bluuebunny/crossref_metadata_2025 huggingface dataset:
1394. Antibiotics Overuse and Cost Analysis among Hospitalized Dengue Virus Infected-Thai Adults.
Authors: Ngamprasertchai Thundon
Published: November 2023

Background

Dengue is a common cause of acute febrile illness, predominantly in Asia which required supportive treatment without antibiotics. The antibiotics overuse leads to antimicrobial resistance threats. This study aimed to determine the use of antibiotics and cost analysis of hospitalized dengue virus infected-Thai adults.

Methods

This retrospective cohort study was conducted in Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Thailand in 2022. All confirmed dengue adults’ cases during 2016-2021 were evaluated by two independent reviewers. Clinical, microbiological characteristics and medical costs per episode were interested outcome. The overuse was defined as inappropriate antibiotics prescription in terms of indications, choices, duration, dosage, or route administration. Factors associated with antibiotics overuse were evaluated using a Poisson regression. Direct medical and non-medical costs per episode also were analysed.

Results

A total of 249 participants were included. More than half were classified as severe or dengue with warning signs upon admission. Nearly 20% were transferred to or admitted at intensive care unit. The cumulative incidence of antibiotics use was 9.3% (95% confidence interval (CI): 8.23–10.47), which majority were empirically given. Of 38.3% among empirical antibiotics given participants showed no definite concurrent bacterial infections. The cumulative incidence of antibiotics overuse was 49.8% (95% CI: 43.42–56.18) mainly thanks to no indications of antibiotics. There was association between disease severity upon admission and antibiotics overuse (p-value 0.014). Median total medical cost was 1,086.6 USD per episode; meanwhile, median cost of antibiotics use was 10.8 USD per episode. There was significant difference of antibiotics cost between overuse and appropriate use (p-value 0.005).

Conclusion

The antibiotics overuse in hospitalized dengue virus infected-Thai adults was high. Doctors in charge should reconsider presumed concurrent bacterial infection before empirical antibiotics administration. Antimicrobial stewardship should be also endorsed in dengue cases or other tropical infectious diseases to control resistance threats and hospitalized medical costs.

Disclosures

All Authors: No reported disclosures
1397. What were the Birth Outcomes of Infants Born to Zika Positive Mothers in Developing Countries?
Authors: Prince Monique A , Orlando Lauren , Prince E’ebony , Fasanmi Abidemi
Published: November 2023

Background

Zika Virus became an emerging health threat in the early 21st century. Epidemics in the Pacific Islands noted flu-like symptoms and complications following human ZIKV infection. However, after a severe outbreak in 2015, Latin American studies reported fetal birth defects with maternal infection but reports in other developing countries where outbreaks occurred were not fully characterized. This study aims to review current reports on birth outcomes associated with maternal ZIKV infection .

Methods

This narrative review evaluated birth outcomes of Zika positive pregnant women. Research articles were found using Google Scholar, PubMed, and MEDLINE. The inclusion criteria were publication between 2012 to 2022, availability as full text in English, categorization as original research, meta-analyses or case reports. Exclusion criteria were studies that were part of a book chapter or encyclopedia and studies that cited results from developed nations. The articles were studied and 20 methodologically sound studies were selected for review, and the data was classified in themes based on birth outcomes.

Results

18 studies reported that infants born to some laboratory-confirmed zika-positive mothers had abnormal birth outcomes after delivery including microcephaly, stillbirth, neurological abnormalities and hearing loss. Maternal ZIKV infection is associated with an increased risk of abnormal birth outcomes in newborns in developing countries. In the countries of studies that did not report abnormal outcomes there may have been a protective factor from previous maternal Dengue Virus (DENV) infection adding protection for their infants.

Conclusion

Overall, there appears a difference in birth outcomes of infants born to mothers infected with ZIKV, however more research is needed on environmental factors and prior arboviral infection as additional factors contributing to these outcomes.

Disclosures

All Authors: No reported disclosures
1400. Geospatial Modeling of the Prevalence of Pediatric Febrile Illness in Uganda
Authors: Ssentongo Paddy , Shah Khush
Published: November 2023

Background

Febrile illness is still one of the major public health problems in Africa. Although it has been recognised as crucial to identify the non-malarial aetiologies and to better understand their spatial distribution, the evidence is still limited. We aim to predict the prevalence of fever cases among children aged under 5 years in Uganda using geostatistical models, whilst exploring the potential association with environmental, nutritional, and socio-demographic factors.

Methods

We analyze household records from the 2016 Demographic and Health Surveys (DHS) conducted in Uganda. We develop a geostatistical Binomial model to predict the prevalence of fever cases among children aged under 5 years in Uganda, accounting for environmental, nutritional, and socio-demographic risk factors obtained from publicly available sources.

Results

The average number of children in each cluster was 20 (interquartile range: 16–25), and the median crude (empirical) febrile illness prevalence for each cluster was 30.4% (interquartile range:13.6–50.0). The model indicates the presence of a strong spatial correlation, predicting a higher prevalence in the eastern and north-eastern regions. The inclusion of some potential risk factors improves the predictive performance of the model. Key environmental, nutritional, and socio-demographic factors strongly associated with febrile illness included

Conclusion

We show that there is extensive within-country spatial variation in children’s febrile illness prevalence in Uganda, whilst indicating the potential association with rainfall, temperature, aridity, poverty, standardized precipitation evapotranspiration index, and anemia. These findings could assist in targeted public health policymaking for fever case management and in hypothesis generation for etiology.

