bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-132. Retrospective Comparison of Short and Prolonged Treatment Strategies for Patients with Neutropenic Enterocolitis
Authors: Pravato Tori , Yassin Arsheena , Narayanan Navaneeth , Mohayya Sana M , Abdul Azim Ahmed , Awad David A , Cho Junhee , Schwartz-Orbach Lianna , Bhatt Pinki 
Published: January 2025

Abstract

Background
Neutropenic enterocolitis (NE) is a severe necrotizing condition affecting the small and/or large intestines in neutropenic patients. With a lack of high-quality studies looking at antimicrobial duration and outcomes for patients with NE, this study aims to evaluate the impact of short versus prolonged antimicrobial treatment durations on clinical outcomes in patients with NE.

Methods
This was a single-center, retrospective, cohort study conducted at a tertiary care academic medical center in New Jersey. Medical records of adult patients with hematologic malignancies admitted between January 2015 to September 2023, with diagnosis of NE and receipt of treatment with broad-spectrum antimicrobials, were reviewed. This study compared patients who received short versus prolonged antimicrobial treatment courses for NE. Patients in the short treatment group included those who received broad antimicrobials for NE treatment, that were stopped or switched to prophylaxis while the patient’s absolute neutrophil count (ANC) was less than 0.5 x 103/uL. The prolonged treatment group included patients who received broad antimicrobials at least until ANC was over 0.5 x 103/uL. The primary endpoint was the time to clinical improvement of symptoms between the two groups. Secondary endpoints included hospital length of stay (LOS), intensive care unit (ICU) admission, incidence of NE complications, and 30-day mortality.

Results
A total of 17 patients were included, with 5 (21.7%) patients who underwent hematopoietic stem cell transplantation. Time to clinical improvement, defined as improvement in symptoms (including resolution of abdominal pain, abdominal distension and/or cramps, diarrhea, nausea, vomiting, lower GI bleed), and 30-day mortality were similar in both treatment groups. However, hospital LOS, ICU admission, and incidence of NE complications were higher in the prolonged treatment group.

Conclusion
Between short and prolonged treatment groups in patients with NE, time to clinical improvement was similar. Larger, randomized controlled trials are needed in this patient population to assess the appropriate duration of therapy for patients with NE.

Disclosures
Navaneeth Narayanan, PharmD, MPH, BCIDP, Astellas: Honoraria|Beckman Coulter: Honoraria|Merck: Grant/Research Support|Shionogi: Grant/Research Support Pinki Bhatt, MD, Sanofi: Grant/Research Support
P-158. Knowledge of Rabies Prevention Measures for Dog Bite Incidents in the Peruvian Population: Findings from a National Survey in 2022
Authors: Perez-Castilla Jesus , De-Los-Rios-Pinto Abraham , Benito-Vargas Raysa M , Soriano-Moreno David , Fernandez-Guzman Daniel , Gonzales-Zamora Jose A 
Published: January 2025

Abstract

Background
Rabies continues to be a significant global zoonotic threat. In the last two decades, Peru has reported nine dog-transmitted rabies cases, including a preventable death in 2023. This study aimed to assess public knowledge of rabies prevention post-dog bites, focusing on sociodemographic disparities to better tailor future interventions.Figure 1.Factors associated with knowledge of the Rabies Preventive Triad of the Peruvian population, ENAPRESS 2022.

Methods
Utilizing data from the 2022 National Survey of Budget Programs, targeting Peruvians aged 14 and older through a stratified two-stage sampling across both urban and rural areas, this cross-sectional study included 89,655 adults who completed interviews on the rabies prevention triad (wound washing, biting animal identification, and medical consultation). The "Survey" package in R facilitated data analysis, acknowledging the complex design. Poisson regression was employed to explore sociodemographic disparities in knowledge.

Results
Out of 89,655 participants, the majority were women (53.7%), aged 30-59 (52.2%), and lived in urban areas (81.6%). The 6.5% displayed adequate knowledge of the rabies preventive triad, 45.7% indicated they would clean their wounds, 20.9% would identify the dog involved, and 86.7% would seek medical attention at a health facility. Regression models revealed better knowledge among older adults and the elderly (adjusted prevalence ratio (aPR): 1.04; 95% confidence interval (95%CI): 1.03-1.05), females (aPR: 1.01; 95% CI: 1.00-1.02), and those with higher educational levels. Highland residents showed greater knowledge than coastal ones (aPR: 1.02; 95% CI: 1.01-1.03). Conversely, Quechua ethnicity and rural residency were negatively associated with knowledge (aPR: 0.97; 95% CI: 0.96-0.98 and aPR: 0.98; 95% CI: 0.97-0.99, respectively) (Figure 1).

