Charts Of Patients Research Articles

Large Single Center Comparison Of Novel and Reusable Duodenoscopes Show Similar Contamination Rates That Do Not Correlate With Clinical Infection.

There are limited data comparing the contamination rates of reusable and novel duodenoscopes with disposable components. The clinical implications of novel duodenoscope bacterial contamination are also unknown. This study aimed to evaluate the rate of pathogenic bacterial contamination of novel and reusable duodenoscopes and assess the clinical implications for patients exposed to contaminated duodenoscopes. We conducted an observational study of the bacterial contamination of reusable duodenoscopes and novel duodenoscopes with disposable caps (which do not have disposable elevators). Following identification of positive cultures from duodenoscopes, corresponding patient charts were reviewed for blood culture data or evidence of sepsis by quick sequential organ failure assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) criteria. The contamination rate of reusable duodenoscopes was 0.80% (95% CI -0.05, 1.65%). The contamination rate of novel duodenoscopes was 0.0%.The contamination rates were not significantly different (p = 0.141). In reusable duodenoscopes, > 1 colony-forming unit (CFU) of gram-negative rods was identified in 4 positive cultures. None of the patients exposed to a positive culture had an existing infection nor developed bacteremia or sepsis after ERCP. Our data suggest bacterial contamination rates of novel duodenoscopes with disposable caps and reusable duodenoscopes are similar. The low contamination rates in this study support consistent high-level disinfection practices regardless of duodenoscope generation.

Assessing the Rate of inappropriately Crushed Medications in Skilled Nursing Facilities.

Purpose: Evaluate the impact of senior care pharmacists' medication management when a Do Not Crush (DNC) list is used to identify patients inappropriately receiving crushed medications. Methods: Participating senior care pharmacists retrospectively assessed skilled nursing residents with active medications on the DNC list for study inclusion. Study outcomes included assessing prevalence of residents with the inability to receive medications whole orally yet receiving DNC medication(s). Additional outcomes included prevalence rate of patients receiving DNC medications who also have enteral feeding tubing, nothing by mouth orders (NPO), or inability/unwillingness to swallow medications whole. Results: A total of 1,070 skilled nursing patients were reviewed with 778 meeting inclusion criteria. Of those 778 patients, approximately 27% were receiving inappropriately crushed medications. Of those patients, 90% warranted pharmacist intervention associated with a total of 473 medications. Females represented 67% of the patient population, and 90% of patients were 65 years of age or older. The average number of DNC medications was three per patient. The reasons for crushing medications varied. Four patients were classified as NPO, 13 had enteral feeding tubes, 130 patients could not physically swallow medications due to dysphagia, and 122 refused to receive medications whole. Conclusion: Senior care pharmacists can play an integral role in ensuring patients receive medications in accordance with manufacturer guidelines, safe medication practices, and use of alternative formulations as appropriate. The rate of inappropriately crushed medications administered in skilled nursing facilities is high at 27% in the present study. This rate could be further confounded because of the possibility of medications being crushed despite the fact that there is not an indication to do so in the patient chart.

Enhanced Potential of Durvalumab in the Initial Treatment of Advanced Biliary Tract Cancer.

The prognosis of biliary tract cancer is extremely poor, with a 5-year survival rate of 20%. Surgery is the only treatment that can be expected to cure biliary tract cancer, but because many cases are unresectable or recurrent, chemotherapy has become the standard treatment. The effects of first-line administration of durvalumab have not been explored. This study examined whether durvalumab has an additive effect in the first line. Twenty-three patients who were diagnosed with recurrent or non-resected biliary tract cancer requiring anticancer chemotherapy were recruited. Three of these cases were excluded because they had only received one course of durvalumab. We retrospectively collected clinical and laboratory data. Progression-free survival (PFS) and overall survival (OS) were compared between patients who received durvalumab as first-line therapy (first group, FG) and those who received it as second-line or later therapy (second group, SG). PFS and OS were also compared in durvalumab-treated patients aged 75 years and older (older group) and in younger patients. Immune-related adverse events (irAEs) were graded using the Common Terminology Criteria for Adverse Events (CTCAE v5) based on the clinical notation available in the patient charts. Kaplan-Meier curves showed that SG was significantly associated with worse PFS (p=0.018), and the FG group also showed significantly prolonged OS (p=0.030). In addition, PFS from the start of durvalumab treatment was significantly longer in the older group compared to the younger group. However, no significant difference in OS was observed between the two groups. Durvalumab appears to contribute to prolonged PFS and OS when administered as an initial treatment. It may also contribute to improved outcomes in older patients with biliary tract cancer.

