bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1300. Themes to Support Identification of Emerging Infections Diseases
Authors: Kalvesmaki Andrea F , Peterson Kelly , Dalton Christian , Vuong Joann , Jones Barbara E , Stevens Vanessa W , Jones Makoto 
Published: January 2025

Abstract

Background
Many outbreaks are first recognized by astute clinicians who notice novel disease presentations, even before statistical anomalies are detected . In our efforts to identify COVID-19 cases using automated surveillance, we noted that the tone and content of clinical notes written early in the pandemic were much different than those written later . We investigated the content of early outbreak notes to identify general patterns that might reflect an emerging disease.

Methods
This study seeks to identify themes in a sample of clinical notes from Veteran Administration (VA) data. We used a convenience sample of early COVID-19 , early mpox, and CDC Nationally Notifiable Diseases cases as well as inference from a natural language processing (NLP) classifier that the clinical document mentioned communication with a public health authority (as an indicator of concern). These notes were reviewed by a VA infectious disease expert and a VA medical anthropologist with training in global health, the medical explanatory model, and diagnostic decision-making. Thematic analysis was applied to the notes.

Results
Five main themes were detected in the 100 documents reviewed. 1-Provider discerned something abnormal and included terms such as “unusual presentation”, and “disproportionate” to describe specific symptoms and indicate an element of being surprised. 2-Initiation of protocols for containment or treatment included terms such as “isolate” and “out of concern for… will treat with ” followed by a description of an established protocol for one or more symptoms. 3-Justification of protocol deviation included terms like “insist(ing)” on a type of test or referral to the health authorities. 4-Exposures included terms detailing locations of travel, potentially exposed persons, or locations that may have been sites of initial contraction. 5-Patient voice, as a theme, were described patient fear or agitation.

Conclusion
Unusual cases can prompt documentation of their exceptionality. Similar patterns may be seen in emerging diseases, such as H5N1, perhaps well before statistical increases are detected in the syndromes they cause. In further research, we will expand on this limited sample and explore NLP systems that could be applied to health records to scan for emerging health threats.

Disclosures
All Authors: No reported disclosures
P-1310. From Website to Parasite: An Analysis of the Unregulated Online Helminth Therapy Supply Chain
Authors: Ramirez Liliana J , Danehy Tessa L , Weiss Louis M 
Published: January 2025

Abstract

Background
Previous literature has demonstrated an inverse relationship between the prevalence of parasitic infections and chronic inflammatory diseases such as allergies, inflammatory bowel diseases, and autoimmunity. The “Old Friends” and “Hygiene” Hypotheses posit that in the sanitized society of high-income countries, the lack of allergens and microbiota is causing immune dysregulation. This research has led some individuals to pursue unregulated "helminth therapies" - ingesting parasites to relieve autoimmune symptoms - despite the lack of FDA approval or controlled clinical trials for the marketed products. The growth of an unregulated market, with transactions often conducted via untraceable Bitcoin and without transparency of origin, poses a public health risk that requires awareness among infectious disease specialists.

Methods
The researchers investigated 9 different helminth distributors to determine helminth species offered, origin, price, and “recommended dosage" of helminth therapy through the website Helminth Therapy Wiki. Helminth distributors analyzed include Symmbio, Au NAturel, Nathural, Tanawisa, Helminth Therapy NZ, Biome Restoration Ltd, The Llamas Clinic, YourSymbionts, and Autoimmune Therapies (AIT).

Results
78% of the helminth providers sold Necator americanus, i.e. hookworms (NA), 22% sold Trichuris trichiura, i.e. whipworms (TTO), 22% sold Hymenolepis diminuta, i.e. rat tapeworms (HDC), and 11% sold Trichuris suis, i.e. pig whipworms (TSO). The price of one dose of these various parasites ranged from $120 USD to $1,789 USD, depending on species and provider. “Doses” were highly variable; the dose of NA ranged from 1 - 25 larvae, while TSO ranged from 500 - 2,500 larvae. Many companies used untraceable payment methods and contact preferences to maintain secrecy. Statements on several provider websites used inaccurate marketing, over-promised benefits, and under-emphasized risks.

Conclusion
The unregulated market for helminth therapies poses significant public health and consumer protection issues, given the variability in doses, high costs, and dubious marketing claims. The lack of transparency and medical provider oversight further exacerbates the safety concerns in this market.

