bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-912. A 10-Year Retrospective, Single-Center Analysis of Nocardiosis in Immunocompetent and Immunocompromised Hosts: Clinical and Microbiological Features, Treatment Outcomes, and Determinants of Central Nervous System Involvement
Authors: Machiavello Roman Francisco J , Grubman Allison , Azar Marwan M , Farhadian Shelli F 
Published: January 2025

Abstract

Background
Nocardia species are organisms with the potential to affect numerous organ systems, including the brain. However, it is unknown whether specific host or microbe factors are associated with central nervous system (CNS) nocardiosis and whether outcomes for CNS nocardiosis differ according to host immune status.
Demographics and clinical characteristics by immune status. SOTr: solid organ transplant recipient. SCTr: stem cell transplant recipient. MSK: musculoskeletal structure, such as bone or joint. COPD: chronic obstructive pulmonary disease. WBC: white blood cell count. *The isolation of Nocardia in 2 or more non-contiguous body sites constituted disseminated disease

Methods
We performed a retrospective review of all adults admitted to Yale New Haven Hospital with laboratory-confirmed nocardiosis from 2013 to 2023. CNS involvement was defined as the identification of Nocardia spp on brain tissue or new radiological brain lesions in a patient with extra-neural nocardiosis. We performed multivariate logistic regression analyses of clinical and microbiological variables related to CNS involvement.
Nocardia species distribution by CNS involvement

Results
94 patients were included, of which 63 (67%) were immunocompromised (Table 1). The most common immunocompromising conditions were recipients of solid organ transplants (32%) and stem cell transplants (22%). Sixteen (17%) patients had CNS involvement of their nocardiosis; this included 22% of immunocompromised and 6% of immunocompetent patients (p=.056). The most common species isolated was the Nocardia nova complex (Table 2). Table 3 summarizes the univariate analysis of factors associated with CNS involvement. Black race [OR 3.7 (1.2-11.7), p=.03] and N. farcinica infection [OR 5.9 (1.8-19.3), p=.005] were associated with increased risk of CNS involvement. In a multivariate analysis, infection by N. farcinica was an independent risk factor for CNS involvement [OR 5.3 (1.5-18.7), p=.009]. There were no significant survival differences in immunocompromised hosts, with or without CNS disease, compared to immunocompetent hosts.
Univariate analysis of demographic, host immune status and organism features associated with CNS involvement.

Conclusion
N. farcinica infection was identified as an independent risk factor of CNS involvement in patients with nocardiosis. Other factors related to the net state of immunosuppression were not associated with an increased risk for CNS involvement.

Disclosures
All Authors: No reported disclosures
P-936. Incidence and Risk Factors for Ventricular Assist Device Infections: A Retrospective Review from the Middle East Gulf Region
Authors: Hisham Mohamed , Salmeh Noor , Shah Hajra , El Lababidi Rania M , Atallah Bassam , Abidi Emna , Afif Claude 
Published: January 2025

Abstract

Background
A ventricular assist device (VAD) is either a destination therapy or a bridge to heart transplant for patients with end-stage heart failure. Unfortunately, VAD infections are a major complication postimplant. We aimed to evaluate the incidence, risk factors, and outcomes for patients with VAD infections.
Baseline characteristics and risk factors for patients implanted with ventricular assist device.

Methods
We performed the single-center, observational, retrospective study on all patients who underwent VAD implantation between May 2016 and August 2022 with a minimum of 12-month follow-up post-placement. We defined VAD infections according to the International Society of Heart and Lung Transplantation (ISHLT) criteria, classifying infections into VAD-specific and VAD-related. We included all patients above 18 years of age with VAD and excluded patients who underwent VAD implantation outside our facility.

Results
We included 29 VAD patients, of which 16 were HeartMate 3 left ventricular assist devices (LVADs), 12 were HeartWare ventricular assist devices (HVADs), and one was a biventricular assist device (BiVAD). We reported an overall incidence of 41.3% (n=12/29) of VAD infections during the study period. Within one year post-implantation, we had two VAD-specific driveline infections, which isolated Pseudomonas aeruginosa and methicillin-sensitiveStaphylococcus aureus from the pus culture, and seven VAD-related infections (mediastinitis and bloodstream infections). Bloodstream infections included coagulase-negative staphylococci (n=4), Klebsiella pneumonia (n=1), andCandida tropicalis (n=1). We also had three patients with driveline infections one year after implantation. There were 15 patients requiring extracorporeal membrane oxygenation (ECMO) and one on Impella®. The mean (SD) length of stay during VAD infection was 56.5 (±37.6) days, all-cause mortality for patients with VAD infections was 41.6% (n=5/12), and the overall all-cause mortality in our study was 44.8% (n=13/29).

