bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1138. Quantifying Antibiotic Prescribing in Children with Tracheostomies
Authors: Steuart Rebecca , Slone Austin , Courter Joshua D , Benscoter Dan , Pan Amy , Shah Samir S , Thomson Joanna 
Published: January 2025

Abstract

Background
Prolonged or unnecessary antibiotic prescribing is associated with adverse outcomes. Children with tracheostomies are at risk for antibiotic overprescribing. We sought to quantify and characterize systemic antibiotic prescribing among children with tracheostomies, and to identify predictors of higher prescribing.

Methods
This single-center retrospective cohort study included children with tracheostomies 2 months-18 years old cared for between 2010-2018. Detailed demographic, clinical, and antibiotic prescribing data were extracted from the medical record. Patient-level antibiotic prescribing was quantified using antibiotic courses initiated and DOT per child per year of enrollment. Group-level prescribing was summarized using total antibiotic courses and days of therapy (DOT) per 1000 person-days. Antibiotics prescribed for &gt; 1 day were classified by spectrum of activity and stratified by setting and year. Clinical predictors of patient-level prescribing were identified using backward stepwise multivariable analyses within a generalized linear model.

Results
The 548 children with tracheostomies (47.6% with baseline ventilator use) were prescribed a median 8 antibiotic courses per child per year (IQR: 4-16) for a total median exposure of 49.3 DOT per child per year (IQR: 22.6-123.2) or 183.7 DOTs per 1000 person-days. Most courses (73.9%) were broad-spectrum, with vancomycin, piperacillin-tazobactam, and ampicillin-clavulanate being the top 3 most frequently-prescribed antibiotic courses. Azithromycin and gentamicin represented a high proportion of all DOTs (azithromycin 25.4%, gentamicin 13.0%). Annual antibiotic prescribing decreased 34.5% from 2010-2018. In adjusted analysis to identify predictors, ventilator use at baseline was associated with fewer DOT per child per year, while higher patient complexity and more ICU hospital days were risk factors for higher DOT.

Conclusion
Children with tracheostomies have high antibiotic use, and are predominantly prescribed broad-spectrum antibiotics. Chronic ventilator use was a protective factor against higher prescribing. This data may inform antimicrobial stewardship work.

Disclosures
All Authors: No reported disclosures
P-1149. Short versus Long Duration of Antibiotic Therapy in Pediatric Intensive Care Unit Patients with Uncomplicated Community Acquired Pneumonia: Impact of an Institutional Guideline Update
Authors: Jan Irza , Nagel Jerod , Tribble Alison C , Riggsbee Daniel , Davidge Karen N 
Published: January 2025

Abstract

Background
Community acquired pneumonia (CAP) is a significant cause of morbidity and antibiotic overutilization among pediatric patients. The 2011 Infectious Diseases Society of America (IDSA) guidelines recommend a treatment duration of 10 days for pediatric CAP but recognize that shorter courses may be appropriate in certain settings. In February 2022, based on newer literature and extrapolations from the adult population, Michigan Medicine updated its institutional guidelines to recommend an antibiotic duration of 5 days to treat uncomplicated CAP in hospitalized pediatric patients. However, there remains limited evidence to support a shorter duration of therapy for patients admitted to the pediatric intensive care unit (PICU).
Baseline characteristics of patients treated for uncomplicated CAP in the PICU at Michigan Medicine from November 2020 to December 2023

Methods
This was a single-center, retrospective cohort study of patients aged 6 months to 17 years old with CAP who were admitted to the PICU at Michigan Medicine from November 2020 to December 2023. Patients with complicated CAP, hospital acquired or ventilator associated pneumonia, cystic fibrosis, severe neutropenia, solid organ or stem cell transplant, tracheostomy dependence, sickle cell disease, or suspicion for fungal infection were excluded from the study. The primary outcome was treatment failure, defined as a composite of readmission, emergency department or outpatient visit, need for antibiotic retreatment, or death attributable to CAP within 30 days of completing antibiotic therapy.
Clinical outcomes of patients treated for uncomplicated CAP in the PICU at Michigan Medicine before and after the institutional guideline update

