bluuebunny/crossref_metadata_2025_split huggingface dataset:
1295. Cross-sectional survey on education of clinical infectious diseases and antimicrobial resistance in pharmaceutical department in Japanese universities
Authors: Koizumi Ryuji , Tanaka Chika , Endo Mio , Fujitomo Yumiko , Tsuzuki Shinya , Asai Yusuke , Ono Akane , Muraki Yuichi , Kitahara Takashi , Ohmagari Norio 
Published: December 2022

Abstract

Background
Pharmacists play an important role in infection control and antimicrobial stewardship teams in hospitals and the community. The need for education on antimicrobial resistance (AMR) and clinical infectious diseases (CID) is increasing. However, the status of Japanese pharmaceutical education on CID and AMR is unclear.

Methods
We conducted a nationwide cross-sectional survey of pharmaceutical department in Japanese universities between February and March 2022. Data on the following were collected using questionnaires: 1) basic information; 2) number of faculty members with experience in CID; 3) lecture times for CID and AMR; 4) self-evaluation of CID and AMR education; and 5) the most important issues in CID and AMR education. Descriptive analyses were conducted.

Results
Among the 74 participating universities, 44 (59.5%) universities responded. The median number [IQR] of faculties of infectious disease education was 7 [4–12], and clinical faculties was 3 [1–6]. Twenty-seven (62.8%) of the universities had faculties with clinical experience in infectious diseases. Lectures time for CID and AMR varied among the universities.
Respondents indicated that CID and AMR lectures were insufficient, compared to microbiology basic lectures. Additionally, insufficient lecture time and specialists were the most common responses as the most important issues in CID and AMR education.
University background and questions regarding CID and AMR lectures (N=44)
Boxplot of lectures time for clinical infectious disease and antimicrobial resistance education
Self-evaluation of clinical infectious disease and antimicrobial resistance education

Conclusion
This study revealed that educational status and resources for CID and AMR education varied widely, and that practical lectures on CID and AMR may be insufficient. We suggest that the entire core curriculum and resources, including the number of faculties, needs to be examined and improved.
The most important issues in clinical infectious disease and antimicrobial resistance education.

Disclosures
All Authors: No reported disclosures.
1302. Interactive Case-based Antimicrobial Stewardship Education Program to Pharmacists at a Large Community Health System
Authors: Wilde Ashley M , Swingler Elena A , Song Matthew , Moore Sarah E 
Published: December 2022

Abstract

Background
Education on antimicrobial stewardship (AMS) is one of the several elements outlined by the Center for Disease Control for hospital antibiotic stewardship programs. However, the Infectious Diseases Society of America guideline on implementing antimicrobial stewardship notes that passive education should not be a sole method for training as the effects are often short lived. AMS education strategies beyond didactic lectures and written material distribution are needed.
We sought to describe the implementation of an interactive, case-based AMS educational program targeting pharmacists across a multi-hospital community health system licensed for over 1,500 beds.

Methods
Each month, a custom patient case was drafted by an infectious diseases trained pharmacist to highlight a common AMS principle encountered in practice. These topics were broadly categorized into appropriate empiric antibiotic selection, treatment plan modification, and identification of non-infectious clinical syndromes. A specific question with multiple choice answers was drafted. The case was disseminated to all hospital pharmacists via email using Microsoft Outlook. Pharmacists were prompted to use the voting buttons to select the correct answer (Figure 1). After a week, results of the survey was shared with the entire pharmacist staff along with information on the primary teaching point and detailed explanations for why each answer was correct or incorrect.
Example Voting Buttons for Case-Based Education

Results
A total of eleven AMS cases were disseminated to 88 hospital pharmacists involved with direct patient care. Average number of responses per case was 27 (31%), range 17-41 (19%-47%). Average number of correct responses for each case was 74%, range 26%-100%. The highest rates of correct responses came from cases focusing on empiric antibiotic selection (87%), followed by identification of non-infectious clinical syndromes (73%). The lowest rate of correct responses were found with treatment plan modification cases (65%).

Conclusion
This case-based AMS education program leveraged existing technology to provide engagement across a large and geographically diverse pharmacist staff, provide opportunity to apply stewardship concepts, and assess staff pharmacist knowledge on general AMS principles.

