bluuebunny/crossref_metadata_2025 huggingface dataset:
1376. A Retrospective Analysis of Intravenous Fluid Therapy Practice at Hospital Admission for Adults with Dengue
Authors: Chia Yvonne M F , Kang James W J , Lea Felicia C Y , Ooi Eng Eong , Low Jenny G
Published: November 2023

Background

Dengue epidemics in Asia was almost exclusively a childhood disease but recently dengue in adults have become increasingly prevalent. Yet intravenous fluid replacement (IVFR), the main supportive therapy for dengue, was developed for pediatric dengue. Evidence-based guidance for fluid replacement, especially for older adults with concomitant chronic diseases that both increases risk of severe dengue and complicate fluid replacement, is lacking. We retrospectively analyzed the use of IVFR in adult dengue patients at admission to a tertiary hospital.

Methods

Medical records of patients diagnosed with dengue (confirmed by rapid NS1 kit or laboratory confirmation of RT-PCR, NS1 or IgM) from January 2020 to December 2022 were analyzed. Recovery phase was defined as fever defervescence for >12 hours with rising platelet count. Appropriateness of IVFR was based on disease severity according to the 2009 WHO dengue classification scheme.

Results

Preliminary analysis of the first 30 patients found an almost equal number of males (47%) and females. The median age was 52.5 years (range 15.0-83.0). 20 patients had at least one comorbidity with hyperlipidemia (33%), hypertension (23%) and ischemic heart disease (10%) being the most common. Average time from onset to presentation was 4.3 days (95% CI: 3.8-4.9). 16 (53%) met the WHO classification scheme as requiring IVFR at admission; 4 hypotension, 5 acute kidney injury (AKI), 2 hypotension with AKI, 4 hemoconcentration, 1 AKI with hemoconcentration. Of these 16, one also had altered mental status and another had hemophagocytic lymphohistiocytosis-like presentation. Despite 47% having uncomplicated dengue, all patients had IVFR at admission. Total fluid volume administered during hospitalization varied across the population and fluctuated daily for each patient, with 8 patients receiving IVFR beyond the recovery phase. One developed fluid overload while another had IV cannula-related thrombophlebitis. There was no mortality.

Conclusion

Preliminary findings of our on-going study suggest excessive use of IVFR and the lack of standardization possibly contributed to two iatrogenic complications. We call for development of evidence-based protocol on fluid management in older dengue patients.

Disclosures

All Authors: No reported disclosures
1386. Chagas Disease in Chile: an Old and Forgotten
Authors: Novoa Catalina , Galindo Carolina , Jorquera Camila , Otth María Laura , Wolff Marcelo , Gonzalez Sandra
Published: November 2023

Background

Chagas disease (ChD) affects 8-10 million people worldwide.

In Chile there are 98,000 people affected. Most endemic region is the middle northern part of the country, but not present south of the central areas. Significant interruption of vector transmission was achieved in the late 1900s. Since 2008, blood products for transfusions are screened universally, and since 2014 ChD serology testing has been implemented in all pregnant women, focusing efforts on prevention of vertical transmision, the most important form of contagion at present.

Being a referal center, we describe the demographic and clinical presentation as well as the treatment offered to the ChD referred patients.

Methods

Descriptive, retrospective study of patients with ChD referred to the San Borja Arriarán Hospital between january 2009 and march 2023. Demographic and clinical variables were analyzed: likely transmission mechanism, reason for testing, classification up on admission, diagnostic laboratory tests, treatment and reported adverse drug reaction (ADRs)

Results

T. cruzi infection was diagnosed in 234 patients, 74% women. The median age in years was 47; 70% Chileans nationals, the majority living in the Metropolitan Region (Fig 1). Among foreigners, the majority were form Bolivian. 76% had no associated comorbidity. Blood donation was the main form of detection (42 %), followed by pregnancy and family history study (Fig 2). Vector transmission was estimated in 50% of the cases; 84% were classified on admission as an indeterminate chronic disease; 42% patients received treatment, all with nifurtimox; 60% of them presented ADRs, more frequently during the first two weeks of treatment initiation. Most ADRs were gastrointestinal (anorexia, nausea and vomiting) (Fig 3); treatment was discontinued 20% of patients. Age and sex were not associated to higher rate of ADRs.

Conclusion

ChD continues to be endemic in Chile. Screening in blood donors and pregnant women is the main approach to diagnosis. The importance of its detection in pregnancy is both, the prevention of vertical transmission and the opportunity for early curative treatment. The incidence of ADRs is lower than that described in other series; a small percentage of these cases led to the discontinuation of treatment.

Disclosures

All Authors: No reported disclosures
1390. Talaromycosis: Differences between Patients with The Anti-interferon-γ Autoantibody and People Living with HIV/AIDS (PLWHA)
Authors: Krasaewes Kawisara , Patanadamrongchai Narootchai , Kaewpoowat Quanhathai , Yasri Saowaluck , Wongthanee Antika , Chaiwarith Romanee
Published: November 2023

Background

Talaromycosis has been increasingly reported among HIV-uninfected immunocompromised conditions in an endemic area. This study aimed to compare characteristics, and mortality associated with talaromycosis with adult-onset immunodeficiency caused by the anti-interferon-gamma autoantibody (anti-IFN- γ AAb) to those of people living with HIV/AIDS (PLWHA).

Methods

A retrospective cohort study was conducted at Maharaj Nakorn Chiang Mai Hospital, Thailand in adults with confirmed documentation of HIV infection or anti-interferon-gamma autoantibody, with a diagnosis of talaromycosis.

