bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1364. Cefiderocol Activity against Pseudomonas aeruginosa Clinical Isolates Carrying Metallo-β-lactamase Genes in United States and European Hospitals (2020–2023)
Authors: Mendes Rodrigo E , Beekman Danielle , Karr Maura , Kimbrough Hank , Hubler Cory , Sader Helio S , Castanheira Mariana 
Published: January 2025

Abstract

Background
Cefiderocol (FDC) is a siderophore cephalosporin that uses the iron transport systems of Gram-negative bacteria to optimize cell entry. FDC is stable to hydrolysis by serine and metallo-β-lactamases (MBL). FDC and comparator activities were analyzed against P. aeruginosa (PSA) carrying MBL genes, as part of the SENTRY Antimicrobial Surveillance Program.

Methods
9,573 PSA were collected from 36 sites in the US and 43 sites in Europe (EU) in 2020–2023. Susceptibility (S) testing used broth microdilution with cation-adjusted Mueller-Hinton broth (CAMHB) for comparators and iron-depleted CAMHB for FDC. CLSI/EUCAST breakpoints were used for FDC; whereas CLSI were applied for comparators (EUCAST for colistin [COL]). Isolates with MIC ≥4 mg/L (nonS by CLSI) for imipenem or meropenem were screened for β-lactamase genes.

Results
Carbapenem-nonS PSA comprised 23.4% (2,236/9,573) of isolates, with 22.3% (980/4,400) and 24.3% (1,256/5,173) originating from US and EU sites, respectively (Table). 5.5% (124/2,236) of PSA carried MBL, and these PSA were mostly from EU (94.4%). FDC (98.3–99.4%S) had MIC50 of 0.12 mg/L and MIC90 of 0.5 mg/L against carbapenem-nonS PSA from the US and EU, whereas other agents had lower S (80.9–90.2%), except for COL (99.7–99.8%S). Aztreonam-avibactam inhibited only 48.4% and 57.6% of carbapenem-nonS PSA from the US and EU at MIC of ≤8 mg/L, respectively. FDC (MIC50/90, 0.25/2 mg/L; 94.4–96.0%S) had activity against the MBL-carrying PSA subset; in contrast, other agents had off-scale MIC90 (i.e. &gt;8 mg/L), except for COL (100%S). All PSA carrying blaIMP and blaVIM were susceptible to FDC (MIC90/100, 1/2 mg/L), whereas higher FDC MIC (MIC50/90, 2/16 mg/L; 57.1–64.3%S) were noted against blaNDM-carrying PSA.

Conclusion
FDC showed potent activity against carbapenem-nonS PSA clinical isolates from US and EU hospitals, including isolates carrying MBL genes, whereas newly launched BL/BLI didn’t show activity. FDC should be considered as an important option for the treatment of infections caused by these resistant subsets for which antibiotic treatment option are limited.

Disclosures
Rodrigo E. Mendes, PhD, GSK: Grant/Research Support
P-1368. High prevalence of class 1 integrons in carbapenem resistant Enterobacterales in Taiwan
Authors: Lee Susan Shin-Jung , Hsia Hui-Ling , Lee Yi-ting , Lin Hsi-Hsun 
Published: January 2025

Abstract

Background
The prevalence of integron in carbapenem resistant Enterobacterales is not well studied. This study aimed to investigate the prevalence and resistance gene cassettes of class 1 integron in carbapenem resistant Enterobacterales.Fig. 1.Integron gene expression in Carbapenem-resistant Enterobacterales (CRE)(N=101).

Methods
In total, 101 carbapenem resistant Enterobacterales strains were collected
through 2020 to2023. Genomic DNA was extractedand PCR method was performed for detection of class 1 integron gene cassettes. Sequences were performed by an automatic sequencer with Applied Biosystems 3730xl and alignment in GenBank.Figure 2.Resistance gene cassettes of Integron(+) in carbapemase-producing and non-carbapenemase producing carbapenem-resistant Klebsiella pneumoniae

Results
The prevalence of class 1 integron cassette of all Carbapenem resistant Enterobacterales (CRE) was 79.21% (80/101), and was high as 83% (44/53) in carbapenem resistant Klebsiella pneumoniae.The most common resistant gene cassettes wer edfrA12-aadA2 (20 %), following by dfrA17-aadA5 (17.5%) and aadA2 (11.25%). No carbapenemase gene was detected in class 1 integron gene cassettes. However, acriflavine resistance B (AcrB) gene, which is a multiple efflux transporter, wasdetected in 4 strains.Table 1.The expression patterns of integron genes (+) and integron genes (-) cassettes in different Carbapenem-resistant Enterobacterales (CRE).