Conclusion
Despite the high frequency of dog bites in Peru, knowledge of rabies prevention is very low. Although limited by potential recall bias and its non-causal inference capacity, the study's strengths lie in its national scope and reliable data collection. The results underscore the urgency of targeted educational campaigns and policy enhancement in high-risk areas to boost community health and rabies prevention.

Disclosures
All Authors: No reported disclosures
P-221. Ribotype Ecology and 90-day Mortality Changes after a CDI Diagnostic Change from a PCR-based to a 2-step Diagnostic Algorithm
Authors: Huynh-Phan Ricky , Eubank Taryn A , Le Thanh , Gonzales-Luna Anne J , Jo Jinhee , Begum Khurshida , Alam M Jahangir , Lasco Todd M , Al Mohajer Mayar , Garey Kevin W 
Published: January 2025

Abstract

Background
Due to detection of Clostridioides difficile colonization, many hospitals changed from a PCR-based CDI diagnostic to a two-step diagnostic using a GDH/EIA assay. How this change affected the ecology of diagnostic C. difficile strains or patient outcomes is unknown. The purpose of this study was to assess differences in strain ecology and patient outcomes after a CDI-diagnostic change from a PCR-based to a GDH/EIA diagnostic assay.

Methods
Stool samples considered CDI positive by institutional policy were collected from a university-affiliated quaternary care hospital and associated community hospitals from 2016-21. Stool samples were cultured for C. difficile and ribotyped by fluorescent PCR. Patient’s health records were reviewed for 30- and 90-day mortality and CDI recurrence. Ribotype distribution and clinical outcomes were compared after the diagnostic change.

Results
The cohort included 418 patients (PCR+: n=315; GDH+/EIA+: n=103). An increased proportion of ribotype (RT) 027 was noted after the change to GDH/EIA and a decreased likelihood of RT014-020 and RT255. An increased likelihood of singletons (PCR ribotypes observed only once) was shown during use of the PCR diagnostic. CDI treatment failures and mortality was higher after implementation of the GDH/EIA diagnostic. Ninety-day mortality was 19.4% using the GDH/EIA diagnostic and 11.1% using the PCR (p=0.030). No differences in CDI recurrence were noted.

Conclusion
C. difficile ecology and clinical outcomes changed after implementation of a GDH/EIA diagnostic, likely due to PCR detection of colonization.

Disclosures
Anne J. Gonzales-Luna, PharmD, BCIDP, Ferring Pharmaceuticals: Advisor/Consultant|Innoviva Specialty Therapeutics: Advisor/Consultant|Merck and Co: Grant/Research Support|Paratek Pharmaceuticals: Grant/Research Support|Seres Therapeutics: Grant/Research Support Kevin W. Garey, PharmD, MS, Acurx: Grant/Research Support
P-306. Characterization of a Rare Hospital-Associated MRSA Lineage
Authors: Felton Emily , Kennedy Sarah , Jackson Jessica , Virgillio Ariana , Cella Eleonora , Becker Deanna , Lima Amorce , Silbert Suzane , Azarian Taj , Kim Kami , Shaw Lindsey 
Published: January 2025

Abstract

Background
The adaptive power of Staphylococcus aureus enables it to cause a wide variety of infections and readily develop resistance to antibiotics. It does this through extensive variability in its genomic repertoire, not only via laterally acquired elements but also through core genome evolution.

Methods
Herein we use whole genome sequencing to study the genomic epidemiology of S. aureus strains circulating within Tampa General Hospital (TGH).

Results
While characterizing the genetics of mupirocin resistance, we identified a rare ST belonging to hospital-associated clonal complex 5. The elevated rate of mupirocin resistance in this ST, ST3390 (83.2% total, high-level resistance 55.5% and low-level resistance 27.7%), was particularly striking. To date, there have only been 6 recorded instances of this lineage globally, whilst this work identified 36 individual strains from TGH alone. Genome analysis of our strains identified numerous completely conserved non-synonymous mutations in genes relating to DNA damage response, metabolism, adhesion/biofilm formation, iron acquisition and peptidoglycan biosynthesis compared to CC5 isolates. Additionally, exploration of AMR genes detected the presence of a unique dual SCCmec type, with two-thirds of strains possessing components of both SCCmecIa and SCCmecIIa. Phenotypically, all ST3390 strains lack the characteristic staphyloxanthin pigment that gives S. aureus its name. Additionally, ST3390 isolates display high levels of cytotoxicity towards human neutrophils compared to other CC5 strains.

