bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-2039. Prognostic factors of disease progression in patients with mild-to-moderate COVID-19 on early remdesivir treatment in Taiwan
Authors: Ho Yu-Chien , Chang Min-Chi , Lin Wen-Ying , Wu Chia-Ying , Liu Szu-Yu , Chuang Chien , Juan Chih-Han , Liu Chia-Jen , Lin Yi-Tsung 
Published: January 2025

Abstract

Background
An early 3-day course of remdesivir treatment was recommended for high risk patients with mild-to-moderate COVID-19. We investigated the prognostic factors of disease progression and mortality in patients with mild-to-moderate COVID-19 who were treated with a 3-day course of remdesivir in Taiwan.

Methods
Adult patients with mild-to-moderate COVID-19 treated with a 3-day course of remdesivir at Taipei Veterans General Hospital from April–July 2022 were identified. The main outcomes were 14-day disease progression (defined as increased oxygen requirement compared with the baseline condition or mortality) and 28-day mortality. Logistic regression was used to identify independent variables associated with poor outcomes.

Results
Among the 345 patients on early remdesivir treatment with a 3-day course, 62 patients (18%) had 14-day disease progression, and 5 patients (1.4%) died within 28 days. Eighty patients (23.2%) did not receive COVID-19 vaccine before the diagnosis of COVID-19. Body mass index, cardiovascular disease, Charlson Comorbidity Index, and secondary bacterial infection were independent factors associated with 14-day disease progression, and nosocomial COVID-19 was the only independent factor associated with 28-day mortality. In 233 patients (67.5%) administered at least two doses of COVID-19 vaccine, 38 patients (16.3%) had 14-day disease progression, and 4 patients (1.7%) died within 28 days. Female sex, cardiovascular disease, and secondary bacterial infection were independent factors for 14-day disease progression. Nosocomial COVID-19 and C-reactive protein levels &gt;10 mg/dL were independent factors associated with 28-day mortality.

Conclusion
Nosocomial COVID-19 and secondary bacterial infections predisposed these patients to poor outcomes, regardless of vaccination. Therefore, infection control measures are important in the fight against COVID-19.

Disclosures
All Authors: No reported disclosures
P-2087. Clinical Application of Broad-Range PCR in Pediatric Patients
Authors: Gagliardo Christina , Halabi Katia Camille , Singer David , Qurbanali Sarah , Davydova Maria , Katragkou Aspasia 
Published: January 2025

Abstract

Background
Broad-range PCR (BRPCR) and next-generation sequencing (NGS) have the potential to be useful adjunctive tools in diagnosing the infectious etiology of a wide range of pediatric infections. We aimed to assess the clinical utility and application of BRPCR and NGS in children with suspected infections.

Methods
A retrospective chart review was performed on pediatric patients with clinical samples sent for BRPCR (University of Washington Molecular Microbiology Laboratory, Seattle, WA, USA) between January 2023 and December 2023. Data was extracted from the electronic medical record, and descriptive statistics were performed.

Results
51 patients had 55 samples sent for BRPCR. The demographics and sample information are listed in Table 1. A total of 18 (35.3%) patients had an organism identified on culture or BRPCR that was contributory to the clinical picture. Of those, 4 (7.3%) were identified on culture but not on BRPCR, and 6 (11%) were identified on BRPCR but not on culture. 4 (7.3%) cases identified the same organism on culture and BRPCR, while 4 (7.3%) cases identified different organisms on culture and concomitant BRPCR. In 6 (11.8%) cases, antibiotics were de-escalated, and in 7 (13.7%) cases, antibiotics were discontinued.

Conclusion
BRPCR can be a valuable adjunct to identifying causative organisms in children with suspected infections and can help tailor antibiotic management. Our results highlight the potential impact of BRPCR results to reduce broad-spectrum antibiotic use. Further studies are needed to guide the optimal use of BRPCR and determine its clinical impact on management of pediatric infections.

