bluuebunny/crossref_metadata_2025 huggingface dataset:
2426. High Reliability Line Stewardship: A Novel Approach to Effective Central Line Associated Bloodstream Infection Risk Reduction
Authors: Kerr Nancy , Bland Jayme , Pasco Karen , Dwivedi Sukrut , Gurunathan Rajan , Hughes Nicole , Moran Christopher , Roman Alyssa
Published: November 2023

Background

Hospital-acquired infections (HAIs) impact health care quality and may cause patient harm. Central to the goal of preventable harm reduction are the tenets of high-reliability, specifically, the principle of deference to expertise and the principle of sensitivity to operations. Barriers can include lack of adherence to standardized criteria in support of best practice, inconsistent application of key concepts related to improvement and reliability, and limited time, resources and engagement.

We set forth to design and implement an effective and sustainable ‘line stewardship’ program, in hopes of improving utilization of CVCs and reducing central line associated bloodstream infection (CLABSI) risk at our academic community hospital in central New Jersey.

Methods

Jan - Feb 2022 : Baseline outcomes measured

Mar - May 2022 : Assessment and planning

Jul - Dec 2022 : Intervention and tracking

Jan - Feb 2023 : Follow-up outcomes measured

Intervention Phases

Results

During the 6 mon. intervention and tracking phase, OUMC experienced a 37% reduction in CVC utilization, with a decrease in the CVC utilization ratio (SUR, as defined by NHSN, from .751 to .537), yielding a reduction of over 550 line days/mon. When compared with baseline, the observed / expected infection rate decreased thru intervention phase (2.365 to 0.347), with an associated decline of CLABSIs. In comparison to the Jan - Feb 2022 data period, results from Jan - Feb 2023 continued to trend favorably, with both a continued decline in SUR (0.448), and sustained use of CVC alternatives (23.5 devices/mon).

Conclusion

The concept of stewardship is well-known in infectious disease circles and mirror principles of high-reliability and harm reduction, care standards, structured processes, and collaborative expertise are key to ensuring consistency and sustaining performance. After some initial push-back from providers who wanted to maintain their autonomy with access selection, the development of our vascular access order pathway and collaborative consult model became well-accepted as a way of triaging appropriate access to fit each patient. Our experience suggests that education, provider engagement, and a shared focus on care guidelines and reliability principles, can be the basis for a sustainable and effective CLABSI risk reduction strategy.

Disclosures

All Authors: No reported disclosures
133. Impact of the BioFire FilmArray Blood Culture Identification 2 (BCID2) Panel on Time to Antimicrobial Escalation or De-escalation in a Community Health System
Authors: DelRusso Katie , Colmerauer Jessica , Premus Jennifer
Published: November 2023

Background

The BioFire FilmArray Blood Culture Identification 2 (BCID2) panel is a rapid diagnostic tool that has been shown to decrease time to culture identification and effective therapy in bacteremia, particularly in conjunction with antimicrobial stewardship (AS) participation. The BCID2 panel was introduced at our 5-hospital community health system in May 2021. BCID2 results were relayed to care teams via the standard critical lab process (bedside nurse notified by phone) without notification of the AS team. This analysis compares outcomes after implementation of the BCID2 panel using a standard laboratory notification process.

Methods

This was a retrospective review of adult patients with positive blood cultures at a community health system in New Jersey. Patients with cultures performed using conventional methods (pre-BCID2) 7/1/2021-8/31/2021 were compared to patients with cultures performed using the BCID2 panel (post-BCID2) 7/1/2022-8/31/2022. Exclusion criteria was death within 72 hours, comfort care within 7 days of admission, organism determined to be a contaminant, culture results with a pathogen not on the BCID2 panel, transfer from an outside facility. The primary outcome was time to antimicrobial escalation or de-escalation. Secondary outcomes included time to culture identification, hospital length of stay (LOS), and duration of antimicrobial therapy.

Results

A total of 190 patients were included with 95 patients in each group. Time to de-escalation pre-BCID2 was 59.2 hours versus 35.3 hours post-BCID2 (p < 0.001). Time to culture identification pre-BCID2 was 53.1 hours versus 22.4 hours post-BCID2 (p < 0.001). LOS pre-BCID2 was 12.2 days versus 10.6 days post-BCID2 (p = 0.13). Duration of antimicrobial therapy was 20.2 days pre-BCID versus 18.4 days post-BCID2 (p = 0.29).

Conclusion

Addition of the BCID2 rapid diagnostic panel using a standard critical lab result notification process improved time to antimicrobial escalation or de-escalation by about 24 hours on average. In hospitals with limited stewardship resources, implementation of a rapid diagnostic blood test such as BCID2 without direct stewardship involvement is effective in improving time to antimicrobial escalation or de-escalation.

Disclosures

All Authors: No reported disclosures
2441. Implementation of Decolonization Strategies and Rates of Bacteremia in ECMO Patients
Authors: Taylor Madyson , Lee Rachael A , Griffin Russell , James Catina , Akinsanya Angela , duncan Mary , Walker Jeremey
Published: November 2023

Background

To date, there is little data on decolonization in extracorporeal membrane oxygenation (ECMO) patients and if decolonization efforts improve rates of bacteremia with multi-drug resistant organisms (MDROs). We sought to determine if implementation of universal nasal decolonization with daily chlorhexidine bathing will decrease blood stream infections (BSI) in patients undergoing ECMO.

