bluuebunny/crossref_metadata_2025 huggingface dataset:
P-183. Barriers and Facilitators to Identifying and Treating Neonatal Sepsis in Ethiopia
Authors: Avanzato Victoria A , Ujari Ogorchi , Yizengaw Behayilu , McCann Conor , Tibeje Hiwot , Gobezayehu Abebe , Cranmer John , Hall-Clifford Rachel , Zerihun Senay , Rule Amy
Published: January 2025

Background

Neonatal sepsis is a major cause of death of children under the age of 5 years globally and in Ethiopia. The high mortality associated with neonatal sepsis is especially pronounced in low-birth weight infants (LBW). Antimicrobial resistance (AMR) further contributes to high mortality. Many hospitalized LBW newborns with sepsis are admitted to NICUs but mortality remains high, partly due to increasing AMR but also due to delayed identification and treatment. Thus, evaluating and describing the existing barriers to sepsis diagnosis and management is urgently needed. This may guide targeted innovations to predict, diagnose, and treat neonatal sepsis earlier and avert newborn deaths.

Methods

Utilizing structured chart review and focus groups we conducted a convergent mixed methods study evaluating facilitators and barriers to early identification and care of neonates admitted with sepsis to the neonatal intensive care unit at Tibebe Ghion Specialized Hospital in Bahir Dar, Ethiopia.

Results

6 resident physicians and 6 nurses participated in 2 focus groups, and 142 charts were reviewed. Chart review revealed that infants with documented warning signs (such as fast breathing or failure to suck) begin an empiric course of ampicillin and gentamycin. Further diagnostic workup is often limited, and blood cultures are rarely performed. Qualitative interviews reenforced and expanded these results. Key barriers identified included limited physical resources (monitoring equipment, laboratory capacity, and imaging) and personnel barriers (limited staffing, low morale, and frequent staff transfer). Primary facilitators included understaffing, retention of experienced staff, and access to necessary equipment and diagnostics.

Conclusion

Even in a higher-level hospital in Ethiopia, neonatal sepsis is challenging to identify due in part to limited diagnostic capacity and understaffing. The absence of cultures and sensitivities and other diagnostics present barriers to early identification and targeted treatment. Future studies could focus on interventions to expand lab capacity and diagnostics, including point of care diagnostics for sepsis or AMR, capacity building of neonatal nursing, and expansion of access to low-cost vital sign monitoring.

Disclosures

All Authors: No reported disclosures
P-187. Clinical Profile of Atypical Manifestations of Dengue Fever and Severe dengue fever in children in Argentina
Authors: Juarez Ximena S , Beatriz Miño Laura , Sevilla Eugenia , Aprea Valeria , Fernanda Gonzalez Maria , Bokser Vivian , Haleblian Emilce , Jose Rial maria
Published: January 2025

Background

The clinical presentation of dengue fever has a wide spectrum; unussual manifestations have been reported and with the rising disease burden, atypical manifestations are also on rise, but are underreported and often missed due to the lack of awareness among health care professionals. In Argentina we are witnessing the largest historical outbreak of dengue in 2024.

The objective of the study is to study the clinical profile and outcome of atypical and severe manifestations of dengue fever in children.

Methods

All children (0–18 y of age) confirmed as dengue fever at a tertiary care hospital at Buenos Aires, Argentina between January 2023-April 2024 were reviewed retrospectively from hospital case records. The diagnosis was confirmed by NS1 antigen/IgM based ELISA or inmunocromatography test, PCR. The data was analyzed using EpiInfo 7.2

Results

Out of 213 children admitted with dengue fever, 7 % had severe dengue. Atypical manifestations were seen in 37 cases ( 17 %). Mean age of presentation was 6.5 (5.2) y. M: F ratio was 1.1:1. The common manifestations of severe dengue infection were shock (80 %), bleeding (20 %) and multi organ dysfunction (6 %).

The most common atypical manifestations of dengue fever were hepatitis (19%), seizures (8 %), acalculous cholecystitis (8%), myositis (8%),pneumonia (8%), febrile infant without focus (8%), febrile diarrhea (19 %). The other atypical manifestations present were ataxia, meningitis, acute respiratory distress syndrome (ARDS), myocarditis, lymphadenitis, prolonged fever, pericardial and pleural effusion. There was one death (0.4 %).

Conclusion

The atypical manifestations of dengue fever are no more a rare entity. Clinicians should have a high index of suspicion and surveillance for atypical manifestations of dengue fever as lack of timely detection and management could be fatal.

Disclosures

All Authors: No reported disclosures
P-188. The Potential Impact of Vaccination on Clade I Mpox Cases in the Democratic Republic of Congo, and Risk of Importation to the United States from International Travel
Authors: Riyaz Zainab , Mortensen Peter , Cutler Samuel , Maguire Thomas , Linley Matt , Buchanan Jacqueline
Published: January 2025

Background

The mpox public health emergency of international concern that emerged in 2022, driven by clade IIb mpox infections in high-income nations, was declared over by the WHO in May 2023, while the more virulent clade I mpox, continues to spread endemically in Central Africa. In November 2023, the Democratic Republic of Congo (DRC) reported its highest ever annual clade I mpox cases, reaching 12,569 with a 4.6% case fatality rate (CFR). The DRC lacks rollout of approved mpox vaccines but has two vaccine trials among healthcare personnel ongoing. The US saw a 78% increase in clade IIb incidence in the first 11 weeks of 2024 compared to the same period in 2023. Only 25% of the eligible US population has completed the two-dose vaccine regimen; waning immunity may leave the population more susceptible to clade I infection should it be imported. Travel is increasing from the DRC and the Congo to the US, particularly within the past year, highlighting the need for enhanced surveillance and vaccination.