Results
A total of 128 patients met eligibility criteria; 59 (46%) patients were treated before the guideline update and 69 (54%) were treated after the guideline update. The median antibiotic treatment duration was 7.71 days in the pre-guideline update group and 5.58 days in the post-guideline update group (P &lt; 0.001). Three patients in the pre-guideline update group and five patients in the post-guideline update group experienced 30-day treatment failure, which was not a statistically significant difference (P = 0.615). There was no difference in the median hospital length of stay between groups.

Conclusion
This study demonstrated that a shorter course of antibiotic therapy did not increase the rate of treatment failure compared to a standard course of therapy for patients admitted to the PICU with uncomplicated CAP.

Disclosures
All Authors: No reported disclosures
P-1164. Prevalence of invasive Candidiasis and antifungal resistance in neonates: a multicenter three-year retrospective analysis from two large Mexican NICUs
Authors: Garza-Castro Abraham P , Ballesteros-Suarez Ana , Concha-Mora Lindsay A , Prieto-Baca Ericka Paulina , Tamez-Rivera Oscar 
Published: January 2025

Abstract

Background
Candida infections are increasingly recognized as clinically relevant pathogens in NICUs, particularly among preterm and low birth-weight infants (LBWI). Due to the emergence of Fluconazole-resistant Candida spp, current treatment guidelines of neonatal invasive Candidiasis (IC) suggest Amphotericin B as first line therapy, leaving Fluconazole as an alternative agent. Microbiological surveillance focused on fungal etiologies in Mexican NICUs is scarce, which may lead to inappropriate antifungal use.

Methods
Retrospective multicenter study conducted in the NICUs of the two pediatric reference hospitals in NL, Mexico. Clinical and microbiological data of all newborns ≤28 days diagnosed with blood culture-proven invasive Candidiasis from 2021-2023 were collected. LBWIs were defined as newborns &lt; 2500 g at birth, and very LBWI (VLBWI) as &lt; 1500 g. Descriptive statistical analyses were performed to determine the frequency of Candida spp and frequency of antifungal resistance.

Results
During the studied period, 928 positive blood cultures were included. Only 38 blood cultures (4%) were positive for Candida spp. No outbreaks occurred during the studied period. Twenty one patients (75%) were preterm. Mean gestational age was 29 weeks. Most patients (55%) were VLBWI (Table 1). All episodes were classified as late-onset sepsis. The most common isolated species were C. albicans (45%), followed by C. glabrata (29%), and C. parapsilosis (16%). No Fluconazole resistance was observed (Table 2). Caspofungin resistance was found in 5 C. glabrata isolates and 1 C. albicans. No cases of endophthalmitis or endocarditis were documented.

Conclusion
We report a low prevalence of blood culture-proven neonatal IC (4%) in two large Mexican NICUs during the studied period. Most patients were LBWI. This is consistent with international data. C. albicans was the most common isolated species. Based on the local epidemiology in two large NICUs of NL Mx, Fluconazole may be considered as a first line antifungal agent instead of Amphotericin B. Local microbial epidemiology and antifungal susceptibility patterns should be considered for the empirical treatment.

Disclosures
All Authors: No reported disclosures
P-1168. Activity of Isavuconazole and Comparator Agents against Pediatric Fungal Isolates Collected from 2017–2023 in a Global Surveillance Program
Authors: Winkler Marisa , Rhomberg Paul , Fedler Kelley A , Klauer Abigail , Castanheira Mariana 
Published: January 2025

Abstract

Background
Isavuconazole (ISA) is an azole antifungal agent with desirable properties, often making it the treatment of choice for invasive fungal infections. In December 2023, ISA became the sole FDA-approved azole antifungal for the treatment of invasive aspergillosis and mucormycosis in pediatric patients as young as 1 year old. Here, we compare the in vitro activity of ISA and comparator agents against pediatric fungal isolates collected from 2017–2023 in the SENTRY Antimicrobial Surveillance Program.
In vitro Activity of Isavuconazole and select comparator agents against pediatric isolates from the SENTRY database in 2017–2023

