bluuebunny/crossref_metadata_2025_split huggingface dataset:
212. Gonorrhea and Chlamydia Opt-Out Screening of Justice-Involved Females During Intake at the Los Angeles County Jail: The Pivotal Role of Correctional Health Systems
Authors: Qureshi Nazia , Herrera Sulma J , Miller Loren G , Judge Stephen , Cardenas Charles M , Henderson Sean O 
Published: January 2025

Abstract

Background
Chlamydia and gonorrhea are two of the most common sexually transmitted infections (STIs) worldwide, presenting major public health challenges and resulting in billions of dollars in direct medical costs in the U.S. Incarcerated females have a particularly elevated risk of these infections, which can result in significant clinical and public/community health-level sequelae if left untreated. On December 13, 2021, the division of Correctional Health Services began offering opt-out urogenital chlamydia and gonorrhea screening to all newly incarcerated females within the Los Angeles County Jail system.

Methods
We retrospectively analyzed electronic health record data for completed urogenital chlamydia/gonorrhea screening among newly incarcerated females between December 13, 2021, and May 31, 2023. We used multivariable logistic regression to examine the association of STIs and treatment non-initiation outcomes with various demographic and self-reported variables.

Results
Of the 13739 women offered STI testing, 10717 (78%) completed screening, with 1151 (11%) having a chlamydial infection, 788 (7%) having a gonococcal infection, and 1626 (15%) having either infection. In a multivariable model, result positivity was associated with age 18-34, reported houselessness, amphetamine use, and history of a positive prior treponemal antibody test. STI treatment non-initiation was associated with shorter length of stay for both chlamydial ([aOR] = 87.4, 95% CI (34.2, 223.2)) and gonococcal ([aOR] = 9.0, 95% CI (5.2, 15.7)) infections.

Conclusion
The STI screening and prevalence among female detainees tested at intake was many-fold higher than that of the general population. The implementation of routine opt-out STI screening and treatment of STI-infected people in carceral settings provides a unique and important opportunity to benefit the health of this high-risk population and has the potential to create a spillover effect that might benefit the surrounding community.

Disclosures
Loren G. Miller, MD MPH, Armata: Grant/Research Support|Contrafect: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Paratek: Grant/Research Support
217. Preliminary Results from a Clinical Trial Comparing the Efficacy of Cefixime Versus Penicillin G for the Treatment of Early Syphilis
Authors: Keith Kori , Wilson Gjermayne , Stafylis Chrysovalantis , Reyes-Diaz Michael , Konda Kelika , Klausner Jeffrey 
Published: January 2025

Abstract

Background
Syphilis has reemerged as a global health concern. The standard treatment for all stages of syphilis is injectable benzathine penicillin G. Cefixime is an FDA-approved, oral antibiotic widely available, low-cost, and safe in pregnancy. A previous pilot study showed cefixime was likely efficacious in treating early syphilis. This study aims to evaluate the efficacy of cefixime in comparison to benzathine penicillin G.

Methods
We are conducting a randomized, multisite, open-label, non-inferiority clinical trial to compare the effectiveness of cefixime (400mg, orally, twice daily for 10 days) to benzathine penicillin G (2.4 million units, intramuscularly) in 400 participants from 12 clinical sites in the United States and Peru, including participants living with and without human immunodeficiency virus (HIV) infection. In the event of a penicillin shortage, participants randomized to penicillin receive doxycycline hyclate (100mg, orally, twice daily for 14 days).
Participants undergo follow-up visits post-treatment at 3-, 6-, and 9-months, involving clinical evaluation and rapid plasma reagin (RPR) testing. The primary outcome is a ≥4-fold decrease in the RPR compared to the initial RPR titer at enrollment, assessed at either 3 or 6 months after treatment.

Results
As of May 1, 2024, 134 participants are enrolled, 67.2% living with HIV. The current cefixime adherence rate is 92.3% (60/65) at the 10 day mark. Evaluable data is available from 104 participants with 3- or 6-month follow-up visits, including 52 cefixime, 45 penicillin, and 7 doxycycline participants. By 3- or 6-month post-treatment, 88.5% (95% CI, 76.5% - 95.6%; 46/52) of cefixime participants, 88.9% (95% CI, 75.6% - 96.3%; 40/45) of penicillin participants, and 100.0% (95% CI, 59.0% - 100%; 7/7) of doxycycline participants achieved a ≥4-fold RPR titer decrease.

Conclusion
Comparable effectiveness was observed among the treatment arms. Enrollment and data collection continue, with study completion expected by June 2026.