Methods

Three vaccination scenarios for the DRC, beyond the baseline of no vaccines received, were built: 1) vaccinating the public who have not received the smallpox vaccine, 2) vaccinating the high-risk GBMSM (gay, bisexual and other men who have sex with men) population aged 18-40 years and 3) vaccinating children, another high-risk group. Direct and indirect international travel volumes from the DRC to the US were analysed and forecasted to assess risk of the introduction of clade I in the US.

Results

Our data suggest that if clade I mpox spreads similarly to clade IIb in 2022, the expected death toll could be > 5000 deaths globally (CFR 5.69%) and ∼ 1800 in the US. A GBMSM-targeting vaccine campaign could avert ∼ 9000 infections and > 250 deaths in the DRC. The number of travellers from the DRC to the US is forecasted to reach a high of > 5600 passengers between April-August 2024, with indirect travel also posing a risk. The top three countries with travel to the US include the UK, France and India; France sees the highest levels of travel from the Congo and the DRC, increasing the risk of onward clade I transmission if an introduction were to occur.

Conclusion

Vaccinating the GBMSM in the DRC could significantly reduce infection rates and reduce the clade I risk posed to nations, such as the US, via international travel.

Disclosures

All Authors: No reported disclosures
P-199. Implementation of a Diagnostic Stewardship Initiative for Hospital Onset Clostridioides difficile Infection
Authors: Bettger Caitlin , Thompson Bernadette , Kiley John L , Townsend Lisa
Published: January 2025

Background

In response to increasing hospital onset CDI (HO-CDI), our Infection Prevention and Control (IPAC) Program undertook a diagnostic stewardship initiative with the goal of improving diagnostic accuracy of HO-CDI at our institution.

Methods

Data acquisition was performed at a single center hospital with 425 inpatient beds as part of hospital surveillance. HO-CDI was defined by the National Health Surveillance Network (NHSN) definitions. A total of 18 months were examined (1/1/23 – 3/31/24). On 11/1/23, the IPAC Program in coordination with the Microbiology Laboratory began suppressing the results for C. difficile on the multiplex Gastrointestinal PCR with the goal of prompting providers to consider pre-test probability of diagnosis and order each PCR separately. Data was compared 10 months prior to implementation and 5 months after implementation. Groups were compared by Fisher exact for categorical variables and Mann-Whitney U for continuous variables.

Results

A total of 82 C. difficile PCR positive tests that met NHSN definitions for HO-CDI were recorded in the study period (Table 1). Of these, 13% of patients were deemed to have met testing criteria (≥3 bowel movements in a 24hr period, no tube feeds or laxatives in the preceding 24hrs). The most common potential disqualifier for testing was not meeting adequate number of bowel movements (47/82, 57%), followed by laxative use and tube feeds (44% and 28% respectively). Of all the positive tests, 9 (11%) were polymicrobial and none of the patients who had polymicrobial infections met testing criteria. The percentage of positive results coming from combined multiplex PCR and C. diff alone PCRs decreased after the intervention with 56% of positives being secondary to combined testing prior to the intervention compared to 32% after the intervention (p=0.078) (Fig 1). Median number of HO-CDI per month decreased after the intervention period along with the NSHSN standard infection rate (Fig 2).

Conclusion

Suppression of C. difficile results on multiplex Gastrointestinal PCR resulted in a decrease in this facility’s standard infection ration (SIR) for HO-CDI. Over three quarters of patients with positive results did not meet stool submission criteria. This has implications for possible next step educational initiatives.

Disclosures

All Authors: No reported disclosures
P-213. Nurse Experiences with a Universal Gloving Intervention to Prevent Clostridioides difficile Infection: A Qualitative Study
Authors: McKinley Linda , Keating Julie , Dolan Katherine , Moriarty Helene , Ray Cara E , Safdar Nasia
Published: January 2025

Background

Gloving is recommended for healthcare workers caring for patients with C. difficile infections, however, the effectiveness of gloving for all patient contact (universal gloving) to prevent transmission from patients with asymptomatic C. difficile colonization is unknown. We conducted a clinical trial to evaluate a universal gloving intervention to prevent C. difficile acquisition among patients in VA acute care settings. We interviewed nurses at participating sites to understand their experiences with the intervention.

Methods

We conducted 8 interviews and 4 focus groups across five participating intervention units at VA hospitals; 23 nurses participated in interviews and focus groups. We used a semi-structured interview guide to ask about the healthcare worker experience with universal gloving; facilitators and barriers to universal gloving; universal gloving impacts on hand hygiene, patient care, and workload; perceived patient experience with healthcare worker gloving; and perceived fidelity with the intervention. Interviews were audio recorded and transcribed, and we used rapid qualitative inquiry methods to analyze transcripts.

Results

Participants reported that gloving was already a standard practice, and universal gloving was easier to expand as an existing practice rather than launching a new practice. Reported fidelity was mixed; some participants reported that gloving was unnecessary for some tasks and difficult to do 100% of the time such as when not having patient contact. Facilitators to universal gloving included providing demonstrated benefit to outweigh burdens, demonstrating leadership support, engaging full healthcare teams including other departments, and ensuring appropriate signage and glove availability. Barriers to universal gloving included role-dependent variation in awareness and compliance, communication across roles, and impacts to patient care such as with tactile tasks and emergency responses.

Conclusion

While universal gloving did not require major changes to nurse workflow or training because of its use for standard and transmission-based precautions, there were increased role- and task-dependent barriers to implementation of universal gloving for all patient contact.

