bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-851. Evaluation of a multifaceted intervention on the management of uncomplicated gram-negative bacteremia
Authors: Shihadeh Katherine C , Deaney Michael , Craig Alex , Cooper Margaret M , Jenkins Timothy C 
Published: January 2025

Abstract

Background
Randomized, controlled trials found 7 days of antibiotics to be as effective as 14 days for the treatment of uncomplicated Gram-negative bacteremia. The routine use of repeat blood cultures for these uncomplicated infections is low yield and not recommended. A review of the management of these infections at Denver Health found the median duration of therapy was 10 days and nearly two-thirds of patients had blood cultures repeated. A multifaceted intervention was implemented to reduce duration of therapy and use of repeat blood cultures. The purpose of this study was to evaluate the impact of the intervention.

Methods
This retrospective cohort study took place from 1/2019 - 12/2019 (pre-intervention) and 10/2022 - 9/2023 (post-intervention). 3 interventions were implemented including a) development and dissemination of a guideline for the management of uncomplicated Gram-negative bacteremia which recommends 7 days of therapy and against repeat blood cultures for most patients b) clinical decision support to discourage repeat blood cultures c) prospective review of positive blood cultures with provider feedback performed by an infectious diseases pharmacist. All patients over 18 years of age with a positive blood culture with a Gram-negative organism were included. The primary outcome was duration of therapy pre-and post-intervention. The secondary outcome was proportion of patients with repeat blood cultures.

Results
Patient demographics were similar between groups. Urinary tract and E. coli were the most common source and pathogen, respectively. Most patients completed therapy with an oral agent; either a fluoroquinolone or cephalosporin. Cefdinir decreased and cephalexin increased based on institutional guidance. The median duration of therapy decreased from 10 to 7 days (p&lt; .01) and fewer patients had repeat blood cultures (60% vs 31%, p&lt; .01). There were fewer cases of C. difficile in the post-intervention group, otherwise no differences in safety outcomes.

Conclusion
Implementation of a guideline for the management of uncomplicated Gram-negative bacteremia, clinical decision support, and review of positive blood cultures with provider feedback performed by an infectious diseases pharmacist reduced duration of therapy and the use of repeat blood cultures.

Disclosures
All Authors: No reported disclosures
P-860. Managing Carbapenem-Resistant Enterobacterales (CRE) Bacteremia: Real World Data and Insights from a Quaternary Care Hospital in the United Arab of Emirates
Authors: Nasef Rama , El Lababidi Rania M , Afif Claude 
Published: January 2025

Abstract

Background
Infections caused by carbapenem-resistant Enterobacterales (CRE) represent significant clinical challenges due to their poor outcomes and high mortality. Real-world data on the treatment of carbapenem-resistant Enterobacterales (CRE) bacteremia in the United Arab of Emirates (UAE) is currently scarce. Our aim was to outline the various treatment approaches for CRE and their respective outcomes

Methods
A retrospective observational study was conducted at our quaternary hospital between July 2021 and March 2024. We included patients with bacteremia caused by CRE infections. Antimicrobial resistance genes were detected using blood culture identification panel (Biofire FilmArray). Our primary outcome was all cause mortality and secondary outcomes were clinical success and 30-days-admission rates. Clinical success was defined as microbiological cure in addition to resolution of symptoms. Data was analyzed through descriptive statistical methods.

Results
A total sample of 40 patients met the inclusion criteria, 23 males, median age of 62 (38-74.2) years and a median Charlson Comorbidity Index of 6 (1.75-8). The New Delhi Metallo-β-lactamase (NDM-1) resistance gene accounted for (32/40, 80%) of patients, of which, (19/32, 59.3%) were treated with the combination of Ceftazidime-avibactam-Aztreonam. All cause mortality was observed in (14/40, 35%) patients. The mortality observed in patients with NDM resistance gene was (12/32, 37.5%). Over all clinical success and 30-days-admission rates were (24/40, 60%) and (3/40, 7.5%) respectively.

Conclusion
In our cohort of patients with CRE bacteremia, we observed high rates of NDM resistance gene. The overall mortality rate was high at 35% which is similar to what is reported in the literature. Data is urgently needed on the management of CREs with NDM resistance gene to improve patient outcomes.

