bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1124. Implementation and Evaluation of a Pediatric Tele-Antimicrobial Stewardship Program in an Integrated Healthcare System
Authors: Stallsmith Jena , Olson Jared , Hersh Adam , Valentine Marilyn E , Thorell Emily A 
Published: January 2025

Abstract

Background
Intermountain Health (IH) has had a successful adult telehealth antimicrobial stewardship program (ASP) since 2016, and Primary Children’s Hospital has also had a longstanding ASP. With 298 pediatric beds throughout the other 23 hospitals within IH, there was an opportunity to expand to these patients that were not previously reviewed. The purpose of this study is to describe the implementation and outcomes of a pediatric tele-antimicrobial stewardship program (PT-ASP) in these hospitals throughout an integrated healthcare system.Figure 1:U chart of antimicrobial days of therapy per patient day

Methods
This is a quasi-experimental, pre- post- analysis of a prospective audit and feedback PT-ASP across 23 medical centers throughout Intermountain Health in Utah. The pre-intervention group included patients &lt; 18 years of age who had antibiotics at any of these 23 hospitals between January 1, 2018, and December 31, 2019. The post-intervention group included patients &lt; 18 years of age who had antibiotics ordered between January 1, 2021, and December 31, 2022. Post-intervention patients were reviewed by a pediatric ASP pharmacist for a descriptive analysis of the daily census and interventions made. The primary outcome was antibiotic days of therapy/patient day (DOT) pre- and post-intervention. The secondary outcomes were to describe the types of interventions and the acceptance rates.Figure 2:U chart of IV antimicrobial days of therapy per patient day

Results
During the first two years of the PT-ASP implementation, 14,999 hospital census days with active antibiotic orders were reviewed. Compared to the pre-intervention period, there was a 21% decrease in total antimicrobial DOT per patient day and a 24% decrease in IV antimicrobial DOT per patient day during the intervention period. The census had a majority of NICU patients (51%). A total of 1,970 interventions were made on 1,287 unique patients, with 13% of the charts reviewed leading to an intervention. The acceptance rate of these interventions was 62%. The two most common types of interventions made were to change the antibiotic regimen and to discontinue antibiotics.Table 1:Pediatric tele-antimicrobial stewardship program intervention acceptance rates by type of intervention

Conclusion
The PT-ASP made over 1,900 interventions leading to a decrease in both total antimicrobial DOT and IV antimicrobial DOT per patient day throughout 23 hospitals in an integrated health system. A PT-ASP is a strategy to steward pediatric beds outside of a stand-alone children’s hospital.

Disclosures
All Authors: No reported disclosures
P-1141. Antibiotic administration for Staphylococcus aureus infections in US children's hospitals, 2015-2023
Authors: Walsh Tyler , Shambhavi Fnu , Newland Jason G , Fritz Stephanie A 
Published: January 2025

Abstract

Background
The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) infections in children has changed. In response to the introduction of new antibiotics published clinical data, treatment strategies have evolved. The objective of this study is to describe the antimicrobial treatment regimens for children hospitalized with this important pathogen.Table 1.Type of Infections by MRSA vs. MSSA

Methods
A retrospective observational study was performed using the Pediatric Health Information System (PHIS) data, including all patients discharged from a PHIS-member hospital from October 1, 2015 to June 31, 2023. Patients with ICD 10 codes identifying an MRSA or MSSA infection and indicating the type of infection were included (Table 1): bacteremia, endovascular, pneumonia, skin and soft tissue infection (SSTI), osteomyelitis, and myositis. The proportion of anti-staphylococcal antibiotics of interest received by all patients, patients with MRSA infections, and patients with MSSA infections were calculated by year.Figure 1.Percent of Antibiotics Prescribed for All Patients with Staphylococcus aureus

Results
21,206 patients met eligibility criteria and were included in the final data set. Infections due to MRSA and MSSA were 9,561 and 11,645, respectively (Table 1). The proportion of patients with S. aureus infections caused by MRSA decreased from 2015 (55%) to 2023 (41%). The most frequent infections were bacteremia (32%), SSTI (27%), and pneumonia (23%, Table 1). The most common antibiotics prescribed for all S. aureus infections in 2015 were clindamycin (53%), vancomycin (49%), and cefazolin (27%) and in 2023 were vancomycin (56%), cefazolin (48%), and ceftriaxone (34%, Figure 1). While vancomycin prescriptions remained consistent over the study period, clindamycin administration decreased 20% (Figure 1). Daptomycin and ceftaroline, the newest MRSA agents, increased from 2% and 3% to 7% and 8%, respectively, of agents prescribed for MRSA infections (Figure 2). For MSSA infections, cefazolin increased in use while oxacillin/nafcillin use remained consistent (Figure 3).