Abstract TMP87: Reasons for Deferring Thrombectomy in Pediatric Large- and Medium Vessel Occlusion

Introduction: Mechanical thrombectomy (MT) is increasingly being performed in children with stroke due to large and medium vessel occlusion (LVO and MeVO). While retrospective series suggest favorable outcomes after MT, selection criteria for the pediatric population have not been defined. We aimed to analyze characteristics of children with LVO and MeVO and describe reasons for not pursing MT in children with acute vascular occlusion. Methods: The Stanford Pediatric Stroke Registry retrospectively enrolled pediatric patients with acute arterial ischemic stroke (AIS) admitted to our tertiary care center between 2007-2024. For this analysis, we included patients age 29 days-21 years with acute neuroimaging and clinical documentation available for direct review. LVO was defined as occlusion of the extra-/intracranial Internal Carotid Artery (eICA/iICA), Middle Cerebral Artery (MCA)-M1, Anterior Cerebral Artery (ACA)-A1, vertebral artery (VA) or basilar artery (BA). MeVO was defined as occlusion of the MCA-M2, MCA-M3 or ACA-A2. Patient charts were reviewed for documentation of medical decision-making, and reasons for forgoing MT were assigned by two pediatric neurologists trained in stroke (SL) and neurocritical care (EM). Clinical and imaging characteristics were compared using chi-squared or Fishers Exact test for categorical variables and Mann-Whitney U test or t-test for continuous variables. Results were reported using descriptive statistics. Results: Among 208 children with acute AIS, 82 (39.4%) had LVO/MeVO (Figure 1); 14 children had multiple occlusions for a total of 114 vascular occlusions (90 LVO, 24 MeVO). Patients with LVO/MeVO were older, had higher NIHSS and more often underwent contrast perfusion imaging compared to non-LVO/MeVO patients (Table 1). Among LVO/MeVO patients, Moyamoya Arteriopathy (MMA) was the final diagnosis in 10 (5 with a pre-existing diagnosis). Excluding those, 72 patients (34.6%) had a non-MMA vascular occlusion. MT was performed in 18 patients; of the 64 who did not undergo MT, the most common primary reasons intervention was not pursued were 1) concern for arteriopathy or infection (n=15) and 2) completed/large infarct burden (n=14, Figure 2). Conclusions: LVO/MeVO is not uncommon in children. In our cohort, LVO/MeVO was diagnosed in over 1/3 of children with acute AIS, and a quarter of those underwent MT. Further multicenter prospective studies are needed to define MT selection criteria in this unique population.

Monitoring and Management of Infection following Prepectoral Implant-based Breast Reconstruction: Retrospective Analysis of Conservative Treatment Versus Implant Removal

Background: Infection following implant-based breast reconstruction (IBBR) represents a major complication, potentially leading to prosthesis removal. However, no clear protocol for its prevention and management exists. This study aimed to evaluate the efficacy of conservative treatment methods in preventing implant removal and analyze factors responsible for implant loss in the context of prepectoral IBBR. Methods: A single-institution retrospective review chart of patients undergoing immediate prepectoral IBBR for breast cancer between October 2020 and January 2024 was performed. The inclusion criteria were the presence of at least one of the following postoperative complications: seromas, cellulitis, clinically suspected prosthesis infection, and confirmed periprosthetic infection. A comparative analysis between patients with successful conservative treatment (ultrasound-guided aspiration and antibiotic therapy) and patients undergoing implant removal was performed. Results: A total of 219 immediate prepectoral IBBR cases were identified, 38 of which met inclusion criteria. Implant removal was required in 11 cases, whereas implant retention was achieved in 27 patients with conservative treatment. Implants were invariably removed when bacterial cultures were positive (P < 0.05). Conversely, when pathogens were not identified, the likelihood of implant removal decreased significantly (P < 0.05). Conservative treatment allowed implant salvage in all patients presenting with postoperative seroma alone, without other associated complications (P < 0.05). Conclusions: This study suggests that when bacterial cultures are positive, implant removal is unavoidable. Conversely, noninfected seromas correlated with implant salvage. Infections from Bacillus pumilus and Corynebacterium pseudodiphtheriticum are reported for the first time.

The Impact of Tonsillectomy on Oropharyngeal Cancer Development.

Decreasing numbers of tonsillectomies (TE) and an increasing frequency of oropharyngeal squamous cell carcinoma (OPSCC) is a well-known finding in western societies. A retrospective cohort study was performed to investigate the association between a history of TE and the development of OPSCC. This study included all OPSCC patients who were treated between 2004 and 2023 at the Department of Otorhinolaryngology in University Medical Centre Ruppin Brandenburg in Germany. Digital patient charts were used to collect patient information. Of the 320 patients with OPSCC, 19 (5.9%) had a history of TE. In 63.2% of cases, the procedure was performed in childhood, and 36.8% in adulthood. Our results indicate significant differences in terms of tumor location between the patients with and without a history of TE (p=0.010). In patients without TE, OPSCC was localized in the tonsillar region (45%), in the base of the tongue (29%), and other regions (26%). In patients with a history of TE the frequency was 16%, 63%, and 21%, respectively. Age at initial diagnosis, initial tumor size, p16/HPV status, residual tumor, venous and lymphatic extracapsular extension, recurrence, and alcohol abuse significantly influenced overall survival without any difference between the two groups. A history of TE is associated with a decreased risk of tumor localization in the tonsillar region, especially when TE was performed in adulthood. Additionally, in patients with OPSCC and a history of TE, the tumor is more frequently localized at the base of the tongue. A history of TE does not affect demographics, the outcomes of tumor parameters or the prognosis of our patients.

