bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-818. Unraveling Mortality Drivers in Gram-negative Bloodstream Infections to Guide Antimicrobial Stewardship Efforts
Authors: Burgess David S , Olney Katie B , Burgess Donna R , Cotner Sarah , VanHoose Jeremy , Turner Leah Catherine , Bruning Rebecca 
Published: January 2025

Abstract

Background
Bloodstream infections (BSIs) represent a significant clinical challenge due to their association with substantial morbidity and mortality. This study aimed to identify predictors of mortality in Gram-negative BSIs to guide more effective antimicrobial stewardship strategies.

Methods
Adult inpatients with Gram-negative BSIs from our academic medical institution between July 2022 and August 2023 were included. Data collected included patient demographics, microbiological data, clinical management variables (qPitt, Charlson Comorbidity Index (CCI), ICU admission, length of stay), ID consultation, and clinical outcomes. Logistic regression and CART analysis identified mortality predictors.

Results
In total, 441 predominately Caucasian patients (85.7%), with a mean age 58.5 yrs and 49.4% male, were included. Majority (61.5%) of infections were community-acquired, with 43.1% requiring ICU admission and 43.8% receiving an ID consultation. Overall mortality was 20.0% with the following prevalence and mortality rates: E. coli (39.7%, 14.9%), K. pneumoniae (14.1%, 17.7%), P. aeruginosa (9.1%, 35.0%), S. marcescens (7.5%, 24.2%), and E. cloacae (5.2%, 17.4%). Multivariable regression identified hospital-acquired infection (p &lt; 0.001), qPitt &gt; 2 (p &lt; 0.001), and ICU admission (0.001) as independently associated with increased mortality. Additionally, renal disease (p=0.025), cancer (p = 0.026), and cardiovascular disease (p=0.040) were significant contributors to mortality. CART highlighted ICU admission as the primary driver of mortality, with higher mortality rates compared to non-ICU admissions (32.1% vs 10.8%, p&lt; 0.001). Among ICU patients, a CCI &gt;4 was identified as a secondary driver of mortality, with rates of 14.5% for CCI &lt; 4 and 39.0% for CCI &gt;4, p=0.001. Non-ICU patients with a length of stay &lt; 8 days had lower mortality (3.3% vs 16.6%, p = 0.001). ICU patients received fewer ID consultations compared to non-ICU patients (49.3% vs 36.7%, p =0.007).

Conclusion
This study underscores the impact of Gram-negative BSIs, particularly regarding ICU admission’s role in mortality. Addressing disparities in ID consultations offers opportunities for optimization of patient outcomes through enhanced care coordination.

Disclosures
Sarah Cotner, PharmD, BCPS, Gilead Sciences, Inc: Advisor/Consultant
P-820. Impact on outcomes and detection of Infective Endocarditis in patients with Staphylococcus aureus bacteremia following an Infectious Disease Consultation: A Quasi-experimental study
Authors: Kumar Deepak , Kaur Navneet , Bohra Gopal Krishna , Kumar Midha Naresh , Meena Durga Shankar , Deora Surender , Choudhary Rahul , Tak Vibhor , Neetha T R , kanagiri Tejasvi , Khatod Yash 
Published: January 2025

Abstract

Background
Staphylococcus aureus Bacteremia (SAB) is associated with high morbidity and mortality ranging from 10-40% with an in-hospital mortality of 13-50%. The primary concern is its ability to cause metastatic complications in as many as 53% of cases which contributes to poor prognosis. The positive impact of formal Infectious Disease consultation (IDc) in SAB management is a well-known concept in Western Countries.
The published data from developing countries is limited, with particularly no studies available from India.
The present study was undertaken to know the impact of ID consultation on outcomes and detection of IE in SAB patients
Workflow of ID Consultation in SAB cases

Methods
This was a quasi-experimental study carried at a tertiary care centre of Western India after approval from Institutional Ethical Committee (IEC).
Inclusion criteria: All hospitalised patients with confirmed blood stream infections (BSI) due to Staphylococcus aureus
Exclusion criteria: Patients with Polymicrobial BSI, with documented SAB in previous 12 weeks and patients surviving ≤72 hours after positive index blood culture
The data of SAB with ID consultation was collected prospectively between January 2023-December 2023 and the data without IDc was collected retrospectively from January 2021 – December 2022. Informed consent was taken from every study participant; however, IEC waived the requirement for informed consent for the retrospective two-year data of SAB.
The primary and secondary outcomes were analyzed
The workflow of ID consultation is summarised in Fig. 1
Baseline characteristics of patients with Staphylococcus aureus bacteremia

Results
A total of 55 patients were diagnosed with SAB in IDc group and 45 were included in final analysis.
A total of 180 patients were diagnosed with SAB in retrospective data who had no access to IDc and 148 were included in final analysis.
Table 1 shows the comparison between demographic profile, co-morbidities and risk factors associated with SAB cases in IDc group vs no IDc group. Most of them were comparable except Diabetes mellitus and Steroid use which was higher in IDc group.
Table 2 depicts statistically significant difference between primary and secondary outcomes among IDc group in comparison to no IDc group.
Primary and Secondary outcomes in patients with SAB

Conclusion
Timely ID consultation in cases of SAB is prudent as this can help in streamlining the management and can bring out improved outcomes for patients.

Disclosures
All Authors: No reported disclosures
P-822. Unraveling the Landscape of Staphylococcus aureus Bloodstream Infection: Insights from a Single-Center Study
Authors: Naguthevar Santhanam , Kaur Navneet , Neetha T R , Khatod Yash , kanagiri Tejasvi , Kumar Bhuvanesh , Ravindra Akshatha , Tak Vibhor , Kumar Deepak , Meena Durga Shankar , Kumar Midha Naresh 
Published: January 2025

Abstract

Background
Staphylococcus aureus significantly impacts human health, with global prevalence ranging from 13% to 74% and 37% in India. By delving into the intricacies of this bloodstream infection, we aim to provide valuable insights into its manifestations, risk factors, and antibiotic sensitivities, crucial for guiding tailored treatment strategies and optimizing patient outcomes.

Methods
Between February 2022 and January 2024, a prospective observational study was conducted at AIIMS, Jodhpur, India, encompassing all blood culture-positive Staphylococcus aureus patients, with comprehensive collection of clinical, epidemiological, microbiological, and outcome data.

Results
In our study, we observed a diverse demographic distribution among Staphylococcus aureus bloodstream infection cases. The most common age group affected was 1-20 years, comprising 29.82% of cases, followed closely by individuals aged 21-40 years (24%), 41-60 years (23.27%), and those over 60 years old (22.91%).
Clinical manifestations varied, with Hospital-Acquired Pneumonia (HAP) being the most common syndrome at 31.27%, followed closely by Central Line-Associated Bloodstream Infection (CLABSI) at 27.27%. Other prevalent syndromes included Community-Acquired Pneumonia (CAP; 17.45%), Bone & Joint infections (22.54%), Meningitis (10.18%), Urinary Tract Infection (UTI; 2.54%), Skin and Soft Tissue Infections (SSTI; 4%), and Endocarditis (4%).
Regarding Staphylococcus aureus strain types, Methicillin-Sensitive Staphylococcus aureus (MSSA) constituted the majority of cases at 55.64%, followed by Methicillin-Resistant Staphylococcus aureus (MRSA) at 42.54%, and Vancomycin-Resistant Staphylococcus aureus (VRSA) at 1.82%.
Among the recorded outcomes, the majority of patients (78.54%) showed improvement following treatment, while 16.36% of patients succumbed to the infection. Additionally, 5.09% of patients were lost to follow-up.

Conclusion
Despite progress, many patients succumbed or were lost, highlighting the need for vigilant monitoring and enhanced treatments. Our study underscores the urgency to improve outcomes and curb Staphylococcus aureus infections.

Disclosures
All Authors: No reported disclosures
P-823. Navigating Staphylococcus aureus Bloodstream Infections in Pediatrics: A Comprehensive Analysis
Authors: Naguthevar Santhanam , Tak Vibhor , Abhishek Kumar S , Khera Daisy 
Published: January 2025

Abstract

Background
Staphylococcus aureus bacteraemia poses substantial morbidity and mortality risks in children, with infection rates ranging from 1.5 to 3.5 per 1000 hospitalizations. Diagnosis and management of Staph. aureus is challenging. This study aims to delineate the spectrum of Staph. aureus bloodstream infections (BSI) in paediatric patients, aiding in the development of more effective management strategies.

Methods
Conducted at AIIMS, Jodhpur, India, from February 2022 to January 2024, this prospective observational study gathered clinical and microbiological data from 82 patients with Staphylococcus aureus BSI.

Results
In this study, the most commonly affected age group was children under 5 years, constituting 39.02% of cases, followed by those aged 11 to 15 years (31.71%), 16 to 20 years (17.07%), and 6 to 10 years (12.19%).
In the observed clinical syndromes, the most common was bone and joint infections, affecting 34.15% of patients, followed by healthcare-associated pneumonia (HAP) at 30.49%. Meningitis was observed in 13.41% of cases, while community-acquired pneumonia (CAP) accounted for 17.07%. Central line-associated bloodstream infections (CLABSI) were reported in 7.32% of patients, with skin and soft tissue infections (SSTI) noted in 3.66% of cases. Urinary tract infections (UTI) represented the least common, affecting 1.22% of patients.
Methicillin Resistant Staphylococcus aureus was present in 54.88% of cases, followed by Methicillin Sensitive Staphylococcus aureus at 40.24%, and Vancomycin Resistant Staphylococcus aureus at 4.88%.
In terms of outcomes, the majority of patients, constituting 75.61%, experienced improvement in their condition. Unfortunately, 21.95% of patients succumbed to the infection, while a small proportion, accounting for 2.44%, were lost to follow-up.

Conclusion
MRSA underscores the challenges posed by antimicrobial resistance. Our comprehensive analysis of Staphylococcus aureus bloodstream infection reveals multifaceted challenges in its management..

Disclosures
All Authors: No reported disclosures
P-833. The trends of hospital-onset bacteremia at a tertiary care center and the impact of the establishment of infectious diseases department on its incidence: a 10-year longitudinal study
Authors: Kawamoto Yuya , Doi Yohei , Honda Hitoshi 
Published: January 2025

Abstract

Background
Hospital-onset bacteremia (HOB) is defined as the onset of bacteremia occurring three or more days after hospitalization. The incidence density of HOB has recently been used to assess the quality of overall hospital infection control practice in lieu of the central line-associated bloodstream infection incidence rate since the HOB incidence might better predict the length of stay, hospital costs, and mortality rates. At the study institution, Infectious Diseases (ID) department was established in April 2018. The present study aims to investigate the incidence density of HOB prior to and after the establishment of ID department.
Change and trend of the incidence density of HOB before and after the establishment of ID department as determined by ITSA.

Methods
We investigated the monthly incidence density of HOB per 1,000 patient-days from 2013 through 2023 at Fujita Health University Hospital. The trends of overall incidence of HOB and HOB by causative pathogens group, including Streptococcus species (spp), Staphylococcus aureus, Coagulase-negative staphylococci (CNS), Enterococcus spp., Enterobacterales, and Candida spp. were tracked. Changes in the trend of HOB before (from July 2013 through March 2018) and after (from April 2018 through June 2023) the establishment of ID department were evaluated. Interrupted time series analysis was used for statistical analyses.
Change and trend of the incidence density of HOB before and after the establishment of ID department as determined by ITSA.

Results
In total, 4,422 HOB events were identified during the study period. The overall incidence density of HOB was 0.94 per 1,000 patient-days. Comparison of the incidence of HOB between the period before and after the establishment of ID department revealed an immediate increase in the incidence of overall HOB (+0.3246; P&lt; .001 for change in level) and HOB caused by S. aureus (+0.10; P&lt; 0.001 for change in level), CNS (+0.12; P&lt; 0.001 for change in level), and Candida spp. (+0.05; P=0.03 for change in level). A significant trend increase in the incidence of HOB was also observed in HOB due to S. aureus (+0.002; P&lt; .001 for change in trend) Candida spp. (+0.002; P=0.002 for change in trend), and Enterobacterales (+0.002; P=0.002 for change in trend).

Conclusion
The overall incidence density of HOB has increased significantly in the last decade, and the trend was steeper after the establishment of ID department. Improvement in ID clinical practice may contribute to increasing the detection of HOB.

Disclosures
Yohei Doi, MD, PHD, AbbVie: Honoraria|Entasis: Grant/Research Support|Gilead: Advisor/Consultant|GSK: Advisor/Consultant|Meiji Seika: Advisor/Consultant|Moderna: Advisor/Consultant|Pfizer: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Honoraria Hitoshi Honda, MD, Moderna Inc: Honoraria|Pfizer: Honoraria|Shionogi: Honoraria
P-834. Epidemiology and Duration of Therapy in Patients with Gram-negative Bloodstream Infections: Retrospective Analysis 2.15.0.02.15.0.0
Authors: Al Lawati Hawra J , Earle Ellen , Lee Matthew S 
Published: January 2025

Abstract

Background
Longer courses of antibiotics can be associated with antimicrobial resistance and adverse effects. Randomized clinical trials support treating uncomplicated gram-negative bloodstream infections (GN-BSI) for a shorter duration with a consensus that a seven-day course of antibiotics is appropriate. Prior to the implementation of a GN-BSI treatment guideline at our institution, we aimed to assess the characteristics of patients with GN-BSI and the duration of antibiotic therapy (DOT).

Methods
We retrospectively reviewed adult inpatients with GN-BSI over a period of 6 months. Patients were excluded if they had a concomitant gram-positive bloodstream infection or if they were transitioned to comfort-focused care within 48 hours of their first positive blood culture. Complicated GN-BSI was defined as having any of the following: bone, joint, endovascular, or foreign body involvement, lack of source control, immunocompromised status, or failure to show clinical improvement or culture clearance within 72 hours. The primary outcome was the mean DOT in patients with GN-BSI.

Results
100 patients met the inclusion criteria. Escherichia coli (54 cases) was most frequent organism. Urine (41) was the predominant source of bacteremia. Cefepime (48) was the most common empiric antibiotic. Of the 91 patients with available ceftriaxone susceptibility results, 84% had a susceptible organism. Of the 51 patients with a complicated GN-BSI, the leading cause was immunosuppression. Table 1 presents a comparative analysis of complicated vs. uncomplicated GN-BSI. Complicated GN-BSI had longer DOT (20 vs. 11 days, P&lt; 0.005) and fewer patients transitioned to oral therapy (33% vs. 67%, P&lt; 0.005).

Conclusion
At our institution, patients with uncomplicated GN-BSI have a shorter DOT and are more likely to transition to oral therapy than those with complicated GN-BSI. However, the mean DOT for uncomplicated infections remained longer than seven days and a large number of uncomplicated GN-BSI patients did not transition to oral therapy, indicating room for improvement in local practice through antimicrobial stewardship initiatives.

Disclosures
All Authors: No reported disclosures
314. Ceftazidime-Avibactam Versus Meropenem-Vaborbactam for the Treatment of Carbapenem-Resistant Enterobacterales Infections
Authors: Karaba Sara M , Hareza Dariusz A , Hawes Armani , Bergman Yehudit , Fiawoo Suiyini , Hyoung Lee Jae , Cosgrove Sara E , Simner Patricia J , Tamma Pranita 
Published: January 2025

Abstract

Background
Infections due to carbapenem-resistant Enterobacterales (CRE) are increasing in the United States, most commonly the result of Klebsiella pneumoniae carbapenemase (KPC) production. Both ceftazidime-avibactam (CZA) and meropenem-vaborbactam (MVB) are preferred treatment options for CRE infections but comparative effectiveness data to assist clinicians with preferentially selecting between these agents are limited.

Baseline characteristics of 118 patients treated with ceftazidime-avibactam or meropenem-vaborbactam for carbapenem-resistant Enterobacterales

Methods
We conducted an observational study of patients with CRE infections between 2018–2023 who received ≥ 3 days of CZA or MVB across five Maryland hospitals. Susceptibility to the administered agent (i.e., CZA or MVB) was required for eligibility. Inverse probability weighting (IPW) using propensity scores was used to assess the primary outcome of 30-day mortality. Development of resistance (i.e., ≥ 4-fold increase in MIC of the agent used to treat the index infection) within 90 days assessed by broth microdilution was a secondary outcome.

