bluuebunny/crossref_metadata_2025 huggingface dataset:
P-325. Lingering Effect of the COVID-19 Pandemic: Unnecessary Glove Use by Medical Trainees at a Large Academic Medical Center
Authors: Brown Breanna , Nolt Dawn , Guzman-Cottrill Judith A
Published: January 2025

Background

In 2023, medical students and house staff were observed wearing disposable gloves during pediatric patient encounters, including those in standard precautions. When asked about their rationale for glove use, students and house staff assumed that universal gloving was a component of standard precautions. We sought reasons for universal glove use, and if universal gloving for all patient care was followed beyond the Children’s Hospital.

Methods

Residents and fellows in all training programs at Oregon Health & Science University (OHSU) were surveyed. We created an electronic survey including questions about demographics, training level during the pandemic, hand hygiene habits, and facilities’ gloving policies where they worked during the pandemic. A free-text response was available to detail routine glove use. The survey was e-mailed by the Graduate Medical Education office in February 2024 and was open for one month. A reminder e-mail was sent 2 days before closure. The OHSU IRB reviewed the survey and determined it not to be human research.

Results

The survey was sent to 972 trainees, representing 95 programs. The response rate was 23% (n=226); not all questions required responses. Only 30 (25%) were pediatric trainees. In ambulatory settings, 3 (1%) respondents report never gloving, 66 (33%) sometimes, 75 (38%) often, and 55 (28%) always wear gloves as part of standard precautions. In inpatient settings, 1 respondent never wears gloves, 43 (22%) sometimes, 70 (36%) often, and 79 (41%) always wear gloves as part of standard precautions. Of the respondents in medical school during the pandemic: 64 (46%) were taught to wear gloves during all patient care, and 28 (20%) reported hospital policy requiring universal gloving. For those in residency and/or fellowship during the pandemic: 74 (55%) were taught to wear gloves during all care, and 17 (13%) reported policies that required gloving.

Conclusion

Many trainees were taught universal gloving during the pandemic. These habits have continued. The concepts behind standard and transmission-based precautions must be highlighted during medical training. It is imperative that all GME programs educate their trainees about the concepts of standard precautions and appropriate glove use.

Disclosures

All Authors: No reported disclosures
P-327. Mitigating Colonization with Carbapenem-resistant Organisms among Neonatal Intensive Care Unit Admissions: Evaluating the Effectiveness of Infection Control Interventions
Authors: Chowdhury Fahmida , Mamun Gazi Md Salahuddin , Khan Sanzida , Mah-E-Muneer Syeda , Islam Md Aminul , Ahmed Dilruba , Sen Debashis , Harun Md Golam Dostogir , Oakley Lisa P , Parra Gemma , Styczynski Ashley R
Published: January 2025

Background

Antimicrobial resistance (AMR) is the global leading cause of death from infections, particularly affecting low- and middle-income countries. Colonization with carbapenem-resistant organisms (CRO) increases the risk of infections with CRO. In an interim analysis of a prospective cohort study, we found 77% (141/182) of neonates in a neonatal intensive care unit (NICU) of a tertiary-care hospital in Bangladesh were colonized with carbapenem-resistant Klebsiella pneumoniae (CR-Kpn), with 63% (89/141) acquiring colonization >48 hours after hospitalization. We aimed to assess the impact of infection control (IC) interventions on CRO colonization among neonates admitted to the NICU.

Methods

From July 2023 to April 2024, we enrolled 604 neonates: 358 before the intervention and 246 after. Neonates were assessed for CRO colonization using rectal swabs collected on admission, days 3 and 7, and weekly thereafter. Swabs were plated on selective agar mSuperCARBA followed by confirmatory identification and susceptibility testing using VITEK® 2. Positive blood cultures collected from patients with suspected sepsis underwent testing using VITEK® 2. Our IC interventions targeted hand hygiene (HH) and environmental cleaning (EC), including staff training on proper HH techniques and more frequent cleaning of high-touch surfaces, as well as regular audits to measure compliance with HH and EC. We conducted descriptive analyses using Pearson’s Chi-square test.

Results

Compliance with HH improved from 13% to 28% following the interventions, while environmental cleaning improved from 9% to 43% based on fluorescent markers. Over the same time, CRO colonization decreased from 74% (265/358) to 63% (153/246) (p=0.002) and CR-Kpn colonization decreased from 65% (232/358) to 54% (134/246) (p=0.011). Overall bacterial blood culture positivity [54% (51/95) vs. 57% (30/53), (p=0.87)] and CRO rates [13% (12/95) vs. 21% (11/53), p=0.19] remained stable at pre and post intervention respectively.

