bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-996. Antibiotic Selection for Group B Streptococcus Prophylaxis in Penicillin Allergic Pregnant Patients
Authors: Lam Jenny , Ham YoungYoon , Yu Diana 
Published: January 2025

Abstract

Background
Penicillin (PCN) is preferred by American College of Obstetricians and Gynecologists (ACOG) for the prevention of early-onset Group B Streptococcus (GBS infections in newborns, but 10% of patients report a PCN allergy. Clindamycin and vancomycin are second-line for GBS prophylaxis because they are less effective; thus ACOG recommends PCN testing in pregnant patients who report an allergy. Cefazolin has limited cross-reactivity in IgE-mediated PCN reactions and has excellent activity against GBS. This study aims to determine how PCN allergy testing is utilized in GBS positive, PCN allergic pregnant patients and its effect on antibiotic selection.

Methods
This is a single-institution, IRB approved, retrospective cohort of patients that gave birth with an EHR documented PCN allergy from January 1, 2022-July 30, 2023. Pregnant patients over the age of 18 with a penicillin allergy and received antibiotics with an indication for GBS prophylaxis were included. Patients were excluded if they received antibiotics for indications other than GBS prophylaxis. The primary outcome was the rate of PCN used compared to cefazolin in skin-tested and non-skin-tested pregnant patients with indications for GBS prophylaxis. The secondary outcomes were rate of PCN allergy testing, adverse effects due to the antibiotic, the rate of neonatal early-onset sepsis, and frequency of PCN use compared to other antibiotics.

Results
Of 4,780 births, 57 patients met inclusion criteria. Of those 57 patients, only 2 patients received PCN allergy testing referrals. Only 1 of the 2 PCN skin-tested patients had a negative result; however, both patients received cefazolin. The 55 patients without skin testing consults received penicillin (3.9%), cefazolin (51%), clindamycin (22%) and vancomycin (27.5%). Of the 25 patients who received clindamycin or vancomycin, all could have received cefazolin based on allergy cross reactivity data. There were no antibiotic-related adverse effects or neonatal early-onset sepsis.

Conclusion
PCN allergy testing was found to be used very infrequently in this population; providers should be educated about the availability of this service. Additionally, providers should be educated regarding cross-sensitivity with PCN allergy and encouraged to use cefazolin for GBS prophylaxis.

Disclosures
YoungYoon Ham, PharmD, Gilead: Honoraria
384. National Trends and Racial Disparities in Sepsis-Related Mortality in Children in the United States, 1999-2019
Authors: Boasiako Ladonna , pappoe Patricia , Asante-Darko Manye Ami , Saka Allotey Felix Nii , Peseo Jennifer , Ononogbu Chidinma S , Dapaah-Siakwan Fredrick 
Published: January 2025

Abstract

Background
There is conflicting data on the racial differences in sepsis-related mortality rate (SRMR) in children and little is known about the trends in SRMR in children in the United States (US). We examined the national trends and racial disparities in SRMR in children in the US from 1999 to 2019.
Sepsis-related mortality rate in US children stratified by age, gender, race, and geographic region.

Sepsis-related mortality rate in US children stratified by age, gender, race, and geographic region.

Methods
This was a retrospective cross-sectional analysis of national death certificate data from the CDC WONDER database from 1999-2019. We used ICD-10 codes to identify children aged 0-18 years who had bacterial sepsis as the underlying cause of death. We excluded deaths from viral, fungal, parasitic, tuberculous, and rickettsial illnesses. The crude SRMR was calculated per 100,000 population and further stratified by age, gender, race, and census region. Racial disparity was evaluated by the NHB-to-NHW SRMR ratio. The Mann-Whitney U test was used to compare two groups and P &lt; 0 .05 defined statistical significance. We evaluated temporal trends with Joinpoint regression, expressed as average annual percentage change (AAPC) with 95% confidence intervals (CI). Next, we repeated the analysis with any mention of bacterial sepsis as a cause of death.Figure 1.Trends in sepsis-related mortality rate in children in the US, 1999-2019.

