bluuebunny/crossref_metadata_2025_split huggingface dataset:
178. Elevating Infectious Diseases Management: Impact of an Inpatient Pharmacist-Led Tele-Antimicrobial Stewardship Program Integrated within a Health System
Authors: Paul Maniara Bejoy , Oommen Jomi , Thomas Jeffery , Millares-Sipin Catherine 
Published: January 2025

Abstract

Background
Antimicrobial resistance (AR) is a growing global threat projected to cause 10 million deaths annually by 2050. Joint Commission requires hospitals to have antimicrobial stewardship programs (ASPs). Centers for Disease Control and Prevention recommends pharmacists co-lead ASPs. Infectious diseases (ID) pharmacists are critical to combat AR and elevate patient care by optimizing antimicrobial use. Tele-ASPs could enhance patient care by extending patient care continuity. This study assesses the impact of an inpatient pharmacist-led Tele-ASP.
This chart depicts monthly ASP-related pharmacist interventions, comparing the amount performed before and after implementation of the Tele-ASP.

Methods
This study evaluated antimicrobial management across 14 Northwell Health hospitals in two phases: Pre-Tele-ASP (August 15, 2021 – August 14, 2022) and Post-Tele-ASP (August 15, 2022 – August 14, 2023). The primary endpoint was the total number of ASP interventions during Tele-ASP hours (i.e., 4 PM – 12 AM). Secondary endpoints included ASP interventions and acceptance rates, cost savings, and length of stay (LOS).
This chart outlines the top 5 antimicrobials that pharmacists performed ASP-related interventions on, as well as the top 5 ASP-related interventions that were performed.

Results
A total of 19,802 patients with ASP interventions were included; 5,919 patients (29.9%) had interventions during Tele-ASP hours. There was a 237% increase in ASP interventions during operating hours in the post-Tele-ASP phase (9,467 vs 2,810; p &lt; 0.001). Overall, there was a 62% increase in accepted ASP interventions (25,192 vs 15,552; p &lt; 0.001), with a 26% increase during the day shift (15,423 vs 12,257; p &lt; 0.001), a 256% increase during the evening shift (9,248 vs 2,601; p &lt; 0.001), and a 25% decrease during the overnight shift (524 vs 694; p &lt; 0.01). The overall ASP intervention acceptance rate was 96.8%. Total cost savings and avoidance across all shifts increased by 74.1% ($10,355,707 vs $5,947,578; p &lt; 0.001). The overall LOS decreased by a mean of 1.1 days (p &lt; 0.001).
This chart stratifies the total number of accepted ASP interventions across each shift.

Conclusion
This unique pharmacist-led Tele-ASP provided services to hospitals across Northwell Health during resource-limited hours and locations. Implementation increased accepted ASP-related interventions without reducing overall interventions, effectively reducing LOS and increasing cost savings and avoidance. This model serves as a blueprint for hospitals to strategically expand ASP services in a clinically and financially efficient manner and optimize antimicrobial use and patient care.
This chart stratifies the total amount of cost savings and cost avoidance, as a result of ASP-related pharmacy interventions, across each shift.

Disclosures
All Authors: No reported disclosures
206. A Cluster Randomized Trial Evaluating Universal Gloving for Reducing Clostridioides difficile Acquisition and Infection in VA: The GloRI Study
Authors: McKinley Linda , Ray Cara E , Keating Julie , Brennan Noreen , Crnich Christopher J , Louise Dembry , Dixon Jonah , Evans Charlesnika T , Gelman Michael , Morgan Daniel J , Moriarty Helene , Ndakuya-Fitzgerald Florine , Pacheco Susan M , Pfeiffer Christopher D , Weintrob Amy , Safdar Nasia 
Published: January 2025

Abstract

Background
Clostridioides difficile infection (CDI), the most common healthcare associated infection (HAI) in U.S. hospitals, causes half a million infections and 30,000 deaths annually. Prevention of hospital-onset (HO) CDI has quickly become a priority for most hospitals. Hospital exposure to C. difficile can occur through cross-contamination of healthcare personnel (HCP) hands or through shared environmental surfaces or equipment. Infection prevention measures focus on HCP hand hygiene and barrier precautions (i.e., gowns and gloves) and cleaning of environmental surfaces, especially for patients with known CDI. However, colonized patients can also serve as a reservoir for cross-contamination, and microbiological screening for C. difficile colonization is not routinely performed in healthcare.

