Type Of Infection Research Articles

Clinical Patterns of Superficial Fungal Infections in Children Attending Outpatient Department of a Tertiary Hospital in Bangladesh

Superficial fungal infections (SFIs) are common skin infections worldwide. These infections significantly affect the health and well-being of children, particularly in a developing country like Bangladesh. Therefore, there is need to provide up-to-date information on this disease for evidence based effective interventions. The aim of the present study was to determine clinical patterns of superficial fungal infections in children attending the outpatient department of Dermatology and Venereology of Mugda Medical College Hospital, Dhaka, Bangladesh. This cross-sectional, descriptive study was conducted from January to June of 2024. A total of 385 children aged £18 years with superficial fungal infections were included in this study. Demographic data, medical history and systemic disease were documented. 10% potassium hydroxide microscopy and Wood’s lamp examination were done when necessary. The groin was the most frequently affected site (41.8%), followed abdomen (24.9%), limbs (23.4%) and face (22.1%). Tinea corporis is the most prevalent type of superficial fungal infections (57.7%), followed by tinea cruris (42.9%), tinea faciei (20.5%), and tinea capitis (16.6%). Tinea capitis, tinea faciei, and cutaneous candidiasis were more prevalent in 0-6 years age group, while tinea corporis, and tinea cruris were more prevalent in 13-18 years age group; the differences were statistically significant (P<0.05). Tinea capitis and pityriasis versicolor were found significantly prevalent in males in comparison to females (P<0.05). Mugda Med Coll J. 2024; 7(2): 114-118

Inflammatory factors predict infection risk during chemotherapy in leukemia patients.

This study explores the novel role of specific inflammatory factors in predicting infection risk among leukemia patients undergoing chemotherapy, providing new insights into managing leukemia-associated infections. This prospective cohort study included 244 leukemia patients suspected of infection, divided into the infected group (n=194) and the uninfected group (n=50) based on etiological testing. The infected group was further categorized into bacterial (n=123), fungal (n=22), and viral (n=49) infection subgroups. Inflammatory cytokines including IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, TNF-α, IFN-γ, IL-17A, IL-127P0, and IFN-α were measured using ELISA kits. Additional markers such as hs-CRP, SAA, and PCT were also assessed for the infected group. The levels of IL-1β, IL-4, IL-5, IL-6, IL-8, IL-10, IFN-γ, IL-12p70, and IFN-α significantly differed between the infected and uninfected groups (P<0.05). IL-1β, IL-4, IL-6, and IL-10 were significantly higher in the infected group compared to the uninfected group. Significant differences in PCT, IL-2, IL-4, IL-5, and IL-10 levels were observed among patients with bacterial, fungal, and viral infections (P<0.05). However, none of these inflammatory factors were predictive of infection type. IL-4, IL-6, IL-8, and IL-10 were identified as independent predictors of infection risk. However, no inflammatory factors could be used to distinguish between different types of infections.

Causes of HIV-related CNS infection in Cameroon, Malawi, and Tanzania: epidemiological findings from the DREAMM HIV-related CNS implementation study.

CNS infections cause approximately a third of HIV-related deaths. The Driving Reduced AIDS-Associated Meningo-encephalitis Mortality DREAMM study aimed to prospectively diagnose the aetiology of HIV-related CNS infection in five public hospitals in Cameroon, Malawi, and Tanzania. DREAMM was a multicentre, hybrid type-2 implementation science project. Adults (aged ≥18 years) presenting with a first episode of suspected CNS infection, who were HIV seropositive or willing to have an HIV test, were eligible for recruitment. Following implementation of the DREAMM model of care, we measured the prevalence of cryptococcal meningitis, tuberculous meningitis, bacterial meningitis, and cerebral toxoplasmosis and did a χ2 test to assess whether prevalence differed between countries. We also reported disease-specific mortality and Toxoplasma gondii seroprevalence. Of 356 participants with suspected CNS infection analysed at baseline, 269 (76%) were diagnosed as having a CNS infection. Of these, 202 (75%) had a confirmed diagnosis. Between Cameroon, Malawi, and Tanzania, the prevalence of the four main types of CNS infection differed (cryptococcal meningitis p=0·0014, bacterial meningitis p=0·0043, CNS tuberculosis p<0·0001, and toxoplasmosis p<0·0001). Cryptococcal meningitis (148 [55%] of 269) was the leading cause overall. The next most common causes were CNS tuberculosis in Tanzania (29 [29%] of 99) and bacterial meningitis in Malawi (15 [19%] of 80). In Cameroon, cerebral toxoplasmosis (39 [43%] of 90) was the leading cause followed by cryptococcal meningitis (36 [40%] of 90). For cryptococcal meningitis, all-cause 2-week mortality was 23% (34 of 147) and all-cause 10-week mortality was 45% (66 of 146). Within the study population, the aetiology of HIV-related CNS infection varied substantially between Malawi, Cameroon, and Tanzania. Additional prospective epidemiological data are needed to inform HIV programmes. 2-week cryptococcal meningitis mortality outcomes were similar to those of clinical trials. However, new interventions are urgently needed to sustain mortality reductions following hospital discharge. European and Developing Countries Clinical Trials Partnership and French Agency for Research on AIDS and Viral Hepatitis. For the French and Portuguese translations of the abstract see Supplementary Materials section.

Research progress on pathogenesis and treatment of febrile seizures.