Results
Among 1.6 billion children, 23,466 had bacterial sepsis as the underlying cause of death [1.4 per 100,000; CI, 1.4 -1.5)]. The SRMR differed by age, gender, race, and geographic region (Table 1). The overall SRMR decreased from 1.7 in 1999 to 1.2 in 2019 (AAPC -1.9%; CI: -2.4, -1.3%) [Figure 1]. The SRMR decreased in males (1.9 to 1.2; AAPC -2.2%, CI: -2.5, -1.9), females (AAPC -2%, CI: -2.5, -1.6), NHB (AAPC -1.7%, CI: -2.3, -0.9); NHW (AAPC -2.1%, CI: -2.4, -1.6), rural (AAPC -2.5%, CI: -3.4, -1.5) and urban areas (AAPC -1.9%, CI: -2.3, -1.5), and in all census regions. The overall NHB-to-NHW SRMR ratio was 2.7 and there was no significant change during the study period. When limited to any mention of sepsis as the cause of death, the differences and trends in SRMR remained unchanged (Figure 1B).

Conclusion
The SRMR declined significantly overall and for all demographic groups. The persistent disparity in SRMR between NHB and NHW suggests differential access to care, recognition and prompt treatment of sepsis. Future studies should unravel the underlying causes of this disparity in mortality outcomes.

Disclosures
All Authors: No reported disclosures
P-1017. Key Fungal Secreted Proteases in Coccidioidomycosis
Authors: Homer Christina , Ochoa Elena , Voorhies Mark , Sil Anita 
Published: January 2025

Abstract

Background
Coccidioides, a dimorphic fungus endemic to the Southwest United States, causes unacceptably high morbidity/mortality. Coccidioides’ virulence stems from its unique and poorly understood host form, the spherule. Spores are inhaled by the host and develop into spherules, which mature until they fill with hundreds of endospores and then rupture, disseminating endospores throughout the host. This entire process is known as spherulation. As spherules are unique to Coccidioides, most spherule biology remains unknown. Coccidioides genomes encode 2 expanded families of proteases, subtilases and deuterolysins, that we hypothesize are involved in spherulation and are promising treatment targets.

Methods
We took 3 approaches to characterize proteases in spherule biology. We studied spherulation by microscopy in the presence of AEBSF (serine protease inhibitor) and 1,10-phenanthroline (metalloprotease inhibitor). We profiled the Coccidioides transcriptome during spherulation, in Converse media, at 39˚C, 10% CO2, or during hyphal growth, in Converse media at room temperature. Using multiplex substrate profiling-mass spectrometry on supernatants from protease deletion mutants or wildtype, we characterized the total amount of secreted protease activity and amino acid preferences around sites of proteolysis.

Results
Treatment of Coccidioides with a protease inhibitor that blocks subtilase activity prevented spherule formation, indicating a role for subtilases in spherulation. Subtilase and deuterolysin expression is induced upon spherule formation in 4 patterns: 1) during early spherule formation, 2) continuous increase over spherulation, 3) 2 peaks of expression in arthroconidia and endospores, or 4) dramatic increase during endospore release. The subtilase Sub1 fits the 4th pattern and is a top 10 most abundant transcript in spherules during endospore release. Sub1 is a major contributor to secreted protease activity in spherules and exhibits a preference for hydrophobic substrates. Phenotypic characterization of this mutant is underway, including virulence studies.

Conclusion
By linking protease activity to spherulation, we have demonstrated the importance of further dissecting the role of these 2 expanded protease families in Coccidioides virulence.

Disclosures
All Authors: No reported disclosures
P-1020. Randomized control trial to study the effectiveness of tablet Fluconazole, capsule Itraconazole and tablet Terbinafine in superficial dermatophytosis
Authors: Mitra Debdeep 
Published: January 2025

Abstract

Background
According to the World Health Organization, dermatophytosis is a relatively frequent superficial fungal infection of the keratinizing structures of the body with a prevalence of 20% - 25% worldwide. The organism is more widespread in tropical areas, with India acting as the main infection hub, because it prefers a hot and humid climate. Tinea corporis is the most common kind of superficial dermatophytic infection, second most common is tinea cruris followed by tinea capitis, tinea unguium, tinea faciei, tinea manuum and tinea pedis. Hot, humid weather, overcrowding, poverty, poor cleanliness, lack of health-care facilities, immunosuppression, and irrational drug use are all risk factors for dermatophytosis.
Fungal skin infection responding to Oral Itraconazole
Clinical response of Dermatophyte infection to Oral Itraconazole at 4 and 8 weeks as compared to baseline

Methods
Total of 180 patients were included in the study and divided into 3 groups based on the day of visit to the hospital and antifungals Fluconazolee, itraconazole or Terbinafine were randomly prescribed to them (60 patients in each group). Patients were followed up at 4th and 8th week for therapy response.