Conclusion
Our study revealed high prevalence of type I integron gene cassettes in carbapenemase resistance Enterobacterales. The role of AcrB gene need to be further studied.

Disclosures
All Authors: No reported disclosures
P-1383. Gap in Doxy PEP Prescription for People Living With HIV Compared with PrEP Users in a Primary Care Practice
Authors: Asiago-Reddy Elizabeth , Himat Nabeil , Myers Courtney 
Published: January 2025

Abstract

Background
Use of 200mg of doxycycline as post-exposure prophylaxis within 72 hours of a condomless sexual encounter (Doxy PEP) has been shown to reduce the risk of key sexually transmitted infections (STIs). Doxy PEP is effective both for people living with HIV (PLH) as well as those who do not have HIV. The goal of this analysis was to describe uptake of Doxy PEP in a primary care practice in Syracuse, NY, a Northeastern U.S. city serving a large population of PLH as well as people prescribed pre-exposure prophylaxis (PrEP) for HIV prevention.

Methods
Data were abstracted from the electronic medical record. Patients who were seen for HIV or PrEP care between 1 Jan and 31 December, 2023 who were transgender women (TGW) or cisgender men self-identified as gay, bisexual, or “other” sexual orientation (MSM) and had been diagnosed with chlamydia, gonorrhea or syphilis during 2023 were analyzed. Doxy PEP discussion and prescription were determined through medication review and office notes up through the first quarter of 2024. Factors associated with providers recommending and/or prescribing doxy PEP were evaluated using bivariable and multivariate logistic regression.

Results
A total of 602 MSM and 25 TGW were seen in the practice during 2023; 117 (18.7%) were diagnosed with at least one STI, specifically syphilis [37; (31.6%)], chlamydia [33 (28.2%)], gonorrhea [23 (19.7%)] or more than 1 of these [24 (20.5%)]. A total of 46 (39.3%) patients were prescribed doxy PEP; 11 (9.3%) declined, and 60 (51.3%) had no documented discussion or prescription. Most 35 (76.1%) prescriptions were in the 1st quarter of 2024; average days between STI diagnosis and doxy PEP prescription was 200 days. On multivariate analysis (MVA), only PrEP vs. HIV was associated with prescription (OR 13.3 p&lt; 0.0001; this held even after excluding 4th quarter STI diagnoses to account for less frequent follow up of PLH vs. PrEP users (OR 17.5, p=0.001). Doxy PEP prescription was not associated with age, race or ethnicity, type or site of STI, provider, or time (days) since STI diagnosis.

Conclusion
Doxy PEP is a valuable tool for reducing STIs; it may be underutilized in people living with HIV despite ongoing risk, and methods to encourage prescription for PLH are warranted.

Disclosures
Elizabeth Asiago-Reddy, MD, Abbvie: Grant/Research Support|GSK/Viiv: Grant/Research Support|Pfizer: Grant/Research Support|Theratechnologies, Inc.: Grant/Research Support
504. Missed opportunities for HIV Prevention and Treatment in People Hospitalized with Serious Injection Related Infections: The CHOICE+ Cohort
Authors: Bryan Nicole , Traver Edward C , Kattakuzhy Sarah , Carpenter Joseph E , Catalanotti Jillian S , Raman Sumitha , Fujita Ayako W , Kuo Irene , Steck Alaina , Rosenthal Elana S , Reece Becky 
Published: January 2025

Abstract

Background
Harm reduction for persons who inject drugs (PWID) has many components, including HIV testing and Pre-exposure Prophylaxis (PrEP). However, despite the increasing evidence of effectiveness, PrEP remains highly underutilized in these patients at high-risk for infection and subsequent transmission risk to others. Our aim is to identify the gaps in HIV prevention care among a hospitalized PWID population.Table 1:Demographics and Clinical Characteristics

Methods
CHOICE+ is a multisite retrospective cohort study of adults hospitalized with infectious complications of active injection opioid use between 1/1/2018 and 3/31/2022 at four US medical centers. Data were collected by abstraction of the electronic medical record and analyzed by chi-square and multivariate logistic regression.Table 2:Multivariate Analysis of Factors Associated with HIV Screening