Methods
A total of 851 isolates from invasive fungal infections were collected from patients ≤ 17 years old, including 284 patients ≤ 1 year old (yo), 186 2–5 yo, 204 6–12 yo, and 177 13–17 yo. The majority of isolates were from bloodstream infections (515/851, 60.5%). The second most common infection source was pneumonia in hospitalized patients (129/851, 15.2%). Antifungal susceptibility testing was performed by broth microdilution according to CLSI guidelines. Results were interpreted using epidemiological cutoff values (ECV) where applicable.

Results
Isolates were from 28 different countries, with 25 hospitals in North America, 25 in Europe, 13 in Asia-Pacific, and 7 in Latin America. There were 684 Candida spp., 19 other yeasts, 123 Aspergillus spp., and 25 other moulds. For ISA tested against Candida spp., the MIC50 was ≤ 0.008 mg/L and the MIC90 was 0.06 mg/L (Table 1). This result was comparable to MIC50/90 for voriconazole (VRC) against Candida spp. The fluconazole (FLC) MIC50/90 was higher at 0.25/2 mg/L. For Aspergillus spp., the MIC50/90 for ISA was 0.5/2 mg/L and 89.2% of isolates were wildtype (WT) by ECV. The VRC MIC50/90 was 0.5/1 mg/L and 95% of isolates were WT. For Mucorales, MICs were 1–8 mg/L for ISA and 4– &gt; 8 mg/L for VRC. For all other moulds, MICs ranged from 0.25– &gt; 8 mg/L for ISA and 0.12– &gt; 8 mg/L for VRC.

Conclusion
ISA has good activity against pediatric fungal isolates from diverse geographical locations and infection sources. MICs were low for Candida spp. and Aspergillus spp., lower than FLC, and comparable to VRC. All agents had high MICs to non-Aspergillus moulds, highlighting the continued need for novel antifungal agents targeting these organisms.

Disclosures
Marisa Winkler, MD, PhD, Element Iowa City (JMI Laboratories) was contracted to perform services in 2023 for &gt; 30 biotech and pharmaceutical companies: Grant/Research Support Kelley A. Fedler, BS, Paratek Pharmaceuticals: Grant/Research Support
P-1188. Mortality among U.S. Children Aged &lt; 18 Years Hospitalized with Laboratory-confirmed Respiratory Syncytial Virus (RSV) Infection, 12 States, 2018–2019, 2021–2022, 2022–2023
Authors: Toth Eszter , Whitaker Michael , Milucky Jennifer , Pham Huong , Kirley Pam Daily , Kent LeAnna , Kim Daewi , Openo Kyle P , Brooks Alicia , Leegwater Lauren , Como-Sabetti Kathryn , Smelser Chad , Rowe Adam , Popham Kevin , Sutton Melissa , Talbot Keipp , Chatelain Ryan , Havers Fiona P , Patton Monica E 
Published: January 2025

Abstract

Background
Pediatric RSV-associated hospitalizations are well-described but mortality data are limited.

Methods
RSV Hospitalization Surveillance Network (RSV-NET), a 12-state population-based surveillance system, captured laboratory-confirmed RSV hospitalizations among catchment-area residents during October–April in 2018–19 and October–September in 2021–22 (excluding May–June) and 2022–23. Medical charts were reviewed for children who died in-hospital and for those who died ≤30 days post-discharge in 2018–19 via matching case and death certificate data. We described in-hospital and 2018–19 post-discharge mortality among RSV-NET children aged &lt; 18 years. 2019–21 and 2020–21 data were excluded due to COVID-19.

