bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-151. Cutaneous Larva Migrans Within the United States Military Health System and Association with International Travel
Authors: Crecelius Elena , Hickey Patrick , Helfrich Alison 
Published: January 2025

Abstract

Background
Cutaneous larva migrans (CLM) is a parasitic dermatitis which occurs after zoonotic hookworm larva from the soil penetrate the skin. CLM is most common in tropical and sub-tropical regions of the world and in returning travelers from those regions. Within the United States (U.S.) autochthonous cases of CLM have been reported, however the epidemiology is not well-described. We seek to describe the epidemiology of CLM and association with geographic location and international travel within the U.S. military health system.

Methods
We performed a retrospective cohort study of active duty service members and their family members who had a diagnosis code of hookworm between October 2012 and September 2018. Of the initial cohort (n = 272), 61 (22.4%) were diagnosed with CLM.

Results
Most patients in this study were male (65.5%), active duty (55.7%), and white (45.9%) [Table 1]. Patients’ ages ranged from 1 to 56 years (mean 24.6) with 80.3% of patients 18 years of age or older. All the patients were born within the United States. Most were diagnosed by their primary care manager, however 19.7% were diagnosed via emergency or urgent care. Patients reported preceding travel to tropical and subtropical world regions in 32.8% of cases: Caribbean (13.1%), Africa (6.6%), Mexico and Central America (6.6%), South America (3.3%) and Japan (3.3%) [Figure 1]. After excluding those with preceding international travel, 67.2% of patients had autochthonous CLM. Of the autochthonous cases, more patients were diagnosed or had preceding travel in the southeast U.S. (68.3%) compared with the western U.S. (19.5%), southwest U.S. (9.8%), or northeast U.S. (2.4%) [Figure 2]. States with the highest number of cases were Florida (26.7%), Georgia (14.6%), North Carolina (9.8%), Texas (9.8%), Washington (7.3%) and Hawaii (7.3%). Based on the reported literature, we found a lower number of cases with preceding international travel than expected. Most autochthonous cases within the U.S. were from the southeast and coastal regions.

Conclusion
CLM should be considered in the U.S. even in patients without recent international travel. These findings are useful in providing nationwide data on the epidemiology of CLM and allowing for informed preventative counseling to travelers and non-travelers within the U.S.

Disclosures
Alison Helfrich, DO, MPH, Moderna: Stocks/Bonds (Public Company)|Sanofi: Stocks/Bonds (Public Company)
P-170. Efficacy and Safety of Intermittent Preventive Treatment with Dihydroartemisinin-Piperaquine for Prevention of Malaria in Pregnant Women with HIV: A Meta-analysis of Randomized Controlled Trials
Authors: Joseph Meghna , Murali Krishna Mrinal , Ezenna Chidubem , Sadasivan Sreemathy Lal 
Published: January 2025

Abstract

Background
WHO recommends intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (S-P) in malaria-endemic areas. In pregnant women with HIV taking cotrimoxazole prophylaxis, IPTp with S-P is contraindicated due to the risk of adverse effects from combining two antifolate and sulfonamide drugs. The growing resistance of the malarial parasite to sulfa-based drugs adds to the problem. We performed a meta-analysis comparing IPTp with dihydroartemisinin-piperaquine (D-P) vs. placebo for malaria prevention in pregnant women with HIV.

Methods
We searched PubMed, Scopus, Cochrane Central, LILACS, and Malaria in Pregnancy Consortium Library databases for trials comparing IPTp with D-P vs. placebo in pregnant women with HIV. Outcomes of interest included placental malaria, maternal malaria, and adverse pregnancy outcomes. Statistical analysis was performed using R software. Heterogeneity was assessed using I2 statistics. The analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline.