Results
1168 (74%) adults with unknown HIV status underwent HIV screening during sentinel admission. For risk comparison, 48% of this cohort had active HCV infection. HIV screening was less likely to occur in PWID who were male (69% vs 78% females), Black (51% vs 78% White), hospitalized &lt; 3 days (56%), on non-medical services (62% vs 75%), and without ID consult (56% vs 79%). Only 3 participants were referred for PrEP, and only 4 initiated PrEP within 1 year of discharge. Additionally, nearly half (49%) of this HIV (-) cohort did not have follow up HIV screening. There were 79 HIV (+) individuals: 66 known HIV (+) and 13 new diagnoses. Forty-five (57%) were on anti-retroviral therapy during hospitalization, 28 (35%) had CD4 &lt; 200, 47 (59%) had detectable viral load, and 49 (62%) were referred for HIV care. However, only 37% were confirmed linked to care. Of those in care, 59% were virally suppressed within 12 months.Table 3:HIV Prevention Outcomes among HIV negative group within 12 months

Conclusion
In a cohort of high-risk PWID hospitalized with infectious complications of substance use, there were low rates of HIV screening, PrEP initiation, and referrals for treatment in HIV (-) individuals. The lack of PrEP initiation in this study is unsurprising; however, the absence of referring patients suggests a lack of awareness of increased PrEP availability. More concerning are the gaps in HIV screening among this high-risk cohort. Clinicians must capitalize on opportunities to provide this population with tools to reduce their risks, which includes HIV screening and PrEP.Figure 1:HIV Care Cascade

Disclosures
Elana S. Rosenthal, MD, Gilead Sciences: Grant/Research Support|Merck: Grant/Research Support
P-1386. Developing a Diagnostic Strategy for the Diagnosis of Bacterial Vaginosis: A Shift from Subjective to Objective Approach
Authors: Grover Pragati , Sethi Sunil , Dadwal Rajneesh , Sehgal Amit , Saini Aastha , Bagga Rashmi , Chopra Seema , Angrup Archana 
Published: January 2025

Abstract

Background
Bacterial vaginosis (BV), a polymicrobial syndrome of unclear etiology is a major public health problem. The current diagnostic approaches lack standardisation and are not easily reproducible. We aim to develop a diagnostic modality to enhance the accurate diagnosis of BV.

Methods
385 vaginal samples were categorised into BV positive (n=108), BV negative (n=208) and intermediate group (n=69). The positive and negative samples were then subjected to qualitative and quantitative PCR. The two pathogens targetted were Fannyhessea vaginae and Gardenerella vaginalis.
Standardisation real time PCR: CP value and Tm value for Gardnerella vaginalis

Results
PCR detection as compared to Nugent criteria yielded a sensitivity of 96% and specificity of 82.9%, positive predicitive value (PPV) of 68.5% and negative predicitive value (NPV) of 98.2%. In contrast, molecular quantification of the two bacteria together had highest specificity (99.52%) with excellent PPV of 98.1%. Although, with a low sensitivity (48.1%) and NPV (78%).

Conclusion
All women in reproductive age group should be screened for BV using qualitative PCR targeting Fannyhessea vaginae and Gardenerella vaginalis together. In symptomatic women, the use of quantitative PCR can provide a consistent diagnosis of BV. Thus this objective diagnostic strategy can play a pivotal role in prevention, early diagnosis, treatment initiation and cure of BV.

Disclosures
All Authors: No reported disclosures
P-1399. Impact of Positive Chlamydia and Gonorrhea Testing Among Male Military Trainees
Authors: Powers Rachel E , Winkler Erin , Casey Theresa , Jung Ga O , Osuna Angela , Marcus Joseph 
Published: January 2025

Abstract

Background
All females trainees entering the U.S. Air Force basic military training (BMT) are tested for chlamydia (CT) and gonorrhea (GC) and account for the vast majority of cases in this population. Recent studies have demonstrated that, when universally tested, BMT males had similar overall rates of CT and GC as compared to females, as most cases are asymptomatic. This study evaluates the incidence of CT and GC in male BMT trainees and follow-up.

Methods
Over 30,000 BMT recruits train at Joint Base San Antonio-Lackland each year. This study included all male trainees who tested positive for CT or GC during their 8-week training period between 2017-2023. Information was obtained regarding patient’s age, indication for testing, facility-type performing testing, date of test, follow-up testing, and occurrence of STIs within three years of diagnosis. Male trainees were then matched with female trainees based on age, date of diagnosis, and pathogen type to determine sex-based differences in follow-up.