Results
During 2018–19, 2021–22, and 2022–23, 18,511 pediatric RSV hospitalizations were reported with 32 (0.2%) in-hospital deaths among 10, 17, and 5 children aged &lt; 1, 1–4, and 5–17 years, respectively (Table 1). Among 28 children with race and ethnicity data, 9 were non-Hispanic (NH) Black, 8 were NH White, 4 were NH Asian, 5 were Hispanic, and 2 were another race or ethnicity. Almost all (83%) children with medical chart review had ≥ 1 underlying medical condition (UMC); 72% had ≥ 2 UMCs. UMCs included chronic lung disease (CLD) (53%), neurologic disorders (37%), and cardiovascular disease (23%). In all, 33% of children had CLD of prematurity; prematurity, only collected for those &lt; 2 years (n=18 deaths), was noted for 5 (28%) children. Co-detections, including 9 bacterial from respiratory or sterile sites and 11 respiratory viral detections, were noted for 16 (55%) children who died (Table 2).
In 2018–19, 8 in-hospital and 4 post-discharge deaths occurred; the median age at death was 1.5 and 6.5 years, respectively, and the median length of stay was 5.5 and 11.5 days, respectively. All (100%) children had ≥ 1 UMC; ≥ 2 UMCs were noted among 50% and 100% of children with in-hospital and post-discharge deaths, respectively. An RSV-specific cause of death was listed on 4 (33%) of 12 death certificates from 2018–19.

Conclusion
Almost all RSV-NET children who died had ≥ 1 UMC; bacterial or viral co-detections were common. RSV-attributable pediatric deaths are likely underestimated if limited to in-hospital deaths or death certificates with RSV-specific causes.

Disclosures
All Authors: No reported disclosures
P-1192. Association between adeno-associated virus 2 and pediatric acute hepatitis of unknown etiology in Japanese children
Authors: Kawada Jun-ichi , Iwada Ken-ichi , Torii Yuka , Sakai Aiko , Fukuda Yuto , Haruta Kazunori , Yamaguchi Makoto , Suzuki Takako , Etani Yuri , Takahashi Yoshiyuki , Umetsu Shuichiro , Inui Ayano , Sumazaki Ryo 
Published: January 2025

Abstract

Background
Outbreaks of acute hepatitis of unknown etiology (AHUE) in children were reported in Western countries in 2022. Previous studies found that the adeno-associated virus 2 (AAV2) and other viruses, such as human adenovirus (HAdV) and human herpesvirus-6 (HHV-6), were frequently detected in patients with AHUE. As HAdV and HHV-6 are known as “helper viruses” that facilitate AAV2 replication, co-infection with AAV2 and helper viruses has been postulated as a potential trigger of AHUE. However, whether hepatitis associated with AAV2 existed prior to the AHUE outbreaks in 2022 has not yet been investigated. We aimed to investigate the association between AAV2 and pediatric acute hepatitis in Japanese children as well as the incidence of AAV2-related hepatitis before 2022.
Visual abstract

Methods
Preserved blood samples from 49 pediatric patients (median age: 3 years) with acute hepatitis of unknown etiology between 2017 and 2023 were retrospectively analyzed. Blood samples from 50 children with acute illnesses, such as infectious diseases and 50 children with chronic conditions were used as controls. Viral DNA loads were quantified using real-time PCR.

Results
AAV2 DNA was detected in 12% (6/49) of acute hepatitis cases (median age: 2.5 years), but in only one acute illness case and none of the chronic condition control cases. The concentration of AAV2 DNA (range: 2.5×103 to 5.0×108 copies/mL) in the six patients in the acute hepatitis group was higher than that in the patient in the acute-illness control case (7.8×102 copies/mL). Co-infection with one or more helper viruses, including HAdV, HHV-6, cytomegalovirus, and Epstein–Barr virus, was observed in five of six AAV2-positive acute hepatitis cases.

