Citations

Abstract Background 16S ribosomal RNA (rRNA) gene PCR and sequencing may serve as an adjunctive diagnostic tool in complex infections, identifying bacteria in patients on antibiotics whose cultures may be negative. Data on the optimal clinical settings for utilizing this type of testing are limited. This study reviews a single center's 16S rRNA PCR/sequencing experience in children to identify clinical syndromes and optimize specimen choice for higher yield, leading to testing of appropriate patients. Methods A retrospective study was performed at Mayo Clinic, Rochester involving children aged 0 to 18 years whose normally sterile tissue or fluid samples underwent 16S rRNA gene PCR/sequencing. The assay involved an up-front real-time PCR assay, reported as negative or submitted to Sanger or next-generation sequencing depending on Ct values. Data was collected on patient characteristics and results of 16S rRNA gene PCR/sequencing and conventional tests. Impact on clinical decision-making was assessed as to whether the advanced molecular diagnostic changed antimicrobial therapy. Results A total of 162 tests were performed on 124 patients, including 47% females (58/124) with a median age of 9.6 (range, 2.2-15.0) years. Overall, 33/162 (20%) of tests were positive in 24/124 (19%) patients. 58% of positive tests (19/33) were from samples with negative bacterial cultures. Cerebrospinal fluid was the most common specimen tested (n=38; 31%). Positive results were more likely from fluid compared to tissue samples (OR [95% CI]: 3.1 [1.3, 7.1], p=.007; OR [95% CI]: 0.3 [0.1, 0.8], p=.007, respectively). Testing was positive in 5/10 (50%) pleural fluids tested, a higher positivity rate than any other specimen type (OR [95% CI]: 5 [1.3, 19.0], p=.011). No significant changes in antibiotics were made within 24 hours of reporting positive 16S rRNA gene PCR/sequencing results. Conclusion This study highlights the importance of selecting appropriate sample types for 16S rRNA gene PCR/sequencing in pediatric patients. The assay is most likely to yield positive results in children with pleural effusion and in other fluid samples such as subdural and synovial fluid. Further implementation science research is needed to achieve impact on clinical practice. Disclosures Robin Patel, MD, a patent on Bordetella pertussis/parapertussis PCR issued, a patent on a device/method for sonication with royalties paid by Samsung to Mayo Clinic, a: See above|MicuRx Pharmaceuticals and BIOFIRE: Grant/Research Support|PhAST, Day Zero Diagnostics, Abbott Laboratories, Sysmex, DEEPULL DIAGNOSTICS, S.L., Netflix, Oxford Nanopore Technologies and CARB-X: Advisor/Consultant|Up-to-Date and the Infectious Diseases Board Review Course.: Honoraria

Abstract Background RSV is a common respiratory infection that causes significant morbidity in SOTR. However, risk factors for complications such as hypoxic respiratory failure, mechanical ventilation, and secondary infections have not been well described. Methods This retrospective, international, multicenter cohort study is actively recruiting SOTR hospitalized with RSV. Here, we analyzed data from Mayo Clinic (Rochester, Florida, Arizona), Miami Transplant Institute, Cleveland Clinic, and Royal Melbourne Hospital between 2016 and 2019. Secondary infection was defined as culture positive infection within 90 days of RSV diagnosis. Whenever appropriate, logistic and Cox regression analysis were conducted to identify risk factors. Survival functions were estimated using the Kaplan-Meier method.Figure 1:Forest plots of multivariable logistic regression models for risk factors for A) hypoxia, B) secondary infections, C) mechanical ventilation. Note: all variables included are the ones statistically significant on univariate analysis. Abbreviations: CI, confidence interval; OR, Odds ratio; LRTI: lower respiratory tract infection. Results 233 SOTRs (58.8% male; median, 61 years), including 77 (49.1%) kidney, 23 (9.9%) liver, 79 (33.9%) lung, and 38 (16.3%) heart transplants (Table). Hypoxic respiratory failure, mechanical ventilation, and secondary infection were seen in 98 (42.1%), 23 (9.9%), and 58 (24.9%) patients, respectively. After multivariate analysis, age >60 years, symptoms and imaging evidence of lower respiratory tract infection (LRTI) were