Febrile seizures (FSs) are the most common pediatric neurological disorder, affecting approximately 5% of children aged 6months to 5years. While most FSs are self-limiting and benign, about 20-30% present as complex FSs (CFSs), which pose a risk of acute brain injury and the development of temporal lobe epilepsy. Various factors, including age, geographical distribution, and type of infection influence the occurrence of FS. Infection is the primary external trigger for FS, while the underlying intrinsic factors are linked to the immature and incomplete myelination of the brain during specific developmental stages. Although the precise pathogenesis of FS is not yet fully understood, it is likely caused by the interaction of immature brain development, fever, neuroinflammation, and genetic susceptibility. This review discussed the pathogenesis of febrile seizures, focusing on factors such as age, fever, neuroinflammation, genetics, and intestinal microbiota, and summarized existing therapeutic approaches. Our review may facilitate the identification of new targets for mechanistic studies and clinical treatment of febrile seizures.

Psychrobacter Infections in Humans—A Narrative Review of Reported Cases

Background: Psychrobacter species are aerobic, Gram-negative, spherical-to-rod-shaped, psychrophilic bacteria that belong to the Moraxellaceae family. In spite of their uncommon manifestation in the general population, infections due to Psychrobacter spp. are increasingly identified especially in immunocompromised individuals or patients with severe comorbidities. Objectives: This review aims to analyze all reported instances of Psychrobacter spp. infections in humans, with an emphasis on data pertaining to epidemiology, microbiology, antimicrobial resistance, treatment strategies, and mortality outcomes. Methods: A narrative review was performed through a literature search of PubMed/MedLine and Scopus databases. Results: In total, 12 articles offered data on 12 patients infected with Psychrobacter spp. Their mean age was 33.41 years, while 63.64% of them were male. Immunosuppression was the predominant risk factor (33.3%). Bacteremia was the most commonly observed type of infection (41.6%), followed by meningitis, skin infection, and conjunctivitis. Psychrobacter immobilis was the most usually identified species (33.3%). The pathogen exhibited sensitivity to most antimicrobials. The most widely administered antimicrobials included cephalosporins (70%), followed by aminopenicillins and vancomycin (40%, respectively). The clinical outcome depended primarily on the infection site; mortality rate was high (44.4%), especially in cases of bacteremia (50%). Conclusion: Due to the potential of Psychrobacter spp. to cause serious infection, clinicians and laboratory professionals should consider it in the differential diagnosis in patients with infections by Gram-negative spherical bacteria, particularly in patients with significant comorbidities and immunodeficiency, in order to accurately establish the diagnosis and proceed to the right treatment.

Infection-Related Hospitalization and Incident Heart Failure: The Atherosclerosis Risk in Communities Study.

The immune response to infections may become dysregulated and promote myocardial damage contributing to heart failure (HF). We examined the relationship between infection-related hospitalization (IRH) and HF, HF with preserved ejection fraction, and HF with reduced ejection fraction. We studied 14 468 adults aged 45 to 64 years in the ARIC (Atherosclerosis Risk in Communities) Study who were HF free at visit 1 (1987-1989). IRH was identified using select International Classification of Diseases (ICD) codes in hospital discharge records and was treated as a time-varying exposure. HF incidence was defined as the first occurrence of either a hospitalization that included an ICD, Ninth Revision (ICD-9) discharge code of 428 (428.0-428.9) among the primary or secondary diagnoses or a death certificate with an ICD-9 code of 428 or an ICD, Tenth Revision (ICD-10) code of I50 among any of the listed diagnoses or underlying causes of death. We used multivariable-adjusted Cox proportional hazards models to assess the association between IRH and incident HF, HF with reduced ejection fraction, and HF with preserved ejection fraction. Median follow-up time was 27 years, 55% were women, 26% were Black, mean age at baseline was 54±6 years, 46% had an IRH, and 3565 had incident HF. Hazard ratio (HR) for incident HF events among participants who had an IRH compared with those who did not was 2.35 (95% CI, 2.19-2.52). This relationship was consistent across different types of infections. Additionally, IRH was associated with both HF with reduced ejection fraction and HF with preserved ejection fraction: 1.77 (95% CI, 1.35-2.32) and 2.97 (95% CI, 2.36-3.75), respectively. IRH was associated with incident HF, HF with reduced ejection fraction, and HF with preserved ejection fraction. IRH might represent a modifiable risk factor for HF pathophysiology.

In-vitro activity of ceftolozane/tazobactam against Pseudomonas aeruginosa and Enterobacterales isolates collected from two general hospitals in Singapore.

The emerging resistance to cephalosporins and carbapenems in gram-negative pathogens poses significant health challenges and increased treatment failures. The development and evaluation of novel therapeutic options are needed urgently. This study aimed to assess the in vitro activity of ceftolozane/tazobactam (C/T), a new cephalosporin and β-lactamase inhibitor combination, against isolates of Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae from different infection sources in two general hospitals in Singapore. Susceptibility testing revealed that C/T has good activity against 600 tested gram-negative pathogens, showing a 94.8% susceptibility rate across different species and infection types. Additionally, emergence of C/T resistance was also observed and characterized with whole genome sequencing (WGS) analysis. WGS analysis indicated that C/T resistance was predominantly associated with harbouring broad-spectrum β-lactamases such as carbapenemases, ESBLs, AmpC and others. Novel mutations in penicillin-binding-protein 3 (PBP3), the target of ceftolozane, and variants associated with hyper ampC expression (ampD, ampR, and dacB), were also found in C/T-resistant isolates, potentially contributing to C/T resistance. The finding of this study provides valuable local data on C/T susceptibility, which is important for guiding the proper clinical use of C/T and promoting antimicrobial stewardship in managing gram-negative infections.

Extension Health Clinic: “Reaching the Unreached.”

Abstract The healthcare services should be delivered to the community’s doorstep with their participation at an affordable cost to achieve “Health for All.” The healthcare services should also be delivered to the vulnerable population to achieve “Health for All.” The three-tier government healthcare delivery services can be complemented with the community-level healthcare services through the Extension Health Clinics (EHC). This study describes the EHC activities of a tertiary healthcare institute in Eastern India. Utilizing resources from the local government healthcare facilities with available resources and a workforce from medical colleges should complement the resources or logistics available at the community level. Vulnerable populations, such as residents of slums, can benefit from achieving an improved health status through this EHC activity. The EHCs provide essential healthcare services and services such as domiciliary care for bedridden patients and referral and follow-up. We conducted EHCs in urban slums for more than two years, encountering 2521 EHC beneficiaries in the last six months, including first-time visits and follow-ups. The mean age of the patients was 32.97 years (SD 20.72 years). Females majorly attended EHCs, with most diagnoses being comprised of non-communicable diseases and communicable diseases such as type-2 diabetes mellitus hypertension and upper respiratory tract infection. The EHCs are helping us to provide quality patient care at the doorstep of an urban slum community to the unreached and unattended ones. It also helps to strengthen undergraduate and postgraduate teaching-learning activities.

P-83. Corynebacterium Striatum, an emerging community and nosocomial pathogen

Abstract Background Corynebacterium striatum is part of the normal flora of the skin and nasal mucosa. Cases of C. striatum isolates are commonly neglected and assumed as contaminants, but increasing reports suggests it is the causative pathogen in many community and nosocomial infections. The objective of this study was to review and analyze C. striatum isolates from sterile sites over a 12-year period (2011 -2023) Corynebacterium Striatum, an emerging community and nosocomial pathogen Table 1 Patient's clinical characteristics divided by type of infection (Monomicrobial vs polymicrobial) Methods This was a retrospective, observational study of patients with microbiologically confirmed C. striatum diabetic foot infection or osteomyelitis from July 1, 2011 to January 10, 2023 at the South Texas Veterans Health Care System. We screened all microbiology results using Theradoc (Premier Inc. Charlotte, NC) and reviewed the medical records of all patients 18 years or older that meet criteria. We collected epidemiological, radiological, laboratory and clinical data from each case. Additional variables included patient demographics, comorbidities (including Charlson comorbidity index), exposure to healthcare and antimicrobials within 12 months, presence of catheters or implants at the time of admission/infection, hemodialysis, treatment and outcomes. Variables were presented descriptively and compared between monomicrobial and polymicrobial infections using the chi-square or Wilcoxon rank sum test. Corynebacterium Striatum, an emerging community and nosocomial pathogen Table 1 continuation Patient's clinical characteristics divided by type of infection (Monomicrobial vs polymicrobial) Results There were 185 potential candidates for inclusion, but 53 cases were included for analysis. Patient and infection characteristics are presented in the Table. Median age was 67 years and 98.1% were male. Most infections were osteomyelitis (79.2%) and polymicrobial (67.9%). Most patients had recent hospital admissions/ER visits (56.6%). and antimicrobial use (90.6%) within the last year. Polymicrobial and monomicrobial infections were similar. Antimicrobial susceptibility was available in 5 cases. All isolates were susceptible to vancomycin, daptomycin, and gentamycin. 4 were tested for linezolid and rifampin and they were all were susceptible. Amputation was frequently required in the management of infections (71.7% of cases). Conclusion While relatively uncommon, C. striatum can lead to bone and wound infections that can result in poor patient health outcomes. Larger studies are needed to confirm the clinical relevance of this pathogen. Disclosures All Authors: No reported disclosures

P-738. A Microbiological Profile of Necrotizing Fasciitis at a Tertiary Referral Hospital in a Low/Middle Income Country

Abstract Background : Necrotizing fasciitis (NF), an uncommon, fatal infection of the skin and soft tissues, carries a significant mortality risk, with rates reaching as high as 76% despite prompt surgical interventions. While polymicrobial infections were more likely to be encountered, few studies reported a monomicrobial predominance. Despite its relevance, there is a notable lack of data in the Eastern Mediterranean region. We aimed to investigate the microbiological profile among patients diagnosed with necrotizing fasciitis in a tertiary referral center in Lebanon, with a particular focus on Multidrug-resistant organisms (MDROs) and Antimicrobial Resistance (AMR), given their increasing prevalence and the challenges they pose in clinical management.Table 1:Distribution of Organisms Methods A retrospective chart review of hospitalized cases between 2011 and 2021. The study population included adult patients diagnosed with NF during this period. Data included microbiological characteristics, with focus on Multidrug-resistant organisms (MDROs).Figure 1:Yearly Trend of MDROs Among Isolated Organisms Results 41 cases of NF were identified showing a mortality rate of 37%. 46 % of cases had polymicrobial infections versus 42% monomicrobial. The predominant gram negative pathogen was E.coli in both types of infections followed by the gram positive pathogen, Enterococcus species. No difference in the type of infection was noticed in the survival group compared to a predominance of polymicrobial infection in the non-survival group. Fungi were recovered represented in 5.4% of cases and were part of a polymicrobial infection. Out of all the isolated organisms, 21.2% showed patterns of resistance (Extended Spectrum Beta Lactamase, Multidrug resistant, Vancomycin Resistant Enterococcus, and Carbapenem Resistant Enterobacteriaceae) with a yearly incremental rise. Conclusion This 10-year study emphasizes the urgency of prompt surgical intervention and tailored antibiotic treatment for NF, particularly in the context of increasing AMR and the presence of MDROs, contributing crucial regional data on NF demographics, comorbidities, and microbiology Disclosures All Authors: No reported disclosures

