bluuebunny/crossref_metadata_2025_split huggingface dataset:
1681. Persistent Increased Invasive Pediatric Streptococcus pyogenes (Group A Streptococcus) Infections with Correlated Increase in Superficial Infection and Pharyngitis
Authors: Dowling Jameson , Werz Daphne , Smith Kenneth , Harris Rebecca , Smathers Sarah , Harrison-Long Cecelia , Sammons Julia , Hayes Ericka 
Published: November 2023

Abstract

Background
Children's Hospital of Philadelphia (CHOP) clinicians observed an increase in invasive group A Streptococcus infections (iGAS) in November 2022. In December 2022, the Centers for Disease Control and Prevention published an investigation of increased iGAS. At CHOP iGAS remain increased, even after peak respiratory viral season. Our objective was to compare pre-pandemic and current case counts and to investigate if the increase in iGAS correlates with an increase in non-invasive GAS infections (nGAS).

Methods
Data for positive Streptococcus pyogenes results at CHOP from January 2018 to April 2023 was collected from the electronic medical record (n=466). Results were classified by source and specimen type as pharyngitis, superficial, and invasive, then further classified as non-invasive (pharyngitis and superficial) or invasive. For infection events with multiple results only one result was included, giving preference to the most aggressive classification (invasive &gt;pharyngitis &gt;superficial). Fisher's exact test was used to assess association between the increase in nGAS and iGAS prior to and after the start of the COVID-19 pandemic (2018-2019 vs. 2021-2023). Fisher's exact test, with Monte Carlo simulation, was used to assess association between the increase in nGAS and iGAS infections by year.

Results
There was a statistically significant association in the increase in pharyngitis, superficial, and invasive group A Streptococcus infections (GAS) (p-value &lt; 0.0001) and in nGAS and iGAS (p-value = 0.0001), when comparing pre- and post-2020. We found statistically significant associations in the increase of pharyngitis, superficial, and invasive GAS cases (p-value = 0.0005) and of nGAS and iGAS cases (p-value = 0.0005).

Conclusion
Our data shows a significant increase in cases from pre-pandemic years for nGAS and iGAS infections. iGAS is correlated with nGAS, even with further stratification of nGAS into pharyngitis and superficial. Notably, increases in nGAS were significantly more than the increase in iGAS, which has unexpectedly persisted beyond the typical winter viral infection peak. Continued monitoring or GAS, particularly iGAS, is justified.

Disclosures
All Authors: No reported disclosures
1692. Increasing incidence of Streptococcus anginosus group intracranial complications of sinusitis, otitis media and mastoiditis in a pediatric population
Authors: Hoyer Elisabeth , Joseph Marritta , Dunn James , Weiner Howard , Dimachkieh Amy , Flores Anthony R , Kaplan Sheldon L , Vallejo Jesus G , McNeil Jonathon C 
Published: November 2023

Abstract

Background
The Streptococcus anginosus group (SAG) pathogens (S. anginosus, S. intermedius, and S. constellatus) are oral flora with the potential to cause head and neck space infections including brain abscesses. Several centers noted an increase in intracranial abscesses in children in the SARS-CoV-2 era, prompting a CDC health alert in May 2022. Notably, a large proportion of such reported cases were associated with SAG and/or sinusitis. We examined the epidemiology of pediatric intracranial abscesses with a focus on SAG in the pre- and post-pandemic periods.

Methods
Cases of intracranial abscesses (parenchymal, subdural, epidural) of any microbiologic etiology from January 1, 2011 to December 31, 2022 were identified at Texas Children's Hospital by ICD10 codes. Subjects were cross referenced with culture results of the microbiology laboratory. Cases included were those associated with either otitis media, mastoiditis, or sinusitis. Temporal trend in these infections was investigated with linear regression.