Conclusion

After implementing IC interventions, we observed a decrease in CRO colonization among NICU patients, though blood culture positivity was unchanged. Results suggest that even modest improvements in IC practices may have a role in curbing CRO transmission in high-risk settings.

Disclosures

All Authors: No reported disclosures
P-329. Estimating changes in MRSA infection rates due to changes in facility MRSA precautions
Authors: Khader Karim , Haroldsen Candace , Evans Martin , Simbartl Loretta , McCauley Brian , Samore Matthew H , Rubin Michael
Published: January 2025

Background

The role of active surveillance (AS) and contact precautions (CP) in acute care settings for preventing transmission of endemic drug resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) remains unsettled. The emergence of SARS-CoV-2 led to a shift in VA policy in March 2020, when VA acute care facilities were allowed to suspend AS for MRSA and CP for patients with MRSA colonization or active infection, resulting in a partial and variable de-implementation of AS/CP across the VA (Figure 1). We evaluated the impact of this change on VA MRSA infection rates.

Methods

We modeled monthly positive MRSA culture rate at the ward-facility level using (1) all positive MRSA cultures, and (2) only positive sterile-site cultures (to more closely capture ‘true infections’). Our primary outcome was HAIs (occurring ≥ 3d after admission), including those up to 30-days post-discharge. We used Poisson, Negative Binomial, and Poisson mixed-effects regression approaches, clustering within ward type (ICU/non-ICU) and facility. With each approach, 4 different models incorporated increasing numbers of covariates to evaluate the robustness of the results.

Results

Using Poisson regression, we found culture rate, discontinuing AS & CP, and discontinuing CP only for colonization are associated with an increased MRSA positive culture rate (Model 1, Table 1). Addition of the year prior infection rate (Models 2–4) nullifies the association between AS & CP and MRSA positive culture rate. Results were similar when modeling positive sterile site cultures only (not shown) and using Negative Binomial regression (Table 2). Facility-level use of AS & CP is not associated with MRSA positive culture rate when using Poisson mixed-effects regression (Table 3), suggesting that accounting for facility-level clustering eliminates (or reduces) the apparent effect of AS/CP.

Conclusion

The impact of de-implementing AS & CP is complex and difficult to discern. The inference that de-implementation of AS & CP increased MRSA infection rates was not robust to relaxation of simplifying assumptions. These findings combined with the existence of unobservable data (e.g., use of gowns/gloves during the pandemic), imply substantial challenges surrounding statistical interpretation.

Disclosures

All Authors: No reported disclosures
P-334. Comparing Observed with Self-Reported Hand Hygiene Adherence Among Bedside Nurses at Two U.S. Hospitals
Authors: Kulkarni Prathit A , Greene M Todd , Saint Sanjay , Fowler Karen E , Jacob Serene , Dillon Laura , Espiritu Michelle , Houchens Nathan , Trautner Barbara
Published: January 2025

Background

Hand hygiene is recommended for all clinicians at entry to and exit from patients’ rooms. Adhering to such recommendations remains suboptimal possibly due, in part, to cognitive biases among clinicians who believe they are more compliant with hand hygiene than they actually are. We observed actual adherence to hand hygiene at room entry and exit among bedside nurses and compared these observations to self-reported perceptions of hand hygiene adherence.

Methods

Hand hygiene observations of bedside nurses (during day and night shifts) were made during their normal workflow in six inpatient general medicine wards at two Department of Veterans Affairs academic medical centers in 2022. The frequency of hand hygiene being performed—with either alcohol-based hand rub or soap and water—was noted at entry to and exit from patient rooms. Nurses were also surveyed regarding how often they perceive they typically perform hand hygiene.

Results

The participating units employed approximately 160 nurses. Hand hygiene was performed in 1,397 out of 3,690 (37.9%) room entry and in 2,159 out of 4,012 (53.8%) room exit opportunities, for a total of 3,556 out of 7,702 opportunities (46%). Hand hygiene was performed for a mean duration of 8.3 seconds at room exit. Among 92 survey respondents, approximately one-third had been a nurse for more than 20 years, 91% were female, 47% were Asian, and 8% were Hispanic. Survey respondents reported that they believe they perform hand hygiene in 95.1% of situations in which it is recommended.