Conclusion
The VAD infections for patients on additional cardiac implantable electronic devices, multiple device reinterventions, or requiring temporary mechanical support complicate the overall outcome. Further studies with a larger population from the region are necessary to make better decisions about preventing and treating VAD infections.

Disclosures
All Authors: No reported disclosures
373. Closing Care Gaps: Optimizing Pre-Transplant Trypanosoma cruzi Testing
Authors: Newstead Sabrina E , Swaminathan Neeraja , Imlay Hannah 
Published: January 2025

Abstract

Background
Chronic Trypanosoma cruzi infection can be asymptomatic, but T.cruzi can reactivate and cause disease among transplant recipients following immunosuppression. Prior to transplant it is recommended to perform 2-step testing among candidates at high risk of exposure, defined as patients who were born or had prolonged residence in Mexico, Central, or South America. We reviewed transplant recipients at our institution to identify the frequency of testing, percentage with positive testing, and whether testing was being performed in the appropriate high-risk population.Figure 1:Percentage of transplant patients tested by organ type.

Methods
We identified patients who underwent organ transplant from January 1, 2018 – April 18 2024 and determined how many patients underwent T.cruzi testing. Among those with positive tests, we identified the proportion with epidemiologic risk factors; we also determined whether appropriate confirmatory testing was obtained. We identified 40 randomly selected patients registered as Spanish-speaking in our electronic medical record (EMR), reviewed their charts to determine whether they were at high risk of exposure, and identified if they received screening.Figure 2:Number of patients with high epidemiologic risk who were tested vs not tested for T.cruzi, among 40 patients reviewed.

Results
Among 1399 patients who underwent transplant (104 lung, 101 heart, 212 liver, 918 kidney, 62 multiorgan, 2 pancreas), 180 (12.9%) were tested for T.cruzi (Figure 1). Twelve of 180 tests (6.7%) were initially positive; only 8/12 (75%) positive tests were among patients with high risk for T.cruzi. Ten of 12 positive tests were sent for confirmatory testing and 2 tests were not sent or followed up. Only one patient had a positive confirmatory test and underwent post-transplant monitoring. Of 40 patients identified as Spanish-speaking in the EMR, all 40 had high epidemiologic risk but only 18 (45%) underwent appropriate pre-transplant T.cruzi testing (Figure 2).

Conclusion
We identified several care gaps in our pre-transplant T.cruzi testing, including over-testing among patients without epidemiologic risk, under-testing among patients with risk for prior T.cruzi exposure, and incomplete confirmatory testing. Our data highlight an opportunity for specific testing guidance and education to optimize patient care.

Disclosures
All Authors: No reported disclosures
P-977. Design and Implementation of a State-Wide Infection Prevention and Control (IPC) Curriculum; Delivering Comprehensive, Engaging, Accessible Content Promotes Sustained Learner Engagement
Authors: Ching Patrick R , Rittmann Barry , Cooper Kaila , Armstrong-Novak Jo Dee , Stevens Michael , Spleen Angela , Lineberger Sarah , Vanhoozer Ginger , Pryor Rachel , Sastry Sangeeta , Wooten Ryan , Doll Michelle 
Published: January 2025

Abstract

Background
In the wake of COVID-19, the Virginia Department of Health (VDH) partnered with Virginia Commonwealth University Health System to produce a comprehensive IPC curriculum to address known gaps in education among healthcare providers. A 2021 needs assessment conducted by VDH found needs for comprehensive IPC education that was more accessible, engaging, and interactive.
Core Content Attendee Work Settings

Methods
A tiered curriculum was developed to address the identified needs from a variety of healthcare provider types: Foundational, Intermediate, and Advanced, targeting respectively concepts critical for anyone in the healthcare environment, concepts for HCP actively engaged in IPC activities in their facility, and concepts for those leading IPC programs or healthcare facilities. The education was delivered in a hybrid model with virtual-synchronous and virtual-asynchronous offerings in addition to in-person conferences. To rapidly build engaging content, expertise to create content was contracted from experts in IP across the United States. Evaluations and content created from 7/2021-4/2024 were reviewed and summarized.
Total Attendees by Learning Experience