Results
50 (0.03%) of the 182,726 males who attended BMT between 2017-2023 tested positive for CT or GC during their training. Most cases (88%) were detected in primary care and the median time in training until diagnosis was 12.5 [IQR: 8-27] days. (56%) of male trainees had symptoms on presentation for STI testing, with dysuria (40%) and penile discharge (35%) being the most common. When compared to matched-females, male trainees had significantly less follow-up testing within one year as compared to female trainees (56% vs. 75%, p=0.05). Despite the difference in follow-up testing, there was no difference in STIs diagnosed in the next three years (18% vs. 24%, p=0.5).

Conclusion
Despite universal access to care, only slightly more than half of male BMT trainees with CT or GC received guideline-directed follow-up within one year. Additionally, approximately one in five men who tested positive for CT or GC during BMT developed a subsequent STI in the next three years, at rates similar to women who tested positive, despite less frequent testing. More work is needed to improve follow-up testing services for those who test positive for CT or GC.

Disclosures
All Authors: No reported disclosures
P-1402. Will You Receive HIV and HCV Testing from a Mobile Pharmacy? Pre-implementation Needs Assessment and Pilot Findings from the United States First Legal Retail Mobile Pharmacy
Authors: Tarfa Adati , Frank Cynthia , Brooks Ralph P , Schultheis Alysse , Di Paola Angela , Shenoi Sheela , Springer Sandra Ann 
Published: January 2025

Abstract

Background
Connecticut enacted Senate Bill No.1102 in July 2023, allowing mobile pharmacies to operate in the state to meet the needs of individuals at risk for and living with HIV, including people who use drugs (PWUD), who often experience difficulties accessing and navigating health care systems. The mobile pharmacy and clinic (MPC) care delivery model uses clinicians, community health workers (CHW), and pharmacists to provide healthcare to people where they live (housed/unhoused), improving accessibility to care for people living with/at risk of HIV as well as Hepatitis C (HCV) and substance use disorder (SUD) treatment. We present pre-implementation needs assessment and pilot data of an MPC from an urban area of Connecticut.

Methods
CHWs conducted a needs assessment of community members from 08/2023 to 11/2023 to characterize barriers to accessing care and the acceptability of health screenings, including rapid HIV and HCV testing. Pilot implementation data includes service use, clinical assessment, and prescription fill data of the MCP from 12/2023 to 04/2024.

Results
Needs assessment: Among 158 respondents, the main barriers to accessing pharmacy services were transportation (67%) and medication cost (24%). The majority (89%) showed willingness to use a mobile pharmacy, and 57% were willing to receive HIV testing by a CHW (Table 1). Implementation: Among 167 individuals who received services from the MPC, a majority were male (62%), White (40%), and ethnicity of Latinx/Hispanic (42%), 11% had never tested for HIV, and 2 were living with HIV (Table 2). Among 38% accepting HIV testing, none tested positive and were all offered PrEP. Also, 56% accepted HCV testing, 10 (20%) had a positive viral load, and 8 (80%) started treatment. Of those screened, 35% (20/57) and 18% (12/66) were positive for Alcohol Use disorder (AUD) and Opioid Use Disorder (OUD), respectively. Of the 284 medications dispensed,10 (4%) were for PrEP, 2 (1%) for long-acting injectable ART, 9 (3%) for AUD, and 4 (1%) for OUD (Table 3).

Conclusion
The MPC can respond to the needs of an urban population when current services are impractical for patients. Providing health services through an MPC is feasible and should be expanded to meet gaps in health care.

Disclosures
Ralph P. Brooks, MS, Merck: Stocks/Bonds (Public Company) Sheela Shenoi, MD MPH, Merck Pharmaceuticals: Stocks/Bonds (Private Company) Sandra Ann Springer, MD, Alkermes Inc: Honoraria|Alkermes Inc: In kind study drug donation for NIH sponsored research|Indivior Pharmaceutical company: In kind study drug donation for NIH sponsored research
P-1404. Trends and Disparities in Viral Load Suppression Among People Living with HIV in Three Texas Cities: A Decade-Long Retrospective Study
Authors: Garcia Angie , Radunsky A L exander P , Naiman Nicole , Cabrejos Lucia , Taylor Barbara S , Vigil Karen J , Jain Mamta K 
Published: January 2025

Abstract

Background
HIV/AIDS remains a significant public health challenge in the United States, especially in states with diverse populations such as Texas. This study examines viral load trends among people living with HIV in Houston, Dallas, and San Antonio over ten years. The aim is to investigate variations in viral load suppression among individuals living with HIV across different cities, considering demographic variables like age, gender, race/ethnicity, and socioeconomic status.