Disclosures

All Authors: No reported disclosures
P-214. Primary Prophylaxis for Clostridioides difficile Infection in Lung Transplant Recipients: A Retrospective Study
Authors: Irwin Mark , Leedy Nicole , Nandavaram Sravanthi , Soria Jaime , Myint Thein
Published: January 2025

Background

There is a paucity of data supporting primary prophylaxis for Clostridioides difficile infection (CDI) in lung transplant recipients (LTRs). We aimed to determine if the incidence of CDI is reduced in LTRs receiving primary prophylaxis.

Table 1

Comparison of clinical characteristics of lung transplant recipients between the two groups.

Methods

A retrospective chart review of all lung transplants from January 2020 to May 2023 was conducted at our institution. CDI was defined as diarrhea with a positive PCR test for the toxin B gene. Primary prophylaxis for CDI at the time of lung transplantation was defined as any use of either oral vancomycin or oral metronidazole in an LTR who received broad-spectrum antibiotics without any history of prior CDI. The incidence of CDI in LTRs was compared between the group with primary prophylaxis and the group without prophylaxis.

Results

Of 92 eligible LTRs, 41 (44.6%) did not receive primary prophylaxis, and 51 (55.4%) received either oral vancomycin (n=45) or oral metronidazole (n=8). The median duration of primary prophylaxis was 23 days (Table1). The median duration of systemic antibiotics was 19 days in the prophylaxis group and 15 days in the no prophylaxis group (p=0.027). Clostridioides difficile testing was done in 55 (60.4%) patients within one year after lung transplantation. Three patients had CDI within three months, and one patient had CDI at eight months after lung transplantation.

The incidence of CDI within one year after lung transplantation was 8.1% (3/37) in the prophylaxis group compared to 5.6% (1/18) in the no prophylaxis group based on the Clostridioides difficile testing (p=0.60). The incidence would be lower if the LTRs who were not tested for Clostridioides difficile due to a lack of concern were included with those who tested negative. All-cause mortality was higher in the prophylaxis group compared to the no prophylaxis group (41.2% vs 19.5%; p=0.041).

Conclusion

Fifty-five percent of LTRs (51/92) received primary CDI prophylaxis, mainly oral vancomycin, at the time of lung transplantation. LTRs who required a longer duration of broad-spectrum antibiotics were more likely to receive primary prophylaxis. There was no difference in the incidence of CDI regardless of primary prophylaxis in LTRs. Our data do not support the use of primary prophylaxis in LTR to reduce incidence of CDI.

Disclosures

All Authors: No reported disclosures
P-222. Emergence and dissemination of Clostridioides difficile isolates with reduced fidaxomicin susceptibility in an acute care hospital
Authors: Redmond Sarah N , Cadnum Jennifer , Jencson Annette , Choi Hosoon , Hwang Munok , Chatterjee Piyali , Jinadatha Chetan , Donskey Curtis
Published: January 2025

Background

Despite increasing use of fidaxomicin for Clostridioides difficile infection (CDI), isolates with reduced susceptibility (minimum-inhibitory concentration [MIC] >2 ug/mL) have been rare in surveillance studies. However, there has been recent reports of clinical isolates with reduced susceptibility associated with mutations in the RpoB and RpoC genes coding for the RNA polymerase target of fidaxomicin. The clinical implications of reduced susceptibility are uncertain because fidaxomicin achieves high concentrations in the intestinal tract.

Whole genome sequencing analysis demonstrating that isolates from 3 patients (patients 1, 3, and 4) infected with ribotype 097 strains (sequence type [ST] 21) are genetically related (<2 single nucleotide polymorphism differences) suggesting patient-to-patient transmission

ST21 = Ribotype 097; ST2 = Ribotype 014-020

Methods

During a 3-year period, patients treated for CDI in an acute care hospital were assessed for recurrence and fidaxomicin treatment failure, defined as persistent symptoms and culture positivity after >10 days of fidaxomicin treatment without an alternative explanation. Serial stool samples from these patients were cultured for C. difficile confirmed by MALDI-TOF. Susceptibility testing was performed by agar dilution. Whole genome sequencing (WGS) was performed to determine relatedness of the isolates (genetically related: <2 single nucleotide polymorphism differences) and to identify mutations associated with reduced fidaxomicin susceptibility.

Results

Among 115 patients treated with fidaxomicin, there were 20 (17%) recurrences and 3 (2.6%) treatment failures. In 2 of the patients with treatment failure, initial C. difficile isolates were susceptible to fidaxomicin but genetically related isolates with reduced susceptibility (MIC >16ug/mL) associated with distinct mutations in rpoB (V1143G) and rpoC (R89G) emerged. The patient with the rpoC mutation had recurrent hospital admissions and maintained carriage of the isolate with reduced susceptibility over a 3-year period. Three additional patients were infected with C. difficile isolates with fidaxomicin MICs >8 ug/mL, including 2 patients with sequence type 21 (ribotype 097) isolates genetically related to the treatment failure isolate with the rpoC mutation (Figure).

Conclusion

Emergence of C. difficile isolates with reduced fidaxomicin susceptibility may play a role in some cases of fidaxomicin treatment failure. Our findings suggest that patient-to-patient transmission could lead to dissemination of isolates with reduced fidaxomicin susceptibility.

Disclosures

Curtis Donskey, MD, Clorox: Grant/Research Support|Pfizer: Grant/Research Support
P-237. The CLABSI (Central Line Audit by Staff Investigators) Intervention: Reducing Central Line Use in a Medical ICU using Physician-Led Prospective Audit and Feedback of Catheter Necessity
Authors: Dekitani Ken , Ben-Aderet Michael , Madhusudhan Meghan
Published: January 2025

Background

Prompt removal of unnecessary central lines has been associated with reduction in central line associated bloodstream infections (CLABSI). Following the COVID-19 pandemic, sustained increases in central line utilization and CLABSI were seen at our medical ICU (MICU). Here we present a quality improvement intervention of a weekly physician-led audit and feedback to reduce central line utilization.