Retrospective, descriptive study of acute myelitis in French Guyana.

Acute myelitis is a neurological entity, often posing the problem of etiology. The two main causes are infectious or autoimmune. French Guyana is a region of the world where infectious etiologies are multiple, in particular human immunodeficiency virus infection, and autoimmune diseases appear to be emerging. The aim of our study was firstly to determine the proportion of each etiology of acute myelitis in French Guyana, and secondly to describe the clinical, paraclinical and epidemiological characteristics of autoimmune myelitis in French Guyana, with particular reference to neuromyelitis optica spectrum disorder (NMOSD). This retrospective, observational study included all patients who presented with acute myelitis between January 2015 and August 2023 at Cayenne Hospital Center. Each patient's chart was reviewed and patients were classified according to etiology. Demographic and clinical data were collected, as well as blood, lumbar puncture, and cerebral and spinal cord magnetic resonance imaging results. Of the 40 patients included, immune etiology was found in 74%, including 49% with NMOSD (37% with positive anti-aquaporin-4 antibodies) compared with three patients with infectious etiology. There was no statistically significant difference in complementary examinations between immune and infectious etiologies. The prevalence of NMOSD in French Guyana was estimated at 8/100,000 (6/100,000 for patients with positive anti-aquaporin-4 antibodies). No significant difference in the geographic distribution of patients with NMOSD in French Guyana was demonstrated. Our results show a high proportion of autoimmune etiology of acute myelitis in French Guyana, and more particularly of NMOSD. There is a high prevalence of NMOSD, the second highest in the world after the French West Indies. Given this high proportion of autoimmune myelitis, several hypotheses can be put forward, with genetic and environmental factors in the foreground. For patients with acute myelitis in French Guyana, an immune cause is the most likely. It is therefore important to think about this and look for NMOSD in particular, without ignoring an infectious etiology.

Generalizability of Randomized Controlled Trials to Routine Clinical Care in Ulcerative Colitis.

Historically, randomized controlled trials (RCTs) have been criticized for being poorly generalizable to patients with ulcerative colitis (UC) evaluated in routine care. We aimed to evaluate the proportion of patients with UC starting an advanced therapy who would be eligible to participate in phase 3 registrational UC RCTs. We conducted a retrospective cohort analysis of UC patients starting vedolizumab, ustekinumab, or tofacitinib at 2 IBD clinics at the University of Calgary. Patient charts, endoscopy reports, and laboratory results were reviewed, and compared against the inclusion and exclusion criteria from 5 RCTs (GEMINI-I, UNIFI, OCTAVE, ELEVATE, and LUCENT). The proportion of patients who would have been deemed eligible versus ineligible for trial participation at the time of starting a new advanced therapy was determined. A total of 125 patients with UC were included: 78 (62.4%) would have been eligible for at least one of the considered RCTs. Trial-eligible patients were younger, less likely to be exposed to prior immunosuppressants, and had higher C-reactive protein and fecal calprotectin. The most common reason for trial ineligibility was having inadequate disease activity at baseline (Mayo endoscopy subscore <2 or absence of rectal bleeding). A significantly greater proportion of patients would have been eligible for LUCENT (45.6%) compared to GEMINI-I (24.8%), OCTAVE (35.2%), or ELEVATE (35.2%) (P < .01 for all comparisons). Half of patients with UC starting advanced therapy in routine care may be eligible for participation in phase 3 RCTs. Disease activity is the primary reason for trial exclusion.

P-1385. Improving Sexually Transmitted Infections Screening at a Quaternary Care Hospital Ryan White HIV Program: A Quality Improvement Initiative

Abstract Background Screening for sexually transmitted infections (STIs) such as gonorrhea, chlamydia, syphilis and hepatitis C (among men who have sex with men) are part of core performance measures and a reporting requirement for every Ryan White HIV/AIDS program. Dartmouth Health's Ryan White HIV program screening rates for these STIs as of August 2022 were ranging from 38% to 44%. The aim of this quality improvement initiative was to improve the screening rates to 80% by June 2024.Figure 1DH-Bedford Clinic Process Flow MapHighlighted in green are parts of the process where observation of clinical encounter and retrospective chart review were conducted. Methods We used principles of models for improvement recommended by Institute of Healthcare Improvement (IHI), clinical microsystem approach and other quality improvement (QI) techniques in this project. The project had two phases. The initial phase comprised of an audit of the program through observation of clinical encounters, semi-structured interviews and retrospective chart review, while the implementation phase involved three quality interventions: (1) Presentation of initial chart audit findings and educational session about STI guidelines, (2) Use of STI screening cards (main intervention), (3) Practice feedback and regular updates. Analysis and display of data were presented using statistical control process (SPC) charts to identify any significant changes in the system or processTable 1Summary of the Findings of Clinical Encounter Observation and Semi-structured Interviews to the Providers Results From August 2022 to March 2024, we increased our screening rates for gonorrhea from 38% to 66%, chlamydia from 38% to 62%, syphilis from 44% to 64% and hepatitis C (among MSM) from 39% to 82%. Several favorable special cause variations were observed in all outcome measures after the implementation phase.Figure 2p chart for Patients Being Screened for Gonorrhea This figure illustrates the proportion of patients seen in clinic each month who are screened for gonorrhea at least annually. The mean screening rates is 48%. The upper control limit is 62% while the lower control limit is 34%. There are two special cause variations (2 data points outside the UCL - red circle). Conclusion The use of quality improvement principles and methods to routinize sexual history taking can improve screening rates for sexually transmitted infections among adult patients in a Ryan White HIV program. Incorporation of the questions through the EMR is the next step for it to become more sustainable.Figure 3p chart for Patients Being Screened for Syphilis This figure illustrates the proportion of patients seen in clinic each month who are screened for syphilis at least annually. The mean screening rates is 53%. The upper control limit is 67% while the lower control limit is 39%. There are two special cause variations. First is upward trend (green circle) from 8/2023 to 2/2024. The second is a point outside the UCL in 2/2023. Disclosures All Authors: No reported disclosures