Disclosures
All Authors: No reported disclosures
P-2092. Evaluation of Daptomycin for MicroScan Dried Gram Positive MIC Panels from a Multicenter Assessment of Select Gram Positive Species
Authors: Dawa Kristianne , Brookman Regina , Diaz Jose , Hastey Christine 
Published: January 2025

Abstract

Background
Given the need for accurate antimicrobial susceptibility testing results to support patient care decisions, data were evaluated from clinical isolates of Staphylococcus aureus and Enterococcus faecalis on an investigational MicroScan Dried Gram Positive MIC (MSDGP) panel with daptomycin.*

Methods
Data from a previous multicenter study conducted at four sites were analyzed by comparing MIC values obtained using the MSDGP panels to MICs from a CLSI broth microdilution reference panel. A total of 444 Staphylococcus aureus and 114 Enterococcus faecalis clinical isolates were analyzed. These isolates were tested using the turbidity and Prompt methods of inoculation on MSDGP panels. The panels were incubated at 35 ± 1°C and read on the WalkAway System, the autoSCAN-4 instrument, and visually. Read times for the MSDGP panels were at 16-20 hours. Frozen reference panels were prepared and read according to CLSI methodology.

Results
Essential agreements were calculated comparing MIC results from the MSDGP panels with MIC results from frozen panels for all isolates tested in efficacy and challenge phases and are found in the following table.

Conclusion
Daptomycin MIC results for Staphylococcus aureus and Enterococcus faecalis obtained with the MSDGP panel correlate well with MICs obtained using frozen reference panels in this multicenter study.
*Pending submission and clearance by the United States Food and Drug Administration; not yet available for in vitro diagnostic use in the US.
For Investigational Use Only. The performance characteristics of this product have not been established.
©2024 Beckman Coulter. All rights reserved. All other trademarks are the property of their respective owners.
Beckman Coulter, the stylized logo, and the Beckman Coulter product and service marks mentioned herein are trademarks or registered trademarks of Beckman Coulter, Inc. in the United States and other countries.
May be covered by one or more patent. See www.beckmancoulter.com/patents.
2024-12909

Disclosures
Kristianne Dawa, n/a, Beckman Coulter: employee Regina Brookman, BS, Beckman Coulter: employee Jose Diaz, BS, Beckman Coulter: employee Christine Hastey, PhD, Beckman Coulter: employee
P-2093. A 30-year Descriptive Analysis of Mycobacterium szulgai Infections
Authors: Vega Pool Tobar , Vikram Holenarasipur R , McGary Alyssa 
Published: January 2025

Abstract

Background
Mycobacteirum Szulgai is a non-tuberculous mycobacterium known to cause human disease. Descriptions in the literature are limited to case reports and a larger case series from the Netherlands. Guidelines from the American Thoracic Society recommend that M. szulgai should always be considered pathogenic and that treatment should be based on in-vitro susceptibilities.
Demographics and patient characteristics

Methods
We embarked on a retrospective study of adults ( &gt;18 years) with M. szulgai infection at the Mayo Clinic sites in Arizona, Minnesota, and Florida. We queried the Mayo Clinic Database using two different search methods, (Advanced Text Explorer and the Mayo Data Explorer) using the terms ‘Mycobacterium Szulgai,’ ‘Mycobacteria Szulgai’,’ M. Szulgai’ and ‘Szulgai.’ Medical records from 1994 to 2023 were reviewed.
Diagnostic studies

Results
Initial search yielded 43 patients. Twenty-seven patients were excluded (incomplete records or prior history of infection treated elsewhere). For our cohort of 16 patients, the mean age was 65 years [IRQ 57-74 years], 13 of those were caucasian. Five patients [31%] were immunosuppressed. Thirteen patients [81%] developed pulmonary infection, 5[31%] had extra pulmonary infection (2[12%] with disseminated disease and 3[19%] with extra-pulmonary disease without primary pulmonary infection). Only 8 [50%] patients received specific therapy. All treated patients met ATS criteria for NTM infections, while 3 [19%] untreated patient met criteria. Only 4 [25%] patient received therapy based on susceptibilities. The most common regimen was a combination of rifampin, ethambutol and macrolide in 5[31%] of the patients. Seven patients [47%] were cured, 4[27%] had ongoing symptoms, 1[7%] had relapse and 1 [7%] is currently receiving therapy. There were 2[ 13%] deaths in the untreated group and none from the treated group. One patient was lost to follow up.
Treatment and outcomes

Conclusion
Our findings echo published literature and ATS recommendations that M. szulgai should be regarded as a true pathogen that necessitates targeted therapy.

