bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1454. Characterizing the Prevalence of Recurrent Antimicrobial Resistant Infections in an Urban County
Authors: Ingle Tanvi A , Beauchamp Alaina M , Cooper Lauren N , Wakene Abdi , Diaz Marlon I , Hanna John J , Lehmann Christoph U , Medford Richard J 
Published: January 2025

Abstract

Background
Individuals treated for antimicrobial resistant organism (AMRO) infections are exposed to broader antibiotics, which can contribute to an increased likelihood of future resistant infections. Given that community transmission and AMRO recurrence remains underexplored, we conducted spatiotemporal analyses of recurrent AMRO infections in an urban county.
Figure 1
Map of spatiotemporal hotspots and recurrent infection counts per 1,000 population (CP1K) for five patterns of antimicrobial resistance at a census block group level.

Methods
We mapped the spatial prevalence of recurrent AMRO infections for census block groups using electronic health records from two major health systems in Tarrant County (Texas) from 2010-2019. We delineated recurrence across five different patterns: AmpC beta-lactamase producing bacteria (AmpC), Carbapenem-Resistant Enterobacterales (CRE), Extended spectrum beta lactamase (ESBL), Methicillin-Resistant Staphylococcus aureus (MRSA), and Vancomycin-resistant Enterococcus (VRE). We compared recurrent AMRO rates against space-time permutation model identified hotspots. We used spatial lag regressions to explore the relationship between recurrent AMRO rates and Area Deprivation Index (ADI), a measure of neighborhood inequity.

Results
Of 105,291 patients, 19,161 (18.2%) had at least one AMRO infection. There were 10,611 (10.1%) patients with multiple AMRO infections: AmpC = 202, CRE = 136, ESBL = 741, MRSA = 1255, and VRE = 205. We observed that AmpC, ESBL, and MRSA recurrence had the greatest co-location with spatiotemporal hotspots (Figure 1). In spatial regressions, increasing neighborhood ADI rank (increasing deprivation) was significantly associated with an increase in block group-rates of recurrent AmpC (β = 0.02), ESBL (β = 0.03), MRSA (β = 0.04) and VRE (β = 0.01) (p-value &lt; 0.05).

Conclusion
We geographically and temporally identified patterns of recurrent AMROs in a large urban county and demonstrated a significant relationship between inequity and AMRO recurrence. This work can enhance our understanding of local infection dynamics and inform antibiotic stewardship.

Disclosures
John J. Hanna, MD, Pieces Technologies: Advisor/Consultant
P-1457. Association of Food Insecurity Risk with HIV Viral Non-suppression among People with HIV, Accessing Care in an Urban Infectious Disease Clinic in Baltimore, MD
Authors: Verinumbe Tarfa I , Lee Ye Eun , Agee Tracy , Hutton Heidi , Kelly Sharon , Hsu Jeffrey H , Jones Joyce L , Schwartz Sheree R , Falade-Nwulia Oluwaseun 
Published: January 2025

Abstract

Background
Food insecurity disproportionately affects people with HIV (PWH) and is associated with increased HIV transmission, interruptions in HIV care, and poor medication adherence. The intersection of depression, anxiety, substance use, and food insecurity among PWH may further exacerbate adverse HIV outcomes. This study assesses the association of food insecurity risk with viral load (VL) non-suppression among PWH, with or at risk for comorbid mental health (MHD) or substance use disorder (SUD), in HIV care.

Methods
PWH in care at The Johns Hopkins Bartlett Infectious Disease Clinic who screened positive for depression (PHQ-2), anxiety (GAD-2), or substance use (NIDA Quick Screen), were enrolled in an interventional trial evaluating optimal strategies for engaging PWH in MHD and SUD treatment. Food insecurity risk was assessed at baseline using a 2-item validated tool: The Hunger Vital Sign. Patients were considered at risk if they reported a response other than “never” to either question on the tool: 1) worry about running out of food or 2) having insufficient food in the prior 12 months. HIV VL assay performed as part of routine care within 6 months of study enrollment were used to evaluate for VL non-suppression. The association of food insecurity risk with VL non-suppression (HIV RNA &gt; 200 copies/ml) was assessed using log-binomial regression adjusting for age, sex, race, education, employment, homelessness, and social support.