P-917. Management of pediatric focal intracranial infections: opportunities to reduce low-value care

Abstract Background Focal intracranial infections are rare but life-threatening complications of sinusitis, otitis media and mastoiditis in children. Management requires collaboration between multiple specialists and prolonged antimicrobial treatment. Methods We retrospectively identified patients hospitalized at our tertiary care children’s hospital with focal intracranial infections from Jan 2022 - April 2024 followed in infectious disease clinic. Patient charts were reviewed to inventory imaging, surgical interventions and antibiotic treatment received. We further identified complications in each case requiring intervention, including surgery, hospitalizations and emergency room visits. MRI imaging was defined as low-value if ordered over 2 weeks prior to the study in a patient without new symptoms, or ordered for a hospitalized patient who was afebrile without neurologic symptoms or parental concerns after 30 days of antibiotic therapy. Results Thirty-four patients were followed in pediatric infectious disease clinic for outpatient management of: subdural empyema (13, 38%), epidural empyema (11, 33%) and brain abscess (10, 29%). Patients were most likely male (68%) and Black or African American (74%), with a median age of 12 (range: 2-18). Nearly all (94%) had at least one MRI; 19 (56%) had a repeat MRI during hospitalization, 22 (65%) had a repeat MRI after discharge. About one-third of MRIs (31%) after discharge required sedation. In our cohort 18 patients had a low-value MRI (53%) and 5 of these (28%) had more than one low-value MRI. No low-value MRI led to a finding requiring surgical intervention. The mean duration of antibiotic treatment was 42 days (SD 10.8 days). Four patients (12%) returned to the ED while on antibiotic therapy for PICC line issues, with one patient returning 3 times for PICC concerns. Conclusion Some management strategies for pediatric focal intracranial infections may be unnecessary or have unrecognized consequences. Repeat MRI for half our cohort was of low-value, exposed many to risks of sedation, and consumed significant family and system resources. Children on prolonged IV antibiotic therapy were at risk for line complications. Routine management of these infections merits reconsideration to decrease unwarranted costs and risks to patient. Disclosures All Authors: No reported disclosures

P-1438. Health-Related Social Needs and Guardian Adversity in Outpatient Pediatric Infectious Diseases

Abstract Background Infectious Diseases (ID) outpatient settings do not routinely screen for psychosocial needs of patients and families that may exacerbate infectious processes or challenge traditional treatment. We assessed the prevalence of health-related social needs (HRSN), guardian adverse childhood experiences (ACEs), and neighborhood-level socioeconomic deprivation in two pediatric outpatient ID clinics. Methods Using a cross-sectional study design, we approached English- and Spanish-speaking guardians of outpatient ID patients at two campuses. Guardians completed a HRSN screen (evaluating food/housing insecurity, transportation access, and mental health concerns) and the 10-question ACEs questionnaire (evaluating traumatic childhood experiences of guardians). Responses were entered into REDCap. We geocoded street addresses to identify census tract-level socioeconomic deprivation index (SDI) scores, with higher scores indicating more deprivation. We quantified individual HRSN items, total ACE scores, and SDI measures. We extracted clinical/demographic information from patient charts. Descriptive analyses were pursued. ANOVA analyses explored associations with psychosocial needs and SDI scores.Figure 1.Association of SDI score and Food Insecurity Over the Past 12 Months. Results To date, 221 caregivers have been surveyed, and results are described in Table 1. Most children identified as White, non-Hispanic, and English-speaking. Many families reported any food insecurity (15%), regular caregiver depressive symptoms (20%), and recent anxiety (70%). Four percent lived in an unsteady place, and 5% had transportation issues that affected access to medical care. Firearms were present in 35% of homes. Nineteen percent of guardians had high ACEs (≥4). The mean SDI score was 0.32 (range 0.11-0.71), similar to our institution’s primary service area. Higher SDI scores were associated with more food insecurity over the past 12 months (Figure 1, p&amp;lt; 0.001) and the past week (Figure 2, p=0.01).Figure 2.Association of SDI Score and Food Insecurity Over the Past Week. Conclusion Guardians of children receiving ID outpatient care reported HRSNs and ACEs. SDI score may be a useful adjuvant to screening to identify more efficiently those at risk for challenges like food insecurity. Outpatient ID settings can identify and help mitigate these concerns in clinical encounters. Disclosures Elizabeth P. Schlaudecker, MD, MPH, Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant

P-477. What Can be Learned from Vermonters Living with HIV Viremia?