Results
At the end of 8th week KOH (Potassium hydroxide) mount was found to be negative in 86.67%, 73.33% and 63.33% among Itraconazole Fluconazole and Terbinafine groups respectively which was highly significant.

Conclusion
Dermatophytosis is comparatively more commonly seen in physically active age group. Clinical features waned off quicker and better with Itraconazole in comparison to Fluconazole and Terbinafine. Again fluconazole was found to be yielding better clinical outcome than Terbinafine. Overall outcome of patients with dermatophytosis was found to be more satisfactory with a 4 week oral dose of itraconazole. So from this study we conclude that Itraconazole is a better choice of drug for Dermatophytosis compared to Fluconazole and Terbinafine. Also fluconazole is comparatively a better choice than Terbinafine for the same.

Disclosures
All Authors: No reported disclosures
P-1022. Ventricular Shunt Failure in Patients with Coccidioidal Meningitis in Central California, A Single Center Experience
Authors: Hyser Elise , Sivasubramanian Geetha , Fox Kenneth , Hughes Alyssa , Sandhu Jasmine , Yan Yueqi , Diaz Pavel 
Published: January 2025

Abstract

Background
Coccidioidal meningitis (CM) represents the most deleterious form of disseminated coccidioidomycosis and warrants lifelong antifungal therapy. Communicating hydrocephalus is a well-known complication of CM. Antifungal therapy and lumbar drain placement is typically insufficient treatment for CM-related hydrocephalus, often requiring shunt placement. Shunt failures and repetitive surgical revisions have been described in patients with CM. We aimed to characterize shunt outcomes in patients with CM with ventricular shunts in our center.

Methods
We performed a retrospective study of patients above the age of 18 with CM requiring shunt placement in our center from 2014-2024. Data pertaining to demographics, comorbidities, clinical presentation, laboratory and imaging data, shunt characteristics, management and outcomes were collected. Descriptive statistics were used to analyze the sample characteristics. Fisher’s exact or Chi-square test was used to compare outcomes using categorical variables and T-test for continuous variables.

Results
We identified 65 patients with CM and shunt placement. Of these, 27 (42%) did not have shunt failure while 38 (58%) had one or more shunt failure events (ranging 1-14 times, total of 198 events in the whole cohort). Mean age of patients in was 41 years, 55% were Hispanic and 38% had outdoor occupational exposure (Table 1). The average number of days between shunt placement and initial shunt failure was 46 days (0-174). Change in mentation was noted in patients during 27% of shunt failure events (Table 2). Infections and shunt malfunction were major reasons for shunt failure (Figure 1). Patients that suffered shunt failure events, had a statistically significant higher risk of death (p value 0.01).

Conclusion
CM related hydrocephalus, a common complication of this infection, remains a difficult condition to manage. Even with availability of potent anti-fungal agents, 58% of our patients developed shunt failure needing repeated hospitalizations and shunt revision surgeries. Patients who developed shunt failure in our cohort had a higher risk of death. More studies are needed to identify modifiable risk factors which may help prevent this complication and further reduce morbidity and mortality.

Disclosures
All Authors: No reported disclosures
387. High Rates of Bacteremia and Fluoroquinolone Resistance during an Outbreak of Shigellosis among People Experiencing Homelessness and Opioid Use Disorder in Philadelphia, PA
Authors: Stedman Eleanor , Molin Andrea , Oglesby Valencia , Torpey Erin , Spivack Stephanie , Schultz Sara K 
Published: January 2025

Abstract

Background
In October 2023, the city of Philadelphia, PA reported a dramatic rise in shigellosis cases from Shigella flexneri, leading to widespread diarrheal illness and many hospitalizations. Notable qualities of this outbreak included high antibiotic resistance, high rates of bacteremia in hospitalized patients, a death due to invasive shigellosis, and extensive housing insecurity and opioid use disorder (OUD) among those affected.
Rates of antibiotic susceptibility and resistance among tested isolates of Shigella flexneri.

Methods
All patients hospitalized at Temple University Health Systems (TUHS) with confirmed shigellosis between October 2023 and April 2024 were included in the study. Diagnosis was made via stool culture, blood culture, and/or polymerase chain reaction (PCR) stool pathogen panel. Charts were reviewed for patient age, sex, housing status, history of OUD, stool and blood culture data, stool pathogen panel data, antibiotic susceptibility data, and any death due to shigellosis.
Hospitalizations and Bacteremia Over Time
Number of patients hospitalized and number of patients with documented Shigella flexneri bacteremia per month during an outbreak of shigellosis.