associated with oxygen requirement (Figure 1A); similar results were observed in an analysis of the lung transplant cohort only. Risk factors on multivariate analysis for secondary infection include a history of rejection within six months and mechanical ventilation (Figure 1B). Risk factors for mechanical ventilation included age >60 years and LRTI on imaging (Figure 1C) after multivariate analysis. Seventeen (7.3%) patients died within 90 days of diagnosis. Cox univariate analysis identified age >60 years and LRTI on imaging, secondary infections, mechanical ventilation and hypoxia on admission were associated with higher mortality (Figure 2 and 3).Figure 2:Forest plot with Cox proportional hazards models. Note: only univariate results shown, multivariate not done due to low number of events. Conclusion This multicenter study of SOTR hospitalized with RSV identified older age ( >60 years old) as a risk factor for hypoxic respiratory failure, mechanical ventilation and death. Mechanical ventilation and a history if rejection within six months of RSV were associated with increased risk of secondary infections, identifying them as high-risk that needs close surveillance for this complication.Figure 3:Effects of A) Age older than 60 years old and B) mechanical ventilation on 90 day probability of survival after RSV infection Disclosures Michelle Yong, MBBS, FRACP, MPH, PhD, MSD: Grant/Research Support|MSD: Honoraria|Takeda: Advisor/Consultant Yoichiro Natori, MD, Eurofin/Viracor: Honoraria|Nobel Pharma: Advisor/Consultant

Abstract Background Studies aiming to synthetize data from literature are helpful to valid the robustness of associations, to assess the quality of the data, and, eventually, to propose recommendations. This is particularly evident for the huge amount of data reported for SARS-CoV-2. The aim of this study was to perform an umbrella review to identify the strength and validity of associations between variants of concern (VOCs) and pre-specified clinical outcomes in COVID-19 patients. Table 1 Effect size measures reported in the studies included in the review, divided by outcome. Acronyms: CI, confidence interval; OR: odds ratio; RR, risk ratio; cCFR, confirmed case-fatality risk; HFR, hospitalization-fatality risk; N/A, not available Methods An umbrella review according to the principles to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed searching multiple databases in January 2024. Peer reviewed systematic reviews considering ≥ 2 VOCs with a clinical outcome among death, hospitalization, severe disease, admission to intensive care unit (ICU), and mechanical ventilation were included. Data on study population and measures of association between clinical outcome and VOCs were considered. The quality of the studies was assessed through the AMSTAR-2 tool. The effect size measures with the confidence interval for each association between VOCs and clinical outcomes were reported. Subgroup analyses were performed, if possible. A citation matrix was used to assess the overlap between the systematic reviews included. Table 2 Risk of bias assessment of the included systematic reviews using the AMSTAR-2 score. In bold the key domains. Results A total of 11 studies were included in our review. 24 total comparison were considered, most regarding Omicron versus Delta (19/24), where Omicron was always associated with better clinical outcomes than Delta. The overall quality of the studies was low. None of the reviewed studies incorporated consideration of risk factors other than VOCs in evaluating clinical outcomes. The overlap between the included reviews is low, only 10% of them having a significant overlap ( > 15%). Conclusion Our umbrella review shows the lower hazard on human health of the Omicron compared to Delta variant. However, the quality of the reviews included were generally low and there is a lack of correction with other risk factors such as comorbidities and vaccination status. While our review provides valuable insights into the association between VOCs and clinical outcomes of SARS-CoV-2 infection, further research incorporating risk factor analysis and ensuring methodological rigor is warranted. Disclosures All Authors: No reported disclosures