Abstract Background Lower rates of viral suppression have been identified in people living with HIV (PLHIV) residing in rural compared to metropolitan areas. This is a barrier to ending the HIV epidemic in the US, and thus represents an urgent focus topic. Vermont is a rural state with roughly 700 PLHIV. Vermonters living with HIV tend to be rigorously engaged into clinical care and have high rates of viral suppression. Yet, there are PLHIV in Vermont that have unsuppressed viral loads, and little is known about the characteristics of this cohort. Our study aims to epidemiologically describe Vermonters with an HIV viral load greater than 200 copies/mL. This characterization can aid in appropriate allocation of resources and improve our understanding of PLHIV with viremia residing in rural areas. Methods Our study used electronic health record data from Epic Systems Corporation (Epic) from 2019 and 2020. We included PLHIV from three infectious disease clinic sites within the University of Vermont Health Network (UVMHN; n = 456) that had at least one clinical visit in the past 18 months. The following data were extracted from patient charts: HIV detection and quantitation, clinic location, race, sexual orientation, and substance use. Results The results of our study are shown in Tables 1 and 2. There was no significant association between clinic location, race, sexual orientation, or substance use and having a viral load greater than 200 copies/mL. Conclusion Our results suggest that in Vermont, the presence of viremia in PLHIV cannot be easily predicted by clinic location race, sexual orientation, or substance use. The authors suggest that traditional clinical markers including low CD4 counts, HIV resistance mutations, pill burden, older age and concomitant clinical comorbidities (dementia, etc.) may be more reliable factors associated with active viremia. Although Vermont is demographically distinct from other rural areas, its residents share many barriers related to HIV care, including long travel distances to visits, limited HIV provider availability, and limited access to harm reduction services. These challenges necessitate our continued efforts to better understand and serve PLHIV living in rural areas to improve HIV equity and ultimately end the HIV epidemic. Disclosures All Authors: No reported disclosures

P-1564. Clinical Findings in Pediatric Patients with Renal Abscesses Treated with Intravenous versus Oral Antibiotics

Abstract Background Renal abscesses in pediatric patients are uncommon and there is a paucity of data published regarding clinical findings and treatment outcomes. Case reports have documented the successful use of intravenous (IV) antibiotics, with or without surgical intervention. However, few case series have documented the use of enteral or oral antibiotics, specifically in the pediatric population. The treatment approach to renal abscesses in pediatric patients remains controversial. Methods This retrospective case study identified children less than or equal to 18 years of age in the Intermountain Health System who had a radiographically diagnosed renal or perirenal abscess between 2015 and 2023. Patient charts were retrospectively reviewed and evaluated for clinical variables and treatment strategies. Patient and clinical outcomes assessed included hospital readmission, emergency department (ED) revisits, re-occurrence of abscess within one year, and length of hospital stay. Results Forty-two patients were evaluated. On average, patients included had an elevated C-reactive protein and serum white blood cell (WBC) count. Escherichia coli was the main pathogen isolated from culture results (50%). Per urinalysis (UA) findings, 50% of UAs had trace or greater leukocyte esterase and 61% had trace or greater protein. Hematuria was observed in 60% of microscopic UA results, and 66% of UAs had WBCs greater than five. The majority of patients (81%) were sent home on oral antibiotics. Of the patients sent home on IV antibiotics, 71% of patients had an oral option. Readmission within 90-days was seen in 6% of patients on oral therapy and 14% of patients on IV therapy (P = 0.48). ED revisit within 90-days was seen in 6% of patients on oral therapy versus 14% of patients on IV therapy (P = 1.00). No patients had a re-occurrence of abscess within one year (P = 1.00). The median length of stay in the oral therapy group and IV therapy group was 3 days (2, 5.75) and 5.5 days (3.5, 8.75) (P = 0.13), respectively. Conclusion No patients had a re-occurrence of abscess within one year. 71% of patients treated with IV antibiotics had an oral option and were treated with an IV antibiotic based on provider preference. Oral antibiotics appear to be effective in the treatment of renal abscesses. Disclosures All Authors: No reported disclosures

P-1450. Impact of Multi-morbidities on Quality of Life Among People Living with HIV at a tertiary care center in India: A cross-sectional study

