bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-142. Clinical and epidemiological profile of patients with malaria hospitalized at a tertiary level hospital of Central America
Authors: Rodriguez Cristel M , Cárdenas Rosa , Tulloch Felicia , Pachar Flores Monica , Suarez Jose , Arauz Rodriguez Ana Belen 
Published: January 2025

Abstract

Background
During the last two years Panama has found itself in the midst of a malaria epidemic, with cases spiking by 65% from 4181 in 2021 to 7083 in 2022. As of October 2023, reported cases reached 8301. This situation is thought to be related with human movements of indigenous groups, and the unprecedented number of migrating people crossing Central America through the Darién Gap, a dense rainforest between Colombia and Panama. The increasing incidence of malaria is reflected in hospital admissions in a tertiary level hospital of the city, a non-endemic region of malaria in the country.

Methods
Retrospective study of malaria diagnosed at Hospital Santo Tomás, Panama City, Panama, between 2017 and 2024. Charts from patients hospitalized and confirmed to have malaria were collected. Demographic, clinical and biochemical variables were analyzed using Excell v.2403.

Results
A total of 46 cases were found from 2017 to 2024. The year with more admissions was 2023. Mean age was 34.52 years. Men and women were affected equally. Migrants represented 30% of the cohort and the most common origin was Venezuela. Admissions were more frequent in the months of February and March which coincides with the dry season of the country. The most frequent region to acquire malaria was Darién, in people crossing the Darien Gap or natives from the region. Mean time to onset of symptoms was 11 days and the most common clinical features were fever in 91%, malaise (80%) , and headache (60%). There were 9 cases of severe malaria and one case of cerebral malaria. Only one patient died. In the biochemical profile, the most common findings were thrombocytopenia in 87% and anemia in 76.5%. The diagnosis was made mostly by rapid diagnostic test of malaria (RDT) and thin smear in 52%. The most common Plasmodium species was vivax, with 43 cases, 2 cases of falciparum and 1 case of falciparum and vivax coinfection. The treatment used for vivax malaria was chloroquine and primaquine, and artemether lumefantrine for falciparum malaria. The most common coinfection was dengue fever.

Conclusion
Malaria admissions have been raising in Panama City. The latter raises concern and calls to action to strengthen community networks to diagnose and treat malaria with more laboratory professionals and vector technicians, as well as diagnostic supplies and treatment.

Disclosures
All Authors: No reported disclosures
P-172. Assessment of the HIV Case Epidemiological Surveillance System in Sughd Region, Tajikistan, 2024 year
Authors: Shamsudinov Muhiddin , Sharifov Rajabali , Horth Roberta , Nabirova Dilyara , Tilloeva Zulfiya H , Mergenova Gaukhar 
Published: January 2025

Abstract

Background
In recent times, the HIV epidemic has emerged as a major challenge in contemporary healthcare, leading to the demise of 40.4 million individuals globally. Across the timeline of the ailment, fatalities have been recorded, and the spread of the virus persists worldwide, Tajikistan included, where over 10.5 thousand cases have been documented. This study aimed to evaluate the efficiency of the HIV surveillance system, which stands as a pivotal strategy in combating HIV/AIDS.

Methods
Between February and March 2024, we conducted a descriptive evaluation study of the existing surveillance system using the CDC's methodology. The analysis covered data from the AIDS Centre and three health centers in Khujand, including a survey of 33 health workers to assess aspects of surveillance such as flexibility, timeliness, sensitivity, predictive positive value, cost, and overall effectiveness.

Results
According to the decision of the Government of the Republic of Tajikistan, from 2012 to 2022, 12 AIDS centers were organized in the cities and districts of the region. However, to date, the infrastructure of these centres has not yet been fully developed. Also, 30% of commission blood samples are collected with a delay. The sensitivity of the system has reached 91%, which means that 91% of the estimated number of people living with HIV are detected by surveillance. The positive predictive value is 78%, indicating the probability that the reported case is indeed consistent with a real case of HIV. The cost of confirming an HIV diagnosis per person was $19.94. Also, the cost of antiretroviral therapy per month ranges from US$3.78 to US$23.94, which remains cost-effective, while HIV prevention costs US$3.06. In the region, HIV testing coverage increased by 1.2 times and reached 13.9% in 2023 compared to previous years, which led to a decrease in the mortality rate by 1% and indicates the effectiveness of the system.