P-1141. Antibiotic administration for Staphylococcus aureus infections in US children's hospitals, 2015-2023

Abstract Background The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) infections in children has changed. In response to the introduction of new antibiotics published clinical data, treatment strategies have evolved. The objective of this study is to describe the antimicrobial treatment regimens for children hospitalized with this important pathogen.Table 1.Type of Infections by MRSA vs. MSSA Methods A retrospective observational study was performed using the Pediatric Health Information System (PHIS) data, including all patients discharged from a PHIS-member hospital from October 1, 2015 to June 31, 2023. Patients with ICD 10 codes identifying an MRSA or MSSA infection and indicating the type of infection were included (Table 1): bacteremia, endovascular, pneumonia, skin and soft tissue infection (SSTI), osteomyelitis, and myositis. The proportion of anti-staphylococcal antibiotics of interest received by all patients, patients with MRSA infections, and patients with MSSA infections were calculated by year.Figure 1.Percent of Antibiotics Prescribed for All Patients with Staphylococcus aureus Results 21,206 patients met eligibility criteria and were included in the final data set. Infections due to MRSA and MSSA were 9,561 and 11,645, respectively (Table 1). The proportion of patients with S. aureus infections caused by MRSA decreased from 2015 (55%) to 2023 (41%). The most frequent infections were bacteremia (32%), SSTI (27%), and pneumonia (23%, Table 1). The most common antibiotics prescribed for all S. aureus infections in 2015 were clindamycin (53%), vancomycin (49%), and cefazolin (27%) and in 2023 were vancomycin (56%), cefazolin (48%), and ceftriaxone (34%, Figure 1). While vancomycin prescriptions remained consistent over the study period, clindamycin administration decreased 20% (Figure 1). Daptomycin and ceftaroline, the newest MRSA agents, increased from 2% and 3% to 7% and 8%, respectively, of agents prescribed for MRSA infections (Figure 2). For MSSA infections, cefazolin increased in use while oxacillin/nafcillin use remained consistent (Figure 3). Conclusion Clindamycin administration has substantially decreased, likely a result of increased resistance prevalence in both MSSA and MRSA. Cefazolin use increased commensurate with the increasing incidence of MSSA infection. Disclosures Jason G. Newland, MD, MEd, Moderna: Grant/Research Support|Pfizer: Grant/Research Support

P-1084. Antimicrobial Activity of Aztreonam-Avibactam and Other β-Lactamase Inhibitor Combinations Tested against Enterobacterales Isolates from Pediatric Patients from United States Medical Centers (2019–2023)

Abstract Background We evaluated the activities of aztreonam-avibactam (ATM-AVI), ceftazidime-avibactam (CAZ-AVI), meropenem-vaborbactam (MEM-VAB), imipenem-relebactam (IMI-REL), ceftolozane-tazobactam (C-T), and comparators against Enterobacterales (ENT) isolates causing infection in pediatric (PED) patients. Activity of β-lactamase inhibitor combinations against Enterobacterales isolates from pediatric patients Methods Among 43,325 ENT (1/patient) collected in 2019–2023 via the INFORM Surveillance Program, 5,723 (13.2%) were from PED patients (≤ 17 years old [yo]). The isolates were consecutively collected from 81 US medical centers and susceptibility tested by CLSI broth microdilution method. Susceptibility was stratified by infection type and patient age: ≤1 yo (n=2,275), 2–5 yo (n=1,130), 6–12 yo (n=1,213), and 13–17 yo (n=1,105) and compared to adults (18–64 yo; n=17,712). Results PED isolates were mainly from pneumonia (21.8%), bloodstream (BSI; 15.3%), and urinary tract infection (UTI; 51.8%). ATM-AVI inhibited &amp;gt; 99.9% of PED isolates at ≤ 8 mg/L; CAZ-AVI and MEM-VAB were active against &amp;gt; 99.9% and 100.0%, respectively, whereas IMI-REL and ceftolozane-tazobactam (TOL-TAZ) were slightly less active (Table). Meropenem, ceftriaxone (CRO), and gentamicin were active against 99.8%, 87.6%, and 92.1% of PED isolates, respectively. CRO susceptibility ranged from 84.5% (6–12 yo) to 89.2% (2–5 and 13–17 yo) among PED isolates and was 81.5% against adult isolates. CRO was active against 86.0%, 87.3%, and 88.4% of PED isolates from pneumonia, BSI, and UTI, respectively. Multidrug-resistant (MDR; non-susceptible [NS] to ≥ 3 classes) phenotype varied from 14.3% (13–17 yo) to 19.7% (6–12 yo) among PED isolates (15.8% overall) and was 20.7% among adult ENT. Carbapenem resistance rate was markedly lower among PED (0.1%) compared to adult isolates (1.3%). TOL-TAZ and piperacillin-tazobactam (PIP-TAZ) exhibited limited activity against CRO-NS and MDR isolates. Susceptibility rates for most comparators were higher among PED than adult isolates, including CRO (87.6% vs. 81.5%), PIP-TAZ (92.2% vs. 88.0%), TOL-TAZ (96.9% vs. 93.9%), and levofloxacin (90.8% vs. 82.1%). Conclusion ATM-AVI, CAZ-AVI, and MEM-VAB were highly active against ENT isolates from PED patients. Susceptibility differences were observed among age groups and infection types. Disclosures Marisa Winkler, MD, PhD, Element Iowa City (JMI Laboratories) was contracted to perform services in 2023 for &amp;gt; 30 biotech and pharmaceutical companies: Grant/Research Support Rodrigo E. Mendes, PhD, GSK: Grant/Research Support