Results
157 cases were identified and 59.9% were due to SAG. The incidence of all sinogenic/otogenic intracranial infections (p=0.006), and SAG specific infections (p=0.01), increased from 2011 to 2022 (Figure 1). SAG infection was more often associated with multiple surgeries and these subjects were specifically more likely to require craniotomy or craniectomy (Figure 2). Among sinogenic abscesses, S. intermedius was the most common pathogen while among otogenic cases S. pyogenes predominated (Figure 3). There were 8 cases of craniectomies and one relapse (due to SAG) after replacement of autologous bone flap. After March 2020, 6/46 cases tested positive for SARS-CoV-2 (13%); the severity of infection was not significantly different with concomitant COVID and intracranial abscess. The proportion of SAG-associated infections was similar prior to and after the COVID pandemic.
*- p= 0.01- &lt;0.05 ** p&lt; 0.01

Conclusion
Over the last decade, intracranial complications of sinusitis/otitis have been increasing, and specifically those caused by SAG. This observed trend clearly predated the COVID pandemic. SAG cases were associated with greater need for surgical intervention and specifically neurosurgery. Further work is necessary to determine the explanation for these rising infections.

Disclosures
Sheldon L. Kaplan, MD, MeMed: Grant/Research Support|Pfizer: Grant/Research Support|Pfizer: Honoraria Jonathon C. McNeil, MD, Allergan: Grant/Research Support|Nabriva Therapeutics: Grant/Research Support
1710. Clostridioides difficile Bundle Implementation Reduces Unnecessary Testing in Pediatric Patients
Authors: Sietsema Lydia , Maples Holly , Honeycutt Michele , Boyanton Bobby , Forbus John , Snowden Jessica 
Published: November 2023

Abstract

Background
Failure to follow proper guidelines can lead to inappropriate Clostridioides difficile infection (CDI) testing in pediatric patients, resulting in incorrect diagnoses and antibiotic overuse. The Infectious Diseases Society of America and Society for Healthcare Epidemiology of America recommend a 2-step testing algorithm incorporating restrictions based on age, exposure, and underlying conditions. With these recommendations, a CDI bundle was implemented to reduce unnecessary testing in pediatric patients. Outcomes were measured via National Healthcare Safety Network (NHSN) LabID reporting.

Methods
An interdisciplinary team reviewed the CDI ordering process in a 24-bed community pediatric hospital with an Emergency Department (ED). Previous testing only used toxigenic C. difficile PCR without order restrictions. In September 2021, a CDI bundle was implemented, including a 2-step algorithm (toxigenic C. difficile PCR, toxin A/B immunoassay), a physician guidance pathway, and Epic order restrictions (Table 1).
Outcomes were measured by examining NHSN LabID data before and after bundle implementation. Inpatient and ED data were reported under the appropriate NHSN patient safety module. CDI rates were calculated by the number of infections/1000 inpatient days and number of infections/1000 ED encounters. There was a 12-month pre-implementation period (August 2020-July 2021), a 3-month implementation period (August 2021-October 2021), and a 12-month post-implementation period (November 2021-October 2022).

Results
A statistically significant decrease in the CDI incidence was seen after CDI bundle implementation (P&lt; 0.05 for both inpatient and ED using test of proportions). The average CDI incidence decreased from 2.24 to zero infections/1000 inpatient days (Figure 1) and from 0.58 to 0.02 infections/1000 ED encounters (Figure 2).

Conclusion
CDI diagnostic bundle implementation effectively decreased the number of abnormal CDI test results, and positively impacted data reported to NHSN. Further analysis is warranted to delineate the impact of CDI bundle implementation on patient treatment, antimicrobial stewardship, and healthcare costs.

Disclosures
Jessica Snowden, MD, MHPTT, Pfizer: Advisor/Consultant
2878. A Regional Antimicrobial Stewardship Collaboration to Address Fluoroquinolones
Authors: Adenew Ayne , McKnight Angela Y , Ketema Pawlose , Cole Mirella , Callahan Patricia , Laake Ann , Huffman Patrick , Dave Rohini , Bork Jacqueline , Tripathi Ravi , Allman James , Gaynor Cecilia , Cork Travis , Liappis Angelike P 
Published: November 2023

Abstract

Background
Geographically associated Antimicrobial Stewardship Programs (ASPs) may benefit from working in collaboration. Independent ASPs can coordinate efforts with other programs to address high-yield targets for quality improvement and share in experience and knowledge to meet both local goals and fulfill national regulatory standards.