Methods

A retrospective cohort study was conducted of all patients with admitted to UAB Hospital and placed on ECMO from 12/22/2017-6/1/2022. Data collected included baseline patient characteristics and clinical data, microbiology data, interventions for source control, dates of line placement, appropriate antibiotic treatment, and outcomes. Categorical variables were analyzed with the Fisher exact test, and continuous variables analyzed with the t test or Wilcoxon rank-sum test when appropriate. Only variables found to be statistically significant will be included in the model. A P value < .05 are considered significant.Table 1.Group Demographics

Results

531 patients placed on ECMO were included in this study and separated into groups: Pre implementation: 401 (76%), post implementation: 130 (24%). (Table 1). 61 (15%) pre patients developed bacteremia with an average of 18.1 ECMO days. 29 (22%) of post patients had a BSI with an average of 25.0 ECMO days. While the average number of BSI per 100 ECMO days increased in the post-implementation group (0.58/100 ECMO days to 1.02/100 ECMO days), the overall incidence rate of MRSA decreased (0.22/100 ECMO days vs 0.09/100 ECMO days). Of note, 89 (17%) patients were found to have COVID-19 at time of ECMO, 12.6% of the pre-implementation group vs 31% of the post-implementation group, (p < 0.001).

Incidence Rate: Number of BSI per ECMO Days

Conclusion

There was no statistical significance between the pre and post groups in the study with the amount of time on ECMO, the time from ECMO cannulation to BSI, the amount of BSIs or the amount of MRSA bacteremia. Implementation of universal decolonization with daily CHG reduced rates of MRSA bacteremia. The lack of research in this field and the timing of this study almost exclusively assessing ECMO patients during the COVID-19 pandemic during the post-implementation period warrants further investigation on if decolonization strategies can reduce BSIs and MDROs bacteremia in ECMO patients.

Disclosures

All Authors: No reported disclosures
2447. Clinical Features and Outcome of Persistent Candidemia Caused by Candida albicans versus Non-albicans Candida Species: A Focus on Antifungal Resistance and Follow-up Blood Cultures
Authors: Kitaya Shiori , Kanamori Hajime , Katori yukio , Tokuda Koichi
Published: November 2023

Background

Candidemia is a common hospital-acquired (HA) infection linked to extended hospitalization and high mortality rates. Risk factors for persistent candidemia (PC) include central venous catheter, empirical treatment, and metastatic infection foci. Antifungal resistance is a significant global infection control issue, especially in non-albicans Candida species. We investigated clinical outcomes and mortality rates associated with HA-PC, focusing on Candida species, antifungal resistance, and PC-clearance.

Methods

Data analysis was conducted using electronic medical records from Tohoku University Hospital from 2012 to 2021 (n = 60). HA-PC cases were categorized based on Candida species, azole or echinocandin resistance, and PC-clearance status, and analyzed respective characteristics. The primary outcome variables were 30-day, 30–90-day, and 90-day mortality after the initial blood culture.

Results

The HA-persistent non-albicans candidemia group had a higher ratio of immunosuppression and catheter-related bloodstream infection (CRBSI) than the HA-persistent Candida albicans bacteremia group (Odds ratio [OR] = 4.6, p = 0.049). CRBSI was more prevalent in the HA-PC resistant strain group than in the susceptible strain group (OR = 4.2, p = 0.008), while HA-PC resistant strain group had a lower incidence of intraocular candidiasis (p = 0.020). Mortality rates were slightly higher in the HA-persistent non-albicans candidemia group compared to the HA-persistent Candida albicans bacteremia group. Similarly, the HA-PC resistant strain group tended to have higher mortality rates compared to the susceptible strain group. In the HA-PC non-clearance group, there was a trend towards higher 30-day, and 90-day mortality rates, and the former group had a statistically significant difference (OR = 19, p = 0.028).

Conclusion

Patients with HA-PC caused by non-albicans Candida or azole or echinocandin resistant strains have higher mortality rates and require careful therapeutic management. Confirming the clearance of PC by performing follow-up blood cultures can improve the survival rate for both susceptive and resistant strain groups.

Disclosures

Shiori Kitaya, MD, AMANO Co., Ltd.: Grant/Research Support Hajime Kanamori, MD, PhD, MPH, Amano Co., Ltd.: Grant/Research Support Koichi Tokuda, MD, PhD, MPH, AMANO Co., Ltd.: Grant/Research Support
2450. Clinical Outcomes of Candida auris Infections at an Academic Medical Center
Authors: Wang Yifan , Drweiga Emily N , Danziger Larry H , Burgos Rodrigo M
Published: November 2023

Background

C. auris (CA) is a globally emerging fungus with a high case fatality rate (CFR). Cases of CA infection have been reported around US with a concentration in large metropolitan areas, but there is still little of data evaluating the prevalence and outcomes associated with CA. The purpose of this study was to evaluate the characteristics and outcomes in patients (pts) with CA isolation at a large urban academic medical center.

Methods

This was a retrospective, observational cohort study of hospitalized pts with a positive culture with CA between Oct 2020 and Dec 2021 via VITEK MS. We included pts ≥18 years of age and excluded those with only a positive surveillance screen from axillary swab. Demographic and clinical data at the time of CA isolation and up to 30 days or hospital discharge were collected from the electronic medical record. The primary outcome was 30-day CFR in patients with a culture positive for CA.