Disclosures
Jeffrey Klausner, MD MPH, Direct Diagnostics: Advisor/Consultant
P-812. Not Little Adults: Key Differences in Antimicrobial Resistance in Australian Bloodstream Isolates between Children and Adults, 2020-2021
Authors: Williams Anita , Coombs Geoff W , Bell Jan , Daley Denise A , Mowlaboccus Shakeel , Bryant Penelope A , Campbell Anita Jane , Cooley Louise , Howard-Jones Annaleise , Iredell Jon , Irwin Adam D , McMullan Brendan , Warner Morgyn , Williams Phoebe , Blyth Christopher C 
Published: January 2025

Abstract

Background
The incidence, risks and organisms causing bloodstream infections (BSI) differ between children and adults due to distinct comorbidities, procedures and antibiotic exposures. Age-specific data are required to inform targeted interventions, empiric treatment and guideline development. We aimed to compare the incidence, risk factors and resistance patterns of bacteria causing BSI in children and adults (2020-21).

Methods
The Australian Group on Antimicrobial Resistance (AGAR) is a national hospital-based BSI surveillance program reporting on Staphylococcus aureus, Enterococcus spp. and key gram-negative pathogens.

Results
Data from 25,958 isolates were assessed (children: 1,679; adults: 24,279). The most common organisms in children and adults were Escherichia coli (20.9 vs 39.1%) and S. aureus (36.2 vs 20.9%). E. faecalis and non-typhoidal Salmonella spp. were more frequent in children (7.3% and 4.4% of surveyed organisms in children vs 5.1% and 0.5% in adults). BSI were more often community onset (69.0% children; 76.4% adults). 30-day mortality was significantly lower in children (3.3% vs 9.8%).
Enterobacterales resistance was more common in children: e.g. to gentamicin/tobramycin (11.6% of child isolates; 8.5%, adult isolates; rate ratio [RR]: 1.4 [95%CI: 1.1-1.7]) and piperacillin-tazobactam resistance (11.2%; 8.6%; RR: 1.3 [1.0-1.6]). However, there was no difference observed in Enterobacterales resistance to cephalosporins, ciprofloxacin, meropenem or multi-drug resistance status. AMR prevalence in Pseudomonas and Acinetobacter spp isolates were also similar between children and adults.
Methicillin-resistant S. aureus isolates were less common in children (13.2 vs 17.7%; RR: 0.7 [0.6-0.9]). Rates of clindamycin and cotrimoxazole resistance in S. aureus were similar to adults.
Children had a lower proportion of E. faecium infections (24.1 vs 39.8%) and the rate of vancomycin-resistant E. faecium in children was half that in adults (19.5 vs 37.2%; RR; 0.5, [0.2-1.0]).

Conclusion
Analysis of national AMR data identifies unique trends in children. Ongoing clinical surveillance, targeted prevention, antimicrobial stewardship strategies and research to evaluate AMR drivers in children are required.

Disclosures
All Authors: No reported disclosures
P-821. Invasive Streptococcus pyogenes Infections: Is Anti-toxin Therapy Necessary?
Authors: Kinsey Daniel , Jagannathan Megha , Jordan Tamara , Kenney Rachel M , Veve Michael , Shallal Anita , Suleyman Geehan 
Published: January 2025

Abstract

Background
Invasive Streptococcus pyogenes or group A Streptococcus (GAS) carries a high morbidity and mortality rate. In addition to penicillin, adjunct anti-toxin therapy (AT) with linezolid or clindamycin is the standard of care. Although the use of AT is supported by in vitro data and observational studies, there are limited conclusive data supporting its efficacy in reducing GAS mortality. Our study aimed to compare clinical outcomes of patients receiving AT versus those who did not.

Methods
This was a retrospective cohort study of hospitalized patients with positive blood cultures for GAS at our five-hospital system from June 2013 to August 2023. Patients were identified through Microsoft SQL Server. Patients who received AT therapy for &gt; 48 hours were defined as the AT group; the control group did not receive AT therapy. Patients who received AT for &lt; 48 hours were excluded. Collected variables included demographics, infection & microbiological characteristics, and clinical outcomes. Data was analyzed using SPSS.