Conclusion

Our study reveals a stark disconnect between actual and perceived adherence to hand hygiene recommendations among bedside nurses in general medicine wards at two geographically distinct academic medical centers. Additionally, the mean duration for which hand hygiene was performed was less than the recommended duration of 20 seconds. Possible explanations for these findings include: social desirability bias and overestimation bias when answering survey questions; the need for multiple trips into and out of patients’ rooms to access medications or supplies located outside the room; and time pressures. Future approaches to improving hand hygiene adherence should ideally address cognitive biases among clinicians.

Disclosures

Barbara Trautner, MD, PhD, Abbott Laboratories: Stocks/Bonds (Public Company)|AbbVie: Stocks/Bonds (Public Company)|Bristol Myers Squibb: Stocks/Bonds (Public Company)|Pfizer: Stocks/Bonds (Public Company)|Phiogen Pharma: Advisor/Consultant
P-335. Environmental Impact of Contact Precaution Use for Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococcus (VRE) in Los Angeles (LA) County: Results of a Countywide Survey
Authors: Lee Pam , OYong Kelsey , LeBrun Michelle , Rubin Zachary A , Miller Loren G
Published: January 2025

Background

United States hospitals produce over 5.9 million tons of waste yearly. Disposable personal protective equipment (PPE) causes up to 70% of hospital municipal plastic waste. Contact precautions, often requiring disposable gowns and gloves, are frequently used to prevent MRSA/VRE transmission. We determined the scope and environmental impact of contact precaution use for MRSA and VRE in LA County.

Methods

We observed patient care at LA acute care hospitals to quantify PPE used for patients in MRSA/VRE contact precautions, as well as for patients with methicillin-susceptible Staphylococcus aureus (MSSA) and vancomycin-susceptible Enterococcus (VSE). We matched observations by hospital type (community, academic safety-net) and care location (intensive care, telemetry, ward). We conducted 24 observations for each organism.

To determine the extent of PPE used for MRSA/VRE, the LA County Department of Public Health surveyed acute care hospitals for the average daily number of hospitalized patients in 2023 in MRSA/VRE contact precautions. We modeled the county-wide solid waste and carbon dioxide (CO2) emissions from MRSA/VRE contact precautions.

Results

Mean gown use was higher for MRSA vs. MSSA (2.33 vs. 0.17 gowns/hour, p< 0.01) and VRE vs. VSE (2.50 vs. 0.59 gowns/hour, p< 0.01). Glove use did not vary between MRSA vs. MSSA (5.08 vs. 4.33 gloves/hour, p = 0.45) or VRE vs. VSE (5.88 vs. 5.46 gloves/hour, p = 0.50).

In total, ∼3% of LA County hospitals’ licensed beds are occupied by patients in contact precautions for MRSA and VRE. In our model this level of occupancy equaled 7.3 million gowns per year for MRSA and VRE contact precautions, which generate 461,400 kilograms (kg) of plastic waste and 2.27 million kg of CO2 emissions annually.

Conclusion

We found that care for patients in MRSA/VRE contact precautions requires significantly more gown use than for patients with MSSA/VSE. Glove use did not differ between patients with antibiotic-resistant infections vs. their antibiotic-sensitive counterparts. LA County’s MRSA/VRE PPE causes abundant plastic waste and greenhouse gas emissions equal to 5.8 million miles driven in an average car. Routine MRSA/VRE contact precautions need to be reconsidered given the paucity of supporting evidence as well as their potential harm to the environment.

Disclosures

Loren G. Miller, MD MPH, Armata: Grant/Research Support|Contrafect: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Paratek: Grant/Research Support
P-336. Validation of a Badge-Based Automated Hand Hygiene Monitoring System
Authors: Patel Palak , Steele Molly , Incesti Jennifer , Chu Vera , Marrs R , Zuccaro Patricia D , Bartlett Allison H , Landon Emily
Published: January 2025

Background

Hand Hygiene (HH) is the cornerstone behavior in preventing healthcare-associated infections (HAIs) yet accurately monitoring HH remains a challenge. We present the validation process and results for a popular badge-based automated monitoring system in the setting of existing aggregate, automated HH monitoring.

Accuracy of Unique Actions of Biovigil Monitoring System by Unit

Accuracy of Biovigil monitoring system compared to observation by IPC Team in behavioral validation phase by unit

Methods

University of Chicago Medicine Hyde Park Campus (UCM) is an 800 bed academic medical center and Ingalls Memorial Hospital (IMH) is a 200 bed community hospital. The Biovigil HH monitoring system (Ann Arbor, MI) was trialed on 4 units: IMH 35 bed med/surg unit (MS1), IMH 8 bed cardiac care unit (CCU), UCM 36 bed med surg unit (MS2), and UCM 19 bed Pediatric intensive care unit (PICU). Validation utilized planned path and behavioral validation techniques previously reported by the authors (Landon ICHE 2016). Participation by employees was voluntary.

Accuracy of Unique Actions of Biovigil Monitoring System by Event

Accuracy of Biovigil monitoring system compared to observation by IPC Team in behavioral validation phase by event

Results

During the planned path, investigators performed 336 unique actions and observations to test functionality. This identified issues with installation of soap use detectors on one unit. Once these were adjusted, overall accuracy was 99.7% (MS1 100%, MS2 100%, CCU 100%, PICU 98.8%). During behavioral validation, investigators observed 259 unique behaviors and compared with system raw data found an overall accuracy of 91% (MS1 95%, MS2 97%, CCU 84%, PICU 87% with 95% CI) as shown in table 1. Accuracy for detecting entry or exit was 91% (95%CI 86-94%), sanitizer use 97% (95%CI 94-99%), and soap and water use 92% (95%CI 62-98%) as seen in table 2. Monthly HH rates measured by the existing monitoring system (only UCM) before and during the trial system validation are shown in table 3.

Monthly HH Rates

Monthly HH rates measured by the existing monitoring system (only UCM) before and during the trial system validation

Conclusion

The trial HH monitoring system was more accurate on floor units than intensive care units but performed similarly and adequately across two different types of hospitals. There is insufficient data to evaluate for accuracy in measuring soap and water compliance. While HH compliance as measured by the existing system increased initially after installation of the trial system, this was not sustained and may be related to attrition in badge wearing for the trial system.

Disclosures

Allison H. Bartlett, MD, MS, CVS/Caremark: Advisor/Consultant
P-340. Evaluating the Efficacy of Nasal Iodophor Antisepsis in Reducing Candida auris Nasal Carriage in Nursing Home Residents
Authors: Gussin Gabrielle , Singh Raveena D , Saavedra Raheeb , Nguyen Eric , Shimabukuro Julie A , Bittencourt Cassiana E , Huang Susan
Published: January 2025

Background

Candida auris is an emerging drug-resistant yeast that is spreading rapidly in U.S. healthcare facilities, particularly in nursing homes. Like MRSA, C. auris is commonly found in the nose, raising questions about whether nasal iodophor application can reduce carriage.

Methods

We evaluated the impact of iodophor on C. auris nasal carriage at two nursing homes. Nasal carriers were identified from point prevalence sampling of bilateral nares of residents for both C. auris and MRSA conducted at each nursing home.

Nasal iodophor was given to carriers according to a 5-day twice-daily decolonization protocol. Nasal swabs for C. auris and MRSA culture were collected on Day 1 (pre-iodophor), Day 5 (last day of iodophor administration), and Day 9 (4 days after iodophor cessation). Bioburden was assessed on an ordinal scale (none = 0, few =1, 1+ = 2, 2+ = 3, 3+ = 4, and 4+ = 5). Paired t-tests compared C. auris and MRSA bioburden between timepoints.

Results

Twenty-two residents with C. auris nares carriage completed the evaluation. Seven (32%) also harbored MRSA. Between Days 1 and 5, mean nares bioburden decreased from 3.6 to 2.8 for C. auris (P=0.03) and from 4.3 to 2.3 for MRSA (P=0.02) (Figure). Comparing Day 9 to Day 1, mean C. auris bioburden at Day 9 was 2.8 (P=0.01) and mean MRSA bioburden at Day 9 was 3.1 (P=0.14).

Conclusion

Five days of nasal iodophor antisepsis appeared to suppress both C. auris and MRSA carriage. Rebound growth four days after iodophor discontinuation was seen for MRSA but not C. auris, although numbers were small. Nasal iodophor may be an effective strategy for reducing nasal carriage in high-risk settings. The value of repeated antisepsis for sustained bioburden reduction was not evaluated in this study.