Abstract Background SARS-CoV-2 vaccination has been shown to prevent severe disease and subsequent secondary infections in immunocompromised patients. This study assessed the rate of SARS-CoV-2 vaccinations among pediatric solid organ transplant (SOT) recipients at a single transplant center.Figure 1.SARS-CoV-2 vaccination status among pediatric solid organ transplant recipients for all ages and by age group. Methods We retrospectively reviewed medical records of pediatric recipients of heart, kidney, and liver transplants at Mayo Clinic, Rochester, MN between January 2011 and December 2023. All SARS-CoV-2 vaccine doses administered on or before April 1, 2024 were recorded. Up-to-date (UTD) status was based on current CDC recommendations for immunocompromised patients for each age group. Deceased patients, those no longer following at Mayo Clinic and whose vaccine records were unavailable were excluded. We also assessed whether patients had been seen by an ID physician in the year prior to collection stop date. Results The study included 136 patients: 48 kidney, 58 heart and 30 liver transplant recipients; 52.9% were male. Two patients subsequently received organs of a different type. Mean age was 16.1 years. Since authorization in 2020, 90 patients (66.2%) received at least one SARS-CoV-2 vaccine. This varied by age group, with 72.8% of > =12 year olds, 40.0% of 5-11 year olds and 62.5% of under 5 year olds (p = 0.007 [Figure 1]). Seventy-three patients (53.7%) completed at least three doses. Based on current recommendations that include the 2023-2024 formulation, 30 patients (22.0%) were UTD. This did not differ between age groups (p = 0.717) or by transplanted organ type (p = 0.21). Patients that saw ID were significantly more likely to be UTD (p = 0.001). Among partially immunized patients, 95% (n = 57) needed one additional dose to be UTD. Conclusion Despite simplified guidelines with fewer doses needed, a third of pediatric SOT recipients remain unvaccinated against SARS-CoV-2 and only 22% are UTD based on current recommendations. The proportion of unvaccinated patients was highest in the 5-11 year old age group and lowest in the oldest. Those that recently saw ID were significantly more likely to be UTD. Our data suggest that continued care provided by ID physicians may increase vaccine uptake, but reasons for undervaccination and strategies to counteract this should be further explored within this vulnerable population. Disclosures All Authors: No reported disclosures

Abstract Background Mycobacteirum Szulgai is a non-tuberculous mycobacterium known to cause human disease. Descriptions in the literature are limited to case reports and a larger case series from the Netherlands. Guidelines from the American Thoracic Society recommend that M. szulgai should always be considered pathogenic and that treatment should be based on in-vitro susceptibilities. Demographics and patient characteristics Methods We embarked on a retrospective study of adults ( >18 years) with M. szulgai infection at the Mayo Clinic sites in Arizona, Minnesota, and Florida. We queried the Mayo Clinic Database using two different search methods, (Advanced Text Explorer and the Mayo Data Explorer) using the terms ‘Mycobacterium Szulgai,’ ‘Mycobacteria Szulgai’,’ M. Szulgai’ and ‘Szulgai.’ Medical records from 1994 to 2023 were reviewed. Diagnostic studies Results Initial search yielded 43 patients. Twenty-seven patients were excluded (incomplete records or prior history of infection treated elsewhere). For our cohort of 16 patients, the mean age was 65 years [IRQ 57-74 years], 13 of those were caucasian. Five patients [31%] were immunosuppressed. Thirteen patients [81%] developed pulmonary infection, 5[31%] had extra pulmonary infection (2[12%] with disseminated disease and 3[19%] with extra-pulmonary disease without primary pulmonary infection). Only 8 [50%] patients received specific therapy. All treated patients met ATS criteria for NTM infections, while 3 [19%] untreated patient met criteria. Only 4 [25%] patient received therapy based on susceptibilities. The most common regimen was a combination of rifampin, ethambutol and macrolide in 5[31%] of the patients. Seven patients [47%] were cured, 4[27%] had ongoing symptoms, 1[7%] had relapse and 1 [7%] is currently receiving therapy. There were 2[ 13%] deaths in the untreated group and none from the treated group. One patient was lost to follow up. Treatment and outcomes Conclusion Our findings echo published literature and ATS recommendations that M. szulgai should be regarded as a true pathogen that necessitates targeted therapy. Disclosures All Authors: No reported disclosures

