bluuebunny/crossref_metadata_2025 huggingface dataset:
2442. Etiology of Leukemoid Reaction in Patients Undergoing Extracorporeal Membrane Oxygenation
Authors: Wells Christian , Sobieszczyk Michal , Marcus Joseph
Published: November 2023

Background

Infections are a common in patients undergoing extracorporeal membrane oxygenation (ECMO), yet there is limited literature describing best practices for identifying infections. Leukemoid reaction, defined as > 50,000 white blood cells (WBC) per microliter, has been associated with infection in some populations. However, the etiology of leukemoid reactions in ECMO is unknown.

Methods

A retrospective cohort study was performed of all adult patients admitted to Brooke Army Medical Center who received ECMO for greater than 72 hours between the years of 2018-2022. Maximum WBC was obtained for all charts. For patients with a leukemoid reaction, charts were examined to determine both demographic information as well as clinical management of patient at time of leukemoid reaction.

Results

Among 182 patients receiving ECMO for greater than 72 hours, 181 (99%) of patients had a WBC greater than 10,000 cells per microliter during their ECMO course. 15 (8%) developed a leukemoid reaction while on ECMO and were included for further analysis. In this cohort, the median age was 38 [32-44.5] with median [IQR] WBC of 53.94 [50.98-62.55]. Among these patients, 14 (93%) underwent an infectious workup with infectious disease being consulted in 10 (67%) cases. Two (13%) patients had antibiotics started and 2 (13%) had their antibiotics broadened. Patients had a median of 2 [IQR: 2-3] contributing factors to their leukemoid reaction. Of these contributing etiologies, eleven (73%) patients were receiving treatment for a known infection, 6 (40%) were found to have a new thrombus, and 4 (27%) were receiving glucocorticoids (Table). One (7%) patient was found to have a new infection, an Acinetobacter bacteremia.Table 3.Contributing Etiologies of Leukemoid Reaction in patients receiving ECMO at Brooke Army Medical Center

Conclusion

Leukocytosis is almost universal in ECMO and leukemoid reactions occur frequently. In this cohort, infectious workups were common for leukemoid reaction, yet new infections were rarely identified. Future studies are needed to determine better infectious markers in this patient population.

Disclosures

All Authors: No reported disclosures
2444. Descriptive Analysis and Control Measures of Candida auris Infections: An Experience form a Quaternary Healthcare Center in Saudi Arabia
Authors: Amer Hala A , Alfaraj Sarah , Memish Ziad
Published: November 2023

Background

Candida auris is a multidrug-resistant fungal pathogen causing a worldwide epidemic. Since C auris has high mortality rate, ambiguous spread, frequent misidentification, and multidrug resistance, therefore it’s considered as a major global public health threat. In Saudi Arabia (SA), 1st case of C auris was identified in 2018.

Methods

We described patients with C auris positive specimens reported between January 2021 and June 2022 at one of the main healthcare facilities in SA. A multiciliary committee headed by the hospital leadership and involved infection control, infectious diseases, intensive care, nursing, environmental services, pharmacy, and laboratory has been formulated to investigate the potential outbreak among clusters of cases at intensive care unit (ICU). A bundle of containment measures has been applied at ICU including, C auris admission screening, point prevalence testing every two weeks, patients and staff post exposure screening, environmental samples, high level disinfection (fig1), dedicated of patients’ placement and equipment of care , enhancing patient hygiene, universal contact precautions , and frequent education and auding of infection control practices.Figure 1:Protocol of Cleaning and Disinfection Process for Candida auris

Results

129 cases of C auris were identified in our facility during the study period with two peaks of cases in June 2021 and March 2022. 78.3% were ICU patients with average length of stay 36.2 days. Demographics, comorbidities and risk factors were analyzed (tables1&2). Mortality rate was 43.4% occurred within 20.13 days of infection. Factors significantly associated with mortality were age, trauma patients, ICU admission, vascular access, foley catheters, mechanical ventilation, tracheostomy and endotracheal tube (table 3). Hundreds of exposed staff screened for C auris , none of them turned positive. C auris was isolated from glucometer and body thermometer. The trend gradually decreased following the mitigation actions.

Conclusion

Transmission of C auris infection presents a risk to chronic critical patients with multiple medical devices. Early detection through active screening in addition to intensive cleaning of patients care area and equipment, strict adherence to infection prevention, leadership support and team coordination are highly effective to reduce C auris transmission.

Disclosures

All Authors: No reported disclosures
2449. Attributable mortality and cause of death of Candida auris cases, Los Angeles County
Authors: OYong Kelsey , Knight Wendy , Nguyen Jennifer , Bhaurla Sandeep , Archer Roxanne , Rubin Zachary
Published: November 2023

Background

Candida auris is a drug-resistant nosocomial pathogen that has a reported mortality rate of 30-50% in infected persons. Mortality among colonized cases has rarely been characterized. The Los Angeles County Department of Public Health (LACDPH) sought to determine attributable mortality among C. auris cases with specimens from sterile and non-sterile body sites.

Methods

C. auris is a reportable condition to LACDPH, and laboratory and epidemiological factors are collected for each case. Sterile body sites included blood, surgical wound, bone, and peritoneal, ascitic, body, and bile fluids. All other body sites, including skin swabs, were categorized as non-sterile. Case data were linked with California death registry data by name and date of birth. C. auris-attributable deaths included any death where the terms ‘Candida auris,’ ‘fungemia,’ ‘Candidemia,’ ‘Candidal sepsis,’ ‘Candida urinary tract infection,’ ‘Candida endocarditis,’ or ‘Candida septic shock’ were listed as the immediate cause of death (COD), as a condition leading to COD, and/or listed in significant conditions contributing to death. Thirty-day mortality was defined as a death within 30 days of the first positive specimen collection.