Conclusion
Collectively, this work provides a deeper understanding of the genetic variability of S. aureus in clinical settings, leading to a better comprehension of in-hospital bacterial population dynamics and the evolution and spread of contemporary isolates.

Disclosures
All Authors: No reported disclosures
P-308. Impactful Implementation of “HAPPI MRSA” - Hospital Onset Pneumonia Prevention and Reduction of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections at a Large U.S. Health System
Authors: Rosello Gemma , Ruiz Maribel , Jones Dr LaShonda , Rosa Rossana , Villamil Dr Susana Flores , Biggs Dr Carol , Abbo Lilian M 
Published: January 2025

Abstract

Background
Hospital onset (HO) Methicillin-Resistant Staphylococcus aureus (MRSA) bloodstream infection is one of the key performance metrics for the CMS Hospital-Acquired Condition (HAC) reduction payment program. MRSA bacteremia is a serious preventable infection associated with increased morbidity and mortality. The goal of our intervention was to implement process changes to reduce MRSA bacteremia and HO pneumonia, improve patient safety, quality of care and decrease healthcare costs associated with treatment.Figure 1:Most Common Sources of All Cases HO MRSA Bacteremia at JHS (Baseline Period: January 2019- September 2021)

Methods
Jackson Health System (JHS) is a 2,289-bed nonprofit academic health system located in Florida, USA. Utilizing a PDSA cycle for process improvement, we implemented a bundle of interventions focused on Hospital Onset Pneumonia Prevention (HAPPI) as the leading cause of MRSA bacteremia across JHS (Figure 1). Planning included focus groups and process mapping to assess barriers to an ideal oral care universal practice (Figure 2). Policies were updated; education and compliance monitoring were incorporated at each hospital. Managers were empowered by hospital leadership to hold staff accountable for each of the metrics within the bundle: universal oral care with kits tailored to independent, dependent, and ventilated patients, universal skin bathing with chlorhexidine gluconate (CHG), nasal decolonization, early mobility, and aspiration precautions.Figure 2:Barriers to Universal Oral Care in Hospitalized Patients at JHS (Focus Groups with Frontline Staff and Infection Prevention Leadership)

Results
During the pre-intervention period Jul 2021-Jun 2022, we identified 46 HO MRSA bacteremias that were secondary to HO pneumonia. System wide education occurred Jul-Dec 2022. During our post-intervention period Jan-Dec 2023, 20 HO MRSA bacteremias were identified that were secondary to HO pneumonia, a 57% reduction (Figure 3). Estimating $60,000 to treat MRSA bacteremia secondary to pneumonia, we identified a $1.5 million dollars in cost savings by preventing 26 infections.Figure 3:Most Common Sources of All Cases HO MRSA Bacteremia at JHS (Post-Intervention Period: January-December 2023)

Conclusion
We reduced HO MRSA bacteremias and subsequently HO pneumonia after implementing and actively monitoring compliance with a bundle of interventions. Facilities considering pneumonia and MRSA prevention should include strategies that reduce organism bioburden with bathing, nasal decolonization, and oral care along with early mobility and aspiration precautions.

Disclosures
All Authors: No reported disclosures
P-314. A Retrospective Review of Long-Acting Lipoglycopeptide Utilization at a VA Tertiary Teaching Medical Center
Authors: Maree Megan B , Chan Bonnie , Goolsby Tiffany , Oliver Nora T 
Published: January 2025

Abstract

Background
Dalbavancin and oritavancin are long-acting lipoglycopeptides (LA-LGPs) approved by the Food and Drug Administration (FDA) for acute skin and soft tissue infections (ASSTIs). With their long-acting pharmacokinetics and broad activity against gram-positive bacteria, LA-LGPs are ideal options for patients with serious infections, such as bone, joint, and bloodstream, who (1) require prolonged antimicrobial therapy, (2) are not candidates for long-term intravascular catheter access, (3) prefer to avoid hospital admission, and/or (4) need early discharge.

Methods
A retrospective chart review was conducted on patients ages older than 18 with a medication order of dalbavancin or oritavancin from September 2020- August 2023 at the Atlanta VA Medical Center. Patients were excluded if the patient did not have an active infection or a LA-LGP was ordered but not administered. Pertinent demographic, clinical, and microbiological data were collected from the patient’s medical record.