Conclusion
Clindamycin administration has substantially decreased, likely a result of increased resistance prevalence in both MSSA and MRSA. Cefazolin use increased commensurate with the increasing incidence of MSSA infection.

Disclosures
Jason G. Newland, MD, MEd, Moderna: Grant/Research Support|Pfizer: Grant/Research Support
419. Changing Epidemiology of Pediatric Invasive Group A Streptococcus Infections in the United States, 2004-2022
Authors: Ramachandran Veena , Okaro Jennifer , McGee Lesley , Gregory Christopher , Anderson Bridget J , Harrison Lee , Houston Jessica , Lynfield Ruth , Youngkin Erin , Tunali Amy , Thomas Ann , Schaffner William , Petit Susan , Chai Shua 
Published: January 2025

Abstract

Background
Recent reports from children’s hospitals of increasing pediatric invasive Group A Streptococcus (iGAS) infections triggered national concern. Clindamycin and penicillin dual therapy is often recommended for iGAS, which is life-threatening. We used active, population and laboratory-based surveillance to assess changes in pediatric iGAS disease incidence, clinical outcomes, and bacterial strain characteristics between 2004–2022.

Methods
Using CDC’s Active Bacterial Core surveillance network, we identified pediatric iGAS cases (GAS isolation from a normally sterile site in persons aged ≤17 years) from 2004–2022. CDC Streptococcus laboratory characterized available isolates by emm typing and antimicrobial susceptibility using conventional and genomic methods. We compared annual incidence during 2004–2019 (pre-COVID-19 pandemic), 2021 (mid COVID-19 pandemic), and 2022 (relaxation of pandemic mitigation measures). Case fatality ratio (CFR), intensive care unit (ICU) admission, and clindamycin non-susceptibility trends (2011-2022) were assessed with the Cochran-Armitage test.

Results
We identified 2,522 pediatric iGAS cases during 2004–2022. Incidence decreased from 1.9 cases per 100,000 persons (2004–2019) to 0.5 (2021) (Incidence Rate Ratio: 0.29 [95% CI: 0.25-0.32]; P&lt; .001) but increased in 2022 to 1.5 (2021 vs 2022 IRR: 2.9 [95% CI: 2.6-3.2]; P&lt; .001). Thirty-four percent of cases were admitted to the ICU; admission increased from 28.9% (2011) to 36.1% (2022) (P = .04). CFR (3.1%) remained stable (P = .69). All isolates were penicillin susceptible; clindamycin non-susceptibility increased from 3.8% (2011) to 28.1% (2021), before declining to 8.4% (2022) (2011 vs 2022 P = .01). emm1, which accounted for 44.8% of ICU admissions (2011-2022) and 38.5% of fatal cases, decreased to 3.1% of isolates in 2021.

Conclusion
Pediatric iGAS incidence was stable for 15 years before declining substantially in 2021. Infections due to emm1, the most identified emm type in children with severe disease, almost disappeared in 2021, potentially due to initiation of COVID-19 mitigation measures; however, clindamycin non-susceptibility continued to increase. Rising iGAS incidence in 2022 necessitates close monitoring for rises in emm1 infections and antimicrobial resistance.

Disclosures
Lee Harrison, MD, GSK: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Sanofi: Advisor/Consultant
P-1145. Geographic and Genetic Similarities between Sporadic Haemophilus influenzae Type b Pediatric Meningitis Cases in New York City
Authors: Ewing Anne T , Otto Caitlin , Ratner Adam J , Haldeman Sydney , Job Megan 
Published: January 2025

Abstract

Background
Two unvaccinated infants residing in Brooklyn, NY presented to our hospital with Haemophilus influenzae type b (Hib) meningitis within one year of each other. Prior outbreak data suggest that communities with low vaccination rates may have circulation of genetically similar Hib strains. We sought to understand the genomic epidemiology of these geographically related cases, hypothesizing that the strains would be closely related.

Mash tree of Hib genomes. One non-typeable H. influenzae (NTHi) genome is included as an outgroup. Study cases described are highlighted.