Results

Thirty-two patients with anti-IFN- γ AAbs and 64 PLWHA were enrolled. Anti-IFN- γ AAbs patients were older, more likely to have nodules and abscess skin lesions, bone and joint infections, leukocytosis, abnormal chest radiograph, and less likely to have fungemia. Time from the first symptom to treatment was longer in patients with anti-IFN- γ AAbs (44.5 days VS. 28.0 days, p-value=0.006). The 24-week-mortality rate was 9.4% (3 patients) in patients with anti-IFN- γ AAbs and 18.8% (12 patients) in PLWHA (p-value=0.225).

Conclusion

The clinical features of talaromycosis in patients with anti-IFN-γ AAbs were different from PLWHA. Clinicians in areas endemic for talaromycosis should be aware of differing characteristics of talaromycosis in anti-IFN- γ AAbs patients.

Disclosures

All Authors: No reported disclosures
1395. The Path of Healing: Demographic Features and Therapeutic Trajectory of Patients with American Tegumentary Leishmaniasis in a City of Northern Brazil
Authors: Alves Alana Pinheiro , Xavier Francisco Alrimar Silva , de Sousa Pereira Gustavo Alessandro , Cardoso Fernanda Jacqueline Teixeira , de Alencar Salgado Andrea Leite , do Nascimento Martins Nadia Vicencia
Published: November 2023

Background

American Tegumentary Leishmaniasis (ATL) is a neglected infectious disease caused by protozoa of the Leishmania genus. Its incidence in the state of Para, Northern Brazil, reached 38,95 cases per 100,000 individuals in 2017. During this illness, people will move through several layers of a healthcare structure on a path for solutions to their affliction. This is described as therapeutic trajectory or itinerary, and it is directly influenced by determinants of health. In this scenario, we question what the trajectory of patients with ATL within healthcare in the city of Ruropolis, Brazil, is.

Methods

This was a transversal retrospective study. Qualitative data was also obtained through patient interviews. The research was developed in the city of Ruropolis, in Northern Brazil, and included individuals who received care through the Brazilian Unified Health System (SUS). All patients or responsible adults involved in the research signed an informed consent form.

Results

A total of 49 patients were initially included, but only 27 were interviewed. In 2021, ATL was diagnosed and notified every month, although April had the highest incidence (12 new cases). Over half of the patients resided in rural areas, and most worked in agriculture. Clear differences in trajectory were noted between patients or urban versus rural areas, as the latter mostly visited the local Emergency Department (ED) for care. Histopathologic work-up of all patients as performed. Regarding treatment, individuals had to relocate up to 50 kilometers daily to receive injections. Home healthcare services were not available.

Overall, 23 patients received intravenous treatment with meglumine antimoniate, and 10 had a myriad of effects, such as fatigue, peripheral edema, and vertigo. Only four patients had intralesional therapy. Of 27 patients, 22 did not know how to prevent ATL or refused to answer.

Conclusion

The struggles faced by patients with ATL are diverse. The local population is unaware of the different layers of service within healthcare, and a hospital-centric model seems to prevail. Patients seek care wherever it seems appropriate to solve their trouble. The narratives on knowledge of the disease reveal the need for further health education, preferably with the introduction of active teaching methods.

Disclosures

All Authors: No reported disclosures
1408. Epidemiology of Nitroimidazole-refractory Giardiasis
Authors: Ydsten Karin , Öhd Joanna Nederby , Hellgren Urban , Asgeirsson Hilmir
Published: November 2023

Background

Giardia intestinalis (G. lamblia or G. duodenalis) is one of the most common pathogenic intestinal parasitic protozoa. Giardiasis refractory (resistant) to nitroimidazoles (e.g., metronidazole and tinidazole) has increasingly been reported, most notably noticed in travellers returning from the Indian subcontinent. Information on the proportion of nitroimidazole-refractory cases from different world regions is scarce, and is difficult to investigate in a high-endemic setting.

Methods

All reported cases of giardiasis in Stockholm County (population 2,391,990 as of Dec 31st 2020) between January 2008 and December 2020 were obtained from the Department of Communicable Disease Control and Prevention, as it is a notifiable disease in Sweden. Refractory cases in Stockholm are referred to the Karolinska University Hospital, a tertiary centre, for treatment since second line drugs are not easily available. Medical records were reviewed. Nitroimidazole-refractory giardiasis was defined as continued symptoms and positive stool sample for giardiasis (microscopy and/or PCR) after a full treatment course.

Results

During the study period 4285 cases of giardiasis were notified and 95 of those (2.2%) were identified as nitroimidazole-refractory. The median age was 38 years (range 5-78) in the refractory group and 30 years (range 0-89) in the non-refractory. In both groups 55% were males. In those who had acquired the infection in India the refractory rate was 11% (60/545) compared to 1.1% in rest of Asia, 1.3% (14/1113) in Africa, 0.9% (11/1247) in Europe, 0.3% (1/349) in the Americas, and 0% (0/5) in Oceania.

Conclusion

The proportion of nitroimidazole-refractory giardiasis was ten times higher in those who had acquired the infection in India compared to other parts of the world, and should be taken into consideration.