Disclosures
All Authors: No reported disclosures
P-2095. Ultrasensitive Clostridioides difficile Toxin A/B Assay (in Development) for Higher Diagnostic Accuracy
Authors: Dave Gipshu , Truong Tiffany , Soban Mariya , Nguyen Justin , Zaugg Frank , Brachet Valerie , Wagner Peter , Sandlund Johanna 
Published: January 2025

Abstract

Background
Diagnostic tests for Clostridioides difficile infection (CDI) have either poor sensitivity or specificity, which has led to guideline recommendations for complex multistep testing algorithms. Ultrasensitive C. difficile toxin A/B measurements correlate with disease and may offer a standalone solution for CDI diagnosis. Fluxus develops ultrasensitive, target-agnostic, and low-complexity single-molecule diagnostic instruments based on optofluidic technology that combines integrated optics and microfluidics on a single chip-based system. Here, we report on the preliminary analytical performance of C. difficile toxin A and B assays (in development) powered by the Fluxus technology.

Methods
C. difficile toxin A (TcdA) and B (TcdB) were spiked into buffer and stool (pooled) and tested across a wide range of TcdA/TcdB concentrations to give dose-response curves and estimate limits of detection (LoD; assay background +2.5 STD of background) and quantification (LoQ; assay background +10 STD of background). TcdA and TcdB concentrations were calculated from a four-parameter logistic nonlinear regression-based calibration curve. Crossreactivity between the toxins was assessed. Further evaluation of expanded analytical and clinical performance is ongoing.

Results
LoDs in buffer for the prototype TcdA and TcdB assays were 0.47 and 0.98 pg/mL, respectively, and LoQs were 0.91 and 3.34 pg/mL, respectively, with a high dynamic range. LoDs in spiked stool for the TcdA and TcdB assays were 2.02 and 1.15 pg/mL, respectively, and LoQs were 4.25 and 4.35 pg/mL, respectively. There was no crossreactivity between the assay targets across a 4-log dynamic range.

Conclusion
Fluxus’ ultrasensitive C. difficile toxin A/B assays in development can detect TcdA and TcdB at pg/mL concentrations. Preliminary evaluation of spiked stool samples indicates a comparable dilution linearity to calibrator dose response in buffer. An ultrasensitive C. difficile toxin A/B assay has the potential to provide both high clinical sensitivity and specificity and may replace current testing methods.

Disclosures
Gipshu Dave, MS, Fluxus, Inc.: Stocks/Bonds (Public Company) Tiffany Truong, MS, Fluxus, Inc.: Stocks/Bonds (Public Company) Mariya Soban, MS, Fluxus, Inc.: Stocks/Bonds (Public Company) Justin Nguyen, BS, Fluxus, Inc.: Stocks/Bonds (Public Company) Frank Zaugg, PhD, Fluxus, Inc.: Stocks/Bonds (Public Company) Valerie Brachet, PhD, Fluxus, Inc.: Stocks/Bonds (Public Company) Peter Wagner, PhD, Fluxus, Inc.: Stocks/Bonds (Public Company) Johanna Sandlund, MD, PhD, Fluxus, Inc.: Stocks/Bonds (Public Company)
P-2101. Coverage Of The Molecular Diagnostic Technology For Pulmonary Tuberculosis In Bangladesh: Diagnostic Milestone For Control Of Tuberculosis
Authors: Khan Ahmadul Hasan , Yeasmin Shakila , Anjum Sanjida , Monirul Haque F M 
Published: January 2025

Abstract

Background
Provision of early and accurate Tuberculosis (TB) diagnosis is crucial to end TB specially in a densely populated like Bangladesh. Molecular WHO-approved rapid diagnostic tests for TB (mWRDs) can significantly improve identification of undiagnosed TB cases. This study estimates the coverage of mWRDs among the total detected Pulmonary TB (PTB).

Methods
Monthly programmatic data on nationwide TB diagnosis in Bangladesh using mWRDs were pulled and compiled. Routine programmatic data for TB detection using mWRDs were segregated and compared quarterly for the first three quarter of 2023 to know the percentage of molecular testing coverage among presumptive TB tested and percentage of pulmonary TB notified diagnosed through molecular testing during that time.