Methods
A retrospective study was conducted on people with HIV (PWH) from 2009 to 2019. Demographic data, clinical variables, and viral suppression status were analyzed across different groups using time-to-event analysis.

Results
The analysis revealed that being female was linked to a reduced hazard ratio for detectable viral load (HR: 0.89, 95% CI: 0.82 - 0., p = 0.005) after adjusting for other demographic factors (table 2). Additionally, younger age groups (18-29, 30-39, and 40-49) exhibited significantly higher hazard ratios compared to those aged 50 and above, indicating a higher risk of detectable viral load. Race/ethnicity emerged as a significant factor, with Non-Hispanic Black individuals displaying a higher hazard ratio compared to Non-Hispanic White individuals (HR: 1.35, 95% CI: 1.22 - 1.48, p &lt; 0.001). Furthermore, Medicaid-insured individuals demonstrated higher risk of detectable viral load, consistent with both univariate and multivariate analyses. However, language preference did not significantly influence viral load detection status, as evidenced by the absence of a significant difference between English and Spanish speakers in the multivariate analysis.

Conclusion
Our research investigates disparities in achieving viral load suppression among individuals with HIV in Texas. Younger people seem to encounter challenges in maintaining viral suppression compared to older age groups. The influence of social determinants of health is highlighted by racial/ethnic disparities. While our study did not find a significant impact of language barriers on viral load detection, further exploration is needed to better comprehend these results.

Disclosures
Karen J. Vigil, MD, Gilead: speaker|theratechnologies: research|ViiV: Advisor/Consultant Mamta K. Jain, MD, MPH, Abbvie: Grant/Research Support|Gilead Sciences: Grant/Research Support|Laurent: Grant/Research Support
P-1406. Racial Disparities in HIV Prevalence and Complications in Hospitalized Patients
Authors: Safdarpour Armin , Harfouch Chawki , Umeh Chukwuemeka 
Published: January 2025

Abstract

Background
Racial and ethnic disparities in HIV care and outcomes are well known. Multiple causes have been reported including inequalities in access to care and pre-exposure prophylaxis (PrEP), housing instability, lack of antiretroviral insurance coverage, and economic disadvantages. We aim to evaluate the disparities in HIV prevalence and outcomes in hospitalized patients.

Methods
We analyzed the 2020 United States National Inpatient Sample (NIS) data of all patients with a diagnosis of HIV admitted inpatient. The NIS database is the largest publicly available database of patients hospitalized in the United States and contains approximately 20% stratified samples of all hospital discharges in the United States.

Results
There were 38,666 admissions with a diagnosis of HIV in 2020, of which 30.3% were females. 51.6% of the HIV patients were Blacks, 30% Whites, 13.7% Hispanics, 0.7% Asians, 0.6% Native Americans, and 3.4% others. The mean age was 50.8 years, and the mean length of stay was 6.4 days. In the bivariate analysis, the Hispanics were more likely compared to others to have Kaposi Sarcoma (1.8% vs. 1.1%, p&lt; 0.001), cryptococcal meningitis (1.5% vs. 0.6%, p&lt; 0.001), disseminated coccidioidomycosis (0.2% vs 0.0%, p&lt; 0.001), hepatitis C (6.7% vs. 5.3%, p&lt; 0.001), Covid-19 infection (7.9% vs. 4.9%, p&lt; 0.001) and pneumocystis jiroveci pneumonia (3.2% vs. 2.3%, p&lt; 0.001). The multivariate analysis showed no statistically significant racial or ethnic difference in all-cause mortality (p=0.17). However, patients in the highest income quartile had significantly lower all-cause mortality compared to those in the lowest quartile after adjusting for variables including race, ethnicity, and HIV complications (OR 0.69, 95% CI 0.54-0.89, p=0.004).

Conclusion
Our study showed that the prevalence of HIV is still disproportionally high in Blacks. While about 16% of all patients in our dataset are Black, about 52% of the HIV patients are Black. However, Hispanic patients appear to have more HIV complications. Cultural appropriate interventions to prevent HIV acquisition, increase HIV screening, and early initiation of treatment in racial and ethnic minorities are warranted.
Mining a national database can provide insights into morbidity and mortality trends in patients living with HIV.

Disclosures
All Authors: No reported disclosures