Methods
We conducted a cluster randomized trial (CRT) in 10 inpatient units at 5 VA hospitals between April 2022 and December 2023 to evaluate the effectiveness of healthcare worker use of gloves for all patient contact (i.e., universal gloving) in reducing acquisition of C. difficile colonization (defined as negative PCR at admission and positive PCR at discharge) and HO-CDI (per NHSN LabID criteria, as adjudicated by facility infection prevention personnel for routine quality reporting).

Results
Of 9779 admissions, 780 consented to specimen collection. Table 1 displays preliminary data. At admission, 11.6% (intervention group) and 10.3% (control group) of patients tested were colonized with C. difficile. There were 474 patients with both admission and discharge perirectal swabs cultured for C. difficile. The C. difficile colonization acquisition rate was 12.9 per 1000 patient days of care (PDOC) for the intervention group and 10.3 for the control group (p=0.79). Unit-level aggregate data for the HO-CDI rate was 0.29 per 1000 PDOC for the intervention group and 0.57 for the control group (p=0.07).

Conclusion
No universal reduction in the acquisition of C. difficile was detected in acute care units implementing a gloving intervention compared with standard practice, but only 5% (474/9779) of admissions had complete testing data. A numerically lower but statistically nonsignificant HO-CDI rate was detected in the universal gloving group compared to standard practice.

Disclosures
Christopher D. Pfeiffer, MD, MHS, Department of Defense/Medpace: Grant/Research Support|Pfizer: Grant/Research Support
P-808. Enterococcal Bloodstream Infection and Infective Endocarditis in a Population-Based Cohort: An Expanded Rochester Epidemiology Project Investigation
Authors: Bayless David , Baddour Larry M , Lahr Brian , Hagan Grace , Cao Jenny , DeSimone Daniel C 
Published: January 2025

Abstract

Background
The Rochester Epidemiology Project (REP) has been used to examine numerous infectious and non-infectious entities in a population-based approach in Olmsted County, Minnesota. To further investigate patterns of enterococcal bloodstream infection (BSI), we used the Expanded Rochester Epidemiology Project (E-REP) to include additional surrounding counties to conduct a retrospective population-based study of adult patients who developed enterococcal BSI, with or without infective endocarditis (IE).

Methods
The E-REP population under study included eight counties in southeastern Minnesota (including Olmsted County), representing a total population of over 250,000 individuals. Adults (age ≥ 18 years) diagnosed with an initial episode of enterococcal BSI with or without enterococcal IE between January 1, 2018 and December 31, 2022 were included; patients with either polymicrobial BSI with enterococci or a previous bout of enterococcal BSI before the study period were excluded. Cases of enterococcal BSI and IE were identified using ICD-10 codes and underwent complete medical record review. Patient characteristics, microbiology, antibiotic regimens, infectious complications, and outcomes were collected.

Results
A total of 113 cases of enterococcal BSI were identified over the five-year study period. The age- and sex-adjusted incidence rate of enterococcal BSI was 6.9 per 100,000 person-years, with a significantly higher rate among males than females (Figure 1). BSI incidence rate varied by age, with patients 80 years or older having the highest incidence rate (Figures 1 and 2). Twenty-two cases of enterococcal IE were identified, yielding an overall IE prevalence of 20.8% (Figure 3). The cumulative mortality rate at 12 months was high at 41.7% (Figure 3). Five patients (4.4%) had a relapse of enterococcal BSI, defined as recurrence of BSI after negative follow-up blood cultures and within 12 weeks of the initial BSI.

Conclusion
This is the first population-based investigation that has focused on the epidemiology and clinical profile of patients with enterococcal BSI and complicating IE in a US population. This included an IE prevalence of 20.8%, which should be considered when evaluating and managing patients with enterococcal BSI.