Disclosures

All Authors: No reported disclosures
1998. The State of Training in Infection Prevention and Control and Healthcare Epidemiology: A National Survey of Infectious Disease Fellowship Program Directors
Authors: Winkler Marisa , Paras Molly L , Wright Sharon B , Shenoy Erica S
Published: November 2023

Background

Infectious disease (ID) clinicians are often identified to lead infection prevention and control (IPC)/healthcare epidemiology (HE) programs, however, there is no standardized training in fellowship for this role. The most recent survey of ID fellows in 2001 found that only 51% of graduates reported adequate training in IPC/HE. Despite this, half of respondents had IPC/HE responsibilities and received compensation from those activities. We conducted a survey of Program Directors (PD) of United States ID fellowship programs to assess current IPC/HE training.

Methods

An electronic survey was distributed in March and April 2023 to all ID fellowship PD identified by the Infectious Disease Society of America using Research Electronic Data Capture (REDCap). Survey questions covered training program characteristics, current required and optional IPC/HE training components, barriers to IPC/HE training, interest among fellows in IPC/HE training, and support for formalization of IPC/HE training.

Results

Of 166 programs, 54 (32.5%) completed the survey, representing programs in 25 states (Figure 1) and size range from 1-10 fellowship positions (mean 4). The majority (49/54, 90.7%) offered didactics in IPC/HE (mean 4.4 hours, range 1-10), of which 45/49 (94%) and 4/49 (6%) were required and elective, respectively. 52/54 (96.3%) of programs reported a formalized curriculum in IPC/HE training for all fellows and 18/54 (33.3%) of the responding programs offered a specialized track in IPC/HE. Reported training components varied (Table 1). A minority of PDs 11/55 (20%) reported considering expanding their IPC/HE training, however, 23/54 (42.6%) reported barriers (Table 2). There was widespread PD support for a formal IPC/HE certification program through a professional society (52/54, 96.3%).Figure 1:Geographic distribution of survey respondents divided by FEMA regions (1-10) of the United States and Territories (N= 54).

Conclusion

ID fellowship programs with dedicated IPC/HE training remain limited and the majority of training in IPC/HE is restricted to a small number of hours of didactics. Among respondents, many barriers to increasing IPC/HE training were identified. Respondents supported creation of a formal IPC/HE training program through a professional society.

Disclosures

Molly L. Paras, MD, Angiodynamics: Honoraria|Angiodynamics: Honoraria
1427. The EpiRate: a multidimensional index for measuring effectiveness in infection prevention
Authors: Couto Braulio , Ladeira Ana Paula , Carvalho Walisson Ferreira , Lima Naísses Zóia , Starling Carlos E
Published: November 2023

Background

Measuring the effectiveness of infection prevention in a hospital setting is a crucial task, particularly from a global perspective and when considering various types of infections simultaneously (Fig. 1). In this paper, we introduce the EpiRate, a multidimensional index designed to assess the effectiveness of a hospital-wide ICP.Figure 1.There are many types of hospital-acquired infections. How to measure the effectiveness in preventing hospital-acquired infection in a global perspective?

Methods

EpiRate is calculated using a scoring system based on a comparison of observed values obtained from a list of hospital-acquired infection rates with the percentiles of their respective benchmarks. For each rate, the observed rate (Tx) is compared with the benchmark percentiles to assign a score. If Tx ≤ p10%, the score is set to 5.00; if Tx ≤ p25%, the score is 4.75; if Tx ≤ p50%, the score is 4.00; if Tx ≤ p75%, the score is 3.75; if Tx ≤ p90%, the score is 3.00; and if Tx > p90%, the score is 0.00 (Fig. 2). The total score is the sum of all points obtained considering the k rates involved in the analysis. The EpiRate is then calculated as the total score divided by the maximum score (= k*5), expressed as a percentage (%), indicating the percentage of effectiveness in preventing the infections measured by the chosen indicators. Furthermore, the prevention effectiveness of each infection can be assessed individually based on the indicators used in the EpiRate, with automatic interpretation (Fig. 3).Figure 2.EpiRate Scoring Algorithm for Each Rate or Infection ConsideredFigure 3.Epidemiological scenarios and action plans associated with the values of EpiRate rate.

Results

Fig. 4 presents an example of the EpiRate for an ICU, utilizing 5 rates in the calculation (k=5). For each rate, observed values are compared with the benchmark percentiles, and the maximum score is 5 * 5 = 25 points. In this example, a total score of 19.5 points was obtained, resulting in an effectiveness rating of 78% for preventing infections in the ICU, from a global perspective. Fig. 5 illustrates the monthly EpiRate trends for two ICUs, from Jan/2021 to Dec/2022. Furthermore, Figure 6 showcases EpiRates specifically for Surgical Site Infections (SSIs), allowing an evaluation of the SSI prevention effectiveness in each service and enabling a summary of the hospital-wide SSI EpiRate.Figure 4.Example of a EpiRate Rate calculating in an Intensive Care Unit (ICU).Figure 5.EpiRate for two ICUs (Jan/2021 to Dec/2022): monthly rates.Figure 6.EpiRate for Surgical Site Infection.

Conclusion

Unlike traditional infection rates that focus on the "bad side of the problem," EpiRate Rate provides a positive perspective by evaluating the effectiveness of infection control program. This multidimensional index has the potential to enhance infection prevention strategies.

Disclosures

All Authors: No reported disclosures
1433. Hand Hygiene Products Consumption and Compliance in Intensive Care Units of 74 Hospitals in Shanghai
Authors: Han Mengge , Pan Hongping , Gao Xiaodong , Hu Bijie
Published: November 2023

Background

Understand the hand hygiene products consumption and compliance of the medical personnel in intensive care units (ICUs) of the secondary and tertiary hospitals in Shanghai to provide a scientific basis for hand hygiene monitoring.

Methods

The data was obtained through the Shanghai Hospital Infection Monitoring System from 2017 to 2021. The average daily consumption per bed was caculated for hand hygiene products. The hand hygiene compliance was calculated as the rate of performed disinfections per observed indications in any medical personnel involved in clinical care during an observation period of approximately 20 minutes. Pearson correlation coefficient was used for the correlation analysis of hand hygiene products consumption and compliance rate.

Results

In 105 ICUs of 74 hospitals in Shanghai, 39.85% of medical personnel selected soap and running water, 42.27% used alcohol-based hand rubs, 4.65% used gloves without performing hand hygiene, and 13.22% did not use golves nor perform hand hygiene. The average daily hand hygiene products consumption was 79.24ml per bed , and 46.14 ml and 33.10 ml per bed for soap and alcohol hand rubs, respectively. The hand hygiene products consumption incereasd from 2017 to 2021 (P<0.001). The overall hand hygiene compliance rate was 81.64%.The hand hygiene compliance rate was 86.59%, 81.33%, 79.63%, 77.36%, 48.90% and 66.83% for nurses, doctors, continue education personnel/interns, nuring workers, medical technicians and others, respectively, and the rates varied statistically among different personnel (P<0.001). The hand hygiene compliance rate incereasd from 2018 to 2021 (P<0.001). There was a positive correlation between the average daily hand hygiene products consumption per bed and compliance rate (r=0.703, P=0.016).Table 1Hand hygiene measures in ICUs of the secondary and tertiary hospitals in Shanghai from 2017-2021Figure 1The trends of the hand hygiene products consumption and compliance rates from 2017-2021Figure 2The relationship between hand hygiene products consumption and compliance in ICUs of the secondary and tertiary hospitals in Shanghai from 2017-2021

Conclusion

Both the hand hygiene products consumption and compliance have shown an increasing trend in recent years in Shanghai. And hand hygiene compliance may be evaluated by continuously monitoring hand hygiene products consumption.

Disclosures

All Authors: No reported disclosures
1443. Characteristics of nursing homes with higher rates of invasive methicillin-resistant Staphylococcus aureus infections
Authors: See Isaac , Jackson Kelly A , Li Rongxia , Paul Prabasaj , Hatfield Kelly M , Nadle Joelle , Petit Susan , Wurm Daniel , Pall Allison , Ray Susan M , Harrison Lee , Jeffrey Laura , Bernu Carmen , Lynfield Ruth , Dumyati Ghinwa , Gellert Anita , Markus Tiffanie M , Schaffner William , Jacobs Slifka Kara M , Stone Nimalie D
Published: November 2023

Background

Invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in nursing home residents now outnumber hospital-onset invasive MRSA infections. Elucidating characteristics of nursing homes with higher invasive MRSA rates could inform strategies to reduce rates of infections and prioritize facilities for prevention efforts.

Methods

Using active laboratory- and population-based surveillance data, invasive MRSA cases (MRSA in a normally sterile body site in a surveillance area resident) were identified in 25 counties in 7 states in 2011-2015. Nursing home-onset cases were those in a patient residing in a nursing home 3 days before collection of the index MRSA specimen. Facility-level characteristics were obtained from Centers for Medicare & Medicaid Services datasets. Facilities with invasive MRSA rates (cases/100,000 resident-days) in the top 15th percentile were defined as having “high rates” and a logistic regression model was used to assess factors associated with having high rates.

Results

There were 626 total nursing homes included, with 2,772 invasive MRSA infections over the 5-year time period; 82% of the facilities had a least one invasive MRSA infection. The median invasive MRSA rate was 1.78 cases per 100,000 resident-days (interquartile range: 0.73-3.14), and nursing homes categorized as having high rates had rates of at least 4.04. In multivariable regression, documented presence of a resident with a multidrug-resistant organism, higher hospital-onset MRSA rates in the surveillance area, and greater proportions of residents who were male, on dialysis, in the facility < 100 days, or needed extensive assistance for bed repositioning were associated with having high invasive MRSA rates (Table). Increasing staffing of registered nurses (hours/resident/day) and a greater proportion of residents who were White were associated with lower rates.

Table

Adjusted odds ratios for facility-level factors associated with high rates (i.e., the top 15% of nursing homes) of nursing home-onset invasive methicillin-resistant Staphylococcus aureus (MRSA)

Conclusion

Our findings suggest facilities with higher invasive MRSA rates are likely to serve residents with more clinical and functional care needs. Increasing hours of registered trained nurses might assist with reduction of invasive MRSA rates. Understanding why differences in rates are associated with the racial composition of residents may reveal health equity issues contributing to risk.

Disclosures

Lee Harrison, MD, GSK: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Sanofi: Advisor/Consultant Ghinwa Dumyati, MD, Pfizer: Grant/Research Support
1448. Characterizing Monkeypox in a Secondary Hospital in Madrid. Is HIV Playing a Role?
Authors: Alonso Samuel Estévez , Gozalbo Ana Simón , González Marta Vara , Guerrero María Gamo , Varela Samuel Manzano , García Jesús Troya , Botezat Ekaterina , de Buitrago Eva Jiménez González , Tomé Roberto Pedrero , Diaz Maria Ángeles Martin , de la Cueva Dobao Pablo , Gómez Beatriz Fernández , Huertas Elena Palma , Vidal Elisa Fernández , Lavalle David Esteban Brown
Published: November 2023

Background

Monkeypox (MPOX) is a zoonotic viral disease, endemic in some Central and West African countries. However, in May 2022, cases began to be reported in non-endemic countries, demonstrating community transmission. Since the beginning of the outbreak, different epidemiological and clinical behavior have been observed.