P-1083. Antimicrobial Activity of Aztreonam-Avibactam and Comparator Agents against a Large Collection of Stenotrophomonas maltophilia Isolates Collected in United States Medical Centers (2019-2023)

Abstract Background The occurrence of S. maltophilia infections has increased continuously in the last few years. We evaluated the in vitro activities of aztreonam-avibactam (ATM-AVI) and comparators against a large collection of S. maltophilia clinical isolates. Activity of aztreonam-avibactam and comparator agents stratified by infection type. Methods 1,400 clinical isolates were consecutively collected from 62 United States (US) medical centers. Infection sites included pneumonia (n=1,020), bacteremia (n=117), skin and skin-structure infection (SSSI; n=124), and others (n=139). Isolates were susceptibility tested by CLSI M07 broth microdilution methods. ATM-AVI was tested with AVI at fixed 4 mg/L and a pharmacodynamic/pharmacokinetic susceptible (S) breakpoint of ≤ 8 mg/L was applied for comparison. Results ATM-AVI inhibited 99.6% of isolates at ≤ 8 mg/L (MIC50/90, 2/4 mg/L) and demonstrated potent activity against isolates from all infection types (Table). ATM-AVI inhibited 99.7% of isolates from pneumonia and 100.0% of isolates from BSI at ≤ 8 mg/L and retained potent activity against isolates non-S to other agents commonly used to treat S. maltophilia infections. ATM-AVI was active (MIC ≤ 8 mg/L) against 100.0% of trimethoprim-sulfamethoxazole (TMP-SMX)-non-S isolates, 99.3% of isolates non-S to minocycline or levofloxacin, and 99.5% of isolates with tigecycline MIC &amp;gt; 2 mg/L. Moreover, ATM-AVI activity remained stable during the study period; the percentages inhibited at ≤ 8 mg/L varied from 100.0% in 2019 and 2020 to 99.3% in 2023. TMP-SMX (MIC50/90, ≤ 0.12/0.5 mg/L; 96.9% S) also showed good activity against S. maltophilia. Minocycline (MIC50/90, 0.5/2 mg/L) and levofloxacin (MIC50/90, 1/8 mg/L) were active against 89.2% and 78.9% of isolates according to the 2024 CLSI breakpoint criteria. Conclusion ATM-AVI exhibited potent activity and broad coverage against S. maltophilia from US hospitals and its activity was not adversely affected by resistance to other agents. Our results indicated that ATM-AVI may represent a valuable option to treat S. maltophilia infections, addressing a major unmet medical need. Disclosures Marisa Winkler, MD, PhD, Element Iowa City (JMI Laboratories) was contracted to perform services in 2023 for &amp;gt; 30 biotech and pharmaceutical companies: Grant/Research Support

P-744. Admission Avoidance: A Protocol for Using Dalbavancin in the Emergency Department for Acute Bacterial Skin and Skin Structure Infections

Abstract Background Dalbavancin is a glycopeptide with a 14.4 day terminal half-life that has been used previously in our institution to facilitate early discharge for acute bacterial skin and skin structure infections (ABSSSI). We have expanded this program with a pharmacist-driven protocol for use in the emergency department (ED) to avoid admission in ABSSSI for selected patients. The goal of this study was to evaluate the protocol for dalbavancin use in the ED for patient selection and financial impact. Dalbavancin Emergency Department Protocol Inclusion/Exclusion criteria for assessment to receive dalbavancin Methods This was a retrospective, multi-center, study performed in a community health system from June 2022 through March 2024 of patients who presented to the ED with ABSSSI, evaluated by pharmacist and physician, and discharged directly after receiving dalbavancin. Inclusion and exclusion criteria were based on the patient's symptoms, type of infection, and comorbidities (Figure 1). Data collected included clinical signs/symptoms of infection, previous antibiotic use, history of substance abuse or methicillin-resistant Staphylococcus aureus (MRSA), renal function, and readmissions. Direct costs and reimbursement, as well as if they received patient assistance, were also tracked. The primary objective was to evaluate adherence to the protocol for use of dalbavancin in the ED. The secondary objective was to analyze the financial impact to the health system. Table 1 &amp; Table 2 Patient Demographics &amp; Clinical Signs/Symptoms Results A total of 57 patients met inclusion/exclusion criteria and were evaluated. Patient demographics associated with adherence to protocol are summarized in Table 1. A majority of patients had failed oral therapy and were expected to be admitted for &amp;gt; 3 days. Six patients (10.5%) were re-admitted within 30 days, similar to national averages. Only 2 patients self-reported as persons who inject drugs (PWID). Table 2 summarizes clinical signs/symptoms associated with diagnosis of ABSSSI for the included population. Most patients met multiple diagnostic criteria, with erythema, tenderness, &amp; swelling all reported &amp;gt;75%. For the secondary objective, patients as part of the ED visit had ∼$3800 average reimbursement per patient not including direct and indirect costs of care. Conclusion Pharmacists can help identify and facilitate appropriate patients to receive dalbavancin within a structured protocol to help prevent admissions for ABSSSI. Disclosures Christopher M. Bland, PharmD, FCCP, FIDSA, BCPS, Merck: Honoraria|Nestle/Seres: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria Bruce M. Jones, Pharm.D., FIDSA, BCPS, AbbVie: Advisor/Consultant|AbbVie: Honoraria|Ferring: Honoraria|Innoviva: Honoraria|Paratek: Honoraria