Results

We identified 37 patients, and 27 met inclusion. Of all included patients, 17 (63%) presented from acute or subacute long-term care facilities. 11 (40.7%) had CA isolated from a blood culture. 8/11 (72.7%) bloodstream infections were catheter-associated. Pts with fungemia had a median [IQR] length of antifungal treatment of 20 [6.5, 49.5] days, and all received micafungin. The median [IQR] days between index blood culture and first negative blood culture was 4 [3, 6.25]. 1 patient with fungemia never cleared repeat cultures despite treatment. Of all included pts, 7 of 27 (25.9%) expired within 30 days of CA isolation. The 30-day case fatality was 45.5% (5/11) in those with fungemia and 12.5% (2/16) in those with isolation from other sites.

Conclusion

In our study, we report a similar institutional CFR of CA infections compared to the crude CFR within the U.S. We also report a higher CFR associated with CA fungemia compared to patients without positive blood cultures. These findings should be validated with a larger study population.

Disclosures

Larry H. Danziger, PharmD, Ferring Pharmacetuicals: Advisor/Consultant Rodrigo M. Burgos, PharmD, MPH, Janssen Therapeutics & Vaccines: Grant/Research Support|Merck & Co., Inc.: Grant/Research Support|ViiV Healthcare: Advisor/Consultant
2451. The Impact of Common Variations in SOFA Score Calculations on Sepsis Surveillance Using Sepsis-3 Criteria
Authors: Alrawashdeh Mohammad , Klompas Michael , Rhee Chanu
Published: November 2023

Background

Sepsis-3 defines sepsis as infection associated with an increase in baseline Sequential Organ Failure Assessment (SOFA) score by ≥2 points. Consistent electronic application of Sepsis-3 criteria could allow for standardized estimates of sepsis incidence and outcomes. However, there are many methods of calculating SOFA scores that may contribute to variability in sepsis surveillance.

Methods

We retrospectively identified all adult patients hospitalized at 5 Massachusetts hospitals between 2015-2022 and calculated the incidence and mortality rates of sepsis, defined as suspected infection (any clinical culture and antibiotics continued for ≥3 days) with concurrent organ dysfunction (increase in SOFA by ≥2 points) using different strategies for calculating respiratory SOFA scores and for handling missing data. We calculated respiratory SOFA scores by 1) using the standard PaO2/FiO2 ratio method, and 2) using SpO2/FiO2 ratios when arterial blood gases were not performed. We managed missing data using: 1) normal value imputation for each organ system if values from that day were missing, 2) mean value imputation, using the mean of the worst values of the preceding and following day, and 3) carry forward imputation, carrying forward the last non-missing observation.

Results

The cohort included 1,064,498 hospitalizations, of which 299,427 (28.1%) had suspected infection. Using the standard respiratory PaO2/FiO2 method, sepsis incidence and mortality rates were 14.2% and 10.1% but incidence rose to 19.7% and mortality dropped to 7.8% using the SpO2/FiO2 respiratory score imputation and normal value imputation. Results were similar with mean value and carry-forward imputation.

Conclusion

We observed substantial differences in calculated sepsis incidence and mortality rates when using SpO2/FiO2 vs PaO2/FiO2 ratios alone to impute respiratory SOFA scores. Common SOFA missing value imputation strategies, however, had little impact on sepsis incidence and mortality rates. These findings highlight an important source of potential variability when applying Sepsis-3 criteria and underscore the need for standardized surveillance methodology.

Disclosures

Michael Klompas, MD, MPH, UpToDate, Inc.: Royalties for chapters on pneumonia Chanu Rhee, MD, MPH, Cytovale: Advisor/Consultant|Pfizer: Advisor/Consultant|UpToDate, Inc.: Honoraria
134. Yield of Fungal and Mycobacterial Cultures for Operative Specimens in Orthopedic Procedures
Authors: Cooper Margaret , Shihadeh Katherine C , Deaney Michael , Miller Whitney , Parry Joshua , Wilson Michael L , Jenkins Timothy C
Published: November 2023

Background

Fungal and mycobacterial cultures are routinely sent on orthopedic operative specimens, but their impact on clinical care is not well established. Processing fungal and mycobacterial cultures is time and labor intensive, associated with significant healthcare costs, and may yield false-positive results due to contamination. The objective of this study was to determine the utility and diagnostic yield of fungal and mycobacterial cultures for orthopedic infections.

Methods

Patients undergoing surgery by the orthopedic or podiatry service that had operative specimens sent for fungal and mycobacterial cultures from January through December 2022 were included. Descriptive statistics were used to evaluate yield of fungal and mycobacterial cultures and incremental yield of fungal cultures over standard bacterial culture media. A random subset of patients was manually reviewed to determine whether microorganisms identified by fungal or mycobacterial cultures were considered clinically relevant and whether culture results changed management.

Results

Fungal and mycobacterial cultures were ordered on a total of 1148 operative specimens in 428 patients. A mean of 2.1 ± 1.4 specimens was collected per operative procedure. A microorganism was identified in 33 (2.8%) of fungal cultures and in no mycobacterial cultures. Fungal organisms included yeast (90.9%) and mold (9.1%).

Of 50 randomly selected patients, a total of 249 operative specimens were collected (mean 5 per patient, 2.7 per operative procedure). A microorganism was identified by fungal culture in 5 (2%) specimens from 3 patients. All three patients were treated with antifungal agents indicating the fungi were deemed to be clinically relevant. However, the fungi also grew on the standard bacterial media from all 5 specimens suggesting there was no incremental benefit of the fungal cultures. There were no positive mycobacterial cultures, and no patients received mycobacterial treatment.

Conclusion

The diagnostic yield of fungal and mycobacterial cultures on operative specimens in orthopedic and podiatry surgery is very low and rarely results in a change in therapeutic management. The results of this study demonstrate an opportunity for diagnostic stewardship for these procedures.

Disclosures

Timothy C. Jenkins, MD, Basilea: Clinical events adjudication committee
2456. Methicillin-Resistant Staphylococcus aureus Bacteremia 30-Day Mortality During 2020 Compared to 2016-2019: Assessing the Impact of COVID-19
Authors: Biggs Holly , Jackson Kelly A , Nadle Joelle , Petit Susan , Ray Susan M , Dumyati Ghinwa , Tracy Marissa , Markus Tiffanie M , Schaffner William , See Isaac , See Isaac
Published: November 2023

Background

Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with substantial mortality, but the effect of the COVID-19 pandemic on MRSA mortality has not been fully explored.

Methods

For 2016-2020, MRSA bacteremia cases among adults aged ≥ 18 years were identified through CDC Emerging Infections Program’s active laboratory- and population-based surveillance in 5 states (16 counties). Death within 30 days of initial MRSA blood culture was determined from medical record documentation or linked state vital statistics data. Cases were classified (epi class) as hospital-onset (HO), healthcare-associated community onset (HACO), or community associated (CA) (Figure 1). Thirty-day mortality was calculated by year and epi class and, for 2020, stratified by whether a SARS-CoV-2 test was positive in the 30 days preceding MRSA culture (recent COVID-19). Using multivariate logistic regression to adjust for potential confounders, the effect of recent COVID-19 on 30-day mortality was assessed.

Results

MRSA bacteremia 30-day mortality was 22% (2,113/9,689) during 5 surveillance years. Mortality in 2020 was higher than in 2016-2019 overall (25% vs. 21%, p< .01), for HO cases (43% vs 32%, p< .01), and for CA cases (19% vs. 13%, p< .01). When limited to cases without recent COVID-19, mortality in 2020 was still higher than in 2016-2019 for CA (18%, p< .01) but not HO (35%, p=.39). During 2020, cases with recent COVID-19 comprised 37% of HO deaths and a smaller proportion of HACO (13%) and CA (7%) deaths. Cases with recent COVID-19 had higher 30-day mortality than those without across all epi classes (Figure 2; p≤ .01 for all), with mortality highest among HO cases with recent COVID-19 (77%). After adjusting for other factors, recent COVID-19 remained a significant risk factor for 30-day mortality (adjusted odds ratio: 5.3, 95% CI: 3.6-8.0; Table).Table.Multivariate Analysis of Factors Associated with Methicillin-Resistant Staphylococcus aureus Bacteremia 30-Day Mortality, 5 Emerging Infections Program Sites, 2020

Conclusion

COVID-19 emerged as a significant independent risk factor for MRSA bacteremia-associated death in 2020, and the very high mortality for HO cases with recent COVID-19 resulted in a higher mortality for HO cases overall. Conversely, the contribution of COVID-19 to the increased mortality for CA cases in 2020 appeared small, and reasons for the increase in mortality for CA cases without recent COVID-19 need additional investigation.

Disclosures

Ghinwa Dumyati, MD, Pfizer: Grant/Research Support
2462. The impact of the COVID-19 pandemic on hospital-acquired infections and multidrug-resistant organisms, and comparison with seasonal influenza
Authors: Dabaja-Younis Halima , Silman Zmira , Tarabeia Jalal , Hussein Khetam
Published: November 2023

Background

Effective preventive measures can curb the spread of hospital-acquired infections (HAIs) and multidrug-resistant organisms (MDROs). However, the impact of coronavirus disease 2019 (COVID-19) and measures taken during it on these infections remains unclear. This study aimed to evaluate the impact of COVID-19 pandemic on HAIs and MDROs and compare it to seasonal influenza.

Methods

A retrospective cohort study that used prospectively collected data from a tertiary referral hospital in Haifa, Israel. The study spanned from 2016 to 2021 and compared the period before and after COVID-19 and the influenza season (December-February) and the non-influenza season (March-November) in terms of the rate of hospital-acquired bloodstream infections (HA-BSI), MDROs, and Clostridium difficile infections (CDI) per 10,000 hospital days (HD). The study also measured the rate of central line-associated BSI (CLABSI) per 1,000 catheter days (CD) and the hand hygiene compliance (HHC) rates.

Results

During the COVID-19 period, HAIs and MDROs decreased compared to before: methicillin-resistant Staphylococcus aureus (4.2 vs. 6.9/10,000 HD; p< 0.001), carbapenem-resistant Acinetobacter baumani (2.2 vs. 3.1/10,000 HD; p=0.02), and nosocomial CDI (3 vs. 4.6/10,000 HD; p< 0.001). However, there were higher rates of carbapenem-resistant Enterobacteriaceae (4.6 vs. 2.7/10,000 HD; p< 0.001) and HA-BSI (29.7 vs. 27.3/10,000 HD; p=0.006) in the COVID-19 period. CLABSI rates were not significantly different (2.3 vs. 2.7/1000 CD; p=0.910). HHC rates were 70% in both periods (p=0.151), and there were no significant differences in rates of MDROs, CDI, HA-BSI, or CLABSI (p=0.233, 0.675, 0.267, and 0.563, respectively) between influenza and non-influenza seasons.

