bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-640. Vancomycin vs Ceftaroline for Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) Pneumonia: A Multicenter Retrospective Study
Authors: Auyeung Austin , Thomas Sanil 
Published: January 2025

Abstract

Background
Vancomycin (V) is considered first-line treatment for MRSA infections, assuming bacterial susceptibility and patient tolerability. Ceftaroline (C) has been used off-label to treat MRSA blood stream infections, osteomyelitis, ventilator-associated pneumonia, hospital-acquired pneumonia and endocarditis. However, the efficacy of C vs V for treatment of MRSA pneumonia has not been studied.Figure 1.Summary of Exclusions for Patient Population

Methods
Data was extracted from a centralized database for 184 HCA Healthcare hospitals from January 1st, 2016 – June 30th, 2023. Patient encounters with a diagnostic code of MRSA pneumonia and received V and/or C were included for further analysis. In-hospital mortality and length of stay (LOS) were the main outcomes studied. Demographics including age, sex and race were extracted. Average vitals values noted included temperature and O2 saturation. Lab values included average WBC count, creatinine and GFR. Time to first dose of V or C from time of admission and time to transition from V to C were included. Patients who received C-only were combined with the patients who first received V and then transitioned to C (VC). IRB approval was obtained prior to data extraction.Table 1.Demographics, Clinical Data and Outcomes

Results
Initial data extraction yielded 5977 encounters with final analysis for 4511 unique patients. Encounters were excluded for missing demographic data, duplicates or when V or C were not received. The V-only group had 4372 encounters and the C+VC combined group had 139 encounters.
The mortality rate in the V-only group was 609/4372 (13.9%), while that in the C+VC group was 31/139 (22.3%). LOS was 13.22 days and 18.45 days in the V only and C+VC groups, respectively.
The average time to transition from V to C in the VC group was 6.4 hours with maximum of 34 hours.
Average temperature and O2 saturation were not significantly different between the two groups. GFR (mL/min/1.73m2) was 63.86 and 60.30 and WBC (103/µL) count was 11.93 and 14.01 in the V and V+VC groups, respectively.

Conclusion
Preliminary data suggest that V may be superior to C for MRSA pneumonia with respect to mortality and hospital LOS. Average WBC may be greater in the C+VC group, suggesting more severe illness. Reasons for transition of V to C were unknown, however given the short transition time, the impact of V on treatment outcome is likely negligible.

Disclosures
All Authors: No reported disclosures
P-641. Distinct Cytokine Profiles in Severe Community-acquired Pneumonia and Metabolic Dysfunction-associated Steatotic Liver Disease
Authors: Gjurasin Branimir , Radmanic Matotek Leona , Jelicic Mia , Papic Neven 
Published: January 2025

Abstract

Background
Metabolic dysfunction-associated steatotic liver disease (MASLD) has recently been identified as a risk factor for severe community-acquired pneumonia (sCAP) outcomes. While MASLD is associated with chronic systemic inflammation, cytokine responses in patients with sCAP and MASLD have not been characterized. The aim of this study was to analyze differences in concentrations and kinetics of cytokines in sCAP patients with and without MASLD.

Methods
A prospective cohort pilot study included patients hospitalized with sCAP defined according to IDSA criteria. Upon admission, clinical and laboratory data were collected, and liver fibroelastography was performed to determine the presence of liver fibrosis and steatosis. Serum concentrations of 13 cytokines (IL-4, IL-2, CXCL10, IL-1β, TNF-α, CCL2, IL-17A, IL-6, IL-10, IFN-γ, IL-12p70, TGF-β1 and IL-8) were analyzed using a multiplex bead-based assay by flow cytometry at admission and on day 5 of hospitalization.

Results
Thirty-eight patients (26 males, median age of 69, [IQR 61-79] years) with sCAP (SOFA 3 [IQR 2-4], PaO2/FiO2 186 [IQR 150-241]) were included. Of them, 18 (47.4%) had MASLD. There were no differences in age, sex and baseline disease severity between the groups. Patients with MASLD more frequently had components of metabolic syndrome. Etiology was identified in 66%, most commonly influenza (50%) and S. pneumoniae (18%). There were no differences in routine laboratory findings at admission, except for lactate, urea, AST, ALT and LDH which were higher in the MASLD group. While at admission we observed no differences in cytokine concentrations, on the 5th-day patients with MASLD had significantly higher concentrations of CXCL10, IL-10, TNF-α, and lower TGF- β1. Both groups had similar cytokine kinetics with significant decreases in CXCL10, CCL2, IL-10, IL-8 and IL-6. However, distinct temporal changes were observed for TGF-β1 and IL-2 which increased only in patients without MASLD.

Conclusion
In conclusion, MASLD is associated with distinct cytokine profiles and kinetics in sCAP. A better understanding of cytokine changes could potentially help elucidate the complex and aberrant immune responses in MASLD patients during sCAP.

Disclosures
All Authors: No reported disclosures
P-660. Exploring the Association Between Helicobacter Pylori Infection and Bronchiectasis: A Meta-analysis
Authors: Yadav Rukesh 
Published: January 2025

Abstract

Background
Helicobacter Pylori (H. pylori) is known to cause various malignancies, and autoimmune disorders. However, the potential association between H. pylori and bronchiectasis has been not analyzed in the literature before. Thus, we aimed to explore the potential association between bronchiectasis and H. pylori.
Forest plot showing the odds of association between H pylori seropositivity and bronchiectasis

Methods
Pubmed, Google Scholar and Embase databases were searched from inception till January 2024 for studies that investigated H. pylori seropositivity, anti H pylori IgG level, urea breath test (UBT) positivity, polymerase chain reaction (PCR) and culture to detect H pylori in gastric juice (GJ) and bronchoalveolar lavage fluid (BALF) in bronchiectasis and matched healthy controls. Outcomes included odds ratio of association between H. pylori and bronchiectasis, detection rate of H. pyroli in BALF, GJ or bronchial biopsies, standardarized mean difference (SMD) of serum anti H pylori IgG level between the bronchiectasis patients and the healthy controls. The analysis was performed in Revman 5.4 software.
Forest plot showing serum anti H. pylori IgG levels between bronchiectasis and healthy controls

Results
Five studies comprising 455 participitants were included in this analysis. H. pylori seropositivity was nearly significantly associated with increased odds of having bronchiectasis. [Odd’s ratio=2.13, Confidence Interval (CI)=1.00-4.53, I2=53%, P value =0.05]. Moreover, the serum anti H. pylori IgG levels were significantly higher in bronchiectasis patients as compared to healthy controls . [SMD=0.37, CI=0.03-0.72, I2=62%, P value =0.03]. However, none of the studies isolated H. pylori from bronchial biopsies in both the bronchiectasis patients and the healthy controls. Interestingly, a study by Teke et al. found that nine patients (22%) of the 41 bronchiectasis patients and three patients (18.8%) of the 16 the controls had positive BALF on PCR, but this was not significantly different between the two groups. The other study by Gulhan et al. however did not find H. pylori on BALF PCR in any of the 26 bronchiectasis patients.

Conclusion
Though the H pylori seropositivity was associated with bronchiectasis, further future studies of larger sample sizes need to be conducted. Further, newer methods to detect H. pylori in bronchiectasis patients need to be explored to prove the association owing to higher H. pylori seropositivity in the general population.

Disclosures
All Authors: No reported disclosures
P-671. Clinical and Laboratory Findings of Measles in Hospitalized Adolescents and Adults in Romania: A Retrospective Study
Authors: Neagu Daniela G , Mangaloiu David V , Molagic Violeta , Tiliscan Catalin , Stratan Laurentiu M , Staicu Isabela D , Adamescu Aida I , Daniel Miron Victor , Sandulescu Oana , Streinu Cercel Anca , Draganescu Anca C , Pitigoi Daniela , Paraschiv Simona , Apostolescu Catalin G , Arama Stefan S , Arama Victoria 
Published: January 2025

Abstract

Background
Despite the availability of efficient and safe vaccines, measles remains a significant public health threat worldwide. In Romania, there has been a resurgence of measles since March 2023, leading up to an outbreak in early December, with many cases reported including among the adult population. Consequently, this study aims to present the epidemiological, clinical, and laboratory data of adolescents and adults hospitalized for measles.Table 1.Patient demographics, clinical, paraclinical and complications characteristics.

Methods
We conducted a retrospective analysis which included 87 patients, aged over 14 years, with measles admitted to National Institute of Infectious Disease „Prof. Dr. Matei Balș”, Bucharest, Romania, between July 2023 and April 2024. For all included patients the diagnosis of measles was serologically confirmed. Demographic, epidemiological, clinical and laboratory data were collected for each patient.

Results
Our results are summarized in Table 1. In brief, the mean age of the participants was 30.82 ± 12.90 years and 57.5% were males. Most of them (89.8%) had no chronic conditions. The most frequent symptoms and signs presented at admission were rash (100%), fever (98.9%) and cough (94.3%). Koplik spots were found in 81.6% of patients. A total of 8% of patients had a full history of MMR vaccination, while 9.2% had been vaccinated with only one dose. The most common laboratory parameter findings were increased C-reactive protein (100%), lymphopenia (95.4%) and liver cytolysis (80.5%). The median duration of hospitalization was 5 days. Pneumonia (74.7%) was the most frequent complication and acute respiratory failure (ARF) was reported in 16.1% of patients. The presence of at least one chronic condition increased the risk of ARF 3.5-fold (p=0.036), and prolonged the duration of hospitalization by at least one day.

Conclusion
The ongoing measles outbreak in Romania highlights significant gaps in adolescents and adults vaccination and immunity. The data underline the severe impact of measles in adults, particularly those with unmanaged chronic conditions, leading to extended hospitalization and complications. This study emphasizes the need for improved vaccination strategies and public health policies to mitigate the measles threat effectively.

Disclosures
All Authors: No reported disclosures
P-713. Two Seasons of Admissions Screening for Influenza and RSV Among a Highly Immunocompromised Patient Population
Authors: Odom Robin T , Forrester LaToya A , Michelin Angela , Scaletta Joseph , Han Alison , Henderson David K 
Published: January 2025

Abstract

Background
To facilitate early detection and prompt isolation of infected patients during the 2022-23 and 2023-24 fall/winter seasons, the NIH Clinical Center, a clinical research hospital serving a significantly immunocompromised patient population, augmented symptom screening with Influenza and RSV testing of all patients on admission.

Methods
Nasopharyngeal (NP) swabs were collected on admission from November 2022-April 2023 and September 2023-April 2024. All samples were tested for Influenza and RSV by PCR on the Panther Fusion® SARS-CoV-2/FluA/B/RSV Assay (Hologic, Inc.) or the Xpert® Xpress CoV-2/Flu/RSV test. Patients who disclosed symptoms on admission were tested using the BioFire® Respiratory Panel. Medical chart reviews and discussions with patient care providers elucidated whether cases identified on admission were asymptomatic.

Results
Of 3197 NP swabs collected from patients admitted to our hospital, 31 swabs were from patients who were symptomatic on admission. Of the remaining 3166 NP swabs (from 2352 unique patients, as some patients had multiple admissions), 17 patients were found to be infected: 7 (0.22%) Influenza A, 1 (0.03%) Influenza B, and 9 (0.28%) RSV. Of these patients that were asymptomatic on admission, 8 (47%) subsequently disclosed symptoms (1 with recent confirmed diagnosis of Rhinovirus/Enterovirus infection), 2 (12%) disclosed a recent history of an unknown respiratory infection, and 7 (41%) were asymptomatic. Seven Influenza A and 8 RSV infections were detected between the months of November and January, yielding positivity rates of 0.57% and 0.66%, respectively, during these months when community transmission was highest.

Conclusion
Admission surveillance for Influenza and RSV during months of increased community transmission allowed us to isolate seventeen patients on admission who would likely not have been appropriately isolated based on symptom screening alone. Admission surveillance testing, in conjunction with symptomatic surveillance, is important to identify infected patients promptly during increased respiratory virus activity in the community, and especially for institutions serving immunocompromised patients.

Disclosures
All Authors: No reported disclosures
P-737. Highly Resistant Myroides Species Infections: Insights from a Comprehensive Case Series and Antibiogram Analysis
Authors: Toiv Avi , Doshi Neal , Ishak Angela , Lanfranco Odaliz Abreu 
Published: January 2025

Abstract

Background
Myroides species (spp.) are rare opportunistic gram-negative bacteria that are highly resistant to commonly used empiric antibiotics. Able to survive in natural and hospital environments, these microbes pose a growing risk of resistant nosocomial infections. Here we present a case series and antibiogram of Myroides infections at an academic medical center, highlighting this potential pathogen’s antibiotic sensitivity to aid clinicians in choosing effective antimicrobial therapies.
Antibiogram

Methods
Retrospective chart review of all patients diagnosed with Myroides spp. infection at Henry Ford Health between January 1, 2019 and December 31, 2023. Patient characteristics, treatments, and outcomes were analyzed. An antibiogram of Myroides spp. susceptibility to 10 antibiotics was generated.

Results
A total of 43 patients (median age 62 yr; range 30-94) presented with 46 Myroides spp. infections. Positive cultures were evenly distributed between hospitalizations (50%) and outpatient (50%) settings. Of the 46 infections, 35 (76%) were in a lower extremity wound. Of the 43 patients, 17 (40%) had sepsis at presentation, including 8 (13%) with Myroides bacteremia. Most Myroides spp. cultures (83%) grew additional organisms, including E. faecalis (34%), S. aureus (21%), Proteus mirabilis (21%), and Pseudomonas spp. (16%). Empiric antibiotics were prescribed in 35/46 cases (76%), mostly vancomycin (17/35) and cefepime (9/35); however, Myroides spp. were sensitive to the empiric agents in only 4 cases (11%). Antibiogram analysis showed 100% susceptibility to meropenem and 0%-50% susceptibility to 9 other agents (Table). A total of 5 (12%) patients died, and 6 patients (14%) required readmission within 1 month of treatment.

Conclusion
Myroides spp. exhibited significant resistance to most empiric antibiotics. Our antibiogram analysis revealed meropenem as the sole effective empiric antibiotic for this opportunistic pathogen. We recommend the prompt empirical use of meropenem when Myroides spp. are identified on antimicrobial culture.

Disclosures
All Authors: No reported disclosures
P-744. Admission Avoidance: A Protocol for Using Dalbavancin in the Emergency Department for Acute Bacterial Skin and Skin Structure Infections
Authors: Weller Katherine , Bland Christopher M , Jones Bruce M 
Published: January 2025

Abstract

Background
Dalbavancin is a glycopeptide with a 14.4 day terminal half-life that has been used previously in our institution to facilitate early discharge for acute bacterial skin and skin structure infections (ABSSSI). We have expanded this program with a pharmacist-driven protocol for use in the emergency department (ED) to avoid admission in ABSSSI for selected patients. The goal of this study was to evaluate the protocol for dalbavancin use in the ED for patient selection and financial impact.
Dalbavancin Emergency Department Protocol
Inclusion/Exclusion criteria for assessment to receive dalbavancin

Methods
This was a retrospective, multi-center, study performed in a community health system from June 2022 through March 2024 of patients who presented to the ED with ABSSSI, evaluated by pharmacist and physician, and discharged directly after receiving dalbavancin. Inclusion and exclusion criteria were based on the patient's symptoms, type of infection, and comorbidities (Figure 1). Data collected included clinical signs/symptoms of infection, previous antibiotic use, history of substance abuse or methicillin-resistant Staphylococcus aureus (MRSA), renal function, and readmissions. Direct costs and reimbursement, as well as if they received patient assistance, were also tracked. The primary objective was to evaluate adherence to the protocol for use of dalbavancin in the ED. The secondary objective was to analyze the financial impact to the health system.
Table 1 & Table 2
Patient Demographics & Clinical Signs/Symptoms

Results
A total of 57 patients met inclusion/exclusion criteria and were evaluated. Patient demographics associated with adherence to protocol are summarized in Table 1. A majority of patients had failed oral therapy and were expected to be admitted for &gt; 3 days. Six patients (10.5%) were re-admitted within 30 days, similar to national averages. Only 2 patients self-reported as persons who inject drugs (PWID). Table 2 summarizes clinical signs/symptoms associated with diagnosis of ABSSSI for the included population. Most patients met multiple diagnostic criteria, with erythema, tenderness, & swelling all reported &gt;75%. For the secondary objective, patients as part of the ED visit had ∼$3800 average reimbursement per patient not including direct and indirect costs of care.

Conclusion
Pharmacists can help identify and facilitate appropriate patients to receive dalbavancin within a structured protocol to help prevent admissions for ABSSSI.

Disclosures
Christopher M. Bland, PharmD, FCCP, FIDSA, BCPS, Merck: Honoraria|Nestle/Seres: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria Bruce M. Jones, Pharm.D., FIDSA, BCPS, AbbVie: Advisor/Consultant|AbbVie: Honoraria|Ferring: Honoraria|Innoviva: Honoraria|Paratek: Honoraria
P-749. Prognostic Determinants in Patients with Necrotizing Fasciitis in a Referral Hospital in Nicaragua
Authors: Hernández-Hernández Francisco , Porras-Cortés Guillermo D 
Published: January 2025

Abstract

Background
Necrotizing fasciitis is a serious condition in which timely diagnosis and therapeutic approaches, both medical and surgical, play an essential role in prognosis. In Nicaragua, the prognostic determinants for this clinical condition in different hospital institutions have not been formally evaluated. The aim of this study was to establish factors that could be determinant for the prognosis of patients with necrotizing fasciitis in a national referral hospital.Table 1.Organ Failure at the Admission in Patients with Necrotizing Fasciitis

Methods
This is a retrospective, cross-sectional, analytical study. It was conducted with patients over 15 years of age with a diagnosis of necrotizing fasciitis hospitalized between January 201 and December 2023 in Dr. Fernando Vélez Paiz Hospital in Managua, Nicaragua. Clinical factors such as comorbidities or organ failure on admission, as well as the LRINEC score, and the times of administration of the first dose of antibiotic and surgical intervention were analyzed and correlated with the clinical outcome of the patients.Table 2.Potentials Prognosis Determinants in Necrotizing Fasciitis that were Evaluated

Results
A total of 45 patients were included in the study, 60% of whom were women. The mean age was 56.0 ± 14.6 years-old. 86.7% of patients had at least one comorbidity. At the time of diagnosis, 31.1% of patients had renal insufficiency, 24.4% had shock, and 15.6% had altered state of consciousness (Table 1). 25 patients died for a mortality rate of 44.4%. The mean time from suspected diagnosis and administration of the first dose of antibiotics was 2.5 ± 1.4 hours (Table 2). Only 20% of patients received the first dose of the antibiotic at the first hour. 17.8% of patients underwent surgery within 6 hours of diagnosis. There was no association between prognosis and the time of initiation of antibiotic therapy and the time of initiation of surgical treatment after diagnosis of necrotizing fasciitis, probably due to a problem of sample size. 60% of the deceased had LRINEC ≥ 8 points, while only 28% in the group of survivors, OR(95%CI): 3.85 (1.10-13.46) (Table 3).Table 3.LRINEC and Mortality in Patients with Necrotizing Fasciitis

Conclusion
Patients with necrotizing fasciitis mostly have comorbidity, mainly diabetes, and almost a quarter of them have shock and a third have renal failure. A LRINEC score greater than or equal to 8 points significantly increases the risk of death in this type of patient.

Disclosures
All Authors: No reported disclosures
P-783. Bedaquiline for the Treatment of Non-tuberculous Mycobacterial Infections: Retrospective Analysis from a Large Healthcare System
Authors: Hysell Kristen , Albin John , Shen Edmund , Hurtado Rocio M 
Published: January 2025

Abstract

Background
Infections from non-tuberculous mycobacteria (NTM) cause significant morbidity and mortality. NTM species are typically highly drug-resistant, requiring prolonged courses of multiple antimicrobials with toxicities and side effects. Bedaquiline, a diarylquinolone approved for treatment of multidrug-resistant tuberculosis, has been shown to have bacteriostatic activity against NTM and appears clinically effective in small case series. We aimed to describe clinical characteristics, tolerability, and treatment outcomes in patients treated with bedaquiline for NTM infections at Mass General Brigham (MGB).
Survival time after starting bedaquiline

Methods
The study was approved by the MGB Institutional Review Board. Electronic medical records were manually reviewed to include all patients treated with bedaquiline between January 2012 through December 2023 for culture-positive pulmonary NTM infection. Kaplan-Meier estimates were used for duration of treatment and survival.
Time from bedaquiline start to stop

Results
There were 31 patients treated with bedaquiline for NTM infection; 21 patients had pulmonary infection and 10 had non-pulmonary infection (6 skin/soft tissue, 2 bone/joint, 2 disseminated). Median age at start of treatment was 56 years (IQR 44, 64). 11 patients (35%) were male, 20 patients (65%) were female. 7 patients (23%) were immunocompromised. 39% had Mycobacterium avium complex and 52% had Mycobacterium abscessus. Bedaquiline was used as salvage therapy for 15 patients (48%) and as oral step-down from an intravenous regimen for 13 patients (42%). Median time from first positive culture to any NTM treatment initiation was 1.3 months (IQR 0.5, 4.6) and median time from first positive culture to bedaquiline start was 29 months (IQR 6.7, 65). 19 patients (61%) underwent surgery in addition to medical management. Culture clearance was documented in 14 patients (45%). 6 patients (19%) experienced drug toxicity while on bedaquiline. 9 patients (29%) died during the follow up period.

Conclusion
This is the largest case series reported to date on the use of bedaquiline for NTM infection. While limited by the retrospective nature and single institutional experience, this analysis suggests bedaquiline may have an evolving role in a multidrug treatment regimen and further analysis in larger cohorts is warranted.

Disclosures
All Authors: No reported disclosures