bluuebunny/crossref_metadata_2025_split huggingface dataset:
1306. Real-World Experience of Cefiderocol in Treating Bacterial Infection in US Hospitals (Jan 2020-June 2021)
Authors: Cai Bin , Zhou Yun , Cooper Andrew , Marcella Stephen 
Published: December 2022

Abstract

Background
Cefiderocol (CFDC) is a Gram-negative antibiotic (GNA) with a unique mode of cell entry against carbapenem resistance. This study described the initial use of CFDC in US hospitals since its approval in November 2019.

Methods
This was a retrospective study of patients treated with CFDC consecutively for ≥3 days in US hospitals, as captured in Premier Healthcare Data from January 2020 to June 2021. This study described the clinical characteristics, CFDC usage, and Post-CFDC initiation 14-day and 28-day in-hospital all-cause mortality (IH-ACM). For patients with microbiology results, the pathogen, susceptibility and culture site associated with CFDC use were described. Index culture was the culture(s) taken on the day closest to CFDC initiation.

Results
Among 313 of 360 in-patients who received ≥3 days CFDC, the median age was 58 years (range: 17 - 89 years), and 91% were hospitalized via emergency room, trauma, or urgent admission. The most common conditions were severe sepsis with septic shock, palliative care, and multi-drug resistant infection. Also 34% had a ‘do not resuscitate order’. About 64% of patients received mechanical ventilation and 79% had ICU stay. Median length of hospital stay was 27 days (range: 3-310 days). Median days on CFDC was 8 days (range: 3 - 66 days). Over 58% received ≥2 other GNAs within 14-days of initiating CFDC. Among 187 patients with microbiology results, 75% had index cultures with one pathogen, and 73% had confirmed carbapenem resistant pathogens. The most common pathogens were Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Klebsiella pneumoniae and Acinetobacter baumannii. The most common index culture site was respiratory. The 14-day and 28-day crude IH-ACM from CFDC initiation was 16.3% (95%CI: 12.2%-20.4%) and 23.6% (95%CI: 18.9 – 28.4%), respectively. Among those with microbiology results, 14-day and 28-day IH-ACM was 17.1% (95%CI: 11.7% - 22.5%) and 23.5% (95%CI: 17.4-29.6%), respectively. Among patients who died, 83% had severe sepsis with septic shock, 76% were in palliative care, 71% had a ‘do not resuscitate order’, and 44% had COVID-19.

Conclusion
CFDC was used most frequently in critically ill patients. IH-ACM was comparable with other studies.

Disclosures
Bin Cai, MD, PhD, Shionogi: Shionogi employee Yun Zhou, MS, Shionogi: Employee of CRO hired by Shionogi Andrew Cooper, PhD, Shionogi: Shionogi employee Stephen Marcella, MD, MPH, Shionogi: Shionogi employee|Shionogi, Inc: Employee.
1592. SHEA Featured Oral Abstract: Reducing Unnecessary Antibiotic Treatment for Asymptomatic Bacteriuria: A Statewide Collaborative Quality Initiative
Authors: Vaughn Valerie , Gupta Ashwin , Petty Lindsay A , Malani Anurag N , Osterholzer Danielle , Patel Payal K , Younas Mariam , Bernstein Steven , Ratz David , McLaughlin Elizabeth , Czilok Tawny , Horowitz Jennifer , Flanders Scott A , Gandhi Tejal N 
Published: December 2022

Abstract

Background
Up to one-third of hospitalized patients treated for urinary tract infection (UTI) have asymptomatic bacteriuria (ASB). Both diagnostic (avoiding inappropriate urine cultures) and antibiotic stewardship (reducing unnecessary antibiotic use in asymptomatic patients) have been proposed to reduce unnecessary antibiotic use for ASB. However, it's unclear which method is most effective.

Methods
The Michigan Hospital Medicine Safety Consortium aimed to improve antibiotic use and outcomes of hospitalized patients with a positive urine culture between 7/1/2017—3/31/2020 (see Table 1 for patient characteristics) by benchmarking performance across 46 Michigan hospitals, sharing best practices, and implementing pay-for-performance metrics related to unnecessary treatment of ASB (see Figure 1). Using logistic regression models controlling for hospital clustering, we assessed change over time in percentage of hospitalized patients treated for UTI who had ASB (i.e., had no documented signs or symptoms of UTI) and hospital characteristics associated with baseline or change in unnecessary antibiotic prescribing. We then estimated the percentage of avoided ASB treatment attributable to diagnostic (decrease in urine cultures ordered on asymptomatic patients) vs. antibiotic stewardship (decrease duration or avoidance of antibiotic treatment).