Results
Resolution of infection in 3 months with LA-LGPs was found to be 76% (35/46) effective in lower extremity osteomyelitis and 74% (72/98) effective for all indications. The mean total length of stay (inpatient) after LA-LGP infusion was 3.9 days. The most common adverse events were nausea and vomiting, which occurred at a rate of 6.1% (6/98).

Conclusion
The utilization of LA-LGPs showed to be effective in infection resolution in a 3-month period in majority of patients. Specifically, lower extremity osteomyelitis, a non-FDA approved use, showed promising results in resolution of infection. The use of LA-LGPs can be beneficial in shortening hospital length of stay and prevention of hospitalizations with minimal adverse events. This can possibly lead to decreased health care cost and hospital acquired infections. In all, the use of LA-LGPs has significant potential use in other serious infections other than ASSTIs with a variety of benefits from the patient and healthcare perspective.

Disclosures
All Authors: No reported disclosures
P-358. Infection Prevention and Control Practice in Tertiary Care Military Hospitals in Bangladesh during COVID-19 Pandemic: Results from WHO IPCAF Assessment Tools
Authors: Abdullah Syed Abul Hassan Md , Harun Md Golam Dostogir , Amin Sumon Md Shariful , Jahan Ishrat , Ul Anwar Md Mahabub , Siddiquee Taufiq H 
Published: January 2025

Abstract

Background
WHO estimates a high burden of the MDR organism in hospital settings in South Asian countries, especially in Bangladesh. Infection prevention and control (IPC) in healthcare settings is critical to limit the healthcare-associated infections, especially during pandemics like COVID-19. Military hospitals in Bangladesh are known for better compliance of health system practice. To measure current IPC level, activities, resources, and gaps, WHO developed the IPC Assessment Framework (IPCAF) assessment tools. We aimed to assess the IPC practices level in Military hospitals of Bangladesh to reduce the gaps.Table of WHO IPCAF score of Dhaka and Jashore CMH

Methods
From Oct to Dec 2019, using IPCAF tools, we conducted a cross-sectional survey at two tertiary level Combined Military hospitals (CMH) in Bangladesh to collect the information. The hospital administrator, IPC focal person, or relevant person who had better knowledge about the overall IPC situation was interviewed. The tool comprises eight sections assessing the eight IPC core components. Based on the scores ranging from 0 to 100, the hospital was categorized into four distinct IPC levels - Advanced, Intermediate, Basic and Inadequate. Descriptive statistics were used to summarize and describe the key findings.

Results
The mean IPCAF score was 421.75 out of 800.The Dhaka CMH (1100 bedded) was categorized as ‘intermediate’ with the score of 497.5 and Jashore CMH (500 bedded) scored 346 which was characterized ‘basic’ level. Both the hospitals scored very high in adherence of IPC guideline 87.5 and 77.5 respectively. Scoring of Dhaka CMH in IPC program (77.5), Workload, staffing & bed occupancy (75) and Built environment, materials and equipment (82.5) is higher than the same components of Jashore CMH. IPC education & training score of both hospitals (50 and 25 respectively) was not satisfactory. None of the hospitals had an IPC surveillance system with standard surveillance case definitions to track HAIs.

Conclusion
Military hospitals needs to attain advanced level IPC practice. To achieve that organized quality improvement programs and feedback mechanisms is required. To strengthen all IPC core components, particularly IPC surveillance, monitoring, education & training is needed to improve for healthcare safety and resilience.

Disclosures
All Authors: No reported disclosures
P-382. Evaluation of Antibiotic Prophylaxis for Patients Undergoing Whipple Procedure
Authors: Crawford Garrett , Soto Caitlin , Tsai Y Vivian , Cosgrove Sara E , Klein Eili , Dzintars Kate 
Published: January 2025

Abstract

Background
Pancreatoduodenectomy (PD) or the Whipple is a complex surgical intervention with high complication rates. The purpose of this study is to evaluate the efficacy of standard of care (SOC) perioperative antibiotics, cefazolin plus metronidazole, as prophylaxis for surgical site infection (SSI) in patients undergoing PD at The Johns Hopkins Hospital (JHH).

Methods
A retrospective study was performed of adult patients undergoing PD at JHH between January 1, 2022 and October 31, 2023. The following information was collected on all patients: peri-operative antibiotics administered, placement of operative drains, pre-operative biliary stent, prior endoscopic retrograde cholangiopancreatography, SSI, pancreatic fistula, and microbiological data. Criteria for SSIs were adapted from the CDC’s National Healthcare Safety Network definitions. SOC prophylaxis included cefazolin plus metronidazole. The primary outcome was the proportion of patients who developed an SSI within 30 days of PD. Secondary outcomes included identification of the causative pathogens of SSI in patients after PD and the proportion of organisms susceptible to SOC antibiotics. Descriptive statistics was used to summarize demographic data and the primary and secondary outcomes.