Results
The systematic review identified 3 randomized controlled trials including 1,770 participants. Placental malaria (RR 0.65; 95%CI 0.48-0.87; p=0.004; I2=2%) at delivery was significantly lower in the D-P group compared with the placebo group. Maternal malaria (RR 0.63; 95%CI 0.29-1.40; p=0.258; I2=22%) at delivery showed no significant difference between the groups. However, a leave-one-out analysis excluding one study conducted during a low-transmission period found a significantly lower risk of maternal malaria (RR 0.47; 95%CI 0.23-0.96; p=0.039; I2=0%) in the D-P group. Adverse pregnancy outcomes like mother-to-child transmission of HIV (RR 1.53; 95%CI 0.25-9.35; p=0.646; I2=0%), spontaneous abortion (RR 1.80; 95%CI 0.60-5.42; p=0.296; I2=0%), stillbirth (RR 1.02; 95%CI 0.56-1.85; p=0.952; I2=0%), congenital anomaly (RR 0.90; 95%CI 0.33-2.43; p=0.830; I2=31%), preterm delivery (RR 1.05; 95%CI 0.56-1.94; p=0.885; I2=42%), and low birth weight (RR 1.13; 95%CI 0.87-1.48; p=0.352; I2=0%) were similar in both groups.

Conclusion
IPTp with D-P reduced the risk of placental malaria and maternal malaria at delivery in pregnant women with HIV. Adverse pregnancy outcomes were similar in both groups.

Disclosures
All Authors: No reported disclosures
P-191. Outcomes of Clostridioides difficile Infection in Patients Treated with a Partial versus Complete Course of Fidaxomicin
Authors: Rosario Caroline , Rausch Ethan P , Soman Rohit , Beckman Kaitlin , Lefemine Amanda 
Published: January 2025

Abstract

Background
Current guidelines recommend fidaxomicin as the preferred treatment for initial and recurrent non-fulminant Clostridioides difficile infection (CDI). However, widespread use of fidaxomicin in practice is limited by high cost and inconsistent insurance coverages which may necessitate partial completion of a fidaxomicin course with an alternative antibiotic. Currently, to our knowledge, there is no published literature to describe how this impacts CDI treatment outcomes.

Methods
This was a retrospective, multicenter cohort study of hospitalized patients with CDI treated with fidaxomicin from May 2022 through August 2023. Patients treated with a full course of fidaxomicin (≥20 doses) were compared to those treated with a partial course of fidaxomicin (&lt; 20 doses). Included patients were age ≥18 years, received ≥6 inpatient doses of fidaxomicin, and had a stool sample positive for C.difficile. Demographic and clinical data were collected via electronic medical record review. The primary outcome was 90-day CDI recurrence. Secondary outcomes were 30-day CDI recurrence, 90-day hospital readmissions, 90-day all-cause mortality, and hospital length of stay.

Results
The study included 39 patients in the full fidaxomicin group and 11 patients in the partial fidaxomicin group. The population was predominately female (56%) with a mean age of 67.2 years. Among all patients who completed treatment after discharge (62%), a gap in therapy of greater than four days was more frequently observed in the full fidaxomicin group (2/22 vs. 0/9; p=1.000). The partial fidaxomicin group observed a numerically higher rate of 90-day recurrence (18.2% vs. 12.8%; p=0.641). Similar patterns were observed for all secondary outcomes (Figure 1). The mean hospital length of stay was 23.9 in the full fidaxomicin group compared to 9.8 days in the partial fidaxomicin group (p=0.301).

Conclusion
Partial completion of a fidaxomicin course with an alternative antibiotic was associated with a numerically higher rate of CDI recurrence, readmission, and all-cause mortality. Due to small sample size, the study was underpowered to detect statistically significant differences in these findings. Larger comparative effectiveness studies are needed.

Disclosures
All Authors: No reported disclosures
P-234. Clinical Factors Associated with Central Line Associated Blood Stream Infections (CLABSI) in Hospitalized Dialysis Patients
Authors: Morton Jackson , Neelakanta Anupama , Betts Wendy , Kester Shelley , Passaretti Catherine 
Published: January 2025

Abstract

Background
We sought to understand factors associated with Central Line Associated Blood Stream Infections (CLABSI) in hospitalized patients receiving dialysis.