Results
Eighty individual modules organized into 3 core courses, a webinar series, and specialty site series were created by 62 individual IPC experts in less than 3 years. The program conducted 4 in-person conferences and 2 additional synchronous virtual conferences, and 13 live webinars. Materials remain accessible for on-demand learning. Content has been consumed by 4152 attendees (by total # registrations, not unique participants) across 43 states and 19 different countries. The breakdown of learner types is shown in Figure 1. Learners were more likely to access live virtual content (3472) than on-demand virtual content (509) or in-person events (171). Total attendees by event type over time are shown in Figure 2.

Conclusion
By leveraging existing expertise within the Infection Prevention community of professionals, a comprehensive IP program was rapidly implemented and provided sustained educational opportunities to HCP. HCPs preferred live virtual events to other delivery models to access the content.

Disclosures
All Authors: No reported disclosures
P-990. Inequities in Testing for Infants Perinatally Exposed to Hepatitis C Viral Infections — Tennessee, 2018–2023
Authors: Thomas Christine M , Wingate Heather , Roberts Shamia , Sizemore Lindsey , Fill Mary-Margaret A , Jones Timothy F , Schaffner William , Dunn John R 
Published: January 2025

Abstract

Background
National guidelines recommend testing infants perinatally exposed to hepatitis C virus (HCV). We sought to examine sociodemographic factors associated with HCV testing and infection among Tennessee infants.
Comparison of Testing Practices for Infants Perinatally Exposed to HCV by Sociodemographic Characteristics — Tennessee, January 2018–July 2020
1 Percentages might not add up to 100% because of missing data.
2 This analysis excludes 177 infants with HCV testing that did not adhere with guidelines.

Methods
The Tennessee Department of Health conducts active perinatal HCV surveillance by requesting that clinicians report all HCV test results for perinatally exposed infants. For infants born during January 2018–July 2020, we linked birth certificate sociodemographic information with HCV test results as of July 31, 2023. We defined HCV RNA testing at 2–36 months or antibody testing at 18–36 months of age as guideline-adherent; testing conducted outside these ages as not guideline adherent. In Tennessee, perinatal hepatitis C is considered confirmed if positive RNA testing at 2–36 months, probable if positive antibody testing only at 18–36 months, and excluded if negative RNA testing at 2–36 months or negative antibody testing at ≤ 36 months of age. We calculated odds ratios (OR) to identify sociodemographic factors associated with guideline-adherent testing.

Results
Among 3,020 infants perinatally exposed to hepatitis C, 776 (26%) had guideline-adherent HCV testing, 177 (6%) had testing that was not guideline adherent, and 2,067 (68%) did not have any testing reported. Infants born to Black or Hispanic persons had lower odds of guideline-adherent testing, compared with White (OR = 0.33 [95% CI: 0.20–0.53]) or non-Hispanic (OR = 0.27 [95% CI: 0.11–0.68]) persons. Infants had higher odds of guideline-adherent testing if born to a person residing in a medium or small, compared with large metropolitan areas (OR = 2.94 [95% CI: 2.32-3.72]), or if public insurance was used at birth, compared with private insurance (OR = 1.64 [95% CI: 1.23–2.18]) (Table). Of 798 infants with hepatitis C status determined by 36 months of age, 51 (6.4%) had either confirmed (n = 45) or probable (n = 6) hepatitis C.

Conclusion
Most perinatally exposed infants in Tennessee were not tested for hepatitis C. Black and Hispanic infants were less often tested and residents of medium or small areas more often tested. Equitable implementation of testing practices for perinatally exposed infants is necessary to avoid compounding disparities in hepatitis C treatment.

