bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-934. Emerging Trends and Challenges in Pediatric Infective Endocarditis: Insights from a Single-Center Observational Study
Authors: Naguthevar Santhanam , Tak Vibhor , Khera Daisy , Didel Siyaram , Abhishek Kumar S 
Published: January 2025

Abstract

Background
Infective endocarditis (IE) in children is rare but challenging, with an incidence of 0.43–0.69 cases per 100,000 children–year. Risk factors include congenital and acquired heart diseases, as well as healthcare-associated acquisition via prosthetic devices

Methods
A prospective study was conducted at AIIMS Jodhpur's Department of Medicine from January 2021 to 2024. It included pediatric patients with suspected infective endocarditis (IE).

Results
In this study, the most common age for pediatric endocarditis was 16-20 years, representing 50% of the patients. Following that, the 11-15 years age group accounted for 20% of cases. Both the 0-5 years and 6-10 years age groups each constituted 15% of the patients.
In the study, 65% of pediatric endocarditis cases were male, and 35% were female. Additionally, 60% of patients had a previous heart disease, while 35% did not. For endocarditis type, 15% were prosthetic IE, and 85% were native valve cases.
In the study, the mitral valve was most commonly affected, accounting for 65% of pediatric endocarditis cases. The aortic valve was involved in 20% of cases, while the tricuspid valve was affected in 10%. A combination of aortic and pulmonary involvement was observed in 5% of the cases.
In the study, culture-negative cases were the most common, accounting for 40% of pediatric endocarditis cases. Following that, both Streptococcus and Burkholderia each represented 15% of the infections. Staph aureus and Libmansack IE were each responsible for 10%, while Acinetobacter baumannii and Bartonella comprised 5% of the cases.
In the study, 80% of pediatric endocarditis patients showed improvement, while 20% unfortunately expired.

Conclusion
This study emphasizes the diagnostic challenges of pediatric IE, with many cases culture-negative and caused by diverse organisms. Predominantly affecting adolescents and those with pre-existing heart conditions, IE in children presents multifaceted complexities, underscoring the need for improved diagnostic and treatment strategies to achieve successful outcomes.

Disclosures
All Authors: No reported disclosures
P-935. Treatment and outcome characteristics in patients with Staphylococcus aureus Infective Endocarditis: A prospective observational study
Authors: Bohra Gopal Krishana , Kumar Deepak , Kaur Navneet , Deora Surender , Choudhary Rahul , Midha Naresh Kumar , Meena Durga Shankar , Khatod Yash , T R Neetha , kanagiri Tejasvi , Tak Vibhor 
Published: January 2025

Abstract

Background
Infective endocarditis (IE) is one of the most serious complication of Staphylococcus aureus bacteremia (SAB) and its incidence is on rise ranging from 10% to 46%.1 When present, it is linked to poor prognosis, with in-hospital mortality ranging from 20% to 30% highlighting to some extent the challenge in clinically diagnosing and treating the disease. 2There is lack of data focusing on the management of such cases in developing countries like India.
The present observational study was carried out to determine the treatment and outcome characteristics in patients with IE due to SAB.

Methods
This was a prospective observational study carried in Division of Infectious diseases, Department of General Medicine, All India Institute of Medical Sciences, Jodhpur between January 2023 to October 2023. All consecutive cases diagnosed in-hospital with SAB related IE using modified Duke’s criteria were enrolled in the study. The demographic and clinical details of each patient, the diagnostic evaluation, treatment given and outcomes were recorded. All these patients were followed at 1 month, 3 and 6 months after discharge.

Results
A total of eight cases of SAB related definite IE were included. The most common presenting symptom was fever, present in all cases. Peripheral signs of IE were observed in only three cases having splinter haemorrhages, Osler’s nodes, and Roth spots. IV drug use, congenital heart disease and hemodialysis dependency were found to be risk factors. All the eight patients received only medical management with 5 of them receiving antibiotic monotherapy and 3 of them receiving combination therapy. The reason for combination therapy was persistent bacteremia, lack of fever defervescence. The duration of therapy varied between 6-8 weeks. Five cases underwent repeat follow – up TEE/TTE revealing no vegetation in 4 cases and reduction of vegetation size in one case. There was no in-hospital mortality seen. At 6 months of follow-up one patient expired which was not attributable to SAB IE. Table 1 summarises the clinical, diagnostic and treatment characteristics of cases.
Figure 1 depicts detailed management of SAB related IE cases

Conclusion
This study underscores multifaceted nature of this disease and the use of systematic approach for its management can improve the patient outcomes.