Abstract Background India is home to an estimated 2.4 million People Living with HIV (PLHIV). The term "multi-morbidity" refers to the simultaneous presence of 2 or more chronic medical conditions in an individual, the prevalence of which is rising. The aim of our study is to assess the impact of multi-morbidities on Quality of Life (QoL) in PLHIV attending the Antiretroviral Therapy (ART) center at a tertiary care hospital in Western Maharashtra, India. Methods This was a cross-sectional study, over 2 months with 285 patients recruited. After ethical clearance was obtained, patients were interviewed to gather comprehensive sociodemographic history, with information on treatment and comorbidities obtained from patient charts. The QoL was measured using the WHOQOL-HIV BREF questionnaire which evaluates QoL across six domains: Physical, Psychological, Independence, Social, Environment, and Spiritual. Results The cohort exhibited an average of 2.2 comorbidities (SD = 1.4), with a notable prevalence of cardiovascular diseases and diabetes. Participants with 3 or more comorbidities demonstrated significantly lower QoL scores in the Physical (mean = 10.4, SD = 1.8, p &amp;lt; 0.01) and Psychological (mean = 11.9, SD = 1.5, p &amp;lt; 0.05) domains compared to those with fewer comorbidities. A longer duration of ART correlated positively with higher scores in the Independence domain (r = 0.26, p &amp;lt; 0.05). Elevated CD4 counts were linked with improvements in the Environmental and Psychological health domains. (p &amp;lt; 0.05) Participants from higher socioeconomic backgrounds reported significantly better scores in the Environmental and Spiritual domains (p &amp;lt; 0.05). Younger patients (&amp;lt; 40 years) reported better Social and Spiritual QoL scores compared to older individuals Gender-specific analysis indicated that females reported higher scores in the Social and Environmental domains. (p &amp;lt; 0.01). Conclusion There is a pressing need for effective management strategies that encompass comprehensive care approaches to address the complex health needs of this population. Enhancing routine screening for comorbidities and educating patients about the implications of multi-morbidities can empower PLHIV to improve QoL. Disclosures All Authors: No reported disclosures

415. Optimizing Blood Culture Utilization in Solid Organ Transplant Recipients: A Diagnostic Stewardship Approach

Abstract Background Diagnostic stewardship of blood culture utilization is paramount to mitigate the risks associated with excessive culturing, including increased contamination rates and inappropriate antimicrobial administration. Although blood culture algorithms have been studied previously, there is insufficient data on their application specifically in solid organ transplant recipients. This study aims to retrospectively apply a blood culture algorithm (initially developed for a non-immunocompromised population) to assess its effectiveness in this immunosuppressed population. Figure 1. Algorithm used by clinical providers to determine if blood cultures are appropriate or inappropriate Methods We conducted a retrospective review of adult solid organ transplant recipients with a blood culture event (BCE) occurring between February 2022 to January 2024 at a single academic medical center. A BCE was defined as the collection of at least one blood culture set for a specific clinical indication. During this time a blood culture algorithm (Figure 1) was implemented across 12 units in the hospital. Patient charts were manually reviewed to categorize BCEs as appropriate (the algorithm agreed with obtaining a blood culture), inappropriate (if the algorithm suggested to not draw a blood culture), or lacking documentation. Results Among 824 BCEs recorded in adult solid organ transplant recipients (Figure 2), 669 (81.2%) were deemed appropriate, 118 (14.3%) were inappropriate, and 37 (5.5%) lacked sufficient documentation. Adjudication of 388 BCEs with available data was performed and revealed 350 (90.2%) negative cultures, 25 (6.4%) true positives, and 13 (3.4%) contaminants (Figure 3). Within the subset of inappropriate BCEs (n=118), 113 (95.8%) yielded negative cultures, while 5 (4.2%) were contaminants; no true positives were identified. Conclusion The retrospective application of the blood culture algorithm did not reveal any missed true positive bacteremias in solid organ transplant recipients. Although this study is limited in scope, it provides initial evidence supporting the cautious application of the algorithm in this population. As a next step, we will adjudciate the remaining 436 BCE in the dataset. Further investigation is warranted to validate these findings and optimize diagnostic stewardship strategies for improved patient outcomes. Disclosures Jessica Seidelman, MD, MPH, 3M: Expert Testimony

P-858. Impact of Infectious Diseases Consultation on the Management of Staphylococcus Aureus Bacteremia in a Large, Predominately Rural, Health System

