bluuebunny/crossref_metadata_2025 huggingface dataset:
P-236. Impact of a New Dressing Protocol for the Prevention of Central Line-Associated Bloodstream Infections in one Neonatal Intensive Care Unit (NICU)
Authors: Kowatsch Katarina , Larone Juneau Audrey , Giroux Justine , Lapointe Marianne , Vlad Alina , Ocampo Laura , Audy Nathalie , Gravel Sophie , Lachance Christian , Buckeridge David , Quach Caroline
Published: January 2025

Background

Newborns in the neonatal intensive care unit (NICU) are vulnerable to infections due to their extremely fragile skin, underdeveloped immune systems, and usual long-term hospitalizations. These infants often require prolonged use of central venous catheters (CVCs). Bloodstream infections can arise from these CVCs and are a major cause of death in the NICU. Every CVC dressing change can damage their fragile skin, increasing infection risk, and potentially resulting in central line-associated bloodstream infections (CLABSIs). Centers for Disease Control and Prevention recommends dressing changes every seven days, more often if visibly damaged or dirty. Our objective was to evaluate the effectiveness of a new protocol and dressing optimized for long-term skin adhesion implemented in the Centre Hospitalier Universitaire Sainte-Justine (CHUSJ) NICU.

Methods

The CHUSJ NICU is a level III-IV NICU with 900 admissions a year from both inborn and outborn infants. CLABSI surveillance is done prospectively by the Infection Prevention and Control team. All CVCs installed in NICU patients are recorded daily. Inclusion criteria were all recorded NICU CVCs from January 1, 2017, to December 31, 2023. Segmented interrupted time-series analysis was conducted according to the three-stage intervention rollout (first for gestational age of 28 weeks or more, then large premature infants, then the entire unit), with a pre-intervention period of January 1, 2017, to May 1, 2021, modeling CLABSIs/1000 CVC days/month and adjusting for mean birth weight.

Results

2653 CVCs and 71 CLABSIs were reported during the surveillance period. Pre-intervention rates were 1.85 CLABSIs/1000 CVC days. CLABSI rate ratios were: during initial intervention rollout 0.448 (95% confidence interval 0.407, 0.492), during the second stage 0.952 (0.932, 0.973), and since complete implementation 0.610 (0.581, 0.639) that of pre-intervention period rates, for the entire NICU population.

Conclusion

With reports of CLABSI rate rebounds during the COVID-19 pandemic and increasing NICU outbreaks from multidrug-resistant organisms with associated high mortality, new infection prevention protocols are crucial to combat these trends in CLABSI rates and severity of case outcomes, especially for the vulnerable NICU population.

Disclosures

All Authors: No reported disclosures
P-252. Culture-based Viability PCR: Strategies to Harness its Sensitivity and Minimize False Positives
Authors: Duane Erin , Sharma Ayanna , Oldenburg Evan , Barrett Aaron , Fils-Aime Guerbine , Graves Amanda M , Anderson Deverick J , Warren Bobby G
Published: January 2025

Background

qPCR is a highly sensitive method for identifying the presence of potential pathogens. However, its utility as a tool to detect environmental contamination is limited by its inability to differentiate between viable and non-viable target cells.Table 1.Detection of target organisms via qPCR and Culture

Methods

We completed a prospective microbiological analysis of patient bed footboard samples at a tertiary care center using foam sponges and the stomacher method to process samples. Target species included E. coli (EC), S. aureus (SA), and C. difficile (CD).

Sponge homogenates were split into three paths: 1) T0: 500uL was added to 4.5ml of species-specific (SS) broth; 500uL of the resulting mixture underwent DNA extraction and qPCR with SS primers, 2) T1: 500uL was added to 4.5mL of SS broth, and 3) Growth negative control (GNC): 500uL was added to 4.5mL of 8.25% sodium hypochlorite, incubated for 10 minutes, centrifuged for 15 minutes at 3100 RPM, then decanted and added to 5mL of SS broth after 2 PBS washes. T1 and GNC samples were then incubated at SS conditions (24 hours at 37C for EC and SA, and 48 hours for CD). After incubation, 500uL from T1 and GNC samples underwent DNA extraction and qPCR. All samples were also cultured on SS agar. A sample was considered viable for each species if 1) it was detected at T0, and the CT decreased by at least 1.0 at T1 compared to GNC or 2) it was undetected at T0, detected at T1, and undetected for GNC, or 3) grew on standard culture agar.

Table 2: Viability of target organisms via qPCR and Culture

Results

468 samples from 26 patient rooms were analyzed, including 156 for each species. Of the 26 original samples, 24 (92%), 11 (42%), and 2 (8%), had detectable levels of EC, SA, and CD via qPCR at T0 or T1, respectively, and could be assessed for viability. Of those, 3 (13%), 8 (73%), and 0 (0%) contained viable cells of EC, SA and, CD via qPCR, respectively. Notably, 5 (19%) of SA samples were culturable at T1, indicating broth enrichment enhances culture sensitivity; however, all were determined viable via qPCR as well.

Conclusion

Culture-based viability PCR outperformed traditional culture methods in detecting viable pathogens with improved specificity compared to qPCR, highlighting its potential as a tool for assessing environmental contamination. Further large-scale studies are needed to confirm these results across different species.