Results
Across 46 hospitals, there were 15,493 patients with a positive urine culture. Of 13,805 patients treated for a UTI, 23.2% (3,197) had ASB. The percentage of patients treated for UTI who had ASB declined over time from 29.0% (95% CI: 26.1%, 32.0%) to 16.9% (95% CI: 14.2%, 20.1%; aOR 0.94 per quarter, 95% CI: 0.92-0.96; Figure 1) with hospitals not belonging to a larger healthcare system having the largest decrease over time (Table 2). Neither the proportion of patients with ASB who were treated with antibiotics (P=0.07) nor the duration of therapy for ASB changed over time (P=0.09); thus, nearly all avoided antibiotic therapy for ASB appeared due to diagnostic stewardship.

Conclusions
Across 46 hospitals, there was a decrease over time in unnecessary treatment for ASB with independent hospitals improving most. Diagnostic stewardship appeared responsible for nearly all improvement.

Disclosures
Payal K. Patel, MD, MPH, Qiagen: Honoraria.
1319. Evolution of Invasive and Colonizing Pediatric Staphylococcus aureus Isolates
Authors: Free Margaret , Soper Nicole , Shrestha Shristi , Cartailler Jean-Philippe , Thomsen Isaac 
Published: December 2022

Abstract

Background
Staphylococcus aureus is the most common invasive bacterial pathogen in children. The constant evolution of S. aureus is a barrier to the development of successful interventions. A detailed understanding of the current molecular epidemiology of actively circulating, invasive S. aureus strains and a comparison to both colonization strains and historical invasive strains to determine which virulence factors and genetic lineages are preserved over time are important unmet needs in this field.

Methods
We compared four groups of S. aureus isolates: 45 invasive strains obtained during the epidemic methicillin-resistance S. aureus (MRSA) peak (2010-2012); 74 invasive contemporary strains (2015-2021); 61 colonizing strains from 2004; and 30 colonizing strains from 2021. Genetic relatedness (via clonal complex typing) and virulence factor presence were determined via whole genome sequencing.

Results
Among invasive isolates, the prevalence of clonal complex 8 (CC8) decreased significantly over time from 87% to 46% among typeable strains (p&lt; 0.05, Fig.1). Similarly, the presence of Panton-Valentine leucocidin (PVL) decreased from 71% to 40% (p&lt; 0.01). 56% of invasive isolates from 2010-2012 were MRSA, vs 37% from 2015-2021 (p= 0.05, Fig. 2). In contrast to PVL, the presence of leukocidins LukED and LukAB remained stably prevalent over time at 84% and 100% (Fig. 3). Colonization isolates overall remained diverse, with no dominant clonal complex (Fig. 1). Figure 1Figure 2Figure 3

Conclusion
Invasive S. aureus molecular epidemiology has changed significantly over the past decade. The former dominance of CC8 and PVL-positive MRSA strains has shifted to a more diverse, predominantly MSSA group of contemporary strains. Other virulence factors (LukED, LukAB) have remained prevalent among invasive strains regardless of genetic lineage. Targets of intervention should be those that are preserved throughout the evolution of this major human pathogen.

Disclosures
All Authors: No reported disclosures.
1340. Yield of Repeat Blood Cultures beyond 48 Hours after Negative Initial Cultures in Patients Hospitalized on a Pediatric Hematology/Oncology Unit
Authors: Prather Cassandra S , Alali Muayad 
Published: December 2022

Abstract

Background
Repeat blood cultures (BCxs) beyond 48 hours are often obtained despite negative initial BCxs in hospitalized pediatric hematology/oncology patients. This study seeks to determine the yield of repeat BCxs after negative initial cultures in these patients and to characterize new positive BCxs beyond 48 hours and the clinical contexts in which they were obtained.

Methods
A retrospective review utilizing MedMined Inc. Data Mining Surveillance database was conducted on all BCxs obtained on hospitalized patients on the pediatric hematology/oncology unit at Riley Hospital for Children in Indianapolis, IN from January 2015 to February 2021. Exclusion criteria are shown in Fig. 1. Patient episodes in which a new pathogen (or commensal treated by the primary team as a pathogen) was identified on a repeat BCx more than 48 hours after negative initial BCxs were further investigated via electronic medical record review.

