8 although with a p-value of 0.8.

Conclusion
The geographic reach of outpatient antibiotic prescriptions is of concern. The burden in their surrounding communities could be contributing to antibiotic resistance in hospitals, explaining the discrepancy of inpatient antibiotic use and antibiograms. Efforts to decrease antibiotic resistance should also include interventions in outpatient facilities. Our model didn’t reach statistical significance, likely due to the small hospital sample size, which we are currently evaluating.

Disclosures
All Authors: No reported disclosures
1430. Outbreak Clusters of Invasive Group A Streptococcus Associated with Wound Care in Long-term Care Facilities
Authors: Zipprich Jennifer , Como-Sabetti Kathryn , Bilski Kayla M , Vagnone Paula S , Dale Jennifer L , Wang Xiong , Chochua Sopio , Beall Bernard , Lehnertz Nicholas , Lim Sarah , Juaire Kristi K , Hale Tammy , Lynfield Ruth 
Published: November 2023

Abstract

Background
Residents of long-term care facilities (LTCFs) are at increased risk of invasive group A Streptococcus (iGAS) infections. It is important to identify intrafacility and interfacility iGAS transmission clusters.

Methods
Minnesota Department of Health (MDH) conducts active surveillance for iGAS infections through the Emerging Infections Program, including necrotizing fasciitis, bacteremia, and other normally sterile sites. Clinical and demographic information, including residence, is collected from medical records, and isolates are submitted to MDH and the Centers for Disease Control and Prevention for characterization. Whole genome sequencing (WGS) was used to determine emm type and identify clusters (isolates exhibiting ≤15 single nucleotide polymorphisms [SNPs]). In 2016–18 and 2022–23, iGAS clusters were investigated among LTCF residents.

Results
From March 2016 to May 2018, 749 iGAS cases were reported, 10% were among LTCF residents. Forty iGAS emm89 case-isolates (pairwise distance of 0–11 SNPs, recovered from LTCF residents at 19 different LTCFs, 1–7 cases/LTCF) defined cluster A. From January 2022–March 2023, 489 iGAS cases were reported, 7% were LTCF residents. Twenty iGAS cases (0–7 SNPs, recovered from LTCF residents at 10 different LTCFs, 1–8 cases/LTCF) defined cluster B. The two clusters represented multiple infection types including bacteremia (40%), septic shock (11%), pneumonia (8%), cellulitis with bacteremia (29%), and one case of necrotizing fasciitis. All were hospitalized and 23% died; 76% had wound care prior to iGAS infection. Among cluster A cases 58% had care from a single wound care physician, and among cluster B cases 36% received wound care from a single (but different) wound care physician. Identification of clusters led to MDH investigation on site.

Conclusion
iGAS is associated with severe morbidity and mortality among LTCF residents. We identified two iGAS clusters, each with cases among multiple LTCFs. Investigations identified common wound care providers and lapses in infection prevention practices. WGS enabled identification of complex multi-facility iGAS clusters, additional epidemiologic links, and development of facility-specific recommendations.

Disclosures
Jennifer Zipprich, PhD, Pfizer: Spouse employment
1469. Development and Implementation of a Predictive Model for a Semi-automated Surgical Site Infection Surveillance System
Authors: Lee Sojeong , Joo Jiyeon , Kim Miseo , Ryu Seung Hee , Lee Jeong Young , Yang Hyejin , Park So-Yeon , Kim Eun Ok , Jung Jiwon , Kim Sung-Han 
Published: November 2023

Abstract

Background
Automated surveillance systems for healthcare-associated infections have been implemented worldwide, but monitoring surgical site infections (SSI) is still challenging. Surveillance of SSI requires a review of multiple clinical aspects and medical records, which is time-consuming and prone to human error. We aimed to develop a predictive model for SSI and implement a semi-automated surveillance system.

Methods
The study included 213 major surgeries randomly selected from 25 different types at a tertiary care hospital in Seoul, South Korea, between June 2019 and May 2022. Infection preventionists diagnosed SSI based on US National Healthcare Safety Network criteria. After identifying variables significantly associated with SSI through univariate analysis, we developed several predictive models. We then conducted multivariable logistic regression analysis, calculated coefficients and p-values, and evaluated model performance using Area Under the ROC Curve (AUC) analysis, as well as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results
Of 213 surgeries, 13 (6.1%) were exploratory laparotomy, while 11 (5.2%) were cesarean section and ventricular shunting each. 74 cases (34.7%) were diagnosed with SSI. The study found that a predictive model that included use of antimicrobial agent, positive culture test, infection-related imaging findings (e.g., CT, MRI, ultrasonography), record of wound dressing, and pus or dehiscence of wound records, identified patients at high risk for SSI with an AUC of 0.853 (95% CI: 0.795-0.911). We weighted these variables and found that with a cutoff of 4 or higher out of a total of 8 points demonstrated sensitivity of 75.7% (95% CI: 65.9-85.5), specificity of 82.7% (95% CI: 76.5-89.0), PPV of 86.5% (95% CI: 80.7-92.3), and NPV of 80.3% (95% CI: 74.9-85.6). Based on this model, a semi-automated surveillance system was developed.