Methods
We performed a retrospective chart review of pediatric patients (0-5 years) seen at our multi-center health system between 2013-2023 with a sterile-site culture positive for Hib. Whole genome sequencing (WGS) was performed on Hib isolates from blood and cerebral spinal fluid (CSF) samples from the 2 identified cases. Multi-locus sequence type (MLST) was determined using the PubMLST database. Single nucleotide polymorphisms (SNPs) and indels were detected with snippy. A genetic distance tree (mashtree) including 75 Hib genomes from GenBank was constructed.

Results
No additional invasive Hib cases were detected over the past 10 years of data. We generated high-quality closed genome sequences from the 2 meningitis cases. Notably, the strains both belonged to a novel MLST, sequence type (ST)-2832, part of the ST-6 complex. Bacterial genetic sequences were identical across sample type (blood vs. CSF) for each patient. Strains from the 2 patients differed at 262 sites (SNPs+indels). A genetic distance tree (Figure) demonstrates that the 2 isolates are more closely related to each other than to any other Hib genomes in the dataset.

Conclusion
The 2 recent meningitis cases represented an increase in incidence of invasive Hib disease at our institution and were both geographically and genetically linked, sharing a novel MLST. Sporadic cases of closely related Hib strains suggest that an under-vaccinated population serves as a reservoir for community strain circulation. Understanding Hib epidemiology can help target public health campaigns, including vaccination efforts.

Disclosures
All Authors: No reported disclosures
P-1151. Clinical Impact of Susceptibility Testing in Anaerobic Infections from Pediatric Patients
Authors: Cruz Vidal Diego A , Benson Raimey , Wang Huanyu , Oyeniran Sophonie J 
Published: January 2025

Abstract

Background
Anaerobic infections are rarely described in pediatric populations, where routine use of anaerobic blood cultures remains controversial. Due to rising resistance, susceptibility to some anti-anaerobic drugs is unpredictable, yet anaerobic antimicrobial susceptibility testing (AST) is not widely available.
Herein we characterize anaerobic isolates recovered from subjects treated at Nationwide Children's Hospital (NCH) and describe the impact of anaerobic culture and AST on prescribing practices.

Methods
All anaerobic cultures from non-blood sources (ANAC) and blood cultures with obligate anaerobic organisms (AnaBC) during 2023 were identified. At NCH, anaerobic bottles are collected for all BC. Anaerobic isolates are identified by molecular methods and AST performed on sterile sites or by request. Prescribing practices for subjects with anaerobic isolates and AST performed were reviewed.

Results
In 2023, AST was performed on 74 ANAC isolates (25% positive cultures) and 22 AnaBC isolates (70%) from 72 distinct infectious episodes. ANAC isolates were mostly from superficial wounds/abscesses (40%) and intra-abdominal sources (22%), while most AnaBC isolates were from peripheral cultures (52%). Bacteroides fragilis group (43%) and Clostridium spp. (28%) were the most frequent organisms in ANAC and AnaBC, respectively. Time to identification (89 h) and time to AST (143 h) did not differ between groups (Table 1).
Of the 72 infectious episodes, 38 (54%) were from males with a median age of 14.7 years; 22 (31%) were admitted to the intensive care unit (ICU) and 7 (10%) had immunocompromise at baseline. In comparing infectious episodes from AnaBC or ANAC, episodes from AnaBC had significantly younger subjects (3.5 vs. 15.6 years), longer lengths of stay (13 vs. 6 days) and were more commonly mono-microbial (95% vs. 40%). While not significant, episodes from AnaBC tended to have higher rates of effective empiric (91% vs. 71%) and targeted (100% vs. 73%) therapy than those from ANAC (Table 2).

Conclusion
Gaps in antimicrobial optimization were observed for ANAC infectious episodes. Low rates of effective empiric therapy in these settings indicates the need for timely anaerobic AST. Rapid availability of results may improve rates of effectively treated anaerobic infections.

Disclosures
All Authors: No reported disclosures
P-1162. Colonization Rates and Antimicrobial Susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in Adolescent Girls: Comparison with Young Adults
Authors: Choi Soo-Han , Choi Soo-Han 
Published: January 2025

Abstract

Background
Sexually transmitted infection rates are increasing among adolescents and young adults and remain a serious health problem worldwide. Mycoplasma hominis and Ureaplasma species are sexually transmitted and considered etiologic agents causing various urogenital diseases. This study aimed to estimate the prevalence and antimicrobial susceptibility of M. hominis and U. urealyticum in adolescent girls and to compare them with young women.