Disclosures

All Authors: No reported disclosures
P-256. Development of Novel Clutter and Cleanliness Scales for Infection Prevention and Control in U.S. Home Healthcare Settings
Authors: Dualeh Khadra , Vergez Sasha , Onorato Nicole , Brasch Judith , Ramos Evette , Chastain Ashley , Russell David , Wang Jinjiao , McDonald Margaret V , Shang Jingjing
Published: January 2025

Background

In the U.S., homebound older adults often have multiple chronic conditions thereby increasing their infection risk. For those receiving home health care (HHC), environmental hazards in the home can not only exacerbate infection risk but can also impede effective infection prevention and control (IPC) practices for HHC clinicians, patients and their caregivers. Timely and accurate assessment of environmental risks are crucial. Yet, no tools exist specifically for HHC clinicians to assess infection risk factors in the home environment. To fill this gap, we developed scales to measure clutter and cleanliness in HHC patients’ homes.

The clutter and cleanliness rating scale.

Methods

First, we reviewed existing clutter and cleanliness scales, noting that most validated scales focused on hoarding. We adapted these scales and developed observational items focused on IPC in the home environment. During pilot testing with 15 HHC patients and caregivers from an urban HHC agency, we used a uniform rating scale for both clutter and cleanliness items, which posed challenges due to variable home environments and interviewer biases. Following pilot testing, we refined the scales based on interviewer feedback. To improve coding consistency, interviewers received training using a procedural manual and completed a home observation quiz with example pictures.

Results

Our revised observational items now have distinct rating scales for cleanliness and clutter. Clutter is rated on percentages of free space to reduce subjectivity, and cleanliness is rated on a scale of visible clean to not clean (Table 1). Even with refinement, there was still difficulty achieving consistent ratings among interviewers, specifically with the middle scale points (mostly and moderately clean; some and moderate clutter). However, after scale revisions and interviewer trainings, home observation quiz responses among interviewers achieved at least 80% consistency.

Conclusion

Our scales represent the first observational items designed to assess home cleanliness and clutter for IPC purposes. If widely adopted, these scales could enable HHC clinicians to effectively assess environmental hazards, informing patient/caregiver educational needs and enhancing patient safety by reducing infection risks.

Disclosures

All Authors: No reported disclosures
P-259. Facilitators and Barriers for the Use of Ultraviolet-C Disinfection at VA Hospitals: A Qualitative Analysis
Authors: Dukes Kimberly C , Hockett-Sherlock Stacey , Cunningham Goedken Cassie , Racila A M , Walhof Julia , Suh Daniel , Goto Michihiko , Perencevich Eli N
Published: January 2025

Background

Ultraviolet-C (UV-C) disinfection has been increasingly used to enhance terminal room cleaning and prevent hospital pathogen transmissions. We reported that UV-C implementation in Veterans Affairs (VA) hospitals was associated with a 17% reduction in Gram-negative bloodstream infections (BSI), but with a significant facility-level variation. To investigate this variation, we evaluated facilitators and barriers to implementing UV-C disinfection at VA hospitals.

Methods

We interviewed environmental management services (EMS) leaders, housekeepers, infection preventionists, and multidrug-resistant-organism prevention coordinators at 22 US VA hospitals that used UV-C during the study period. Interviews focused on the context of external and internal environments, organization, tools and technology, tasks, and persons. We conducted a thematic analysis on transcripts.

Results

21 of 22 participating VA hospitals report using UV-C as an adjunct to 2-step manual room cleaning. 34 staff completed interviews. The frequency of UV-C disinfection, locations, and rationales for use varied across hospitals. Interviewees reported using UV-C in operating rooms and patient rooms most often. Room use varied (e.g., routine discharge, contact precautions, other reasons).

Barriers at some hospitals included leaders’ distrust of manufacturer claims for exposure times, risks, and efficacy; concerns that non-VA data may not apply to the VA context; and a perceived lack of UV-C’s impact on local infection rates. Other barriers include high patient loads requiring fast room turnovers, reduced staffing, equipment and maintenance costs, and competing priorities. Facilitators for UV-C use included COVID-19-related financial resources, collaborative communication between EMS, Nursing, and Infection Prevention, and professional competence and commitment to infection prevention.

Conclusion

Given the reported barriers and facilitators, a UV-C implementation toolkit informed by VA staff feedback could improve acceptability of UV-C technology for staff and is worth further study. Interprofessional collaboration and leadership support could improve integration of UV-C into environmental cleaning best practices in VA hospitals.

Disclosures

Michihiko Goto, MD MSCI, Merck: Grant/Research Support
P-289. Short-Duration vs. Long-Duration of Therapy for Hospital-Acquired or Ventilator-Associated Pneumonia due to Multi-Drug Resistant Pseudomonas aeruginosa
Authors: Al Musawa Mohammed , Caniff Kaylee E , Judd Chloe , Veve Michael , Rybak Michael J
Published: January 2025

Background

The duration of therapy for hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP) due to non-lactose fermenter Gram-negatives bacilli including Pseudomonas aeruginosa (PsA) remains a topic of debate. Our study aimed to compare the efficacy of short-duration (≤8 days) to long-duration ( >8 days) therapy for HAP/VAP due to multi-drug resistant (MDR) or difficult-to-treat (DTR) PsA infection.

Methods

A two-center, retrospective cohort study was conducted from 5/2010 to 12/2022. We included all patients ≥18 years old with HAP or VAP due to MDR- or DTR-PsA in respiratory cultures who were treated for ≥72 hours. The primary outcome was a 30-day recurrence from the index culture, and the secondary outcomes were a 60-day recurrence, 30-day, and 60-day mortality from the index culture.