Results
Among 241 participants, mean age was 51 years (SD 13.7), 85% were Black, 65% were male, 74% had a clinical diagnosis of MHD and 44% a diagnosis of SUD. Most participants were employed (41%) or retired/on disability (44%). Homelessness in the prior 6 months was reported by 15%. Overall, 61% had food insecurity risk and 13% were virally non-suppressed. PWH at risk of food insecurity were more likely to be virally non-suppressed compared to food secure individuals (adjusted PR: 3.16; 95% CI: 1.26 – 7.91).

Conclusion
Food insecurity risk was high in this study of PWH with or at risk for MHD/SUD, and was significantly associated with VL non-suppression. In populations of PWH with or at risk for MHD/SUD, screening for food insecurity as part of routine HIV care and subsequent linkage of individuals at risk to food intervention programs may support improved VL suppression.

Disclosures
Oluwaseun Falade-Nwulia, MBBS ,MPH, Abbvie Inc: Grant/Research Support|Gilead Sciences: Advisor/Consultant
P-1458. The Implementation Science Coordination Initiative (ISCI) for evidence-based HIV services: supporting implementation in practice
Authors: McKay Virginia , Zamantakis Alithia , Pachicano Ana , Merle James , Purrier Morgan , Brewer Russel , Li Dennis , Smith Justin , Benbow Nanette , Mustanski Brian 
Published: January 2025

Abstract

Background
The Ending the HIV Epidemic (EHE) Initiative was launched in 2019 to address implementation problems related to HIV interventions. In alignment with EHE, the National Institutes of Health supported research projects focusing on implementation science (IS), or the scientific examination of strategies to overcome barriers to and improve effective implementation of HIV-related interventions. The result is a growing IS knowledge base. The Implementation Science Coordination Initiative (ISCI) at Northwestern University has developed a suite of tools and resources for providers for practice communities to improve implementation and uptake of HIV prevention, testing, and treatment using IS.

Methods
We will describe tools, projects, and programs available to clinicians to support implementation of evidence-based HIV interventions in practice including that have been developed over from 2020-2024.

Results
ISCI maintains a literature review dashboard for that summarizes ongoing systematic reviews of the HIV implementation science literature. It includes common barriers and facilitators to evidence-based HIV interventions, interventions to support patients, and implementation strategies for practitioners and clinics. Literature is filterable along various dimensions so that users can quickly review literature relevant to their setting and patient population. See Figure 1. ISCI provides two training opportunities for practitioners interested in learning about IS and innovative tools that can be applied to real-world practice. The IS Navigation Practitioner Page is an online, freely available self-paced curriculum. The Practitioner-Oriented Implementation Science Education (POISE) Training Program is a mix of in-person and remote training over a 5-month period leveraging IS to support implementation in one’s practice setting. The Best Practices Project identifies and disseminates implementation strategies for evidence-based HIV interventions with the best evidence. We accomplish this through a review process and then develop a mix of resources to support use of implementation strategies in practice, which are freely accessible on the ISCI webpage

Conclusion
There are a number of resources available to support evidence-based HIV services.

Disclosures
Brian Mustanski, PhD, Hologic: Grant/Research Support
P-1460. Judicious Use of Benzathine Penicillin G in Response to a Medication Shortage Alert
Authors: Terrazas William Campillo , Kenney Rachel M , Argyris Amy , Shallal Anita , Veve Michael 
Published: January 2025

Abstract

Background
The national shortage of benzathine penicillin G (BPG) poses challenges in the treatment of syphilis. In response to this critical BPG shortage, our health system implemented a medication shortage alert within the electronic health record (EHR). The alert provides recommendations to optimize BPG utilization. This study investigates the impact of the BPG drug shortage on clinical practice.

Methods
This was an IRB-approved, retrospective cohort study focusing on patients &gt;3 months who received BPG between 5/9/23–2/28/24. The study included inpatient and outpatient visits after implementing the medication shortage alert. Exclusions were applied for severe penicillin allergy, neurosyphilis, or congenital syphilis. Two cohorts were analyzed: the judicious BPG group (patients with primary, secondary, or latent syphilis receiving BPG), and the non-judicious group (patients receiving BPG for alternative diagnoses). The study assessed social determinants of health (SDOH) as primary outcomes and compared a separate cohort of syphilis patients receiving BPG or alternative therapy (e.g., doxycycline).