Disclosures

All Authors: No reported disclosures
1402. The Landscape of Infections Caused by Rare Bacterial Pathogens
Authors: Farid Tahsin , Charles Reema , Tumas Keyla , Stone Heather , Tirupathi Raghavendra
Published: November 2023

Background

Rare infectious diseases (RIDs) are a significant source of morbidity and mortality1. Most lack approved treatments and it is difficult to perform comprehensive trials on therapeutic efficacy due to their sporadic nature and distribution in resource limited settings2. Lack of monetary incentives has also discouraged drug development3. RIDs therefore represent an area of high unmet medical need. Here the landscape of rare bacterial infections (RBIs) is reviewed, as a pilot project, to explore the use of real-world data to better inform therapy.

Disclaimers and Affiliations

Table 1: List of Included Rare Bacterial Infections

Methods

A list of bacterial infections was curated by combining reportable infections from health agencies4-7 with the CURE ID8 database of diseases. This list was independently reviewed by two experts in infectious diseases to identify potential RBIs. A literature review identified which of these bacteria met the inclusion criteria: a global incidence of less than or equal to 10,000 cases per year (Figure 1). Data on each RBI that met the inclusion criteria was collected (Table 1) and analyzed.Figure 1.Data Flow Diagram

Results

From the comprehensive list of 163 bacterial infections, 22 met the inclusion criteria. Figure 2 displays the distribution of World Health Organization (WHO) Regions where each RBI has the highest incidence. The most frequent mode of transmission amongst analyzed RBIs was zoonotic (Figure 3). 13 RBIs did not have FDA-approved therapies, but only 2 lacked a standard of care therapy (Table 2). Figure 4 depicts the transmission mode of RBIs according to the WHO region where they are most frequent.Figure 2:Percentage and number of diseases listed in table 1 by highest Incidence occurring per WHO RegionFigure 3:Breakdown of diseases in table 1 by mode of transmissionTable 2:Standard of care availability plotted against FDA approved therapy availability

Conclusion

It was expected that a majority of RIDs would occur through zoonoses while environmental and commensal organisms cause opportunistic infections in the immunocompromised. The majority of zoonoses had worldwide distributions. This does not imply higher incidence, but rather may indicate a lack of sustained endemicity with outbreaks in varied geographic areas when animal to human spillover occurs. Transmission patterns may also relate to socioeconomic conditions, climate change, war/civil unrest, and population growth. The lack of FDA-approved therapies for RIDs stems from the paucity of cases and little financial interest; real-world data may help improve treatment efficacy. This project aims to explore these possibilities and expand to all RIDs.Figure 4:Plot of transmission mode by WHO region

References

Disclosures

All Authors: No reported disclosures
1403. Baseline Electrocardiographic Profile of Patients with Severe Tetanus who developed Dysautonomia in a National Tertiary Hospital for Infectious Diseases
Authors: Edrada Edna , Tulawie Janice de Grace L , Teano Ruel O
Published: November 2023

Background

The main causative agent of Tetanus infection is the bacterium Clostridium tetani, a gram-positive, spore-former obligate anaerobic microorganism. It continues to be an important public health concern in developing countries like the Philippines, even though it is preventable by vaccination. This infection produces a tetanospasmin which cause dysautonomia. The toxin effects on the cardiovascular system have been observed and seem to cause increasing morbidity and mortality. The paucity of literature on the degree of myocardial complications of this toxin in a local health setting geared the investigator to do this research.

Methods

This retrospective included all patients with severe tetanus infections. 325 patient’s records were retrieved. 204 met the inclusion criteria. The research investigator collected the baseline clinico-demographic of patients as to age, sex, body mass index, and presence of co-morbidities. Once collected, the investigator recorded the result of the baseline electrocardiogram of patients. Specifically, this included incidence of bradycardia, tachycardia, arrythmia and other significant electrocardiogram findings. Clinical outcome specifically length of hospital stays, and final clinical status were also determined.

Results

Of the 204 patients included, 90 (44%) developed dysautonomia, while the remaining 114 (56%) did not developed dysautonomia. Most of patients with tetanus infection were males, in the 41 to 60 years of age, married, and had normal body mass index. Comorbidities present were hypertension and diabetes mellitus. Diabetes mellitus increased the risk of dysautonomia. The most common baseline electrocardiogram finding was Sinus tachycardia (63.7%). Other arrythmia and other electrocardiogram finding such as myocardial infarction or ischemia were uncommon in this investigation.

Conclusion

Among the baseline electrocardiogram, finding of Sinus Tachycardia is the only result that is associated with dysautonomia and carries poor clinical outcome. As mention, diabetes mellitus increases the risk of developing dysautonomia. Patients who developed dysautonomia has shorter length of hospital stay and expired.

Disclosures

All Authors: No reported disclosures
1404. Remotely Piloted Aircraft & Quadcopters used in Combating Malaria/Dengue in desert terrain
Authors: Srikanth V S
Published: November 2023

Background

Malaria is a major vector borne disease across the world. The major problem we are facing is difficulty in elimination of source. WHO World Malaria Day theme is “Harness innovation to reduce the malaria disease burden and save lives” which is the only way to eradicate malaria by using modern technologies. We used remotely piloted aircraft and quadcopters for effective malaria surveillances and also created a task force DMSEU (Drone Malaria Surveillance and eradication unit). This is first of its kind study where multimode surveillances was done using different types of UAV.