Disclosures
All Authors: No reported disclosures
P-891. Clinical Impact of Central Venous Catheter-Only Positive Cultures in Staphylococcus aureus Bacteremia
Authors: Yoon Choseok , Chang Euijin , Bae Seongman , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Lee Sang-Oh , Choi Sang-Ho , Kim Sung-Han , Kim Yang Soo 
Published: January 2025

Abstract

Background
There is limited data on patients with indwelling central venous catheter (CVC) presenting with Staphylococcus aureus bacteremia (SAB) isolated exclusively from the CVC, without positive results from peripheral venipuncture. The aim of this study was to assess the clinical characteristics and prognoses of SAB patients with cultures positive only from CVC-drawn samples.

Methods
A retrospective cohort study was conducted from 2014 to 2018 on SAB patients with indwelling CVCs. The prevalence of patients with S. aureus isolated only from the CVC (CVC-only positive group) was calculated among SAB patients with indwelling CVCs. The clinical characteristics and 90-day clinical outcomes were compared between CVC-only positive group and those with catheter-related bloodstream infections (CRBSI), where S. aureus was positive in peripheral venipuncture as CVC-drawn culture.

Results
A total of 390 SAB patients with indwelling CVC were identified during 5 years: 39 (10.0%) had cultures positive solely from the CVC, 203 (52.1%) were diagnosed with CRBSI, and the remaining 148 (37.9%) had an infection focus other than the CVC. No significant differences in underlying comorbidities or infection severity of CVC-only positive group compared to the CRBSI group. There were no significant differences in the 90-day outcomes for mortality (33.3% vs. 22.7%), recurrence (10.3% vs. 4.4%), or metastatic infection (10.3% vs. 14.8%) between the CVC-only positive group and the CRBSI group (all P &gt;0.05), except for a significantly lower incidence of persistent bacteremia in the former group (12.8% vs. 36.9%, P=0.006). In multivariable Cox regression analyses adjusted confounders, no significant differences in 90-day mortality (adjusted hazard ratio [aHR] 0.96; 95% confidence interval [CI], 0.50–1.84) or recurrence rates (aHR 1.68; 95% CI, 0.48–5.95) in CVC-only positive group compared to the CRBSI group.

Conclusion
S. aureus bacteremia isolated solely from CVCs demonstrated significant mortality and recurrence rates comparable to those observed in CRBSI. These findings indicate that S. aureus bacteremia, even when isolated solely from CVCs, should not be dismissed as contamination, underscoring the necessity for appropriate antibiotic treatment.

Disclosures
All Authors: No reported disclosures
P-893. Expedited Transition to Oral Antibiotics in Gram Negative Bacteremia Reduces Hospital Length of Stay
Authors: Nelson Zachary , Christensen Alyssa 
Published: January 2025

Abstract

Background
Uncomplicated Gram-negative bloodstream infection (GN-BSI), often originating from the urinary tract, is a common reason for hospitalization in the United States. No high-quality data exist that suggest a specific duration of intravenous treatment is indicated for GN-BSI. As such, we hypothesized that expedited transition to oral antibiotics (at the time of susceptibility testing result availability) may facilitate earlier discharge from the hospital. Efforts to reduce hospital length of stay (LOS) yield benefits to both the patient and the healthcare system and have not been as consistently reported as more traditional stewardship metrics, such as time to optimal treatment. A combination of targeted provider and pharmacist education and formal ASP recommendations documented in the medical record were used to facilitate swift transition to oral antimicrobials.

Methods
Data was collected prior to (January to July 2023) and after (August 2023 to December 2023) the intervention consisting of targeted physician and pharmacist education and formal documentation of ASP recommendations in the medical record was deployed on August 1, 2023. The post-intervention cohort was stratified by whether formal ASP recommendations were documented in the medical record, which may reflect the impact of the targeted education efforts alone. The three groups were compared using an analysis of variance.

Results
The average hospital LOS for the pre-intervention (n = 421), post-intervention without ASP recommendations (n = 260), and post-intervention with ASP recommendations (n = 83) groups were 7.13, 6.84, and 5.84 days, respectively (p = 0.63). While not statistically significant, using a conservative estimate of $1,100 per hospital day yields an estimated cost savings due to reduced LOS alone of approximately $187,200 from August to December 2023 that may be attributable to the aforementioned interventions.

Conclusion
Targeted physician and pharmacist education and documenting formal ASP evidence-based recommendations in the medical record that guide clinicians to transition to oral antibiotics when susceptibility results are available can meaningfully reduce hospital length of stay. The reduction in LOS observed in our study was greatest when the two strategies were combined.

Disclosures
All Authors: No reported disclosures
P-903. Human Parechovirus Central Nervous System (CNS) Infection in Infants: A Multicenter Retrospective Case Series of the 2022 outbreak
Authors: Sheth Avni , Shah Nisha , Fortin Oliver , Gagliardo Christina , Hauger Sarmistha Bhaduri , Calardo Sarah J , Santos-Oren Marina , Souverbielle Cristina Tomatis , Erdem Guliz , Sanchez Pablo J , Solaiman Adil , Harik Nada , Mulkey Sarah B , Downey Rachel , Angelis Dimitrios , Ansusinha Emily , Chalak Lina , Russo Susan , Teran Paul , Katragkou Aspasia 
Published: January 2025

Abstract

Background
Human parechovirus (PeVA) typically causes self-limiting respiratory and gastrointestinal infections. However, in infants, it can cause severe sepsis-like illness and CNS disease. In 2022, a CDC Health Advisory reported severe PeVA infections in young infants in multiple states. Our aim was to describe the clinical features, laboratory characteristics, and outcomes in infants with PeVA CNS infection during the 2022 multistate outbreak.

Methods
A multicenter retrospective chart review was conducted at 7 children’s hospitals (6 states) of infants with PeVA CNS infection. Cases were identified by positive CSF PCR testing using the FilmArray meningitis/encephalitis panel (BioFire Diagnostics, Salt Lake City, UT). Data were entered in REDCap and pertinent demographic and clinical data were analyzed.

Results
103 infants were admitted from March-October 2022 with 30 (29%) of the admissions occurring in July. Patients’ median age was 18 days, 55% were male, and 93% born full term. The median length of hospital stay was 3.3 days. 19% required admission to an intensive care unit, 29% had increased oxygen requirement, and 5% required inotropic support. The most common clinical manifestations were fever (84%), irritability (63%), poor feeding (37%), tachycardia (31%), seizures (23%) and hypothermia (19%). The median peripheral white blood cell count was 5.6 x109/L and median CSF white blood cell count was 3 cells/mm3. The median CRP was 0.3 mg/dL and 54% of the infants had transaminitis. Brain MRIs were obtained in 55 cases; 31 (56%) demonstrated abnormalities with diffusion restriction involving white matter and thalami. EEGs were obtained in 40 cases; 22 (55%) revealed abnormalities. 99% of our infants survived, 13% were discharged with anti-seizure medications, and 10% received developmental follow-up.

Conclusion
PeVA should be considered in young infants presenting with fever or hypothermia, sepsis-like symptoms, or meningitis even with no laboratory findings of significant inflammatory responses. PeVA CNS infection in young infants can cause neurologic injury requiring long term neurodevelopmental follow up. Nationwide epidemiological studies are necessary to elucidate the dynamics of this infection.

Disclosures
Cristina Tomatis Souverbielle, MD, Merck, inc: Grant/Research Support
P-904. Spinal Arachnoiditis and Syringomyelia in Coccidioidomycosis: A Case Series of 53 Adult Patients
Authors: Torres Bianca , Khalid Danish , Dunn Chelsea , Sharma Rupam , Kooner Lovedip , Valdez Michael , Mishra Shikha , D’Assumpcao Carlos M , Johnson Royce H , Kuran Rasha 
Published: January 2025

Abstract

Background
Central nervous system (CNS) involvement with coccidioidomycosis (cocci) is a serious infection that is universally fatal if not treated. Prior to the advent of magnetic resonance imaging (MRI), very few reports describe spinal cord involvement and autopsies often omitted spinal cord examination. Accurate and anatomic localization of areas affected by CNS cocci can be challenging due to mental status changes and the presence of brain abnormalities. Here, we describe radiologic and clinical characteristics of 53 cases of CNS cocci who had spinal MRI imaging performed.

Methods
This retrospective case series reviewed 53 adult patients at the Valley Fever Institute in Bakersfield, California. Patients had confirmed CNS cocci and MRI of at least one segment of the spinal image with and without contrast. A waiver of consent was submitted, and approval was obtained by Kern Medical’s Institutional Review Board. ICD 9 and ICD 10 codes were used to query electronic health record and cross referenced with imaging. Each record reviewed required inclusion criteria of age above 18 years, cerebrospinal fluid (CSF) abnormalities compatible with chronic meningitis and one of the following: positive CSF IgG antibody, CSF complement fixation (CF) or growth of Coccidioides on CSF culture. MRI Imaging with and without contrast of at least one of the following: cervical, thoracic or lumbar spine.

Results
77% of the patients were Latinx, 13% African American, 4% Asian and 6% Caucasian. Males make up the majority at 72%. 37% had intrathecal (IT) amphotericin (ABD) injections. Spinal cord abnormalities can be asymptomatic with the most common symptom of back pain followed by radiculopathy. Abnormal findings included leptomeningeal enhancement, arachnoid cysts, masses or adhesions, syringomyelia, myelitis, cord edema, myelomalcia, flattened cord, nerve root "clumping" or solid cauda equina.

Conclusion
This study suggests the benefit of obtaining neuro axis imaging with and without contrast on all new cases of Coccidioidal meningitis. Spinal cord involvement with CNS cocci is common and contributes to significant morbidity. Contrary to common belief, our study shows that spinal arachnoiditis occurs in patients who were never treated with IT ABD. This may suggest that IT ABD may not cause arachnoiditis.

Disclosures
All Authors: No reported disclosures
P-910. Enhancing Awareness: Early Detection of Varicella-Zoster in CNS Among Immunocompromised Patients
Authors: Sienra-Iracheta Estefania , Rodea Bianca Paola Aguilar , Lopez Angela Michelle Arias , Ramos Melissa Mariana Lopez , Ramírez-Hinojosa Juan Pablo , Castellanos Juan Pablo Venzor , Rodriguez-Zulueta Patricia , Godinez Xochitl Yadira Sanchez , Julio David Medina 
Published: January 2025

Abstract

Background
Varicella zoster virus (VZV) reactivation typically presents as herpes zoster, but central nervous system (CNS) involvement is more prevalent in immunocompromised individuals.

Methods
This retrospective study, conducted from January 2023 to March 2024 at two hospitals, aimed to characterize VZV CNS infections in this population. Twenty-seven immunocompromised patients with active herpes zoster were included. Clinical data, cerebrospinal fluid (CSF) analysis, and treatment outcomes were analyzed.

Results
The mean age was 45 years, with a predominance of males (60%). Most patients had HIV (16) with a mean CD4 count of 126, while others had cancer (5), autoimmune diseases (2), or diabetes mellitus (1). Headache was the most common symptom (64%), followed by fever (19%), altered consciousness, and behavioural changes (7%). Facial palsy was observed in 3 patients, but no seizures were reported. CSF analysis revealed hyperproteinorrachia (mean 75 mg/dL) and pleocytosis (mean 39 cells). All patients received intravenous acyclovir for an average of 14 days, with a 100% survival rate at 30 days.

Conclusion
This study highlights the importance of early suspicion and diagnosis of VZV CNS infections in immunocompromised individuals, even in the absence of classical neurological symptoms. Prompt initiation of intravenous acyclovir therapy is crucial for favourable outcomes.

Disclosures
Estefania Sienra-Iracheta, MD, PFIZER: Advisor/Consultant|STENDHAL: Advisor/Consultant Juan Pablo Ramírez-Hinojosa, MD, Abott: Honoraria|Jansen: Honoraria|Silanes: Honoraria Patricia Rodriguez-Zulueta, MD, PFIZER: Advisor/Consultant|STENDHAL: Advisor/Consultant
P-916. Use of BCID2 on CSF in nosocomial CNS surgical site infections
Authors: Walters Laura , Weber Devin , Nassur Jamie , Pettengill Matthew 
Published: January 2025