Results

Among 2,055 reported C. auris cases between January 2020 and March 2023, 1,080 matched a death certificate (53%); 74 deaths were cases with sterile site specimens and 970 deaths were cases with non-sterile site specimens. Thirty-day mortality varied by cases with sterile site specimens vs. non-sterile sites (26% vs. 20%, respectively), as did 30-day attributable mortality (17% vs. 1.9%, respectively). Three cases had C. auris listed as an immediate COD, all of which were cases with non-sterile specimens. The most common COD among cases were cardiopulmonary arrest, pneumonia, and respiratory failure.

Conclusion

Attributable mortality among C. auris cases with sterile site specimens was lower than previously reported, possibly because the circulating clade in LAC is relatively drug-susceptible. Attributable mortality among cases with non-sterile site specimens, including skin swabs, was quite low. Vital records can provide a valuable supplement to traditional public health surveillance, but accuracy and completeness are subject to individual providers’ practice.

Disclosures

All Authors: No reported disclosures
2455. National Trends in the Rates of Drug-resistant Bacteria Commonly Associated with Healthcare in U.S. Acute Care Hospitals, 2019-2021
Authors: Baggs James , Wolford Hannah , McCarthy Natalie , Olubajo Babatunde , Li Deana , Maillis Alex , Reddy Sujan
Published: November 2023

Background

The 2022 Special Report: COVID-19 U.S. Impact on Antimicrobial Resistance identified significant increases in the rate of hospital-onset (HO) infections during the year 2020 for bacteria commonly associated with healthcare. Using the same data sources and methodology, we provide updated estimates for the year 2021.

Methods

We identified a cohort of patients from the PINC AI PHD and BD Research Insights databases with a clinical culture yielding an isolate of an organism of interest with accompanying susceptibility testing. Isolates from patients with no culture yielding the same resistance phenotype of interest in the previous 14 days were counted as an incident case. Community-onset (CO) cultures were obtained ≤ day 3 of hospitalization; HO cultures were obtained ≥ day 4. We used a raking-procedure to determine weights for extrapolating the number of discharges included in our sample to match the distribution of discharges, stratified by bed size, U.S. census division, urban/rural designation, and teaching status, for U.S. hospitals included in the American Hospital Association survey. We examined temporal trends using a multivariable logistic model incorporating a survey design with the corresponding weights and hospital designation as the specific cluster controlling for hospital characteristics, month of discharge, proportion of patients in specific age group, proportion of male patients, and database. Results were stratified by HO and CO.

Results

From 2019-2021, the overall number of hospitals contributing data was 640. HO rates were significantly higher in 2020 and 2021 compared with 2019. The HO rates of VRE, MDRPseu, and CRE were significantly higher in 2021 when compared to 2020 (Table 1). For CO infections, we found that MRSA rates decreased significantly during the study period, while VRE and CRAB were significantly higher in 2021 compared to 2019 (Table 1).

Conclusion

Hospital onset antibiotic resistant infection rates in 2021 remain higher than pre-pandemic rates with increasing rates for several pathogens in 2021 compared to 2020, while CO MRSA declined. As infections caused by resistant pathogens represent a serious threat to patient safety, further study of factors contributing to the continued increases and decreases may inform prevention strategies.

Disclosures

All Authors: No reported disclosures
2458. Carbapenem-resistant Acinetobacter baumannii complex infections and SARS-CoV-2 positivity in 9 U.S. sites, 2020-2022
Authors: Bulens Sandra N , Hall Amanda , Jacob Jesse T , Smith Gillian , Wilson Lucy E , Vaeth Elisabeth , Wilson Christopher , Muleta Daniel , Dumyati Ghinwa , Tsay Rebecca , Maloney Meghan , Stabach Nicole , Lynfield Ruth , O’Malley Sean , Pierce Rebecca , Hertzel Heather , Czaja Christopher A , Johnston Helen , Grass Julian E , Brandenburg Joshua , Guh Alice , Magill Shelley
Published: November 2023

Background

Reports have shown increases in carbapenem-resistant Acinetobacter baumannii complex (CRAB) infections during the COVID-19 pandemic. To describe the effect of SARS-CoV-2 (SC2) infection on CRAB infection epidemiology, we analyzed data from the Centers for Disease Control and Prevention’s Emerging Infections Program (EIP) population-based CRAB surveillance in 9 U.S. sites.

Methods: In 2020–22, among surveillance-area residents, an incident CRAB case was defined as the 1st isolation of A. baumannii complex resistant to ≥1 carbapenem (excluding ertapenem) from a normally sterile site or urine (or lower respiratory tract or wound, as of 2021) in a 30-day period. We included cases that underwent chart review. Cases with a culture collected ≥3 days after hospitalization were considered hospital-onset (HO); all others were community-onset (CO). Cases with a SC2+ test ≤14 days before the incident CRAB culture were compared to other CRAB cases.