Methods

This is an observation study during malaria outbreak during Oct 2022 – Dec 2022. DMSEU was formed. Mosquito breeding locations were identified based on map marking of the areas from where clusters of malaria cases were reported. Then satellite images of locations were evaluated for gross land scape assessment. Based on this assessment RPAs were used for identification of breeding sites with the help of the the imagery systems like FLIR and Day CAM. In our unit Quad copters were used for assessment of breeding sites.

Results

Ramgarh was identified as an area of source of malarial outbreak based on cluster mapping. When the satellite images of Ramgarh was analysed, it showed a dense vegetation developed near TV tower area during rains. RPA was flown over that area to find out exact breeding sites using the coordinates. We also noticed that there were many drip irrigation fields. When RPA were flown over the area, it was identified that each field had an open water storage tank for drip irrigation. Using Quad copter, we did further assessment at each roof tops for potential breeding sites like open overhead tank, water stagnation

RPA - Surveillance of malaria breeding site

Quardcopter Malaria Breeding site surveillance

Conclusion

The malaria menace can be brought to an end only by using newer technologies and multi-sector collaboration working hand in hand. Using different types of UAV like RPA and Quadcopter was very effective in source identification and eradication. To improve the scope of area coverage and efficiency of mosquito breeding sites eradication, new drone should be built with upgraded capability of spraying and fogging capacities. Using quadcopters and drone played a major role in eliminating them and curtailing the cases drastically in a very short span of time in effective way and also saved manpower and time.

Disclosures

All Authors: No reported disclosures
1406. A Systematic Quality Improvement Initiative to Improve Chagas Disease Screening in Patients with HIV at a Large Safety Net Clinic in Denver
Authors: Barahona Lilian Vargas , Henao Martínez Andrés F , McLees Margaret P , Gardner Edward , Hawkins Kellie
Published: November 2023

Background

Chagas Disease (CD) is a neglected parasitic disease that affects people living in continental Latin America. Immigrants from these countries or those born to mothers from Latin America are at risk of developing disease. Detection of cases before end-organ damage has occurred is crucial for treatment to be beneficial. Patients with HIV (PWH) may be at high risk of reactivation and death. We sought to screen PWH at risk of CD that receive medical care in the safety net hospital for the Denver area.

Methods

We identified 325 PWH that receive care in the Denver Health system who self-identified as born in Latin American countries. We ordered serological Trypanosoma cruzi testing for all patients (T cruzi IgG, ELISA, ARUP Laboratories, UT). Providers were educated about the intervention and CD via email (Figure 1). Concurrently, the Denver Health refugee clinic began a process to screen for CD among people at risk who do not have HIV.Figure 1.Chagas disease screening process in patients with HIV in Denver Health, March 2022 - March 2023

Results

Between March 2021 and March 2022, a total of 265 patients completed testing (81.5%). 89.8% were male and the mean age was 45.4 years (SD +/- 11.5). Most patients had controlled HIV (mean CD4 624 +/- 303.5 cells/µL, HIV viral load < 30 cps/mL in 92%). Most patients were born in Mexico (80%), followed by El Salvador (5%). Three patients had a positive test, yielding a prevalence of 1.1%. One of these patients had an already confirmed and treated infection. The other 2 patients had uncontrolled HIV with CD4 count < 200 cells and have been lost to follow-up with inability to obtain confirmatory testing. Using a 2.2% prevalence of serologic positivity for CD in Hispanic patients, 90 patients at risk will need to be screened in order to detect a positive patient. Due to increased awareness of CD in our primary care clinics, a parallel 3-fold increase in testing in non-HIV patients was seen in the study period.

Conclusion

Chagas disease screening in patients at risk can be performed in clinics that provide care for patients with HIV. Obtaining a second confirmatory test is challenging and processes to facilitate blood collection should be implemented to not delay testing. Increased awareness of medical providers leads to increased screening for this disease.

Disclosures

Edward Gardner, MD, Cepheid: Grant/Research Support|Gilead Sciences: Grant/Research Support|ViiV Healthcare: Grant/Research Support
1407. Migration Timing and its Association with Disease Features in a Chagas Disease Cohort in New England
Authors: Wheelock Alyse , Reifler Katherine , Hamer Davidson H , Hochberg Natasha , Gopal Deepa , Bourque Daniel
Published: November 2023

Background

Chagas disease is under-recognized in the United States (US) and little is known about how time spent living in endemic versus non-endemic settings affects features of the disease.

Methods

We performed a cross-sectional, retrospective analysis of 108 individuals with Chagas disease. Presence of cardiac disease was defined according to the American Heart Association classification of Chagas cardiomyopathy. We performed a multivariate logistic regression adjusting for country of birth (COB, analyzed as El Salvador vs. other) and age at confirmatory diagnosis to evaluate whether proportion of lifetime in COB was associated with cardiac disease. We also performed an exploratory analysis of semi-quantitative Trypanosoma cruzi ELISA optical density (OD) values to assess for association with proportion of lifetime in COB, including the same covariates in a multivariate linear regression.

Results

This patient cohort was predominantly from El Salvador (92/108, 85%) and other countries in Central America (11/108, 10%), with a median age at diagnosis of 44 years (interquartile range [IQR] 18). Most individuals originated from rural areas (84/90, 93%) and immigrated to the US in adulthood (median 26 years, IQR 13) after having lived a median of 70% (IQR 25) of their life in their COB. Age at migration and age at confirmatory diagnosis were highly correlated (Pearson’s correlation coefficient [CC]= 0.69, p< 0.001). Confirmatory diagnosis occurred a median of 13 years (IQR 14) after arrival in the US. Cardiac disease was present in 47/108 (44%). Adjusting for age at diagnosis and COB, the proportion of lifetime in COB was not significantly associated with cardiac disease (odds ratio 5.6, [95% CI 0.355 - 87.1], p=0.22), nor was it associated with higher OD values (CC = –0.2, 95% CI –1.2-0.9, p=0.74).