The median acquisition rate of multi-drug resistant organisms and Clostridium difficile infections before and during the COVID-19 pandemic and during or between influenza seasons

Conclusion

During the COVID-19 period, there was a significant decrease in rates of HAIs and MDROs, accompanied by an increase in CRE rates, which could be attributed to the nationwide increase in CRE rates in Israel since 2016. The decrease in these infections was not attributable to improvement in HHC, suggesting that other factors may be involved. Furthermore, influenza did not show an impact on these infections, likely due to the particular way it is perceived by healthcare workers.

Disclosures

All Authors: No reported disclosures
2467. Automated Genomic Healthcare Epidemiology with One Codex
Authors: Davis-Richardson Austin , Zdanavicius Petras , Reynolds Timothy , Stillwell Terri , Valyko Amanda , Washer Laraine , White Jackie , Hawken Shawn
Published: November 2023

Background

Genomic epidemiology is promising for precision Healthcare Associated Infection (HAI) tracking, and reducing the cost of infection prevention. Despite growing access to whole-genome sequencing (WGS), genomic healthcare epidemiology is not mainstream. For healthcare genomic epidemiology to become standard, tools for analysis and interpretation that are automated, reproducible, and accessible are required.

Methods

We have extended One Codex to support analysis and interactive data visualization for genomic pathogen surveillance and outbreak investigation. First, these capabilities were evaluated for concordance with previous results including probable transmission, strain, antimicrobial resistance and virulence marker detection. Next, we describe the use of One Codex Genomic Epidemiology to investigate a potential HAI cluster of Bacillus cereus in a neonatal intensive care unit (NICU) at an academic medical center.

Results

We developed a platform integrating sequencing, analysis, health record tracking, interactive visualization and interpretation (Figure 1). WGS data can be generated or uploaded manually or through an interface with lab information systems. Data QC, taxonomic classification, antimicrobial resistance and strain detection, variant calling and phylogenetics are automatically conducted. Analysis modes include an epidemiologic curve, patient exposure and location history across isolate phylogenies (Figure 2). Clinical and sequence data and analysis results are versioned, allowing for review and audit, and are available through the application programming interface. Investigation of datasets demonstrated concordance with previous results (Table 1). Evaluation of a B. cereus cluster revealed unlikely transmission involving two patients and an environmental NICU isolate. This analysis pinpointed a single plausible transmission event requiring further investigation by Infection Prevention (Figure 2).

Investigation of a B. cereus cluster using the Genomic Epidemiology interface showing summary of SNP distances, spatiotemporal information for patients, MLST designation, epidemiologic curve and metadata summary. Patients 1 and 3 had isolates from MLST 73 which had a pairwise distance of 17 core SNPs, warranting further investigation by infection prevention to evaluate plausibility of transmission.

Conclusion

One Codex facilitated accurate, and reproducible sequence to epidemiologic insight. Applications include evaluation of prospective surveillance, early outbreak detection, and genomics-driven deployment of infection prevention resources.

Disclosures

Austin Davis-Richardson, PhD, Invitae: Employee|One Codex: employee Petras Zdanavicius, MS, Invitae: employee|One Codex: employee Timothy Reynolds, PhD, Invitae: Employee|One Codex: employee Shawn Hawken, PhD, MPH, Invitae: employee|One Codex: employee
2475. Admissions Screening for Influenza and RSV Among a Highly Immunosuppressed Patient Population
Authors: Odom Robin T , Forrester LaToya A , Michelin Angela V , Scaletta Joseph M , Henderson David K
Published: November 2023

Background

During the Fall/Winter 2022-23, the U.S. experienced an early surge of Influenza and RSV cases, while SARS-CoV-2 cases persisted. With concerns of a potential “tripledemic” on the horizon, the NIH Clinical Center, a clinical research hospital with a heavily immunosuppressed patient population, implemented Influenza and RSV testing, in addition to SARS-CoV-2, for all patients on admission to facilitate early detection and prompt isolation of infected patients.

Methods

Nasopharyngeal (NP) swabs (n=1213) were collected on admission from 11/2022 to 4/2023 and tested for Influenza and RSV by PCR. 1213 NP swabs from 985 unique patients were tested (some patients had multiple admissions); 1100 were tested on the Panther Fusion® SARS-CoV-2 Assay (Hologic, Inc.) and 113 using the SARS-CoV-2 RT-PCR Xpert® Xpress test. Medical chart reviews and discussions with patient care providers elucidated whether cases identified on admission were asymptomatic.

Results

Of 1213 NP swabs collected from patients admitted to our hospital, 5 (0.41%) were identified with Influenza A infection, 4 (0.33%) RSV infection and no patients were identified with Influenza B. Two (0.16%) had a known history of RSV infection, 3 (0.25%) screened negative for symptoms but subsequently disclosed symptoms, 1 (0.08%) was asymptomatic on admission but disclosed a recent history of an upper respiratory infection, and 3 were asymptomatic. All infections were detected between late November 2022 to mid-January 2023, when community transmission was high, yielding a 2-month positivity rate of 2.3% during this time of peak community spread.