Methods

We conducted an observational study at a secondary hospital in Madrid, Spain, to characterize the MPOX suspected and confirmed cases epidemiologically and clinically. Besides the general descriptive analysis, we compared data between MPOX-confirmed cases vs MPOX-negative cases, between patients living with HIV (PLWHIV) and HIV-negative patients, and between patients vaccinated against smallpox vs unvaccinated.

Results

The study comprised 133 patients with MPOX suspicion, of which 100 were confirmed. Regarding positive cases, 71.0% were PLWHIV, and 99.0% were men with a mean age of 33. Sexual behavior in the previous year included 97.6% reporting having sex with men (MSM), 53.6% using apps for sexual encounters, 22.9% practicing "chemsex”, and 16.7% with sexual intercourse in saunas. Other epidemiological data are summarized in Table 1. In the clinical aspect, the presence of inguinal lymphadenopathy was significantly higher in positive MPOX cases (54.0% vs 12.1%, p< 0.001), as the involvement of genital and perianal area (57.0% vs 27.3% and 17.0% vs 1.0%, p= 0.006 and p= 0.082 respectively). In addition, of them, 45.0% presented pustules as the most common skin lesions, and the genital area is the most frequently affected (57.0%). In PLWHIV, only 6.9% had a detectable viral load, and the mean CD4 count was 607.0/mm3. Compared to HIV-negative cases they had a trend towards greater involvement of the perianal area (3.6% vs 22.5%, p=0.05). This is more remarkable if PLWHIV had poor control criteria (CD4 count < 500 cells/mm3), with perianal involvement in this group at 30.3% vs 0.0% if optimal HIV control. Other clinical results are summarized in Table 2 and Table 3.

Conclusion

The recent MPOX outbreak was epidemiologically related to sexual intercourses in MSM with no significant differences observed in the disease course between PLWHIV and HIV-negative cases, except for a greater tendency to appearance of perianal lesions.

Disclosures

All Authors: No reported disclosures
1450. Managing a Multidrug-resistant Acinetobacter baumannii Outbreak in the ICU: A Successful KAIZEN Program Using Process Indicators for Antimicrobial Stewardship, Hand Hygiene, and Standardization
Authors: Kawamura Hideki , Arimura Syoko , Murata Nao , Shigemi Akari , Niiyama Syuhei , Nishi Junichiro , Kakihana Yasuyuki
Published: November 2023

Background

Between 2016 and 2018, we detected Multidrug-resistant Acinetobacter baumannii (MDRA) carrying the IMP-1 gene in 15 patients including 14 of whom had been admitted to the ICU (Figure 1). The hospital environment including bed rail and mattresses became a reservoir for MDRA. We implemented the KAIZEN program in the ICU, which included process indicators for antimicrobial stewardship (AS), hand hygiene, and standardizing. The aim of this study is to evaluate the effectiveness of this KAIZEN program and establish infection control measures against MDRA.Figure 1.Epicurve of Multidrug-resistant Acinetobacter baumannii

Methods

In August 2018, we implemented several process indicators in the ICU at August 2018 to monitor antimicrobial use density (AUD) for carbapenems (target: less than 10 per 100 patient-days), use of an alcohol antiseptic agent (target: more than 200 times per patient-days), and weekly infection control rounds. We implemented a policy requiring staff to disinfect their hands when entering and exiting patient rooms, displayed posters reinforcing the rules of hand hygiene, used video monitoring to provide feedback on compliance rates, and encouraged staff to remind each other. Doctors were required to obtain permission using a checklist before prescribing carbapenems and held weekly conferences with ICU doctors to review AS bundles. We formed a 5S (Sorting, Setting-in-order, Shining, Standardizing, Sustaining) working group to discuss and implement strategies to maintain a clean environment and address infection control issues raised in the weekly rounds

Results

AUD for carbapenems decreased from 17.8 in 2016 to 6.7 in 2019, while use of an alcohol antiseptic agent increased from 51.5 in 2016 to 219.6 in 2019 (Figure 2). There was improvement in the issues identified during infection control rounds related to 5S, as demonstrated by a reduction in the number of previously identified problems (Figure 3). The MDRA outbreak was deemed successfully resolved based on improvements in process indicators and the absence of MDRA cases in patients or the environment for a year.Figure 2.Antimicrobial use density (AUD) for carbapenems and Use of an alcohol antiseptic agent from 2016 to 2019 in ICUFigure 3.The number of issues about 5S infection control rounds

Conclusion

The KAIZEN program, which involved planning and implementing improvement measures based on process indicators, effectively controlled the MDRA outbreak by standardizing infection control and antimicrobial use through the establishment of rules.

Disclosures

All Authors: No reported disclosures
1462. Analysis of Clindamycin and Vancomycin Use and Reported Beta Lactam Allergy in Procedural Antimicrobial Prophylaxis
Authors: Veach Lisa A , Bushman Amanda , Wall Geoff , Hadziric Adela , Olstinke Kayla , Blackmer Sydney
Published: November 2023

Background

Patients with a penicillin (pcn) allergy are less likely to receive cefazolin (cef) and more likely to receive vancomycin (vanco) or clindamycin (clinda) for procedures. Literature reveals a 51% increased risk of surgical site infection in patients with a reported pcn allergy attributed, in multivariable analysis, to use of second line antimicrobial agents.

Methods

We conducted a retrospective review of intravenous vanco and clinda administration in procedural areas during a 6 -month period in 2022.