P-1352. Epidemiology and Clinical Profile of Infections Caused by Carbapenem-resistant Gram-negative Bacilli Identified by a Rapid Molecular Method in a Referral Hospital in Nicaragua

Abstract Background Bacterial resistance is a public health problem and resistance to carbapenems has a special connotation and it is important that each institution and country establish the characteristics of these infections. The objective of this study was to determine the epidemiology, clinical profile, and outcome of infections caused by carbapenem-resistant microorganisms in a referral hospital in Nicaragua.Figure 1.Prevalence of Carbapenemases Detected by Xpert Carba-R and Types of Carbapenemases in Clinical Samples Methods An ambidirectional cohort study was carried out between January 2019 and November 2023 at the Dr. Fernando Vélez Paiz Hospital (Managua, Nicaragua) including all patients with infection and a clinical sample that had been processed directly by the Xpert Carba-R® rapid diagnostic molecular method to detect carbapenemases of the NDM, KPC, VIM, IMP, and OXA-48 type. Patients of the Surgery, Orthopedics, Internal Medicine, and Critical Care Department were included. The clinical data were obtained from the hospital's electronic medical record system.Figure 2.Number of Carbapenemases Detected by Patients Results A total of 346 patients with infectious processes had their clinical samples processed directly by Xpert Carba-R®, and 56 (16.1%) had a carbapenem resistance gene detected (Figure 1). By type of infection, resistance to carbapenems was 36% in ventilator-associated pneumonia, 34% in intra-abdominal infection, and 30% in surgical site infection. NDM carbapenemase was present in 91.1% of patients, and KPC in 27% (Figure 1). More than one type of carbapenemase was found in 26.8% of patients. In 4% of the patients 3 types of carbapenemases was found. (Figure 2). The most frequently identified bacterium was K. pneumoniae (36.4%), followed by E. coli (16.9%) (Figure 3). Mortality in patients with carbapenem resistance was 58.9%. Risk factors for mortality were infection with the presence of two carpanemases, requiring mechanical ventilation on admission, presence of shock on admission, Charlson index ≥ 3 points, among others (Table 2).Figure 3.Gram Negative Bacilli Identified in Clinical Samples with Carbapenemases Detected by Xpert Carba-R Conclusion The prevalence and mortality associated with the presence of carbapenemases detected by the molecular method used were high. The most prevalent carbapenemase was NDM. Different factors were associated with mortality, including shock on admission, invasive devices (eg: vascular catheter), patient comorbidities, and the presence of 2 different types of carbapenemases in the infection.Table 1.Risk Factors for Mortality in Patients with Infection with Gram Negative Bacilli Resistant to Carbapenems Detected by Xpert Carba-R Disclosures All Authors: No reported disclosures

P-1919. Incidence of Invasive Group A Streptococcus Infection in relation to the COVID-19 Pandemic (GASCO) – a pilot study

Abstract Background Group A Streptococcus (GAS) is a known cause of invasive infections in humans leading to significant morbidity and mortality. During the COVID-19 pandemic the incidence of respiratory infections had decreased, likely due to pandemic interventions. Previous studies found a correlation between the rates of viral respiratory infections and a predisposition to invasive GAS infections (iGAS). We hypothesize that the incidence of iGAS among adults may have been affected by the COVID-19 pandemic, but evidence is lacking. GASCO compares the rate of iGAS infections before, during and after the COVID-19 pandemic, and evaluates factors that may affect the incidence and outcomes. In this pilot study, we describe the incidence of total GAS infection (tGAS) and iGAS in relation to the COVID-19 pandemic. Study FlowFigure 1.*GAS= Group A Streptococcus infection. **Invasive GAS = Group A Streptococcus isolated from blood, sputum, body fluid, tissue, urine, or cervical culture. ***Non-invasive GAS = Group A Streptococcus isolated from throat or wound culture. Methods We retrospectively identified all patients hospitalized at Corewell Health in West Michigan from April 1st, 2018, through March 31st, 2024, with positive GAS culture obtained in the emergency department or hospital. Patients were classified based on the type of infection (invasive versus noninvasive) and time period in relation to COVID-19 (pre-COVID, COVID, and post-COVID) (figure 1). iGAS was defined as being isolated from blood, sputum, body fluid, tissue, urine or cervical culture. Cultures from throat or wound samples were classified as non-invasive. Number of Total and Invasive Group A Streptococcus Infections during Pre-COVID, COVID and Post-COVIDFigure 2.The number of total GAS infections was 2.7 times higher post-COVID than during and pre-COVID. Number of invasive GAS infections post-COVID was 2 times higher than pre-COVID and 3.2 times higher than during the COVID pandemic. Results Of 1278 patients who had positive GAS culture between 2018 and 2024, 350 (27%) had iGAS. Absolute number of tGAS and iGAS increased post-COVID compared with COVID and pre-COVID (figure 2), although percentage of tGAS representing iGAS was higher pre-COVID (94/269, 35%) than during COVID (61/272, 22%) or post-COVID (195/737, 26%), p=0.003 (Figure 3). Types of iGAS are shown in figure 4.Figure 3.Percentage of total Group A Streptococcus (GAS) infections representing invasive and non-invasive infections during pre-COVID, COVID, and post-COVID periods. Although the absolute number of total and invasive GAS infections was highest post-COVID, the proportion of total GAS infections classified as invasive was highest pre-COVID. Conclusion Our findings suggest that the incidence of tGAS and iGAS increased significantly after COVID-19. Some pediatric studies documented an increase in total GAS infections in Europe, possibly due to the pandemic interventions that led to a gap in immunity and increased susceptibility to infection, and expansion of strains with increased fitness. The full study will evaluate iGAS outcomes and address the factors impacting incidence and outcomes, aiming to provide better insight into the epidemiology of iGAS infections.Figure 4.Types of invasive Group A Streptococcus infection during pre-COVID, COVID, and post-COVID periods. Blood cultures were the most frequently positive throughout the whole study period. There was no significant difference in the types of positive cultures between periods. Disclosures All Authors: No reported disclosures