Disclosures
All Authors: No reported disclosures
P-1314. Assessment of the Effect of WHO and USA Antibiotic Awareness Campaigns on Search Engine Queries for Antimicrobial Resistance
Authors: Whitman Melissa , Barajas-Ochoa Aldo , Pedersen Laura 
Published: January 2025

Abstract

Background
Antimicrobial resistance (AMR) is a public health threat according to the World Health Organization (WHO), affecting all countries and at all income levels. Since the WHO’s initial action plan in 2001, multiple campaigns have arisen such as the WHO AMR Awareness Week and the CDC’s U.S. Antibiotic Awareness Week (November 18 to 24). Here, we use Google Trends (GTr) to assess the effects of three awareness campaigns on online search queries related to AMR in the US from their inception to April 2024.

Methods
GTr analyzes a sample of Google® web searches and allows users to make relative comparisons among searched terms by reporting the highest search volume as 100 and all other search volumes as a proportion of 100. Search queries related to AMR and AMR-related campaigns were used in GTr to generate normalized relative search volumes (RSVs) for each term (Table1). AMR-related campaigns' search volumes were compared to other established disease campaigns (Table 2). GTr search data from Jan 1, 2005 to April 20, 2024 was used. Descriptive statistics were used. No inferential statistics were used due to the nature of the data.

Results
When assessing RSVs for AMR-related campaigns, “Antibiotic Awareness week” had the highest RSV and peaked each November after 2017 (Figure 1a). When compared to established campaigns for other diseases, the average RSVs over time for AMR-related campaigns was smaller by a ratio of 8 (prostate cancer) to 219 times (breast cancer) (Figure 1b). Amongst AMR-related terms, “antibiotic resistance” was more searched over other terms and had only a slight increase in RSV over the years (Figure 2a). Notably, RSVs for “antibiotic resistance” each year peaked in Feb-Apr and not in November, the month of the AMR campaign (Figure 2b and 2c).

Conclusion
Despite AMR being one of the most concerning public health threats in the coming decade, public knowledge of this issue trails behind other health related campaigns. RSVs related to AMR did not increase over time despite awareness efforts. Although AMR-related campaigns take place in November, it was not the month with highest RSVs. These findings suggest that more resources may be needed to support the success of these campaign efforts.

Disclosures
All Authors: No reported disclosures
P-1331. Effect of Transfusion-Transmitted Infection Pre-Donation Deferrals on Subsequent Donations in a Military Blood Donation Center
Authors: Kwon Somin , Raiciulescu Sorana , Casleton Brian , Rivera Glorimar , Gella Melita , Winkler Erin , Osuna Angela , Casey Theresa , Yun Heather , Marcus Joseph 
Published: January 2025

Abstract

Background
To minimize the risk of transfusion-transmitted infections (TTI), all prospective blood donors are required to undergo extensive screening via questionnaire and physical exam. Donors who report behaviors or conditions that may increase risk of TTIs are temporarily deferred from donating. In recent years, significant changes to the deferral policy have been instituted to expand the donor eligibility pool and mitigate the blood supply crisis. In this study, we evaluate the impact of deferring donors at increased risk of TTI on future donation attempts to further inform how these policies may affect the military population.

Methods
This retrospective chart review evaluated all blood donors with pre-donation deferrals at a single site between October 2019 to December 2022. Among the fourteen deferral categories, seven were classified as behaviors or conditions that increase risk of TTI including: taking an anti-infective, travel to malaria-endemic area, recent tattoo or piercing, recent sexually transmitted infection (STI), recent COVID-19 infection, man who has sex with men (MSM), or other infectious concern. The rate of donation reattempts within the study period was assessed in donors deferred for TTI risk and compared to that of donors deferred for low hemoglobin matched by sex, age, and BMT status.

Results
6,352 (12.8%) of the 49,613 blood donors identified during the study had a pre-donation deferral. Over half of all deferrals were due to anemia (54.2%) and approximately a tenth for TTI risk (Table 1). We found that donors who were deferred for TTI risk were significantly less likely to attempt redonation during the study period compared to those deferred for anemia (p&lt; 0.001). On multivariate analysis, donors deferred for MSM and travel or residence in a malaria-endemic area were independently associated with a decreased redonation attempt rate and increased time to reattempt (Table 2, Figure 1).
Time to redonation for deferred blood donors with a TTI risk (dark green) or anemia (light blue).