Abstract Background Little is known regarding outcomes for patients prescribed antibiotics on discharge from the hospital to nursing homes (NHs). We quantified the association between suboptimal antibiotic prescribing and clinical outcomes at discharge to NHs. Methods This was a multicenter, retrospective cohort study of adult (age >18 years) patients prescribed systemic antibiotics on discharge from 9 acute care hospitals in Oregon, Washington, and Wisconsin to a NH from 2016 – 2018. Study data were electronically extracted from hospital and NH electronic health records and supplemented with chart review. Suboptimal antibiotic therapy was determined by an infectious disease pharmacist or physician using clinical information (e.g., antibiotic regimen, indication, and culture results) available at discharge. Outcomes included emergency department (ED) visits, hospital readmissions, or Clostridioides difficile infection (CDI) within 30 days of hospital discharge. Comparison of outcomes between patients with suboptimal and non-suboptimal antibiotic therapy were tested by chi-squared tests. Results Among 280 included patients, mean (SD) age was 76.0 (11.5) years, 35.7% (n=100) were male, and median (IQR) inpatient length of stay was 6 (4-9) days. The most prevalent antibiotic indications were urinary tract infections (n =109, 38.9%), lung indications (n=60, 21.4%), and prophylaxis (n=29, 10.4%). Among 317 antibiotic prescriptions, the most frequently prescribed antibiotic classes were cephalosporins (n=83, 29.6%), fluoroquinolones (n=57, 20.4%), and beta-lactam/beta-lactamase-inhibitors (n=40, 14.3%). Fifty-eight patients (20.7%) were prescribed suboptimal antibiotic therapy on hospital discharge. There were no significant differences in the frequency of 30-day ED visits (14% vs 11%, p=0.76) or hospital readmission (19% vs 18%, p=0.94) between patients prescribed and not prescribed suboptimal antibiotics; however, suboptimal antibiotics were significantly associated with CDI within 30 days of discharge (10% vs 2%, p=0.01). Conclusion Suboptimal antibiotic prescribing on discharge to NHs was associated with increased risk of CDI within 30 days of discharge. This finding may inform interventions to improve antibiotic prescribing on discharge to NHs. Disclosures YoungYoon Ham, PharmD, Gilead: Honoraria Jon P. Furuno, PhD, Merck & Co., Inc: Grant/Research Support

Abstract Background Lung transplant recipients (LTRs) can experience hyperammonemia syndrome (HS) correlated with lung infection by ammonia-producing Ureaplasma species. HS in LTRs can be managed by Ureaplasma-directed antibiotic therapy; however, Ureaplasma species lack a cell wall, limiting treatment options. Precise guidelines for Ureaplasma-directed antibiotic therapy in LTRs is lacking, and antibiotic resistance may complicate treatment. Here, levofloxacin (LEV), azithromycin (AZM), and doxycycline (DOX) were tested against isolates of U. urealyticum and U. parvum with varying antibiotic resistance profiles, and efficacies compared.Fig 1.Antibiotic prophylaxis of murine infection by antibiotic resistant Ureaplasma isolates. Mice were prophylaxed with levofloxacin (LEV; 100 mg/kg SQ), azithromycin (AZM; 100 mg/kg PO), or doxycycline (DOX; 100 mg/kg IP) 12 hours prior to infection with isolates of Ureaplasma parvum or Ureaplasma urealyticum resistant to one or none of the antibiotics. 18 hours after infection, mice were sacrificed and lungs harvested, with resulting Ureaplasma loads quantified (color changing units: CCU). Control animals (CTRL) were given no antibiotics. Significance between groups was determined via Kruskal-Wallis tests with Dunn’s multiple comparison tests. * p ≤0.05, **p ≤0.01, ***p ≤0.001. Methods Mice were immunosuppressed using a combination of tacrolimus (1.2 mg/kg daily), mycophenolate mofetil (40 mg/kg daily), and methylprednisolone (20 mg/kg weekly) to mimic immunosuppression given to LTRs. Prophylactic antibiotics were given 12 hours prior to infection, including either LEV (100 mg/kg subcutaneously), AZM (100 mg/kg orally), or DOX (100 mg/kg intraperitoneally). Mice were then infected with Ureaplasma isolates resistant to one or none of the antibiotics, including U. parvum IDRL-10774 (fully susceptible), U parvum IDRL-10774R (IDLR-10774 with evolved AZM resistance; serial passage in sub-MIC AZM), U. parvum IDRL-11160 (LEV resistant), and U. urealyticum ATCC-33175 (DOX resistant). Mice were euthanized 18 hours post-infection, and lung bacterial loads (color changing units; CCU/gram) quantified. Results The effect of various antibiotic treatments against mouse lung infections with the four Ureaplasma isolates is displayed in Fig 1. Infection with IDRL-10774 (fully susceptible) and IDRL-11160 (LEV resistant) was only prevented by doxycycline (p=0.09 and p=0.01, respectively). For IDRL-10774, insignificant mean reductions (possibly due to a high standard deviation in the controls) were observed for both LEV (-106.9 CCU/g) and AZM (-105.25 CCU/g). IDRL-10774R (evolved AZM resistance) showed a complete loss of susceptibility to AZM compared to unevolved IDRL-10774. ATCC-33175 (DOX resistant) was not reduced by any antibiotics tested. Conclusion DOX was the most effective antibiotic tested, preventing lung infection by all isolates, except a DOX resistant isolate. Disclosures Robin Patel, MD, a patent on Bordetella pertussis/parapertussis PCR issued, a patent on a device/method for sonication with royalties paid by Samsung to Mayo Clinic, a: See above|MicuRx Pharmaceuticals and BIOFIRE: Grant/Research Support|PhAST, Day Zero Diagnostics, Abbott Laboratories, Sysmex, DEEPULL DIAGNOSTICS, S.L., Netflix, Oxford Nanopore Technologies and CARB-X: Advisor/Consultant|Up-to-Date and the Infectious Diseases Board Review Course.: Honoraria

Abstract Background Patients experiencing ≥1 recurrence of CDI are at elevated risk for subsequent recurrences and complications versus those with an initial CDI episode. Treatment selection for recurrent CDI (rCDI) is influenced by the number of recurrences a patient has experienced. Fecal microbiota spores, live-brpk (VOWST™; formerly SER-109, hereafter referred to as VOS for Vowst Oral Spores) is an oral microbiota-based therapeutic to prevent rCDI in adults with rCDI after antibacterial treatment for rCDI, thought to work by enabling rapid restoration of the microbiome. We report results from an integrated analysis of two Phase 3 trials to further describe safety/efficacy of VOS in patients, stratified by number of prior CDI recurrences. Methods The randomized, controlled ECOSPOR III trial enrolled 182 patients with ≥2 CDI recurrences, and the open-label, single-arm ECOSPOR IV trial enrolled 263 patients with ≥1 CDI recurrence. VOS was given as 4 capsules over 3 consecutive days after completing antibiotic treatment. Treatment-emergent adverse events (TEAEs) were collected through Week 8 after VOS; serious TEAEs/AEs of special interest were collected through Week 24. Efficacy endpoint included rCDI (toxin-positive diarrhea requiring treatment) through Week 8. Results A total of 77 patients had 1, 150 patients had 2, and 121 patients had ≥3 prior CDI recurrences; incidence of TEAEs was 44%, 70%, and 67%, respectively (Table 1). No serious TEAEs, TEAEs of special interest, or TEAEs leading to study withdrawal were considered related to VOS by investigators. TEAEs in ≥15% of patients with 1, 2, or ≥3 prior CDI recurrences were flatulence (6%; 29%; 29%), abdominal pain (6%; 27%; 16%), fatigue (1%; 26%; 20%), abdominal distension (3%; 22%; 20%), and diarrhea (27%; 21%; 23%). On-study recurrence rate through Week 8 in the overall population was 9.5% (95% CI: 6.6%–13.0%); in those with 1 or multiple (≥2) CDI recurrences, rates (95% CI) were 6.5% (2.1%–14.5%) and 10.3% (7.0%–14.6%), respectively. Conclusion This integrated analysis confirms VOS was well tolerated and rCDI rates were low/consistent in patients, regardless of the number of CDI recurrences. Results suggest VOS may be considered in patients with rCDI, regardless of the number of prior CDI recurrences. Disclosures Matthew Sims, MD, PhD, Adaptive Phage Therapeutics: Grant/Research Support|Applied Biocode: Advisor/Consultant|Applied Biocode: Grant/Research Support|Astra Zeneca: Grant/Research Support|Biotest AG: Grant/Research Support|ContraFect: Grant/Research Support|Janssen: Grant/Research Support|Leonard-Meron Biosciences: Grant/Research Support|Novozyme: Grant/Research Support|OpGen: Advisor/Consultant|OpGen: Grant/Research Support|Pfizer: Grant/Research Support|Prenosis: Advisor/Consultant|Prenosis: Grant/Research Support|QIAGEN: Grant/Research Support|Seres: Advisor/Consultant|Seres: Grant/Research Support|Summit Therapeutics: Grant/Research Support|Venatorx: Advisor/Consultant Colleen S. Kraft, MD, MSc, Ferring: Advisor/Consultant|Seres: Advisor/Consultant Lisa von Moltke, MD, Cara Therapeutics: Board Member|Cara Therapeutics: Stocks/Bonds (Public Company)|Seres Therapeutics: Employee|Seres Therapeutics: Stocks/Bonds (Public Company) Brooke Hasson, PhD, Seres Therapeutics: employee|Seres Therapeutics: Stocks/Bonds (Public Company) Maximilian von Eynatten, MD, Nestlé Health Science: Employment Darrell Pardi, MD, AMT, Inc: Grant/Research Support|Boehringer Ingelheim: Grant/Research Support|Exe GI: Grant/Research Support|Immunic: Advisor/Consultant|Lilly: Advisor/Consultant|Rise Therapeutics: Advisor/Consultant|Rise Therapeutics: Grant/Research Support|Seres Therapeutics: Advisor/Consultant|Seres Therapeutics: Expert Testimony|Vedanta: Advisor/Consultant|Vedanta: Grant/Research Support

Abstract Background Drug-resistant E. coli is a leading cause of antimicrobial resistance-associated deaths globally. Specifically, resistance to ceftriaxone (CRO-R) is increasing in E. coli. High-risk clonal group ST131 and its pandemic H30 subclone are of high concern yet studies characterizing these infections are limited. We evaluated baseline characteristics and clinical outcomes associated with H30 ST131, non-H30 ST131 and non-ST131 E. coli bloodstream infections (BSI). Methods Patients with monomicrobial carbapenem-susceptible E. coli BSI that were matched 1:1 by study site (CRO-R and CRO-susceptible community-acquired and hospital onset cases) were prospectively enrolled from 14 United States hospitals between November 12, 2020 to April 28, 2021 in the multicenter Study of Highly Resistant E. coli (SHREC). Isolates underwent whole genome sequencing. The primary outcome was a 30-day Desirability of Outcome Ranking (DOOR) after index culture including clinical response to treatment and all-cause mortality. Results There were 92 (33%) H30 ST131, 29 (10%) non-H30 ST131, and 161 (57%) non-ST131 isolates in 282 E. coli BSI (Table 1). Most ceftriaxone resistance was conferred by CTX-M-15 produced by H30 ST131 isolates (Figure 1, Table 1). H30 ST131 BSI patients were older (median age [IQR] 70.5 [63,76] vs. 67 [56,77] vs 65 [51,74] years, p = 0.017), had higher Charlson comorbidity indices (3 [2,5] vs. 2 [1,4] vs. 2 [1,4], p=0.009), and were more often admitted from long-term care facilities (18/92 [20%] vs. 3/29 [10%] vs. 7/161 [4%], p = 0.003) compared to non-H30 ST131 and non-ST131 BSI patients. Among H30 ST131 isolates, high rates of antibiotic resistance were observed to cephalosporins and fluoroquinolones, resulting in significantly more carbapenem use compared with non-H30 ST131 and non-ST131 isolates (75/92 [82%] vs. 14/29 [48%] vs. 50/161 [31%], p < 0.001) (Figure 2). 30-day DOOR and hospital length of stay did not differ between groups (Table 2). Conclusion Compared with non-H30 ST131 and non-ST131 E. coli BSI, H30 ST131 E. coli BSI have a unique epidemiology with more healthcare exposures, comorbidities and antibiotic resistance and are more likely to be treated with carbapenems, though no significant difference in clinical outcomes was observed. Disclosures Yohei Doi, MD, PHD, AbbVie: Honoraria|Entasis: Grant/Research Support|Gilead: Advisor/Consultant|GSK: Advisor/Consultant|Meiji Seika: Advisor/Consultant|Moderna: Advisor/Consultant|Pfizer: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Honoraria Elie Saade, MD, MPH, FIDSA, Janssen Global Services: Advisor/Consultant|Janssen Global Services: Advisor/Consultant|Janssen Research and Development: Advisor/Consultant|Janssen Research and Development: Advisor/Consultant Loren G. Miller, MD MPH, Armata: Grant/Research Support|Contrafect: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Paratek: Grant/Research Support Michael J. Satlin, MD, AbbVie: DSMB participant|bioMerieux: Grant/Research Support|Merck: Grant/Research Support|Selux Diagnostics: Grant/Research Support|SNIPRBiome: Grant/Research Support W. Charles Huskins, MD, MSc, ADMA Biologics: Advisor/Consultant|Bristol Myers Squibb: Stocks/Bonds (Public Company)|Pfizer: Advisor/Consultant|Pfizer: Stocks/Bonds (Public Company)|Zimmer Biomet: Stocks/Bonds (Public Company) Carol Hill, PhD, Glaxo SmithKline: Retirement Health, Cash Balance Plan|Glaxo SmithKline: Stocks/Bonds (Public Company) Robin Patel, MD, a patent on Bordetella pertussis/parapertussis PCR issued, a patent on a device/method for sonication with royalties paid by Samsung to Mayo Clinic, a: See above|MicuRx Pharmaceuticals and BIOFIRE: Grant/Research Support|PhAST, Day Zero Diagnostics, Abbott Laboratories, Sysmex, DEEPULL DIAGNOSTICS, S.L., Netflix, Oxford Nanopore Technologies and CARB-X: Advisor/Consultant|Up-to-Date and the Infectious Diseases Board Review Course.: Honoraria Vance G. Fowler, MD, MHS, Affinergy: Advisor/Consultant|ArcBio: Stocks/Bonds (Private Company)|Armata: Advisor/Consultant|Astra Zeneca: Advisor/Consultant|Astra Zeneca: Grant/Research Support|Basilea: Advisor/Consultant|Basilea: Grant/Research Support|ContraFect: Advisor/Consultant|ContraFect: Grant/Research Support|Debiopharm: Advisor/Consultant|Destiny: Advisor/Consultant|EDE: Grant/Research Support|Genentech: Advisor/Consultant|Genentech: Grant/Research Support|GSK: Advisor/Consultant|Janssen: Advisor/Consultant|Karius: Grant/Research Support|MedImmune: Grant/Research Support|Merck: Grant/Research Support|sepsis diagnostics: Patent pending|UptoDate: Royalties|Valanbuio: Stocks/Bonds (Private Company)|Valanbuio: Stocks/Bonds (Private Company) David van Duin, MD, PhD, Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Qpex: Advisor/Consultant|Roche: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support

Abstract Background Although infectious diseases present significant challenges in pediatric care, formal training in pediatric infectious diseases is not mandated in categorical pediatric residency training. This research seeks to examine the self-assessed confidence levels of general pediatric residents in Washington DC in managing common infectious diseases. The study specifically compares the confidence levels of residents who have undergone elective infectious diseases training with those who have not. Subjective Confidence in the Management of Common Infectious Diseases Encounters Methods A cross-sectional study was conducted using voluntary surveys distributed among pediatric residents from various programs in Washington DC. The surveys aimed to assess subjective confidence levels in managing common infectious disease conditions and to explore motivation to pursue infectious disease training. Effect of infectious diseases elective rotation on interest in infectious diseases as a career. Are you more or less likely to pursue infectious diseases fellowship? Results Analysis of 20 completed surveys revealed that residents who completed infectious diseases rotations demonstrated significantly higher confidence levels in managing infectious disease conditions compared to their counterparts (P: < 0.001). Notably, residents with specialized training showed increased confidence in antibiotic selection and in their diagnostic abilities. Additionally, they exhibited enhanced confidence in managing specific presentations such as sexually transmitted diseases, fever of unknown origin, and central nervous system infections (all with P < 0.05). Finally, 22% of respondents expressed an increased likelihood of pursuing a career in infectious diseases following their rotation. Effect of infectious diseases rotation on the confidence in the management of inpatient and outpatient infectious diseases encounters Conclusion These findings underscore the potential benefits of incorporating infectious diseases rotations into pediatric residency programs, as evidenced by improved skills in antibiotic selection, diagnosis, and management of specific infectious disease scenarios. Additionally, the observed increased interest in pursuing a career in infectious diseases among a subset of residents highlights the positive impact of such training on career trajectory and specialty choice. Investigators plan to distribute the questionnaire more broadly across the US to see if these results are more widespread. Disclosures All Authors: No reported disclosures