Results

Of 406 CRAB cases representing 344 patients, 26 (6%) cases in 24 patients were SC2+. SC2+ case-patients were more likely to be female than other CRAB case-patients (58% vs 34%, p=0.02); there were no significant differences in race/ethnicity or age distribution. SC2+ cases were more likely to be obese (42% vs. 23%, p=0.03), have bacteremia (23% vs. 10%, p=0.05), and to have died (39% vs. 16%, p=0.003). SC2+ cases were also more likely to require hospitalization (100% vs. 75%, p=0.005) and have HO CRAB (58% vs 29%, p=0.003). Median hospital length of stay was longer in SC2+ cases (19 days, interquartile range [IQR] 8–30) than in other CRAB cases (14 days, IQR 7–26, p=0.42), but there were no significant differences in the percentages with intensive care unit stays or mechanical ventilation in the 7 days before CRAB culture. Culture sources and infection types in SC2+ cases vs. other CRAB cases are shown in the Table.

Conclusion

A small minority of CRAB patients were infected with SC2+ in the 14 days before CRAB infection but these patients had epidemiological and clinical features that were distinct from other CRAB patients, including higher mortality. Infection control and clinical measures are needed to protect SC2+ patients from secondary bacterial infection and mitigate poor outcomes in those with SC2 and CRAB infection.

Disclosures

Ghinwa Dumyati, MD, Pfizer: Grant/Research Support Rebecca Tsay, MPH, CDC: Grant/Research Support
2461. Carbapenem-resistant Enterobacterales reported to the National Healthcare Safety Network Multidrug-Resistant Organism & Clostridioides difficile Infection Module, January 2018 to July 2022
Authors: Cincotta Samuel E , Octaria Rany , Maroya Walters
Published: November 2023

Background

To describe the COVID-19 pandemic’s impact on the spread of multidrug-resistant organisms, we compared pre-pandemic and pandemic laboratory-identified carbapenem-resistant Enterobacterales (CRE) events reported to the National Healthcare Safety Network (NHSN).

Methods

A CRE event was a patient’s first Escherichia coli, Klebsiella aerogenes, K. oxytoca, K. pneumoniae, or Enterobacter spp. collected on an inpatient unit in a 14-day period and resistant to ≥ 1 of the following: imipenem, meropenem, doripenem, ertapenem, meropenem/vaborbactam (as of 2021), or imipenem/relebactam (as of 2021). We included events from acute care general hospitals (ACH) performing and continuously reporting facility-wide inpatient CRE surveillance for the same specimen sources in each month, from 2018 through 2019 (Period 1) and July 2020 to July 2022 (Period 2); the first half of 2020 was excluded due to initial pandemic disruptions in reporting to the NHSN. We compared patient demographics and epidemiological changes of events between the periods using Pearson’s χ2 or Wilcoxon rank-sum test as appropriate.

Results

Overall, 523 ACHs in 28 states met inclusion criteria. During Period 1, there were 5499 events from 4725 patients in 22 states compared to 5483 events from 4690 patients in 22 states in Period 2; 21 states were consistent in both periods. More facilities had ≥ 1 event in Period 1 compared to Period 2 (56% versus 51%; p< 0.001). Four public health jurisdictions with mandates to report CRE to the NHSN accounted for 86.7% of Period 1 events and 86.0% of Period 2 events. Between Periods 1 and 2, the proportion of events that were hospital onset (on or after admission day four) (54.3% to 62.6%, p< 0.001), from respiratory sources (26.3% to 31.5%, p< 0.001), and bloodstream infections (10.4% to 12.6%, p< 0.001) increased, and the median patient age decreased (66.5 to 64.6, p< 0.001) (Table 1).

Conclusion

Despite a consistent number of events in ACHs during the two periods, we observed a shift toward events that were hospital onset, associated with invasive infection, and occurring in younger people. The timely availability of robust laboratory-based surveillance is an important public health resource for understanding potential epidemiological changes in antimicrobial resistant threats.

Disclosures

All Authors: No reported disclosures
2466. The Evolution of Candidemia during the COVID-19 Pandemic in Connecticut
Authors: Gleason-Vergados Johanna , Correa Maria , Meek James , Banach David
Published: November 2023

Background

Candidemia is a life-threatening bloodstream infection. The changing epidemiology of candidemia during the COVID-19 pandemic has not been well described. The goal of this study is to describe trends in candidemia epidemiology throughout various phases of the COVID-19 pandemic in Connecticut.

Methods

Using statewide surveillance we identified all adult Connecticut residents with candidemia between January 2020 and October 2022. Cases were aggregated by four-month intervals. Three surges of COVID-19 (Initial, Delta, and Omicron variant surges) were identified based on statewide COVID-19 case numbers. Incidence rate ratios (IRR) were calculated to compare the incidence rate (IR) of candidemia during surge periods to the IR of candidemia in non-surge periods (four-month intervals before and after surges). Patient demographics and clinical characteristics were compared using chi-square analysis.

Results

721 candidemia cases were included in the analysis (255 in 2020, 290 in 2021, and 176 in 2022). The IR of candidemia during the Initial surge was 1.49 times higher than the 4 months after the Initial surge (95% CI: 1.09-2.03). The IR of candidemia during the Delta surge was 1.46 times higher than the preceding 4 months (95% CI: 1.07-1.99) and 1.13 times higher than the 4 months after the Delta surge (95% CI: 0.84-1.51). The IR candidemia during the Omicron surge was 1.05 times higher than the preceding 4 months (95% CI: 0.78-1.41) but 1.56 times higher than 4 months after the surge (95% CI: 1.12-2.17). During surge periods candidemia was more frequently associated with persons of non-white race/ethnicity, hospital-onset infection, mechanical ventilation and mortality (all p < 0.05).