Conclusion
Pre-donation deferrals for TTI risk were associated with a decreased rate of redonation and increased time to reattempt compared to donors deferred for anemia.

Disclosures
All Authors: No reported disclosures
499. Seeing the full picture: Adding discharge antibiotic durations to the dashboard
Authors: Dodds Ashley Elizabeth , Dyer April , Bouchard Jeannette , Johnson Melissa D , Davis Angelina , Anderson Deverick J , Anderson Deverick J , Moehring Rebekah W 
Published: January 2025

Abstract

Background
Antibiotic use (AU) at hospital discharge is often inappropriate and can account for the majority of antibiotic exposure attributed to an admission. Tracking and optimizing discharge antibiotic prescriptions (Rx) can be challenging for antimicrobial stewardship programs (ASPs), as inpatient and outpatient AU are not linked in many electronic health records. Our aim was to establish a routine metric for total antimicrobial durations across a network of hospitals comprising Duke Antimicrobial Stewardship Outreach Network (DASON) and Duke University Health System (DUHS).

Methods
We created a data extract for discharge antibiotic Rx and incorporated this into existing data infrastructure supporting DASON and DUHS hospital-based ASPs. Extracts included discharge antibiotic Rx for agents within the American Hospital Formulary Service (AHFS) category for anti-infectives (8.00). Administration instructions and quantity were used to calculate antibiotic days of therapy (DOT) by agent for discharge Rx. Exclusion criteria were: 1) antiretroviral and anti-COVID medications, 2) Rx that had a paired discontinuation order within the first 24-48 hours 3) Rx with a duration &gt; 30 days, 4) Rx where durations could not be calculated, and 5) non-enteral medications. The clinical reason for use was inferred from most proximal inpatient AU order if prescriber entered indication was available. Total antibiotic duration was determined by adding inpatient DOT and calculated discharge Rx DOT.

Results
Data from calendar year 2023 was available for 20 hospitals in DASON/DUHS. Of the initial 307,825 Rx identified, 255,543 Rx in 194,428 patients remained after applying exclusion criteria. Of interest, 83,276 (27%) patients received a discharge antibiotic Rx despite no record of inpatient AU. Data for the top 20 agents with a discharge Rx are shown in the Table; narrow spectrum agent use was common. Much of the total antibiotic course was prescribed post-discharge (range 27-90%). Genitourinary and skin/soft tissue infection (SSTI) were the most common Rx indications (Figure).

Conclusion
Antibiotics prescribed at discharge remains an important stewardship target. Data regarding AU at discharge can be combined with inpatient AU for routine monitoring to facilitate ASP interventions at TOC.

Disclosures
Elizabeth Dodds Ashley, PharmD, MHS, HealthtrackRx: Advisor/Consultant|UpToDate: Royalties Melissa D. Johnson, PharmD MHS AAHIVP, Biomeme: Licensed Technology|Scynexis, Inc: Grant/Research Support|UpToDate: Author Royalties Rebekah W. Moehring, MD, MPH, FIDSA, FSHEA, UpToDate, Inc.: Author Royalties
P-1336. Building Connections: Rise in Construction Projects correlated with New Cluster of Infantile Botulism in North Texas
Authors: Evans Amanda S , Wood William 
Published: January 2025

Abstract

Background
Regional clustering of infantile botulism is well documented in throughout the United States. We report a new cluster of cases in Northeast Texas.

Methods
We performed a single center retrospective chart review of all patients with suspected and confirmed infant botulism admitted to Children’s Medical Center Dallas from January 1, 2010 through December 31, 2023. Environmental conditions near each patient’s home prior to hospitalization were analyzed. County level data on annual birth, population, and death rates was collected from The United States Census Bureau. Construction permit data from Tyler, Texas was analyzed.