Methods

The intervention was conducted in the MICU at a single tertiary-care hospital from June 2023 to February 2024. Once weekly, 2 physicians did an electronic medical record audit of all central lines. Line necessity was defined as requiring one or more of the following: irritant medication use, renal replacement therapy, hemodynamic monitoring, total parenteral nutrition, or inability to obtain peripheral access. Lines for renal replacement therapy (HD lines) were excluded from evaluation as they were medically necessary by definition. Once an unnecessary line was identified, the primary ICU fellow and attending were sent a text message prior to morning rounds to recommend removal. Central line removal rates and patient demographic data were collected from June 2023 to February 2024. Data on central line utilization and CLABSI rates were collected from July 2023 to December 2023 and compared to data from January 2022 to June 2023.

Results

365 patients and 447 central lines were reviewed. 49 (11%) central lines were deemed unnecessary and removal recommended, of which 26 (53%) were removed within 24 hours. The central line device utilization ratio (DUR) in line days per patient days decreased by 20%, from 0.48 to 0.38 [p = < 0.0001]. When HD lines were included, we observed a reduction in DUR by 8%, from 0.61 to 0.56 [p = < 0.0001]. The CLABSI National Healthcare Safety Network Standardized Infection Ratio (SIR) pre-implementation was 2.84 and post-implementation was 2.83 [p = 1.00].

Conclusion

A physician-led, once weekly prospective audit and feedback of central line necessity led to a substantial decline in central line utilization rates in our medical ICU. There was no observed reduction in CLABSI SIR, however this may be due to the short intervention period and low incidence rate of CLABSI; over time it would be expected that a reduction in central line days would lead to a reduction in CLABSI.

Disclosures

All Authors: No reported disclosures
P-261. Physician Attitude on Stethoscope Sanitization: A Quality Improvement Project
Authors: Chang Lin , White Cilian J
Published: January 2025

Background

Literature has demonstrated that stethoscopes can harbor pathogenic bacteria (Staphylococcus aureus, Pseudomonas aeruginosa, vancomycin-resistant Enterococci and Clostridium difficile) and act as vectors of infection transmission between patients. Although it seems most healthcare professionals are aware of the potential of stethoscopes to transmit infections, the practice of stethoscope cleaning varies widely and is often not up to standard recommendations. This QI project aims to determine current stethoscope sanitization practices at our hospital, Morristown Medical Center (MMC), barriers that prevent more frequent cleaning, and whether education and easier access to sanitization methods changes practices of providers.

Figure 1: Frequency of stethoscope sanitization pre- and post-intervention

Methods

Participants (physicians at MMC) were asked to complete a pre- and post-intervention survey about their stethoscope cleaning practices and barriers to more frequent cleaning. Intervention consisted of physician education and placement of alcohol wipes at physician workspaces for 3 weeks.

Figure 2: Obstacles to stethoscope sanitization

Results

Of the 35 responses from the pre-intervention survey, 97% believed stethoscopes harbor harmful bacteria. 17% of physicians sanitized their stethoscopes after every patient encounter, 37% every day, 34% every week and 11.5% less than every week (Figure 1). Barriers to more frequent stethoscope cleaning included: inaccessibility of alcohol wipes (62.9%), difficult to remember (51.4%), too time-consuming (45.7%), and other (22.9%) (Figure 2). Post-intervention survey (25 responses) showed an increase from 17% to 48% for physicians that sanitize after every patient encounter. More importantly, 96% of participants agreed they would implement better stethoscope sanitization practices going forward.

Conclusion

Physicians are aware of the potential for stethoscopes to harbor bacteria and transmit infections, however, their stethoscope cleaning practices do not necessarily align with this knowledge, with only 17% sanitizing after every patient encounter. Allowing easier access to alcohol wipes as well as physician education served to increase frequency of stethoscope sanitization overall. Our conclusion is that ongoing education and reminders can help improve overall stethoscope sanitization practices in the hospital.

Disclosures

All Authors: No reported disclosures
P-270. Effects of Suppressed Susceptibilities on CRE Case Identification in Clinical Settings in Tennessee, 2016–2022
Authors: Daniel Lauren , Gambrell Ashley , Patel Dipen , Villegas Raquel , Muleta Daniel
Published: January 2025

Background

Carbapenem-resistant Enterobacterales (CRE) are multi-drug resistant organisms (MDRO) often spread in healthcare settings and reported as urgent public health threats by the Centers for Disease Control and Prevention (CDC). Antibiotic susceptibility testing (AST) is often performed, but some results get suppressed to encourage antibiotic stewardship. Tennessee participates in the Multi-site Gram-negative Surveillance Initiative (MuGSI) for CREs in Davidson and seven other surrounding counties. We evaluated the effect of suppression on the clinical identification of CREs in Tennessee.

Methods

Cases reported to MuGSI from 2016­–2022 were analyzed for case determination differences based on AST result interpretations between laboratory reports obtained from instrument and laboratory reports in the medical record. A CRE case was defined as E. coli, Enterobacter cloacae complex, or Klebsiella species resistant to one or more carbapenems and isolated from urine or a normally sterile site, from a resident of the catchment area. Doripenem is excluded from the susceptibility panel in most facilities, and thus not included in analysis. Data analysis was performed using SAS Version 9.4

Results

From 2016–2022 there were 570 cases of CRE, 32% male, 68% female and a mean age of 66 years. Among 570 reported cases, 407 (∼71%) were found to meet the case definition in both the reports obtained from laboratory instrument and reports in medical records. The remaining 163 (∼29%) of cases were found to be CRE based on reports from laboratory instrument but had no AST results for the carbapenems for clinicians in the medical record. The most suppressed carbapenem was imipenem (387), followed by ertapenem (148), and meropenem (119).