Results
265 patients were included in the study of whom 179 (68%) received AT (Table 1). About half were female, and the median age was 58 years. Comorbidities were overall similar between the two groups. Persons who inject drugs or with chronic hepatitis C were more common in the control group. Abscess/cellulitis was the most common clinical syndrome in both groups. Shock requiring vasopressors, need for dialysis and mechanical ventilation, and toxic shock syndrome were prevalent in the AT group. There was no difference in the duration of bacteremia, clindamycin resistance, and management between the two groups except for receipt of intravenous immunoglobulin (IVIG), which was more common in the AT group (Table 2). Outcomes, including length of stay, readmission for infection-related complications, and 30-day mortality, were similar between the two groups.

Conclusion
Utilization of AT for invasive GAS infections correlated with severity of illness, but clinical outcomes did not significantly differ between patients receiving AT and those who did not, suggesting a potential opportunity for antimicrobial stewardship. Further research is needed to determine whether AT should be reserved for patients with select infectious syndromes

Disclosures
Rachel M. Kenney, PharmD, BCIDP, Medtronic Inc: Spouse is an employee, stockholder
P-839. Clinical Diagnostic Performance of Droplet Digital PCR for Pathogen Detection in Patients with Escherichia coli Bloodstream Infections
Authors: Kitagawa Hiroki , Kojima Masato , Tadera Kayoko , Omori Keitaro , Nomura Toshihito , Shigemoto Norifumi , Ohge Hiroki 
Published: January 2025

Abstract

Background
Rapid diagnosis and early administration of appropriate antimicrobials are crucial to improve the prognosis and decrease the mortality of patients with bacterial bloodstream infections (BSIs). Droplet digital PCR (ddPCR) is a new tool for pathogen detection in BSIs. This study aimed to examine the sensitivity of ddPCR and explore the association between bacterial DNA load in whole blood and time-to-positivity (TTP) of blood cultures (BCs) in patients with Escherichia coli BSIs.
Relationship between E. coli DNA load in whole blood and time-to-positivity of blood cultures

Methods
This prospective study included 59 patients with E. coli BSIs confirmed using BCs enrolled at the Hiroshima University Hospital between June, 2023 and April, 2024. The E. coli DNA load in whole blood, which was simultaneously obtained from two sets of BCs, was evaluated using ddPCR. For each patient, only the TTP of the first positive BC obtained using the BacT/ALERT Virtuo System was used for analysis.

Results
The median TTP was 9.0 (IQR: 8.3–10.2) h, and 15.2% (9/59) of the patients exhibited septic shock during BC sampling. In 83.1% (49/59) of the whole blood samples, E. coli DNA was detected via ddPCR. Patients with positive ddPCR results exhibited significantly shorter TTP than those with negative ddPCR results (median TTP: 8.8 vs. 10.5 h; p &lt; 0.001). The rate of positive results for both sets of BCs was significantly higher in patients with positive ddPCR results than in those with negative ddPCR results (87.8 vs. 40.0%, p = 0.003). The E. coli DNA load was 75–200,475 copies/mL. Moreover, ddPCR revealed a significant correlation between the E. coli DNA load in whole blood and TTP (r: –0.58; 95% confidence interval: –0.74 to –0.36; p &lt; 0.001). All patients with septic shock exhibited positive ddPCR results and significantly higher E. coli DNA loads in whole blood than those without septic shock (median E. coli DNA load: 6,375 vs. 113 copies/mL; p &lt; 0.001).

Conclusion
Overall, ddPCR effectively detected E. coli DNA in the whole blood of patients with septic shock with a relatively short TTP. Notably, E. coli DNA load was associated with the infection severity of the patient. Further optimization of the bacterial DNA extraction protocol from blood and reaction systems and conditions can enhance the sensitivity of ddPCR.

Disclosures
All Authors: No reported disclosures
P-842. Community-onset vs. Hospital-onset Staphylococcus aureus Bacteremia: Implications for Patients and Healthcare Systems
Authors: Rico Crescencio Juan Carlos , Dare Ryan K , Myers Jordan 
Published: January 2025

Abstract

Background
Staphylococcus aureus is a leading cause of bacteremia, associated with high rates of morbidity and mortality. It poses a tremendous burden to the healthcare system in terms of cost and resource utilization. This study's objective is to evaluate the incidence and clinical outcomes of both community and hospital-onset S. aureus bacteremia (SAB).

Methods
This study is a retrospective analysis of adult patients with SAB at an academic medical center in Arkansas from May 2016 to January 2024. Subjects were identified as hospital-onset SAB (HO-SAB) if positive blood cultures were collected ≥ 48 hours after admission or community-onset SAB (CO-SAB) if blood cultures were collected &lt; 48 hours after admission.