Methods
We evaluated the results of M. hominis and U. urealyticum isolated from vaginal swab culture between January 2011 and August 2023. The data were selected from young women aged 12-26 and analyzed by dividing the two groups into adolescents (12-18 years) and young adults (19-26 years).

Results
Among 66 adolescent girls, 58 (87.9%) were positive for mycoplasma culture. Twenty-nine (43.9%) had both M. hominis and U. urealyticum. Compared with the young adult group, colonization rates of M. hominis (45.5% [30/66] vs. 21.7% [64/295], P=0.0002) and U. urealyticum (86.4% [57/66] vs. 79.4% [219/295], P=0.0373) were significantly higher in the adolescent group. As age increased, colonization rates of M. hominis (rho = -0.6703; 95% confidence interval [CI], -0.8840 to -0.2248) and U. urealyticum (rho = -0.5993; 95% CI, -0.8550 to -0.1091) tended to decrease. Macrolides (azithromycin, clarithromycin, and erythromycin) susceptibility rate of M. hominis was less than 10% in both groups. Of M. hominis isolates from adolescents, susceptibility rates to azithromycin, clarithromycin, and erythromycin were 0.0%, 6.7%, and 0.0%, respectively. Ninety percent and 76.7% of M. hominis isolates from adolescents were susceptible to doxycycline and tetracycline. Compared with the young adult group, the macrolides susceptibility rate of U. urealyticum was significantly lower in the adolescent group: azithromycin (36.8% vs. 53.4%, P=0.0368), clarithromycin (47.4% vs. 68.9%, P=0.0031), and erythromycin (38.6% vs. 54.3%, P=0.038). Susceptibility rates of U. urealyticum to doxycycline and tetracycline were 94.7% and 87.7% in the adolescent group.

Conclusion
Compared with young adults, higher rates of colonization and resistance to macrolides for both M. hominis and U. urealyticum were more frequently observed in adolescent girls.

Disclosures
All Authors: No reported disclosures
P-1167. Pediatric Coccidioidal Meningitis: a 39-year Single-Center Retrospective Cohort
Authors: Chan Lienna Y , Gotwalt Jordan , Lacy Marian , Price Nathan B , Olson Scott C , Ampel Neil M , Shehab Kareem W 
Published: January 2025

Abstract

Background
Coccidioidal meningitis (CM) is a rare complication of coccidioidomycosis, an endemic mycosis of the southwestern United States. CM is associated with significant morbidity and mortality, but its clinical characteristics and outcomes are poorly described in children. Herein we present a 39-year retrospective cohort of pediatric CM at a single academic center in the endemic area.

Methods
We conducted retrospective chart review with IRB approval of all patients from birth to 18 years of age with CM from 1981-2010 and 2013-2023. Demographic and clinical data, including presenting signs/symptoms, initial lab and imaging results, treatment course, and complications were collected and summarized.

Results
Sixteen patients with CM were identified. The most common presenting symptoms included headache (50%), fever (44%), nausea/vomiting (38%), weight loss (31%), and cough (19%). Ten patients (63%) initially presented with CM, while 6 patients (38%) presented with CM between 2 weeks to 4 years after initial diagnosis of primary pulmonary coccidioidomycosis. Of 14 patients with serologies, 100% had a positive IgG and 43.8% had positive IgM. Of 14 with an initial CSF sample, 12 (86%) had pleocytosis (median 114.5, range 7-690 WBC/mm3). Of 13 with initial complete blood counts, four (30.7%) had leukocytosis and one had eosinophilia. Hydrocephalus requiring ventriculoperitoneal shunt (VPS) developed in 13 patients (81.3%); two died before a VPS could be placed and one developed CM without hydrocephalus 4 years after initial diagnosis. Of 15 patients prescribed lifelong therapy, 14 received fluconazole and one received voriconazole. Two received IV amphotericin B during their course.

Conclusion
Most children with CM presented without recognized primary pulmonary coccidioidomycosis, with 50% presenting with headache and fewer than 50% with fever. Most patients had CSF pleocytosis without peripheral leukocytosis. Nearly all were treated with fluconazole. Death occurred in two patients; all survivors required VPS. Future prospective trials examining higher doses of fluconazole and use of mold-active azoles are needed to assess their efficacy in preventing hydrocephalus in children with CM.