Conclusion

We identified an association between COVID-19 surges and increased rates of candidemia. Candidemia cases during surge periods occurred more frequently among non-white persons, were more likely to have hospital-onset and were more severe suggesting that COVID-19 treatments or interventions may have impacted candidemia rates. Further study is needed to understand factors that resulted in different IRs of candidemia during various phases of the COVID-19 pandemic to inform strategies to prevent candidemia during future public health crises.

Disclosures

All Authors: No reported disclosures
2471. Comparison of Dialysis Infection Events in Outpatient End Stage Renal Facilities Pre- and During the COVID-19 Pandemic: Louisiana, 2018-2021
Authors: Lee Grace , Washington Erica , Pinkins Ashlyn
Published: November 2023

Background

Bloodstream infections (BSIs) in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) are associated with significant morbidity and mortality. While robust infection prevention and control (IPC) education has lowered BSI rates in the last decade, the COVID-19 pandemic posed significant challenges in terms of IPC practices. The aim of this review is to determine if COVID-19, and associated strains on IPC capacity, impacted dialysis events (DEs) in outpatient ESRDs in Louisiana.

Methods

Dialysis events and associated patient-months data from the National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Module from January 2018 to December 2021 were extracted to compare outcomes in patients receiving HD from free-standing ESRD facilities in Louisiana in the time preceding the COVID-19 pandemic (January 2018 to February 2020) and during the COVID-19 pandemic (March 2020 to December 2021). Incidence density rates (IDR) and relative risks (RR) were computed in the NHSN Statistics Calculator and openepi.com, respectively, for the retrospective cohort. Statistical significance was considered at the 95% confidence level.

Results

From 2018 to 2021, 189 facilities reported 12,583 DEs to NHSN. The pre-COVID IDR (184.22/10,000 patient-months) was higher than the COVID IDR (173.85/10,000 patient-months; p< 0.001). ESRD patients with DEs were 23% more likely to be hospitalized pre-COVID in comparison to the COVID period (95% CI: 1.18-1.27), and were 4% more likely to die due to DE before COVID, though this risk was not statistically significant (95% CI: 0.92-1.17). Independent free-standing ESRD facilities had a lower rate of DE (15.03/10,000 patient-months) compared to corporate facilities (357.66/10,000 patient-months; p< 0.001).

Conclusion

Despite disruptions in healthcare delivery and IPC practices during the COVID-19 pandemic, indicators of BSIs as reported to NHSN did not worsen during this period. This may be attributed to heightened awareness of vulnerabilities exposed to dialysis patients during the pandemic and increased IPC awareness despite constraints. Granularity with respect to data reviews is warranted due to PPE and staffing constraints over the study period to determine if risk differences were variable during the COVID period.

Disclosures

All Authors: No reported disclosures
2472. Hospital Onset Antibiotic Resistant Infections among Patients without COVID-19 Diagnosis in Pre-Pandemic and Pandemic Periods
Authors: Baggs James , McCarthy Natalie , Reddy Sujan , Wolford Hannah
Published: November 2023

Background

In 2022, Centers for Disease Control and Prevention reported that hospital onset (HO) antibiotic resistant (AR) infections increased during the COVID-19 pandemic. To determine whether these increases were related only to patients diagnosed with COVID-19 or to changes in healthcare utilization and case-mix, we compared the risk of HO AR infections before and during the COVID-19 pandemic among hospitalized patients without a diagnosis of COVID-19.

Methods

Using the PINC AI Healthcare Database, we included discharges from the pre-pandemic period (January 1, 2019-January 30, 2020) and the pandemic period (April 1, 2020-December 31, 2021), among facilities reporting microbiology data. We excluded discharges with a COVID-19 diagnosis, an inpatient COVID-19 diagnosis in the previous 90 days, or length of stay ≤ 3 days. Using a multivariable Cox proportional hazards model, we calculated hazard ratios (HR) comparing the risk of incident HO AR infections during the pre-pandemic and pandemic periods, adjusting for patient demographics, comorbidities, hospitalization in the previous 30 days, facility-level rate of community onset AR infections by discharge month, time-dependent intensive care unit stay and mechanical ventilation, facility characteristics, and inter-facility correlation.

Results

There were 1,153,799 discharges from 280 facilities in the pre-pandemic period, and 1,470,063 discharges from 287 facilities in the pandemic period. The risk of HO ESBL, CRAsp, MDR Pseudomonas, and VRE among patients without COVID-19 was significantly elevated during the pandemic period (Figure 1). The risk of HO MRSA was significantly decreased during the pandemic period.

Conclusion

The risk of HO AR infections, except for MRSA and CRE, was significantly increased in patients not diagnosed with COVID-19 during the pandemic period even after controlling for demographics, clinical, and facility characteristics. Understanding potential drivers for these increases, such as infection prevention barriers, is important for pandemic preparedness and healthcare resiliency.

Disclosures

All Authors: No reported disclosures
2474. Emergence of Candida auris in Michigan
Authors: McNamara Sara E , Brennan Brenda M , Mach Niki , McGuire Nicole , Sturgis Margaret , Rogers Jane E , Malani Anurag , Pogue jason M
Published: November 2023

Background

Candida auris is an emerging multidrug-resistant fungal pathogen associated with high rates of morbidity and mortality, and outbreaks in healthcare facilities (HCF). In May 2021, Michigan detected its first case of C. auris and has since seen an increase in C. auris cases. We aimed to characterize the epidemiology of the emergence of C. auris in Michigan and subsequent regional public health containment response activities.