Methods
In 2016 ASPs from six neighboring urban/rural VA Medical Centers serving 800K veterans agreed to target fluoroquinolone (FQ) use with shared messaging on preferred indications and reducing avoidable FQ toxicity. All sites had an established ASP and dedicated ASP Champions; two sites lacked FT ID trained MD and ASP FTE allocation varied per site. Sites pooled antibiograms 2018-22 and national metrics for FQ use in outpatient (OP) 2017-22, inpatient (IP) 2020-22 and the pandemic period (PP). Electronic platforms sustained communication and regular teleconferences facilitated planning and coordination. Local decisions determined interventions to target based on resources and patterns of use. FQ-targeted prospective audit/feedback, peer-peer reports and modified EMR- order entry were supplemented with shared educational materials. Messaging with reinforced with bi-annual regional events used targeted email campaigns and teleconferenced talks, including throughout the PP.

Results
Over six years FQ total OP fills sustainably fell 13.6K to 4.3K with annual pharmacy visits 25K (1.5-7K site/year) and DOT/1,000 unique OP visits fell by nearly 70% in the same period across all sites urban/rural (P=.01). In the 522 (28-175) acute, 594 (50-275) LTC beds FQs fell 22.3 to 10.8 DOT/1,000 patient days by 2022. Regional-trends did not increase in PP, but decline slowed. In the region E. coli resistance was unchanged but in sites reporting FQs, suscepblity improved for isolates of MRSA (n 1294) and MSSA (n 1931); with sustained gains in the PP.

Conclusion
Despite differences in hospital size, settings and resources, sustained outcomes can be achieved through efforts developed with regional partners. Coordinated regional stewardship initiatives facilitated by shared metrics are effective, support local efforts, allow for program autonomy and lessen the overall workload through shared experience.

Disclosures
All Authors: No reported disclosures
2882. Impact of a Tele-Antimicrobial Stewardship Program at Two Small Community Hospitals in Partnership with an Academic Medical Center: 2 Years of Experience
Authors: Ross Jennifer , Chandorkar Aditya 
Published: November 2023

Abstract

Background
Community and rural hospitals often lack resources for infectious diseases (ID) specialists. Tele-antimicrobial stewardship programs (TASPs) have emerged as a method for health systems to meet regulatory requirements. We analyzed the impact of a fully remote TASP at two small community hospitals in partnership with an academic medical center over a two-year period.

Methods
A TASP, co-led by an ID physician and ID pharmacist, was implemented at a 21-bed hospital in Princeton, MN, and 49-bed hospital in Wyoming, MN, in August 2020. Figure 1 outlines daily TASP workflows in which the ID physician and ID pharmacist were located at an academic medical center. Frequently encountered restricted antimicrobial agents included vancomycin (intravenous and enteral), piperacillin-tazobactam, cefepime, meropenem, ertapenem, micafungin, and remdesivir. Antimicrobial stewardship interventions were tracked monthly. Restricted antimicrobial days of therapy per 1000 patient days (DOT/1000 PD) mean averages two years pre- and post-implementation were compared. Annual antimicrobial expenditures were followed.

Results
For the first two TASP years (8/1/2020 to 7/31/2022), a total of 789 antimicrobial interventions were made with 85.6% being accepted. Each site boasted similar TASP intervention acceptance rates, 85% for the Princeton hospital and 86% for Wyoming (Figure 2 and Table 1). Restricted antimicrobial use trended down from 141.97 to 113.97 DOT/1000 PD at Princeton. A smaller decrease from 106.3 to 103.12 DOT/1000 PD was seen at Wyoming. Annual antimicrobial costs per total patient days also decreased (Figure 3). Princeton hospital’s annual antimicrobial expenditures per total patient days fell from $18.89 in 2019 (pre-implementation) to $6.64. Wyoming showed a reduction in antimicrobial costs per total patient days by decreasing from $11.20 to $5.36.

Conclusion
A fully remote TASP in partnership with an academic medical center for two small community hospitals resulted in a rapid increase in the rates of accepted interventions. These high rates were sustained over two years. Restricted antimicrobial use and antimicrobial costs trended down. Consistent communication with tele-hospital physicians and pharmacists helped establish trusting relationships.