Disclosures
Nathan B. Price, MD, DSM-Firmenrich: Advisor/Consultant
P-1175. Healthcare-Associated Respiratory Viral Infection Outbreak in a Neonatal Intensive Care Unit
Authors: Marrero Elizabeth , Honeycutt Michele , Henthorne Jennifer , Pool Kristin , Del Valle Penella Ana 
Published: January 2025

Abstract

Background
Healthcare-associated respiratory viral infections (HARVIs) have the potential to cause considerable harm including increased morbidity and mortality in patients in neonatal intensive care units (NICUs). We report an HAVRI outbreak in an open pod 104 bed Level IV NICU at a standalone children’s hospital in the south-central region of the United States and the control measures implemented to contain the outbreak.

Methods
An outbreak was identified through a 255% increase in HARVI rates over four months (figure 1). An interdisciplinary team was formed to address the outbreak.
Interventions included: 1) universal masking, 2) isolation of positive patients and pod-mates with a total of three pods being closed for a total of two weeks from the date of last exposure, 3) visitor restrictions with symptom screening at unit entrance, 4) enhanced environmental measures such as equipment cohorting, baseline deep clean, and increased cleaning frequency, 5) infection prevention practices such as hand hygiene, bare below the elbows, and isolation practices were reinforced with the staff.

Results
Post-interventions, the HARVI rate dropped by 70% over a five month period. During the outbreak, several patients experienced longer hospital stays, three patients required escalation of care, and no deaths occurred (Figure 1).

Conclusion
Rapid identification and response are crucial in managing HARVIs in NICUs. The collaborative efforts between NICU leadership, infection prevention, and hospital administration played a key role in promptly controlling the outbreak.

Disclosures
All Authors: No reported disclosures
P-1198. Molecular and Microbiome/Metagenome Correlates of Illness in Respiratory Syncytial Virus (RSV) Infected Infants
Authors: Caserta Mary T , Mariani Thomas , Gill Steven R , Gill Ann Lindley , Walsh Edward E , Corbett Anthony , Chu Chin-Yi , Qiu Xing 
Published: January 2025

Abstract

Background
Respiratory syncytial virus (RSV) epidemics are a leading cause of hospitalization in infants. Those infants with severe illness appear more likely to develop recurrent wheeze. We aimed to test if airway gene expression and microbiome/metagenome composition in the nasal epithelium during primary RSV infection are associated with illness severity and can identify infants with recurrent wheeze.Table 1.Subject Characteristics

Methods
Healthy infants with PCR confirmed RSV were prospectively recruited from inpatient and outpatient locations over three seasons (Dec 2019 to Dec 2023). Clinical and demographic data, 2 anterior nasal swabs and a nasal wash were collected. Microbiome/metagenome analysis and transcriptome/RNA sequencing were performed on the nasal biospecimens. Disease severity was measured by the Global Respiratory Severity Score (GRSS) and retrained improved Global Respiratory Severity Score (iGRSS). Subjects were followed for 12 months to identify recurrent wheezing.Figure 1.Top 20 genes associated with iGRSS

Results
100 (80 hospitalized) infants were enrolled. Two children were found to be ineligible leaving 98 for analysis. The average age was 3.2 (2.3 SD) months. 60 (61%) were male. A multivariate linear regression model was used to associate gene expression profiles with GRSS and iGRSS. After controlling false discovery rate (FDR) at 0.10 level, 283 genes were significantly associated with iGRSS (95 at 0.05). Gene expression changes involved both Innate Immune and Interleukin Signaling pathways. Metagenome analysis identified microbial species and the microbial metabolic state of the nares during acute infection. We found an abundance of Moraxella in the anterior nares was inversely associated with iGRSS while the abundance of Haemophilus was directly associated with iGRSS. We also identified 29 metabolic pathways associated with the iGRSS including coenzyme A biosynthesis I (procaryotic), mixed acid fermentation, Cavin-Benson-Bassham cycle and superpathways of branched chain amino acid biosynthesis.Figure 2.Bacterial Abundance vs. iGRSS

Conclusion
We enrolled a cohort of previously healthy infants with primary RSV infection and identified associations between host nasal gene expression, nasal microbiome/metagenome composition/activity and disease severity. We are currently testing for associations between these biomarkers and recurrent wheeze.Figure 3.Metabolic Pathways associated with iGRSS

Disclosures
Mary T. Caserta, MD, Merck: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Edward E. Walsh, MD, Enanta: Advisor/Consultant|Enanta: Honoraria|GSK: Advisor/Consultant|Janssen: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support