Abstract

Background
Nosocomial intracranial infections, arising from surgical procedures or neuroinvasive devices like ventricular drains or shunts, present distinct risk factors and microbiologic etiologies compared to community-acquired meningitides. Pathogens typically include Staphylococcus spp., Gram-negative bacilli, and multidrug-resistant bacteria. The current diagnostic standard for nosocomial central nervous system (CNS) infections is cerebrospinal fluid (CSF) Gram stain and culture, but rapid molecular diagnostics could improve diagnosis and treatment, enhancing patient outcomes. This pilot study aimed to assess the validity of the BioFire® Blood Culture Identification Panel 2 (BCID2) panel used for blood culture positivity detection on CSF samples in patients presenting with nosocomial meningitis/ ventriculitis. Sensitivity and specificity were calculated, and patient characteristics and co-morbidities were reviewed.
Microbiologic data comparing gold standard Gram stain and culture of CSF to BCID2 result.

Methods
Patients over 18, admitted to Thomas Jefferson University Health System hospitals between 4/1/2017 to 4/1/2024, were included if meeting Centers for Disease Control (CDC) criteria for intracranial infection or meningitis/ventriculitis.
Positive CSF samples (n=30) from 28 patients with nosocomial infections included Gram-positive bacteria (13), Gram-negative bacteria (13), and fungi (4). Positive CSF samples included those positive on culture, while control samples (n=26) had negative cultures or cultures positive for Cutibacterium acnes, an organism not detected by the BCID2 panel.

Results
Across all positive CSF specimens, sensitivity for organism detection was 76.7%. When culture-positive samples were classified based on Gram Stain, samples with organisms detected on Gram Stain had a sensitivity of 94.7% compared to 45.5% for samples with no organisms seen. For samples with organisms detected on Gram Stain, sensitivity for Gram-negative organisms was 100% and 88.9% for Gram-positive organisms. Among all control specimens, specificity was 100%.

Conclusion
The ability to rapidly identify a pathogen is crucial for managing nosocomial CNS infections effectively. Our study found that the BCID2 panel offers a promising utility in the detection of nosocomial CNS infections through CSF analysis.

Disclosures
Matthew Pettengill, PhD, Cepheid: Grant/Research Support
P-929. Identification and Treatment Outcomes of Patients with Infective Endocarditis Coinfected with Hepatitis C Virus
Authors: McQuaide Lauren C , El-Dalati Sami , Walston Bobbi Jo 
Published: January 2025

Abstract

Background
Patients with infective endocarditis (IE) often have co-morbid injection substance use and are at risk for infection with hepatitis C virus (HCV). As of 2023, only 10% of patients who inject drugs have been treated for HCV in the United States. Low rates of treatment may reflect the logistical challenges associated with HCV therapy. To improve access to treatment for patients with IE and HCV, we developed an interdisciplinary collaboration between pharmacy and clinical infectious diseases (ID) providers.

Methods
The University of Kentucky (UK) implemented a cardiovascular ID consult service in September 2021. The service including physicians, advanced practice providers, a pharmacist and nurse. The consult team worked with UK Healthcare specialty pharmacy to create a pathway connecting patients with IE and HCV to treatment and outpatient follow-up. Regimens included either glecaprevir/pibrentasvir for 8 weeks or sofosbuvir/velpatasvir for 12 weeks. IRB approval was obtained from UK. Study investigators then retrospectively reviewed the endocarditis team registry to identify patients referred for HCV treatment and collect demographic and outcomes related data.

Results
Between September 2021 and April 2024, 64 patients with IE and HCV who were referred for expedited treatment were identified. The mean age was 37.9 years and 40.6% were female. Sixty-two patients had recent injection drug use. Only 1 was treatment experienced and 51.6% had HCV genotype 1A. Seventy-five percent (48) started treatment and 57.8% were prescribed sofosbuvir/velpatasvir. Thirty-three of 48 (68.8%) patients who started treatment completed therapy. Of the 15 patients who did not complete treatment,10 were lost to follow-up and 3 had adverse drug reactions. Twenty-two of 48 had viral loads collected for SVR12 and 20 were negative.

Conclusion
Using a standardized, interdisciplinary approach, 31.3% of patients with IE and HCV completed treatment with documented evidence of SVR12. An additional 17% of patients completed therapy but were unable to complete testing for SVR12. Loss to follow-up remains the primary barrier to starting therapy and accurately recording treatment outcomes. Future efforts should focus on ease of access to treatment and follow-up.

Disclosures
All Authors: No reported disclosures