Results
453 patients were included. Majority of patients were non-Hispanic Black (273, 60%) men (272, 60%), with a median age of 32 years (IQR: 22-44). Of these patients, 318 (70%) received judicious BPG, while 135 (30%) received non-judicious BPG. The most common non-judicious diagnosis was streptococcal pharyngitis (128, 95%). In multivariable logistic regression (Table 1), variables associated with judicious use included: age &gt;32 years (adjOR: 2.273; 95% CI: 1.488-3.472), male sex at birth (adjOR: 1.835; 95% CI: 1.206-2.792), and black race (adjOR: 1.847; 95% CI: 1.212-2.815). Among a cohort of 128 syphilis patients who received either BPG (64, 50%) or doxycycline (64, 50%) treatment, those who received doxycycline were more likely to lack health insurance (35 [54.7%] vs. 43 [67.2%], p=0.15) and receive outpatient treatment (3 [4.7%] vs. 12 [18.7%], p=0.13) (Table 2). SDOH data were reported in &lt; 50% of patient charts.

Conclusion
Despite implementing an EHR drug shortage alert, 30% of BPG use was suboptimal and mostly for pharyngitis. Optimizing SDOH documentation represents an opportunity to assess health inequities and the impacts on patient outcomes for syphilis management.

Disclosures
Rachel M. Kenney, PharmD, BCIDP, Medtronic Inc: Spouse is an employee, stockholder
P-1470. Single-dose Aminoglycosides versus Carbapenems for the Treatment of Uncomplicated Urinary Tract Infections caused by Extended-spectrum Beta-lactamase-phenotype Enterobacterales
Authors: DeFrank Anna , Bosco Michael , Zafonte Veronica B , Islam Shahidul , Johnson Diane 
Published: January 2025

Abstract

Background
Carbapenems are often used for treatment of infections caused by extended-spectrum β-lactamase-producing (ESBL) Enterobacterales. Over utilization has led to carbapenem resistance and these infections can be difficult to treat. Limiting unnecessary carbapenem exposure has been shown to decrease the risk of carbapenem resistance and a 2023 Infectious Disease Society of America guidance document recommends non-carbapenem alternatives for the treatment of uncomplicated urinary tract infections (uUTI). A single dose of an aminoglycoside (AG) can be considered, however clinical trial data is lacking, especially for those with infections caused by drug-resistant pathogens.

Methods
A retrospective, multi-center, cohort study over 60-months evaluated hospitalized patients within the NYU Langone Health System ≥18 years of age who received a single dose of an AG for the treatment of an uUTI caused by an AG-susceptible, ESBL-phenotype (defined as ceftriaxone MIC ≥2 mcg/mL) gram-negative bacilli (GNB). Patients who received MEM for ≥72 hours were the active comparator. Clinical success, a composite of the following, was assessed at Day 7 (±2 days) post-therapy or at discharge, whichever occurred sooner: clinical cure, defined as complete resolution or significant improvement of baseline uUTI signs/symptoms; microbiological response, defined as reduction in baseline uropathogen to &lt; 103 CFU/mL. To demonstrate non-inferiority, 352 patients were needed to achieve 90% power.

Results
Baseline characteristics can be found in Table 1. Clinical success occurred in 97% (N=37) vs. 86% (N=129) of patients treated with an AG vs. MEM, respectively (p=0.052). Non-inferiority was met with a 0.11 proportion difference in clinical success (90% confidence interval [-0.011, 0.25]) within the predefined non-inferiority limit. No statistically significant differences in secondary outcomes were observed (Table 2). Diarrhea was more common in those treated with MEM (p=0.049; Table 3).

Conclusion
Single dose AG demonstrated comparable clinical success and recurrence rates to MEM for the treatment of uUTI caused by ESBL-producing GNB. The study was underpowered, increasing the chance for type II error. A future prospective study is warranted to justify preliminary findings.