Conclusion

Admission surveillance for Influenza and RSV during a respiratory virus surge in our community allowed us to isolate nine patients on admission who would likely not have been appropriately isolated, as symptom screening alone is not reliable. Surveillance is important to be able to identify infected patients promptly when respiratory infections are rampant in the community, and especially for institutions serving immunosuppressed patients.

Disclosures

All Authors: No reported disclosures
2485. Candida auris Hospital Cluster: Were Our Unwelcome Guests Driven Away by the COVID-19 Delta Surge?
Authors: Somani Jyoti , Fauzi Nazira Muhammad , Sridhar Revathi , Chan Hwang Ching , Low Isaac Taoyang , Chew Ka Lip , Fisher Dale
Published: November 2023

Background

Candida auris (CA) is an MDR pathogen that persists in the environment, causing outbreaks. NUH is an academic medical centre in Singapore. We describe a cluster of CA cases from April 2019 – October 2021. Our last case was during our Delta surge, just before we changed our routine inpatient cleaning to bleach based from quarternary-ammonium.

Methods

Any CA from the micro lab is escalated to the Infection Prevention Team to initiate isolation, cleaning, and contact tracing (CT) up to 30 days prior to positive cultures. In September 2020, we started enhanced surveillance via NAG (Nasal, axilla and groin) swabs in all new CRE (Carbapenem-Resistant Enterobacterales) patients. Surveillance cultures used sabouraud dulcitol agar with 10% saline incubated at 40°C. Identification and susceptibility testing done using Bruker MALDI Biotyper and Etest (Biomerieux). Hospital onset (HO) is defined as positive cultures sent after day 3 of admission. CA isolates were sent for whole genome sequencing (WGS).

Results

The 10 cases included 7 from clinical isolates, 2 from enhanced surveillance and 1 from CT. 8 were HO. 7 deaths were during the CA admission, but only 1 due to CA, and 1 occurred > 60 days after positive culture [Table 1]. Of 231 contacts swabbed all were negative, except for Case 8, in whom one contact (Case 9) was positive. Positive yield from enhanced surveillance of CRE patients, was 0.84% (2/239). WGS results indicated all except Case 9 belonged to Clade I with Y132F mutation in ERG111 gene [Table 2]. Cases 2, 3, 5, 6 were closely related with 2-7 SNPs difference, but spaced in years. Cases 7 and 8 differed by 3 SNPs hence, closely related. There were 2 related clones being transmitted, and 4 unrelated sub-types of CA. Case 8 and 9 were not related, though 9 was a contact of 8. Possible links were shared equipment or admission to a common room however, admissions were either non-overlapping or non-successive [Table 3]. Case 5 was admitted to the same room after a long stay by Case 3, with one patient in between. No links found between Cases 7 and 8.

Conclusion

WGS results suggest that various clones of CA remain in the environment as reservoirs, and related cases are not often spatiotemporally related. There have been no CA cases since Oct 2021, possibly due to the change to bleach-based cleaner during our Delta surge.

Disclosures

All Authors: No reported disclosures
2488. Healthcare-associated infections in acute care hospitals in Greece, results of the third Point Prevalence Survey, April – December 2022
Authors: Palaiopanos Konstantinos , Krystallaki Dimitra , Mellou Kassiani , Mellou Kassiani , Maragkos Antonios , Politi Lida , Paraskevis Dimitrios , Tsiodras Sotirios , Zaoutis Theoklis
Published: November 2023

Background

The burden of healthcare-associated infections (HAIs) in European acute care hospitals is estimated through periodic Point Prevalence Studies (PPS) coordinated by European Centre for Disease Prevention and Control (ECDC). In 2016, Greece had the highest HAI prevalence among European countries (10%). The current PPS aimed to estimate the prevalence of HAIs among inpatients, especially in the context of COVID-19 pandemic.

Methods

A cross-sectional study was conducted between April and December 2022, according to ECDC PPS protocol v.6.1, in a representative sample of 50 Greek hospitals across all country regions. Patients admitted in wards before 8.00 am of the study day were screened for inclusion. Infection control teams collected hospital characteristics (e.g., total beds, infection control markers), wards (specialty, bed occupancy) and active HAIs (type, origin, microbiological results). Active HAIs included present HAIs or past HAIs that are still being treated. ECDC HelicsWin.Net software v.4.4.0, was used for data entry and analysis.

Results

Overall, 12.1% inpatients (1,175 of a total 9,707) had at least one active HAI. Among the 1,408 HAIs, the most commonly observed were lower respiratory tract infections (28.9%), bloodstream infections (20%), among which 4.6% were catheter-related, and urinary tract infections (13.1%), as shown in table 1. HAI prevalence was higher in patients of intensive care units (45.7%), compared to medical (13.5%) and surgical ones (8.2%).

Laboratory data were available for 58.9% of HAIs and 1,259 microorganisms were identified. Klebsiella species (20.5%), Acinetobacter species (12.8%), P. aeruginosa (10.2%), Candida species (7.9%) and S. aureus (6.3%) were frequent isolates. Antimicrobial susceptibility patterns varied depending on the pathogen (table 2).

Conclusion

This study shows the increased burden of HAIs among inpatients and the emergence of difficult-to-treat pathogens in Greek hospitals. Subsequent prevalence studies will provide additional evidence regarding the trend in HAI prevalence among inpatients and support the identification of modifiable practices. The invigoration of infection control and antimicrobial stewardship programs in these settings is essential.