Results
A total of 1,362 BCx sets were obtained beyond 48 hours in 792 patient hospitalizations, resulting in 303 positive BCxs (Fig. 2). Of these positive cultures, 193 were the same pathogen cultured on day 0 and 74 were contaminant cultures (in 4.0% (23/573) of patient hospitalizations without a positive BCx before 48 hours). Only 36 (2.6%) of positive BCxs beyond 48 hours were determined to be new pathogens, or commensals treated as pathogens, that were not cultured before 48 hours, corresponding to seven patient hospitalizations (1.2% (7/573) of patient hospitalizations without a positive BCx before 48 hours). The majority (6/7) of these patients were neutropenic and on broad spectrum antibiotics when the new positive BCxs were obtained. Fever pattern was prolonged in one patient and recurrent in six. No deaths occurred in these seven patients. All patients with new, true pathogens on BCxs beyond 48 hours (n=5) were either hemodynamically unstable (n=3) or had clinical changes (n=2, mucositis, diarrhea) the day the new positive BCx was drawn.

Conclusion
The yield of repeat BCxs beyond 48 hours in hospitalized pediatric hematology/oncology patients with negative initial BCxs is low, while the associated costs are high. Repeat BCxs beyond 48 hours after negative initial cultures need not be obtained in febrile patients that remain hemodynamically stable and without clinical changes.

Disclosures
Cassandra S. Prather, MD, Eli Lilly and Company: Spouse is employed by Eli Lilly and Company. Spouse owns stock in the company.|Eli Lilly and Company: Stocks/Bonds.
1347. @Women_in_ID : A Social Media Platform for Advocacy and Amplification of Women in Infectious Diseases
Authors: Krishnan Gayathri , Mattar Caline , Babcock Hilary 
Published: December 2022

Abstract

Background
In 2015, 39.7% of active infectious diseases (ID) physicians in USA were women. This calculation does not include the many other women professionals in ID such as Advanced Practice Providers, ID pharmacists, researchers in ID and Infection Preventionists. There is no dedicated national platform for women in ID and no Twitter representation of groups dedicated to women in ID. Women in Infectious Disease (WIID) with twitter handle @Women_in_ID was created April 22nd 2021, for women providers in ID to collaborate, promote, and advocate for each other through a social media platform; and to highlight significant issues like gender pay gap, inequity in career advancement and leadership, research funding etc. We sought to explore the social media impact of this account over the last year.

Methods
A descriptive content analysis of this account from April 2021 to May 1st, 2022 was done to reflect on lessons learned, plan future directions, and highlight some real-world changes that happened after creation of WIID. Twitter analytics were used, and manual review of followers’ accounts and tweet activities were done to assess engagement.

Results
In 12 months, this account has gained 1709 followers (Image 1). Out of the followers, 109 are twitter accounts of organizations, such as fellowship programs, ID societies and their foundations, ID divisions, and journals. The rest appear to be individuals. Since demographics of followers are not revealed in twitter accounts, this could not be assessed. Table 1 provides detailed twitter analytics and content that got the most engagement each month. During the month of September, the account highlighted 20 nominated profiles (including women from other countries), and several other women in ID with significant historical contributions (Image 2). This content resulted in our highest engagement and new members. Some previously unnoticed women in history had Wikipedia pages created after their work was amplified. Image 1:Women in ID (WIID) twitter profile pageImage 2:Women in Medicine Month call for nominations created to amplify women in ID

Conclusion
@Women_in_ID is the first and only twitter platform dedicated for women in ID. This platform is accessible to every woman in ID with a twitter account, hence networking, amplification and collaboration transcends local or institutional boundaries. In future, social media work must translate to real life changes to have meaningful impact.

Disclosures
All Authors: No reported disclosures.
1360. Investigating Transmission Dynamics Between Pets and Caretakers in Households of Children with Methicillin-resistant S. aureus Skin and Soft Tissue Infections
Authors: Kinzer Hannah , Malone Sara , Boyle Mary G , Norton Lauren , Tal Rinat , Olson Hunter , Fritz Stephanie A 
Published: December 2022

Abstract

Background
Household pets are susceptible to Staphylococcus aureus (S. aureus) colonization. Our objective was to examine transmission of S. aureus between pets and their caretakers following a human household decolonization intervention.