Conclusion
Our results indicate the sporadic occurrence of severe pediatric hepatitis associated with AAV2 infection in Japan prior to AHUE outbreaks in Western countries in 2022. Conversely, the detection rate of AAV2 in this study was much lower than that of AHUE in Western countries, suggesting that the outbreak of AHUE related with AAV2 is an exceptional phenomenon associated with mitigation measures against COVID-19. Our findings suggest that coinfection with AAV2 and helper viruses plays a role in the development of severe hepatitis.

Disclosures
All Authors: No reported disclosures
P-1202. Human Bocavirus detection among children presenting to tertiary care with acute respiratory infections in Oman: clinical characteristics, seasonality and comparison with common viruses
Authors: Al Fahdi Ahmed S , Al Qanobi Abdulrahman S , Al Maani Mohammed , Al Maani Bushra , Al Khatri Mariya , Al Khatri Hanan , Al Hinai Abdulaziz , Alhinai Zaid 
Published: January 2025

Abstract

Background
Human Bocavirus (HBoV) was first identified in 2005 among children suffering from acute respiratory symptoms. It is frequently detected as a co-infecting virus, and the degree to which it causes to symptoms is unclear. Little is known about its epidemiology in the Middle East.

Methods
Children who presented to Sultan Qaboos University Hospital, Muscat, Oman between January, 2018 and December, 2019, with acute respiratory symptoms and were tested for respiratory viruses were reviewed. Respiratory specimens were tested using the FTD Respiratory Pathogens 21 Assay (Siemens Healthineers). Patients with HBoV detection were included. A subset of patients with sole detection of RSV or Rhinovirus was included for comparison. Clinical presentation, laboratory results, and outcomes were analyzed and compared.

Results
A total of 3789 patients were tested for respiratory viruses, of whom 2714 (72%) had positive results, and 163 (5%) were positive for HBoV. HBoV was detected as the only pathogen in 34 cases (21%), while 129 (79%) represented co-infection. For comparison, 252 cases of Rhinovirus and 80 cases of RSV were included. HBoV detection occurred year-round with no clear seasonal variation (Figure 1). HBoV detection was most common in children under 2 years of age, and uncommon after 5. RSV was only detected under 2 years of age, and Rhinovirus was commonly detected in all age groups (Figure 2). Patients with HBoV without co-infection were more likely to be immunocompromised (29% vs 8%, P 0.002) or suffer from other chronic disease (68% vs 35%, P 0.001) compared to those with co-infection (Table 1). They were also more likely to suffer from diarrhea (35% vs 14%, P 0.009) and tachycardia (77% vs 54%, P 0.032). Patients with HBoV without co-infection did not significantly differ otherwise from those with co-infection. Compared with RSV, patients with HBoV had a higher median age (1.95 vs 0.2 years, P &lt; 0.001) and were more likely to be immunocompromised (29% vs 1%, P &lt; 0.001) (Table 2). Patients with RSV were more likely to require respiratory support (67% vs 29%, P &lt; 0.001).

Conclusion
HBoV had year-round circulation with no seasonal pattern. HBoV likely contributed significantly to acute respiratory disease in children under 5 years of age, especially those with chronic underlying conditions.

Disclosures
All Authors: No reported disclosures
P-1208. Multi-year Analysis of Respiratory Viral Dynamics at a Los Angeles County Academic Health System Reveals Significance of Rhinovirus in Young Children with Severe Respiratory Illness
Authors: Caldera J R , Saleh Tawny , Fuller Trevon , Yang Shangxin , Nielsen-Saines Karin 
Published: January 2025

Abstract

Background
Respiratory infections in children are highly dynamic requiring frequent assessments of epidemiological trends to mitigate their impact on the population. We aimed to analyze the landscape of viral respiratory illnesses (VRIs) in a large metropolitan area in Southern California with a focus on the COVID-19 pandemic.

Methods
We conducted a retrospective cohort study within the UCLA Health System, which evaluated children aged 0-5 years who received comprehensive respiratory viral panel (cRVP) testing during August to February of 2018 to 2023. Patient demographics, disease severity, and clinical course were specifically compared during the pandemic. Predictors of moderate-to-severe VRI were determined by multivariate logistic regression.