Disclosures
Matthew Song, PharmD, BCIDP, Merck: Stocks/Bonds|ObsEva: Stocks/Bonds.
1305. PrEParing for success: An intervention to increase HIV prevention awareness among internal medicine residents.
Authors: Torres Mario A , Ojeda-Martinez Hector , Cluzet Valerie , Mazurkiewicz Rebecca 
Published: December 2022

Abstract

Background
PrEP (Pre-Exposure Prophylaxis) is a strategy that involves a combination of antiretrovirals medications aimed to reduce HIV transmission among at-risk individuals. The purpose of this quality improvement project is to increase internal medicine residents' knowledge and prescribing of PrEP.

Methods
We administered an anonymous paper survey to internal medicine residents at all stages of training at our suburban community hospital in the Hudson Valley, NY in the summer of 2021 during the academic half-day of their ambulatory block rotation. The survey consisted of questions about the residents’ demographics, PrEP knowledge, and previous prescribing of PrEP. Following the survey participants were given a 1-hour lecture by the authors on sexual history and PrEP including indications, available options, dosing, monitoring, side effects, and access to the therapy. Six months later we reissued the same survey to the residents. Surveys were analyzed using descriptive statistics.

Results
All 74 eligible residents completed the survey. Out of the 74, 35 (47.3%) identified as male and 40 (52.7%) identified as female. Medical school graduation year range between 2007 to 2021. Only 69 residents completed the post-survey. To Q1 “which medications are FDA approved to be used as PrEP,” 40 (54.05%) answered correctly prior to the intervention, whereas 51 (73.91%) did after. When they were asked Q3 “How effective was PrEP at reducing the risk of contracting HIV through sex,” 21 (28.38%) responded correctly, which improved to 46 (66.67%) after. To the other knowledge-based questions there was no significant improvement (see table). The number of people who reported prescribing PrEP increased from 2 (2.7%) to 7 (10.14%).
PrEP survey Pre and Post results

Conclusion
Although experiencing this educational intervention did not improve long-term retention of knowledge among the participants, there was a substantial increase in the number of residents who prescribed PrEP. One of the limitations that can contribute to these results; is the short time frame between the intervention and post-survey. These findings demonstrate the need for early introduction of this topic into medical school and residency program curricula.

Disclosures
All Authors: No reported disclosures.
1308. Virtual ID Fellowship Interviewing & DEI: A Win for Everyone?
Authors: Schultz Sara K , Clauss Heather , Matt Brionna 
Published: December 2022

Abstract

Background
Graduate medical education programs shifted to an all-virtual recruitment in 2020. There is little published on the impact of this shift on the demographics of applicants, particularly in a field such as infectious disease where there are typically fewer applicants than available spots. Program directors were forced to make a radical change to their typical recruitment process. This study illustrates a single-center experience with virtual ID fellowship interviewing.

Methods
Using the Program Director Work Station on Electronic Residency Application Service (ERAS), we reviewed our program specific data from 2018-2021. We extracted the total number of applicants, the self-identified race/ethnicity of the applicants, their medical school type (US MD grad, DO grad, Non-US grad), their sex, and their location. We used simple descriptive statistics to identify trends and comparisons from in-person interviewing (2018 and 2019) and virtual interviewing (2020 and 2021).

Results
The number of virtual ID fellowship applicants to our program increased in 2021 by 24% compared to in-person applicants in 2019 (123 vs. 99). This exceeds what a program would expect from the 13% nation-wide increase in ID applicants in 2021 as there were a record 404 total applicants compared to 356 total applicants in 2019 We also saw an increase in Black or African American applicants; 13 Black applicants in 2021 compared to 2 Black applicants in 2019. We saw a stable rate of applicants who self-identified Hispanic, Latino, or of Spanish origin; 18 in 2019 and 17 in 2021. as Notably, we also saw an increase in geographic diversity of our applicants as we drew applicants from 22 states in 2019 (Figure 1a) and 35 states in 2021 (Figure 1b). Additionally, in 2020 we matched two applicants from geographically distant states (Ohio and Colorado) and in 2021 we matched one (Mississippi). Figure 1aFigure 1b

Conclusion
Virtual interviewing was advantageous for our infectious disease fellowship program at Temple University. We saw a 24% increase in applicants, had more Black applicants and more geographic diversity in our applicants. Furthermore, we were able to recruit these applicants into matched fellows.