Disclosures
All Authors: No reported disclosures
1763. Attendance and Learning Outcomes of Statewide Infection Prevention and Control Education and Support Webinars Initiative During the COVID-19 Pandemic: The Nebraska Experience
Authors: Martinez Rebecca , Soma Mounica , McConville Josette , Tyner Laura "Kate" , Donahue Matthew , Ashraf Muhammad Salman , Brailita Daniel M 
Published: November 2023

Abstract

Background
In October 2020, the Nebraska Infection Control Assessment and Promotion program (ICAP), funded by the Nebraska Department of Health and Human Services (DHHS) through a CDC grant, launched a statewide initiative providing infection prevention and control (IPC) education and guidance through weekly webinars to long-term care (LTC) facilities. In March 2021, this was expanded to include a twice monthly webinar for acute care (AC) and outpatient facilities. ICAP infection preventionists (IPs) and medical directors developed the content of webinars in collaboration with Nebraska DHHS. Webinar recordings and slides were posted for reference. Webinar reminders were shared with facilities through the ICAP email distribution list. We investigated factors driving attendance and learning outcomes for this initiative.

Methods
Attendance was recorded for each webinar and compared between LTC and AC considering webinar focus and known denominators of Nebraska LTC and acute facilities. A comprehensive survey regarding learning outcomes and factors driving participation was sent to webinar contacts in early 2023. Responses from IPs working in AC and LTC were compared by independent two-sample T-Test with Pooled and Satterthwaite distribution using SAS version 9.04.01

Results
On average, 69 (range 42 to 110) facility IP leaders attended AC webinars and 160 (range 123 to 526) attended LTC webinars since the inception. Of the 96 AC and 429 LTC operational facilities, 50% AC and 25% LTC facilities responded to the survey. Of the 51 AC and 170 LTC respondents, IPs constituted 86% (n=44) and 25% (n=42) respectively. LTC IPs were more likely than AC IPs to join the webinars to learn about changes in regulatory requirements and national IPC guidance. More than 60% of IPs in both settings implemented a new policy or procedure based on the webinar, with LTC IP’s implementing 5% more general IP and 9% more COVID-19 specific policies. 83.3 % of LTC IPs and 52.3% of the AC IPs reported attending almost all webinars. IPs self-rated learning outcomes were high (AC 4.5-4.6 and LTC 4.3-4.6 on a 1-5 scale)

Conclusion
A statewide initiative to provide infection prevention education and guidance was well received by Nebraska facilities and led to just-in-time policy and procedure changes during COVID-19 pandemic.

Disclosures
Muhammad Salman Ashraf, MBBS, Merck: Grant/Research Support
1768. Engaging Clinically and Socially Vulnerable Populations to Understand Their Perceptions of mRNA Vaccines
Authors: D’Silva Chelsea 
Published: November 2023

Abstract

Background
One of the COVID-19 pandemic’s greatest silver linings has been the success of mRNA-based vaccines. While successful, the public has had many questions and even concerns about these vaccines as the pandemic is the first time they were clinically used. Both clinically and socially vulnerable populations have borne a hugely disproportionate burden of the pandemic. It is a public health imperative to ensure vaccine uptake in these groups are as high as possible. This project aimed to understand vulnerable populations perspectives on mRNA vaccines and immunizations to inform the development and dissemination of educational materials.

Methods
We conducted semi-structured qualitative descriptive interviews with clinically vulnerable (e.g., 50+, those living in LTC and congregate settings, having immunocompromising conditions/treatments) and socially vulnerable (e.g., racialized, newcomer and indigenous) populations across Canada. We thematically analyzed the data to identify patterns of meaning across the interviews.

Results
Fourteen people participated in interviews. Themes include: 1) clinically vulnerable populations view mRNA vaccines as safe and important for protecting themselves against COVID-19 and wish for the general public to get vaccinated to protect those who are most vulnerable; 2) socially vulnerable populations felt that there was a lack of accessible and concise information about who is high risk for COVID-19, timing of vaccination and how natural immunity to COVID-19 impacts the need for vaccination; and 3) vulnerable populations felt that the general public no longer views getting vaccinated as important since they do not view themselves as at-risk of hospitalization or severe adverse events.

Conclusion
These findings suggest that vulnerable populations view the vaccine as safe but perceive that getting vaccinated is not a priority for the general public. Our team is developing educational resources for vulnerable populations and the public to promote vaccine uptake. With more mRNA vaccines being developed for other infectious diseases, these findings can help inform vaccine promotion efforts and increase confidence in mRNA vaccines.