The aim of our study was to assess the appropriateness of the procedural prophylaxis antibiotic given based on the allergy information available in the medical record.

Documented allergy responses were classified as: severe, cutaneous and other. Multiple documented reactions were classified using the most severe reaction type.

Results

Seven hundred and eighty-eight patient encounters were reviewed: 434 encounters receiving vanco and 354 encounters receiving clinda.

Of the encounters receiving vanco, 237 (55%) had documentation of beta lactam allergy (pcn allergy (212), cef allergy (64), both (39)). Within the pcn allergy group, reaction was cutaneous only in 47% (100). In 79 encounters previous receipt of a cephalosporin was documented in the EHR.

Of the encounters receiving clinda, 330 (93%) had documentation of a beta lactam allergy (pcn allergy (277), cef allergy (98), both (45)). Within the pcn allergy group, reaction was cutaneous only in 60% (167). In 109 encounters previous receipt of a cephalosporin was documented in the EHR. (Figures 1 and 2)

In both groups nursing placed the majority of the vanco (69%) and clinda (70%) orders.

Conclusion

At least 55% (N=267) of pcn allergic patients could have received the optimal agent (cefazolin) for procedural prophylaxis as they had only a cutaneous reaction. EHR review for prior cephalosporin administration in non-cutaneous reaction further increases that number.

In recognition of the role of nursing, our health system has developed guidance documents to aid pre-op nursing staff in selecting the appropriate surgical prophylaxis antimicrobial in patients reporting pcn allergy. This document is readily available and shared with key stakeholders. Process improvement opportunities are ongoing.

Disclosures

All Authors: No reported disclosures
2006. The Impact of Race and Rurality on Healthcare-Associated Infections and Downstream Adverse Outcomes
Authors: Nickel Katelin B , Kinzer Hannah , Fraser Victoria J , Burnham Jason P , Kwon Jennie H
Published: November 2023

Background

There is limited information on racial disparities and healthcare-associated infections (HAIs). The objective of this study was to evaluate the impact of race and rurality on HAIs and outcomes of HAIs including death and intensive care unit (ICU) admission.

Methods

We established a retrospective cohort of adults ≥ 18 years admitted ≥ 48 hours from 1/1/2017–8/31/2020 at three Missouri hospitals. HAIs were defined as positive cultures from urine, blood, or respiratory specimens ≥ 48 hours after admission. The primary exposure was patient race and rurality defined as combinations of race (Black or white) and residence (urban vs. rural based on patient ZIP code and using the National Center for Health Statistics Urban-Rural classification). We used a generalized estimating equations (GEE) model to determine disparity-related (i.e., race/rurality, sex, Medicaid payer, census median income quartile) risk factors for HAI accounting for clustering of admissions at the patient-level and adjusting for other factors (e.g., comorbidities, age, transfer status). Among HAI admissions, similar GEE models examined in-hospital death and ICU admission after HAI.

Results

The cohort included 214,955 admissions (Table 1), with HAIs occurring during 6,699 (3.1%) of admissions (1,572 blood; 3,146 urine; 2,497 respiratory HAIs). HAIs developed during 3.1% of admissions among white urban patients, 3.9% among white rural patients, 2.7% among Black urban patients, and 4.1% among Black rural patients (Figure 1). White rural patients had an increased risk of HAI (adjusted relative risk [aRR] 1.13; 95% confidence interval [CI] 1.06, 1.20) while Black urban patients had a decreased risk of HAI (aRR 0.82; 95% CI 0.76, 0.88) compared to white urban patients. Among HAIs, adverse outcomes were more common in Black rural patients (Figure 2). Specifically, Black rural patients had an increased risk of ICU admission (aRR 1.35; 95% CI 1.15, 1.58) and in-hospital death (aRR 1.85; 95% CI 1.31, 2.60) while white rural and Black urban patients had similar outcomes compared to white urban patients.Table 1.Patient characteristicsFigure 1.Proportion of admissions with an HAI by race and ruralityFigure 2.Among HAIs, proportion of admissions with adverse outcomes by race and rurality

Conclusion

We identified disparities related to race and rurality in HAIs and adverse outcomes from HAIs. Future work to understand the reasons underpinning these differences is critical to identify targets for intervention.

Disclosures

All Authors: No reported disclosures
1474. Getting to Zero: Our Journey to Decrease CABG Deep Sternal Wound Infections
Authors: Gentile Paul M , Roberts Scott , Wilson Erin , Martinello Richard A
Published: November 2023

Background

Deep sternal wound infections (DSWI) are a serious complication of cardiac thoracic surgeries and are associated with a significantly higher mortality risk. Our center experienced increased surgical site infection (SSI) rates prompting an epidemiologic evaluation.

Methods

A retrospective cohort review of 10 cardiac surgery patients with DWSI from 2020-2021 were reviewed. An SSI bundle to decrease DSWI was implemented using a standardized pos-operative wound dressing (prior to this, dressing selection was per the cardiac thoracic surgeon's discretion), glucose optimization in collaboration with our endocrinology team, and chlorhexidine bathing practices.

Results

Starting in September 2020 Yale New Haven Hospital observed a statistically significant increase in DSWI (0.51), which was a 285% increase in DSWI. Of the 10 out of 15 patients with DSWI who underwent review, the majority were inpatient prior to surgery with a mean length of stay of 5 days before undergoing surgery. Following selective implementation of the SSI bundle to urgent cases who were inpatient at the time of surgery, the DSWI rate decreased from 1.97 in 2021 to 1.13 in 2022, which reflected a 43% clinical decrease with 0 DSWI reported.