Disclosures
Larry M. Baddour, MD, UpToDate, Inc.: Royalty payments (authorship duties).
P-810. Impact of Comorbid Heart Failure among Hospitalized Patients with Escherichia coli Sepsis: a United States Population-Based Cohort Study
Authors: Casipit Carlo Gabriel C , Casipit Bruce Adrian C , Subramanian Apoorva , Arya Yajur , Syal Arshi , Jara-Tantoco Mikaela Nikkola , Wattanachayakul Phuuwadith 
Published: January 2025

Abstract

Background
Sepsis-induced cardiomyopathy was deemed an independent predictor of increased risk for morbidity and mortality, especially for those individuals with pre-existing heart failure (HF). Although previous studies suggested that comorbid HF adversely impacted the outcomes of septic patients in general, there is paucity of data looking specifically at its impact among hospital patients with Escherichia coli (E. coli) sepsis.

Methods
We utilized the National Inpatient Sample (NIS) to identify patients with HF who were hospitalized for E. coli sepsis during the index hospitalization using appropriate ICD-10 codes between 2018-2020. We aim to investigate the impact of HF among E. coli septic patients based on in-hospital mortality, risk for acute respiratory failure and cardiogenic shock, and utilization of mechanical ventilation. A multivariable logistic regression analysis was used to calculate adjusted odds ratios (ORs) for the outcomes of interest.

Results
A total of 93,896 hospitalized patients with E. coli sepsis were identified, of which 23.51% (22,075/93,896) had concomitant HF during the index hospitalization. The overall in-hospital mortality rate among patients with E. coli sepsis was 8.71% (8,178/93,896). Among those with concomitant HF, the mortality rate was significantly elevated to 13.05% (2,881/22,075, p= &lt; 0.001). After adjusting for possible confounders, concomitant HF in patients with E.coli sepsis was found to be an independent predictor of increased risk for in-hospital mortality (aOR 1.54; 95% CI, 1.34-1.76; p=&lt; 0.001), acute respiratory failure (aOR 2.45; 95% CI, 2.23-2.69; p=&lt; 0.001), cardiogenic shock (aOR 10.11; 95% CI, 7.11-14.39; p=&lt; 0.001), and utilization of mechanical ventilation (aOR 2.00; 95% CI, 1.78-2.24; p=&lt; 0.001)

Conclusion
Our analysis showed that HF among hospitalized E. coli sepsis patients was associated with an increased risk for adverse outcomes. This is likely due to the hemodynamic alterations in HF that are adversely impacted by sepsis treatment including fluid resuscitation, vasopressor use, and the advanced virulence factors of E. coli in adhesion, toxin production, and iron acquisition. Hence, identification of at-risk patients with HF is needed to mitigate its adverse impact among hospitalized patients with E. coli sepsis.

Disclosures
All Authors: No reported disclosures
P-832. The Skip Phenomenon in Patients with Staphylococcus lugdunensis Bloodstream Infection
Authors: Gasca Luis R , Crowley Patrick , Streck Nicholas , Baddour Larry M , DeSimone Daniel C 
Published: January 2025

Abstract

Background
Staphylococcus lugdunensis (SL) is a coagulase-negative staphylococcus with virulence comparable to that of Staphylococcus aureus. The “skip phenomenon” (SP) is a pattern where blood cultures are intermittently negative before final clearance of bloodstream infection (BSI). SP is well-documented in S. aureus bacteremia but has not been described previously in SL. In this report, we present a cohort with SL BSI and describe its prevalence and their clinical features and outcomes.

Methods
We conducted a retrospective review of patients with blood cultures positive for SL in samples referred to the Mayo Clinic reference lab between June 2012 and June 2022. We assessed clinical characteristics, including time to positivity, prevalence of the skip phenomenon (defined by a positive culture after 24 hours of negative cultures), patient demographics including Charlson Comorbidity Index, mortality and length of hospital stay.

Results
We identified 55 patients with SL BSI and 33 of them had enough laboratory data to determine the prevalence of the skip phenomenon. SP was present in 5 of 33 (15.2%) patients. For all patients with SL BSI, the median age was 67 years (interquartile range [IQR] 61-79); mean CCI in the group with SP was 5.6 (standard deviation 2) and those without SP was 5.9 (standard deviation 2.7); median duration of bacteremia was 3 days (IQR 1-4); median hospital length of stay was 14 days (IQR 8-20); and 1-year mortality was 45%. Oxacillin susceptibility was present in 33 of 34 cases.