Methods

Since 2018, cases of C. auris from clinical or colonization screening specimens are reportable to public health in Michigan. Epidemiologic information collected on each case included clinical status and HCF exposures. Contact investigations and colonization screenings were conducted to identify potential healthcare contact exposures. Facilities with confirmed cases were set up with Infection Control and Assessment Response (ICAR) visits to identify and address infection prevention and control (IPC) practice gaps. Action plans outlining all recommendations and resources were provided.

Results

From May 2021 – March 2023, 224 cases of C. auris have been identified in Southeast Michigan. 159 were from screening specimens and 65 from clinical specimens (25 of which were collected from patients previously known to be colonized). Cases were detected at 28 HCFs across 7 local health jurisdictions in Southeast MI, most frequently at long-term acute care hospitals (LTACHs; 103 cases), followed by acute care hospitals (98 cases). 2663 response-driven colonization screenings of healthcare contacts were collected at 56 HCFs, with the highest percent positive in LTACHs (9.3%). 32 ICAR visits were conducted which identified areas for improvement in IPC practices, personal protective equipment use, and cleaning and disinfection practices.

Conclusion

C. auris has recently emerged in Southeast Michigan HCFs with a 44-fold increase in cases within the second year. Vulnerable patient populations were at highest risk including those in high acuity care in a hospital or long-term care setting. Enhanced surveillance, early detection, and a robust public health containment response, including colonization screenings and assessments of IPC practices are essential to help mitigate future outbreaks and further spread of C. auris in MI HCFs.

Disclosures

jason M. Pogue, PharmD, AbbVie: Advisor/Consultant|Entasis: Advisor/Consultant|Ferring: Advisor/Consultant|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Qpex: Advisor/Consultant|Shionogi: Advisor/Consultant
2476. Universal detection of healthcare-related bacterial transmissions using de novo assembly with short-read whole genome sequencing
Authors: Pak Theodore R , Baker Meghan , McSweeney Rebecca , Sands Kenneth E , Moody Julia , Sljivo Selsebil , Isaacs Amanda , Septimus Edward J , Coady Micaela H , Poland Russell , Blanchard Eunice , Carver Brandon , Smith Kimberly N , McLean Laura E , Guy Jeffrey , Huang Susan S , Grad Yonatan H
Published: November 2023

Background

Whole genome sequencing (WGS) is the gold standard for molecular evidence of pathogen transmission. To date, most WGS investigations within healthcare settings have used low cost short-read technologies (e.g., Illumina), aligning reads to a high quality reference genome. However, this relies on either public repositories having closely-related high quality references, which is not guaranteed for arbitrary clinical isolates, or additional long-read sequencing. De novo assembly avoids reliance on references, but the utility of fragmented assemblies of short reads is not well-established in hospital outbreak investigations.

Methods

24 clusters of clinical isolates were identified by automated and routine methods at 17 U.S. hospitals and underwent paired-end WGS on Illumina platforms, followed by two parallel analyses. For a reference-free analysis, de novo assembly was performed with Shovill, assemblies were clustered with Mash, core-genome alignments were created with Harvest, and finally single nucleotide polymorphism (SNP) distances were visualized using the PathoSPOT phylogenomics toolkit to highlight likely transmission events. For a reference-guided analysis, references were selected for each isolate using StrainGST, and SNPs called by read alignment were used to define phylogenomic distances. Finally, conclusions from both analyses were compared.

Results

92 bacterial isolates underwent WGS, of which 86 (93%) completed de novo assembly and passed quality control, comprising 10 isolates of Acinetobacter baumanii, 4 of Klebsiella oxytoca, 46 of Klebsiella pneumoniae, and 26 of Staphylococcus aureus. Reference-free analysis with PathoSPOT identified close relatedness consistent with transmission in 13 of 24 clusters (54%), while the reference-guided analysis identified the same in 12 clusters (50%). Overall, 21 clusters (88%) showed concordance between reference-free and reference-guided methods. Cohen’s kappa indicated substantial agreement (0.75; 95% CI, 0.49–1.0).

Conclusion

De novo assembly of short reads is tenable for WGS investigation of hospital outbreaks, elides the need for reference genomes or long-read sequencing, and compares favorably with SNP calling via read alignment for detecting likely healthcare-related transmissions.

Disclosures

Laura E. McLean, M.Ed., HCA Healthcare: Stocks/Bonds Susan S. Huang, MD MPH, Medline Industries, Inc: Conducted studies whereby participating nursing homes and hospital patients received cleaning & antiseptic products|Xttrium Laboratories: Conducted studies where participating nursing homes and hospital patients received antiseptic products Yonatan H. Grad, MD, PhD, Day Zero Diagnostics: Board Member|GSK: Advisor/Consultant
2477. Characteristics of patients infected with Carbapenem-resistant Acinetobacter baumannii complex and Carbapenem-resistant Enterobacterales in Tennessee, 2016–2021
Authors: Patel Dipen , Mutamba Glodi , Villegas Raquel , Gambrell Ashley , Bailey Cherlly , Mounsey Jacquelyn , Muleta Daniel
Published: November 2023

Background

The spread of Carbapenem-resistant pathogens is a growing global public health concern. Tennessee conducts surveillance of Carbapenem-resistant Enterobacterales (CRE) since 2011 and participates in Multi-site Gram-negative Surveillance Initiative (MuGSI) in Davidson County and seven surrounding counties since 2014.