Results
Sixty-seven patients were hospitalized at TUHS from October 2023 to April 2024 with confirmed shigellosis. The average age of patients was 43 and 60% were male. Bacteremia was documented in 21 patients (31.3%). Among cultured isolates, 0% were ampicillin or ciprofloxacin susceptible, 2.1% were levofloxacin susceptible, 4.8% were ceftriaxone susceptible, and 89.6% were trimethoprim-sulfamethoxazole (TMP-SMX) susceptible. One patient died from shigellosis, a 1.5% mortality rate in hospitalized patients. Housing insecurity was documented for 67% of patients, and 68.7% of patients had OUD.

Conclusion
This shigellosis outbreak in Philadelphia saw an unprecedented rate of bacteremia among hospitalized patients. Cultured isolates were highly beta-lactam and fluoroquinolone resistant. TMP-SMX was the only oral antibiotic with reliable susceptibility. Most hospitalized patients had housing insecurity and OUD. Due to the fecal-oral route of infection, outbreak containment challenges reflect the insufficient sanitation facilities for people experiencing homelessness.

Disclosures
Sara K. Schultz, MD FACP FIDSA, AbbVie: Advisor/Consultant
P-1042. Comparison of clinical characteristics and outcomes of patients with candidemia caused by Candida auris versus other Candida species – A retrospective case-control study at a community hospital in the Bronx
Authors: Ahmed Nada , Cani Eris , Raymond Lendelle , Zeana Cosmina 
Published: January 2025

Abstract

Background
Conflicting data exists on the mortality rate of Candida auris fungemia compared to other Candida species. The purpose of this study was to compare the clinical outcomes and characteristics of hospitalized patients with candidemia due to C. auris versus non-C. auris species.

Methods
This retrospective case-control study included adult patients with microbiologically confirmed candidemia at an urban hospital in New York City from January 2018 to August 2023. Data collected included demographics, medical history, microbiology data, antifungal treatment, in-hospital mortality, length of hospital stay (LoS), recurrence rate, mycological eradication, and discharge status. Descriptive statistics and t test were utilized for continuous variables, and categorical data was analyzed by Fischer’s exact test with significance set at a p-value &lt; 0.05.

Results
Out of 171 candidemia cases, 17% were due to C. auris and 83% were due to other Candida species, mainly C. albicans (29%) and C. glabrata (19%). Average patient age was 65 years and majority were of Hispanic descent (49%) with common comorbidities including diabetes (55% vs. 43%; p = 0.044) and chronic kidney disease (14% vs. 25%; p = 0.093) in C. auris vs. non-C auris groups, respectively. More C. auris patients required mechanical ventilation (86% vs. 63%; p = 0.019), and had central lines placed (93% vs. 67%; p = 0.002). All C. auris isolates were susceptible to echinocandins but resistant to fluconazole. C. auris patients had a non-significantly higher crude rate of in-hospital mortality (62% vs. 49%; p = 0.075) with a longer mycological eradication time (mean 5 vs. 3 days; p = 0.196). Median time to mortality was longer in C. auris patients (76 days vs. 30 days, p &lt; 0.0006). These patients also had longer hospital stays (median 111 vs. 40 days, p &lt; 0.002) and nonsignificant higher recurrence rates (14% vs. 6%; p = 0.091). More C. auris survivors were discharged to long-term care facilities (78% vs. 56%).

Conclusion
Patients with C. auris fungemia had a significantly longer median time to mortality and LoS, in addition to a non-significantly higher rate of recurrence and mortality.

Disclosures
All Authors: No reported disclosures
P-1048. Coccidioides immitis Fungemia in Central California: A 10 Year Experience
Authors: Hwang Sang Jo , Fayed Mohamed , Mitchell Marilyn , Sivasubramanian Geetha 
Published: January 2025

Abstract

Background
Coccidioides immitis is a soil-borne fungus endemic to Southwestern United States. While about 40% of patients develop symptomatic infections, disseminated infections remain rare (1-3%). Coccidioides fungemia is extremely uncommon and associated with high mortality. Previous reports on Coccidioides fungemia in the 90’s to early 2000’s, mostly from Arizona, showed affected patients had underlying immunocompromising conditions such as HIV/AIDS, and survival was poor. We aim to characterize Coccidioides immitis fungemia in our Central California population in recent years.