Results
A total of 1,179 patients had SAB during the study period of which 230 (19.5%) died or transitioned to hospice care. In-house mortality varied by age(11%&lt; 35y vs 48%≥ 85 y). There were similar rates of mortality between patients with MRSA (21%) and MSSA (19%) bacteremia. Infectious disease (ID) consultation was common (N=1,013; 86%) and resulted in a lower mortality rate compared to patients without ID consultation (16.2% vs 39.8%; P&lt; 0.001). There were 254 (21%) HO-SAB cases with an incidence of 0.22 episodes per 1,000 patient days. HO-SAB incidence increased following the onset of the COVID-19 pandemic (0.17 vs 0.28 cases per 1,000 patient days). In addition, in-house mortality of patients with HO-SAB also increased following the onset of the COVID-19 pandemic (20.8% vs 32.8%). Patients with HO-SAB had a longer median length of stay (20.8 days vs 8.9 days; P&lt; 0.001) and a higher rate of in-hospital mortality (27.2% vs 17.4%; P&lt; 0.001) compared to patients with CO-SAB.

Conclusion
This study highlights the tremendous impact of SAB for patients and the healthcare system. SAB mortality remained high however, ID consultation resulted in significantly lower mortality rates. HO-SAB is unfortunately common and patients with HO-SAB had longer LOS and a higher rate of in-house mortality compared to patients with CO-SAB. Following the onset of the pandemic, HO-SAB incidence and in-hospital mortality increased. Further studies are necessary to understand the risk factors and prevention of HO-SAB.

Disclosures
All Authors: No reported disclosures
P-845. HECK-Yes This is The Remix!! Ceftriaxone vs Cefepime or Carbapenems for Definitive Treatment of Low-Risk AmpC-Harboring Enterobacterales Bloodstream Infections
Authors: Kenney Rachel M , Veve Michael , Shallal Anita , Tibbetts Robert , Mulbah Jessica L 
Published: January 2025

Abstract

Background
Recent literature suggests ceftriaxone as a viable treatment of low-risk AmpC-producing organisms, allowing for the preservation of AmpC-stable therapies for moderate to high-risk organisms. This study aimed to determine whether ceftriaxone is effective in patients with bloodstream infections (BSI) caused by low-risk AmpC harboring Enterobacterales compared to AmpC-stable therapies.

Methods
This was an IRB-approved, retrospective cohort of hospitalized patients ≥18 years old with a BSI due to Serratia marcescens, Morganella morganii, or Providencia spp. from 1/1/2017-2/28/2024. Patients were compared according to definitive therapy with ceftriaxone vs AmpC stable therapy (cefepime or carbapenem). The primary endpoint was 30-day all-cause mortality; secondary endpoints were clinical failure, development of ceftriaxone resistance, and hospital length of stay (LOS) after index culture. Clinical failure was defined as persistent signs and symptoms of infection, repeat positive blood cultures on days 3-5 of therapy, antibiotic escalation, or death.

Results
163 patients were included: 54 (33.1%) received ceftriaxone vs 109 (66.9%) AmpC stable therapies. Baseline, infection, and treatment characteristics are found in Table 1. 30-day all-cause mortality was observed in 5 (9.3%) ceftriaxone vs 11 (10.1%) AmpC stable patients (P=0.87). There were no differences in clinical success (49 [90.7%] vs 86 [78.9%], P=0.059), relapsing infection (3 [5.6%] vs 10 [9.3%], P=0.55), or rehospitalization (11 [20.4%] vs 38 [34.9%], P=0.06) between ceftriaxone and AmpC stable patients, respectively. Ceftriaxone resistance was only observed in AmpC stable patients (0 vs. 4 [3.7%], P=0.302), and median (IQR) LOS was similar between groups (5 [4-8] vs 6 [3-13] days, P=0.39). After adjustment for vasopressor use (adjOR 4.2; 95%CI, 1.3-13.1), ceftriaxone definitive therapy (adjOR, 0.79; 95%CI, 0.23-2.3) was not independently associated with 30-day all-cause mortality

Conclusion
Patients treated with definitive ceftriaxone for low-risk AmpC Enterobacterales BSI achieved comparable outcomes to those treated with AmpC stable therapies. These findings support ceftriaxone as a treatment option for low-risk AmpC producers.

Disclosures
Rachel M. Kenney, PharmD, BCIDP, Medtronic Inc: Spouse is an employee, stockholder
P-846. A Single-Institution Retrospective Analysis on the Administration of Beta-lactam Antibiotics Prior to Vancomycin in Bacteremic Patients
Authors: Cravero John C , Telchik Collin M , Yakubik Taylor , Woods Lewis , Sisco Lauren 
Published: January 2025

Abstract

Background
According to the 2021 IDSA Surviving Sepsis Guidelines, prompt administration of antibiotics is an essential recommendation for patients with bacteremia. Similarly to a recent study published by Amoah et al., we sought to determine if the sequence of antibiotic administration impacted 30-day mortality.

Methods
We conducted a single-institution retrospective study at Baylor Scott & White Medical Center in Temple, Texas, on patients greater than 18 years of age admitted with sepsis and confirmed bacteremia from January 1st, 2021, to July 1st, 2023 who received sequential antibiotic administration with a Beta-lactam and vancomycin within the first 6 hours of admission time. Our primary endpoint was odds ratio for 30-day mortality.

Results
Of 6143 patients generated from electronic search, 222 patients were included in the Beta-lactam first group and 16 were included in the vancomycin first group. Of these 238 patients, 132 patients were admitted to the ICU upon admission. The most common Beta-lactam antibiotic administered was piperacillin-tazobactam (58.40%) followed by Cefepime (25.47%), then Ceftriaxone (13.03%). For patients with monomicrobial bacteremia, the most common organisms isolated were Escherichia coli (25.21%), Methicillin resistant Staphylococcus aureus (MRSA) (13.45%), Methicillin sensitive Staphylococcus aureus (MSSA) (11.34%), and Proteus mirabilis (7.56%). The calculated odds ratio for 30-day mortality was 0.40 (95% CI 0.089-1.831), indicating a decreased occurrence of mortality within 30 days for patients who received Beta-lactam antibiotics first, though this result was not statistically significant due to limited sample size, particularly within the vancomycin first group.

Conclusion
Although not statistically significant, our results suggest that prompt administration of Beta-lactam antibiotics prior to vancomycin may have mortality benefit in patients with bacteremia. Further confirmatory studies will be required to investigate this principle.

Disclosures
All Authors: No reported disclosures
P-854. Determining whether presence of Lower Urinary Tract Infection Symptoms is Associated with Better Graft Outcomes in Kidney Transplant Recipients with Bacteremia from a Urinary Source
Authors: Donzo Maja Wichhart , Anderson Rebecca , Eichenberger Emily 
Published: January 2025

Abstract

Background
Bloodstream infection is a feared complication of bacteriuria in kidney transplant recipients (KTR). We recently found that among KTR with blood stream infection from a urinary source (BSIU), only 28.9% had experienced lower urinary tract infection (UTI) symptoms prior to or upon presentation for their bacteremia. We hypothesized that presence of lower UTI symptoms may lead to earlier recognition of BSIU and therefore better outcomes.

Methods
Patients who underwent a kidney transplant at our institution between 01/2010-09/2022 with BSIU were eligible for inclusion. BSIU was defined as KTR with concordant organisms growing in blood and urine cultures. For subjects with &gt;1 episode of BSIU, only the first episode was included for analysis. KTR with BSIU were classified into one of two groups: presence of lower UTI symptoms or absence of lower UTI symptoms. Lower UTI symptoms were defined as presence of urinary frequency, urgency, dysuria, or suprapubic pain.
Continuous and categorical variables were compared using Wilcoxon-rank sum and fisher exact tests as appropriate. Time to graft failure and acute cellular rejection were analyzed with Kaplan Meier curves and compared using log rank tests.

Results
Among 142 patients who presented with BSIU, 41 (28.9%) presented with lower UTI symptoms. Relative to BSIU without UTI symptoms, BSIU with lower UTI symptoms were less likely to have a history of diabetes induced renal failure (20% vs 43%, P=0.012), and less likely to have a had acute cellular rejection preceding infection (7.3% vs 27%, P=0.012). Race, gender, recipient age at transplant, donor type, and immunosuppression regimen did not differ between the two groups. 90-day mortality among BSIU was 0% for those with lower UTI symptoms versus 4% for those without symptoms (P=0.324). Time from BSIU to acute cellular rejection did not differ by symptom status (P = 0.99). Overall time to graft failure was longer in BSIU with UTI symptoms (P=0.041).

Conclusion
Longer time to graft failure was noted among BSIU who presented with lower UTI symptoms. Larger studies are needed to validate these findings and investigate how we can use clinical data and symptomatology to predict outcomes for KTR with BSIU.

Disclosures
All Authors: No reported disclosures