Methods
7353 patients hospitalized between 2019 and 2021 with an ICD-10 code for dialysis and who had a central line accessed during their stay were identified. Demographics, comorbidities, central line characteristics, and length of stay data were collated from the electronic health record and linked to infection prevention CLABSI data. 38 cases on dialysis at the time of CLABSI were identified and matched to controls who did not have a CLABSI. Controls were matched to cases (2:1) by age (+/- 10 years), race, facility, admission date (+/-6 months) and intensive care unit admission during their stay. 2 cases were excluded due to inability to match.
Descriptive statistics were performed. Univariate and multivariable logistic regression models were used to assess for factors associated with increased odds of CLABSI.

Results
Dialysis patients with CLABSI were predominantly Black and male. 76% of cases were admitted to the ICU during their stay and 33% died within 30 days of CLABSI. Tunneled catheters, non-tunneled catheters and arteriovenous fistula/graft (AVF/G) were present in 50%, 31% and 14% of patients respectively at time of CLABSI. Cases were more likely than controls to have a non-tunneled catheter for hemodialysis access, longer length of stay, longer central line duration, and have had a transplant. (Table 1) Patients with non-tunneled catheters were 13 times more likely to have a CLABSI than those with AVF/G (p 0.02). Patients who received dialysis prior to admission had lower odds of CLABSI compared to acute dialysis patients (OR 0.5, p 0.08). (Table 2) After adjustment for age, sex, history of transplant, and being on dialysis prior to admission, increased length of stay (OR 1.03, p 0.01) and use of non-tunneled catheter for dialysis (OR 10.2, p 0.03) remained associated with increased odds of CLABSI. (Table 3)

Conclusion
The use of non-tunneled catheters and longer length of stay were identified as key predictors of CLABSI in patients on dialysis. These findings emphasize the need for strict infection control measures and careful monitoring of catheter types in this vulnerable population.

Disclosures
All Authors: No reported disclosures
P-255. Evaluation of automated disinfectant dispenser systems in 6 hospitals demonstrates a need for improved monitoring to ensure that correct disinfectant concentrations are delivered
Authors: Cadnum Jennifer , Kaple Claire , Saade Elie , Ray Amy , Donskey Curtis 
Published: January 2025

Abstract

Background
Automated dispensers that dilute concentrated disinfectants with water are commonly used in healthcare facilities. However, most facilities do not perform routine monitoring to ensure that the dispensers are functioning correctly and being used as recommended by the manufacturer.Table 1.Concentrations of disinfectant measured in samples obtained from automated dispensers and from in-use buckets on environmental services carts in 6 hospitalsQA, quaternary ammonium disinfectant; PA, peracetic acid-based disinfectant.a. Expected concentrations, ∼1,300 parts per million (PPM) for PA and ∼800 PPM for QA; higher-than-expected concentration of peracetic acid, &gt;1,800 ppm; b. Lower than expected concentration, 300-900 PPM for PA and 200-400 PPM for QA; cNo disinfectant detected, limit of detection (∼300 PPM for PA and ∼150 PPM for QA); d. Wrong product, the in-use product that was supposed to be PA or QA was a detergent intended for floors.

Methods
In 6 acute care hospitals in Northeast Ohio, we tested disinfectant concentrations and pH of products obtained from automated dispensers and in-use containers from environmental services (EVS) personnel carts. The disinfectants included quaternary ammonium (800 parts per million [ppm]; pH 8) and peracetic acid-based products (∼1300 ppm; pH 3).

Results
All 6 hospitals had 1 or more malfunctioning dispensers (Table 1). Of 57 systems assessed, 14 (25%) dispensed products with lower-than-expected concentrations, including 8 (14%) with no detectable disinfectant (i.e., water). Nine of 62 (15%) in-use products had no detectable disinfectant, and 4 (7%) were the wrong product (i.e., a detergent for floors used for high-touch surfaces). Reasons for dispenser malfunction included incorrect connection of the concentrate container, dysfunction of a low-product indicator, and failure to change the concentrate container when indicated. pH measurements identified disinfectants with lower-than-expected concentrations, and an intervention that included monitoring was effective in ensuring that the dispensers were operating correctly.

Conclusion
Improved monitoring of automated disinfectant dispenser systems in healthcare facilities is needed to ensure patient safety. pH measurements could provide a simple means to ensure that dispensers are functioning correctly.