Disclosures

All Authors: No reported disclosures
2489. An Innovative Capacity-Building Approach to Enhance Acute Flaccid Paralysis Surveillance During a Wild Poliovirus Type 1 Outbreak in Malawi, October 2022 - March 2023
Authors: Dagoe Edward , Zgambo Austin C , Tobolowsky Farrell A , Mapemba Daniel D , Kabaghe Alinune Nathanael , Tafatatha Terence , Yelewa Mtisunge , Chisema Mike N , Funsani Grace M , Mhone Brenda
Published: November 2023

Background

After 30 years without a poliovirus case, a wild poliovirus type 1 outbreak was declared in Malawi on 16th February 2022. To improve detection of poliovirus transmission, the country implemented enhanced AFP surveillance by deploying Frontline Field Epidemiology Training Program (FETP) graduates who had received a three-month general epidemiology training. We describe the results from October 2022 to March 2023.

Methods

Ten districts with increased risk of polio transmission and suboptimal AFP surveillance performance indicators were identified for enhanced AFP surveillance. One FETP graduate already working in each priority district was selected to be trained on poliovirus epidemiology and AFP surveillance. FETP graduates conducted active case finding for AFP cases in 100 priority health facilities (defined by epidemiologic risk and population size), provided on-the-job training for health care workers, and sensitized community volunteers and traditional healers on AFP recognition and reporting. A senior technical coordinator provided supportive supervision to FETP graduates in all 10 districts.

Results

During the observation period, FETP graduates completed 811 (44%) of 1839 visits to priority health facilities and reported 84% (59/83) of all AFP cases in the priority districts. Eleven additional AFP cases were retrospectively identified during FETP graduates’ health facility register reviews. FETP graduates trained 5,047 health care workers and educated 2,093 community volunteers.Figure 2.Number of health care workers and community members that were educated by FETP graduates on AFP case detection and notification in the priority districts by visiting month, October 2022 - March 2023.

Conclusion

The enhanced surveillance contributed to almost half of all active case search visits, detected most AFP cases in the identified priority districts, and educated the community to improve poliovirus identification and reporting. Including FETP graduates to train the local public health workforce is an innovative approach in Malawi to build capacity, rapidly mobilize in-country staff, optimize the available resources, and strengthen surveillance during a novel disease outbreak.

Disclosures

All Authors: No reported disclosures
2495. Inpatient Hepatitis C Virus Testing Increased During the COVID-19 Pandemic
Authors: Fitzgerald Brendan J , Jain Mamta K , Radunsky A L exander P , Cooper Lauren N , Hansen Laura
Published: November 2023

Background

We have observed an unexpected increase in hepatitis C virus (HCV) testing in the inpatient setting since the beginning of the COVID-19 pandemic. We hypothesized that this increase was driven by abnormal liver function tests (LFTs) due to COVID-19. We undertook a large observational study to test this hypothesis and to better understand the predictors of inpatient HCV testing.

Methods

We obtained medical record data for inpatients at Parkland Health and Hospital System (PHHS) from either of two 18-month time periods, representing before (8/1/2018-1/31/2020) and during (3/1/2020-8/31/2021) the COVID-19 pandemic. We evaluated possible predictors of inpatient HCV testing, including LFTs and COVID-19.

Results

Among the 34940 patients examined (18170 pre-pandemic [PP] and 16770 during pandemic [DP]), those hospitalized DP were more likely to be Hispanic and to have charity coverage (Figure 1). DP, 14.8% of inpatients received an HCV antibody (Ab) test, as compared to 13.4% of inpatients PP (p< 0.001). This increase specifically occurred among patients with COVID-19, of whom 18.5% received an HCV Ab test (Figure 2). This finding correlated with a much higher occurrence of elevated initial LFTs among patients with COVID-19 (Figure 3). The positivity rate of inpatient HCV Ab tests decreased from 9.07% PP to 4.87% among patients with COVID-19 (p=0.002), but there was no difference between time periods for patients without COVID-19 (Figure 2). When considering the subset of patients with COVID-19 who had an abnormal LFT, the Ab positivity rate was 4.13% (95% CI = [2.15%, 6.12%]). Among these Ab-positive patients, the HCV RNA positivity rate was 31.3% (95% CI = [8.5%, 54.0%]).

Conclusion

Hepatic injury associated with COVID-19 inadvertently resulted in more HCV Ab testing among inpatients. The Ab positivity rate and RNA detection were lower among these patients. Compared to non-COVID-19 inpatients who have abnormal LFTs, those with COVID-19 represent a lower risk population for HCV. Nevertheless, HCV testing still led to detection of new cases. Although abnormal LFTs among those with COVID-19 likely reflect hepatic injury due to SARS-CoV-2, it should be considered as an opportunity to screen a population who may not otherwise receive routine healthcare.

Disclosures

Brendan J. Fitzgerald, Pfizer Inc.: Stocks/Bonds|Viatris Inc.: Stocks/Bonds Mamta K. Jain, MD, MPH, Gilead Sciences: Grant/Research Support|Laurent: Grant/Research Support
2505. Using an Electronic Medical Record Alert to Screen Inpatient Encounters for People with Hepatitis C
Authors: Pryal Patrick , El-Nahal Walid , Grader-Beck Thomas , Wilson Grant , Beatson Brad , Falade-Nwulia Oluwaseun , Gebo Kelly , Berry Stephen
Published: November 2023

Background

Despite the availability of effective therapy, rates of linkage and uptake of hepatitis C virus (HCV) treatment remain suboptimal. People with HCV are hospitalized at a rate 3.7 times that of the general population, presenting an opportunity for linkage to care during inpatient admissions. We designed two novel electronic medical record (EMR) alerts to identify patients with HCV in two hospitals, and report on the alerts’ test-performance characteristics.