Disclosures

Raveena D. Singh, MA, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work Raheeb Saavedra, AS, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work Susan Huang, MD, MPH, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work
P-341. Multidrug-Resistant Organism Sharing Among Nursing Home Roommates
Authors: Gussin Gabrielle , Kleinman Ken , Singh Raveena D , Bui Justina , Gadia Gabriel , Tjoa Thomas T , Mitchell John , Saavedra Raheeb , Shimabukuro Julie A , Bittencourt Cassiana E , Huang Susan
Published: January 2025

Background

Nursing homes are high-risk settings for multidrug-resistant organism (MDRO) prevalence and spread. We investigated whether nursing home roommates were more likely to carry the same MDRO compared to non-roommates.

Methods

We conducted a secondary analysis of 44 nursing homes in two studies (Protect Trial-Miller NEJM 2023; SHIELD-Gussin JAMA 2024) involving universal chlorhexidine bathing and nasal iodophor. We used MDRO status from baseline (2016-17) and end-intervention (2018-19) visits where 50 residents were sampled at random at each nursing home. Sampling included bilateral nares swabs processed for methicillin-resistant Staphylococcus aureus (MRSA), and axilla/groin swabs processed for MRSA, vancomycin-resistant Enterococci (VRE), and extended-spectrum beta-lactamase (ESBL) producers.

We used generalized estimating equations with alternating logistic regressions to assess the odds ratio (OR) for each MDRO while clustering by nursing home. These ORs are the relative odds of one person being positive (outcome) given that the paired person is positive (exposure), divided by the odds of being positive if the paired person is negative. We estimated separate values when the two people are roommates and when they are non-roommates.

Models adjusted for age, gender, post-acute status, need for full care assistance, presence of an indwelling device, MDRO history, and baseline vs. decolonization period. Shared room assignments (cohorting) due to known history of the specific MDRO being modeled were excluded.

Results

The 44 nursing home sample included 4851 residents who were roomed in 180 single rooms, 1945 doubles, 874 triples, 93 quads, four 5-bed rooms, and six 6-bed rooms. The Table shows significantly higher ORs of concordant MDRO carriage among roommates than among non-roommates for each MDRO.

Conclusion

Roommates in nursing homes are significantly more likely to carry the same MDRO versus non-roommates, indicating potential transmission within shared rooms.

Disclosures

Ken Kleinman, ScD, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work Raveena D. Singh, MA, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work Raheeb Saavedra, AS, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work Susan Huang, MD, MPH, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work
P-374. Bacterial Outbreak Investigations Associated with Drug Diversion by U.S. Healthcare Personnel, 1990-2023
Authors: Pierce Rebecca , Vazquez Deida Axel A , Perz Joe , Perkins Kiran M
Published: January 2025

Background

Diversion of injectable medications by healthcare personnel (HCP) is widely recognized as a source of bloodborne pathogen transmission. Drug diversion can also cause bloodstream infections (BSIs) but may not be identified as a transmission source due to the myriad of potential etiologies of bacterial outbreaks in healthcare settings. Here, we describe characteristics of drug diversion-related bacterial outbreaks to inform identification and control.

Methods

We searched PubMed using the key terms “outbreak” or “cluster” and “diversion” to identify outbreaks reported from 1990-2023. Publication references were reviewed to identify additional reports. We excluded outbreaks outside the US and those caused by non-bacterial pathogens. We compiled patient- and outbreak-level data, including infection type, pathogen, length of stay, healthcare setting, diversion mechanism, and epidemiologic investigation strategies.

Results

We identified six drug diversion-related bacterial outbreaks published between 1991-2019, involving 80 patients. 93% (n=74) of patients presented with BSIs; 93% (n=74) were identified after surgery or procedure; 24% (n=18) of patients with a BSI had a polymicrobial infection. Median outbreak duration was 119 days (range: 38-288). All outbreaks involved water-associated bacteria (Table) and four outbreaks reported BSI onset within 48 hours of admission for at least one patient. Outbreaks necessitated multiple epidemiologic strategies, including routine approaches (e.g., case-control study [n=4]) and techniques specific to medication tampering (e.g., medication concentration testing [n=4]). At least three patients (range: 3-24) in each outbreak had related isolates by molecular typing or whole genome sequencing. Four outbreaks reported tampering with opioids administered by patient-controlled analgesia (PCA) pumps.

Conclusion

Certain features of healthcare BSI outbreaks, including involvement of water-associated bacteria, post-surgical populations, or rapid infection onset, should prompt consideration of drug diversion as a potential route of transmission. Multifaceted strategies, including evaluation for medication tampering, are needed to identify outbreaks from drug diversion.

Disclosures

All Authors: No reported disclosures
P-383. Do Intraoperative Bile Cultures in Pancreaticoduodenectomy Change Antibiotic Management? A Retrospective Observational Study
Authors: Ndungu Elizabeth , Kofahi Ahmad , Zraik Lara , Jackson Morgan , Beal Eliza , Monday Lea
Published: January 2025

Background

Biliary stenting increases post-operative surgical site infections (SSIs) following Whipple procedure due to bactibilia. Intraoperative bile culture (IOBC) is performed to guide empiric therapy for SSIs; however, its utility and impact on antibiotic utilization is poorly studied.

Methods

We performed a retrospective cohort study of adult patients undergoing pancreaticoduodenectomy over a 3 year period (2021-2023). Patients with and without IOBCs were compared for pre and post-operative characteristics and complications. Post-operative antibiotic utilization was also compared between cohorts (Fig1).

Results

36 patients underwent Whipple’s procedure during the study period; 26 (72%) had IOBC obtained, while 10 (28%) did not. Cohorts were similar in terms of comorbidities, neoplasm, and surgical characteristics (Table 1). All 17 Patients with prior biliary stenting had IOBC obtained, but IOBC were also obtained in 9 patients who had not previously been stented (Table1). Post-operative fever, leukocytosis, SSI, bacteremia, and deep abscess were similar between cohorts, however, more biliary leaks occurred in the group that did not have IOBC (P=0.010)(Table 2a). Compared to the group without cultures, the IOBC group had longer median antibiotic duration (11 versus 3 days, P=0.52), and fewer short course antibiotics under 14 days (65% vs 100%, P=0.197), however these were non-significant trends (Table 2b). Patients in the IOBC group also trended toward more antipseudomonal, carbapenem, and antifungal use (P=0.068 to P=0.285, Table 2b). 10 of 22 (45%) of patients with growth on their IOBC did not have antibiotics adjusted based on that result. Patients whose antibiotics were adjusted did not differ in their microbiology results from those whose cultures were ignored (Figure 2).

Conclusion

Almost 3 / 4 of patients undergoing Whipple’s procedure had IOBC obtained; some not previously been stented. 45% of patients with positive IOBCs did not have their antibiotics adjusted to target them. Patients who underwent IOBC trended toward longer antibiotic durations and use of broader agents despite having lower rates of post operative biliary leak. These results indicate physicians may feel compelled to treat these cultures without a clinical indication.

Disclosures

All Authors: No reported disclosures
P-388. A Cluster of Pseudomonas Infections After Vascular Surgery
Authors: Patel Palak , Chu Vera , Enriquez Aurea , Marrs R , Landon Emily , Zuccaro Patricia D
Published: January 2025

Background

Deep surgical site infection after vascular surgery is a dreaded complication. In October 2023 a vascular surgeon raised concerns about an increase in post-operative Pseudomonas infections with the infection prevention and control team at the University of Chicago Medicine.

Methods

University of Chicago Medicine is an 800 bed tertiary academic medical center with an active vascular surgery practice. Investigation of the suspected cluster was conducted by the Infection Prevention and Control (IPC) team and included molecular analysis of clinical isolates, environmental cultures of shared equipment and supplies, observation of operative practices, and observation on daily bedside rounds. Available Pseudomonas strains from patients included in the investigation were sent to Mayo labs (Rochester, Minnesota) for sequencing and relatedness analysis.

Results

Between 10/3/2023 and 11/3/2023, a total of 5 patients with Pseudomonas groin infection after vascular surgery were identified. 2 isolates were available for sequencing and were not related. Inspection of the vascular surgery workroom and supply room yielded shared equipment and supplies that were cultured by the IPC team. Pseudomonas was not recovered in these cultures but items from a surgical supply bag grew various gram positive organisms and a black mold that was not further identified. OR observation of operative practices revealed inadequate prep time of moist sites, lack of glove change before closing, and high traffic/occupancy during the case. Observation of daily rounds revealed multiple instances of failure to clean shared equipment (like portable ultrasound machines) between patients, lack of compliance with PPE for contact precautions, and inadequate hand hygiene practices.

Conclusion

Although these cases were not clonally related, the shared organism sparked high concern on the part of the surgeon which led to swift investigation and faster remediation than would have been possible with routine surgical site infection surveillance timelines. The investigation was able to identify multiple opportunities to improve routine infection prevention practices in the care of vascular surgery patients at this hospital.

Disclosures

All Authors: No reported disclosures
P-413. Epidemiology of Clostridioides difficile and Bloodstream Infection in Belgium: Insights from 2014-2022 Data
Authors: Shodu Nathalie , Callies Milena , Vaes Louise , Mertens Karl , Catry Boudewijn
Published: January 2025

Background

Healthcare-associated infections (HAI), like bloodstream infections (BSI) and Clostridioides difficile (CDI), strain Belgian hospitals. Since 2014, national surveillance requires data on hospital-associated (HABSI) and central line-associated bloodstream infections (CLABSI). Although CDI surveillance was obligatory until 2014, hospitals must join a surveillance program since 2015. This study delves into BSI and CDI trends in Belgium from 2014 to 2022.

Mean incidence of central line-associated bloodstream infections,hospital-wide ans in intensive care, Belgium 2013-2022, (CLABSI,central line-associated bloodstream infections; CRBSI, catheter related bloodstream infection=Confirmed CLABSI)

Methods

Data from national surveillance programs were analyzed using negative binomial longitudinal regression models. Incidence changes in CLABSI between pre-pandemic (2013-2019) and 2020-2022 were assessed, along with CDI incidence calculations. Statistical analyses utilized SAS Enterprise Guide 7.13 and STATA 16. Insights into incidence and causative agents for both BSI and CDI were analyzed.

Mean incidence of central line-associated bloodstream infections, hospital-wide,Belgium 2013-2022 ( CLABSI, central line-associated bloodstream infections; CRBSI, catheter related bloodstream infection=Confirmed CLABSI)

Results

Results show stable BSI incidence from 2014 to 2019. The 2020-2022 incidence calculation included 97, 99, and 95 participating hospitals, respectively. Hospital-wide CLABSI incidence increased from 2.0 to 2.6 per 10,000 patient-days in 2019 and then declined to 2.4 in 2022. ICU-only CLABSI incidence rose from 11.77 to 18.78 in 2020 and declined to 15.50 in 2022. The predominant microorganisms observed in total CLABSI since 2014 were S. epidermidis and E. faecium. In 2022 there was a statistically significant increase of HA-CDI incidence per 10,000 hospital-days compared to 2021, from 1.31 to 1.62. However, even though this increase was observed, most characteristics remain stable, such as percentage of recurrent episodes, age group of patients with infection. Since 2014, the most detected strain remained BR014.

Mean incidence of HA-CDI/10, 000 Hospitalisation-days in hospitals, per region. Belgium, 2010-2022.

Conclusion

The analysis of BSI and CDI epidemiology reveals significant trends crucial for healthcare management. The impact of the COVID-19 pandemic on CLABSI rates underscores the importance of targeted interventions, while ongoing challenges in HA-CDI incidence highlight the need for continued surveillance improvement. Future efforts should focus on effective prevention and control strategies to mitigate HAIs in Belgian healthcare facilities.

Disclosures

All Authors: No reported disclosures
P-438. T-cell Immune Exhaustion and the Atherogenic Index of Plasma in People Living with HIV on Antiretroviral Therapy
Authors: Francisco Christian , Padua Ana Joy
Published: January 2025

Background

The atherogenic index of plasma (AIP), an index that correlates with atherosclerosis, has been reported to be abnormal among people with human immunodeficiency virus (PWH). Few subclinical markers of atherosclerosis were linked to T-cell immune exhaustion. However, no study has explored the relationship of AIP to the different immune exhaustion markers. We compared the AIP and immunologic parameters of PWH on antiretroviral therapy (ART) to that of people without HIV (PWoH). Correlation of different clinical, laboratory and immunologic parameters with AIP in PWH were investigated.Table 1.Demographic and clinical characteristics of study participants (N=100)