Disclosures
Michael Bosco, PharmD, BCIDP, AAHIVP, Shionogi Inc: Advisor/Consultant|Shionogi Inc: Grant/Research Support
P-1493. In Vitro Activity of Clindamycin in Comparison with Linezolid Versus Streptococcus pyogenes Clinical Isolates Recovered from Patients in Manitoba, Canada
Authors: Li Jeremy , Lagace-Wiens Philippe , Adam Heather , Pieroni Peter , Zhanel George , Karlowsky James , Walkty Andrew 
Published: January 2025

Abstract

Background
Clindamycin is often used in combination with a beta-lactam antimicrobial for the treatment of serious infections caused by Streptococcus pyogenes (e.g., necrotizing fasciitis, streptococcal toxic shock syndrome) due to its ability to suppress bacterial toxin synthesis. Of concern, increasing clindamycin resistance among S. pyogenes isolates has been reported in many parts of the world. The purpose of this study was to compare the in vitro activity of clindamycin with linezolid versus a contemporary Canadian collection of S. pyogenes clinical isolates.

Methods
S. pyogenes isolates from wounds and sterile body sites (one per patient) were obtained from three microbiology laboratories in Manitoba, Canada between December, 2022 and November, 2023. Susceptibility testing was performed by broth microdilution as described by CLSI, with MICs interpreted using current CLSI breakpoints. A D-test was set up for each isolate to investigate whether inducible clindamycin resistance was present.

Results
Susceptibility testing was performed on 140 S. pyogenes clinical isolates. The isolates were obtained from wound swabs (n = 71, 50.7%), sterile fluid/tissue samples (n = 27, 19.3%), and blood cultures (n = 42, 30.0%). All isolates were fully susceptible in vitro to penicillin and vancomycin. The proportion of isolates testing susceptible to clindamycin and linezolid was 82.9% and 100%, respectively. All of the clindamycin-resistant isolates demonstrated an inducible resistance phenotype (clindamycin MIC ≤0.12 ug/mL in all cases). Clindamycin susceptibility was similar for isolates from wound swabs (81.7%) and isolates from blood/sterile sites (84.1%).

Conclusion
The proportion of S. pyogenes isolates testing susceptible to clindamycin was 82.9%. All clindamycin resistant isolates demonstrated an inducible resistance phenotype. Further data are required to determine whether inducible clindamycin resistance is clinically relevant when clindamycin is used as adjunctive therapy (in combination with a beta-lactam) for serious S. pyogenes infections. All isolates tested remained susceptible to linezolid.

Disclosures
All Authors: No reported disclosures
P-1514. Cefepime-taniborbactam Exhibits Limited Cross-resistance with Ceftazidime-avibactam and Ceftolozane-tazobactam against Carbapenem-nonsusceptible Enterobacterales and Multidrug-resistant Pseudomonas aeruginosa from the United States 2018-2022
Authors: Hackel Meredith , Wise Mark G , Moeck Greg , Sahm Daniel F 
Published: January 2025

Abstract

Background
Cefepime-taniborbactam (FTB) is an investigational β-lactam/β-lactamase inhibitor combination with activity against most isolates of carbapenem-resistant and multidrug-resistant (MDR) Enterobacterales and P. aeruginosa. We evaluated the activity of FTB and comparators against clinical isolates of Enterobacterales and P. aeruginosa from the US and assessed FTB cross-resistance to ceftazidime-avibactam (CZA) and ceftolozane-tazobactam (CT) in resistant subsets.

Methods
MICs were determined by CLSI reference broth microdilution against Enterobacterales (n=4,932) and P. aeruginosa (n=1,508) collected in the US in 2018-2022. Phenotypes were based on 2024 CLSI breakpoints. A provisional FTB susceptible breakpoint of ≤16 µg/mL was used for comparative purposes. An MDR phenotype was defined as resistance to ≥1 agent from ≥3 drug classes.