Results
In total, 1,321 children with a median age of 2 years (44% female) underwent cRVP testing. A total of 753 positive subjects were identified during the study period. Rhinovirus (RV) was by far the most frequent virus identified in children across 5 years, even during the COVID-19 pandemic period, followed by respiratory syncytial virus (RSV). Along with RSV and human metapneumovirus, rhinovirus (RV) was associated with the highest disease severity across the years, particularly in the Hispanic/Latino ethnic group. Importantly, RV-driven respiratory disease occurred independently of co-infection with other viruses.

Conclusion
RV was the most common viral pathogen in young children even during the height of the COVID-19 pandemic and was an independent driver of moderate-to-severe disease particularly in children with co-morbidities. Ethnic disparities were observed in disease severity, underscoring the need for targeted interventions, and heightened clinical vigilance in pediatric populations.

Disclosures
All Authors: No reported disclosures
P-1218. Assessment of Cefepime-Taniborbactam (FEP-TAN) Transmembrane Clearance (CLTM) in an Ex vivo Continuous Renal Replacement Therapy (CRRT) Model
Authors: Fouad Aliaa , McGrath Cole , Buyukyanbolu Ecem , Kuti Joseph L 
Published: January 2025

Abstract

Background
Optimal antibiotic dosing in patients undergoing CRRT is influenced by many factors that affect drug adsorption and clearance. These factors include filter type, CRRT mode, effluent rate (ER), and drug characteristics. FEP-TAN is an investigational β-lactam/β-lactamase inhibitor combination having broad-spectrum activity against carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa. Both FEP and TAN are primarily eliminated through glomerular filtration. Hence, we conducted an ex vivo CRRT model to characterize the adsorption and CLTM when co-administered.

Methods
CLTM was characterized in hemofiltration (CVVH) and hemodialysis (CVVHD) modes using the Prismaflex ST150 and HF1400 hemofilter sets. One liter of heparinized bovine blood was allowed to circulate in the CRRT system for 10 minutes. FEP and TAN were then added simultaneously to attain plasma concentrations of 70 and 20 mg/L, respectively, the average Cmax achieved in humans following FEP-TAN 2g/0.5g q8h as a 4h infusion. Pre-filter blood, post-filter blood, and effluent samples were collected over 60 minutes to determine FEP and TAN concentrations. Combinations of filters, modes, and points of fluid replacement were tested at ERs of 2, 3, and 4 L/h. The sieving coefficient (SC) for CVVH and the saturation coefficient (SA) for CVVHD were calculated to determine CLTM. Protein binding (PB) was assessed by ultrafiltration. Adsorption was determined using a closed circuit bypassing effluent elimination.

Results
Adsorption and degradation in the ex vivo CRRT model were negligible for both drugs. Mean ± SD initial FEP and TAN concentrations were 66.9 ± 5.3 and 18.7 ± 1.7 mg/L, respectively. PB was 0% for FEP and 5.4 ± 3.7% for TAN in bovine plasma. The overall mean ± SD SC/SA across different modes, filters, and ERs were 1.1 ± 0.06 for FEP and 1.0 ± 0.05 for TAN. The CLTM at ERs of 2, 3, and 4 L/h were 2.1 ± 0.2, 2.9 ± 0.3, and 3.8 ± 0.5 for FEP and 1.9 ± 0.2, 2.7 ± 0.2, and 3.4 ± 0.3 L/h for TAN, respectively.

Conclusion
FEP and TAN were efficiently cleared by both CVVH and CVVHD CRRT modes through ST150 and HF1400 filters. When incorporated into an established population pharmacokinetic models, these data can be used to develop dosing recommendations for FEP-TAN in patients undergoing CRRT.

Disclosures
Joseph L. Kuti, PharmD, Abbvie: Advisor/Consultant|bioMerieux: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi Inc: Advisor/Consultant|Shionogi Inc: Grant/Research Support|Shionogi Inc: Honoraria|Venatorx: Grant/Research Support