Disclosures
All Authors: No reported disclosures
P-994. Cellular and humoral immunological profile of Human T-Lymphotropic Virus type I (HTLV-1) in a pediatric case series
Authors: Rojas Juan P , Donneys Diana , James Ingara 
Published: January 2025

Abstract

Background
Human T- lymphotropic Virus type 1 (HTLV-1) is a powerful oncovirus. In South America there is a high incidence of cases in countries such as Brazil, Peru and Colombia, mainly affecting the indigenous and Afro-descendant population. In children, the main clinical findings are dermatological manifestations followed by lung disease, opportunistic coinfections, and autoinflammatory disorders. The main target of HTLV-1 is CD4+ T lymphocytes, which are the regulators of the acquired immune response, but It’s also capable of infecting CD8+ T lymphocytes, B cells, dendritic cells and synovial cells.
The purpose of this study is to describe the humoral and cellular immunological profile in pediatric patients diagnosed with HTLV-1 in a reference center in Cali, Colombia.Table 1.Characterization of cellular immunity in pediatric patients diagnosed with HTLV1 (n = 6)BL: B lymphocyte, TL: T lymphocyte Source: Self elaboration

Methods
This is an observational, descriptive, retrospective cross-sectional study carried out between January 2017 and March 2021.Table 2.Characterization of humoral immunity in pediatric patients diagnosed with HTLV1 (n = 16)

Results
Nineteen patients were included in this study with a median age at diagnosis of 94 months, most of them were schoolchildren (52.6%), 50% of patients had elevated B lymphocytes (CD19), and 50% of them had normal range cytotoxic T lymphocytes (CD8+) and helper T lymphocytes (CD4) (Table 1 and graph 1). None of the patients had decreases in serum immunoglobulins (IgM, IgG, IgE and IgA) (Table 2 and graph 2)Graph 1.Cellular immunological profile (n=6)

Conclusion
HTLV-1 immunosuppression is not mediated by low levels of lymphocyte subpopulations in the pediatric population.Graph 2.Humoral immunological profile (n=16)

Disclosures
All Authors: No reported disclosures
P-998. A multi-center observational study in Northern Italy to evaluate the impact of Sepsis bundle in Obstetric Settings: the SOS study
Authors: Colaneri Marta , Biscarini Simona , Tiranini Lara , Pesare Rebecca , Valsecchi Pietro , Seminari Elena Maria , Spinillo Arsenio , Bandera Alessandra , Ferrazzi Enrico Maria , Gori Andrea , Carenzi Laura , Pusterla Luigi , D’Amico Federico , Raimondi Alessandro , Puoti Massimo , Vallicella Elisa , Grisolia Gianpaolo , Zavatta Alice , Cetin Irene , Bonetti Alice , Baldanti Fausto , Cambieri Patrizia , Pan Angelo , Seminari Elena Maria , Torriani Camilla , Monti Cristina Maria , Bruno Raffaele 
Published: January 2025

Abstract

Background
Maternal sepsis presents challenges in early detection and treatment. A pregnancy-specific sepsis scoring system (MEOWS) and management bundles for pregnant septic patients were recently introduced, but there is a lack of data on their effectiveness. Our study aims to assess the impact of implementing a Lombardy sepsis bundle for septic pregnant and puerperal patients.Table 1:Demographic and clinical data of the patients included

Methods
The SOS, a retrospective multicenter study across 7 Lombardy Hospitals, focuses on adult pregnant and puerperal women diagnosed with sepsis according to SCC [1]. Medical records from 2 periods were analyzed: pre-bundle implementation (May 2015 - May 2018) and post-bundle implementation (Jan 2019 - Jan 2022). The primary outcome was to describe clinical and microbiological data, while the secondary outcome was to evaluate the impact of the Sepsis bundle on the length of stay (LOS), the timing of antibiotic treatment, and the rate of positive blood cultures (BCs).

Results
Eighty patients (24 in the pre-bundle and 56 in the post bundle period) were found (Table 1). Overall, median age was 31 years, they had few underlying comorbidities and mostly were pregnant (rather than puerperal) in the moment of sepsis occurrence (Table 2).
More than half of the post-bundle patients had a high MEOWS score (62%) and an mSOFA score of more than 1 (70%) (tablee 2). Microbiological data are detailed in Table 3, while outcome data in Table 4. No significant differences were found in the rate of positive BCs (p=1) between the 2 periods. Similarly, the rate of antibiotic treatment started before BCs collection, and the LOS did not significantly differ (p=0.40). However, in the post-bundle period there were both a marked increase in infectious disease (ID) consultations (p=0.003), and a reduction of neonatal Intensive Care Unit admission (p=0.013).

Conclusion
While the bundle did not significantly improve maternal outcomes, it led to an increased number of ID consultations, providing a more comprehensive understanding of sepsis severity, and a consequent reduction of neonatal severity conditions.