Methods
From 2015-2021, a pragmatic randomized trial enrolled 196 households of children with community-associated methicillin-resistant S. aureus skin and soft tissue infection. Mouth and dorsal fur samples from indoor dogs and cats were cultured. Human nares, axillae, and inguinal fold samples were cultured. Samples were collected at enrollment and 1, 3, 6, and 9 months post-intervention. Participants were asked about pet daycare use, whether pets slept with caretakers, and pet skin conditions. Univariate and bivariate analyses, including McNemar tests, were conducted. Inclusion criteria were cat or dogs with at least one swab pre- and post-intervention.

Results
Our populations included 95 households with 161 pets; 35 households (39%) had ≥1 pet colonized with S. aureus. Within 2 weeks prior to enrollment, 3 (2%) pets had attended daycare, 70 (44%) slept with a caretaker, and 16 (10%) had skin conditions (see Table 1). 27 (17%) pets were colonized at enrollment. Of the 121 dogs, 20 (17%) were colonized at enrollment, 9 (7%) with MRSA. Of the 40 cats, 7 (18%) were colonized at enrollment, and 4 (10%) were colonized with MRSA. 72 (45%) pets had ≥1 caretakers who were colonized at enrollment; 18 (25%) of these pets were also colonized. Of the 137 caretakers, 48 (35%) were colonized at enrollment, and 16 (12%) were colonized with MRSA.
Whether a pet was colonized at enrollment was associated with colonization post-intervention (p&lt; 0.001, see Table 2). All pets that were colonized at enrollment remained colonized post-intervention. Caretaker colonization at enrollment was associated with pet colonization post-intervention (p=0.04). Of the 72 pets whose caretakers were colonized at baseline, 36 (50%) pets were colonized post-intervention.

Conclusion
Both pet colonization and caretaker colonization at enrollment are significantly associated with pet colonization after human household member decolonization. This indicates that S. aureus may transmit from human caretakers to pets and human decolonization may not be fully protective against pet colonization.

Disclosures
Sara Malone, PhD, LCSW, AHRQ: Grant/Research Support|NIH: Grant/Research Support.
1373. Using Geospatial Analysis to Describe the Association between Active Tick Surveillance Data and Clinical Cases of Anaplasmosis
Authors: Desiato Julia T , Banach David , Chan Grace , Palmeri Marco 
Published: December 2022

Abstract

Background
Anaplasmosis is a vector-borne disease spread by Ixodes scapularis ticks mainly in the Northeastern United States. The Connecticut Department of Public Health (CT DPH) made anaplasmosis a state-wide reportable disease in 2008 and a large increase in reportable cases was seen in Connecticut between 2014 and 2019.

Methods
This study used clinical cases of anaplasmosis reported to the CT DPH and tick infection prevalence data to understand emerging geographic hotspots for the disease in the state and to evaluate the association between the human and tick infections. Human incidence rates (IR) were calculated per 100,000 in the population by county. Tick infection prevalence was calculated as an acarological risk index (ARI) using active tick surveillance data from the Connecticut Agricultural Experiment Station (CAES). These two calculations were analyzed with a Spearman rank correlation in SAS version 9.4 and overlaid on ArcMap.

Results
During the 2019-2020 period, 420 human cases of anaplasmosis were included and 148 infected ticks were identified. There was a significant positive correlation between IR and ARI identified (Spearman correlation 0.54, p = 0.03). Litchfield County had the highest number of human cases (128) and Fairfield County had the highest proportion of infected ticks (11.25%). The area with the greatest increase in both ARI and IR in Connecticut from 2019-2020 was New London County (ARI increased from 0.073 to 0.108, IR increased from 2.64 to 8.57).

Conclusion
This study supports the use of active tick surveillance in identifying geographic areas high incidence of human anaplasmosis and provides a strategy to evaluate tick surveillance for anaplasma infection. Active tick surveillance can be useful in guiding public health interventions and inform public health and clinician education on anaplasmosis.

Disclosures
All Authors: No reported disclosures.
1376. An Analysis of Weight Based Dosing for Sulfamethoxazole-Trimethoprim in Skin and Soft Tissue Infections
Authors: Melgarejo Gabriel , Conklin Taylor , Weihs Sayo 
Published: December 2022

Abstract

Background
Guideline recommendations for sulfamethoxazole-trimethoprim (TMP/SMX) in skin and soft tissue infections (SSTIs) are 1 to 2 double strength (DS) tablets by mouth twice daily. Studies suggest that weight-based dosing of TMP/SMX for SSTIs has a clinical impact on treatment failures. One study suggested TMP/SMX dosed at &lt; 5mg/kg/day, based on the trimethoprim component, was inadequate for the treatment of SSTIs. There are currently no studies to date that assess the incidence of treatment failures with TMP/SMX dosed at ≥ 5mg/kg/day compared to &lt; 5mg/kg/day.