Conclusion
A total of 15% of patient cases with SL BSI demonstrated the SP. Recognition of the SP in patients with SL BSI is important as this may impact duration of antibiotic therapy and timing of long-term cardiovascular device placement.

Disclosures
Larry M. Baddour, MD, UpToDate, Inc.: Royalty payments (authorship duties).
P-835. The microbiological characteristics of Acinetobacter baumannii associated with early mortality in patients with bloodstream infection
Authors: Mi Lee Chan , Choi Yunsang , Jin Choi Seong , Mi Moon Song , Suk Kim Eu , Bin Kim Hong , Young Ham Sin , Su Park Jeong , Yeom Jinki , Song Kyoung-Ho 
Published: January 2025

Abstract

Background
Despite the rapid deaths due to Acinetobacter baumannii bacteremia, the clinical impact of the microbiological characteristics of A. baumannii strains on early mortality (EM) is unclear. We aimed to identify the microbiological characteristics of A. baumannii strains associated with EM.

Methods
Clinical information and isolates from patients with A. baumannii bacteremia from January 2015 to December 2021 were collected. We collected patients’ clinical data, including demographic data, clinical severity, source of infection, and antibiotic therapy. EM was defined as death within 3 d of the initial positive blood culture, whereas late mortality meant death within 5–30 d. The microbiological characteristics of A. baumannii were analyzed using multilocus sequence typing, polymerase chain reactions, and a Galleria mellonella in vivo infection model.Figure 1.The virulence of Acinetobacter baumannii isolates by Galleria mellonella infection model.(A) Health index scores of larvae injected with isolates from the early mortality (EM), late mortality (LM), and 30-d survivor groups. (B) Health index scores of larvae injected with ST191 and non-ST191. (C) Health index scores of larvae injected with isolates carrying bfmS and those without bfmS. (D) Health index scores of larvae injected with isolates carrying bauA and those without bauA. The circles, squares, and triangles represent the mean, and the lines indicates standard error of the mean. The health index score of larvae was calculated by summing the scores for activity, cocoon formation, melanization, and survival. Health index scores of fifteen larvae were summed at every 24-h time point.

Results
Among 130 patients, 69 (53.1%) died within 30 d, and 38 (55.1% of 30-d deaths) were classified as EM and 27 (39.1% of 30-d deaths) as LM. Sequence type 191 (ST191) was the most prevalent ST, consistently identified throughout the study period. ST191 strain was more prevalent patients with EM than in 30-d survivors (31.6% vs. 6.6%, P = 0.001). Regarding virulence genes, bfmS was more frequent (92.1% vs. 47.5%, P &lt; 0.001), whereas bauA was less frequent (13.2% vs. 52.5%, P &lt; 0.001) in patients with EM than in 30-d survivors. Higher clinical severity, pneumonia, and ST191 infection were identified as independent risk factors for EM. In the G. mellonella infection model, ST191, bfmS+, and bauA- isolates showed higher virulence than non-ST191, bfmS-, and bauA+ isolates, respectively.

Conclusion
ST191 and bfmS were more frequently found in the EM group. ST191 infection was also an independent risk factor for EM and highly virulent in the in vivo model. Tailored infection control measures based on these characteristics are necessary for A. baumannii bacteremia management.

Disclosures
All Authors: No reported disclosures
P-844. Bacteraemia Caused by High Risk AmpC-producing Enterobacterales: Influence of IDSA Guidelines Adequacy and Antimicrobial Stewardship Activity on Outcomes
Authors: Lamas Ferreiro Jose Luis , Sanjurjo Rivo Ana , Ortero Judith Alvarez , Canoa Rico Alejandra , Costas Vila Marta , Gutierrez Garcia Monica , Valerio Laura Intanno , Aguado Javier de la Fuente 
Published: January 2025

Abstract

Background
Treatment of high risk AmpC-producing Enterobacterales bloodstream infections (BSIs) is challenging due to the posibility of development of antibiotic resistance during treatment. The aim of this study was to analyze the impact of antimicrobial stewardship activity and IDSA guidelines adequacy in patients with high risk AmpC-producing Enterobacterales BSIs.