Methods

We analyzed the CRE and Carbapenem-resistant Acinetobacter baumannii complex (CRAB) incident cases reported to the MuGSI project from 2016–2021. A CRE case is defined as the isolation of Escherichia coli, Enterobacter species and Klebsiella species from normally sterile site or urine, and resistant to ≥1 carbapenem. A CRAB case is defined as the isolation of A.baumannii complex from a normally sterile site or urine (2016-2020). In 2021, cultures from a lower respiratory tract or wound were added. Incident case is defined as a report of the first case in 30 days. Data analysis was performed using SAS Version 9.4.

Results

One hundred nine CRAB and 467 CRE cases were reported from 2016–2021. The proportion of males was higher for CRAB (62.39% vs 37.61%, p< 0.0001), while the proportion of females were higher for CRE cases (68.74% vs 31.26%, p< 0.0001). The mean age was 65 and 60 years for CRE and CRAB case respectively. The incidence rate of CRAB was significantly higher in non-white populations (15.90 per 100,000) compared to white populations (4.86 per 100,000) (p< 0.0001). Smoking was more prevalent among CRAB patients (27.52%) than CRE patients (16.49%) (p=0.0076). The prevalence of neurological health conditions was higher in CRAB than CRE (59.63% vs 38.33%; p< 0.0001), as were renal conditions (38.53% vs 26.12%; p=0.0097) and diabetes (48.62% vs 37.69%; p=0.0357). The prevalence of urinary tract infections was higher in CRE than CRAB cases (52.29% vs 77.09%; p< 0.0001). CRAB (95%) and CRE (65%) cases were healthcare-associated infections.

Conclusion

Patients with CRAB had significantly higher prevalence of neurological, renal, diabetes and smoking history, while UTI was more common in patients with CRE. CRAB incidence was significantly higher in non-whites than whites. More research is needed to explain the disparities and reduce infection burden in vulnerable populations.

Disclosures

All Authors: No reported disclosures
2480. A Legionella pneumophila Investigation at an Outpatient Residence in a Tertiary Cancer Center
Authors: Rizzo Stephanie , Kullar Rajkiran , Reyes Michell , Bubb Tania N , Aslam Anoshe
Published: November 2023

Background

Legionella pneumophila (L. pneumophila) infections can severely affect immunocompromised patients. Found in water systems, the presence of Legionella in healthcare water sources creates an opportunity for hospital acquired infections. After a high-risk patient acquired L. pneumophila in June 2022 while at Memorial Sloan Kettering (MSK), a tertiary cancer center, Infection Control worked to identify the source. A timeline of events is illustrated in Figure 1. Between inpatient admissions, the patient stayed at MSK’s outpatient residence known as the Bone Marrow Transplant Residence (BMTR).

Methods

Monthly surveillance cultures are collected at BMTR following a 2021 L. pneumophila investigation. To date, all surveillance cultures for Legionella were negative. Table 1 shows L. pneumophila patient cases at MSK from 2019 to 2022. Targeted environmental cultures were collected from inpatient rooms and the BMTR apartment. Inpatient cultures were negative but the apartment shower tested positive for L. pneumophila along with a respiratory culture from the patient. Both positive cultures were sent to a third-party lab for whole genome sequencing (WGS). Mitigation included chlorinated cleaning of showerheads in all BMTR apartments. Infection Control collected 93 environmental samples from all BMTR showers and kitchen sinks. To identify further clinical cases, surveillance was deployed on 53 patient admissions from BMTR to MSK between June and September. Upon admission, urine antigen tests were collected on patients who reported respiratory symptoms and resided at BMTR 21 days prior to presentation at MSK.Table 1.L. pneumophila Patient Cases: 2019-2022. *It should be noted that the two cases listed in 2019 were investigated but found not to be definitively linked to BMTR.

Results

All 93 cultures were negative, and the patient and environmental isolates did not match from WGS. Of the 53 patients that were surveilled, 32 presented to MSK following or during their BMTR stays; 5 presenting with respiratory symptoms and zero testing positive for Legionella. The investigation was considered complete and closed.

Conclusion

Although the isolates did not match, proactive surveillance emphasizes the importance of monitoring Legionella in outpatient settings. Monthly cultures and passive patient surveillance continues. Additionally, Copper-Silver ionization and UV disinfection and ultra-filtration are part of the water system at BMTR and monitored.

Disclosures

All Authors: No reported disclosures
2482. Cross Validation of Surgical Procedure Data in National Healthcare Safety Network vs Hospital Discharge Data
Authors: Sato Yoran (Lana) , Parriott Andrea M , Kazerouni N Neely , Epson Erin
Published: November 2023

Background

California acute care hospitals (ACH) are required to report data on 28 types of inpatient surgical procedures via the National Healthcare Safety Network (NHSN). ACH also report discharge data, including procedure data, to the California Department of Healthcare Access and Information (HCAI). We compared the number of adult (age >=18) procedures reported in NHSN versus HCAI in 2019 for cardiac surgery (CARD), coronary bypass with chest and donor incisions (CBGB), hip prosthesis (HPRO), kidney transplant (KTP), and rectal surgery (REC).