Results
A total of 5,53,172 presumptive cases undergone mWRDs to detect the Mycobacterium Tuberculosis (MTB) and Rifampicin Resistant (RR) cases. Among them, 80,414 (14.54%) cases were detected as MTB including RR. During the 1st, 2nd, and 3rd quarters of 2023, the total number of presumptive tests conducted were 133,845, 175,038, and 244,289, respectively. Among them, the detected TB cases according to each quarter were 15,418 (11.52%), 24,397 (13.94%), and 40,599 (16.62%), respectively (Figure 1). With this data it was obvious that in the 3rd quarter of 2023 the percentage of case detection by mWRDs increased compared to the consecutive previous two quarters. It revealed that, percentage of case detection by mWRDs gradually increased over the time during 1st to 3rd quarter 2023. To assess the coverage of mWRDs, quarterly data was analyzed and compared. It was determined how many TB cases were confirmed using molecular technology (GeneXpert and TrueNat) out of the total number of pulmonary cases over time. The analysis revealed that the quarterly percentage coverage of mWRDs was 26.85%, 42.68%, and 68.89% during the 1st, 2nd, and 3rd quarters, respectively, indicating an increasing trend over time (Figure 2).

Conclusion
Scaling up the mWRDs as a point of care diagnostic test for presumptive TB cases in resource limited settings would have a significant impact to meet the SDG and End TB strategy for TB detection. Increasing coverage of molecular testing for more PTB case detection is inevitable considering the context of Bangladesh.

Disclosures
All Authors: No reported disclosures
P-2104. A Quality Improvement Project that Implements Multi-disciplinary Residency Training on Point-of-Care (POCUS) Assistance for Lumbar Punctures (LP) in Infants &lt; 6 Months
Authors: Locke Nathaniel , Glenn Daniel , Kelly Connor , Hull Aicha , Sainato Rebecca 
Published: January 2025

Abstract

Background
LPs are critical in the work-up febrile infants to evaluate for meningitis. National data suggests many clinicians struggle to perform this procedure successfully which leads to additional procedures, delayed treatment, and unnecessary hospitalization/antimicrobials. There is evidence that suggests POCUS assistance leads to greater LP success as it is uniquely suited to visualize the infant spine in great detail, which can provide critical information (Figure 1). By increasing POCUS application and awareness, we hope to obtain cerebral spinal fluid (CSF) from &gt; 90% of infants &lt; 6 months within 3 attempts, and before antibiotics in &gt; 75% of cases.

Methods
Utilizing our institution’s electronic medical record (EMR), we reviewed all infants &lt; 6 months admitted to the pediatric ward who had an LP from January 2021 to June 2023 to establish our baseline. Hands-on and didactic training on POCUS-assistance for LP in neonates were provided to multiple residency faculty, and training was integrated within each programs’ curriculum. We created a post-procedural survey and perform quarterly EMR reviews of our progress.

Results
Baseline: CSF was obtained in 33/35 infants (94%). The average number of attempts was 3, interquartile range (IQR) 1-3, and max 10. 14/35 infants (40%) received antibiotics before a sample was obtained. The average time from antibiotics to obtaining an LP was 8.8 hours, IQR 1.4-6.2 hours. 16 infants (46%) had either a traumatic LP or no CSF obtained, including 7 (20%) where LP occurred following antibiotics.
Post-implementation: All interns in family practice, pediatrics, and emergency medicine now receive training on POCUS-assistance for obtaining LPs in infants (Table 1). 7 surveys have been completed and 3 infants were admitted to our ward with concern for meningitis. CSF was obtained in all 3 prior to antibiotics and within 3 attempts (Table 2).

Conclusion
Our EMR review is congruent with national data, suggesting a high rate of LP failure in infants. A new multi-disciplinary curriculum has been established at our hospital and POCUS assistance is now routinely being used for obtaining LPs in those &lt; 6 months. While we have limited post-implementation data, our results show promise towards increasing success, reducing attempts, and decreasing time to antibiotics.

Disclosures
All Authors: No reported disclosures
P-2105. Concordance of Multiplexed Molecular Lower Respiratory Panel with Standard Culture Method and Potential Clinical Impact on Antimicrobial Therapy
Authors: Patel Nisha M , Gitman Melissa R 
Published: January 2025

Abstract

Background
Pneumonia is the most common cause of health-care associated infections. The mainstay of diagnosis is respiratory culture, which is limited by up to 72-hour turnaround time and variable sensitivity. An added challenge is the emergence of antimicrobial resistance, which may confound the choice for empirical therapy. Rapid diagnostic tests have been developed to mitigate the challenges of diagnosis and treatment, but the clinical impact is not known. The Unyvero Lower Respiratory Tract Panel (LRT) is a qualitative multiplex nucleic acid test that can detect DNA of 20 microorganisms and 10 resistance genes in respiratory samples, with a 5-hour turnaround time. We hypothesized that use of the LRT on respiratory samples may have an impact on antimicrobial therapy and, consequently, antimicrobial stewardship.