Conclusion
The system shows potential for further improvement and adaptation. Improved strategies need to be implemented to increase timeliness and flexibility in responses to epidemiological changes. Particular attention should be paid to optimizing logistics processes and expanding infrastructure to achieve higher standards in HIV diagnosis and treatment.

Disclosures
All Authors: No reported disclosures
P-175. Assessing the Dynamics of Fecal Colonization with Antibiotic-Resistant Bacteria in a Chilean Cohort: A Longitudinal Study
Authors: Rafael Araos , Jara Alejandro , Sanchez Felipe , Adell Aiko , Olivares Jorge , Ferreccio Catterina , Huidobro Laura , Garrido Macarena , Rivas Lina M , Peters Anne S , Munita Jose M , D’Agata Erika M C 
Published: January 2025

Abstract

Background
In low- and middle-income countries, the community burden of antibiotic-resistant Gram-negative bacteria (AR-GNB) colonization is high. Understanding factors influencing AR-GNB colonization is crucial for controlling antimicrobial resistance.

Methods
We conducted a cohort study from December 2019 to November 2020 with community-dwelling adults in Molina, an agricultural town in Central Chile. We collected questionnaires and fecal samples every two weeks for six months to identify colonization by extended-spectrum cephalosporin-resistant Enterobacterales (ESCRE). ESCRE detection involved selective media screening, MALDI-TOF identification, and disk-diffusion antibiotic-susceptibility testing. We assessed the impact of epidemiological and clinical features and exposure to various water sources, foods, and animals on i) baseline ESCRE fecal colonization, ii) ESCRE acquisition during follow-up, and iii) ESCRE clearance. The study included 198 subjects, using multiple imputations for missing predictor values. We used two hidden Markov models for each dataset, with Model 1 assuming perfect sensitivity and specificity and Model 2 estimating sensitivity. A Bayesian approach with Markov chain Monte Carlo algorithms estimated odds ratios (OR) and credible intervals (CI).

Results
The sample consisted of 198 residents with a mean age of 60.9 and a predominance of women (75%). Model 1 showed that treating drinking water before consumption reduced the risk of baseline ESCRE colonization (OR: 0.38; 95% CI: 0.02 – 0.89). No significant associations were found for ESCRE acquisition during follow-up. Males and individuals with comorbidities had a lower risk of clearing ESCRE (ORs: 0.58, 0.54; CIs: 0.24 – 0.97, 0.258 – 0.88, respectively). Model 2, with imperfect sensitivity, showed similar results.

Conclusion
This study highlights the significance of environmental and individual health factors in ESCRE colonization. Interventions like treating drinking water could reduce baseline ESCRE colonization risk. The varied impacts of gender and comorbidities on ESCRE clearance provide insights for targeted AR-GNB management strategies. Further research is needed to understand these associations and develop effective community-level interventions against AMR.

Disclosures
All Authors: No reported disclosures
P-179. A Retrospective Review of Plasmodium falciparum Malaria at a Pediatric Hospital in the United States
Authors: Doshi Shreya M , Ansusinha Emily , Dassner Aimee , Yonts Alexandra B , Jantausch Barbara A 
Published: January 2025

Abstract

Background
Malaria infects millions globally, and recently is also reported to have endemic transmission in the US. CDC definition of severe malaria applies to patients with at least one of the following : High percent parasitemia (≥5%), impaired consciousness, seizures or acute respiratory distress syndrome (ARDS), acidosis, acute kidney injury (AKI), DIC, jaundice, (Hb &lt; 7 g/dL ). Artesunate was recently approved in 2020 for treatment of severe malaria. Our goal was to describe demographic features, insurance status, clinical characteristics, and hospital course of children with severe malaria admitted to our hospital from 01/2018-11/2023 and assess any differences in outcomes between those receiving quinidine versus artesunate.

Methods
After IRB approval medical records of children with severe malaria due to P. falciparum were reviewed for demographic and clinical characteristics of patients. Time to reduction in parasitemia (less than 1%) after drug administration patients who received artesunate (n=30) & patients who received quinidine (n=11) was calculated. Readmission to the hospital for relapsed of malaria or side effects, including post-artesunate delayed hemolysis was noted.

Results
In an analysis of 41 patients with severe malaria 27 % were uninsured, 24 % were recent immigrants to the US. Peak parasitemia was mean was 11.2 %. Time to reduction in parasitemia on artesunate (n=30) was 24.2 hours and time to reduction in parasitemia on quinidine (n=5) was 23.8 hours (comparable). See Tables 1-3, and Figure 1 for results.
Table 3

Conclusion
Severe malaria presentation in children is unique to travelers and immigrants. Clinical presentation and features are important to know as it could have fatality. Time to reduction in parasitemia was comparable for the two drugs. Artesunate was well tolerated with low incidence of post-artesunate delayed hemolysis (n=1) leading to readmission. No deaths were attributable to malaria. Research and advocacy are important as 27 % were uninsured, 24 % were recent immigrants to the US highlighting the need for systemic changes. Future studies could include time to drug administration and time to reduction in parasitemia for children in the US vs children in developing countries highlighting access and equity issues globally.
Figure 1

Disclosures
Alexandra B. Yonts, MD, Pfizer: Grant/Research Support
P-183. Barriers and Facilitators to Identifying and Treating Neonatal Sepsis in Ethiopia
Authors: Avanzato Victoria A , Ujari Ogorchi , Yizengaw Behayilu , McCann Conor , Tibeje Hiwot , Gobezayehu Abebe , Cranmer John , Hall-Clifford Rachel , Zerihun Senay , Rule Amy 
Published: January 2025

Abstract

Background
Neonatal sepsis is a major cause of death of children under the age of 5 years globally and in Ethiopia. The high mortality associated with neonatal sepsis is especially pronounced in low-birth weight infants (LBW). Antimicrobial resistance (AMR) further contributes to high mortality. Many hospitalized LBW newborns with sepsis are admitted to NICUs but mortality remains high, partly due to increasing AMR but also due to delayed identification and treatment. Thus, evaluating and describing the existing barriers to sepsis diagnosis and management is urgently needed. This may guide targeted innovations to predict, diagnose, and treat neonatal sepsis earlier and avert newborn deaths.

Methods
Utilizing structured chart review and focus groups we conducted a convergent mixed methods study evaluating facilitators and barriers to early identification and care of neonates admitted with sepsis to the neonatal intensive care unit at Tibebe Ghion Specialized Hospital in Bahir Dar, Ethiopia.

Results
6 resident physicians and 6 nurses participated in 2 focus groups, and 142 charts were reviewed. Chart review revealed that infants with documented warning signs (such as fast breathing or failure to suck) begin an empiric course of ampicillin and gentamycin. Further diagnostic workup is often limited, and blood cultures are rarely performed. Qualitative interviews reenforced and expanded these results. Key barriers identified included limited physical resources (monitoring equipment, laboratory capacity, and imaging) and personnel barriers (limited staffing, low morale, and frequent staff transfer). Primary facilitators included understaffing, retention of experienced staff, and access to necessary equipment and diagnostics.

Conclusion
Even in a higher-level hospital in Ethiopia, neonatal sepsis is challenging to identify due in part to limited diagnostic capacity and understaffing. The absence of cultures and sensitivities and other diagnostics present barriers to early identification and targeted treatment. Future studies could focus on interventions to expand lab capacity and diagnostics, including point of care diagnostics for sepsis or AMR, capacity building of neonatal nursing, and expansion of access to low-cost vital sign monitoring.

Disclosures
All Authors: No reported disclosures
P-187. Clinical Profile of Atypical Manifestations of Dengue Fever and Severe dengue fever in children in Argentina
Authors: Juarez Ximena S , Beatriz Miño Laura , Sevilla Eugenia , Aprea Valeria , Fernanda Gonzalez Maria , Bokser Vivian , Haleblian Emilce , Jose Rial maria 
Published: January 2025

Abstract

Background
The clinical presentation of dengue fever has a wide spectrum; unussual manifestations have been reported and with the rising disease burden, atypical manifestations are also on rise, but are underreported and often missed due to the lack of awareness among health care professionals. In Argentina we are witnessing the largest historical outbreak of dengue in 2024.
The objective of the study is to study the clinical profile and outcome of atypical and severe manifestations of dengue fever in children.

Methods
All children (0–18 y of age) confirmed as dengue fever at a tertiary care hospital at Buenos Aires, Argentina between January 2023-April 2024 were reviewed retrospectively from hospital case records. The diagnosis was confirmed by NS1 antigen/IgM based ELISA or inmunocromatography test, PCR. The data was analyzed using EpiInfo 7.2

Results
Out of 213 children admitted with dengue fever, 7 % had severe dengue. Atypical manifestations were seen in 37 cases ( 17 %). Mean age of presentation was 6.5 (5.2) y. M: F ratio was 1.1:1. The common manifestations of severe dengue infection were shock (80 %), bleeding (20 %) and multi organ dysfunction (6 %).
The most common atypical manifestations of dengue fever were hepatitis (19%), seizures (8 %), acalculous cholecystitis (8%), myositis (8%),pneumonia (8%), febrile infant without focus (8%), febrile diarrhea (19 %). The other atypical manifestations present were ataxia, meningitis, acute respiratory distress syndrome (ARDS), myocarditis, lymphadenitis, prolonged fever, pericardial and pleural effusion. There was one death (0.4 %).

Conclusion
The atypical manifestations of dengue fever are no more a rare entity. Clinicians should have a high index of suspicion and surveillance for atypical manifestations of dengue fever as lack of timely detection and management could be fatal.

Disclosures
All Authors: No reported disclosures
P-188. The Potential Impact of Vaccination on Clade I Mpox Cases in the Democratic Republic of Congo, and Risk of Importation to the United States from International Travel
Authors: Riyaz Zainab , Mortensen Peter , Cutler Samuel , Maguire Thomas , Linley Matt , Buchanan Jacqueline 
Published: January 2025

Abstract

Background
The mpox public health emergency of international concern that emerged in 2022, driven by clade IIb mpox infections in high-income nations, was declared over by the WHO in May 2023, while the more virulent clade I mpox, continues to spread endemically in Central Africa. In November 2023, the Democratic Republic of Congo (DRC) reported its highest ever annual clade I mpox cases, reaching 12,569 with a 4.6% case fatality rate (CFR). The DRC lacks rollout of approved mpox vaccines but has two vaccine trials among healthcare personnel ongoing. The US saw a 78% increase in clade IIb incidence in the first 11 weeks of 2024 compared to the same period in 2023. Only 25% of the eligible US population has completed the two-dose vaccine regimen; waning immunity may leave the population more susceptible to clade I infection should it be imported. Travel is increasing from the DRC and the Congo to the US, particularly within the past year, highlighting the need for enhanced surveillance and vaccination.

Methods
Three vaccination scenarios for the DRC, beyond the baseline of no vaccines received, were built: 1) vaccinating the public who have not received the smallpox vaccine, 2) vaccinating the high-risk GBMSM (gay, bisexual and other men who have sex with men) population aged 18-40 years and 3) vaccinating children, another high-risk group. Direct and indirect international travel volumes from the DRC to the US were analysed and forecasted to assess risk of the introduction of clade I in the US.

Results
Our data suggest that if clade I mpox spreads similarly to clade IIb in 2022, the expected death toll could be &gt; 5000 deaths globally (CFR 5.69%) and ∼ 1800 in the US. A GBMSM-targeting vaccine campaign could avert ∼ 9000 infections and &gt; 250 deaths in the DRC. The number of travellers from the DRC to the US is forecasted to reach a high of &gt; 5600 passengers between April-August 2024, with indirect travel also posing a risk. The top three countries with travel to the US include the UK, France and India; France sees the highest levels of travel from the Congo and the DRC, increasing the risk of onward clade I transmission if an introduction were to occur.

Conclusion
Vaccinating the GBMSM in the DRC could significantly reduce infection rates and reduce the clade I risk posed to nations, such as the US, via international travel.