Results

Overall, 203 patients (short duration, n=91 and long duration, n=112) were included. Sixty-nine percent were male, and 58.6% were of African American descent. The mean (SD) for age and APACHE II score were 58.5 (15.8) and 23.9 (7.9), respectively. The common comorbidities were diabetes (39.9%), cerebrovascular disease (28.6%), and chronic obstructive pulmonary disease (24.1%). The primary admission source was a nursing home (44.8%). VAP was diagnosed in 53.0% of patients, with DTR-PsA accounting for 58.1% of all infections. Polymicrobial infection was present in 20.1% of the cases with Enterobactarales species present in all cases. Ceftazidime-avibactam and ceftolozane-tazobactam were used for treatment in 33.0% and 47.8%, respectively; combination therapy was used for 11.8% of cases. The 30-day recurrence was significantly lower in the long-duration therapy compared with the short-duration (5.4% vs. 15.9%, p = 0.017). Similarly, there was a lower 60-day recurrence rate in the long-duration group vs. short-duration group (8.9% vs. 24.4%, p=0.026). There were no significant differences in 30-day and 60-day mortality rates observed.

Conclusion

Prolonged duration ( >8 days) has resulted in lower recurrence rates of HAP/VAP caused by MDR/DTR PsA infection at 30 and 60 days. Although our study is insightful, a larger-scale study is necessary, and logistic regression should be conducted to determine the predictors of the significant differences in the primary outcome.

Disclosures

Kaylee E. Caniff, PharmD, BCIDP, T2Biosystems: Honoraria Michael J. Rybak, PharmD, PhD, MPH, Abbvie, Melinta, Sionogi, Merck, T2Biosystems: Advisor/Consultant|Abbvie, Melinta, Sionogi, Merck, T2Biosystems: Grant/Research Support|Abbvie, Melinta, Sionogi, Merck, T2Biosystems: Speaker
P-299. Clinical and microbiological characteristics of hospital-onset and community-onset invasive urinary tract infection caused by extended-spectrum β-lactamase-producing Escherichia coli
Authors: Tsuda Yusuke , Matsumara Yasufumi , Hayakawa Kayoko , Tsuzuki Shinya , Shinohara Koh , Arasawa Soichi , Tsuchido Yasuhiro , Yukawa Satomi , Noguchi Taro , Yamamoto Masaki , Nagao Miki
Published: January 2025

Background

In the era of community spread of extended-spectrum β-lactamase-producing Escherichia coli (ESBLEC), the differences in clinical and microbiological characteristics between hospital-onset (HO) and community-onset (CO) invasive urinary tract infection (iUTI) caused by ESBLEC have not been well documented in East Asia.

Methods

We conducted a post-hoc analysis of a multicenter, observational study between 2020 and 2021 at 10 facilities across Japan. The inclusion criteria were 1) diagnosis of iUTI, 2) isolation of ESBLEC from urine or blood cultures, and 3) treatment with cefmetazole (CMZ) or meropenem (MEM) as definitive therapy within 96 hours of culture collection and continued for at least 3 days. Patients diagnosed with iUTI within 3 days after admission were assigned to the CO group, while others were assigned to the HO group. Clinical characteristics of the HO and CO groups were compared after reduction of treatment bias between the CMZ and MEM groups using a propensity score-based adjustment. Antimicrobial susceptibility testing and whole-genome sequencing analysis were performed to investigate differences between the HO and CO isolates.

Results

Thirty-two and ninety-five patients were included in the HO and CO groups, respectively.

The clinical and microbiological characteristics were summarized in Tables 1 and 2, respectively.

In multivariable logistic regression analysis, exposure to β-lactam antimicrobials and indwelling urinary catheter were associated with the HO group. Clinical effectiveness in the early treatment period was more frequently observed in the CO group, although the 30-day mortality rates were not significantly different between the HO and CO groups. There was no difference in distributions of sequence types and CTX-M subtypes between the HO and CO isolates. The CO isolates had a higher resistance rate to gentamicin than the HO isolates. Pangenome analysis revealed that aac(3)-II (aac(3)-IId or IIe), which confers resistance to gentamicin, was frequently present in the CO isolates.

Conclusion

Compared to the patients with CO-iUTI by ESBLEC, those with HO-iUTI were characterized by prior exposure to β-lactam antimicrobials and indwelling urinary catheter. The CO isolates were associated with resistance to gentamicin and carriage of aac(3)-II.

Disclosures

All Authors: No reported disclosures
P-302. Changes in Antimicrobial Susceptibilities of Enterobacterales Causing Sepsis in Neutropenic Pediatric Patients with Underlying Hemato-oncologic Diseases
Authors: Kyung Cho Yoon , Ji Kim Ye , Won Yoo Jae , Mi Kang Hyun , Wook Lee Jae , Chung Nack-Gyun , Cho Bin , Chul Jeong Dae
Published: January 2025

Background

As neutropenia episodes in pediatric hemato-oncology often lead to sepsis and need antibiotics, monitoring resistance is crucial for empirical antibiotics choice. We analyzed antimicrobial susceptibility changes in Enterobacterales from sepsis pediatric patients at Seoul St. Mary’s bone marrow (BMT) center. Data from 2016-2020 and 2021-2023 were compared after shifting initial empirical antibiotics from piperacillin-tazobactam (PIP-TZ) to cefepime (CEF).