Disclosures
All Authors: No reported disclosures.
1311. Associations Between Microbiological Diagnoses and Clinical Outcomes in Children with Acute Hematogenous Osteomyelitis: A Retrospective Cohort Study
Authors: Enderle Madison , Gallizzi Gina , Hu Nina , Yonts Alexandra B , Martin Benjamin D , Hamdy Rana F 
Published: December 2022

Abstract

Background
Acute hematogenous osteomyelitis (AHO) affects about 2-13 children per 100,000 in developed countries each year. Staphylococcus aureus is the most common causative pathogen of AHO and, due to antibiotic resistant strains of this species, a microbial diagnosis is often desired. Blood and bone cultures may identify causative pathogens and determine antibiotic susceptibilities but obtaining bone cultures carries risks. The benefit to patients of having a pathogen identified is disputed and further research is required to address this question. The objectives of this study were to determine if length of stay differs between culture-negative and culture-positive patients and to determine if odds of receiving 3 or more unique antibiotics differs between culture-negative and culture-positive patients.

Methods
Data were retrospectively abstracted from medical records of pediatric patients with a clinician’s diagnosis of AHO admitted to Children’s National Hospital (CNH) between January 1, 2010 – June 30, 2020. Baseline characteristics, treatment, and outcomes were described. For culture-negative and culture-positive AHO patients, length of stay and odds of receiving 3 or more unique antibiotics were compared using multiple linear regression and multiple logistic regression, respectively.

Results
Of 367 included patients, 210 had a positive culture result about 83% of which were identified as S. aureus. Culture-negative patients were associated with a 6.45-day shorter length of stay compared to culture-positive patients, adjusting for age, peak C-reactive protein (CRP), and surgery (p = 0.02). Culture-negative patients had 0.196 times the odds of receiving 3 or more unique antibiotics than culture-positive patients, adjusting for age, peak CRP, and surgery (95% CI: 0.114, 0.336).

Conclusion
Among AHO patients admitted to CNH, being culture-negative was associated with shorter length of stay and lower odds of receiving 3 or more unique antibiotics.

Disclosures
All Authors: No reported disclosures.
1325. Macrolide versus Non-macrolide in Combination with Steroids for the Treatment of Lobar or Segmental Mycoplasma Pneumoniae Pneumonia Unresponsive to Initial Macrolide Monotherapy
Authors: Bae Eunha , Kang Hyun Mi , Kim Ye Ji , Jeong Dae Chul , Kang Jin Han 
Published: December 2022

Abstract

Background
Mycoplasma pneumoniae (MP) is one of the most common causes of bacterial pneumonia in children. In the recent decade, macrolide-resistant MP (MRMP) has been increasing in proportion, leading to children unresponsive to initial macrolide therapy. The purpose of this study was to evaluate the outcomes of children with lobar or segmental MP pneumonia unresponsive to initial macrolide therapy, who received non-macrolide (NM), macrolide plus steroids (M+S), and non-macrolide plus steroids (NM+S) according to the 2019 guideline during the 2019-2020 Mycoplasma epidemic in South Korea.

Methods
This was a retrospective cohort study of children below 18 years old, admitted during the 2019-2020 MP outbreak for lobar or segmental MP pneumonia. The inclusion criteria were as follows: 1) sputum or nasopharyngeal swab MP PCR positive, 2) no history of pneumonia within one month of positive MP PCR, 3) lobar or segmental pneumonia on chest x-ray, and 4) initial treatment with macrolide monotherapy. Children that were unresponsive to the initial 3-5-day macrolide monotherapy were divided into 3 groups depending on the next regimen: NM, M+S, and NM+S group. Their outcomes were assessed.

Results
During May 2019 to March 2020 MP epidemic, a total 190 patients that fit all of the inclusion criteria were included as study participants. Of these, 16.8% (n=32/190) were responsive to initial macrolide monotherapy and 83.2% (158/190) were unresponsive. Of the 158 patients unresponsive during the initial 5-day macrolide therapy, 8.2% (n=13) were switched to a NM, 75.9% (n=120) were added steroids (M+S), and 15.8% (25/158) were switched to a non-macrolide plus steroids (NM+S). Treatment success rates were 46%, 81%, and 100% in the NM, M+S, and NM+S groups, respectively (P=0.001). Compared to patients in the NM+S group, those in the M+S group were 8.0 (Confidence interval [CI], 1.3-61.7; P=0.046) times more likely to have prolonged fever ≥4 days after the switch in treatment regimen compared to patients with NM+S, and 10.7 (CI, 1.5-108.7; P=0.046) times more likely in the NM group.