Conclusion

Approximately 29% of CRE cases in our data had AST result suppressed or a lack of AST results available in the medical record. Although lack of complete AST results does not preclude the clinician being aware of CRE status, it may result in additional difficulty treating a pathogen with few treatment options. Suppression can lead to better antibiotic stewardship, but MDROs often have complex treatment requirements with high morbidity and mortality for patients. More research is needed to determine the value of suppression as it relates to CREs and MDROs.

Disclosures

All Authors: No reported disclosures
P-278. Emerging Threat: Rising Incidence and Antimicrobial Resistance of Serratia marcescens in a Guatemalan Intensive Care Unit
Authors: Barrios Andrea , Elisa Rosales Ana , Orozco Jarleny , Pezzarossi Franco , Valenzuela Laura , Rodriguez Luis , Erdmenger Diego
Published: January 2025

Background

Serratia marcescen, a gram-negative bacillus, is an important pathogen associated with hospital acquired infections. It ranks as the 5thmost common Gram-negative organism in Intensive Care Units infections globally. With a global case-mortality of 2.8%, Serratia marcescens poses a substantial threat to healthcare systems.

The use of broad-spectrum antibiotics has led to increased antimicrobial resistance among Serratia strains. Rates of ESBL-producing isolates of Serratia have been reported ranging from 6-24% of all strains, in low- and middle-income countries.

This study evaluates the incidence and resistance patterns of Serratia isolates in Guatemala City.

Methods

An ecological study was conducted at an intensive care unit from a third-level reference hospital in Guatemala City from 2022 to 2023. All microbiologic isolates of Serratia Marcescens were included, and antimicrobial resistance was determined through the use VITEK® MS (Maldi Tof) and VITEK® 2 systems. Antimicrobial resistance patterns were identified according to the Clinical and Laboratory Standard Institute (CLSI) guidelines. GyrA/ParC phenotype was inferred through resistance to fluoroquinolones.

Results

A total of 20 isolates of Serratia were identified in 2022 and 49 in 2023. The majority of strains were isolated from respiratory samples (81.15%). There was a significant increase in Serratia positivity rates (4.72 vs 9.06 per 1000 cultures) and incidence of Serratia isolates (24.75 vs. 94.59 per 1000 admissions) from 2022 to 2023.

An increase in antimicrobial resistance was observed between 2022 and 2023. In 2022, 70% of strains where susceptible, and 20% showed only one mechanism of resistance. Conversely, in 2023, only 6% of strains where susceptible and over 57% presented more than one mechanism of resistance. An increase in inferred GyrA/ParC (5% vs 83.6%) and confirmed ESBL (0% vs 36.7%) phenotypes were observed.

Conclusion

An increased use of antimicrobials in the ICU may be associated with the sudden and alarming rise in resistance in Serratia isolates. The clinical impact of these ecological changes is yet to be determined.

The escalating incidence and resistance of S. marcescen in Guatemala City highlights the urgency for enhanced surveillance and antimicrobial stewardship programs.

Disclosures

All Authors: No reported disclosures
P-279. An Online Registry of Carbapenemase Producing Gram Negative Organisms for Evaluating the Clinical Profile, Outcomes and Mechanisms of Resistance in Two Tertiary Level Hospitals (ORiGiN Study): An Interim Analysis
Authors: Espino Adrian Ronald A , Alombro Danice Faith B , Ong Justin Allister G , Valdez Christel M , Joy Daguit Shanaia Esthelle , Ombao Daniel Jose N , Macalalad Lawrence S , Carascal Mark , Agnew Cajucom Marc , Flor Malundo Anna , Abad Cybele Lara R
Published: January 2025

Background

Infections with gram-negative carbapenem-resistant organisms (CRO) are an emerging global problem, but little is known about CRO in the Philippines. This study aims to build a registry and describe the clinical profile and molecular mechanisms of resistance of carbapenem-resistant infections.

Methods

This prospective study will enroll patients from two tertiary-level hospitals from 01/01/2023 to 12/31/2025. Admitted patients >18 years old with documented CRO infection confirmed by phenotypic resistance and molecular testing are included in this year-1 analysis.

Results

150 patients were enrolled in the first year. Around half (79/150, 54.7%) were female. Median age was 60 (range 21-94) years. Many had at least one comorbidity -- hypertension (90/150 65.2%), diabetes mellitus (45/150, 32.6%), and congestive heart failure (42/150, 30.4%). Most patients experienced CR infection only once (123/150, 82%), while a few (27/150,18%) had two or more. Infections originated from respiratory (63.3%), blood (22.6%), or urinary (16.4%) sites. Higher mortality was seen among patients who received three or more antibiotics (119/150, 57.1%) or had prolonged treatment ( >15 days) during admission (53.1%). Resistance to fluoroquinolones (ORadjusted=4.32 (95% CI: 1.11, 16.81); p=0.035) and older tetracyclines (ORadjusted=5.49 (95% CI: 1.08, 27.93); p=0.040) were significantly associated with mortality in the adjusted models. Only 9 out of 169 (5.32%) were Extended Spectrum Beta Lactamase (ESBL) producing. 40/169 (23.7%) were tested for carbapenem resistance genes and the two most common antimicrobial resistance genes were blandm (n= 17) and blaoxa51 (n=20).