Methods

This was a retrospective cohort study of sepsis patients at the pediatric BMT center of Seoul St. Mary’s hospital. Data from two time periods, 2016-2020 and 2021-2023, were compared, as the initial empirical antibiotic was switched from piperacillin-tazobactam (PIP-TZ) to cefepime (CEF).

Results

Of 370 bacteremia cases, 70% (n=259) occurred during 2016-2020, and 30% (n=111) during 2021-2023. The proportion of sepsis by Enterobacterales increased, with 32.8% (n=85/259) during 2016-2020 and 57.6% (n=64/111) during 2021-2023 (P < 0.001). After antibiotic switch, the proportion of extended-spectrum beta-lactamases-producing E.coli and K.pneumoniae increased from 14.1% (n=10/71) to 30.9% (n=17/55) (P = 0.02). The overall susceptibilities of to third and fourth generation cephalosporins decreased: cefotaxime (78.3% to 49.3%, P < 0.001); ceftazidime (87.4% to 64.4%, P = 0.0046), and CEF (87.4% to 68.5%, P = 0.002). The overall susceptibilities to PIP-TZ increased: 78.2% to 83.6% (P = 0.30). For P.aeruginosa, the susceptibilities to PIP-TZ and CEF decreased: 78.6% to 66.7%, P = 0.53 and 85.7% to 77.8%, P = 0.62, respectively. Carbapenem-resistance was observed in P.aeruginosa, A.baumannii and K.pneumoniae during 2016-2020 while it was observed in S.pneumoniae, K.pneumoniae, P.aeruginosa, E.cloacae and M.morganii during 2021-2023. 3.5% (n=4/115) of gram negative sepsis patients had carbapenem-resistance in 2016-2020 while 10.9% (n=8/73) in 2021-2023 (P = 0.04).

Conclusion

Cephalosporin resistance increased after the change of initial empirical antibiotics, while P.aeruginosa showed the opposite resistance. Continuous monitoring for any increase in carbapenem resistance is necessary.

Disclosures

All Authors: No reported disclosures
P-313. Trends in Invasive Staphylococcus aureus infections in Monroe County, NY, 2016-2023
Authors: Walsh Marissa , Nakamura Lauren , Gellert Anita , Keller Elizabeth , Tracy Marissa , Felsen Christina , Dumyati Ghinwa
Published: January 2025

Background

Since the COVID-19 pandemic, increases in healthcare-associated invasive methicillin-resistant S. aureus (MRSA) infections were observed. Limited data exist for invasive methicillin-sensitive S. aureus (MSSA) infections. We identified trends in community and healthcare associated invasive S. aureus (iSA) infections during 2016-2023.Figure 1.Incidence of iSA infections by resistance-type, Monroe County, NY, 2016-2023.

Methods

Active, population-based surveillance data for iSA was collected as part of the CDC Emerging Infections Program. A case was defined as a resident of Monroe County, NY with S. aureus isolated from a normally sterile site. Cases were classified as hospital onset (HO) if the culture was obtained >3 days after hospitalization, healthcare-associated community-onset (HACO) if the culture was obtained in an outpatient setting or < 3 days after hospitalization in a patient with ≥1 prior major healthcare exposures, or otherwise community-associated (CA); incidence was calculated for each epidemiologic classification.Figure 2.Incidence of iSA infections by epidemiologic classification, Monroe County, NY, 2016-2023.

Results

A total 4,440 iSA cases were identified during 2016-2023; 3,512 had S. aureus isolated from blood and 942 were from other sterile sites. iSA incidence increased from 66.5 (per 100,000 population) in 2016 to a peak of 87.9 in 2023 (Figure 1). HACO comprised >50% cases and incidence mirrored the pattern of overall rates, rising from 33.8 in 2016 to 48.9 in 2023 (Figure 2). HO incidence doubled, rising from 9 in 2016 to 18.2 in 2023; CA incidence remained stable.

MSSA incidence was approximately twice the rate of MRSA for each year. Incidence of MSSA rapidly increased from 2020 to 2021 (42.7 to 57.6) with increases in all epidemiologic classes (Figure 3). MRSA rose the following year (23.8 to 31.1) with a decline in CA cases; HO increased by 59% and HACO increased by 33%.Figure 3.Comparison of epidemiologic classification between MRSA vs. MSSA cases, Monroe County, NY, 2016-2023.

Conclusion

Our study highlights an increase in iSA infections since 2016, predominantly driven by HACO cases. MSSA infections surpassed MRSA infections throughout, with both experiencing sustained increases since COVID-19 emerged. These findings emphasize the importance of continued surveillance and targeted interventions to address the growing burden of iSA infections, particularly those associated with healthcare.

Disclosures

All Authors: No reported disclosures
P-333. Teaching Hand Hygiene Technique to Preschool-aged Students Using a Musical Mnemonic: A Vanguard Study
Authors: Thampi Nisha , Darbha Aparna , Zumbansen Anna , Comeau Gilles , Longtin Yves
Published: January 2025

Background

The World Health Organization (WHO) recommends a 6-step protocol for hand hygiene (HH). A musical mnemonic, with instructions sung before completion of each step, was developed in 2019 to increase awareness of HH technique. The primary objective of this study was to determine whether the musical mnemonic improves HH technique compared to prose instruction among preschool-aged children through a novel set of process and outcome measures. The secondary objective was to assess feasibility of rolling out the musical mnemonic as part of HH education at a class level.