Cohort demographics and time to Chagas disease diagnosis after arrival in the U.S.

Features of migration history and Chagas cardiac disease status

Conclusion

In this cohort of individuals with Chagas disease, there was a substantial delay in diagnosis after arrival to the US, which may have been longer if not for local screening efforts. Cardiac disease was prevalent but not associated with higher proportion of time spent in COB. Exploratory analysis of serology titers was not associated with proportion of lifetime spent in COB, contrary to our expectation.

Disclosures

Davidson H. Hamer, MD, Kephera Diagnostics: Grant/Research Support|Takeda: Advisor/Consultant|Takeda: Grant/Research Support|Trinity Biotech, LLC: Advisor/Consultant|Valneva: Advisor/Consultant|Valneva: Grant/Research Support Natasha Hochberg, MD, MPH, Novartis Institute for Biomedical Research: Full-time employment|Novartis Institute for Biomedical Research: Stocks/Bonds Daniel Bourque, MD, Kephera Diagnostics: Grant/Research Support
1414. Residual Surface Disinfectant Reduces Finger Transfer of Antibiotic Resistant Bacteria and Viruses from Surfaces for 24 hours after Treatment
Authors: Gerba Charles P
Published: November 2023

Background

It is believed that as much as 80% of common infections are spread by the hands. Touching surfaces (fomites) contaminated with infectious microorganisms results in their transfer to the hands (fingers). Subsequent touching of the mouth, nose, or skin can result in their transmission. Disinfection of surfaces has been found to reduce such transmission. Unfortunately, highly touched surfaces (door knobs, escalator hand rails, buttons, etc.) can quickly become re-contaminated. Disinfectants which leave a residual can act as an additional barrier in between regular disinfection of surfaces, reducing the risk of transmission.

The goal of this study was to assess the reduction in the transfer of bacteria and viruses from surfaces treated with a quaternary ammonium based disinfectant (Actizone F5® spray) that leaves a residual disinfectant capability for more than 24 hours.

Methods

Stainless steel and plastic coupons were treated with Actizone F5® spray and allowed to dry for 24 hours. The test microorganisms were then added to the surfaces and after 2, 5 or 10 minutes, the surface was touched with a finger. The number of microorganisms transferred to the finger was then quantified. The experiment was repeated with untreated coupons as a control.

Results

The degree of finger transfer was reduced by more than 99.99% by the treated coupons for Salmonella Typhimurium, MRSA, Acinetobacter baumannii, and Escherichia coli. Candida auris was reduced by > 99.99% on the stainless steel and ∼99.6% for the plastic coupons. Pseudomonas aeruginosa and antibiotic-resistant Klebsiella pneumoniae (CRE) were reduced by ∼98%. The transfer of human coronavirus 229E was reduced by 98.7% from the stainless steel surfaces.

Conclusion

Transfer of all the test microorganisms was reduced by the treated surfaces even after 24 hours, demonstrating residual activity. The transfer for some of the microorganisms was less from the ABS plastic than from the stainless steel surfaces. This may have been due to the attachment or spreading of the product on this type of surface, resulting in a less even coating. A longer contact time may result in significant reduction of these microorganisms. The relative humidity and short exposure time to the treated surfaces used in this study should probably be considered a worst case scenario.

Disclosures

Charles P. Gerba, PhD, □ Corning: Advisor/Consultant| □ Reckitt: Advisor/Consultant| □ Reckitt: Grant/Research Support| □ Savory: Grant/Research Support
1415. Effect of Self-Sanitizing Copper Impregnated Surfaces on Healthcare-Associated Infection Rates
Authors: Chatterjee Piyali , Williams Marjory , Choi Hosoon , Coppin John David , Bennett Morgan , Navarathna Thanuri , Corona Brandon , Bridges Angelia , Hwang Munok , Nelson Richard , Keene Robin , Jinadatha Chetan
Published: November 2023

Background

Healthcare-associated infections (HAI) are a major cause of morbidity and mortality in the United States. Prevention of HAIs is a multipronged approach that involves hand hygiene, antibiotic stewardship, and environmental sanitation. The efficacy of polymer-based self-sanitizing copper oxide-impregnated solid surface on Clostridioides difficile (C. diff) spores in a laboratory setting showed 1-2 log reduction. Here we assessed the efficacy of the same surface for preventing HAIs over a 7-year period in a hospital setting.

Methods

The copper surfaces installation in the hospital began in late 2016 and peaked in January 2018. HAIs that met 2017 National Healthcare Surveillance Network definitions were recorded for all infections between 2014 and 2022. A Bayesian multivariate multilevel negative binomial model was fit to assess the mean HAI rate over time for blood, urine, site specific, pneumonia, and C. diff infections, and the effect of copper on those trends while adjusting for autocorrelation, seasonality, average length of stay, and the COVID-19 pandemic. We report the median incidence rate ratio (IRR) and 95% uncertainty interval (UI), as defined by the highest density posterior interval, for the intervention.

Copper Surface Installation

The figure demonstrates the various components of the copper surfaces that were installed in the hospital and the timelines for installation.