Methods

For both systems, we aggregated procedure counts to the facility level and matched individual facilities. HCAI ICD-10 codes were mapped to NHSN procedure codes. Because NHSN counts multiple procedures that map to the same procedure code done via the same incision as one procedure and HCAI does not specify how many procedures were done per incision, CARD, CBGB, and REC were counted only once per procedure code per patient per day. HPRO and KTP were counted up to twice per patient per day if ICD-10 codes for both right and left side surgeries were present. ANOVA was used to compare the means of log standardized infection ratio (SIR) by NHSN to HCAI procedure count ratio as categories of less than 0.9, between 0.9 and 1.1, and more than 1.1.

Results

Three hundred eleven facilities reported 82,847 procedures to NHSN and 300 facilities reported 91,961 procedures to HCAI. Median and interquartile interval for the facility-specific ratio of NHSN to HCAI procedures among facilities that reported procedures in both systems are displayed in Table 1. ANOVA failed to detect any difference in mean of log SIR by different NHSN to HCAI procedure count ratio at α of 0.05.

Conclusion

For all procedure types, there were more procedures documented in HCAI than NHSN, but the ratios of NHSN procedures to HCAI procedures varied widely by procedure type. However, difference in ratio was not associated with SIR. Ability to compare procedure counts was limited by inability to ascertain operating room deaths (which are not counted in NHSN) and if procedures were done using the same incision in HCAI. Further analysis is recommended since SSI denominator quality is crucial to the accuracy of SIR, which informs many analyses and interventions.

Disclosures

All Authors: No reported disclosures
2490. Improving Hepatitis C Continuum of Care in an Outpatient Internal Medicine Population
Authors: Sharath Deepali Boothankad , McCann Timothy , Patel Neha , Aryal Sarthak , Thapa Usha , Contreras Cynthia , Patel Anar
Published: November 2023

Background

According to the WHO, approximately 71 million people are infected with Hepatitis C virus (HCV), and more than 400,000 people die each year due to HCV-related liver diseases. Since the advent of safe and highly effective direct-acting antivirals (DAA) in 2014, treatment for HCV has been revolutionized with cure rates exceeding 90%. Although the detection of undiagnosed HCV infection itself likely has some inherent benefit, the impact of screening is greatly reduced if it does not lead to treatment and cure. Studies on the HCV continuum of care have concluded many patients are lost at each stage, highlighting the need to raise awareness among healthcare professionals and at-risk populations about hepatitis testing, referral, support, and care. A practical model to help fill care gaps in urban internal medicine clinics and improved treatment enrollment and adherence is necessary, which in turn will improve public health outcomes.

Methods

The objective of the study is to improve the continuum of care of HCV, from diagnosis to treatment of the disease at the outpatient Faculty Medical Center (FMC) Internal Medicine Clinic, and identify hurdles to treatment. We enrolled 31 patients who screened positive for hepatitis C antibody into a pooled cohort, where biweekly telephone encounters were initiated for 3 months to facilitate close follow-up, including scheduling labs and office visits and facilitating subspecialty referrals. (Table 1).

Hepatitis C Continuum of Care Workflow

HCV labs include HCV viral load and genotype, Fibroscan, Hepatitis B surface antigen, and antibody, Hepatitis A antibody, and HIV 1/2 antibody test.

Results

Six months post-study, 7 out of 31 (22%) patients enrolled in our intensive follow-up completed treatment. Among the patients who were lost to follow-up, the most common issue encountered was following up with specialists (58%). The most common communication barrier was patients having inactive phone numbers.

Results

Conclusion

Our next step is to establish an HCV clinic within our FMC Internal Medicine Center to expand access to care for HCV-affected patients. The HCV clinic will include coordination with the Infectious Diseases specialist through E-Consult and TriHealth Specialty Pharmacy. The impact will be early treatment of HCV-affected patients, improved treatment success which ultimately reduces the risk of transmission and progression of the disease, and improved quality of life.

Disclosures

All Authors: No reported disclosures
2492. Implementation of a Hepatitis C Referral Workflow: A Pilot Program
Authors: Chun Katherine , Lau Gary , Lee Jenica , Ham YoungYoon
Published: November 2023

Background

Direct-acting antiviral (DAA) treatment for hepatitis C viral infection (HCV) is typically initiated in the outpatient setting. Currently at Oregon Health and Science University (OHSU) hospital, there is no standardized method of connecting hospitalized patients who test positive for HCV with outpatient care for treatment. As a result, patients are infrequently referred. We created and implemented a pharmacist-led workflow to evaluate patients and officially refer admitted patients to outpatient care. The goal is to increase the rate of patients who attend follow-up appointments that address HCV diagnosis and treatment after a hospitalization, and increase the rate of patients who are treated.

Methods

The pharmacist-led workflow was implemented from October through December 2021. Pre- and post-implementation (Pre-I and post-I) data was collected and analyzed. Hepatitis C positive patients were identified and assessed for willingness to be treated. If willing, assessment was completed while inpatient and an official outpatient referral was placed. The data includes patients who attended an appointment (primary outcome) and patients who were prescribed a DAA (secondary outcome).

Results

In pre-I, 44 patients were screened and 18 patients met inclusion. In post-I, 75 patients were screened and 33 met inclusion.

Fourteen patients (33%) in post-I and 4 patients (22%) in pre-I were referred to hepatology. Nine patients (50%) in pre-I and 6 patients (14%) in post-I attended a clinic appointment within 3 months. Three patients (17%) in pre-I and 5 patients (12%) in post-I were prescribed a DAA within 3 months.