Poster demonstrating hand hygiene technique with instructions according to musical mnemonic

Methods

We partnered with a local school and co-designed a vanguard trial involving students in toddler (age 1-2 years) and preschool (age 3-5 years) classrooms. In all rooms, we introduced the HH technique using conventional teaching, i.e., visual demonstration using a poster with written instructions (Figure 1) and lotion visible under ultraviolet light. Intervention rooms had additional musical mnemonic, or lyrical, instructions. The demonstration was repeated one week later. Four classes (2 toddlers and 2 preschool) were randomized to either conventional or lyrical teaching and followed on Day 1, 2, 5, 8, 9, 22 and 29 to assess the immediate and long-term impact on the degree of completion of the HH steps (scores from 0 to 9).

Overall impact of hand hygiene teaching on hand hygiene score (combined toddler and preschool age groups)

Results

We performed 378 HH observations in January and February, 2024. Both lyrical and conventional instruction groups were comparable in terms of HH score at baseline (median [IQR], 1 [0-1] vs 1 [0-1], respectively, p=0.90). Immediately after training, the lyrical group achieved a significantly better HH score than the conventional group (median [IQR], 2 [1-7] vs 1 [0-4], p=0.007). The effect of the intervention was sustained, with significantly higher HH scores in both toddler and preschool age groups on Day 2, 15, 22 and 29 after intervention (p< 0.05 for each comparison, Figure 2).

Conclusion

A musical mnemonic was associated with an immediate, improved uptake of the WHO-recommended HH technique, then decreased but remained significantly higher compared to conventional teaching over 4 weeks among preschool- and toddler-aged students. A multimodal HH education program that incorporates the musical mnemonic can be co-designed with education specialists and evaluated in a school setting.

Disclosures

All Authors: No reported disclosures
P-339. Infection Control Link staff program that involves all professionals improves the quality of infection control in hospitals
Authors: Shirano Michinori , Nakagawa Hidenori , IIida Ko , Asaoka Tomohiro , Fukuoka Risa , Morita Ryo , Yamaguchi Naoki , Nanri Sumiyo , Imasaki Mika , Yamaguchi Naomi , Goto Tetsushi
Published: January 2025

Background

Collaboration among all medical staff is essential to improve the quality of infection control. However, it is not easy to fully disseminate infection control knowledge to all. The purpose of this study was to evaluate whether the implementation of the Infection Control Link staff program organized in our hospital improved the quality indicator (QI) of infection control.

Methods

Our hospital's link staff program is unique in that it is composed of all healthcare professions, including not only physicians and nurses, but also laboratory technicians, pharmacists, radiologists, and physical therapists. The program was launched in 2012. Various lectures and hands-on learning experiences (hand hygiene compliance audit experience, personal protective equipment (PPE) donning and doffing training, etc.) were conducted at monthly meetings, and each department was asked to take the training home and put it into practice. As QI for infection control included the number of new hospital-acquired cases of Methicillin-resistant Staphylococcus aureus (MRSA) infection, the percentage of MRSA among all S. aureus detected in culture, the number of blood culture tests per 1000 patients/day, two sets of blood culture collection rate were used as indicators to evaluate efforts; QI data through 2020 were used for evaluation due to activity limitations imposed by COVID-19.

Results

In terms of indicators related to MRSA, the nosocomial incidence of MRSA infections was 3.4‰ in 2011, but gradually decreased to 1.1‰ in 2020. The MRSA/S. aureus detection rate also declined from 47.0% to 33.4% during the same period (Fig. 1). On the other hand, the number of blood culture tests per 1000 patients/day decreased from 14.1 in 2011 to 37.3 in 2020, and the collection rate of 2 sets of blood cultures improved from 42.5% to 93.7% during the same period (Fig. 2).

Conclusion

Bundling of various initiatives is important to improve the quality of hospital infection control. Although the Link Staff Program was not the only factor that improved quality, it is believed that this initiative was successful in providing knowledge and increasing awareness of infection control to all staff in all professions.

Disclosures

All Authors: No reported disclosures
P-352. Resistance of the Public Health Threat Emerging Pathogen Candida Auris from Multiple Sources to Antifungal Agents (ARIA 2020-2022)
Authors: Hawser Stephen , Monti Federica , Olari Sara , Kothari Nimmi
Published: January 2025

Background

As highlighted by the Centers for Disease Control (CDC), resistance to antifungal therapies leads to high morbidity and moderate to severely high mortality. In recent years, infections caused by Candida auris have been extremely difficult to treat and C. auris is now labelled as a public health threat. ARIA is a global surveillance initiative collecting yeast and fungal isolates from worldwide sources designed to determine resistance to antifungal agents and trends over time. The current study reports C. auris isolates from the ARIA project and outlines the susceptibility of these isolates to clinically used antifungal agents.

Methods

A total of 62 clinical isolates of C. auris were collected between 2020 and 2022. These originated from specific hospital sites in Germany (1), India (26), Kuwait (5), Panama (20) and the United Arab Emirates (10). All isolates were non-consecutive non-duplicate isolates. Isolates were identified via MALDI-TOF mass spectroscopy and susceptibility testing was performed in line with Clinical Laboratory Standard Institute (CLSI) guidelines using amphotericin B, anidulafungin, caspofungin, fluconazole, isavuconazole, micafungin, posaconazole and voriconazole. As there are no accepted breakpoints for C. auris, CDC tentative e breakpoints were adopted.