Conclusion

The study provides initial data on the local epidemiology and molecular mechanisms of resistance of gram-negative CRO. Interim results show that CR infections affect the older population and are mainly respiratory in origin. Multiple antibiotics, prolonged therapy, and the use of fluoroquinolones and tetracyclines were all associated with higher mortality. Class D (OXA-51) and Class B (NDM) beta-lactamases were most frequently isolated.

Disclosures

All Authors: No reported disclosures
P-280. Risk Factors for Household Colonization with Extended-Spectrum Cephalosporin-Resistant Enterobacterales (ESCrE) in Botswana
Authors: Shivji Sukaina , Mannathoko Naledi , Mosepele Mosepele , Mosepele Mosepele , Gross Robert , Cressman Leigh , Jaskowiak Anne , Bilker Warren B , Alby Kevin , Glaser Laurel , Greenblatt Melissa , Cowden Laura , Patel Alexa , Sewawa Kgotlaetsile , Otukile Dimpho , Paganotti Giacomo , Mokomane Margaret , Snitkin Evan , Lautenbach Ebbing
Published: January 2025

Background

The epidemiology of colonization with ESCrE in the community in low- and middle-income countries (LMICs) is largely uncharacterized. In the community, the household is of particular importance as it is the setting in which individuals spend a majority of their time. Identifying risk factors for household ESCrE colonization is critical to inform antibiotic resistance reduction strategies in LMICs.

Methods

Participants were enrolled from 1/1/20-9/4/20, with a pause 4/2/20-5/21/20 due to a country-wide COVID lockdown. This study was conducted in 6 clinics located in 3 regions in Botswana. In each clinic, we surveyed a random sample of outpatients presenting for care. We also invited each enrolled subject to refer household members. Only those subjects who referred at least one other household member were included. All participants had rectal swabs collected for identification of ESCrE. Data were collected on demographics, comorbidities, antibiotic use, healthcare exposures, travel, and farm/animal contact. Households were considered exposed if any member had the exposure of interest. Households with ESCrE colonization (cases) were compared to non-colonized households (controls). Bivariable and multivariable analyses were conducted to identify risk factors for household ESCrE colonization.

Results

327 households were enrolled. The median (IQR) number of people enrolled per household was 3 (2-4) ranging from 2-10. Among enrolled households, the median proportion of household residents participating was 0.71 (0.5 – 1). The median (IQR) age of subjects was 18 years (5-34) and 304 (93%) households included at least one child. Of 327 households, 176 (54%) had at least one household member colonized with ESCrE. Independent risk factors for household colonization are noted in the table.

Conclusion

ESCrE household colonization was common with evidence of geographic variability in ESCrE epidemiology as well as a possible role of animal exposure. The role of yogurt exposure requires additional study as we did not distinguish source (commercial, homemade). Further prospective studies of household ESCrE colonization with longitudinal assessments of exposures are required to identify effective prevention strategies.

Disclosures

Robert Gross, MD, MSCE, Pfizer Inc: DSMB member for drug unrelated to study
P-284. Effect of Different Disinfection Methods on Hospital Sink Drain Disinfection
Authors: Ahmed El-Imam Ibrahim , O’Hara Lyndsay M , McClintock Christopher , French Indira , Paszkiewicz Gwen , Robinson Gwen , Thomas Amber R , Johnson J Kristie , Leekha Surbhi
Published: January 2025

Background

A commercially available foaming disinfectant containing hydrogen peroxide, peracetic acid, and octanoic acid is EPA-registered for biofilm disinfection in sink drains, but recolonization occurs quickly. We evaluated the impact of adding physical removal of bioburden to foaming disinfectant use on bacterial colonization in sink drains.

Methods

We conducted a longitudinal study in a level-IV neonatal intensive care unit (NICU) at an academic medical center in Baltimore, MD. The NICU has 52 single-patient rooms with sinks with removable drain plug covers. We included 20 unique rooms to investigate the effect of foaming disinfectant alone and coupled with physical removal of biofilm through (1) mechanical cleaning with a brush, and (2) replacement of drain cover (Figure 1). In addition, we sampled 10 room sinks as control (no intervention). Samples were collected from 2 inches below the sink drain and underside of the drain cover using a polyester tripped swab (Puritan ESK environmental sampling kit with neutralizing buffer) at baseline (day 0) and days 1, 3, 5, and 7 post-intervention. Samples were serially diluted, plated on MacConkey II agar (Becton Dickinson), and incubated for 24 hours at 35+2°C. Colony-forming units (CFU) of total gram-negative bacilli (GNB) were calculated. The primary outcome was the difference in GNB burden (mean log CFUs) from baseline at each time point, for each intervention strategy, compared using paired t-test.

Results

Baseline counts for all groups including control were similar. On day 1, we found significant reductions from baseline for each intervention strategy, with differences from baseline becoming smaller over time. There was no significant change in GNB counts for the control group at any time point (Figure 2, Table 1). Strategies with mechanical cleaning (vs without) performed better for sinks, whereas sink cover change (vs without) resulted in greater log reductions in the cover bioburden through day 7 (Figure 2, Table 1).

Conclusion

Physical bioburden removal improved the effect of a foaming disinfectant on GNB counts in hospital sink drains. The impact of this strategy on hospital-acquired infections needs to be studied.