Results

During the copper intervention there was 0.36 (0.04 – 0.94) times the incidence for blood, 0.44 (0.06 – 1.26) for pneumonias, 0.61 (0.10 – 1.61) for urine, 0.70 (0.02 – 2.89) for site specific, and 0.85 (0.31 – 1.72) for C. diff infections, indicating reduced HAIs during the intervention. Although only the effect for blood infections had a 95% UI excluding an IRR=1, the posterior probability for the model estimates indicates that conditional on this model and data, the chance that the IRR< 1 (indicating reduced HAIs) was 96% for blood, 90% for pneumonia, 80% for urine, 66% for site specific, and 66% for C diff infections.

HAI Rates by time

Incident Rate Ratios for HAI and Effect of Copper

Conclusion

The overall effect of introducing copper bed rails appears to be beneficial with respect to lowering HAIs. The trends were stronger for certain infections such as blood infections and for pneumonias but weaker for C. diff infections. Due to this study being a real-world intervention that also overlapped with the COVID-19 pandemic certain beneficial factors may have been overshadowed by the unknowns that the pandemic bought.

Disclosures

All Authors: No reported disclosures
1422. Surveillance for fungi in hospital environments housing high-risk hosts using culture and culture-independent methods
Authors: Clancy Cornelius J , Cheng Shaoji , Hao Binghua , Driscoll Eileen , Fleres Giuseppe , Buser Katherine , Sundermann Alexander , Ayres Ashley , Snyder Graham M , Hong Nguyen M
Published: November 2023

Background

Nosocomial outbreaks of fungal infections are increasingly reported. There are scant data on fungal burdens in hospital environments. Standardized surveillance methods are lacking.

Methods

We developed culture and culture-independent (real-time PCR, reference to standard curve) methods for measuring airborne fungal burdens using SAS Super 100 and SASS 3100 Dry Air samplers. We performed serial surveillance in 7 units with high-risk, immunosuppressed patients in 2 hospitals and outside.

Results

Methods were optimized for multiple variables, including volume, duration, flow of air sampling; culturing techniques (direct impact plates, cultures at different stages of filter processing); filter DNA recovery (extraction protocols, stage of filter processing); PCR (targets, primers, PCR parameters). To date, we have surveyed each unit ≥4 times. Pathogenic moulds were cultured in >50% of outdoor and indoor air, including azole-resistant Aspergillus species [Figures 1A-B]. Fungal burdens were significantly greater outside than inside hospitals, by both positive culture % and DNA burden [Figure 2]. There was no correlation between outside and inside genome equivalents (GEs; R2< 0.06), nor were there significant differences in GEs within a given unit (nurses stations, patient rooms; all p >0.1). GEs were greater in culture-positive than culture-negative samples (Aspergillus, 2.4 vs. 1.5 log10; pan-fungal, 2.8 vs. 1.5 log10GE; p< 0.0001; best results with sonicated filters). Direct impact cultures were less sensitive than filter cultures.

Conclusion

We developed standardized methods for sampling airborne fungi in hospitals that yield reproducible results. Fungal burdens were significantly lower in hospitals than those immediately outside, but fungal DNA and viable Aspergillus and other moulds were commonly recovered from units housing high-risk patients. Outside fungal burdens could not be used to estimate relative burdens within hospitals. Direct impact cultures, commonly used in surveillance, lacked sensitivity for detecting viable fungi and did not correlate with DNA burdens. We are optimizing direct metagenomic sequencing from airborne samples. We will assess correlations between environmental surveillance data and nosocomial fungal infections.

Disclosures

Alexander Sundermann, DrPH, CIC, FAPIC, OpGen: Honoraria Graham M. Snyder, MD, SM, Infectious Diseases Connect: Advisor/Consultant
1999. Assessment of Communication Strategies 1 to 2 Years After Completion of a Vaccine Hesitancy Communication Training Program During Residency
Authors: Barton Shanna M , Calhoun Aaron W , Feygin Yana , Marshall Gary S
Published: November 2023

Background

We previously showed (J Pediatr 2022;241:203; Open Forum Infect Dis 2022;9(2):ofac492.626) that residents trained in a structured communication strategy called AIMS (Announce, Inquire, Mirror, Secure) demonstrated specific behaviors of interest during live and virtual encounters with standardized patients (SPs) portraying vaccine-hesitant parents. The current study was conducted to determine if those behaviors were prioritized long after completion of training.

Methods

In the original studies, blinded Pediatrics and Medicine-Pediatrics residents were randomized to AIMS training (AIMS Group) or standard of care training (Control Group; Figure 1); blinding was maintained after training and until the time of the current study. Subjects were invited to complete an online survey wherein 10 possible communication behaviors were ranked from highest priority to lowest priority (Figure 2). Respondents were considered to have prioritized AIMS behaviors if they ranked each of the 3 AIMS items in the top 5; the ability of this measure to detect prioritization of AIMS behaviors was assessed by surveying unblinded residents who underwent AIMS training in the prior 2 weeks (Validation Group). Differences between groups were assessed using Chi-square tests for proportions. We hypothesized that a higher proportion of subjects in the AIMS Group would prioritize AIMS behaviors compared to subjects in the Control Group.Figure 1:Curriculum Flow DiagramFigure 2:Rank Task

Results

Characteristics of study participants are shown in Figure 3. Seventy-seven percent of the 31 residents in the Validation Group met criteria for prioritization of AIMS behaviors, compared with only 38% of the 32 subjects in the Control Group (p-value = 0.003). However, only 19% of the 32 residents in the AIMS Group met criteria for prioritization of AIMS behaviors (p-value = 0.164, AIMS Group vs Control Group).