Results

MIC distributions with respect to CDC tentative breakpoints specific for C. auris are shown in the Table. 14 of the 62 isolates (23%) were resistant to amphotericin B, 1 isolate (1.6%) resistant to caspofungin, 53 isolates (85%) resistant to fluconazole and 1 isolate resistant to micafungin. Notably, all amphotericin-B resistant isolates were also fluconazole-resistant.

Conclusion

The data from the ARIA study further emphasize the threat posed by C. auris considering its ability to resist commonly used antifungal agents. Continued monitoring of C. auris susceptibility is essential.

Disclosures

All Authors: No reported disclosures
P-361. Outcome of Candida auris Point Prevalence Survey in a Tertiary Care Hospital in Southeast Michigan
Authors: Malik Ambreen , Shallal Anita , Ruby Abigail , Malm Jessica , Mclenon Jennifer , Shanahan Clare , Chami Eman , Alangaden George J , Suleyman Geehan
Published: January 2025

Background

C. auris, an emerging multi-drug resistant organism associated with nosocomial outbreaks, is becoming more prevalent in Southeast Michigan due to interfacility healthcare transfer. The CDC recommends contact isolation and screening of epi-linked healthcare contacts of newly identified C. auris patients to prevent spread and assess potential transmission. We describe our institution’s experience with C. auris point prevalence surveys (PPS).

Methods

PPS was conducted at an 877-bed academic, tertiary care center consisting of private and semi-private rooms in Detroit. In collaboration with Michigan Department of Health and Human Services, we performed PPS by swabbing the axilla and groin of all patients on the implicated unit when a C. auris index case was incidentally identified from June-Dec 2023. In addition, potentially exposed roommates were flagged in the electronic health record for future screening. When additional cases were identified, 2 negative PPS conducted biweekly were required to stop PPS.

Results

Six C. auris index cases were identified during the 6-month period. We performed 18 PPS on 9 units and screened 430 patients (Table); 5 refused and 14 were discharged prior to screening. Four (22%) of the PPS resulted in identification of new cases; 2 PPS yielded 1 case each, 1 PPS yielded 3 cases, and the final PPS yielded 2 cases. Of those screened, 7 (1.6%) tested positive on 4 units. Nosocomial transmission was implicated in 4 patients across 2 units after an epidemiologic investigation. Terminal cleaning was performed on units implicated in nosocomial transmission, in addition to ancillary areas visited by the affected patients. Infection Prevention emphasized the importance of adhering to hand hygiene, appropriate PPE use, and cleaning and disinfection of the environment and shared equipment.

Conclusion

Controlling the spread of C. auris is a public health priority. However, only 1.6% of cases were detected with intense PPS. Despite considerable effort and healthcare resources being utilized to identify additional cases and mitigate possible nosocomial transmission, C. auris continues to spread in our region. Alternatively, healthcare facilities should consider active surveillance of high-risk patients at the point of hospitalization to mitigate the need for PPS.

Disclosures

All Authors: No reported disclosures
P-373. The VREy Resistant Enterococcus: Retracing VRE Transmission and Contamination Events in Healthcare Settings
Authors: O’Sullivan Tierney , Brazelton William , Khader Karim , Leecaster Molly , Tanner Windy , Rubin Michael , Samore Matthew H , Keegan Lindsay T
Published: January 2025

Background

Healthcare associated infections (HAIs), particularly those involving antibiotic resistant bacteria, are some of the most common, deadly, and preventable adverse events affecting patients in the clinical setting. Lowering HAI transmission rates would reduce the clinical burden to patients, economic burden to healthcare systems, and could help slow an alarming trend toward antimicrobial resistant organisms. However, determining definitive routes of transmission within healthcare facilities (HCFs) of HAIs is difficult and costly. Since HAIs are common in settings with little direct patient-patient contact, discerning the role of fomites in transmission pathways is critical, either via health care workers (HCWs) or from direct patient contact with contaminated surfaces.

Methods

We present preliminary results of a model of who-infected-whom using densely sampled data from ICU units in two HCFs over 13 weeks. We combine daily microbiologic samples from three patient body sites, HCW hands, three zones within patient room environments, and shared environmental surfaces with epidemiologic data on HCW movement. Microbiologic samples were whole genome sequenced (WGS) for all distinct cultures. We developed a Bayesian transmission model that incorporates genomic and epidemiologic information to reconstruct probabilistic estimates of transmission routes to estimate who-infected-whom and rule out unlikely transmission or contamination events.

Results

This poster focuses on results for the vancomycin-resistant enterococci (VRE) samples (N=44). We characterize the relationship between overlapping and non-overlapping patient stays, HCW hands, and environmental surfaces, and their roles in transmission and contamination within the two HCFs.

Conclusion

Ultimately, these results provide further evidence on pathogen movement in HCFs and provide insights for developing and improving interventions to minimize transmission in HCFs.