Conclusion

Implementation of an inpatient pre-operative, SSI bundle, including standardization of post-operative sternal wound dressings, resulted in a significant decrease in DSWI that has persisted post-intervention.

Disclosures

All Authors: No reported disclosures
1477. Do Federal Risk Assessment Criteria Adequately Classify Patients for Surgical Site Infections Following Colon Surgery?
Authors: Yusuf Yasna , Episcopia Briana , Fornek Mary , Abdallah Marie , Quale John
Published: November 2023

Background

Infections related to colon surgery are associated with adverse outcomes. Colon SSIs are reportable to National Healthcare Safety Network (NSHN) and Centers for Medicare and Medicaid Services (CMS). Rates of SSIs are factored into federal reimbursement programs; financial penalty may exist for “low-performing” hospitals. CMS employs a risk assessment tool to calculate the number of expected colon SSIs for each center.

Methods

The NYC H+H consist of hospitals that serve patients of low socioeconomic status. Five of the eleven are designated as level 1 trauma centers. Data regarding patients that underwent colon surgery from 2015-2022, including those that developed SSIs, were obtained from NHSN. Propensity score matching was done to match patients with colon SSIs to those without SSIs. Covariates included the CMS risk factors: gender, diabetes, age, BMI, ASA score, surgical closure type.

Results

A total of 5217 patients underwent colon surgery from 2015-2022. There were 276 patients with a colon SSI. A propensity matched cohort (n=276), using the CMS risk assessment variables, was matched with the 276 patients with SSIs (Table 1).

Other features involving the colon surgery were examined for the two cohorts (Table 2). Compared to the matched controls, there was a disproportionate distribution of wound class groups among the SSI cohort. Significantly more patients had dirty wounds in the SSI group. Surgery was more often emergent, and had a significantly longer duration in the SSI cohort. Of the patients with SSIs, more were trauma cases, and a significantly greater percentage had surgery performed in a trauma center compared to the other hospitals.

Conclusion

Colon SSI preventive measures are not applicable for emergent and trauma cases. The current risk assessment model used by CMS does not fully adjust for the complexity of various colon surgeries. As such, hospital performance as judged by federal SSI assessments does not correlate with the quality of care provided. Financial penalties imposed by CMS may be devastating, particularly for safety net hospitals serving patients primarily of low socioeconomic status. Until appropriate risk assessment models are developed, the use of colon surgery SSIs as a quality measure should be re-evaluated.

Disclosures

All Authors: No reported disclosures
1482. Combined Test and Treat Campaigns for HIV, Hepatitis B and Hepatitis C: A Systematic Review to Provide Evidence to Support WHO Treatment Guidelines
Authors: Beard Natasha , Hill Andrew
Published: November 2023

Background

Over 38 million individuals are living with HIV, 296 million with chronic Hepatitis B (HBV) and 58 million with chronic Hepatitis C (HCV). Globally, despite successful and cost-effective treatments for these blood-borne viruses (BBVs), over 1.7 million people die per annum. HIV testing is common practise in many countries, yet HBV and HCV screening is often neglected. This systematic review aims to identify the prevalence of the aforementioned BBVs and discuss the cost-effectiveness of implementing combined testing and treatment for HIV, HBV and HCV as one package.

Methods

MEDLINE, Embase and Global Health were searched to identify papers published between 1st January 2013 and 24th February 2023. Included studies reported the prevalence of HIV (anti-HIV 1/2 antibodies), HBV (Hepatitis B surface antigen) and HCV (anti-HCV antibody). Results were stratified into risk groups: blood donors, general population, healthcare attendees, homeless individuals, men who have sex with men (MSM), people who use drugs (PWUD), pregnant women, prisoners, and refugees.

Results

175 studies conducted in 56 countries sampling over 14 million individuals met the eligibility criteria and were included. The mean prevalence of HIV, HBV and HCV was 3.12% (± 7.71%), 4.01% (±5.80%) and 6.70% (±14.64%) respectively. The mean number of individuals testing positive for at least one BBV was 11.83% (±16.86%); with the greatest burden of disease being reported in MSM and PWUD. Therefore, if combined testing was implemented on a global scale, for every 3 individuals diagnosed with HIV, another 4 would be diagnosed with HBV and 7 with HCV.Table 1:Prevalence of HIV, HBV and HCV and the total testing positive for at least one blood-borne virus in included risk groupsFigure 1:A Bar Chart demonstrating the prevalence of HIV, HBV and HCV in each included risk group

Conclusion

The cost of manufacturing a triple BBV test is $1. Additionally, HIV can be treated for $60/year using TDF/FTC+DTG, HBV for $32/year using generic TDF and HCV can be cured for $79 via generic Sof/Vel, thus providing a cost-effective package solution that could be implemented in the majority of countries. The results of this paper highlight a potential avenue for healthcare improvement by expanding common place isolated HIV testing to combination test and treat programmes. It is only through global diagnosis of all three BBVs, coupled with successful linkage to care, that the Sustainable Development Goal of elimination of these BBV epidemics by 2030 will be achieved.