Disclosures

J Kristie Johnson, PhD, D (ABMM), biomerieux: has given presentations/speeches for the company listed above
P-287. Risk factors for Pseudomonas aeruginosa in ICU-Related Respiratory Infections. An analysis from the European Network for ICU-Related Respiratory Infections (ENIRRIs) study
Authors: Serrano-Mayorga Cristian C , Olivella-Gomez Juan , Torres Antoni , Martin-Loeches Ignacio , Reyes Luis Felipe F
Published: January 2025

Background

Nosocomial low respiratory infections (nLRTIs) represent a significant complication prevalent among patients who require admission to the intensive care unit (ICU). Gram-negative microorganisms are related to nLRTIs, such as ventilator-associated pneumonia (VAP), ventilator-associated tracheobronchitis (VAT), ICU-acquired pneumonia (ICU-HAP), and hospital-acquired pneumonia (HAP). Pseudomonas aeruginosa (PA) is frequently identified among nLRTIs; however, not all patients with nLRTI may require antipseudomonal treatment and this is not clear in the literature. This study aims to describe the characteristics and principal outcomes of patients with confirmed PA nLRTI. 

Table 1. Characteristics of patients with Pseudomonas aeruginosa identification Vs Non-Pseudomonas aeruginosa identification.

Methods

This prospective cohort was conducted in 12 countries over two continents from 9th May 2016 until 16th August 2019. Characteristics and outcomes of nLRTI’s patients admitted to the ICU were collected. All patients were tested to find microbiological-causing agents. Patients with confirmed isolation for PA were compared to patients with non-PA isolation. The Mam Whitney and Chi-squared were used to compare the group's proportions depending on their distribution.

Table 2. Bivariate analysis for risk factors associated with Pseudomonas aeruginosa

Results

1059 patients with nLRTIs who underwent testing for microbiological diagnosis were included, 14.4% patients had confirmed infection by PA. 74% were male with a median age of 64 (49-73) years old. The principal diagnosis among patients with PA was VAP. The principal comorbidities were diabetes and heart disease, followed by COPD. The most frequent complication was septic shock, followed by acute kidney injury. There were differences among the comorbidities, complications and outcomes among the groups (Table 1). However, there were no differences in mortality (Table 1 - Figure 1). VAT and VAP diagnosis, COPD Gold D and AKI on the 1st day were associated with a high risk of infection by PA (Table 2).

Figure 1. Sankey diagram showing mortality outcome. Pseudomonas aeruginosa Vs. Non-Pseudomonas aeruginosa LRTI-diagnosed patients who were admitted to the ICU.

Conclusion

This multi-country study found some important risk factors associated with PA in nLRTI patients. Differences among groups were notorious; diabetes and COPD comorbidities are more frequent among PA nLRTI patients. Finally, PA infection increases the length of stay of patients. Further studies are needed to confirm these findings.

Disclosures

All Authors: No reported disclosures
P-311. Shifts in Methicillin-Resistant Staphylococcus aureus Types in Bloodstream Infections: Nationwide and Regional Influences and Their Impact on Mortality
Authors: Kaku Norihito , Ishige Masaki , Yasutake Go , Sasaki Daisuke , Ota Kenji , Mitsumoto-Kaseida Fujiko , Kosai Kosuke , Hasegawa Hiroo , Izumikawa Koichi , Mukae Hiroshi , Yanagihara Katsunori
Published: January 2025

Background

Methicillin-resistant Staphylococcus aureus (MRSA) is the leading cause of bloodstream infections (BSI). In the USA and Japan, the New York/Japan clone (ST5-II) was historically prevalent, but recent studies in Japan have shown a shift towards ST8-IV and CC1-IV as the dominant strains. The extent to which these trends are mirrored in individual facilities and the variation in patient backgrounds across different MRSA types remains unclear.

Methods

We analyzed MRSA strains from blood cultures collected at Nagasaki University between 2012 and 2019. Whole-genome sequencing was utilized to determine sequence types, SCCmec, spa types, and resistance and virulence genes, complemented by phylogenetic analysis using core-genome MLST. Data were compared with earlier studies from 2003-2011 at the same hospital.

Results

Between 2003 and 2019, SCCmec type II decreased from 79.2% to 15.5%, whereas type IV increased from 18.2% to 65.5%. Severity and outcomes also changed: SOFA score decreased from 5.8 to 3.1, while in-hospital mortality decreased from 39.8% to 15.5%. No changes in the patient background, such as age, sex, or underlying diseases, were observed (Table 1). Further, the percentage of intravascular device-related BSI increased significantly from 18.1% during 2003–2007 to 46.6% during 2016–2019.

The most common SCCmec type IV detected between 2012 and 2019 were ST8-IV and CC1-IV (Fig. 1A). ST8 was the predominant ST in both 2012–2015 and 2016–2019, but CC1 was detected only during 2016–2019 (Fig. 1B). In ST8-IV, MRSA/J and ST8-IV with spa type t5071 were identified, with MRSA/J being predominant. The detected MRSA/J, ST8-IV with spa type t5071, and CC1-IV subtypes were similar in terms of drug resistance, molecular characteristics, and phylogenetic features to those detected in the nationwide surveillance (Fig. 2). Patient characteristics across major MRSA types (ST8-IV, CC1-IV, ST8-I, ST5-II) revealed no significant differences, with lower SOFA scores and in-hospital mortality for CC1-IV (Table 2).

Conclusion

The evolving nature of MRSA types in bloodstream infections, correlating with improved outcomes over time and influenced by changes in nationally and regionally circulating strains, is highlighted.