Conclusion
In patients with severe mycoplasma pneumonia with failure of response to initial macrolide therapy, a non-macrolide antibiotic plus steroid combination had the highest treatment success rate and shorter duration of fever.

Disclosures
All Authors: No reported disclosures.
1327. Nontyphoidal salmonella infection in children and adolescent; A retrospective, multicenter study in Korea
Authors: Shin Je Hee , Lim Sung Min , Choi Joon-sik , Kim Ji Hong , Ahn Jong Gyun , Kang Ji-Man 
Published: December 2022

Abstract

Background
Non-typhoidal salmonella (NTS) infections usually have a self-limiting course, but can cause invasive NTS (iNTS) diseases, including bacteremia, meningitis, osteomyelitis or other focal infection. However, information on NTS infections in children is scarce in Asian countries. We investigated the differences in clinical features and antimicrobial susceptibility patterns of NTS infections in Korean children.

Methods
From November 2006 to May 2021, we collected NTS cases isolated from patients under the age of 20 at three Severance Hospitals (Sinchon, Gangnam, and Yongin) in Korea. All NTS cases were extracted through the Severance Clinical Research Analysis Portal. NTS cases isolated from the genitourinary tract were excluded. Clinical data were collected through chart review.

Results
A total of 837 isolates were identified from 637 patients. 22 patients were excluded, and a 615 patients were included in the study. The median age at NTS infection was 4.6 years (IQR, 2.4-7.9 years), and those under 5 years of age accounted for 54.1% of all cases. The male to female ratio was 1.6:1 and approximately 15.8% (n=97) had at least one comorbidity. By clinical diagnosis, enterocolitis was the most common with 543 cases (88.3%), followed by bacteremia without local sign in 11 cases (1.8%), osteomyelitis in 7 cases (1.1%). The iNTS group (n=68) did not have any significant differences in age of onset, presence of fever, white blood cells, absolute neutrophils, and C-reactive protein levels, but the frequency of diarrhea (67.6% vs. 89.9%, p&lt;0.001) was less than the non-invasive NTS group (n=547). Extra-intestinal symptoms were more common in the iNTS group than in the non-invasive group (30.9% vs. 14.3%, p=0.003), and the length of hospital stay (8.65±6.4 days vs. 5.13±3.3 days, p=0.001) were significantly longer in the iNTS group. Notably, 2 out of 7 patients with NTS osteomyelitis showed a poor clinical response even with cefotaxime-sensitive antimicrobial susceptibility results. Antimicrobial susceptibility pattern between the group was shown in Figure 1.
Antimicrobial susceptibility pattern between the group

Conclusion
Children with iNTS infection showed a relatively severe clinical course compared to children with non-iNTS infection. Further studies on the epidemiology and characteristics of invasive NTS infection are needed.

Disclosures
Joon-sik Choi, MD, MS, Ministry of Trade, industry and Energy, Republic of Korea: Grant/Research Support.
1332. Population structure and genomic analysis of pediatric Streptococcus pyogenes clinical isolates in the United States, 2020 – 2022
Authors: Ozer Egon A , Gatesy Samuel W , Patel Ami B , Guzman-Cottrill Judith A , Fleming-Dutra Katherine E , Chochua Sopio , Beall Bernard , Jaggi Preeti , Inguglia Christine L , Katsogridakis Yiannis L , Shulman Stanford , Tanz Robert R , Rippe Jason 
Published: December 2022

Abstract

Background
Streptococcus pyogenes (GAS) is the major cause of bacterial pharyngitis in children. GAS can cause conditions ranging from asymptomatic pharyngeal carriage to invasive infection. We compared the genomic characteristics of GAS pharyngeal and invasive isolates from U.S. children.

Methods
We cultured GAS from throat swabs collected from children aged 3–18 years with acute GAS pharyngitis, diagnosed by rapid antigen or molecular test, and from a convenience sample of asymptomatic children during 1/2020 to 3/2022 in Chicago, IL; Atlanta, GA; Portland, OR; Phoenix, AZ. We collected invasive isolates in Chicago. Whole-genome sequencing (WGS) was performed on the Illumina MiSeq for species confirmation, isolate typing, and virulence and antimicrobial gene identification. Reference-based read alignment was used for whole genome phylogenetic analysis.