Disclosures

All Authors: No reported disclosures
2062. In Vivo Efficacy of CD388, a Novel Drug Fc-Conjugate (DFC), Against Seasonal Subtypes of Influenza in Prophylaxis in Immune Competent Mice, and in a Severe Immunodeficient (SCID) Mouse Model
Authors: Levin James , Döhrmann Simon , Cole Jason N , Amundson Karin , Borchardt Allen , Brady Thomas P , Lam Thanh , Fortier Joanne , Almaguer Amanda , Tari Leslie W
Published: November 2023

Background

Influenza remains a significant public health concern due to the limited efficacy of vaccines. Cidara has developed CD388, a multivalent conjugate of a dimeric neuraminidase inhibitor with a proprietary hIgG1 Fc domain engineered for extended half-life, currently in clinical development. Here we describe the efficacy of CD388 against a panel of geographically and temporally diverse influenza A and B subtypes in mouse prophylactic models, and against H1N1 in a SCID model.

Methods

Efficacy studies were conducted in BALB/c mice lethally challenged with influenza virus. CD388 was administered intramuscularly (IM), seven days prior to challenge. Animals were monitored daily for 21 days or longer for survival (< 20% BW loss). For SCID studies, mice were dosed with CD388 two hours prior to lethal challenge with influenza A H1N1. Oseltamivir and baloxavir were included as comparators.

Results

Across all influenza subtypes, CD388 treatment at ≤1 mg/kg resulted in 100% survival (Table 1). Daily BW measurements of treatment groups supported survival findings and showed a transient BW loss (generally between 5 and 15% of starting weight), before animals recovered weight.

In SCID studies, the median time of death for vehicle treated animals was seven days. Treatment with oseltamivir (5 mg/kg, bid x5d) and baloxavir (15 mg/kg, bid x1d) at their human equivalent doses extended the median survival time to Day 10 and 16, respectively (Figure 1). In contrast, a single dose of CD388 at 1 mg/kg extended the median time of death to beyond Day 21. A dose response was evident at higher CD388 doses with the median time of death extended to Day 30 and 35 for 3 and 10 mg/kg groups, respectively.

Conclusion

This data demonstrated a single IM administration of CD388 fully protected animals from lethal challenge against seasonal influenza A and B. Importantly, CD388 was found to be efficacious in a severe model of immune deficiency. This data supports the prophylactic use of CD388 to prevent seasonal influenza in individuals.

Disclosures

James Levin, PhD, Cidara Therapeutics: Stocks/Bonds Simon Döhrmann, PhD, Cidara Therapeutics: Stocks/Bonds Jason N. Cole, Ph.D., Cidara Therapeutics: Stocks/Bonds Karin Amundson, BSc, Cidara Therapeutics: Stocks/Bonds Allen Borchardt, PhD, Cidara Therapeutics: Stocks/Bonds Thomas P. Brady, Ph.D., Cidara Therapeutics: Stocks/Bonds Thanh Lam, PhD, Cidara Therapeutics: Stocks/Bonds Joanne Fortier, BSc, Cidara Therapeutics: Stocks/Bonds Amanda Almaguer, Bachelors, Cidara Therapeutics: Stocks/Bonds Leslie W. Tari, Ph.D., Cidara Therapeutics: Stocks/Bonds
1493. Targets for Primary Prevention in Newly Diagnosed People Living with HIV: Applying Life's Simple 7 to Assess Cardiovascular Health Needs in ART-Naive People Living with HIV in Tanzania
Authors: Khan Safah , Manyangu Gloria J , Peck Robert N
Published: November 2023

Background

People living with HIV (PLWH) are at elevated cardiovascular disease risk by virtue of their infection, even before initiation of antiretroviral therapy (ART). There is a need to characterize cardiovascular health (CVH) during the early infection phase to appropriately direct primary prevention efforts. Therefore, we applied American Heart Association's Life's Simple 7 (LS7) scale to compare CVH between ART-Naive PLWH and HIV-uninfected adults in Tanzania.

Methods

A cross-sectional analysis was conducted on a cohort of ART-Naive PLWH and HIV-uninfected adults recruited from HIV clinics between June 2016 and August 2019 in Mwanza, Tanzania (HIV&HTN cohort). We applied modified Life's Simple 7 (LS7) definitions (Table 1), categorizing each metric as ideal (2 points), intermediate (1 point) and poor (0 point). We compared distribution of these categories for each LS7 metric between study groups. Ordinal regressions were employed to investigate associations between HIV status and each individual LS7 metric adjusting for age, sex, education, income.

Results

Our study included 997 participants (493 PLWH, 504 controls). The distribution of LS7 metrics differed between PLWH and HIV-uninfected controls, as displayed in figures 1a and 1b. PLWH had higher prevalence of ideal BMI (75.6% vs 65.4%) and ideal blood pressure (56.1% vs 35.1%) than HIV-uninfected counterparts. By contrast, PLWH had lower prevalence of ideal smoking (83.5% vs 89.6%), physical activity (38.9% vs 45.0%), blood glucose (93.9% vs 97.8%) compared with controls. These associations were validated by multivariate ordinal regression wherein PLWH were found to be more likely to have ideal BMI (aOR= 1.59 [95%CI= 1.20-2.12], p=0.001), ideal blood pressure (aOR =2.50 [1.95-2.31], p< 0.001) but less likely to have ideal smoking (aOR =0.63 [0.49-0.97], p=0.04), ideal physical activity (aOR= 0.63 [0.49-0.81], p< 0.001), ideal blood glucose (aOR=0.34 [0.16-0.68], p=0.003).

Conclusion

Cardiovascular health profiles differ between PLWH and uninfected counterparts, even in the early pre-ART phase. Although PLWH had lower rates of traditional risk factors, there is room for improvement with regards to smoking cessation, improving physical activity and diabetes screening in newly diagnosed PLWH.

Disclosures

All Authors: No reported disclosures