Methods
Patients with Citrobacter spp, Enterobacter spp and Klebsiella aerogenes BSIs were included between June 2019-March 2024. Outcomes of death and relapse of infection at 30 days were assessed. Adequacy of definitive antimicrobial treatment according to IDSA guidelines was evaluated. The impact of antimicrobial stewardship activity in treatment adequacy and outcome was analyzed. Analysis was performed using SPSS version 25.

Results
2049 BSIs were evaluated and 67 were finally included. 80% were monomicrobial. Median patient age was 74 years, 73% were male. The most frequent microorganism isolated was Enterobacter cloacae (55%). 50% were nosocomial and the most frequent origen was biliary tract (35,8%). 35% met sepsis criteria. 30% of cases presented cefotaxim resistance. Empiric and definitive antibiotic treatment was prescribed according IDSA guidelinesi n 34% and 91% of cases, respectively.. Death at 30 days was 6% and a combination outcome of death and relapse of infection at 30 days was 11,9%. Definitive antibiotic treatment adequacy according to IDSA guidelines was associated with lower mortality and relapse at 30 days (OR 0,04; IC95 0,003-0,6; P=0,02). Antimicrobial stewardship team did an intervention in 34% cases. This intervention was associated with a trend toward of lower mortality and relapse (4% vs 15%, P=0,2), a trend toward of higher IDSA guidelines adequacy (100% vs 86%, P=0,08), and a higher switch to oral treatment (78% vs 52%; P=0,03).

Conclusion
Adequacy of definitive antimicrobial treatment in high risk AmpC producing Enterobacterales BSIs according to IDSA guidelines was associated with a better outcome. Antimicrobial stewardship is desired for management of these patients.

Disclosures
All Authors: No reported disclosures
P-862. Hospital administered MOUD is associated with decreased one-year mortality among PWUD admitted with bloodstream infections
Authors: Blair Nicholas , Kopp Adam , Kubin Christine J , Cotton Jesse , Yin Michael , Scherer Matt 
Published: January 2025

Abstract

Background
Bloodstream infections (BSI) including infective endocarditis (IE) are highly morbid complications of substance use that contribute to the syndemic of invasive bacterial infections in persons who use drugs (PWUD). In this retrospective analysis we evaluated whether inpatient administration of medication for opioid use disorder (MOUD) impacted one-year all-cause mortality and antibiotic adherence in PWUD hospitalized with BSI.

Methods
We conducted a retrospective cohort study of index admissions for PWUD admitted with IE cases from 2/2020 through 7/2023 and/or BSI from 7/2022 through 7/2023 at Columbia University Irving Medical Center. Patients were included if they 1) Were aged 18-65 years old 2) Had a positive blood culture with an organism known to cause invasive disease and 3) Had documented substance use (opioid and/or stimulant) within the previous 12 months. One-year all-cause mortality was the primary outcome of interest. Administration of MOUD was counted as a treatment exposure only if received for the majority (≥ 50%) of hospitalized days. We defined the primary antibiotic outcome as a percentage of days a patient received standard of care (SOC) treatment compared to the recommended duration in days for their infection.

Results
Of the 99 patients who met study criteria, the majority were male (69%) with a history of injection drug use (77%). Opioids (79%), cocaine (68%) and methamphetamines (19%) were the most commonly used substances (Table 1). In multivariate logistic regression, hospital administration of MOUD was associated with reduced mortality (aOR 0.14, 0.021 – 0.60, P = 0.017) after adjusting for prosthetic valve endocarditis (Table 2). In sub-analysis of the MOUD group, PWUD who received buprenorphine achieved a higher percentage of SOC antibiotic days (93%, p = 0.011) than either the methadone (61.4%) or no-MOUD (72.9%) groups (Table 3).

Conclusion
Hospital administration of MOUD was associated with improved survival in PWUD admitted with serious bloodstream infections. Buprenorphine receipt was associated with a greater likelihood of completing SOC antibiotic course than methadone or no MOUD. To our knowledge, this is the first study to demonstrate a survival benefit to hospital administration of MOUD in PWUD during infection-related admission.

Disclosures
All Authors: No reported disclosures