Disclosures
All Authors: No reported disclosures
1773. Complement level measurements for children in England suggest a possible unreported Post Streptococcal Glomerulonephritis Outbreak
Authors: Dale Rachel , Manson Ania , Mok Hoi-Ping , Kumararatne Dinakantha , Gkrania-Klotsas Effrossyni 
Published: November 2023

Abstract

Background
Poststreptococcal glomerulonephritis (PSGN) is caused by prior infection with specific strains of group A streptococcus (GAS). PSGN is commonly characterised by significant complement C3 depression and maintained C4 levels, especially in children. The 2022-23 GAS outbreak has been associated with childhood morbidity and mortality in the UK due to invasive GAS infections but no PSGN outbreak has been described.

Methods
We reviewed the laboratory requests for complement C3 and C4 measurements received by the main East of England immunology laboratory for the 48 months between April 1st, 2019 and March 31st, 2023 and for patients under the age of 18 at the time of the request. We collected demographic information as well as concurrent anti antistreptolysin and anti-DNAase B antibody levels. We excluded 4 individuals who had only marginally decreased C3 levels (less than 10% drop from lower limit of normal).
We assigned cases as possible PSGN if C3 was low, C4 was normal and antistreptolysin serologies were not obtained. We assigned cases as probable PSGN if C3 was low, C4 was normal and antistreptolysin and anti-DNAase B antibody levels were elevated.

Results
24 unique patients aged 0-18 were identified (18 boys and 6 girls), 8 possible and 16 probable PSGN cases. All but two of the probable cases were boys. There were no cases of possible or probable PSGN between 9.3.20 and 20.3.22. Half of the observed cases have been observed within the last 12 months, mirroring the reported invasive GAS incidence in England.
Table of possible and probable Post Streptococcal Glomerulonephritis cases, East of England Immunology Laboratory

Conclusion
PSGN is unusual in industrialized countries. The monitoring of C3 and C4 complement level requests suggests a possible undiagnosed concurrent to the GAS PSGN outbreak in the UK and the circulation of possible nephritogenic strains.

Disclosures
All Authors: No reported disclosures
1774. Surveillance for Emerging and Reemerging Pathogens Using Pathogen Agnostic Metagenomic Sequencing in the United States: A Critical Role for Federal Government Agencies
Authors: Downie Diane L , Rao Preetika , David-Ferdon Corinne , Courtney Sean , Lee Justin , Quiner Claire , MacDonald Pia , Barnes Keegan , Fisher Shelby S , Andreadis Joanne D , Chaitram Jasmine , Mauldin Matthew R , Salerno Reyolds M , Schiffer Jarad , Gundlapalli Adi 
Published: November 2023

Abstract

Background
The surveillance and identification of emerging, reemerging, and unknown infectious disease pathogens is essential to national public health preparedness and relies on fluidity, coordination, and interconnectivity between public and private surveillance systems and networks. Implementing and sustaining programs to detect emerging and re-emerging pathogens in humans using advanced molecular methods, such as metagenomic sequencing, requires large investments in testing equipment and developing networks of clinicians, laboratory scientists, and bioinformaticians.

Methods
This study sought to gain an understanding of the role of federal government agencies in supporting such pathogen-agnostic testing of human specimens in the United States. A landscape analysis was conducted of federal agency websites for publicly accessible information on the availability and type of pathogen-agnostic testing and details on flow of clinical specimens and data. The website analysis was supplemented by expert review of results with representatives from the federal agencies.

Results
Operating divisions within the Department of Health and Human Services and the US Department of Veterans Affairs have developed and sustained extensive clinical and research networks to obtain patient specimens and perform metagenomic sequencing at scale. Metagenomic facilities supported by US agencies were not equally geographically distributed across the US. Although many entities have work dedicated to metagenomics and/or support emerging infectious disease surveillance specimen collection, there was minimal apparent collaboration across agencies.

Conclusion
Developing a national sentinel surveillance network with existing resources and infrastructure could potentially increase efficiency, accelerate identification of emerging biothreats, and support coordinated intervention strategies that reduce morbidity and mortality.

Disclosures
All Authors: No reported disclosures