Conclusion

AIMS communication behaviors are ranked highly shortly after training, but this prioritization is not retained over time. Future studies of the utility of structured vaccine hesitancy communication strategies should incorporate repetition and spaced retrieval to enhance retention and ensure deployment in practice.

Disclosures

Shanna M. Barton, MD, M.Sc., Sanofi Pasteur: Grant/Research Support Gary S. Marshall, MD, GSK: Advisor/Consultant|GSK: Grant/Research Support|GSK: Honoraria|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Moderna: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Sanofi: Advisor/Consultant|Sanofi: Grant/Research Support|Sanofi: Honoraria|Seqirus: Advisor/Consultant|Seqirus: Grant/Research Support|Seqirus: Honoraria
1423. A Simple Electronic Medical Record-Based Predictors of Illness Severity in Sepsis (SEPSIS) Score
Authors: Cressman Alex , Wen Bijun , Saha Sudipta , Jun Hae Young , Waters Riley , Lail Sharan , Jabeen Aneela , Koppula Radha , Lapointe-Shaw Lauren , Sheehan Kathleen , Daneman Nick , Verma Amol , Razak Fahad , MacFadden Derek
Published: November 2023

Background

Current scores for predicting sepsis outcomes are limited by generalizability, complexity, and electronic medical record (EMR) integration. Here, we validate a simple EMR-based score for sepsis outcomes in a large multi-centre cohort.

Methods

A simple electronic medical record-based predictor of illness severity in sepsis (SEPSIS) score was developed (4 additive lab-based predictors: Creatinine, Bilirubin, Platelet Count, Lactate) using a retrospective cohort study of patients admitted to internal medicine services from April 2010 - March 2015, across four hospitals in Toronto, Canada. We identified patients with sepsis based upon receipt of antibiotics and positive (non-screening) cultures on admission. Chart review was conducted to extract components of qSOFA and NEWS2 scores. The primary outcome was in-hospital mortality and secondary outcomes were ICU admission at 72 hours, and hospital length of stay (LOS). We calculated the area under the receiver operating curve (AUROC) for the SEPSIS score, qSOFA, and NEWS2. We then evaluated the SEPSIS score in a contemporary cohort (2015 to 2019) of patients receiving systemic antibiotics.

Results

Our initial cohort included 1,890 patients with a median age of 72 years (IQR: 56-83). 9% of the cohort died during hospitalization, 13% were admitted to ICU at 72 hours, and mean LOS was 12.7 days (SD: 21.5). In the initial and the contemporary (2015-2019, 4811 patients) cohorts, the AUROCs of the SEPSIS score for predicting in-hospital mortality were 0.63 and 0.64 respectively, which were similar to NEWS2 (0.62 and 0.67) and qSOFA (0.62 and 0.68). AUROCs for predicting ICU admission at 72 hours, and length of stay >14 days, were similar between scores, in the initial and contemporary cohorts. All scores were generally well calibrated for predicting mortality (Figure 1).Figure 1.Mortality risk by predictor score (low, medium, high) and score type.

Conclusion

The EMR-based SEPSIS score shows a similar ability to predict important clinical outcomes compared with other validated scores (qSOFA and NEWS2). Because of the SEPSIS score’s simplicity, it may prove a useful tool for clinical and research applications.

Disclosures

All Authors: No reported disclosures
1431. Dosing Matters – Consistency Analysis of Touch-Free Automatic Hand Hygiene Dispensers
Authors: Arbogast James W , Smith Nicole M , Bansaghi Szava , Chen Nanshan , Neal Travis B , McNulty John J , Haidegger Tamas P
Published: November 2023

Background

Touch-free automatic alcohol-based hand rub (ABHR) dispensers are used extensively in healthcare settings to facilitate hand hygiene (HH). U.S. Centers for Disease Control and Prevention and the World Health Organization HH guidance suggests ABHR dosing per use should be enough to cover the whole hand and keep hands wet for at least 15-20 seconds. Leapfrog 2022 guidance states each activation needs to produce at least 1.0 ml liquid volume. The objective of this study was to determine mean dose volumes and dispensing consistency for five leading US foam ABHR dispenser systems and to assess design impact on dosing variability.

Methods

In total, over 15 dispensers and 32 distinct refills were tested, with >10,000 dispenses analyzed for each of the five systems. Automated testing used computer programming and custom mechatronics to activate the dispensers and capture weights at predetermined delay patterns. Low, medium and high usage patterns of 7x, 48x and 100x activations per day were set with dispense delay patterns based on cluster analysis of actual ABHR dispenser usage patterns from time stamped HH monitoring. In another laboratory, measurements were carried out manually; 50 doses were rapidly collected and weighed within an hour for each refill. Density values were used to calculate dispensed volumes. A linear mixed effects model was fit, and total variance components were compared using a 2-Sample Variance Test.

Results

Three of the dispenser systems had mean ABHR output >1.0ml, and two were < 1.0ml (see Table 1). Test results are compiled into histograms (Figures 1 & 2) to visually display the large differences in average dose and consistency between doses. Dispensers #A & #B have significantly greater variability (p < 0.001), which is driven by pump design used to foam the ABHR.

Conclusion

Testing patterns (timing delays between dispenses) impacts dosing performance. The dispenser design and engineering cause significant differences in volume dispensed and consistency across dispenses. Using enough ABHR to cover hands completely and keeping hands wet long enough to significantly reduce pathogens is an important requirement. Facilities should assess ABHR dispenser outputs and consider consistent dosing as an essential performance criterion for effective HH policies and practices.

Disclosures

James W. Arbogast, PhD, GOJO Industries, Inc.: employee Nicole M. Smith, n/a, GOJO Industries, Inc.: employee Szava Bansaghi, n/a, GOJO Industries, Inc.: Grant/Research Support Nanshan Chen, n/a, GOJO Industries, Inc.: Grant/Research Support Travis B. Neal, n/a, GOJO Industries, Inc.: employee John J. McNulty, n/a, GOJO Industries, Inc.: employee Tamas P. Haidegger, PhD, GOJO Industries, Inc.: Grant/Research Support
1442. Use of a Spaced-Education Platform to Assess Hand Hygiene Auditor Competency
Authors: Vaughan-Malloy Ana M , Lehane Renee , Wells Mary , Sandora Thomas J
Published: November 2023

Background

Hand hygiene reliability is a top priority in healthcare. Infection Prevention and Control (IPC) programs often rely on clinical personnel to audit hand hygiene performance. Interrater reliability among auditors is critical to ensuring data validity. We evaluated whether spaced education, which increases long-term knowledge retention, could be integrated into auditor competency assessment.

Methods

113 trained hand hygiene auditors were enrolled in a 13-month online spaced-education platform to assess their mastery of knowledge needed for the role. We delivered 46 unique questions (3 per week, with 2 weeks between repeat delivery of a question) followed by rationale; we retired questions after 3 correct answers. A 10-item survey consisting of 9 Likert-scale questions and one free-text comment was emailed to gauge participant satisfaction with the competency program. Frequencies and percentages were used to summarize Likert responses, and themes were elicited from comments.

Results

From November 2021 to December 2022, a total of 12,120 questions were attempted, and 32 of 113 auditors (28%) completed the competency. Auditors answered 70% of questions correctly on the first attempt and 83% on the final attempt. 30 of 113 auditors (27%) responded to the survey. The majority agreed the number and complexity of questions were appropriate (57% and 67%, respectively). 87% reported the platform easy to navigate, 63% reported the spaced-education model worked, and 77% agreed adequate time was provided for completion. 30% of respondents reported the individual competition as enjoyable. Time and effort required for completion was the most common theme identified among auditor comments; several respondents recommended fewer questions at a narrower spacing interval over a shorter time frame due to competing work demands; 5 individuals expressed a preference for an annual computer-based module.

Conclusion

A spaced education competency program improved hand hygiene auditor knowledge in the short term. Completion rate was low and participants expressed a desire for fewer questions over a shorter time frame. This study offers insight into ways to optimize spaced education as a potential tool for hand hygiene competency assessment.

Disclosures

Ana M. Vaughan-Malloy, MD, MPH, Asana: Stocks/Bonds|Aurora: Stocks/Bonds|Ayr Wellness: Stocks/Bonds|Bionano Genomics: Stocks/Bonds|Butterfly Network: Stocks/Bonds|Canopy Growth: Stocks/Bonds|Cresco Labs: Stocks/Bonds|CRISPR Therapeutics: Stocks/Bonds|Cronos Group: Stocks/Bonds|Curaleaf Holdings: Stocks/Bonds|Editas Medicine: Stocks/Bonds|Green Thumb Industries: Stocks/Bonds|High Tide: Stocks/Bonds|Iovance Biotherapeutics: Stocks/Bonds|Jushi Holdings: Stocks/Bonds|Moderna: Stocks/Bonds|Organigram Holdings: Stocks/Bonds|Pacific Biosciences of California: Stocks/Bonds|Personalis: Stocks/Bonds|Pfizer: Stocks/Bonds|SNDL Inc: Stocks/Bonds|Terrascend: Stocks/Bonds|Tilray Brands: Stocks/Bonds|Trulieve: Stocks/Bonds
1444. Candida auris Outbreak in a COVID-19 Hospital: Detection and Containment
Authors: Baylon-Valdez Victor , Aguirre-García Gloria Mayela , Guajardo-Lara Claudia E , Aleman-Bocanegra Mary C , Martínez-Reséndez Michel F
Published: November 2023

Background

Candida auris has become an important nosocomial infection in ICU patients. The difficulty in isolating and detecting this pathogen, its inherent multidrug resistance, and rapid transmission make it a menace to public health. The present work details the first C. auris outbreak in Mexico and containment techniques used in a Tertiary Care Center that underwent restructuring due to COVID-19.

Methods

We performed a single-center, retrospective, descriptive study from June 2020 to February 2022 at Hospital San Jose TecSalud, Monterrey, including hospitalized COVID-19 patients with detection of Candida auris by MALDI-TOF. After identifying the first cases, the exposed patients were screened twice weekly by skin (armpit/groin) swab culture. Those who tested positive were classified as colonization. Patients with clinical signs of infection were tested from sterile sites (blood/urine), and if the culture came back positive they were classified as cases. Finally, we described the interventions for containment.

Results

During the study period, 4,025 patients were hospitalized due to COVID-19; 971 were critically ill patients admitted to the ICU. 160 patients tested positive for Candida auris, 131 colonizations, and 29 cases (Figure 1). Of the total, 83% were male, mean age ± SD = 56.96 ± 13.29. The most common sites of infection in the cases group were urinary tract infections (55.17%) and bloodstream infections (44.81%; from this, 23% were catheter-associated). The first case was detected on June 4th, 2020, in July 2020, we transitioned to a single patient-per-nurse model and implemented disinfection validation via ATP bioluminescence. Also, to control the increase in cases, by the end of 2020, we standardized chlorine cleaning and de-escalated PPE, and implemented hydrogen peroxide vapor and reinforcement of hand-washing techniques (Figure 2).Figure 1.Patient’s Demographics.Figure 2.Outbreak.

Conclusion

In the setting of the transition of Hospital San Jose into a COVID-19 Hospital in response to the high volume of patients, and the emergence of C. auris at the ICU; early detection and screening of the exposed population, multi-disciplinary coordination between healthcare teams, and the rapid installation of interventions were crucial for the containment and termination of the outbreak.

Disclosures

All Authors: No reported disclosures
1445. Public Health Containment Response Detects Possible Transmission of Echinocandin-Resistant Candida auris in a Long-term Acute Care Hospital
Authors: Brennan Brenda M , McNamara Sara E , Valley Ann M , Podzorski Diane , Lyman Meghan , Parnell Lindsay
Published: November 2023

Background

Candida auris is an emerging fungal pathogen which is often multidrug-resistant, can cause severe infections, and spreads readily in healthcare settings. While echinocandin resistance (ech-R) remains low in the United States (< 5%), the number has been increasing, which is concerning because echinocandins are first-line therapy for C. auris infections. In May 2022, the first ech-R C. auris isolate in Michigan was detected at long-term acute care hospital (LTACH) A and enhanced lab surveillance was conducted to assess potential for ech-R transmission.

Methods

Upon detection of C. auris in a urine specimen at LTACH A in March 2022, a containment response was initiated, which included clinical surveillance and colonization screening of patients at LTACH A. C. auris colonization screening testing and antifungal susceptibility testing (AFST) was performed at Wisconsin State Laboratory of Hygiene and whole genome sequencing (WGS) by the CDC. Ech-R was determined using tentative breakpoints defined by CDC.

Results

From Mar 2022 – Sept 2022, 15 C. auris-positive specimens were detected from 12 patients at LTACH A (5 clinical specimens, 10 screening swabs). In May 2022, AFST on a blood isolate from a C. auris-colonized patient showed resistance to azole and echinocandin classes. This patient had no history of prior echinocandins use. AFST conducted on 12 available isolates (5 clinical, 7 screening) detected ech-R in 10 (83%) isolates (3 clinical, 7 screening); all isolates were resistant to azoles and susceptible to polyenes. WGS was performed on 4 isolates and revealed 3 closely-related clade III isolates (all ech-R), suggesting possible facility transmission, and 1 clade IV isolate (susceptible), suggesting a separate introduction.

Conclusion

Multiple ech-R C. auris isolates detected among patients overlapping in the same facility and with close genetic relatedness provide further evidence that echinocandin resistant strains can be transmitted among patients and raise concerns about spread to a larger population of patients without prior echinocandin use. Enhanced surveillance for C. auris detection and antifungal resistance, public health reporting, and robust infection prevention and control measures are critical to containing the spread of concerning resistance.

Disclosures

All Authors: No reported disclosures
1447. Cluster of Carbapenem-resistant Acinetobacter baumannii in the Context of Local Community Transmission
Authors: Darwish Malik , Desai Angel , Catalan Marinell , Wilson Timothy , McGlynn Colin , Suhd-Brondstatter Jennifer , Dow Allison , Kingsley Amy , Reilly Mary , Cohen Stuart H
Published: November 2023

Background

Carbapenem-resistant Acinetobacter baumannii is increasingly being recognized as a nosocomial pathogen of concern. We report on a cluster of infections at a tertiary-care hospital in the context of local community outbreaks.

Methods

Between July and October 2021, we identified an increase in carbapenem-resistant Acinetobacter baumannii infections at our medical center. We conducted epidemiological investigation followed by whole-genome sequencing of clinical isolates in tandem with the Public Health Department, who was monitoring ongoing regional long-term care facility outbreaks.

Results

Of 9 patients with carbapenem-resistant Acinetobacter baumannii isolates, 8 were sent for whole genome sequencing (WGS) which revealed two clonally related groups; Clone 1 accounted for four cases, Clone 2 accounted for two, and the remaining two were unrelated to the other isolates. Half of the Clone 1 cases and all of the Clone 2 cases presented from the same two long-term care facilities, likely reflecting a known regional outbreak. The other two Clone 1 cases presented from the community and were suspected to be healthcare-acquired prior to WGS confirmation, although no definite route of transmission was ultimately identified. In response, we performed audits on the affected wards to improve targeted infection prevention practices, including enhanced cleaning and disinfection of respiratory therapy equipment. Concurrently, we initiated a surveillance system to screen all patients upon admission from long-term care facilities for colonization via rectal swabs cultured on Acinetobacter-selective media. Subsequent point prevalence testing revealed no additional healthcare-associated infections.

Conclusion

We identified a cluster of carbapenem-resistant Acinetobacter baumannii cases that predominantly reflected ongoing outbreaks at long-term care facilities in the community. Two likely healthcare-associated cases were also identified through whole genome sequencing, prompting infection prevention measures and targeted screening. Our experience highlights the necessity of a robust surveillance system and mitigation efforts to prevent transmission of healthcare-associated infections.

Disclosures

All Authors: No reported disclosures