Disclosures
All Authors: No reported disclosures
P-952. A Proposed National Quality Improvement Curriculum for Pediatric Infectious Diseases Trainees
Authors: Li Caitlin , Alkema Hannah 
Published: January 2025

Abstract

Background
Quality improvement is a required competency for all pediatric fellowships, and this skill set is particularly important for infectious diseases (ID) clinicians. However, almost half of pediatric ID program directors report that they do not have a formal QI curriculum for their fellows.
Proposed Quality Improvement and Patient Safety Framework

Methods
A pediatric infectious diseases attending with fellowship and Master’s level training in QI collaborated with the director of improvement science at a large, standalone pediatric hospital to adapt a successful local QI workshop curriculum to align with the needs of pediatric ID fellows. Pediatric ID programs of varied sizes and geographic locations were identified as test sites so the program could be iteratively improved prior to scaling to the national level.

Results
In current state, the designed curriculum has three sections: Patient Safety, Quality Improvement – Background and Tools, and Quality Improvement – Data and Measurement. Each section is designed to be available as a recorded lecture that can be viewed asynchronously or a set of slides with lecture notes that can be reviewed by the participant at their preferred pace. The curriculum will be presented to pediatric fellows at identified programs and iterated based on their feedback prior to widespread distribution.

Conclusion
A national QI curriculum for pediatric ID fellows fills a current gap in resources available for training the next generation of pediatric ID physicians and will equip them with tools that are critical for many facets of a career in ID.

Disclosures
All Authors: No reported disclosures
P-957. Introducing PrEP to Primary Care: A Resident-Focused Initiative
Authors: Moise Hope Oddo , Bell Maren , Gilbert Danielle , Holmes Daniel , Matrana Dexter , Clement Meredith E 
Published: January 2025

Abstract

Background
Despite studies showing that HIV pre-exposure prophylaxis (PrEP) dramatically decreases risk of HIV acquisition, it is only currently prescribed to 30% of those who could benefit. The buy in of primary care providers (PCPs), who have an essential role as preventionists, is critical for the most successful reach; however, studies have shown that PCPs often do not feel knowledgeable about PrEP or may be uncomfortable discussing sexual activity or HIV. We hypothesized that dedicated PrEP training for PCPs in a resident clinic would increase prescribing habits.

Methods
At an Internal Medicine residency clinic with 73 trainees in New Orleans, LA, a pre-intervention survey was distributed to gauge baseline PrEP knowledge and comfort in discussing sexual practices, HIV status and risk factors. Following the training, residents attended a one-hour PrEP training. A post-training survey then assessed interest and intent to prescribe PrEP. We abstracted primary care clinic records to evaluate PrEP prescribing outcomes post-training, from October 2023 to April 2024.

Results
Forty-four residents completed the pre-training assessment. Most indicated non-routine discussions regarding sexual practices (37/44, 84.1%) and HIV risk assessments (41/44, 93.2%). Many trainees reported being not at all familiar with PrEP indications (40.9%), medications (45.5%), or monitoring (81.8%). Most (61.4%) had never discussed PrEP with clients. 53/73 (72.6%) residents attended the educational session, and 26/73 (35.6%) completed the post-training survey. All of the residents who completed both indicated that the training was informative, and 20/21 (95.2%) reported willingness to prescribe PrEP. In the six months post-training, we found that 11 clients were successfully initiated on PrEP. One client was diagnosed with HIV on intake labs, and 3 clients were found to have sexually transmitted infections, all of whom were treated or referred for treatment.

Conclusion
The results of this initiative’s pre-training surveys highlight a lack of routine sexual health and HIV risk assessments in a resident primary care clinic, as well as deficiencies in education regarding HIV PrEP. Following training, residents began prescribing PrEP, demonstrating promise for scaling such educational programs.
PrEP Primary Care Pocket Card
A pocket card adapted from the CDC PrEP TRAIN module was provided to trainees in the resident clinic. Contains information regarding medications available, contraindications, side effects, laboratory monitoring (on back side), ICD-10 code, etc.