Results
Among Enterobacterales, 1.8% of isolates were nonsusceptible to meropenem (MEM; Table 1). FTB was the most active agent, inhibiting 96.7% of MEM-nonsusceptible Enterobacterales isolates at ≤16 µg/mL whereas 80.4% were susceptible to CZA and 87.0% were susceptible to meropenem-vaborbactam (MEV). Among P. aeruginosa, 11.9% of isolates were MDR (Table 1). FTB was the most active agent, inhibiting 82.2% of MDR P. aeruginosa isolates at ≤16 µg/mL whereas 56.1% were susceptible to CT and 63.9% were susceptible to CZA (Table 1). Among MEM-nonsusceptible Enterobacterales, 80.2% were susceptible to both FTB and CZA, 16.5% were susceptible to FTB but not to CZA, 1.1% were susceptible to CZA but not to FTB, and 2.2% were nonsusceptible to both agents (Table 2A). Among MDR P. aeruginosa, 54.4% were susceptible to both FTB and CT, 27.8% were susceptible to FTB but not to CT, 1.7% were susceptible to CT but not to FTB, and 16.1% were nonsusceptible to both agents (Table 2B).

Conclusion
FTB was active in vitro against recent clinical isolates of Enterobacterales and P. aeruginosa from the US including most isolates resistant to CZA and CT in key resistant subsets. These data support continued development of FTB as a potential treatment option for patients with challenging infections due to carbapenem-resistant Enterobacterales and MDR P. aeruginosa.

Disclosures
Greg Moeck, PhD, Biomedical Advanced Research and Development Authority (BARDA): Grant/Research Support|Venatorx Pharmaceuticals, Inc.: Grant/Research Support|Venatorx Pharmaceuticals, Inc.: Stocks/Bonds (Private Company) Daniel F. Sahm, PhD, Pfizer, Inc.: Advisor/Consultant
P-1520. Addition of Relebactam Increases Susceptibility to Imipenem Among Imipenem-Intermediate Pseudomonas aeruginosa: Asia/Pacific SMART 2018-2022
Authors: Wise Mark G , Andrew DeRyke C , Chen Wei-Ting , Siddiqui Fakhar , Young Katherine , Motyl Mary , Sahm Daniel F 
Published: January 2025

Abstract

Background
Imipenem/relebactam (IMR) combines imipenem with the β-lactamase inhibitor relebactam, an inhibitor of class A and C β-lactamases. We assessed the activity of IMR and comparators against Pseudomonas aeruginosa collected in 9 countries in the Asia/Pacific region as part of the global SMART surveillance program, with a focus on the increased antimicrobial activity brought by the addition of relebactam to imipenem for those organisms interpreted as “intermediate” by 2024 CLSI criteria (MIC = 4 µg/mL) to imipenem alone.

Methods
From 2018-2022, 50 clinical laboratories in nine countries in Asia/Pacific (Australia, Hong Kong, Malaysia, New Zealand, Philippines, South Korea, Taiwan, Thailand, and Vietnam) each collected up to 250 consecutive, aerobic or facultative, Gram-negative pathogens per year from patients with bloodstream, intraabdominal, lower respiratory tract, and urinary tract infections. MICs were determined using CLSI broth microdilution and interpreted with 2024 CLSI breakpoints. Most isolates that were imipenem or ceftolozane/tazobactam-nonsusceptible (NS) were screened for β-lactamases.

Results
IMR demonstrated excellent antimicrobial activity against isolates from most countries, inhibiting &gt;80% of the isolates from each country except Vietnam (63.2% susceptible; Table). Ceftolozane/tazobactam and amikacin showed similar levels of activity. Limiting the analysis to isolates that tested “intermediate” to imipenem (MIC = 4 µg/mL) revealed that the addition of relebactam rendered &gt;96% of the organisms from each country susceptible, ranging from 100% (Australia, New Zealand and South Korea) to 96.3% (Vietnam). Most imipenem-I P. aeruginosa examined molecularly (727/740; 98.2%) did not carry an acquired β-lactamase. As relebactam itself does not possess antibacterial activity, this suggests that the increased antimicrobial activity attributable to its addition is likely a result of its inhibitory activity on the intrinsic AmpC (blaPDC) in this species.

Conclusion
IMR showed potent activity against clinical P. aeruginosa collected in Asia/Pacific. The addition of relebactam to imipenem was responsible for the inhibition of &gt;96% of isolates that were “intermediate” to imipenem alone.

Disclosures
Daniel F. Sahm, PhD, Pfizer, Inc.: Advisor/Consultant