Methods
We performed a retrospective analysis of patients with Coccidioides fungemia in a major 750-bed referral center in Central California between the years of 2014 – 2024. Data was collected pertaining to demographics, comorbidities, clinical presentation, management, and outcomes. Descriptive statistics were used to analyze sample characteristics.

Results
We identified 11 patients with Coccidioides fungemia during the study period. The mean age of affected patients was 40 years (Table 1). Mortality was extremely high with death occurring in an overwhelming 82% of patients. Duration of symptoms was less than 1 week in 6/11 (55%) of patients. Death occurred in 44%, even before blood cultures came back positive (Table 2). Cultures returned positive within 7 days of plating in 7/11(64%) patients. Notably, 9 out of 11 patients had acute Coccidioides infection. Only 1 patient had no underlying comorbid condition (Table 3). All patients received anti-fungal therapy with either liposomal amphotericin B or fluconazole.

Conclusion
Coccidioides immitis fungemia continues to be a rare and fatal form of disseminated disease. The majority of patients in our cohort had acute infection, rapid progression of disease and death. Only 27% of patients in our study had HIV/AIDS, which is less than what has been documented in previous studies (which were done in the early 80s-90s). However, many patients in our cohort had other underlying immunocompromising conditions such as SLE, diabetes mellitus). Despite the advances in management of HIV/AIDS, due to increase in other immunocompromising conditions and use of immunomodulatory agents, Coccidioides fungemia remains a threat.

Disclosures
All Authors: No reported disclosures
P-1049. Retrospective Analysis on the Efficacy and Adverse Effects of Antifungal Prophylaxis in Patients with Peritoneal Dialysis-Associated Peritonitis
Authors: Luchana Vidal , Gandhi Shivanthidevi , Doan Thien-Ly , Kamel Barbara , Jain Sumeet , Sohail Rubab , Sison Cristina , Donaghy Henry 
Published: January 2025

Abstract

Background
Fungal peritonitis causes significant mortality for patients on peritoneal dialysis (PD). Antibiotic exposure is a major risk factor for fungal peritonitis amongst PD patients. The 2016 and 2022 International Society for Peritoneal Dialysis (ISPD) Guideline recommends the use of antifungal prophylaxis in PD patients on antibiotics. There is still no consensus on the optimal approach to prevent secondary fungal peritonitis. This study's objective was to evaluate the impact of antifungal prophylaxis on patients with PD-associated peritonitis as secondary prevention for fungal peritonitis.

Methods
This is a retrospective cohort study of patients on concomitant antifungal prophylaxis and those with no antifungal prophylaxis who had confirmed or suspected PD-associated peritonitis while on antibiotic therapy from 2018 to 2023. Descriptive analysis was used to compare the outcome of development of secondary fungal peritonitis. Side effects such as QTc prolongation are also described.

Results
Of the 101 patients with PD-associated peritonitis, there were 36 (35.6%) gram-positive infections, 24 (23.8%) gram-negative infections, 6 (5.9%) fungal infections, and 41 (40.6%) culture negative peritonitis. The most common isolates were Coagulase-negative Staphylococcus (14), eight of which were Staphylococcus epidermidis, followed by Pseudomonas aeruginosa (6). Among the 101 patients, 33 (32.7%) were co-prescribed with antifungal prophylaxis while 68 (67.3%) did not. Fluconazole 100 mg daily was the most common antifungal agent used (84.8%). Over a 1-year period, two patients developed secondary fungal peritonitis in patients with concomitant antifungal prophylaxis (6.1%; 95% CI: 0.74% to 20.23%), compared to 1 patient (1.5%; 95% CI: 0.037% to 7.92%) in patients without antifungal prophylaxis. Among 28 patients on fluconazole, 10 had repeat ECGs. Of these, 7 patients had a QTc greater than 460 ms (70%; 95% CI: 34.8% to 93.3%), and 3 were greater than 500 ms (30%; 95% CI: 6.7% to 65.2%).

Conclusion
Antifungal prophylaxis in the setting of PD-associated peritonitis does not correlate to fewer episodes of secondary fungal peritonitis. Increased QTc with azole use is a potential risk factor for cardiac arrhythmia.

Disclosures
All Authors: No reported disclosures