Results
A total of 333 patients met inclusion criteria and were documented as having PD during our study period. Of these patients, 106 (31.2%) had post-operative complications including infection or fistula. Overall, 81 patients (24.3%) had a SSI after PD. Seventy-one SSIs occurred in 295 patients (24.1%) receiving SOC antibiotic prophylaxis compared to 10 SSIs in 38 patients (26.3%) receiving non-SOC antibiotics (p=0.761). Of the 81 patients with a SSI, pathogens were identified through post-operative culture data in 33 patients. Thirty-two of the 55 (58%) clinically relevant pathogens were susceptible to SOC antibiotics.

Conclusion
The incidence of surgical complications associated with PD at our institution is comparable to rates reported in the available literature. While the incidence of clinically relevant organisms not covered by SOC prophylaxis is low, a targeted approach for prophylaxis may be required for select patients.

Disclosures
All Authors: No reported disclosures
P-385. A Change of Heart: Limitations of National Healthcare Safety Network (NHSN) and Society of Thoracic Surgeons (STS) Surveillance Systems in Identifying SSI After Heart Transplant Surgery
Authors: Seidelman Jessica , Smith Becky A , Arif Sana , Lewis Sarah , Gettler Erin , Padgette Polly W , Wood Brittain A , Williams Melissa , Fleming Peter , Schroder Jacob , Milano Carmelo , Miller Rachel , Alexander Barbara D , Carugati Manuela 
Published: January 2025

Abstract

Background
Surgical site infections (SSI) complicate 4.8-12.4% of orthotopic heart transplants (OHT) and result in increased length of hospital stay, mortality, and health care costs. As such, the need for accurate SSI surveillance systems for OHT is critical. This study aimed to evaluate the diagnostic accuracy of the National Healthcare Safety Network (NHSN) and Society of Thoracic Surgeons (STS) surveillance systems for SSI against the gold standard of a detailed manual adjudication process performed by Transplant ID physicians (TXID).

Methods
We retrospectively reviewed single-organ OHT performed at an academic medical center between 1/1/19 and 12/31/20 among adult patients (≥18 years). Each OHT was adjudicated for SSI by NHSN, STS, and TXID SSI definitions. The TXID definition was the same as the NHSN classification. The surveillance window was 90 days for NHSN and TXID. STS adopted a 90-day surveillance window for deep sternal wound infections from 7/1/20 onward.

Results
TXID identified 17 (10.5%) SSI among 162 OHT surgeries during the study period. NHSN identified only 7 (4.3%) SSI, including 3 false positive SSI, which were not considered SSI by TXID. STS identified only 4 (2.5%) SSI during the study period and no false positive SSI(Fig 1). The sensitivity, specificity, positive-predicted-value, and negative-predicted-value for NHSN were 23.5%, 97.9%, 57.1%, and 91.6% and for STS 23.5%, 100%, 100%, and 91.8%, respectively. The suboptimal sensitivity of NHSN was mostly explained by intervening surgeries (such as chest closures or washouts) that prevented a subsequent SSI from being attributed to the OHT, and by STS’s prior 30-day surveillance window.

Conclusion
Accuracy of SSI surveillance is essential for SSI prevention. Current SSI surveillance systems have low sensitivity in detecting OHT SSI, which is likely due to the complex nature of the hospital courses following OHT surgeries. While a manual adjudication performed by Transplant ID physicians is time- and resource-intensive, it likely provides a more accurate depiction of SSI rates compared to automated surveillance systems. Future studies are needed to determine how NHSN and STS surveillance systems can be adjusted to more accurately identify OHT SSI.

Disclosures
Jessica Seidelman, MD, MPH, 3M: Expert Testimony Becky A. Smith, MD, UpToDate: royalties Jacob Schroder, MD, Abbott: Advisor/Consultant|Abiomed: Advisor/Consultant Barbara D. Alexander, MD, Basilea: Advisor/Consultant|F2G: Advisor/Consultant|F2G: Grant/Research Support|HealthTrackRx: Advisor/Consultant|HealthTrackRx: Board Member|Scynexis: Grant/Research Support|TFF Pharmaceuticals: Advisor/Consultant