Methods

We developed two distinct EMR alerts and ran them silently on all adult hospitalizations at two academic medical centers in Baltimore, MD. Based on laboratory data, and diagnosis codes (Figure 1); the first alert identified all people ever infected with HCV (ever-alert); and, the second, only people with active HCV viremia (active-alert). We evaluated each alert’s positive predictive value (PPV) by manually reviewing all charts alerted during the study period. We evaluated alert sensitivity by reviewing a sample of consecutive hospital encounters during the same period to determine if they were alerted.

Results

From 6/29/2022-8/9/2022, the alerts examined 7,519 adult hospital encounters. The ever-alert was triggered for 569 encounters; 563 of 569 were truly ever-infected (PPV 98.9% [95% CI 98.1%, 99.8%]), and 202 of 569 were actively-infected (PPV 35.5% [31.6%, 39.4%]), corresponding to an active infection prevalence of 202/7,519 (2.7%). The active-alert was triggered for 267 encounters; 188 of 267 were actively-infected (PPV 70.4% [65.0%-75.8%]), corresponding to a 2.5% prevalence of active infection. The consecutive chart review examined 1157 patients, 122 (10.5%) of whom were ever-infected, including 44 (3.8%) actively-infected. The ever-alert identified 106/122 (sensitivity 86.9% [80.9%, 92.9%]) and the active-alert identified 37/44 (sensitivity 84.1% [73.3%, 94.9%]) of these respectively (Table 1).

Conclusion

An alert designed to identify only active infection has a comparable sensitivity (84.1% vs 86.9%) but significantly higher PPV (70.4% vs. 35.5%) for active infection than an alert designed to capture any infection (active or ever). These results support the use of an EMR alert for an HCV outreach program to link patients to care.

Disclosures

Oluwaseun Falade-Nwulia, MBBS ,MPH, Abbvie Inc: Grant/Research Support|Gilead Sciences: Advisor/Consultant Kelly Gebo, MD, MPH, Pfizer: Advisor/Consultant|Spark HealthCare: Advisor/Consultant
2508. Evaluation of Infectious Diseases Complications in US Veterans with Opioid Use Disorder, a Single Site Experience
Authors: Srivastava Pronoma , Modi Viraj , Lier Audun J
Published: November 2023

Background

Opioid use disorder (OUD) affects 2.7 million people in the United States and rates of OUD diagnosis are rising in US Veterans (USV). Injection drug use (IDU), including opioids, can lead to acquisition of bloodborne infections and severe injection related infections (SIRI). This study aims to describe infectious diseases epidemiology, substance use characteristics, and health care utilization in persons who inject drugs (PWID) and non-PWID with OUD who presented to the Northport Veterans Affairs Medical Center (NVAMC).Table 1.Demographic characteristics of USV with OUD, stratified by history of injection substance use. OUD, opioid use disorder. MOUD, medication for opioid use disorder. USV, US Veterans. PTSD, post-traumatic stress disorder.

Methods

Data was collected from a retrospective chart review of Veterans aged >18 years who had an ICD9 or ICD10 diagnosis of OUD and presented to the NVAMC between 2010-2020. Demographics, concomitant substance use and prior overdose histories, receipt of medications for opioid use disorder (MOUD), prior infection histories, hospitalizations, and emergency department (ED) visits were compared between PWID and non-PWID. Two-sample T-tests and Chi-square analyses were utilized.

Results

We identified 502 USV with a diagnosis of OUD. Mean age was 52.6 years, 469 (93.4%) were male, 396 (78.9%) were white, 172 (34.3%) were employed and 216 (43%) had health insurance. Post-traumatic stress disorder (n=275, 54.8%) was the most frequent psychiatric diagnosis and 216 (43%) USV had a history of IDU. PWID were more likely to have unstable housing (71.3% PWID vs 21.7% non-PWID, p< 0.001), be unemployed (60.2% PWID vs 43.7% non-PWID, p< 0.001), use cocaine (77.8% PWID vs 59.1% non PWID, p< 0.001), have a history of incarceration (49.1% PWID vs 38.5% non PWID, p=0.002), and have a prior overdose (53.7% PWID vs 27.3% non PWID, p< 0.001). Among PWID, 134 (62%) had hepatitis C virus and 30 (13.9%) had at least 1 SIRI, most frequently a skin and soft tissue infection (n=29, 13.4%). PWID were more likely to be hospitalized with an infection (26.4% PWID vs. 12.2% non PWID, p< 0.001) and had more inpatient admissions (5.5 PWID vs. 3.51 non PWID, p=0.003). ED visit frequency did not differ between groups.Table 2.Characteristics of SIRI and non SIRI among Veterans with OUD presenting to the Northport VAMC. SIRI, severe injection-related infection. OUD, opioid use disorder. SSTI, skin and skin structure infection. HBV, hepatitis B virus. HCV, hepatitis C virus. LOS, length of stay.

Conclusion

Veterans with OUD frequently present to the NVAMC with infections that require hospitalization. USV with OUD, especially PWID, would benefit from increased social support, as well as screening and treatment for OUD related infections.

Disclosures

All Authors: No reported disclosures