Disclosures
Meredith E. Clement, MD, Gilead Sciences: Grant/Research Support|Viiv Pharmaceuticals: Advisor/Consultant
P-965. Using Simulated Corrective Mentoring to Improve Clinical Decision-Making for Patients with HIV and Identify Drivers for Treatment Choices
Authors: Robinson Katie , Frederick Jennifer , Esgro Robert A , Hegde Bharati , Surich Jennifer 
Published: January 2025

Abstract

Background
Due to the vast number of treatment options for the management of patients with HIV, providers are challenged to optimally individualize treatment based on comorbidities, viral resistance, and patient preferences. The use of corrective mentoring in continuing education (CE), is a proven method to improve clinical decision-making while identifying persisting practice challenges.

Methods
Vindico Medical Education and Syandus developed four virtual clinical scenarios designed to encourage optimal decision-making for patients with HIV by providing immediate feedback via simulated corrective mentoring.

Results
As of April 2024, 220 physicians or advanced practice providers involved in the management of patients with HIV had participated in the simulations. Across simulations, only 27% of initial decisions were optimal. At baseline, the most challenging topics regarding medication management were related to management during pregnancy (33% optimal), initial ART selection (49% optimal), and identifying candidates for injectable therapy (44% optimal). However, after corrective mentoring, there was over a 300% increase in optimal decisions made. Of optimal decisions, 48% of clinicians preferred BIC/FTC/TAF as initial treatment selection for a young male with no comorbidities and 47% preferred this regimen for an older patient with early-stage chronic kidney disease (CKD) and various other cardiovascular comorbidities. However, for a patient who is pregnant, BIC/FTC/TAF was also the preferred regimen, even though at the time of the simulation development there was insufficient data to recommend its use. These findings suggest that comfortability with certain regimens may be a driving force for clinical decision-making, even when those decisions may not be ideal. Drivers of choosing alternatives such as CAB/RPV or DTC/3TC include avoidance of weight gain, reduced pill burden, and later stage CKD.

Conclusion
The use of corrective mentoring in simulation-based CE is an impactful way to encourage clinical decision-making aligned with the latest evidence. Moreover, these data highlight the need to educate clinicians who manage patients with HIV on the importance of individualizing treatment based on patient characteristics.

Disclosures
All Authors: No reported disclosures
P-966. Infectious Disease Enrichment Program: Medical Student Accuracy in Pathogen Identification
Authors: Bernard Lauren , Brown Vincent T , Achufusi Thelma M , Le Nhu , Sherchan Juliana , Widjaja Astrid , Beher Richa , Patel Devang M 
Published: January 2025

Abstract

Background
There has been increased interest in identifying learning strategies that promote long-term retention of medical school content. In 2022, an extracurricular clinical microbiology project called “Pokébug'' was created by the Infectious Disease Interest Group (IDIG) to encourage such retention among preclinical students at the University of Maryland School of Medicine (UMSOM). Students are given “pseudo-case presentations” including five clues such as pathogen route of entry, clinical symptoms, and treatment. At the end of the year, the student with the highest total correct points in each class receives a gift card.Table 1.Medical Student Accuracy in the Pokébug Program

Methods
Here, we studied students’ accuracy as a measure of their long-term retention of clinical microbiology material. Primary aims were to study accuracy: a) overall b) across different pathogen types c) among pathogens that had been learned in class versus not d) temporal variation.

Results
A total of 194 medical students from 3 classes participated in at least one of the 52 weekly quizzes. Students demonstrated marginally higher accuracy among pathogens that had been previously taught in class (87%) versus those they had not (82%). The highest accuracy was observed for parasitic pathogens (95%), while the lowest accuracy was observed for gram positive bacteria (78%). Student accuracy improves over time, which may be due to the project’s incentive structure.