Disclosures
All Authors: No reported disclosures
P-1006. If You Build It Will They Come?: Lessons Learned from a Dedicated Congenital Syphilis Clinic
Authors: Rochat Ryan H 
Published: January 2025

Abstract

Background
Cases of congenital syphilis (CS) have been rising for the past decade, with 3755 infants affected in 2022 alone. Texas accounted for nearly 25% of these children, with 922 cases reported in 2022, up 35% from the year prior. A review of the management of these children across our system of over 2000 medical professionals suggested that a clinic dedicated to CS, may be warranted to ensure that these children receive evaluations as recommended by the CDC. Here we report on the logistics of this clinic with insights into its success and failures, and the implication of these findings for the general pediatric population and its providers.

Methods
Laboratory and encounter specific data for children diagnosed with CS from 1/1/2010 to 12/31/2021 was obtained from our Epic® electronic health record (EHR). Additionally, we requested scheduling and appointment information for patients evaluated in our CS clinic at Texas Children’s Hospital which started in 2022.

Results
Prior to the establishment of our dedicated CS clinic in 2022, we identified 458 children born into our hospital system and had been evaluated for CS from 2010-2021. Of these 458 infants, 233(51%) had a subsequent encounter within our system at ≥2months of age, with only 66(28%) of them having a repeat RPR. From 4/2022-12/2023 there were a total of 367 outpatient encounters in our CS clinic (239 completed, 128 no show/cancelled). All children seen in our CS clinic had repeat RPR testing, in addition to age-appropriate developmental screening, according to CDC recommendations.

Conclusion
The rising rate of CS in the US should concern all pediatricians. Our findings call attention to the reality that follow up is not guaranteed and recommendations are not universally followed. Given that CS cases were at lifetime lows a decade ago, there is a concern that providers may be unaware of current management recommendations for these children. Integrated healthcare systems, coupled with clinical informatics, give us the opportunity to address these problems in real-time and make sure no child falls through the cracks. Our results and experiences from this unique clinic will be invaluable in providing timely feedback for tailoring education to providers and families to make sure that these children get the care they deserve.

Disclosures
Ryan H. Rochat, MD, PhD, MS, Merck Sharpe Dohme: Grant/Research Support
P-1007. Cytomegalovirus reinfections and viral shedding in seropositive pregnant women
Authors: Ross Shannon , Boppana Suresh , Vinson Anslee , Fowler Karen 
Published: January 2025

Abstract

Background
Congenital Cytomegalovirus (CMV) is a common cause of hearing loss and other sequelae in children. Rates of congenital CMV are higher in maternal populations seropositive before pregnancy, often due to the acquisition of a new strain of CMV. The objective of this study is to document CMV reinfections in CMV seropositive pregnant women and correlate them with CMV shedding.

Methods
Pregnant women positive for CMV IgG were enrolled after their first prenatal visit but before 20 weeks gestation and followed prospectively. Maternal demographics were obtained, and blood, urine, saliva, and vaginal samples were obtained at enrollment and regular intervals during pregnancy and immediately post-partum. Maternal sera were analyzed for strain-specific anti-CMV antibody reactivity to four CMV epitopes, and when a new strain-specific antibody reactivity occurred during pregnancy, they were considered reinfected. All specimens were tested for CMV DNA by Real-time PCR.

Results
Among 165 pregnant women, the mean age at enrollment was 26.6 years (±5.4). 80% of the women were non-Hispanic Black and never married. At study enrollment, 52 women (31.5%) had antibody reactivity to one CMV strain while 83 (50%) had 2 or more strain-specific antibodies. There was no difference in viral shedding at study enrollment between the women with one strain-specific antibody (4/52, 7.7%) compared with women with two or morestrain specific antibodies (11/83, 13.3%, p=0.34). Ten of 165 women (6%) acquired antibodies reactive with a new strain of CMV during the study period (reinfection). Among the 10 women with CMV reinfection, 3 (33.3%) had CMV shedding, with 2 shedding in the visit before documented serological reinfection and one with viral shedding after reinfection. The majority of women with reinfection provided direct care of young children (9/10), lived in a household with 3 or more people (8/10), and lived with children &lt; 6 years of age (8/10).

Conclusion
In this urban, young cohort of seropositive pregnant women, CMV reinfections occur. However, viral shedding was documented in only a third of women with new CMV antibody reactivity. Most women with reinfection had close contact with young children.

Disclosures
Suresh Boppana, MD, GSK: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support Karen Fowler, DrPH, Moderna: Advisor/Consultant