Disclosures

All Authors: No reported disclosures
P-379. Timing Variations for Surgical Prophylaxis Within One Hour Pre-Incision: Impact on Surgical Site Infections in Elective Colorectal Surgery Procedures
Authors: Collins Curtis D , Hartsfield Eric , Cleary Robert K , Veve Michael , Brockhaus Kara K
Published: January 2025

Background

The optimal timing of surgical infection prophylaxis (SIP) is generally recommended to be given 60 minutes, or in some cases 120 minutes, prior to incision. Conflicting results have hampered further optimization of prophylaxis timing within this timing window. This study aimed to assess the impact of alternative prophylaxis timing on surgical outcomes, particularly surgical site infections (SSIs).

Methods

A large, validated database of elective colorectal surgeries in Michigan was used to perform a multi-center, retrospective cohort study. Cohorts included patients who received SIP within 0-15 minutes and 16-60 minutes prior to incision. Adult patients who received colorectal surgeries spanning from July 2012 to June 2021 were included. Emergent or urgent surgeries, missing follow-up and antibiotic information, and patients who did not receive all prophylaxis prior to incision were excluded. The primary outcome was incidence of SSIs. A multivariable logistic regression model analyzed the impact of timing and other confounding variables on SSIs.

Results

A total of 21,061 procedures were included. Of these, 6,405 patients (30.4%) received prophylaxis 0-15 minutes pre-incision and 14,656 (69.6%) received prophylaxis within 16-60 minutes. Cohorts were generally similar with differences in patients receiving β-lactam prophylaxis (97.1% vs 96%; P = < 0.001), mechanical and oral bowel preparation (64.5% vs. 67; P = 0.023), and adherence to recommended dosing (82% vs. 83.7%; P =0.002). There was no difference between cohorts in total SSIs (6.8% vs. 7.1%, P = 0.419) or CDI (1.1% vs. 1%; P =0.324); however, deep SSIs were increased in the 16–60-minute cohort (0.8% vs. 1.1%; P = 0.032). Multivariable logistic regression showed no association between prophylaxis timing and SSIs (adjusted odds ratio (aOR) 0.98; 95% CI 0.86-1.13; P = 0.817).

Conclusion

Timing differences (0-15 minutes vs. 16-60 minutes pre-incision) did not significantly impacts overall SSIs incidence in elective colorectal surgeries.

Disclosures

Robert K. Cleary, MD, FASCRS, FACS, Intuitive Surgical, Inc: Honoraria
P-395. Clinical and Demographic Characteristics of Community Associated (CA) Clostridioides difficile
Authors: Hawco Adam J , Myers christopher J , Dahhan Runda , Hurley Christine , Dumyati Ghinwa
Published: January 2025

Background

The incidence of community associated Clostridiodes difficile infections CDI (CA CDI) increased over the last decade; with antibiotic use recognized as a risk factor for infection. In 2017, we noticed an increase in the number of CA cases occurring without recent antibiotic exposure. Our aim was to characterize CA CDI cases both with and without prior antibiotic use to better understand this emerging trend.

Methods

Active laboratory and population-based surveillance for CDI was performed in Monroe County, NY as part of the CDC Emerging Infections Program between 2017-2022. An incident CA CDI case was defined as a patient with a positive C. difficile assay with no prior positive assay in the previous 8 weeks and no evidence of an overnight stay in a healthcare facility in the preceding 12 weeks. Clinical, demographic and exposure data were collected through medical record review. Descriptive and bivariate analyses were then performed.

Results

The incidence of CA CDI increased from 72.6 in 2017 to 100/100,000 population in 2022 (Figure 1). Among CA cases that received antibiotics in the 12 weeks prior to their infection, the proportion receiving fluoroquinolones and clindamycin decreased over time (Figure 2). During this period, the proportion of CA CDI cases that did not receive any prior antibiotics increased from 33.7% to 46.9% (Figure 2). Compared to cases with prior antibiotics, cases without prior antibiotic exposure were more likely to be male, on immunosuppressants, have a higher Charlson comorbidity score, have underlying inflammatory bowel disease and prior CDI (Table 1). Prior proton pump inhibitor or H2 blocker use was not significantly different between the two groups.

Conclusion

The study observed an increase in the incidence of CA CDI over the study period, with a growing proportion of cases occurring without recent antibiotic exposure. Additionally, the use of high-risk antibiotics decreased over time. These findings suggest that other factors, beyond antibiotic use, may play a significant role in the development of CA CDI. Further research into these emerging risk factors is necessary to inform targeted prevention strategies and address the rising incidence of CA CDI.

Disclosures

All Authors: No reported disclosures
P-416. The Unexpected Costs of Cutting Costs
Authors: Patel Palak , Marrs R , Steele Molly , Chu Vera , Zuccaro Patricia D , Bartlett Allison H , Landon Emily
Published: January 2025

Background

Hand Hygiene (HH) is the cornerstone of preventing healthcare-associated infections, however maintaining compliance is challenging especially when staffing changes. Here we show HH performance as measured by an automated monitoring system before and after a reduction in force (RIF) affecting unit-based nursing leadership.

Methods

University of Chicago is a large 800 bed academic medical center with 30 adult inpatient units that monitors HH using the GOJO Smartlink System (Akron, OH) to track entries and exits (denominator) as well as soap and hand sanitizer dispenses (numerator) aggregated over a nursing unit. The adult inpatient units span across two buildings and aggregate compliance data by nursing unit from Jan 1, 2024 through Mar 30, 2024 is included. A 4% RIF that changed unit-based nursing leadership but not direct patient care staff took place on 2/1/2024. The paired t-test was used to compare data from before and after the RIF.