P-2288. Antibiotic Use and Infectious Complications in Hematological Patients Undergoing CAR T-Cell Therapy

Abstract Background Patients undergoing chimeric antigen receptor (CAR) T-cell therapy face significant infection risks. Current data on the frequency and nature of these infections remain limited. Table 1 Methods Prospective multicenter cohort including all consecutive patients treated with CD19 or BCMA CAR T-cell therapy from January 2022 to February 2024 in three university hospitals in Spain. All participants provided informed consent and were monitored for 90 days post-treatment. Table 1 (continued) Results A total of 210 patients were enrolled. Demographics, comorbidities, and specific therapy details are outlined in Table 1. Overall, 71% of patients experienced fever at a median of 2 days (IQR 1-3) after CAR T-cell infusion. Antibiotics were administered to 79.3% of patients for a median duration of 7 days (IQR 4-11) with meropenem (57.6%) and piperacillin-tazobactam (40.5%) being the most frequently used. Bacteremia was evidenced in 17 (8.1%) patients, with 6 (2.9%) patients experiencing multiple episodes. The median onset of first bacteremia was 27 days (IQR 16.5-36), with 14/17 (82.3%) episodes occurring over 2 weeks after CAR T-cell infusion. Predominant pathogens were P. aeruginosa (5, 2.4%), coagulase-negative staphylococci (5, 2.4%), and E. coli (4, 1.9%). Clostridioides difficile infection occurred in 7 (3.3%) patients. Viral infections were reported in 37 (17.6%) patients, primarily due to SARS-CoV-2 (22, 10.5%) and Influenza (6, 2.9%), while fungal infections were noted in 10 (4.8%) patients (4 aspergillosis, 3 candidemia, 1 mucormycosis, 1 other mold, and 1 possible fungal infection). ICU admission was required for 38 (18.1%) patients, with infections prompting 6 of these cases. The 90-day mortality rate stood at 6.2%, with 61.5% of these deaths attributed to infections. Patients suffering any infection (bacterial, viral, or fungal) had significantly higher 90-day mortality (17.2% vs 2.0%, p &amp;lt; 0.001). Table 2 shows the different 90-day mortality rates regarding the type of infection. Conclusion Antibiotic use is prevalent immediately following CAR T-cell infusion, despite a low initial bacterial infection rate. Nonetheless, infections within the first 90 days post-CAR-T infusion are common and correlate with worse outcomes. Disclosures All Authors: No reported disclosures

P-1483. Clinical Features and Outcomes of KPC and NDM Carbapenemase-Producing Enterobacterales Infection in the Era of Avibactam

Abstract Background Carbapenemase-producing Enterobacterales infections (CPEi) often have poor prognosis and high mortality. However, no local studies compare KPC and NDM-CPEi treated with ceftazidime-avibactam (CA) or ceftazidime-avibactam plus aztreonam (CA+ATM). Methods Prospective cohort study. We included episodes of KPC and NDM-CPEi in patients admitted to a university hospital (from August 2018 to April 2023) who received definitive antibiotic treatment (AT) with CA or CA+ATM, respectively. We compared clinical characteristics and outcomes with 30-day follow-up. We performed a logistic regression for 30-day mortality analyses. Results One hundred and fifty-six episodes of CPEi were included (117 KPC and 39 NDM). Median APACHE II score was 15 (10-21) vs. 16 (10-20.5), p=0.755. Patients were immunocompromised in 53.8% vs. 41%, p=0.165. Bacteremia was present in 47% vs. 59%, p=0.196, and urinary and abdominal were the most frequent clinical sources of infection (44.4% vs. 38.5%, p=0.513; and 9.4% vs 15.4%,p=0.224; respectively). Klebsiella spp. was the main isolate in both groups (75.2% vs. 87.2%, p=0.117). Empirical AT was appropriate in 59.8% vs. 56.4%, p=0.707; and they received empirical CA in 45.3% vs 38.5%, p=0.456. Septic shock occurred in 24.8% vs. 35.9%, p=0.179. Seven and 30-day mortality and infection-related mortality were 3.4% vs. 0%, p=0.312; 13.7% vs. 25.6%,p=0.082; and 4.3% vs. 12.8%, p=0.071. APACHE II &amp;gt;20 [OR 5.9 (95% CI 1.97-17.98), p=0.002], and skin and soft tissue infection [OR 6.02 (95% CI 1.22-29.62), p=0.027] were independently associated with 30-day mortality, while the 7-day clinical response was a protective factor [OR 0.04 (95% CI 0.004-0.405) p=0.006]. Conclusion In patients with KPC and NDM-CPEi treated with CA or CA+ATM, clinical features and outcomes were similar. Mortality was associated with the severity and the source of infection while the seven-day clinical response was a protective factor. Our data support the role of CA AND CA+ ATM in these types of infections. Disclosures Diego Torres, Medical Doctor, Gador: Honoraria|GSK: Advisor/Consultant|Khight Therapeutics: Honoraria|MSD: Honoraria