Disclosures
Elie Saade, MD, MPH, FIDSA, Janssen Global Services: Advisor/Consultant|Janssen Global Services: Advisor/Consultant|Janssen Research and Development: Advisor/Consultant|Janssen Research and Development: Advisor/Consultant Curtis Donskey, MD, Clorox: Grant/Research Support|Pfizer: Grant/Research Support
P-260. Antibiotic residues in hospital sink p-trap water in Kilifi, Kenya
Authors: Hookham Lauren , Tigoi Caroline , Amulele Anne , Rodger Gillian , Chau Kevin , Musyimi Robert , Berkley James A , Stoesser Nicole 
Published: January 2025

Abstract

Background
The hospital environment, including sink drains, may act as reservoirs for bacteria and antimicrobial resistance (AMR) gene amplification and spread. Selective pressures in sink environments, such as from disposal of antibiotics, may promote AMR. This pilot study at Kilifi County Hospital, Kenya, aimed to describe the prevalence of common antimicrobials in wastewater.
Presence of antibiotics in sinks by ward type
Presence of antibiotics (beta-lactam, sulpha, quinolone or tetracycline) detected in p-trap water of sinks in in-patient wards at Kilifi County Hospital, Kenya.

Methods
Data were collected on the number of beds/patients/sinks per bay and ward, distance from sink to patient bed, and sink design. We aimed to obtain 50ml of p-trap water from different sink types (i.e. bay, sluice, toilet) across all hospital wards.
Dipstick testing was performed using the QuaTest BTSQ 4-1 kit, which was previously validated using serial dilutions of ampicillin, doxycycline, sulfamethoxazole and ciprofloxacin (1). All samples were processed at Kenya Medical Research Institute Wellcome Trust Research Programme on the day of collection.

Results
34 sinks were targeted across nine wards. Two sinks on the neonatal birth unit (NBU) were broken or blocked and not sampled. One sink p-trap on NBU could not be aspirated despite running water to fill the p-trap. 1 sample from ICU was lost in transit from hospital to laboratory. In total, p-trap aspirates from 30 sinks were available for analysis.
Antibiotic testing failed in 1/30 (3%) samples, with absent control lines. Antibiotics were detected in 6/30 (20%) samples (complex triage, adult ICU, maternity, NBU, paediatric HDU). Most positive samples (67%, 4/6) were from patient bays, and the remainder from sluices (33% 2/6). No association was found between the presence of any antibiotic in p-trap water and building or sink type. The proportion of sinks in wards caring for pregnant women (50%, 2/4) and neonates (67%, 2/3) with detectable beta-lactam antibiotics was higher than wards caring for adults or children (p=0.03).

Conclusion
We describe prevalence of antibiotic residue in hospital wards at Kilifi County Hospital, Kenya. Antibiotics were predominantly found in patient bays in wards caring for pregnant women and neonates. This finding may reflect differences in antibiotic usage and waste disposal practices. Targeted interventions with healthcare staff and hospital governance are necessary to promote responsible antibiotic and patient waste management.

Disclosures
All Authors: No reported disclosures
P-275. Risk Factors for Community Colonization with Extended-Spectrum Cephalosporin-Resistant Enterobacterales (ESCrE) among People with HIV in Botswana
Authors: Loabile Bogadi , Lautenbach Ebbing , Mannathoko Naledi B , Mosepele Mosepele , Mosepele Mosepele , Styczynski Ashley R , Mann Smith Rachel , Cressman Leigh , Jaskowiak Anne , Bilker Warren B , Alby Kevin , Glaser Laurel , Richard-Greenblatt Melissa , Cowden Laura , Sewawa Kgotlaetsile , Otukile Dimpho , Paganotti Giacomo , Mokomane Margaret , Gross Robert 
Published: January 2025

Abstract

Background
Extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) are a major global threat, and there is a significant gap in research on the burden and associated risk factors for ESCrE in low-and middle income countries(LMICs). This is particularly true for people with HIV (PWH), who make up a significant proportion of the population in sub-Saharan Africa. In Botswana, 20% of individuals aged 15-49 are PWH. The risk factors associated with ESCrE colonization, typically a precursor to infection, are important to understand as such infections can result in increased healthcare costs as well as high morbidity and mortality.