Conclusion
These findings support the conclusion that Pokébug reflects long-term retention of course material and can guide curricula improvements (e.g., additional time could be given to gram-positive bacteria, employ similar active learning strategies in other content areas to strengthen students’ long-term retention). Additionally, IDIG may want to reevaluate the incentive structure to maximize longitudinal student participation.

Disclosures
All Authors: No reported disclosures
P-969. Antibiotic Prescribing Patterns for Surgical Prophylaxis Before and After an Educational Campaign about Penicillin Allergies
Authors: Backus Megan , Romanos Marianne , Wasielewski Anthony , Paz Natalie , Gauthier Timothy 
Published: January 2025

Abstract

Background
Patients with a documented penicillin allergy often do not receive first-line antibiotics for surgical prophylaxis due to the concern for allergic cross-reactivity between cefazolin and penicillins. Receiving suboptimal antibiotics unnecessarily may contribute to increased risk of adverse drug reactions and undesirable clinical outcomes. This study evaluated the rate of first-line antibiotic regimen utilization for surgical prophylaxis in penicillin allergy-labeled patients before and after a prescriber-facing educational campaign about penicillin allergies.Figure 1.WINK Educational Document

Methods
This was a single-center retrospective cohort study conducted at a tertiary care community hospital. Education was provided over one month in-person by infectious diseases and surgical services pharmacists to surgeons and anesthesiologists, including review of an educational handout detailing current penicillin allergy label literature, cefazolin side-chain dissimilarity, and when cefazolin should be considered or avoided (Figure 1). This content was also provided to pharmacists and posted to the system intranet. Patients were included if they had a documented penicillin allergy and received an antibiotic during admission for procedural prophylaxis. Patients receiving systemic antibiotics or with an infection within three days of procedure were excluded. The primary outcome was rate of first-line pre-operative antibiotic regimen utilization for surgical prophylaxis pre-education versus post-education. Secondary outcomes included all-cause hospital readmission within 90 days, acute care length of stay, surgical site infection rate, and safety outcomes. This study was approved by the local Institutional Review Board.Table 1.Baseline Patient Characteristics

Results
340 patients were included in the study, evenly split into the pre- and post-groups. Patient demographics are shown in Table 1. First-line pre-operative antibiotic regimen utilization occurred in 89 patients in the pre-education group (52.4%), and in 113 patients in the post-education group (66.5%) (P = 0.011). Secondary outcomes are listed in Table 2.Table 2.Results for Secondary Outcomes

Conclusion
An educational campaign focusing on reasonable use of cefazolin in the setting of a penicillin allergy label may improve use of first-line antibiotics, which may positively influence clinical outcomes.

Disclosures
Timothy Gauthier, PharmD, BCPS, BCIDP, AbbVie Pharma: Advisor/Consultant|Antimicrobial Therapy, Inc: Advisor/Consultant|Ferring Pharma: Advisor/Consultant|Firstline Mobile Health: Advisor/Consultant|Gilead Pharma: Advisor/Consultant|GoodRx: Advisor/Consultant|GSK Pharma: Advisor/Consultant|Melinta Pharma: Advisor/Consultant|Pattern Biosciences: Advisor/Consultant|Pfizer Pharma: Advisor/Consultant|ProCE: Honoraria|WWW.LearnAntibiotics.com: Ownership Interest
P-979. Clinician Willingness to Consider Long-Acting Therapies and Culturally Supportive Strategies in Caring for Heavily Treatment-Experienced Black, Indigenous, or People of Color (BIPOC) with HIV
Authors: Ackbarali Sumera , Fields Sheldon D , Jain Mamta K , Ogbuagu Onyema 
Published: January 2025

Abstract

Background
Black, Indigenous, or People of Color (BIPOC) are overrepresented among heavily treatment-experienced (HTE) people with HIV (PWH). They face complex treatment challenges, exacerbated by socioeconomic disadvantages, and cultural insensitivities in healthcare settings that lead to suboptimal care and outcomes. To improve clinician competence in integrating long-acting agents into practice and providing culturally supportive care, an educational web-based initiative was designed in collaboration with the Association of Nurses in AIDS Care (ANAC).