Results
Of 1144 collected throat swabs, 684 were from children with pharyngitis and 460 from asymptomatic children. 13 invasive GAS isolates were collected. GAS were cultured from 359 pharyngitis and 20 asymptomatic swabs. Of these, 371 GAS isolates could be recovered and underwent WGS. Thirty isolates (8%) were either low-quality sequences and/or identified as species other than S. pyogenes and were excluded. Whole-genome phylogenetic analysis of 341 GAS (215 pharyngitis, 13 asymptomatic, 13 invasive) identified 25 related clusters and 8 singletons (Figure 1). Virulence gene complements within given emm types were generally concordant with recently published CDC strain data. The most frequently identified resistance genes were tetM and ermB. 281 isolates (82%) carried no antibiotic resistance genes. Some clusters were significantly more represented at certain sites within apparent geographically defined clusters of nearly indistinguishable isolates (Figure 1): cluster 1 in Chicago, emm type 3; cluster 14 in Phoenix and Portland, emm 28, 12; and cluster 15 in Atlanta, emm 89. No major genomic factors were significantly associated with asymptomatic vs pharyngitis vs invasive presentation. Figure 1:Whole genome phylogenetic tree of pediatric GAS isolates
Maximum likelihood phylogenetic analysis based on whole-genome alignment of 371 Group A Streptococcus isolates. Tip colors represent cluster assignments based on genetic similarity. Inner ring represents geographic location of GAS isolation. Outer ring represents patient presentation: asymptomatic colonization, symptomatic pharyngitis, or invasive infection.

Conclusion
Pharyngeal and invasive GAS in children within individual clonal complexes are co-included in closely related clusters, with evidence of close transmission within individual sites

Disclosures
All Authors: No reported disclosures.
1333. Prognostic Factors Associated with Complications of Acute Hematogenous Osteomyelitis in Children
Authors: Clemente Adriana Sarmiento , McNeil Jonathon C , Hulten Kristina G , Vallejo Jesus G , Kaplan Sheldon L 
Published: December 2022

Abstract

Background
The clinical presentation and management of acute hematogenous osteomyelitis (AHO) in children can vary significantly. Scores to predict acute complications utilize prolonged fever after antibiotics, bone abscess, suppurative arthritis, disseminated infection and delayed source control. By contrast, elevated CRP after 48-96 hours of therapy, disseminated disease and bone debridement are predictive of chronic complications. Such scoring systems have undergone limited validation. We examined factors associated with acute and chronic AHO complications at our center to identify other variables that may enhance published scores.

Methods
A retrospective chart review was conducted of all children 6 mo-18 years with AHO and with acute symptoms of &lt; 14 days at Texas Children’s Hospital from January 2012 through December 2020. An acute complicated course was defined as treatment failure within 6 weeks of starting antibiotics, &gt; 2 bone debridements, prolonged admission ( &gt;14 days) and acute avascular necrosis. Chronic complications included growth arrest or limb leg discrepancy, pathologic fracture, avascular necrosis, chronic osteomyelitis or frozen joint. Statistical analysis was completed using STATA 17.

Results
418 patients met the inclusion criteria. 106 (25.4%) had an acute complicated course. 51 (13.5%) of 377 followed had a chronic complication. Clinical factors associated with acute and chronic complications were very similar. Factors associated with either an acute complicated course (Figure 1) or chronic orthopedic complications (Figure 2) included: older age, tibia involvement, infection due to S. aureus/MRSA, presence of multifocal or disseminated infection, DVT, fever &gt; 48 hours of antibiotic therapy, admission laboratory values including higher absolute neutrophil count (ANC) and higher CRP, ICU admission, associated suppurative arthritis, bacteremia, bone abscess, surgical debridement and delayed source control.

Conclusion
In children with AHO, risk factors for acute and chronic complications are highly similar. Older age, tibia involvement, MRSA, higher ANC and bacteremia were linked to complications in our population and will be assessed in current clinical scoring systems which may help guide management.

Disclosures
Jonathon C. McNeil, MD, Agency for Healthcare Research and Quality: Grant/Research Support|Allergan: Provided reagents for unrelated research|Nabriva: Site investigator for multicenter clinical trial Kristina G. Hulten, PhD, Me-med: Grant/Research Support|Pfizer: Grant/Research Support Sheldon L. Kaplan, MD, MeMed: Grant/Research Support|Pfizer: Grant/Research Support.