Baseline characteristics of 75 patients treated with ceftazidime-avibactam or meropenem-vaborbactam for carbapenem-resistance Enterobacterales that harbored KPC genes

Results
In the entire cohort there were 95 and 23 patients in the CZA and MVB groups, respectively. Balance was achieved across all variables in the IPW cohort (Table 1). 30-day mortality was similar between the antibiotic groups comparing CZA to MVB (aOR 0.997, 95% CI 0.86–1.63, p=0.97) and in the subgroup of 75 patients with isolates with an identified blaKPC gene present who underwent IPW with good balance achieved (Table 2) (aOR 1.02, 95% CI 0.85–1.21, p=0.87).

Conclusion
In a cohort of patients with CRE infections treated with either CZA or MVB, 30-day mortality was similar. The frequency of subsequent emergence of resistance is currently being investigated.

Disclosures
Sara M. Karaba, MD, PhD, MHS, Entasis: Advisor/Consultant Patricia J. Simner, PhD, Affinity Biosensors: Grant/Research Support|BD Diagnostics: Grant/Research Support|bioMérieux: Grant/Research Support|Entasis: Personal fees|GeneCapture: Personal Fees|Merck: Personal fees|OpGen Inc: Grant/Research Support|Qiagen: Grant/Research Support|Shionogi: Personal fees|T2 Biosystems: Grant/Research Support
P-864. Systematic Review and Meta-analysis of the Impact of Infectious Diseases Consultation on Management and Outcomes of Staphylococcus aureus Bacteremia in Children
Authors: Santhanam Haripriya , Muthukumarasamy Nirmal , Hsieh Mariana Kim , Brust Karen , Wellington Melanie , Naito Toshio , Samuelson Riley J , Marra Alexandre , Kobayashi Takaaki 
Published: January 2025

Abstract

Background
Staphylococcus aureus is a common cause of both community-acquired and nosocomial bacteremia in children. Multiple studies evaluating the role of infectious disease consultation (IDC) in adult patients with Staphylococcus aureus bacteremia (SAB) have shown a protective effect of IDC on mortality and recurrence rates. However, there is limited data available regarding the impact of IDC on outcomes of SAB in the pediatric population.
Literature Search on the Impact of Infectious Disease Consultation in Pediatric Patients with Staphylococcus aureus Bacteremia

Methods
This systematic literature review and meta-analysis were performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. A search strategy to identify publications about SAB and IDC in children was developed in collaboration with a health sciences librarian. The primary outcomes were all-cause mortality and SAB recurrence rates. Crude or unadjusted numbers were used for the pooled odds ratios (ORs) as adjusted ORs were not available in all articles.
Meta-analysis of outcomes of Staphylococcus aureus Bacteremia in pediatric patients

Results
Among 972 articles screened, 8 studies were included in the systematic review, of which, 2 were retrospective cohort studies, 2 were prospective cross-sectional studies, and 4 were quasi-experimental studies. The quality of 6 studies was considered good ( &gt;18 of 28 possible points) per the Downs and Black quality tool while two studies were considered fair (15 – 18 points). Five of 8 studies directly evaluated the impact of IDC on outcomes in pediatric SAB and included in the meta-analysis. Pooled results showed IDC was associated with significantly lower mortality in pediatric SAB with low heterogeneity (pooled OR = 0.44, 95% confidence interval [CI]: 0.20−0.97, I2 = 0%). IDC was associated with lower recurrence rates, however this was not statistically significant with moderate heterogeneity (pooled OR = 0.24, 95% CI: 0.04 to 1.34, I2 = 56%).
Funnel Plot of Mortality and Recurrence in Pediatric Patients with Staphylococcus aureus Bacteremia

Conclusion
Our study suggests that IDC significantly improves the mortality of pediatric patients with SAB. Given there have been only five papers evaluating the same topic, with most being retrospective studies at a single center, a multicenter prospective study will be required. Our study provides a strong argument in favor of policies such as “automatic” IDC for children with SAB.

Disclosures
All Authors: No reported disclosures