Infectious Diseases Society Of America Research Articles

Clinical guideline highlights for the hospitalist: Diagnosis and treatment of diabetes-related foot infections.

IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections RELEASE DATE: October 2, 2023 PRIOR VERSION: March 16, 2020 DEVELOPER: IWGDF Editorial Board FUNDING SOURCE: International Working Group on the Diabetic Foot (IWGDF), Infectious Diseases Society of America (IDSA) TARGET POPULATION: Adults with suspected or confirmed diabetes-related foot infections.

Vaccination of Adults With Cancer: ASCO Guideline.

To guide the vaccination of adults with solid tumors or hematologic malignancies. A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and nonrandomized studies on the efficacy and safety of vaccines used by adults with cancer or their household contacts. This review builds on a 2013 guideline by the Infectious Disease Society of America. PubMed and the Cochrane Library were searched from January 1, 2013, to February 16, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations. A total of 102 publications were included in the systematic review: 24 systematic reviews, 14 RCTs, and 64 nonrandomized studies. The largest body of evidence addressed COVID-19 vaccines. The goal of vaccination is to limit the severity of infection and prevent infection where feasible. Optimizing vaccination status should be considered a key element in the care of patients with cancer. This approach includes the documentation of vaccination status at the time of the first patient visit; timely provision of recommended vaccines; and appropriate revaccination after hematopoietic stem-cell transplantation, chimeric antigen receptor T-cell therapy, or B-cell-depleting therapy. Active interaction and coordination among healthcare providers, including primary care practitioners, pharmacists, and nursing team members, are needed. Vaccination of household contacts will enhance protection for patients with cancer. Some vaccination and revaccination plans for patients with cancer may be affected by the underlying immune status and the anticancer therapy received. As a result, vaccine strategies may differ from the vaccine recommendations for the general healthy adult population vaccine.Additional information is available at www.asco.org/supportive-care-guidelines.

Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Serologic Testing.

The role of serologic testing for SARS-CoV-2 has evolved during the pandemic as seroprevalence in global populations has increased. The Infectious Diseases Society of America (IDSA) convened an expert panel to perform a systematic review of the coronavirus disease 2019 (COVID-19) serology literature and construct updated best practice guidance related to SARS-CoV-2 serologic testing. This guideline is an update to the fourth in a series of rapid, frequently updated COVID-19 guidelines developed by IDSA. To develop evidence-based recommendations and identify unmet research needs pertaining to the use of anti-SARS-CoV-2 antibody tests for diagnosis, decisions related to vaccination and administration of monoclonal antibodies or convalescent plasma in immunocompromised patients, and identification of a serologic correlate of immunity. A multidisciplinary panel of infectious diseases clinicians, clinical microbiologists and experts in systematic literature reviewed, identified, and prioritized clinical questions related to the use of SARS-CoV-2 serologic tests. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. The panel recommends against serologic testing to diagnose SARS-CoV-2 infection in the first two weeks after symptom onset (strong recommendations, low certainty of evidence). Serologic testing should not be used to provide evidence of COVID-19 in symptomatic patients with a high clinical suspicion and repeatedly negative nucleic acid amplification test results (strong recommendation, very low certainty of evidence). Serologic testing may assist with the diagnosis of multisystem inflammatory syndrome in children (strong recommendation, very low certainty of evidence). To seek evidence for prior SARS-CoV-2 infection, the panel suggests testing for IgG, IgG/IgM, or total antibodies to nucleocapsid protein three to five weeks after symptom onset (conditional recommendation, low certainty of evidence). In individuals with previous SARS-CoV-2 infection or vaccination, we suggest against routine serologic testing given no demonstrated benefit to improving patient outcomes (conditional recommendation, very low certainty of evidence.) The panel acknowledges further that a negative spike antibody test may be a useful metric to identify immunocompromised patients who are candidates for immune therapy. The high seroprevalence of antibodies against SARS-CoV-2 worldwide limits the utility of detecting anti-SARS CoV-2 antibody. The certainty of available evidence supporting the use of serology for diagnosis was graded as very low to low. Future studies should use serologic assays calibrated to a common reference standard.

Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM).

The critical nature of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician and the microbiologists who provide enormous value to the health care team. This document, developed by experts in both adult and pediatric laboratory and clinical medicine, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions. Sections are divided into anatomic systems, including Bloodstream Infections and Infections of the Cardiovascular System, Central Nervous System Infections, Ocular Infections, Soft Tissue Infections of the Head and Neck, Upper Respiratory Infections, Lower Respiratory Tract infections, Infections of the Gastrointestinal Tract, Intraabdominal Infections, Bone and Joint Infections, Urinary Tract Infections, Genital Infections, and Skin and Soft Tissue Infections; or into etiologic agent groups, including arboviral Infections, Viral Syndromes, and Blood and Tissue Parasite Infections. Each section contains introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specific issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times. In addition, the pediatric needs of specimen management are also addressed. There is redundancy among the tables and sections, as many agents and assay choices overlap. The document is intended to serve as a reference to guide physicians in choosing tests that will aid them to diagnose infectious diseases in their patients.

Discrepancy between IDSA and ESGBOR in Lyme disease: Individual participant meta-analysis in Türkiye.

The evidence on the prevalence of Lyme borreliosis (LB) is limited, but there is a suspicion of overdiagnosis of LB in recent years. We reviewed the LB diagnosis and treatment-related data in Türkiye, based on the Infectious Diseases Society of America (IDSA) 2020 and European Society of Clinical Microbiology and Infectious Diseases Study Group for Lyme Borreliosis (ESGBOR) 2018 guidelines. By detecting the disagreements between these two, we outlined the areas to be improved for future guidelines. We performed a literature search according to the PRISMA guidelines in PubMed, Ovid-Medline, Web of Science, Turkish Medline, Scopus, CINAHL, ULAKBIM TR Index, Google Scholar and Cochrane Library databases. We included the published cases in a database and evaluated according to IDSA and ESGBOR guidelines. We outlined the reasons for misdiagnoses and inappropriate uses of antibiotics. We included 42 relevant studies with 84 LB cases reported from Türkiye between 1990 and December 2022. Among 84 cases, the most common clinical findings were nervous system findings (n = 37, 44.0%), erythema migrans (n = 29, 34.5%) and ophthalmologic findings (n = 15, 17.9%). The IDSA 2020 and ESGBOR 2018 guidelines agreed on the diagnosis of 71 (84.5%) cases; there was an agreement that 31 cases (36.9%) were misdiagnosed and 40 cases (47.6%) were correctly diagnosed, and there was disagreement for 13 cases (15.5%). Serum immunoglobulin M (IgM), IgG measurements by ELISA and western blot were widely performed, and they were effective in definitive diagnosis merely when used according to guidelines. Inappropriate use of antibiotics was detected in 42 (50.0%) of cases which were classified in the following categories: incorrect LB diagnosis, inappropriate choice of antibiotic, inappropriate route of drug administration and prolonged antibiotic treatment. Overdiagnosis and non-adherence to guidelines is a common problem. The discordance between seroprevalence and clinical studies necessitates a consensus over the best clinical approach.

Compliance with guideline recommendations in the management of patients with hospitalized community-acquired pneumonia.

Compliance with guidelines in the empirical treatment for community-acquired pneumonia (CAP) is very important to increase treatment success and reduce mortality. This study aimed to determine compliance with guideline recommendations for CAP and define the role of the clinical pharmacist (CP). Patients diagnosed with CAP were evaluated retrospectively between January 2018 and January 2020 and prospectively between February 2020 and February 2021. Compliance with guidelines was evaluated according to the local, national (Turkish Thoracic Society), and international (American Thoracic Society and Infectious Disease Society of America, European Society of Clinical Microbiology and Infectious Diseases) guidelines. A total of 751 patients (423 in the retrospective and 328 in the prospective period) were included. It was determined that the 30-day mortality and length of stay were higher in patients who were not treated according to the guidelines. The compliance for empirical treatments was 16.3%-59.1% and 7.8%-30.1% in retrospective and prospective periods, respectively. During the prospective period, a total of 603 recommendations were made by CP, and 578 (95.9%) were accepted and implemented. In the prospective period, treatment duration was shortened, inappropriate fluoroquinolone use was decreased, the switch to oral treatment was increased, and the number of potential drug-drug interactions was decreased (p < 0.001). Compliance with guidelines is essential to be improved to reduce mortality, shorten the length of stay, determine the appropriate antimicrobial duration, and reduce the use of fluoroquinolones and broad-spectrum antibiotics unless necessary. CP intervention contributes to the rational selection of antimicrobials, limiting drug-drug interactions, avoiding toxicities, and compliance with guidelines.

Audit of adherence to international guidelines (IDSA) in the treatment of infectious meningitis in pediatric patients in Jordan

Objective This study aims to audit the adherence of Jordanian medical care staff to the guidelines provided by the Infectious Disease Society of America (IDSA) for managing pediatric patients admitted with suspected cases of meningitis. Methods A retrospective observational study was conducted at Jordan University Hospital (JUH). All pediatric patients admitted to JUH with suspected meningitis between January 1, 2019, and September 30, 2022, who underwent Cerebrospinal Fluid (CSF) and blood culture tests were recruited in this study unless there was a reason for exclusion. The study collected data on the empiric antibiotics prescribed prior to diagnostic cultures and susceptibility results. Additionally, the length of hospital stay and all-cause mortality were observed. The appropriateness of antibiotics prescription before culture results was compared to IDSA guidelines, and an overall adherence rate was calculated. Results A total of 332 pediatric patients were included in this study, of whom 12.3% (n = 41) were diagnosed with bacterial meningitis. Among the enrolled pediatric patients, only 27 patients (8.1%) received appropriate treatment adhering to the IDSA guidelines. The remaining 91.9% (n = 305) showed various forms of non-adherence to recommendations. The highest adherence rate was observed for performing CSF culture (n = 330, 99.4%), while the lowest adherence rate was found in selecting the appropriate dose and duration for empiric antibiotics (n = 107, 41.3% and n = 133, 51.0%, respectively). Conclusion This study revealed a low overall adherence in the management of pediatric patients with meningitis in Jordan. Establishing an antimicrobial stewardship program may improve the outcomes of meningitis infections found in Jordan, and prevent dangerous adverse effects and bacterial resistance.

Modeling Invasive Aspergillosis Risk for the Application of Prophylaxis Strategies.

The epidemiology of invasive aspergillosis (IA) is evolving. To define the patient groups who will most likely benefit from primary or secondary Aspergillus prophylaxis, particularly those whose medical conditions and IA risk change over time, it is helpful to depict patient populations and their risk periods in a temporal visual model. The Sankey approach provides a dynamic figure to understand the risk of IA for various patient populations. While the figure depicted within this article is static, an internet-based version could provide pop-up highlights of any given flow's origin and destination nodes. A future version could highlight links to publications that support the color-coded incidence rates or other actionable items, such as bundles of applicable pharmacologic or non-pharmacologic interventions. The figure, as part of the upcoming Infectious Diseases Society of America's aspergillosis clinical practice guidelines, can guide decision-making in clinical settings.

The Leaders in Epidemiology, Antimicrobial Stewardship, and Public Health (LEAP) Fellowship, a Novel Training Program in Public Health for Infectious Diseases Physicians.

The severe acute respiratory syndrome coronavirus 2 pandemic demonstrated a critical need for partnerships between practicing infectious diseases (ID) physicians and public health departments. The soon-to-launch combined ID and Epidemic Intelligence Service fellowship can only address a fraction of this need, and otherwise US ID training lacks development pathways for physicians aiming to make careers working with public health departments. The Leaders in Epidemiology, Antimicrobial Stewardship, and Public Health (LEAP) fellowship is a model compatible with the current training paradigm with a proven track record of developing careers of long-term collaboration. Established in 2017 by the ID Society of America, Society for Healthcare Epidemiology of America, Pediatric ID Society, and supported by the Centers for Disease Control and Prevention, LEAP is a single-year in-place, structured training for senior trainees and early career ID physicians. In this viewpoint, we describe the LEAP fellowship, its outcomes, and how it could be adapted into ID training.

An algorithm for simplified hepatitis C virus treatment with non-specialist care based on nation-wide data from Taiwan

BackgroundBoth European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases and the Infectious Diseases Society of America (AASLD-IDSA) guidelines recommend simplified hepatitis C virus (HCV) treatment with pan-genotypic sofosbuvir/velpatasvir or glecaprevir/pibrentasvir for eligible patients. This observational study used real-world data to assess these regimens’ safety in eligible patients and develop an algorithm to identify patients suitable for simplified treatment by non-specialists.Methods7,677 HCV-infected patients from Taiwan Hepatitis C Registry (TACR) who received at least one dose of sofosbuvir/velpatasvir or glecaprevir/pibrentasvir, and fulfilled the EASL/AASLD-IDSA criteria for simplified treatment were analyzed. Multivariate analysis was conducted on patient characteristics and safety data.ResultsOverall, 92.8% (7,128/7,677) of patients achieved sustained virological response and only 1.9% (146/7,677) experienced Grades 2–4 laboratory abnormalities in key liver function parameters (alanine aminotransferase, aspartate aminotransferase, and total bilirubin), with only 18 patients (0.23%) experiencing Grades 3–4 abnormalities. Age > 70 years old, presence of hepatocellular carcinoma, total bilirubin > 1.2 mg/dL, estimated glomerular filtration rate < 60 mL/min/1.73 m2, and Fibrosis-4 > 3.25 were associated with higher risks of Grades 2–4 abnormalities. Patients with any of these had an odds of 4.53 times than that of those without in developing Grades 2–4 abnormalities (p < 0.01).ConclusionsReal-world data from Taiwan confirmed that simplified HCV treatment for eligible patients with pan-genotypic regimens is effective and well tolerated. The TACR algorithm, developed based on this study’s results, can further identify patients who can be safely managed by non-specialist care.Graphical

The Utility of Risk Factors to Define Complicated Staphylococcus aureus Bacteremia in a Setting With Low Methicillin-Resistant S. aureus Prevalence.

Recommended duration of antibiotic treatment of Staphylococcus aureus bacteremia (SAB) is frequently based on distinguishing uncomplicated and complicated SAB, and several risk factors at the onset of infection have been proposed to define complicated SAB. Predictive values of risk factors for complicated SAB have not been validated, and consequences of their use on antibiotic prescriptions are unknown. In a prospective cohort, patients with SAB were categorized as complicated or uncomplicated through adjudication (reference definition). Associations and predictive values of 9 risk factors were determined, compared with the reference definition, as was accuracy of Infectious Diseases Society of America (IDSA) criteria that include 4 risk factors, and the projected consequences of applying IDSA criteria on antibiotic use. Among 490 patients, 296 (60%) had complicated SAB. In multivariable analysis, persistent bacteremia (odds ratio [OR], 6.8; 95% confidence interval [CI], 3.9-12.0), community acquisition of SAB (OR, 2.9; 95% CI, 1.9-4.7) and presence of prosthetic material (OR, 2.3; 95% CI, 1.5-3.6) were associated with complicated SAB. Presence of any of the 4 risk factors in the IDSA definition of complicated SAB had a positive predictive value of 70.9% (95% CI, 65.5-75.9) and a negative predictive value of 57.5% (95% CI, 49.1-64.8). Compared with the reference, IDSA criteria yielded 24 (5%) false-negative and 90 (18%) false-positive classifications of complicated SAB. Median duration of antibiotic treatment of these 90 patients was 16 days (interquartile range, 14-19), all with favorable clinical outcome. Risk factors have low to moderate predictive value to identify complicated SAB and their use may lead to unnecessary prolonged antibiotic use.

The Therapy of SARS-CoV-2 Infection in Children.

The impact of SARS-CoV-2 infections in children has fortunately been lower than what has been seen in adults. However, even previously healthy children have developed severe disease, sometimes with subsequent mortality, and those who are infants or adolescents, are from racial and ethnic minority groups, or have certain chronic conditions are at higher risk of these outcomes. During the pandemic, extensive studies of therapeutic agents, including antivirals and immunomodulators, were conducted in adults. Few trials included children, and most were in older children and adolescents. Thus, the potential benefits of therapies in children must be extrapolated from adult evidence. Despite these limitations, advisory committees of the National Institute of Health (NIH), the Infectious Disease Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS) were constituted, and expert consensus guidelines were developed. This review provides a synthesis of those comprehensive recommendations for therapy in children. These address treatment during the early infectious period with antiviral agents, including remdesivir and nirmatrelvir/ritonavir, as well as treatment in the later period of immune dysregulation with corticosteroids and immunomodulators. In addition, the therapeutic approach for multisystem inflammatory syndrome in children (MIS-C), also referred to as Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS), is also provided.

The Infectious Diseases Society of America Guidelines on the Diagnosis of Coronavirus Disease 2019 (COVID-19): Molecular Diagnostic Testing.

Accurate molecular diagnostic tests are necessary for confirming a diagnosis of coronavirus disease 2019 (COVID-19) and for identifying asymptomatic carriage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The number of available SARS-CoV-2 nucleic acid detection tests continues to increase as does the COVID-19 diagnostic literature. Thus, the Infectious Diseases Society of America (IDSA) developed an evidence-based diagnostic guideline to assist clinicians, clinical laboratorians, patients, and policymakers in decisions related to the optimal use of SARS-CoV-2 nucleic acid amplification tests. In addition, we provide a conceptual framework for understanding molecular diagnostic test performance, discuss nuances of test result interpretation in a variety of practice settings, and highlight important unmet research needs related to COVID-19 diagnostic testing. IDSA convened a multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review to identify and prioritize clinical questions and outcomes related to the use of SARS-CoV-2 molecular diagnostics. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. The panel agreed on 12 diagnostic recommendations. Access to accurate SARS-CoV-2 nucleic acid testing is critical for patient care, hospital infection prevention, and the public health response to COVID-19 infection. Information on the clinical performance of available tests continues to grow, but the quality of evidence of the current literature to support this updated molecular diagnostic guideline remains moderate to very low. Recognizing these limitations, the IDSA panel weighed available diagnostic evidence and recommends nucleic acid testing for all symptomatic individuals suspected of having COVID-19. In addition, testing is suggested for asymptomatic individuals with known or suspected contact with a COVID-19 case when the results will impact isolation/quarantine/personal protective equipment (PPE) usage decisions. Evidence in support of rapid testing and testing of upper respiratory specimens other than nasopharyngeal swabs, which offer logistical advantages, is sufficient to warrant conditional recommendations in favor of these approaches.

Macrolide-resistant Mycoplasma pneumoniae in an Iranian Pediatric Sample with Community-Acquired Pneumonia

Background: To the best of our knowledge, the prevalence of macrolide-resistant Mycoplasma pneumoniae (MRM) in Iranian children has not been investigated. Objectives: The present study aimed to evaluate the prevalence of MRM in Iranian children with community-acquired pneumonia (CAP). Methods: A total of 222 children with CAP, aged 3 - 15 years, who were hospitalized in 10 different children's hospitals, were enrolled in this study. Mycoplasmas were detected using the polymerase chain reaction (PCR) assay. The severity of CAP was evaluated according to the Infectious Diseases Society of America (IDSA) guidelines. The level of C-reactive protein (CRP) was also measured by the particle-enhanced turbidimetric immunoassay. Additionally, the chest X-rays of children with CAP were recorded and sent to a radiologist for further evaluation. Results: Twenty-one children (9.4%) diagnosed with CAP also had M. pneumoniae infection, 17 (77.27%) of whom were positive for A2063G transition and high-level macrolide resistance. The severity of CAP (P ≥ 0.99), CRP level (0.07), and chest X-ray changes (P = 0.08) were not significantly different between children with MRM pneumonia and those with macrolide-susceptible M. pneumoniae. Conclusions: The prevalence of high-level MRM pneumonia in children is high in Iran, similar to other Asian countries. However, this type of Mycoplasma infection was not associated with the severity of CAP and did not have significant effects on chest X-ray (CXR) changes or the CRP level in the patients.

962. Impact of Care Bundle Element Compliance on Clinical Outcomes for Pediatric Patients with Staphylococcus aureus Bacteremia

Abstract Background Staphylococcus aureus bacteremia (SAB) is a major cause of morbidity and mortality in children. The Infectious Disease Society of America (IDSA) outlines standards of care for patients with SAB known to positively impact morbidity and mortality, which have been validated in numerous studies within the adult population. However, there is limited data evaluating the clinical impact of compliance with these standards in pediatric patients. The primary objective of this study was to evaluate the impact of compliance with seven key bundle elements for the treatment of SAB in children. Methods This was a retrospective, single-center, cohort study of pediatric patients aged 18 years or younger with SAB admitted to Michigan Medicine from 2019–2022. The seven bundle elements evaluated included timely initiation of antibiotics, appropriate targeted antibiotic therapy, ID consultation, documented culture clearance, an echocardiogram for high-risk patients, source control, and appropriate duration of therapy. To be considered fully compliant, patients had to meet all seven elements. The primary endpoint was a composite endpoint of mortality and 30-day infection-related readmission rates. Results A total of 73 patients were included; 40 (54.8%) met the fully compliant bundle definition, and 33 (45.2%) were partially compliant. Fully compliant patients had a significantly lower incidence of combined mortality and readmission (7.5% vs. 24.2%; p = 0.0466). Lack of appropriate targeted therapy and lack of source control in patients with a removable source were the most common reasons for not meeting full bundle compliance (Table 1). Appropriate duration of therapy was met in 78.8% of patients in the partially compliant group (26/33, p = 0.0026).Table 1.Bundle Element Compliance.Bundle element compliance between the two cohorts (fully bundle compliant vs partially bundle compliant)Table 2.Primary OutcomeCombine primary outcome of 30-day mortality and 30-day infection-related readmission (fully bundle compliant vs partially bundle compliant) Conclusion Adherence to all bundle elements was associated with lower incidences of mortality and readmission. The results of this study will assist in quality improvement interventions at Michigan Medicine. Disclosures All Authors: No reported disclosures

764. Return to the Roundtable: A Clinical Case Discussion Curriculum for Infectious Diseases Fellows

Abstract Background The Accreditation Council for Graduate Medical Education (ACGME) and the Infectious Diseases Society of America (IDSA) require infectious diseases fellowship programs to include a core curriculum as part of their requirements for clinical training, though recommendations regarding content and structure are limited. Despite advances in online tools available for asynchronous learning in medical education, there remains a scarcity of published ready-to-teach content. We hypothesized that case-based clinical reasoning sessions covering core clinical topics would improve the attitudes and confidence of infectious diseases fellows. Methods We conducted an informal needs assessment of current fellows, reviewed published recommendations and other fellowship curricula. Then, we developed a series of case-based clinical reasoning sessions for clinical and research fellows based on constructivist theory and emphasizing adult learning principles. Topics were rooted in published guidelines and evidence-based practice, prioritizing complex and high-yield clinical topics. Content was peer-reviewed by faculty and sessions were facilitated by senior fellows. Facilitation guides were created to allow for dissemination in the future. Faculty and pharmacists attended the sessions as expert discussants. Fellows completed anonymous surveys assessing attitudes and confidence after each session. Results Three sessions covering Endemic Mycoses, Non-tuberculous Mycobacteria, and Toxoplasmosis were completed with 6-8 fellows in attendance at each. Surveyed fellows felt that the sessions were valuable and improved their confidence in clinical management of the topics presented (Figure 1). Participants also provided narrative feedback (Table 1). Post-session Survey ResultsFigure 1.Post-session survey results from Likert-scale questions assessing attitudes and confidence, n=11 surveys completed by infectious diseases fellows. Post-session Narrative FeedbackTable 1.Narrative feedback from fellows who completed the post-session surveys. Conclusion This curriculum represents a novel initiative by trainee physicians to create a series of peer-facilitated, discussion-based sessions for learners at the level of subspecialty fellowship. We demonstrated that these sessions improve the attitudes and confidence of fellows in a single-program pilot. Future directions will include studying the intervention in other fellowship programs and sharing this program broadly within the infectious diseases education community. Disclosures Eileen K. Maziarz, MD, Karius, Inc: Advisor/Consultant

2137. Real World Experience with Eravacycline for the Treatment of Infections Caused by Carbapenem-Resistant Acinetobacter baumannii

Abstract Background Carbapenem-resistant Acinetobacter baumannii (CRAB) are considered an urgent public health threat responsible for causing severe infections with high associated mortality. CRAB isolates are often resistant to several antibiotic classes thereby limiting treatment options. Eravacycline is a novel tetracycline antibiotic with potent in vitro activity against CRAB. Per the recent Infectious Diseases Society of America (IDSA) Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections, clinical data are limited for eravacycline use for CRAB infections. The purpose of this study was to evaluate clinical outcomes of patients treated with eravacycline for CRAB infections at Montefiore Medical Center. Methods This was a retrospective chart review of patients 18 years of age and older who received eravacycline for at least 72 hours for the treatment of an infection due to CRAB between January 1, 2019 to February 28, 2023. Patients were excluded if they had a urinary tract infection. Patient demographics, risk factors, type/source of infection, clinical outcomes, etc. were collected. Results Eighteen patients received eravacycline for the treatment of non-urinary CRAB infections (Table 1). Ventilator-associated pneumonia was the predominant infection, representing 14/18 (78%) cases. High rates of antibiotic non-susceptibility were demonstrated in all cases. Median eravacycline minimum inhibitory concentration (MIC) was 1 mg/L, with a range of 0.19 – 6 mg/L. Median duration of eravacycline therapy was 7 days. Overall, the clinical success rate was 33% (6/18). Four patients (22%) experienced progression or worsening of symptoms that required a change in antibiotics. Of 11 evaluable patients, three patients (27%) had a recurrent infection caused by CRAB within 30 days of completion of eravacycline therapy. All-cause 30-day mortality was 56% (10/18), with six deaths (33%) attributed to CRAB infection. Conclusion CRAB infections pose a significant challenge in the healthcare setting and are associated with high mortality rates. Eravacycline remains a last resort option for these difficult to treat infections. Further study is warranted for eravacycline use for CRAB infections. Disclosures All Authors: No reported disclosures

2572. Adherence to Evidence-based Guidelines for the Management of Pneumonia in a Tertiary Teaching Hospital in Saudi Arabia

Abstract Background Abstract: Background Adherence to therapeutic guidelines is crucial when treating pneumonia, as it reduces mortality rate, length of hospital stay and duration of antibiotic therapy. However, the high non-adherence rate to treatment guidelines, in general, and Infectious Disease Society of America (IDSA) guidelines, are still reported globally. According to our knowledge, no existing data is available regarding the rate of physicians' adherence to the IDSA guidelines for managing pneumonia in Saudi Arabia. Therefore, we aim to assess the adherence rate and the clinical outcomes among patients treated according to the IDSA guidelines, in a tertiary care center in Riyadh. Methods Methods A single-centered, retrospective observational study was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia. All data were extracted from the hospital's electronic information system, known as Esihi. Adult patients (≥18 years old) who have been diagnosed and treated in the hospital for community-acquired pneumonia, hospital-acquired pneumonia, or ventilator-associated pneumonia from Nov 2019 to Nov 2021 were included. Results A total of 148 patients were included in this study, with an average age of 65 ± 20 years. Demographics and baseline characteristics of the included patients are shown in Table 1. The data showed that only 74 (50%) were treated according to the guidelines' recommendations, while the other 74 (50%) were not. The former group had a statistically higher cure rate and lower mortality compared to the latter (95% vs. 84%; p = 0.034) and (5% vs. 14%; p = 0.022), respectively (Figure 1). Nevertheless, patients who were treated according to the guidelines had a higher CURB-64 score for pneumonia severity and Average Calculated Charlson comorbidity index than patients who were treated irrespectively of the guidelines (1.86 vs 1.39) and (4.62 vs 3.28), respectively, yet, no statistically significant difference was observed (Table 1 and 2). Demographics and Clinical outcomes of included patients n=148 Conclusion Conclusion Non-adherence to the evidence-based guidelines has been observed in 50% of patients treated for pneumonia. In addition, higher clinically cure rate, shorter length of stay and lower mortality rate have been observed in patients who were treated based on the evidence-based guidelines. Disclosures All Authors: No reported disclosures

1222. Impact of Microbiology Reporting Changes in Treatment of AmpC Bloodstream Infections

Abstract Background Recent literature suggests that AmpC production may be overcalled in Enterobacterales, leading to unnecessary broad-spectrum antimicrobial utilization. The Infectious Diseases Society of America (IDSA) has since reassessed classification of high and low risk organisms with inducible AmpC expression. With this updated guidance, our health system approved changes to our microbiology reporting of AmpC producers in an effort to guide prescribing of appropriate antibiotics. The primary objective of this project was to compare antibiotic prescribing patterns for high and low risk AmpC producers in patients with bloodstream infections (BSI) based on the addition of appended comments to antimicrobial susceptibility results. Methods This multicenter, retrospective, cohort study included patients with BSI from October 2022 to March 2023who received at least 48 hours of antimicrobial therapy for the following high and low risk AmpC producers: Citrobacter spp., Enterobacter spp., Klebsiella aerogenes, Serratia spp., Morganella spp., Providencia spp. The primary endpoint was the number of patients placed on optimal therapy based on adherence to the appended microbiology comment and IDSA guidance. Secondary endpoints included time to effective treatment, time to optimal treatment, duration of therapy, 30 day mortality, microbiological failure, microbiological relapse, 30 day readmission, length of stay, and hospital acquired Clostridioides difficile infection. Results A total of 191 positive blood cultures were identified with 93 patients (pre-appended comment = 57; post-appended comment = 36) meeting inclusion criteria. Patients were more likely to receive optimal therapy post-appended comment based on IDSA guidance for BSI (38.6% vs 72.2%, OR 4.14; 1.68-10.21). When stratified by high risk and low risk organism, the number of patients on optimal therapy increased in the post-appended comment group but was not statistically significant (high risk: 70.3% vs 88%, OR 3.08; 0.72-13.32; low risk: 10% vs 36.3%, 5.14; 0.92-28.50). No difference in secondary outcomes were detected. Conclusion Implementation of an appended microbiology note has the potential to have a positive impact on antimicrobial prescribing patterns in treatment of AmpC bloodstream infections. Disclosures All Authors: No reported disclosures

1998. The State of Training in Infection Prevention and Control and Healthcare Epidemiology: A National Survey of Infectious Disease Fellowship Program Directors

Abstract Background Infectious disease (ID) clinicians are often identified to lead infection prevention and control (IPC)/healthcare epidemiology (HE) programs, however, there is no standardized training in fellowship for this role. The most recent survey of ID fellows in 2001 found that only 51% of graduates reported adequate training in IPC/HE. Despite this, half of respondents had IPC/HE responsibilities and received compensation from those activities. We conducted a survey of Program Directors (PD) of United States ID fellowship programs to assess current IPC/HE training. Methods An electronic survey was distributed in March and April 2023 to all ID fellowship PD identified by the Infectious Disease Society of America using Research Electronic Data Capture (REDCap). Survey questions covered training program characteristics, current required and optional IPC/HE training components, barriers to IPC/HE training, interest among fellows in IPC/HE training, and support for formalization of IPC/HE training. Results Of 166 programs, 54 (32.5%) completed the survey, representing programs in 25 states (Figure 1) and size range from 1-10 fellowship positions (mean 4). The majority (49/54, 90.7%) offered didactics in IPC/HE (mean 4.4 hours, range 1-10), of which 45/49 (94%) and 4/49 (6%) were required and elective, respectively. 52/54 (96.3%) of programs reported a formalized curriculum in IPC/HE training for all fellows and 18/54 (33.3%) of the responding programs offered a specialized track in IPC/HE. Reported training components varied (Table 1). A minority of PDs 11/55 (20%) reported considering expanding their IPC/HE training, however, 23/54 (42.6%) reported barriers (Table 2). There was widespread PD support for a formal IPC/HE certification program through a professional society (52/54, 96.3%).Figure 1:Geographic distribution of survey respondents divided by FEMA regions (1-10) of the United States and Territories (N= 54). Conclusion ID fellowship programs with dedicated IPC/HE training remain limited and the majority of training in IPC/HE is restricted to a small number of hours of didactics. Among respondents, many barriers to increasing IPC/HE training were identified. Respondents supported creation of a formal IPC/HE training program through a professional society. Disclosures Molly L. Paras, MD, Angiodynamics: Honoraria|Angiodynamics: Honoraria