Conclusion
The predictive model and semi-automated surveillance system of SSI have the potential to improve the efficiency and accuracy. Further optimization of the predictive model by validating it for different types of surgeries and incorporating additional infectious variables and weights for each variable to increase its accuracy and applicability is needed.

Disclosures
All Authors: No reported disclosures
1473. Procedural risk factors for deep and organ/space surgical site infection post-coronary artery bypass graft surgery
Authors: Pearl Abarna , Gordon Patrick S , Feeser Baevin , Pepe Dana , Mehrotra Preeti , Wright Sharon B 
Published: November 2023

Abstract

Background
Advances in coronary artery bypass graft (CABG) surgery have improved graft patency and survival. Our prior work suggested a reduction in deep and organ/space surgical site infection (SSI) with single versus bilateral internal mammary arteries and a skeletonized approach. Even for the same number of arterial grafts used, specific artery type may impact SSI incidence. We aim to assess the effect of potentially modifiable risk factors on post-CABG deep and organ/space SSI, including number and type of vessel grafts, and closure method.

Methods
This was a single-center retrospective cohort study of post-CABG surgery patients from 01/01/19-12/31/22. SSIs were identified during routine surveillance using National Healthcare Safety Network criteria. Data on demographics, comorbidities, surgical technique and surgeon were obtained from hospital and cardiac surgery databases. A sub-analysis evaluated the risk of SSI in patients with two arterial grafts by type of artery used, specifically bilateral internal mammary (BIMA) graft versus single internal mammary artery plus radial graft (SIMA-R). We performed univariate analyses to determine association of risk factors with SSI.

Results
Of the 2050 included patients, 23 developed an SSI . In univariate analyses, diabetes mellitus (OR 5.6, p &lt; 0.001) and negative pressure wound therapy (NPWT) versus surgical adhesive (OR 19.82, p&lt; 0.001) were associated with SSI. There was no significant association between SSI and the total number of arteries or combination of vessel grafts used. In the sub-analysis, 281 patients underwent SIMA-R and 154 underwent BIMA. None of the SIMA-R, versus 4 of the BIMA developed SSI (p=0.02). There were other differences between the groups, including a greater proportion with a skeletonized (versus pedicled) arterial harvest (OR 2.19, p=0.003) and longer case duration (238 vs 217 minutes, p=0.003) in the BIMA group, which could confound this relationship.

Conclusion
In the overall cohort, NPWT was associated with SSI on univariate analysis, though notably this closure method is often used in patients with higher pre-operative risk. Amongst those patients who received two arterial grafts, there was a reduced SSI risk with SIMA-R approach. Future studies should explore the impacts of graft choice and wound care.

Disclosures
All Authors: No reported disclosures
1476. Optimizing Preoperative Antibiotic Administration Timing to Reduce Surgical Site Infections
Authors: Voss Heather , Salim Asra , Postelnick Mike , Borkowski Jaime 
Published: November 2023

Abstract

Background
The administration of clinically indicated antibiotics prior to surgery in combination with other evidence-based practices reduces the risk of surgical site infection (SSI). A retrospective study of SSI at a community-based hospital that performs 5,700 procedures annually revealed broad variability in the timing of prophylactic antibiotic administration in relation to the time of incision. A Tableau dashboard was created to compare antibiotic administration to surgical incision timing and the impact variability may have on the incidence of SSI.

Methods
A multidisciplinary team was formed with surgeons, anesthesia, nursing, antimicrobial and diagnostic stewardship, infection prevention, and analytics representatives. Antibiotics selected for inclusion were those most prescribed for surgical prophylaxis according to organizational practice guidelines. Using the dashboard, optimal administration times were identified based upon the pharmacokinetics of the antibiotic as well as the expected tissue concentration at the incision site when available. (See table) Surgical encounters that received an antibiotic were classified as “pass”, “fail”, or “other”. Antibiotics started within the determined timeframe passed, those started earlier or later than the timeframe failed, and the others received antibiotics not included in the dashboard logic.

Results
In a baseline review 35.5% of cases failed timing criteria. Failures occurred most frequently with cefazolin, ceftriaxone and clindamycin. A retrospective analysis of SSI (n = 34) classified using the National Healthcare Safety Network (NHSN) definitions correlated with the baseline data. The outliers were comprised of antibiotics started too close to or after incision (14.7%) and antibiotics started much earlier than the dosing timeframe and incision (17.6%).

Conclusion
The surgical prophylaxis timing dashboard helped to identify gaps in administration practices and highlighted the need for process improvement initiatives. Ongoing interventions to improve adherence to national guidelines will be evaluated to determine the impact on SSI rates.