However, of the referred patients, 2 patients in pre-I and 3 patients in post-I attended an appointment within 3 months. No patients in pre-I and 1 patient in post-I were prescribed a DAA. In both pre- and post-I, 33% of those who attended an appointment received a prescription for a DAA within three months.

Conclusion

A pharmacist-led HCV referral workflow increased the rate of referrals to hepatology. However, this increase in referrals did not correspond with a substantial increase in appointments or receipt of a prescription.

While the workflow increased referrals, it did not increase patient receipt of DAAs. More intensive interventions may be needed to reach this population.

Disclosures

All Authors: No reported disclosures
2493. Barriers and Facilitators to Hepatitis B Screening, Vaccination, and Treatment Amongst West African Immigrants in The Bronx
Authors: Coe Jared , Birnbaum Jessie , Omarufilo Fatima , Sigal Samuel , Akiyama Matthew J
Published: November 2023

Background

There is a high burden of hepatitis B virus (HBV) in West Africa. Over the past 20 years, West African immigration to the U.S. has been increasing, especially to the Bronx. Prevalence of HBV infection in West Africa has been reported to be as high as 5-10%. We sought to understand knowledge and attitudes of and barriers and facilitators to HBV screening, vaccination, and treatment in a cohort of people living with and at risk for HBV.

Methods

We recruited participants through an HBV outreach program (The Starfish Program) which provides free HBV education, screening, and vaccination with a focus on West Africans. We conducted one-on-one in-depth, in-person qualitative interviews with West African immigrants over the age of 18 residing in the Bronx. Our interviews were guided by the modified socioecological model (SEM), which includes individual, social network, community, and societal domains. The interviews assessed participants’ understanding of HBV, social issues surrounding HBV in their community, and structural factors affecting their ability to seek healthcare. Data were analyzed in an iterative process using a thematic analysis.

Results

Participants (n=23) had origins in 6 different West African nations, although mainly from Ghana and Nigeria, with a median age of 49.5 (IQR 40-66). 56.5% were female. 7 were HBV surface antigen (HBsAg) positive, 6 were HBsAg negative, and 10 had unknown status at the time of interview. Median time since immigrating was 15.5 years (IQR 4-21). Key barriers included limited knowledge of HBV, HBV-related stigma, lack of health insurance, and undocumented immigration status/fear of deportation. Key facilitators included trust in U.S. healthcare providers and healthcare system, social support networks, and ease of accessing healthcare after obtaining health insurance.

Demographics of interview participants

Conclusion

Raising awareness of HBV, addressing social and structural barriers such as stigma and health insurance, and improving access to culturally sensitive programs among West African communities could help increase HBV screening, vaccination, and treatment in this vulnerable population.

Disclosures

Samuel Sigal, MD, Eli Lilly: Grant/Research Support|Gilead Sciences: Grant/Research Support|Gilead Sciences: Speakers Bureau|Intercept: Grant/Research Support|Mallenchrodt: Advisor/Consultant|Mallenchrodt: Grant/Research Support
2497. Analysis of Social Determinants of Health (SDOH) and their Implications for Hepatitis C Treatment in People Who Inject Drugs: The Case of Baltimore
Authors: Corro Luis A Gonzalez , Falade-Nwulia Oluwaseun , Page Kathleen R , Lucas Gregory
Published: November 2023

Background

Of 3.5 million people living with HCV in the US, nearly 60% are people who inject drugs (PWID). Despite the availability of a cure for HCV, uptake remains low in PWID. We set out to study the social determinants of health (SDOH) that impact the HCV care cascade.

Methods

We conducted a secondary analysis of baseline data from 720 PWID in a cluster-randomized trial. We recruited PWID via an outreach van from 12 drug-affected areas in Baltimore City. Inclusion criteria included injection in the prior month or needle sharing in the past 6 months. An intake visit included a survey and a blood draw for HCV testing (serology reflexed to HCV RNA). Focusing on SDOH, we analyzed factors related to self-report of i) awareness of HCV infection (in the subgroup with active or treated HCV) and ii) prior HCV treatment (in the subgroup that was aware of their HCV infection). We used descriptive statistics and logistic regression for statistical analyses.

Results

The 342 PWID included in our study had a median age of 52 years and most were male and Black. 53% injected daily and 67% reported receptive needle sharing in the past 6 months. Of 251 who were aware of their HCV infection, 34% reported treatment.

Women were more likely to be aware of their status but less likely to be treated. Older age and Black race were both associated with increased odds of HCV treatment (with evidence of confounding as the median age was 8 years lower in white vs. Black people). Having a primary care provider and HIV+ status (a likely proxy for care access) were both significantly tied to higher odds of awareness and of treatment. Unhoused people had 51% lower odds of HCV treatment (vs. stably housed). Finally, we found a positive link to social support: people who reported that other PWID had shared their HCV+ status with them had 2.3-fold higher odds of awareness of their own status. Similarly, people with ≥ 3 (median) close people to talk to had over twice the odds of HCV treatment (vs. < 3) in an unadjusted model.

Conclusion

In this study of street recruited PWID, we observed a lower treatment uptake in women despite greater HCV infection awareness. SDOH categories with significant associations to the HCV care cascade included finances, stigma, support system, healthcare usage, and housing status. Strategies to not only identify but address SDOH are vital to end HCV.

Disclosures

Oluwaseun Falade-Nwulia, MBBS ,MPH, Abbvie Inc: Grant/Research Support|Gilead Sciences: Advisor/Consultant