P-78. Observational Comparison of In-Person vs. Remote Care for Bone and Joint Infections

Abstract Background Telemedicine can overcome barriers to accessing subspecialty expertise including for infectious disease (ID). A common need for ID expertise is bone and joint infections (BJI), which are associated with substantial morbidity and mortality. Access to BJI expertise in underserved locations could be increased through ID telemedicine (Tele-ID). Here, we compare patients, and outcomes of Tele-ID vs in-person ID care of BJI.Table 1:Characteristics of the Study Population Methods We conducted a retrospective study of BJI patients who received Tele-ID (live audio-video) care at hospital #1 vs. in-person ID care at hospital #2 between 2015-2019. Both hospitals are affiliated with a larger academic institution and have care provided by the same ID physicians. Demographic data, comorbidities, diagnostic and microbiological data, treatment, and outcomes were assessed.Table 2:Primary Outcomes of the Study Population Results Of the first 100 patients, half received Tele-ID care at hospital #1 and the other half received in-person ID care at hospital #2. Both groups had similar patient characteristics (Table 1), except for higher frequency of same site infection at hospital #2 (68 vs 26%). Patients cared for via Tele-ID were more often transferred to an alternative tertiary-care facility (30% vs. 0%) for surgical specialty services not available at hospital #1 (Table 2). For Tele-ID patients transferred vs in-person care, LOS was longer and discharge to home occurred less often compared with those not transferred. Readmission for the same infection within 30 days and mortality were not different (Table 2). The most common BJI managed by Tele-ID was diabetic foot osteomyelitis without any hardware, whereas joint infections with hardware were most commonly seen by in-person ID (Figure 1). Amongst patients with OR procedures, most OR cultures were negative, with Staphylococcus aureus being isolated most frequently at both hospitals (Figure 2).Figure 1:Type of Infection by Hospital Conclusion This initial observational study suggests that clinical outcomes are similar for patients with BJI cared for by in-person vs. Tele-ID, although hospital transfer for surgical interventions was more common at the Tele-ID site. Further comparison in a larger number of patients at each hospital is ongoing. This preliminary experience suggests that Tele-ID could provide appropriate care for BJI where in-person ID expertise is not available.Figure 2:OR Culture Organism(s) by Hospital Disclosures Seema Mehta Steinke, MD, MS, Pearl Diagnostics: Advisor/Consultant Rima Abdel-Massih, MD, Infectious Disease Connect: CEO &amp; co-founder|Infectious Disease Connect: Ownership Interest John W. Mellors, MD, Infectious Disease (ID) Connect, Inc.: Share Options

P-1784. Reduction of bacterial resistance in isolates from nosocomial infections through a program of antibiotic stewardship based on a local mobile application in a hospital in Mexico City; 10 years of success

Abstract Background Hospital-acquired infections caused by multidrug-resistant microorganisms (MDR-HAI) are associated with high healthcare costs, prolonged hospital stays, and concerning morbidity and mortality. The prevalence of MDR-HAI has increased worldwide as a result of the COVID-19 pandemic. In this context, antimicrobial stewardship programs (ASP) have become more relevant. Methods A mobile application was implemented for hospital staff to guide optimal antibiotic use. This application is based on local resistance patterns for major nosocomial microorganisms, to provide treatment recommendations (initial regimen based on suspicion, adjustment according to microbiological results, antibiotic discontinuation, etc.). Descriptive statistics were performed. Results In 2013, before the implementation of the application, the compliance rate was 25% for hospital-acquired infections and 42.2% adherence to guidelines. After the introduction of the application, compliance in 2014 was 56.7%, with a reported 20% MDR-HAI rate. In 2015, the usage was 60.7% and MDR-HAI rate was 18%. In 2016, compliance was 68.7% and MDR-HAI rate was 16%. In 2017, compliance was 73.7% and MDR-HAI rate was 14%. In 2018, the prevalence of MDR-HAI was 15%, while the usage of local guidelines was 78.7%. In 2019, compliance was 81.1% and MDR-HAI rate was 16.9%. Considering the COVID-19 pandemic (starting in 2020) as a period in which there was a significant increase in the presence of MDR-HAI worldwide, thanks to the implementation of the application, the percentage of MDR-HAI decreased from 27.8% to 11.1% in 2023 (Image 1). The number of different types of infections (VAP, HAP, UTI, ICS, BSI) also decreased by following the guidelines recommendations. Conclusion These programs are necessary as part of the healthcare program to control the morbidity and complications of MDR-HAI. Simple and user-friendly electronic applications, such as the one implemented in our hospital, have led to increased compliance and a decrease in bacterial resistance of infections acquired in our institution. Disclosures All Authors: No reported disclosures