Disclosures
All Authors: No reported disclosures
1478. Evaluation Of Anal Cancer Screening Program in men who have sex with men (MSM) persons with HIV (PWH) At Two academic center HIV Clinics 2018-2022
Authors: Achhra Amit , Chan Elizabeth , Applebaum Serina , Guerrero Maggie , Hao Ritche , Pantel Haddon , Virata Michael D , Barakat Lydia A 
Published: November 2023

Abstract

Background
Treatment of anal dysplasia has been shown to reduce incidence of squamous cell carcinoma of the anus (SCCA) in PWH, particularly in MSM. Annual anal cytology (PAP) has been offered for SCCA screening since ∼2010 at our urban academic center ambulatory HIV clinics, and those with abnormal PAP (atypical squamous cells of undetermined significance (ASCUS), or Anal Intraepithelial Neoplasia (AIN) 1-3) are referred for high-resolution anoscopy (HRA) and dysplasia treatment. Evaluation of screening cascade can help better understand and improve SCCA screening protocols.

Methods
We performed a retrospective chart review (2018-2022) on MSM PWH, age 35 and older, enrolled at our two HIV clinics who had at least one clinic visit by 12/31/2019. Of total eligible for SCCA screening, we calculated proportion of those engaged (received at least one screening (PAP or HRA)) and retained (received at least one subsequent screening) in care. Characteristics of people who did not engage in screening were evaluated by logistic regression.

Results
A total of 432 individuals were eligible for SCCA screening. The median [interquartile range] age was 57 [48-62] years, 97% were on antiretroviral therapy, 28% were Blacks, 62% had history of smoking, and 24% had a prior history of anal dysplasia. A total of 219 (50.7%) engaged in screening, and only 113 (26%) were retained (Figure-1). Seventy-four individuals had at least one abnormal PAP during follow-up, of which 35 (47%) received HRA at least once. In multivariable analysis, older age and history of smoking negatively correlated with engagement while history of anal dysplasia positively correlated with engagement (table-1). Race (Blacks vs other) and type of insurance (public/private) did not correlate with engagement.

Conclusion
We noted high rates of loss of engagement and retention in SCCA screening even in PWH highly engaged in HIV care. Older MSM PWH, who are at higher risk of SCCA, were less likely to be engaged in screening.

Disclosures
Michael D. Virata, MD, FACP, Gilead Sciences: Advisor/Consultant|Janssen: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant
2063. Elucidating the Gram-Positive Selective Spectrum Activity of Ibezapolstat; Secondary Analysis from the phase 2a trial
Authors: Lancaster Chris , McPherson Jacob , Alam M Jahangir , Begum Khurshida , Ekramul Karim Md , Hu Chenlin , Basseres Eugenie , Garey Kevin W 
Published: November 2023

Abstract

Background
Ibezapolstat (IBZ) is a non-absorbable antimicrobial currently in phase 2 clinical trials for the treatment of Clostridioides difficile infection (CDI). In vitro and human studies have shown potent activity of IBZ against C. difficile but selective activity against other beneficial Gram-positive gut microbiota shown to reduce the risk of recurrent CDI. As the target DNA Pol IIIC enzyme is present in most Gram-positive species, the reasons for this selectivity are unclear. The purpose of this study was to assess the selectivity of IBZ against Gram-positive gut commensal microbiota.

Methods
Using stool samples and microbiome data from the phase 2a CDI study, concentration changes in certain Gram-positive commensals were analyzed by qPCR over time in patients with CDI given IBZ. Gram-positive isolates were cultured from stool, speciated, and MIC determined. AlphaFold2-enabled drug docking was used to assess in silico differences in drug-binding residue sites predictive of IBZ binding across a large range of Gram-positive bacteria isolated from the stool.

Results
From the phase 2a study, relative abundance of Firmicutes and concentrations of certain species (Clostridium leptum and Clostridium coccoides groups) increased while on IBZ therapy. Thirty-six strains were isolated from Families Clostridiaceae (n=25), Enterococcaceae (n=3), Lachnospiraceae (n=3), and Peptostreptococcaceae (n=5). MIC50/90 values averaged 1.5/3.0 ug/mL (geometric mean) for strains isolated at baseline and early therapy (days 1-3) and 12/126 ug/mL for samples taken later on therapy and three-day follow-up. Two strains isolated at day 30 follow-up were &lt; 2 ug/mL and another was &gt;128 ug/mL. All C. difficile strains were IBZ susceptible (MIC&lt;2 ug/mL). Using a protein sequence alignment from more than 500 Firmicute PolC sequences, potential contact points of interest were identified that helped explain the selectivity of Ibezapolstat.

Conclusion
Increased Firmicute abundance and concentration may be explained by selection of non-susceptible Firmicute species during therapy. Distinct IBZ drug-binding residues in the Pol IIIC enzyme may explain this selectivity. Structural biology experiments will confirm these results.

Disclosures
Eugenie Basseres, PhD, Accurx: Grant/Research Support Kevin W. Garey, PharmD, MS, Acurx: Grant/Research Support|Ferring: Advisor/Consultant|Paratek: Grant/Research Support