Disclosures

Hiroshi Mukae, M.D., Ph.D., AstraZeneca: Lecture fees|Gilead Sciences: Lecture fees|GSK: Lecture fees|MSD: Advisor/Consultant|MSD: Lecture fees|Pfizer: Lecture fees|Shionogi & Co., Ltd.: Advisor/Consultant|Shionogi & Co., Ltd.: Grant/Research Support|Shionogi & Co., Ltd.: Lecture fees
P-315. Safety and Effectiveness of Nasal Povidone-Iodine Decolonization Among Patients on Hemodialysis: A Multicenter Stepped-Wedge Cluster Randomized Trial
Authors: Schweizer Marin , Racila A M , Vijayan Anitha , Pegues David A , Bleasdale Susan C , Jacob Jesse T , O’Shea Amy , Cobb Jason , Fraer Mony , Ward Melissa , Tolomeo Pam C , Kellogg Joseph , Lindsey Brenna , Armstrong-Pavlik Fiona , Dukes Kimberly C , Hockett-Sherlock Stacey , Marra Alexandre , Boyken Linda , Diekema Daniel , Herwaldt Loreen
Published: January 2025

Background

The SHEA/IDSA/APIC Strategies to Prevent MRSA Transmission and Infection Practice Recommendations advised that facilities consider decolonizing patients on hemodialysis. We implemented a nasal decolonization intervention in which patients self-administered povidone-iodine (PVI) at each dialysis session. We aimed to assess intervention safety and effectiveness.

Methods

We performed a stepped wedge cluster randomized trial at 16 outpatient hemodialysis units affiliated with 5 academic medical centers between 2020-2023. Adverse events were self-reported at 1 and 6 months. While the analysis was at the hemodialysis unit level, patients were required to give verbal informed consent for PVI use. Outcomes included National Healthcare Safety Network reportable dialysis events aggregated at hemodialysis unit level, including bloodstream infections (BSI), access-related BSI, and central venous catheter (CVC) BSI for all pathogens and for Staphylococcus aureus (SA). The primary outcome was SA BSI. A generalized linear mixed model with a negative binomial distribution, log link function, and an offset for person-months with a random intercept for each hemodialysis unit was performed.

Results

Overall, 1,351 patients received hemodialysis at these centers each month. Of those, 362 patients verbally consented to use PVI. Among these, 3.9% reported side effects: nasal drip, congestion or burning/stinging, unpleasant smell, headache, or minor nose bleed. A reported side effect ‘yellow tears’ was assessed via chart review and resolved by discontinuing PVI. There were no statistically significant associations between unit level randomization to the PVI intervention and infections. However, there was a non-statistically significant trend toward a protective association between unit-level randomization to PVI and SA infections, particularly SA CVC BSI.(Table)

Conclusion

Long-term nasal decolonization with PVI was safe with few adverse events. Unit level randomization to the PVI intervention did not significantly decrease unit-level infections. Given low patient enrollment and added infection prevention interventions due to COVID-19, the study could not determine if PVI decolonization could decrease BSI rates in the hemodialysis setting.

Disclosures

Marin Schweizer, PhD, 3M: Grant/Research Support Anitha Vijayan, MD, Baxter: Honoraria|NxStage: Advisor/Consultant|Qanta: Honoraria David A. Pegues, MD, DaVita/Total Renal Care: Advisor/Consultant Daniel Diekema, MD, Affinity Biosensors: Grant/Research Support|bioMerieux, Inc: Grant/Research Support Loreen Herwaldt, MD, 3M: Grant/Research Support|PDI: Grant/Research Support
P-322. Transmission of Methicillin-Resistant Staphylococcus aureus to Healthcare Personnel Gloves and Gowns: a Cohort Study of VA Hospitals in 5 States
Authors: O’Hara Lyndsay M , Newman Michelle , Pineles Lisa , Rubin Michael , Khader Karim , Nelson Richard , Bahr-Robertson Mary , Baracco Gio , Goetz Matthew B , Evans Martin , Linder Kathleen A , Perencevich Eli N , Harris Anthony
Published: January 2025

Background

The aim of this study was to determine the rate of MRSA transmission to healthcare personnel (HCP) gloves and gown and to determine which patient care interactions and HCP roles are associated with greater transmission of MRSA.

Methods

Patients with a positive MRSA clinical or surveillance culture within the past 7 days were enrolled at 5 VA medical centers. Research team members observed 5 HCP in the room for each patient and recorded any items that were touched on a standardized data collection form. After completion of tasks and prior to room exit, HCP gloves and gown were cultured separately. The primary outcome was a surrogate measure for transmission defined as “yes” if a HCP glove or gown was contaminated with MRSA.

Results

We enrolled 799 patients and obtained 3,832 glove and gown cultures. Transmission of MRSA to gloves or gown occurred 713/3832 (18.6%) of the time while 589/3832 (15.4%) of interactions resulted in contamination of gloves and 319/3831 (8.3%) of interactions resulted in contamination of gowns. The gloves and gown of physical therapists and occupational therapists were most frequently contaminated with transmission occurring in 24/84 (29%) and 11/38 (29%) of observations respectively (Table 1). Any interactions that involved touching the patient (patient alone or patient and environment) resulted in glove or gown contamination in 622/2901 (21.4%) of observations, while touching only the environment resulted contamination in 91/931 (9.8%) of observations. Specific patient care activities with the highest rates of transmission included touching the endotracheal tube (12/35, 34%) and assisting the patient with bathing and hygiene (89/283, 31%). Specific environmental items touched with the highest rates of transmission included the call button (75/221, 34%) and the lift (31/125, 27%) (Figure 1).

Conclusion

Contamination of HCP gloves and gowns with MRSA occurs frequently when caring for Veteran patients particularly when there is direct patient contact. Hospitals may consider optimizing contact precautions by using fewer precautions for low-risk interactions and more precautions for high-risk interactions.

Disclosures

Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor