bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-873. Efficacy and Safety of Cefadroxil for Oral Transitional Therapy for Staphylococcal and Streptococcal Bloodstream Infections
Authors: Nguyen Stefanie , Minejima Emi 
Published: January 2025

Abstract

Background
Cefadroxil has a longer half-life and reduced clearance allowing for once or twice daily administration, making it an appealing alternative to cephalexin, which requires up to four times daily dosing. There has been increased interest in utilization of oral beta-lactams as oral transitional therapy for bloodstream infections (BSI) due to its favorable safety profile, however, there is currently limited data available evaluating cefadroxil for BSI.

Methods
A retrospective cohort study of adult patients hospitalized with MSSA or Streptococcal BSI from January 2022 to March 2024 and transitioned from IV to oral antibiotics was conducted. Patients were grouped by cefadroxil vs other highly bioavailable antibiotics (linezolid, TMP/SMX, fluoroquinolones) and compared for clinical outcomes of 30-day all-cause mortality, 30-day readmission, and 90-day recurrence.

Results
103 patients were included (cefadroxil 40 patients vs other 63 patients). Overall, 79% were male, 69% were Hispanic, 33% had uncontrolled diabetes, and median CCI was 2. Clinical presentation was similar with median Pitt bacteremia score of 0 in both groups (p=ns). 56% were MSSA BSI, and the most common Strep spp. was Strep pyogenes (15%). The most common source of infection was an intermediate-risk source of infection (78%). Median days of lead in IV antibiotic therapy did not differ between groups (cefadroxil 5 vs other 6, p=0.121). Majority of patients received cefadroxil dose of 1000 mg BID (65%). No differences were observed in 30-day all-cause mortality (cefadroxil 5% vs other 1.6%, p=0.56), 30-day readmission (30% vs 15.9%, p=0.14), or 90-day recurrence (2.5% vs 14.29%, p=0.084). Similar outcomes were seen in sub-analyses comparing cefadroxil dose, MSSA vs Strep spp., and source risk of BSI (p=ns). Adverse effects from oral therapy were reported in 35% of cefadroxil vs 15% in other group (p=0.12); resulting in 0 patients in cefadroxil and 4 patients in the other group changing to alternative therapy.

Conclusion
Cefadroxil had similar clinical outcomes to other highly bioavailable antibiotic therapy for transitional therapy for MSSA and Streptococcal BSI. As cefadroxil can be dosed less frequently compared to certain other oral beta lactams, it may be an attractive option for outpatient therapy.

Disclosures
All Authors: No reported disclosures
P-875. Bacteroides spp. drug resistance in patients with anaerobic bacteremia: a multicentric retrospective observational study
Authors: Kubo Ryotaro , Iwanaga Naoki , Nagaoka Kentaro , Yoshida Masataka , Takeda Kazuaki , Ide Shotaro , Takazono Takahiro , Kosai Kosuke , Morinaga Yoshitomo , Izumikawa Koichi , Yamamoto Yoshihiro , Yanagihara Katsunori , Kohno Shigeru , Mukae Hiroshi 
Published: January 2025

Abstract

Background
Bacteroides spp. are important causative anaerobes in intra-abdominal infections; however, recent reports have shown a trend toward drug resistance in non-Bacteroides fragilis. The present study aimed to evaluate bacteremia due to Bacteroides spp. by performing a multicentric retrospective observational study.

Methods
Obligate anaerobes isolated from blood culture specimens were collected from patients at Nagasaki University Hospital and five core hospitals in Toyama Prefecture from January 2012 to March 2022. Of a total of 528 patients, 102 specimens with B. fragilis and 72 with non-B. fragilis were clinically characterized using Fisher’s exact test and multiple logistic regression analysis. Drug-resistant rates over time were analyzed by the Spearman rank correlation test.

Results
In the non-B. fragilis group, compared to the B. fragilis group, the clindamycin resistance rate (non-B. fragilis group [59.7%] vs. B. fragilis group [38.2%] odds ratio [OR]=2.40 [95% confidence interval [CI]; 1.23–4.43] p=0.0058) and carbapenem resistance rate (non-B. fragilis group [27.8%] vs. B. fragilis group [10.8%] OR=3.18 [95%CI; 1.41–6.78] p=0.0049) was significantly increased. Furthermore, in the non-B. fragilis group, excluding patients who died owing to an underlying disease, a significantly increased 30-d mortality rate (non-B. fragilis group [16.7%] vs. B. fragilis group [5.9%] OR=3.20 [95%CI; 1.15–8.91] p=0.0251) was observed. Moreover, as of risk factors for 30-d mortality in non-B. fragilis bacteremia, SOFA score (adjusted OR=1.30 [95%CI; 1.11–1.57] p=0.0027) and carbapenem resistance (adjusted OR=7.05 [95%CI; 1.54–41.9] p=0.0171) were elucidated. Of note, in the non-B. fragilis group, rather than the B. fragilis group, the carbapenem resistance rate (non-B. fragilis group [r = 0.77, p=0.0141] vs. B. fragilis group [r = 0.17, p=0.6433]) and tazobactam/piperacillin resistance rate (non-B. fragilis group [r = 0.78, p=0.0120] vs. B. fragilis group [r = -0.05, p=0.8988]) have increased over time.

Conclusion
Non-B. fragilis isolated from blood cultures, compared to B. fragilis, exhibited an increasing trend in carbapenem and tazobactam/piperacillin resistance and contributed to 30-d mortality.

Disclosures
Shigeru Kohno, n/a, SHIONOGI & CO., LTD.: Board Member|SHIONOGI & CO., LTD.: Grant/Research Support Hiroshi Mukae, M.D., Ph.D., AstraZeneca: Lecture fees|Gilead Sciences: Lecture fees|GSK: Lecture fees|MSD: Advisor/Consultant|MSD: Lecture fees|Pfizer: Lecture fees|Shionogi & Co., Ltd.: Advisor/Consultant|Shionogi & Co., Ltd.: Grant/Research Support|Shionogi & Co., Ltd.: Lecture fees
P-878. The Impact of Inappropriate Empirical Antibiotic Choices on Hemodynamics in Multidrug-Resistant Bacterial Sepsis
Authors: Pakapanich Sarunya , Panichote Anupol , Meesing Atibordee 
Published: January 2025

Abstract

Background
Empirical antibiotics are crucial in managing sepsis, especially in multidrug-resistant (MDR) bacteria. This study aims to investigate the hemodynamic consequences of administering inappropriate empirical antibiotics to sepsis patients with MDR bacteremia.
Characteristics of the Patients

Methods
This ambispective cohort study (January 1, 2018, to December 31, 2023) focused on adults over 18 with MDR septicemia.
The inappropriate empirical antibiotic was defined as patients who did not receive the first antibiotic active in vitro against the bacteria. The primary outcome was shock control rates within 3 hours after vasopressor use.
Sepsis data and shock control

Results
Our study included 290 patients; 177 (61.0%) received inappropriate empirical antibiotic therapy. Escherichia coli and Klebsiella pneumoniae were the most common pathogens. The median time to antibiotic initiation was longer in the inappropriate group (370 minutes; IQR 139–1135) than in the appropriate group (190 minutes; IQR 82–550). Shock control within 3 hours was achieved by 73.4% in the inappropriate group and 75.2% in the appropriate group, and within 6 hours by 79.7% and 79.6%, respectively. Cox regression showed no significant difference in time to shock control or 28-day mortality due to inappropriate empirical antibiotic (HR 0.82; 95%CI 0.38–1.77 for 3 hours, HR 0.87; 95%CI 0.46–1.64 for 6 hours, and HR 1.25; 95%CI 0.82–1.91 for 28-day mortality), even after adjusting for various confounders. Achieving shock control correlated with lower 28-day mortality (HR 0.17; 95%CI 0.11–0.25 for 3 hours, HR 0.15; 95%CI 0.10–0.21 for 6 hours).
Probability of shock control at 3 hours

Conclusion
The choice of empirical antibiotics administered was not associated with shock control or mortality outcomes.

Disclosures
All Authors: No reported disclosures
P-883. Descriptive single center study on hospital acquired gram negative bloodstream infection: epidemiology, susceptibilities and outcomes in a six-year period
Authors: Palanivetpillai Sivanthini , Dingle Tanis , Smith Stephanie W 
Published: January 2025

Abstract

Background
Hospital acquired (HA)gram negative bacteremia contribute to substantial mortality and morbidity. Understanding the epidemiology of this entity including susceptibility patterns can inform appropriate antimicrobial therapy.
Objective: To describe the epidemiology, antimicrobial susceptibilities and outcomes of hospital acquired gram negative blood stream infection over six-year period in a quaternary care hospital.

Methods
We used the Infection Prevention Control data base to identify all cases of hospital acquired -gram negative bacteremia from Jan 1 2014 to Dec 31 2019. Charts and susceptibilities were reviewed retrospectively.

Results
440 HA-gram negative bacteremia cases with 469 gram negative bacterial isolates were included in the study after the exclusion of repeat positives within the first 2 weeks of first positive culture. 65% were male. The mean patient age was 62. Mortality was 23% at 30 days. 90% were monomicrobial infection. The majority had secondary blood stream infection accounting for 80% while 20% had primary blood stream infections. The most common source of secondary blood stream infections was UTI at38%. E. coli was the most common organism isolated during this period followed by K. pneumoniae and P aeruginosa, 44%, 16% and 11% respectively. 14% of isolates were ESBL/AMPC organisms with increasing rates over time. Only 77% of P. aeruginosa was susceptible to meropenem. 42%(n=22/52) of Pseudomonas isolates were multidrug resistant and 12%(n=6/52) were identified as difficult to treat resistance. Enterobacterales group organisms (n=372) were susceptible to ceftriaxone 82%, meropenem 99%, piperacillin-tazobactam 80%, ciprofloxacin 77% and TMP-SMX 74%. Overall, vast majority of gram-negative isolates were susceptible to meropenem (97%).

Conclusion
Over the six-year period there was a slight increase in ESBL/AMPC organisms but resistance of non ESBL organisms remained stable. The majority were susceptible to meropenem (97). A significant percentage of P. aeruginosa was resistant to meropenem (23%).

Disclosures
All Authors: No reported disclosures
P-924. Infective Endocarditis Outcomes in Older Patients with HIV
Authors: Papamanoli Aikaterini , Kalogeropoulos Andreas P , Psevdos George 
Published: January 2025

Abstract

Background
Previous reports in patients with HIV (PWH) and infective endocarditis (IE) have reported variable mortality compared to their non-HIV counterparts. However, most studies are older, have included younger patients with high rates of IV drug use, and uncontrolled HIV status with low CD4 count. Contemporary antiretroviral therapy has stabilized HIV, but little is known about IE outcomes in the current PWH population, as underlying HIV-related inflammatory process may impact outcomes or HIV status may affect therapeutic approaches due to access issues or provider bias.Table 1.Baseline characteritics of the propensity matched cohorts.

Methods
We used data from the TriNetX Research Network, an electronic health records network with over 100 million patients. We identified (1) a cohort of patients age ≥65 with HIV (ICD-10-CM code B.20) and IE (code I33.X) diagnosed between 1/1/2014 and 12/31/2023, and (2) a propensity score-matched cohort of patients age ≥65 with IE without HIV, matched for demographics, social history including substance abuse, and comorbid conditions. We evaluated 1-year rates of all-cause mortality, stroke, heart failure, and cerebral infections. We also evaluated the proportions of patients who underwent cardiac surgery in both groups. We used Cox proportional hazards regression to compare 1-year outcomes and logistic regression to estimate odds ratio for surgical treatment.Figure 1.One-Year Kaplan-Meier rates of death, incident stroke, incident heart failure, and cerebral infections among patients with infective endocarditis and HIV (+) (black line) vs. HIV (-) (red line) status

Results
We identified 269 PWH and IE and 269 matched patients with IE without HIV. The baseline characteristics of the cohorts were well balanced, Table 1. After 1-year, 68 (28.5%) patients in the PWH group had died vs. 69 (30.4%) in the non-HIV group (HR: 0.88, 95%CI 0.63 – 1.23; P=0.46). Both patient groups experienced similar 1-year rates of stroke (7.6% vs. 4.3%; P=0.23), heart failure (14.3% vs. 16.5%; P=0.55), and cerebral infections (0.8% vs. 0.8%; P=0.99), Fig. 1. Only 10 patients in each group (3.7% for both) underwent cardiac surgery (P &gt;0.99).

Conclusion
In contemporary older (age ≥65) PWH and IE, compared to matched patients without HIV and IE, no difference in 1-year mortality was observed. Other IE-associated outcomes were also similar. Interestingly, rates of cardiac surgery were similar but low in both groups. Therefore, our data suggest that possible HIV-related inflammation does not affect outcomes in IE among older patients with stable HIV status.

Disclosures
All Authors: No reported disclosures
P-942. Infective Endocarditis in Pregnancy: a Retrospective Review of Maternal and Neonatal Outcomes
Authors: Robinson Andrew J , King Madeline , Hanretty Alexandra , Kludjian Geena 
Published: January 2025

Abstract

Background
Infective endocarditis (IE) in pregnancy has an annual incidence of 0.006%. As rates of injection drug use increase across the US, there is the likelihood that the rates of pregnant people with IE increases. There is a paucity of data of IE in pregnancy and implications on maternal and neonatal outcomes. The purpose of this retrospective chart review was to describe the maternal outcomes of patients who are pregnant with IE and neonatal outcomes from a tertiary care center with a level 3 neonatal intensive care unit (NICU).

Methods
33 patients were identified as having both IE and pregnancy from January 1, 2017, through January 31, 2022; 16 met inclusion criteria. Data was matched to birth records and 10 neonates were included. Maternal outcomes included survival, clinical cure, complications in pregnancy, type of birth and term of childbirth. Neonatal outcomes included survival, need for NICU admission, treatment for neonatal abstinence syndrome (NAS), and complications at birth including social issues. All maternal and neonatal results are reported in figures 1-3.

Results
All patients had IE of their tricuspid valve, and 1 had concomitant aortic valve infection. None had valvular surgery during pregnancy, and one had valvular surgery after pregnancy. Preeclampsia occurred in 1 patient. 40% of births were preterm, which is higher than the national average of 10.4%; 10% were cesarean births, 90% were vaginal. 70% of neonates required NICU admission and treatment for NAS, and 40% required respiratory support. The average neonatal length of stay was 39.9 days. 6 babies had delayed discharge due to social issues.

Conclusion
The study demonstrates 100% maternal and neonatal survival, however, conveys significant neonatal morbidity, including need for NICU level of care, increased rates of preterm births, need for treatment for NAS and prolonged hospitalization due to social issues. There are potential health consequences for the neonate, as treatment for NAS has been shown to increase risk for substance use disorder later in life. This study is limited by its small sample size; however, this cohort is one of the larger cohorts to represent this population.

Disclosures
Madeline King, PharmD, Innoviva: Advisor/Consultant Alexandra Hanretty, PharmD, Abbvie: Advisor/Consultant
P-943. Adherence to Guideline-Recommended Duration of Antibiotic Treatment for Uncomplicated Cardiovascular Implantable Electronic Device Lead Infections
Authors: Cummings Shenae , Al Shaikhli Hiba , Sohail Muhammad R , Vijayvargiya Prakhar , Hernandez Gabriel , Bensler James , Garrigos Zerelda Esquer 
Published: January 2025

Abstract

Background
Cardiovascular Implantable Electronic Device lead infection (CIEDLI) is defined as infection involving the leads without concurrent valvular endocardial involvement. These infections are categorized as complicated when extracardiac infection is present and as uncomplicated when distant sites of infection are absent. According to the American Heart Association (AHA), uncomplicated CIEDLI due to Staphylococcus aureus should be treated for 2 to 4 weeks of antibiotic treatment, while non-S. aureus infections typically require a 2-week course. We aimed to evaluate physician adherence to AHA guidelines regarding duration of treatment for CIEDLI.

Methods
We retrospectively reviewed adults presenting with CIEDLI at our institution between 2015 and 2023 to identify those with uncomplicated infection. Physician recommendations regarding treatment duration for CIEDLI were examined. Patients with evidence of CIED-related endocarditis, complicated CIEDLI, and pocket infections without evidence of CIEDLI were excluded.

Results
Twenty-three patients met study criteria. The median age at the time of presentation was 66 years (IQR 46-75) with the majority being male (13/23, 57%) and Caucasian (12/23, 52%). Most patients had an Implantable Cardioverter Defibrillator (11/23, 48%). S. aureus was the most common causative pathogen (13/23, 56%), followed by coagulase negative staphylococci. Only 30% (7/23) of patients received therapy for the duration recommended by guidelines, while the remaining 70% were treated for longer periods, up to six weeks, despite having uncomplicated infection. Side effects to antibiotic therapy (acute kidney injury) were reported in two patients receiving prolonged treatment, whereas none were reported in the group treated according to guidelines.

Conclusion
Our study highlights a lack of adherence to AHA guidelines regarding the duration of antibiotic treatment for uncomplicated CIEDLI. Future efforts should focus on improving awareness and implementing evidence-based practices to optimize patient outcomes, minimize unnecessary antibiotic exposure, potentially mitigating the development of antibiotic resistance, and conserve healthcare resources.

Disclosures
Muhammad R. Sohail, MD, Angiodynamics: consulting fees from Medtronic, Phillips and Angiodynamics|Medtronic: Honoraria|Medtronic: Consulting fees from Medtronic, Phillips and Angiodynamics|Phillips: consulting fees from Medtronic, Phillips and Angiodynamics
P-954. Integration Station - The Train Stops Here: Measuring Effectiveness of Integration of Medicinal Chemistry and Clinical Practice Content in a Required Infectious Diseases Pharmacotherapy Course for Pharmacy Students
Authors: Nieto Marcelo , Cady Beth 
Published: January 2025

Abstract

Background
Pharmacy school accrediting bodies require curricular integration with medicinal chemistry, pharmacology and practice in the curriculum. No studies discuss how to execute that integration effectively. Two pharmacy faculty (one from pharmaceutical sciences and one from pharmacy practice) developed an innovative method to integrate their content in a required ID course. The goal was to determine if exam scores improved.

Methods
Two faculty at one school of pharmacy developed an innovative method to deliver integrated content in a required ID pharmacotherapy course. They utilized methods of backward design and in-class application during the 2024 course delivery. Objectively, exam scores were compared to prior years (both overall scores and individual content questions such as pharmaceutical science and pharmacy practice) to assess effectiveness of content delivery.

Results
All of the infectious diseases content was assessed on two exams (exam 3 and 4) in the required course. The exam 3 average from 2024 was 71% and average scores from the three years prior were 72% (2023), 73.3% (2022), and 65.8% (2021). The exam 4 average from 2024 was 80.4%, and past average scores were 68.4% (2023), 69.3% (2022), and 67.1% (2021). Individual content between pharmaceutical sciences and pharmacy practice content from the exam scores from 2024 were higher than all previous exam scores, with a range of 1.6-14% points better in practice content, and 1.6-12.2% points better in science content.

Conclusion
While there may not have been a dramatic increase in exam scores from the 2024 iteration compared to the previous years, it can be noted that there were some improvements with the newly implemented method of integrated content delivery. Despite the fact that the overall exam 3 average did not increase in 2024 compared to 2023/2022, it is important to note that the content of the exam was weighted differently. There was 1.5x the amount of medicinal chemistry content on the 2024 exam vs previous exams. Students tend to perform worse on medicinal chemistry content. With improved exam scores, this method of integrated science and practice content appears to have been delivered more effectively than in past years.

Disclosures
All Authors: No reported disclosures
P-959. Evaluation of Online Medical Education to Improve Pre-Exposure Prophylaxis (PrEP) Knowledge and Competency among Providers
Authors: Devlin Samantha A , Friedman Eleanor E , Kasal Nikki , Ducheny Kelly , Johnson Amy K , Liegeon Geoffroy , Ridgway Jessica 
Published: January 2025

Abstract

Background
Pre-exposure prophylaxis (PrEP) use for HIV prevention remains low among Black women in the U.S. compared to their need. Barriers to uptake include provider discomfort prescribing PrEP to this group. We sought to evaluate the impact of medical education on providers’ knowledge and attitudes toward PrEP among Black women.

Methods
Providers at two community health centers in Florida and Illinois participated in a live, online PrEP training and completed an online pre- and post-test. The training lasted 45-60 minutes and included didactic and interactive content to equip providers with the clinical knowledge for prescribing PrEP (e.g., indications/side effects, PrEP during pregnancy/breast-feeding, maintenance of therapy) while building their competency discussing PrEP with Black women (e.g., culturally-competent and “health-based” rather than “risk-based” scripts). The test evaluated objective knowledge of PrEP, attitudes toward PrEP and discussing PrEP with/prescribing PrEP to Black women, and likelihood of prescribing PrEP in the future. Data were analyzed descriptively.

Results
Nineteen providers completed the pre-test and fifteen providers completed the post-test. Most were physicians or nurse practitioners (68%, 13/19 and 80%, 12/15, respectively) and female (63%, 12/19 and 60%, 9/15, respectively). In the pre-test, 32% (6/19) of participants thought that pregnant women should not use PrEP; 100% (15/15) of post-test participants understood that PrEP was safe during pregnancy. In terms of discussing PrEP with Black women, originally 53% (10/19) of participants rated their comfort level as “Poor” or “Fair”, which fell to 13% (2/15) after the training. In the pre-test, 47% (9/19) of participants rated their comfort level in prescribing PrEP to Black women as “Poor” or “Fair”, which decreased to 20% (3/15) in the post-test. When asked how likely they were to prescribe PrEP to a Black woman within the next 6 months, 42% (8/19) of participants stated “Likely or “Very Likely” which increased to 80% (12/15) after the training.

Conclusion
Knowledge of PrEP, comfort discussing PrEP with Black women, and intention to prescribe PrEP all improved post-education. Additional data is needed to evaluate the long-term impact of the training on PrEP uptake among Black women.

Disclosures
Jessica Ridgway, MD, Gilead Sciences: Expert Testimony