Methods
A single center, retrospective chart review was conducted on adult patients diagnosed with a SSTI based on ICD-9/10 codes from January 2009 through August 2021 at University Health Truman Medical Center. Patients included were divided into two groups based on the dosing strategy of TMP/SMX (&lt; 5mg/kg/day or ≥ 5mg/kg/day). The primary and secondary outcome was incidence of treatment failures and incidence of adverse events, respectively. Exploratory variables that may influence treatment failures were also collected.

Results
A total of 351 patients were included in the analysis with 190 in the &lt; 5mg/kg/day group and 161 in the ≥ 5mg/kg/day group. Patients dosed at ≥ 5mg/kg/day had significantly less treatment failures compared to those dosed at &lt; 5mg/kg/day (17.4% vs 7.5%, p=0.006). After a multivariate analysis, patients dosed with TMP/SMX at ≥ 5mg/kg/day were 58% less likely to have a treatment failure (OR 0.42, 95% CI 0.17 to 0.96, p=0.044). Incidence of adverse events were similar in both groups (p=0.105).

Conclusion
TMP/SMX dosed at ≥ 5mg/kg/day had significantly fewer treatment failures for SSTIs compared to TMP/SMX dosed at &lt; 5mg/kg/day and was not associated with increased adverse events. These findings suggest that the current recommendations for dosing of TMP/SMX in SSTIs may need to be addressed.

Disclosures
All Authors: No reported disclosures.
1381. Infectious Disease Complications in Hospitalized Patients with Opioid Use Disorder at a Southern County Hospital
Authors: Balakrishnan Harini , Campalans Nicholas A , Marambage Kapila , Nijhawan Ank E 
Published: December 2022

Abstract

Background
Injection drug-use (IDU) has increased over the past two decades and contributes towards the morbidity and mortality of opioid use disorder (OUD). Recent studies of IDU-associated infections have primarily focused on regions outside of the southern United States; however, this area presents greater barriers to healthcare funding and harm reduction services for patients with OUD seeking care. This study aims to describe the burden of IDU-associated infections amongst patients with OUD referred to addiction psychiatry at a southern county hospital.

Methods
A retrospective electronic health record review was conducted for patients admitted to a large urban county hospital from February 2018 to December 2019. Inclusion criteria included active OUD within the last 12 months and an addiction psychiatry consultation. Frequency of baseline patient characteristics were compared between those with and without IDU-associated infections, and IDU-associated infections were characterized. Additionally, medication for opioid use disorder (MOUD) uptake was described.

Results
260 charts were reviewed, and 229 individuals met inclusion criteria. 36% were female, 47% non-Hispanic white, and 36% Hispanic. 62% reported IDU in the past 30 days. 45% had IDU-associated infections, with skin and soft-tissue infections (SSTI) being most common (77%), followed by bacteremia (23%), osteomyelitis, (13%), and endocarditis (9%). Comorbid stimulant use disorder was also prevalent (72%). Patients with IDU-associated infections were uninsured at higher rates (79% vs. 60%). 48% of patients with IDU-associated infections had monomicrobial infections, and 23% had polymicrobial infections. While patients with no IDU-associated infections had higher rates of active MOUD on admission (28% vs. 10%), new MOUD uptake was higher among patients with IDU-associated infections (80% vs. 53%).
Abbreviations: OUD, opioid use disorder; IDU, injection drug-use; COPD, chronic obstructive pulmonary disease; HTN, hypertension; CHF, congestive heart failure; Hep, hepatitis; HIV, human immunodeficiency virus
Abbreviations: OUD, opioid use disorder; IDU, injection drug-use; SSTI, skin and soft tissue infection; Hep, hepatitis; HIV, human immunodeficiency virus; ID, infectious diseases
Abbreviations: IDU, injection drug-use

Conclusion
These findings indicate that SSTIs compose most IDU-associated infections in hospitalized patients with OUD, which may reflect greater black tar heroin availability in the southern United States. Furthermore, increased rates of MOUD uptake amongst those with IDU-associated infections support the notion that hospitalization can be an effective circumstance in which to initiate substance use treatment.

Disclosures
Ank E. Nijhawan, MD, MPH, MSCS, Gilead Sciences: Grant/Research Support.