Results

Building 1 had HH rate 45.28% in January before the RIF and 40.91% after the RIF (p< 0.01). For building 2, HH before the RIF was 61.27% before and 57.26% after the RIF (p< 0.01). 10 units had a change in nursing manager (PCM) and 20 units had a 50% reduction in assistant manager (ACM) staffing. In univariate analysis, both units with a change in PCM (51.62% to 47.33%, p=0.05) and those without a change in PCM (58.46% to 54.78%, p< 0.01) had statistically significant decreases in HH. Units with a decrease in ACM staffing also had a significant decrease in HH (56.46% to 52.67%, p< 0.01) but those who kept their ACM staffing did not (55.04% to 51.47%, p=0.19).

Conclusion

Overall, HH performance decreased significantly after the RIF despite not affecting any direct patient care roles. A decrease in staffing of the Assistant Care Manager role may have a larger impact on HH adherence than PCM role.

Disclosures

Allison H. Bartlett, MD, MS, CVS/Caremark: Advisor/Consultant
P-428. Impact of Diagnostic Stewardship Interventions on Ventilator-Associated Event Rates
Authors: Garcia Zachary S , Troost Jonathan , Albin Owen
Published: January 2025

Background

Ventilator-associated events (VAEs) are CDC/NHSN surveillance definitions for monitoring nosocomial complications from invasive mechanical ventilation. In 2022, we executed the Diagnosis of Ventilator-Associated Pneumonia (DIVA) trial (NCT05176353), a quasi-experimental pilot/feasibility clinical trial of a VAP bundled diagnostic stewardship intervention (VAP-DSI) targeting the ICU respiratory culturing pathway. This VAP-DSI associated with a 20% rate reduction in positive respiratory cultures per 1000 mechanically ventilated patient days. In this post hoc analysis, we present a secondary data analysis evaluating the impact of a VAP-DSI on VAE surveillance rates.

Methods

The DIVA trial operationalized a VAP-DSI using an interruptive clinical decision support tool and modifications to clinical laboratory workflows. Interventions included gatekeeping access to respiratory culture ordering, preferential use of non-bronchoscopic bronchoalveolar lavage for culture collection, and suppression of culture results for samples with minimal alveolar neutrophilia. We compared monthly VAE rates among study ICUs (those that utilized the VAP-DSI) and non-study ICUs over both a 5-year pre-intervention period (2017-2022) and the post-intervention period (2022-2023). Event rates were compared using a Z-test approximation for person-time rates.

Results

Figure 1 demonstrates monthly VAE rates stratified by ICU and pre- vs post-intervention time periods. Study ICUs demonstrated significant decreases in rates of VAEs, VACs, and PVAPs following VAP-DSI implementation. Conversely, non-study ICUs experienced no significant changes in VAE rates.

Conclusion

In this single-center pilot/feasibility clinical trial, diagnostic stewardship interventions targeting the ICU respiratory culturing pathway associated with significant reductions in VACs, PVAPs, and total VAEs. These findings suggest a potential impact of diagnostic stewardship interventions on VAE surveillance rates.

Disclosures

All Authors: No reported disclosures
P-434. Comparison of Cardiovascular Disease Risk Calculators in People Living with HIV in the US Military Natural History Study
Authors: Bettger Caitlin , Horn Mackensie , Aden James , Xu Xiaohe , Agan Brian , Blaylock Jason , Larson Derek , O’Connell Robert , Colombo Rhonda , Lalani Tahaniyat , Yabes Joseph , Markelz Ana E
Published: January 2025

Background

Primary prevention of atherosclerotic cardiovascular disease (ASCVD) is a vital component of care for people living with HIV (PLWH). Current guidelines recommend at least moderate intensity statin for low to moderate ASCVD risk and high intensity statin for high risk. Determining ASCVD risk in PLWH is difficult due to a paucity of precise risk calculators. We retrospectively compared available ASCVD risk calculators in a population who had known ASCVD events.

Methods

We included US Military HIV Natural History Study (NHS) participants between 2006-2019 who experienced a known ASCVD event as defined in Table 1. Participants missing data to perform all four calculators were excluded from the analysis. Four risk calculators: American College of Cardiology/American Heart Association Pooled Cohort Equation (PCE), Framingham Heart Study Risk Score (FRS), Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D) model, and the newly published HIV-CARDIO-PREDICT (HCP) were applied for each participant at 10, 5, and 2 years prior to the ASCVD event. Proportion of participants categorized as high risk was determined for each calculator. Paired calculators were compared by Fisher’s exact or Chi-squared tests.

Results

A total of 134 participants met initial inclusion criteria (Table 2). Of these, 113, 75, and 42 were excluded from the 10, 5, and 2 year analyses respectively due to missing data. HCP had the highest percentage of high-risk participants at any given time interval (Table 3). PCE had the lowest percentage of high-risk participants across all intervals. Head-to head comparison of PCE versus HCP demonstrated a significant difference in proportion of participants classified as high risk at all time intervals (p < 0.0001).

Conclusion

In this military study cohort of PLWH who had a known ASCVD event, HCP had the highest sensitivity in classifying participants as high risk at all intervals. PCE, which is guideline recommended for ASCVD risk analysis, had the worst sensitivity. Further understanding of these calculator scores including their driving components over time (especially for HCP), their correlations with outcomes when non-cases are included, and their predictive ability among younger participants are needed.

Disclosures

All Authors: No reported disclosures