Abstract Background Staphylococcus Aureus Bacteremia(SAB) is associated with high morbidity and mortality. Infectious Diseases (ID)consultation has been associated with a decrease in mortality. The WVU Medicine Health System (WVUM) serves as a predominantly rural population and includes 24 hospitals (9 of which are critical access hospitals). Access to ID consultations is limited across the system and region. Methods We generated a list of patients with SAB who presented to WVUM hospitals between 6/1/22 to 5/30/2023. A subset of patient charts were selected for review. We manually reviewed patient records and recorded key information and assessed whether patients met IDSA guidelines criteria for complicated versus uncomplicated SAB. Results Please see Table 1 Table 1.Management of SAB for Patients With and Without ID ConsultationVariablePatients with ID Consult (143)Patients without ID Consult (93)P-valueDiagnostic ImagingMRI C-spine: 27/143 (19%)MRI C-spine: 2/93 (2%)&amp;lt; 0.001MRI T-spine: 32/143 (22%)MRI T-spine: 4/93 (4%)&amp;lt; 0.001MRI LS spine: 41/143 (29%)MRI LS spine: 3/93 (3%)&amp;lt; 0.001TTE: 129/143 (90%)TTE: 38/93 (41%)&amp;lt; 0.001TEE: 62/143 (43%)TEE: 3/93 (3%)&amp;lt; 0.001Metastatic Infection48/143 (34%)5/93 (5%)&amp;lt; 0.001Complicated139/143 (97%)93/93 (100%)0.1557Antibiotic duration&amp;lt; 2 weeks: 0/143 (0%)&amp;lt; 2 weeks: 52/93 (56%)&amp;lt; 0.0012 weeks 10/143 (7%)2 weeks 16/93 (17%)0.0254 weeks 24/143 (17%)4 weeks 2/93 (2%)&amp;lt; 0.0016 weeks 95/143 (66%)6 weeks 10/93 (11%)&amp;lt; 0.001Died within 72 hours of presentation0/143 (0%)16/93 (17%)&amp;lt; 0.00130 Day re-admission*30/143 (21%)26/77 (34%)0.30130-Day mortality*10/143 (7%)11/77 (14%)&amp;lt; 0.001*Excluding people who died within 72 hours of presentation Conclusion We found major differences in the work up of SAB and in clinical outcomes for patients receiving ID consultation and those who did not. Patients who received ID consultation were more likely to receive guidelines compliant evaluation and treatment, and were less likely to be re-admitted and die. When patients who died within 72 hours of presentation were excluded from analysis , patients without ID consults were still significantly more likely to die. These data will inform efforts to expand access to ID consultation for patients with SAB across our health system. Disclosures All Authors: No reported disclosures

P-1460. Judicious Use of Benzathine Penicillin G in Response to a Medication Shortage Alert

Abstract Background The national shortage of benzathine penicillin G (BPG) poses challenges in the treatment of syphilis. In response to this critical BPG shortage, our health system implemented a medication shortage alert within the electronic health record (EHR). The alert provides recommendations to optimize BPG utilization. This study investigates the impact of the BPG drug shortage on clinical practice. Methods This was an IRB-approved, retrospective cohort study focusing on patients &amp;gt;3 months who received BPG between 5/9/23–2/28/24. The study included inpatient and outpatient visits after implementing the medication shortage alert. Exclusions were applied for severe penicillin allergy, neurosyphilis, or congenital syphilis. Two cohorts were analyzed: the judicious BPG group (patients with primary, secondary, or latent syphilis receiving BPG), and the non-judicious group (patients receiving BPG for alternative diagnoses). The study assessed social determinants of health (SDOH) as primary outcomes and compared a separate cohort of syphilis patients receiving BPG or alternative therapy (e.g., doxycycline). Results 453 patients were included. Majority of patients were non-Hispanic Black (273, 60%) men (272, 60%), with a median age of 32 years (IQR: 22-44). Of these patients, 318 (70%) received judicious BPG, while 135 (30%) received non-judicious BPG. The most common non-judicious diagnosis was streptococcal pharyngitis (128, 95%). In multivariable logistic regression (Table 1), variables associated with judicious use included: age &amp;gt;32 years (adjOR: 2.273; 95% CI: 1.488-3.472), male sex at birth (adjOR: 1.835; 95% CI: 1.206-2.792), and black race (adjOR: 1.847; 95% CI: 1.212-2.815). Among a cohort of 128 syphilis patients who received either BPG (64, 50%) or doxycycline (64, 50%) treatment, those who received doxycycline were more likely to lack health insurance (35 [54.7%] vs. 43 [67.2%], p=0.15) and receive outpatient treatment (3 [4.7%] vs. 12 [18.7%], p=0.13) (Table 2). SDOH data were reported in &amp;lt; 50% of patient charts. Conclusion Despite implementing an EHR drug shortage alert, 30% of BPG use was suboptimal and mostly for pharyngitis. Optimizing SDOH documentation represents an opportunity to assess health inequities and the impacts on patient outcomes for syphilis management. Disclosures Rachel M. Kenney, PharmD, BCIDP, Medtronic Inc: Spouse is an employee, stockholder

P-1633. Evaluating an Urgent Care Antibiotic Stewardship Intervention: A Multi-Network Collaborative Effort

Abstract Background Urgent care centers (UCCs) have previously been associated with high rates of inappropriate antibiotic prescribing without supporting appropriate diagnoses. Prior antibiotic stewardship studies in urgent care settings have generally been limited to pediatric clinics and diagnoses or conducted within single urgent care networks. Broadly generalizable stewardship efforts targeting common diagnoses across ages are needed. Methods This quality improvement study's participants were UCC clinicians from a national collaborative of 49 UCCs in 27 networks across 18 states within the United States. Stewardship interventions included signing of a commitment statement, and a choice of intervention options to implement during two plan-do-study-act (PDSA) cycles during the intervention period. The primary outcome was the percent of urgent care encounters (from randomly selected patient charts) for viral illness or bronchitis diagnoses with inappropriate antibiotic prescribing, stratified by whether the clinician was a direct participant in the quality improvement study and by diagnosis. A 3-month baseline and 9-month intervention period were compared using an interrupted time series with a generalized estimating equation model. Results 15,588 patient encounters were included with a diagnosis of bronchitis or viral illness. The intervention was associated with a 39% relative decrease in inappropriate antibiotic prescribing (aOR=0.61, 95%CI 0.48-0.77) among participating clinicians compared to baseline. The intervention did not result in a significant change in inappropriate antibiotic prescribing (aOR=1.08, p=0.54) for clinicians who did not directly participate. Conclusion This antibiotic stewardship intervention was associated with significant reductions in inappropriate prescribing among clinicians who directly participated. Implementing stewardship interventions in UCCs may reduce inappropriate antibiotic prescriptions for common diagnoses; however, direct clinician participation may be necessary, especially in settings with high rates of clinician turnover. Disclosures All Authors: No reported disclosures

P-2340. Single-Center Inpatient Measles Analysis During a Congregate Setting Outbreak; Comparing Vaccine History between Measles Positive and Negative Cohorts

Abstract Background Chicago’s 2024 measles outbreak affected many new arrivals living in congregate settings with unknown or poorly documented vaccination history. Despite post-exposure prophylaxis provided at shelters, many families still developed measles. Frequency of measles exposure in congregate settings certainly plays a role in infection, but vaccination history and source should also be evaluated.Table.Characteristics of Measles Patients Under Investigation (PUI) stratified by PCR result * One case received IGIM and five received 1 MMR post-exposure prophylaxis dose given at the shelter between 10—30 days prior to rash onset (median: 11 days), ∞ including vaccine strain case, # n=7, ^n=10, ^^Countries of origin: Venezuela, Peru, Ecuador Methods Data was abstracted from 12 measles PCR positive and 13 measles PCR negative patient charts from 3/10/24—4/23/24 including measles vaccination history, IgG antibody titers, concurrent infections and measles complications. Relative risks and p-values were calculated using MedCalc Software Ltd (Version 22.023). Results From 3/10/24—4/23/24, 12 measles PCR positive patients were admitted with median age 16 years (range 13 months—43 years) including 3 parent-child dyads; serotyping through the Illinois Department of Public Health reported one vaccine strain and 11 wild type cases. Of the 11 wild type measles cases, 3 (27%) had concurrent infections; (2 of 3 group A streptococcus culture positive (oropharynx); 1 of 3 was rhinovirus/enterovirus positive (nasopharyngeal PCR); 8 of 11 (73%) had at least 1 measles complication including dehydration (4), acute otitis media (3), pneumonia (1), and hepatitis (2). Comparing vaccine history between measles negative and positive cohorts, there was a non-significant trend towards history of international vaccination in the measles positive cohort. History of current congregate setting residence and exposure to a known measles case were significantly associated with measles positivity with a relative risk of 2.2. Conclusion Inpatient data is lacking during the 2024 international measles surge and new arrivals' vaccination history documentation is inconsistent. A trend towards international measles vaccine receipt in a measles positive cohort highlights the importance of US public health efforts to offer MMR vaccination to new arrivals. Limitations of this report include small cohort sizes and recall bias. Additional data is needed to describe the impact of improper vaccine storage and handling on vaccine effectiveness in the current international measles epidemic. Disclosures All Authors: No reported disclosures

P-1817. Reducing The Use of Piperacillin/Tazobactam for Common Infections – A Danish Quality Improvement Study

Abstract Background During a 4-year period we noticed a doubling of Piperacillin/Tazobactam (PIT) consumption in our hospital, which was not supported by the local antibiotic guideline. This quality improvement study aimed to study prescription behavior. We hypothesized that an intervention might increase guideline adherence, thus decreasing the use of PIT as first line treatment for common infections. Methods Baseline data on PIT consumption were collected from April 2022 to March 2023 as defined daily doses (DDD)/100 bed-days. We collected baseline data on guideline adherence from January to March 2023 and performed an audit by reviewing patient charts. A multifaceted intervention was carried out from April 1st to December 31st, 2023, consisting of teaching sessions, feedback to prescribers, discouraging use of urinary dipsticks, creating pocket guidelines, and revision of the antibiotic guideline. Inclusion criteria: Immuno-competent patients ≥ 18 years being prescribed PIT for community-acquired infections. Patients with immunosuppression or at risk of hospital-acquired infection were excluded. We compared the number of PIT prescriptions between baseline and intervention by using unpaired t-tests. Change in adherence to guidelines was tested using the Chi-squared test. The primary outcome was reduction in PIT use and secondary outcome was increased guideline adherence. Results Three-hundred and sixty-nine patients were included. During the intervention, we observed a 26% decrease in PIT use (DDD/100 bed days) and 41% reduction in the number prescribed PIT doses/week. Correctly prescribed PIT doses increased from 49.6% to 53.8% after the intervention. The correct prescriptions were differentiated between senior (75%), junior (57.7%) and locum doctors (43.5%). Conclusion By using a multifaceted intervention strategy to encourage prescribers to follow local guidelines, we observed a substantial reduction in the use of PIT for community-acquired infections in immuno-competent patients. Forming a formal antimicrobial stewardship team may play an important role in maintaining vigilance towards antibiotic prescribing behavior. Disclosures All Authors: No reported disclosures