Methods
A 60-minute CME activity, led by a multidisciplinary expert panel, was broadcast live on ClinicalSeriesLive and IDCareLive in August 2023 (on-demand until August 2024). Two vignettes of the treatment journey of HTE patients from BIPOC communities (Hispanic & African-American) were utilized to elevate awareness of unique challenges with care. Changes on knowledge/competence pre-/post-test questions and clinician perspectives and challenges (5-point Likert scale) were assessed.

Results
As of April 30th, 2024, 1,728 clinicians participated in these activities (92% were physicians, advanced practitioners, and nurses). Prior to the activity, only 38% of learners had prescribed or administered a long-acting antiviral agent for HTE patients. Patients’ ability to access long-acting antiretroviral (ARV) therapy was the most frequently cited barrier by clinicians when considering this option (43%). Regarding culturally supportive care pre-activity, 12% of learners sought to understand stigma faced by patients within their communities and 11% spoke patients’ languages or referred them to translation services. Post-activity, learners demonstrated increased confidence in selecting a long-acting therapy (59%), discussing options with HTE patients (64%), and developing strategies to deliver more culturally supportive care (73%). Improvements in pre/post paired responses to CME questions are shown in Table 1.

Conclusion
Web-based education on strategies to incorporate long-acting ARV therapies and culturally supportive care can improve clinician knowledge, uncover barriers, and stimulate practice change that improves care of HTE PWH from BIPOC communities.

Disclosures
Mamta K. Jain, MD, MPH, Abbvie: Grant/Research Support|Gilead Sciences: Grant/Research Support|Laurent: Grant/Research Support Onyema Ogbuagu, MD, Gilead Sciences, Inc.: Advisor/Consultant|Gilead Sciences, Inc.: Honoraria|GSK/ViiV: Advisor/Consultant|GSK/ViiV: Honoraria|Janssen: Advisor/Consultant|Moderna: Advisor/Consultant|Moderna: Honoraria
P-993. Increased Reporting of RPR Seronegative Infants with Congenital Syphilis to the Chicago Department of Public Health, A Quality Improvement Project
Authors: Flores John , Ahn Yeo Won , Kasal Nikki , Osayande Osasu , Betz Amy , Bartlett Allison H 
Published: January 2025

Abstract

Background
We are in the midst of an epidemic of congenital syphilis (CS). Nationwide CS diagnosis and treatment recommendations provided by the Centers for Disease Control are dependent on the timing of maternal treatment, and laboratory and procedural results of the mother and infants. There are specific circumstances where infants with a non-reactive rapid plasma reagin (RPR-) should receive a 10-day course of treatment in the context of inadequate maternal treatment. Depending on the institutional reporting practices of CS to departments of public health, there may be scenarios where RPR-based reporting protocols will leave out this specific cohort.

Methods
Baseline data of Infants stratified by RPR status was collected through electronic medical record (EMR) review for those born at the University of Chicago Comer Children’s Hospital in Chicago, IL between January 2011 and December 2022, using billing codes & penicillin administration data. From September 1st, 2023, through March 31st, 2024, a quality improvement intervention was implemented that involved communicating with the hospital’s Pediatric Infectious Diseases specialists, Pediatric & Newborn Hospitalists, Neonatologists, Infection Prevention & Control, and Chicago Department of Public Health (CDPH). The intervention components included 1) formalize expectation to page Pediatric ID on-call team all infants with concern for maternal syphilis exposure, 2) create an Epic Smart Phrase to standardize data presentation for clinical and reporting purposes, 3) standardize ICD-10 diagnosis coding practices, and 4)email reminders monthly to teams involved.

Results
154 infants were identified who had a CDC case definition of CS and received penicillin administration therapy. Infants with CS from 2011-2022 showed 107/154 (69.4%) were RPR- and 41/154 (26.6%) were RPR- and received &gt; 1 day of penicillin. At the end of the first PDSA cycle, a total of 22 infants were reported to CDPH with 36% (n=8) being RPR-.

Conclusion
Our Quality Improvement project identified a large percentage of infants diagnosed and treated with CS who were not reported to the CDPH with our previous RPR-positive – based reporting strategy. We implemented an intervention that successfully improved reporting of this specific type of patient.

Disclosures
Allison H. Bartlett, MD, MS, CVS/Caremark: Advisor/Consultant