Methods
The LRT was performed on a random sample of 48 respiratory tract specimens that were obtained inpatient. We assessed concordance of LRT with standard-of-care (SoC) testing. We performed a retrospective chart review for the clinical context in which specimens were obtained (infection suspected versus not) and to determine whether use of LRT would have had an impact on antimicrobial therapy at the time of care.

Results
Of 48 specimens, 25 (52%) had concordance between LRT and SoC testing and the remaining 23 specimens (48%) had discordance between LRT and SoC testing. Notably, 8 (17%) “discordant” specimens had organisms grow on culture that have no targets on the LRT (Candida species, Klebsiella aerogenes, Burkholderia cepacia complex, Streptococcus anginosus). In 3 cases where a resistance gene (CTX-M, mecA) was identified by LRT, antimicrobial susceptibility testing was compatible. In 7 cases, antibiotic therapy may have been impacted by use of LRT; in 5 cases therapy may have been initiated unnecessarily, and in 2 cases additional therapy may have been warranted. There were no cases where de-escalation of antibiotics would have been warranted.

Conclusion
The Unyvero LRT panel is an appealing diagnostic tool due to fast turnaround time, but a significant clinical impact due to its use has not yet been demonstrated. Though our study was limited by sample size, we found that LRT may have increased inappropriate use of antibiotics, rather than promoting stewardship.

Disclosures
Melissa R. Gitman, MD, Biomerieux, Inc: Grant/Research Support
P-2106. Streamlining Care Delivery in the Pediatric Emergency Department Using Rapid Point-Of-Care Molecular Diagnostics For Group A Streptococcus: A Randomized Controlled Trial
Authors: Pernica Jeffrey , Kam April J , Smaill Fiona , Ewusie Joycelyne , Khan Sarah , Elliott Shakeap , Sung Melani , Doan Quynh , Smieja Marek , Thabane Lehana , Goldfarb David 
Published: January 2025

Abstract

Background
As per IDSA guidelines, throat swab testing for group A Streptococcus is important to ensure appropriate antimicrobial use for children with pharyngitis that is not obviously viral. Bacterial culture is the diagnostic reference standard but takes days to result. With culture, physicians often initially provide a prescription that is only to be filled later on if GAS testing is positive. Unfortunately, this strategy can result in inappropriate treatment if parents of children with negative tests fill the script anyway, or if parents of children with positive tests cannot be contacted later. Point-of-care (POC) antigen testing in children is specific but not sensitive, so a negative test still requires culture verification, which limits its overall usefulness. POC molecular GAS testing is as sensitive as culture, and provides a result in minutes, which simplifies prescribing.
ED physician satisfaction at enrolment
Satisfaction was captured using a 5-point Likert scale on the day of enrolment.

Methods
A randomized controlled trial was done in a Canadian children’s emergency department (ED). Children aged &gt;3 y with throat swabs ordered to diagnose GAS pharyngitis were eligible. Participants were randomized 1:1 to either the IDNOW Strep A2 (intervention) or bacterial culture (control). The primary outcome was appropriate treatment, ie taking antibiotics if GAS-positive or not taking antibiotics if GAS-negative. Secondary outcomes included physician and parent satisfaction and time to symptom resolution.
Caregiver satisfaction at enrolment
Satisfaction was captured using a 5-point Likert scale on the day of enrolment.

Results
392 participants were recruited from Jan 2021 – Mar 2024. Intervention and control groups were similar in terms of mean age (8.2 vs 8.3 y) and mean MacIsaac score (both 3.3); 29% of the intervention group and 41% of the control group were GAS-positive. Participants in the intervention group were significantly more likely to receive appropriate antibiotics (90.8% vs 76.3%, OR 3.1 [95%CI 1.7-5.7], p&lt; 0.001). ED physicians (pOR 147, p&lt; 0.001) and parents (pOR 2.4, p&lt; 0.001) were also much more likely to be satisfied with POC molecular testing. There were no statistically significant differences in time to resolution of symptoms, though comparisons favoured the intervention.

Conclusion
In the largest RCT of molecular GAS testing yet done, the intervention was associated with substantial improvements in appropriate antibiotic prescribing and was clearly preferred by both ED physicians and parents.

Disclosures
Jeffrey Pernica, MD, MSc, FRCPC, DTMH, MedImmune: Grant/Research Support|Merck: Grant/Research Support