Methods
Within a larger regional surveillance study, 546 adults with HIV were recruited from clinics and communities in 3 districts and underwent interviews and rectal sampling. ESCrE was defined as Enterobacterales demonstrating non-susceptibility to ceftriaxone or ceftazidime.

Results
27% of participants screened positive for ESCrE colonization. The mean CD4 count was 635 cells/mm3 (SD± 267). Table 1 describes the demographics of the participants with and without ESCrE colonization. Escherichia coli was the most commonly isolated ESCrE (146/174; 84%). Bivariate and multivariate analysis was used to determine risk factors associated with ESCrE colonization (Table 2). Recent hospitalization and certain geographic locations were independent risk factors for ESCrE colonization. Recent antibiotic use had an elevated OR for ESCrE colonization that did not achieve statistical significance in adjusted analysis.

Conclusion
These results add to the limited data on risk factors associated with ESCrE colonization in PWH. Hospitalization is an independent risk factor for colonization despite controlling for antibiotic use, which suggests the need for further investigation into hospital-specific factors that contribute to ESCrE colonization. Further research is needed to understand the geographic differences in ESCrE colonization in this setting. As LMICs with high HIV burdens build capacity for antimicrobial stewardship and infection prevention infrastructure in healthcare, research on unique potential mechanisms that result in multi-drug resistant colonization in PWH may impact strategies and priorities to combat antimicrobial resistance.

Disclosures
Robert Gross, MD, MSCE, Pfizer Inc: DSMB member for drug unrelated to study
P-281. Risk Factors for Treatment Failure in Infections Caused by Carbapenem-Resistant Enterobacterales (CRE)
Authors: Ting Michelle , Martens Mycah , Albazzaz Haya , Wolesensky Christine , Kobic Emir 
Published: January 2025

Abstract

Background
Multi-drug resistant organisms (MDROs) are a rising global public health threat. During the COVID-19 pandemic, there was a surge in New Delhi Metallo-Beta-Lactamases (NDM) amidst increasing prevalence of Carbapenem-Resistant Enterobacterales (CRE) infections in Maricopa County, Arizona. The objective of this study was to investigate risk factors associated with CRE treatment failure by measuring the composite of 30-day mortality and 30-day microbiologic recurrence.Table 1.Patient Characteristics

Methods
A multicenter observational retrospective chart review of a large health system’s 31 acute care facilities was performed for adult patients with infections caused by an organism in the Enterobacterales group with resistance to at least one carbapenem between January 1st, 2023 and July 31st, 2023. Key exclusion criteria were pregnancy and any patients with prior positive cultures with CRE within 60 days (only the first instance was included). Data was obtained via reports provided by pharmacy analytics.Table 1.Multivariable Logistic Regression, Predictors of Clinical Failure

Results
Of 169 included patients, 21% faced 30-day mortality, while 18% encountered microbiologic recurrence within 30 days. The majority (53%) of patients were admitted from assisted living facilities. The most common organism was Klebsiella pneumoniae occurring in 82% of cases and NDMs were the most prevalent carbapenemase, occurring in 76% of patients; urine was the source of infection in 60% of patients. Our multivariable logistic regression identified several significant risk factors associated with CRE treatment failure, including receipt of renal replacement therapy (RRT), prior diagnosis of peripheral vascular disease (PVD), and prior hospitalization within 90 days of index culture. Patients infected with an MBL producer and those not being seen by ID consult also trended towards worse outcomes.

Conclusion
Our study highlights the concerning prevalence of Klebsiella pneumoniae infections with metallo-beta lactamases in Maricopa County Arizona, along with clinically significant risk factors contributing to treatment failure against CREs. Notably, the majority of patients arrived from a healthcare related facility, underscoring the importance of implementing best infection prevention and antimicrobial stewardship practices in these settings.

Disclosures
Emir Kobic, BCIDP, Shionogi: Grant/Research Support|Shionogi: Speaker Bureau