Results
46 infants with suspected infant botulism presented to care and received botulism immune globulin from 2010-2023. 3 infants were excluded due to alternative neurologic diagnosis. Features of cohort (N=43) without alternative diagnosis included in Table 1. 39 infants without honey exposure were included in environmental analysis: Group 1: 2010-2016 (N=8 infants), and Group 2: 2017-2023 (N=31 infants). The mean number of yearly residential construction permits issued (235.0 vs 352.7, p=0.01) and projects finalized (208.6 vs 333.5, p=0.01) increased from 2010-2016 to 2017-2022. The mean number of yearly commercial construction permits issued (40.1.0 vs 14.5, p=&lt; 0.01) and projects finalized (36.9 vs 17.5, p=0.01) decreased between 2010-2016 as compared to 2017-2022. A sudden cessation of infantile botulism cases occurred during the COVID-19 pandemic that appears to coincide with delays in construction projects being complete. There were no significant differences between the 2 cohorts in environmental changes near the patient’s home address: temperature, precipitation, wind speed or direction, soil moisture, or drought index (Table 2). Specific humidity was significantly higher (p=0.01) in the 30-60 days before admission for patients presenting 2017-2023 as compared to 2010-2016 (-0.53 g/kg vs 0.70 g/kg).

Conclusion
Changes in local construction patterns are associated with a notable increase in infantile botulism cases in Northeast Texas over the past 14 years. Changes in environmental conditions do not appear to play a large role in this increasing case count.

Disclosures
All Authors: No reported disclosures
P-1339. Navigating Antibiotic Susceptibility Testing: The Antibiotic Breakpoint Explorer (ABE 1.0)
Authors: Craney Arryn , Lau Suetping , Jones Addae , Mandal Sanjay 
Published: January 2025

Abstract

Background
The landscape of antibiotic susceptibility testing has evolved significantly, with constant revisions to antibiotic breakpoint definitions by key standard-setting bodies: the Clinical and Laboratory Standards Institute (CLSI), the Food and Drug Administration (FDA), and the European Committee on Antimicrobial Susceptibility Testing (EUCAST). These changes reflect advances in scientific understanding, emerging resistance patterns, and the need for harmonization across international guidelines. However, staying abreast of these evolving breakpoints can be challenging for healthcare professionals. The Antibiotic Breakpoint Explorer 1.0 (ABE 1.0) is an innovative tool that simplifies antibiotic susceptibility testing interpretation with current 2024 breakpoint interpretive criteria.

Methods
Antibiotic breakpoints for minimum inhibitor concentration (MIC) were consolidated from the CLSI, FDA and EUCAST websites for current 2024 breakpoint interpretative criteria for 15 Gram-negative pathogens and 30 antibiotics from 10 antibiotic classes (Table 1). ABE 1.0 was programmed using Python 3.12.2 and the Streamlit package. ABE 1.0 is hosted as a web-based tool hosted at www.petrifiedbugs.com. The initial beta version of the program is accessible at https://newbreak-hxdfezfsrkpuusfjpfkrby.streamlit.app/

Results
By consolidating breakpoint information from CLSI, FDA, and EUCAST guidelines for the top 15 Gram-negative pathogens, ABE 1.0 provides a simple user-friendly web-based tool to help users make informed decisions regarding antibiotic therapy and resistance management for 30 key clinically used antibiotics (Figure 1).

Conclusion
ABE 1.0 addresses the challenge of navigating antibiotic breakpoints by offering a user-friendly platform that consolidates antibiotic breakpoint information from CLSI, FDA, and EUCAST guidelines into a single, easily accessible resource.

Disclosures
Arryn Craney, PhD D(ABMM), MiraVista Diagnostics: Employee; Salary
P-1340. Genetic Factors Associated with Cefepime and Piperacillin/Tazobactam Resistance in Clinical Extended-Spectrum Beta-Lactamase-Producing Enterobacterales from the Intensive Care Unit
Authors: Hokunson Todd W , Hernandez Erica , Annavajhala Medini K , Uhlemann Anne-Catrin , Gomez-Simmonds Angela 
Published: January 2025

Abstract

Background
Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBLE) are common pathogens in intensive care units (ICUs) causing infection at a range of body sites. While carbapenems are considered first-line agents, non-carbapenem beta-lactams such as piperacillin/tazobactam (TZP) and cefepime (FEP) are often used to treat non-severe ESBLE infections. Few studies have examined the molecular epidemiology and mechanisms of TZP and FEP resistance in non-bloodstream ESBLE isolates (e.g. urine, respiratory tract).