Disclosures
All Authors: No reported disclosures
P-199. Implementation of a Diagnostic Stewardship Initiative for Hospital Onset Clostridioides difficile Infection
Authors: Bettger Caitlin , Thompson Bernadette , Kiley John L , Townsend Lisa 
Published: January 2025

Abstract

Background
In response to increasing hospital onset CDI (HO-CDI), our Infection Prevention and Control (IPAC) Program undertook a diagnostic stewardship initiative with the goal of improving diagnostic accuracy of HO-CDI at our institution.

Methods
Data acquisition was performed at a single center hospital with 425 inpatient beds as part of hospital surveillance. HO-CDI was defined by the National Health Surveillance Network (NHSN) definitions. A total of 18 months were examined (1/1/23 – 3/31/24). On 11/1/23, the IPAC Program in coordination with the Microbiology Laboratory began suppressing the results for C. difficile on the multiplex Gastrointestinal PCR with the goal of prompting providers to consider pre-test probability of diagnosis and order each PCR separately. Data was compared 10 months prior to implementation and 5 months after implementation. Groups were compared by Fisher exact for categorical variables and Mann-Whitney U for continuous variables.

Results
A total of 82 C. difficile PCR positive tests that met NHSN definitions for HO-CDI were recorded in the study period (Table 1). Of these, 13% of patients were deemed to have met testing criteria (≥3 bowel movements in a 24hr period, no tube feeds or laxatives in the preceding 24hrs). The most common potential disqualifier for testing was not meeting adequate number of bowel movements (47/82, 57%), followed by laxative use and tube feeds (44% and 28% respectively). Of all the positive tests, 9 (11%) were polymicrobial and none of the patients who had polymicrobial infections met testing criteria. The percentage of positive results coming from combined multiplex PCR and C. diff alone PCRs decreased after the intervention with 56% of positives being secondary to combined testing prior to the intervention compared to 32% after the intervention (p=0.078) (Fig 1). Median number of HO-CDI per month decreased after the intervention period along with the NSHSN standard infection rate (Fig 2).

Conclusion
Suppression of C. difficile results on multiplex Gastrointestinal PCR resulted in a decrease in this facility’s standard infection ration (SIR) for HO-CDI. Over three quarters of patients with positive results did not meet stool submission criteria. This has implications for possible next step educational initiatives.

Disclosures
All Authors: No reported disclosures
P-213. Nurse Experiences with a Universal Gloving Intervention to Prevent Clostridioides difficile Infection: A Qualitative Study
Authors: McKinley Linda , Keating Julie , Dolan Katherine , Moriarty Helene , Ray Cara E , Safdar Nasia 
Published: January 2025

Abstract

Background
Gloving is recommended for healthcare workers caring for patients with C. difficile infections, however, the effectiveness of gloving for all patient contact (universal gloving) to prevent transmission from patients with asymptomatic C. difficile colonization is unknown. We conducted a clinical trial to evaluate a universal gloving intervention to prevent C. difficile acquisition among patients in VA acute care settings. We interviewed nurses at participating sites to understand their experiences with the intervention.

Methods
We conducted 8 interviews and 4 focus groups across five participating intervention units at VA hospitals; 23 nurses participated in interviews and focus groups. We used a semi-structured interview guide to ask about the healthcare worker experience with universal gloving; facilitators and barriers to universal gloving; universal gloving impacts on hand hygiene, patient care, and workload; perceived patient experience with healthcare worker gloving; and perceived fidelity with the intervention. Interviews were audio recorded and transcribed, and we used rapid qualitative inquiry methods to analyze transcripts.

Results
Participants reported that gloving was already a standard practice, and universal gloving was easier to expand as an existing practice rather than launching a new practice. Reported fidelity was mixed; some participants reported that gloving was unnecessary for some tasks and difficult to do 100% of the time such as when not having patient contact. Facilitators to universal gloving included providing demonstrated benefit to outweigh burdens, demonstrating leadership support, engaging full healthcare teams including other departments, and ensuring appropriate signage and glove availability. Barriers to universal gloving included role-dependent variation in awareness and compliance, communication across roles, and impacts to patient care such as with tactile tasks and emergency responses.

Conclusion
While universal gloving did not require major changes to nurse workflow or training because of its use for standard and transmission-based precautions, there were increased role- and task-dependent barriers to implementation of universal gloving for all patient contact.

Disclosures
All Authors: No reported disclosures