Methods
We screened Enterobacterales isolates collected between 2015-2019 for the ESBL gene blaCTX-M using multiplex PCR and performed nanopore sequencing positive isolates (n=164). FEP and TZP susceptibilities were determined by broth microdilution (BMD). We assessed the impact of genetic factors such as the location and genetic context of blaCTX-M, other beta-lactamase gene presence, and porin gene disruption on TZP and FEP MICs (Figure 1); univariable and multivariable logistic regression were used to test their association with FEP and TZP resistance.

Results
Most isolates belonged to Klebsiella pneumoniae (47%) or Escherichia coli(45%) and were highly clonally diverse. blaCTX-M-15 was the most common blaCTX-M allele (78%) followed by blaCTX-M-27 (15%). 47% of isolates demonstrated FEP resistance (MIC50/90 8/64 µg/mL), which was significantly associated with blaCTX-M allele, location, and copy number and narrow-spectrum β-lactamase co-carriage. Only 10% of isolates were resistant to TZP (MIC50/90 4/16 µg/mL), which did not appear to be modulated by presence of blaCTX-M. In multivariable analyses, FEP resistance was independently associated with blaCTX-M copies (OR 5.21, 95% CI 1.7-24.6, p=0.01) and association with truncated ISEcp1 (OR 12.9, 95% CI 3.1-65, p&lt; 0.001); TZP resistance was associated with organism (OR 5.82 for K. pneumoniae versus E. coli, 95% CI 1.3-43.8, p=0.04), presence of blaOXA-1 (OR 5.2, 95% CI 1.3-35.9, p=0.04), and porin gene disruption (OR 6.5, 95% CI 1.3-32.3, p=0.02).

Conclusion
In summary, TZP resistance was uncommon and appeared to be independent of blaCTX-M carriage. TZP may be an appropriate treatment for nonbloodstream ESBLE infections in the ICU and should be evaluated further in clinical studies.

Disclosures
All Authors: No reported disclosures
P-1350. Novel mutations in PBP1 and AcrB associated with methicillin resistance in clinical isolates of S. aureus lacking mec variants
Authors: Mancera Maria Alejandra , Matiz Juan , Leal Castro Aura Lucia , de Paula Baptista Rodrigo , Rincon Sandra , Carvajal Lina Paola , Celis Ramirez Adriana Marcela , Reyes Jinnethe 
Published: January 2025

Abstract

Background
Methicillin-resistant S. aureus (MRSA) is a major global pathogen. In the absence of mecA and mecC, methicillin resistance has been associated with genetic changes, such as PBP1 to PBP4 (Penicillin-Binding Protein) and GdpP (c-di-AMP phosphodiesterase) mutations. However, this unusual genotype has not been reported in Colombia. Here, the aim was to characterize the genetic determinants in two methicillin-resistant clinical isolates of S. aureus lacking mec variants in Colombia.
Table 1
Genetic changes associated with methicillin resistance lacking mec variants in SaA and SaB isolates.

Methods
One isolate (SaA) was recovered in 2015 from a urine culture and the second (SaB) was obtained in 2016 from a peritoneal fluid secretion. OXA susceptibility was assessed via broth microdilution according to CLSI M100 guidelines, and species confirmation and mecA detection were performed using multiplex PCR. Genome characterization by Illumina Whole Genome Sequencing was conducted to evaluate the presence of mec variants (A, B, or C) and determinants associated with OXA resistance lacking mec variants (mutations in PBP1 to PBP4, pbp4 promoter, GdpP, and AcrB).

Results
Both isolates were identified as MRSA (OXA MIC of 16 ug/mL) but lacked mecA by PCR. In addition, genomic characterization showed that SaA (ST-5/CC-5/agr-III) and SaB (ST-765/CC-30/agr-I) do not harbor any mec variants. Moreover, the bla operon was complete in SaB, whereas was absent in SaA. Notably, we found genetic changes in SaA and SaB previously associated with methicillin resistance lacking mec (Table 1), some of which were common in both isolates (PBP1: N118D, PBP3: T438S and PBP4: T409A). Mutations in PBP2 were only detected in SaB. Remarkably, novel mutations, such as D604G in PBP1 and AcrB mutations (T52S, A282T, P285S, A577T, A677V, A711T, and V747I) were identified (Table 1).

Conclusion
Novel mutations in PBP1 and AcrB were found in clinical isolates of MRSA lacking mec variants, as well as previously documented genetic changes. This emergent unusual genotype needs further investigation.

Disclosures
All Authors: No reported disclosures