Methods

This is a cross-sectional study conducted from March 2018 to February 2019 in a treatment hub in Manila, Philippines. We recruited 50 virally suppressed PWH on ART and 50 age- and sex- matched PWoH. Demographic and clinical data were recorded. Fasting blood samples were collected for complete blood count, blood glucose, and lipid profile. Peripheral blood monocytes were isolated and analyzed for immune exhaustion markers in T-cells and monocytes (LAG-3, PD-1, TIGIT+, TIM-3) via flow cytometry. AIP was computed as log (trigylyceride/high density lipoprotein-c). Abnormal AIP was defined as values in the medium (0.1-0.24) and high-risk ( >0.24) categories. Pearson correlation was performed to determine linear correlation between clinical, laboratory and immunologic factors and AIP.Table 2.Laboratory and immunologic parameters of study participants (N=100)

Results

Majority of the participants were male (96%) with mean age of 31. Among PWH, the mean recent CD4+ count is at 515 cells/mm3. Median ART exposure is 4 years. Majority were on efavirenz based ART (41, 82%). Few were on protease inhibitors (6, 12%). All PWH had abnormal AIP. There is no difference in AIP between PWH and PWoH (0.5; 0.3 vs 0.62; 0.3, p 0.5). Recent CD4+ (R 0.32, p 0.02), nadir Cd4+ (R 0.31, p 0.03) and zenith CD4+ (R 0.30, p 0.04) were positively correlated with AIP in PWH. Only dual expression of PD-1 TIGIT+ CD8+ T-cells showed positive correlation with AIP (R 0.20, p 0.04).Figure 1.Correlation of AIP levels with CD4+ count

Conclusion

AIP in PWH is comparable to that of PWoH. The correlation of AIP to PD-1 TIGIT+ CD8+ T-cells supports the role of T-cell immune exhaustion in the pathogenesis of dyslipidemia and atherosclerosis. Strategies to decrease immune exhaustion can possibly prevent or delay metabolic complications in PWH.

Correlation of AIP levels with frequency expression of PD-1 TIGIT+ on CD8+ T-cells

Disclosures

All Authors: No reported disclosures
P-439. Breast Cancer (BC) and Colorectal Cancer (CRC) Screenings among Persons with HIV (PWH): The Role of Individual and System-Level Factors on Screening Completion
Authors: Bredehoeft Cole T , Peng Jing , Lipps Ashley , Sobhanie Mohammad Mahdee , Malvestutto Carlos , Koletar Susan L , Patel Yesha
Published: January 2025

Background

Non-AIDS-defining cancers (NADCs) are a leading cause of morbidity and mortality among PWH. With healthcare digitization and evolving HIV care models, equitable access to preventative care is crucial. We investigated individual and system-level factors associated with completion of BC and CRC screenings.

Methods

This was a single-center, retrospective cohort study from 7/1/2022 to 7/1/2023. Established PWH (≥ 3 appointments between 7/1/2020-7/1/2023 with ≥ 1 within the study period) aged 40-75 were included. The primary outcome was ordering and completion of BC and CRC screenings. Demographics were summarized using frequency and percentage for groups with differing screening statuses. Chi-Square or Fisher’s exact test were used to evaluate associations between factors and outcomes. Descriptive statistics and p values were considered for evaluating associations between characteristics and screening status.

Results

178 PWH eligible for BC screening were included. 113 (63.5%) were of Black/African American race, 151 (84.8%) had a primary care physician (PCP), and 138 (77.5%) were enrolled in an electronic medical record application (MyChart®). 52.7% were up to date on BC screening. Demographics and BC screening statuses are listed in Table 1. We observed a statistically significant association between having a PCP (90.2% vs 75.8%; p=0.018) and ordering of BC screening. Moreover, patients who completed BC screening are less likely to have obesity (39.4% vs 56.0%; p=0.039) (Table 2).

739 PWH eligible for CRC screening were included. 591 (80%) were assigned male sex at birth, 634 (85.8%) had a PCP, and 601 (81.3%) were enrolled in MyChart®. 349 (47.2%) were up to date on CRC screening. Demographics and CRC screening statuses are listed in Table 3. Significant associations were noted between having a PCP (90.8% vs 81.3%; p < 0.001), higher median income (79.6% vs 69.9%; p=0.003), and MyChart® enrollment (88.0% vs 75.4%; p < 0.001) and CRC screening completion. Other notable variables are listed in Table 4.

Conclusion

BC and CRC screening is essential in reducing morbidity, mortality, and disparities of BC and CRC among PWH. Our findings provide insight on target populations for interventions and highlight opportunities to utilize digital technologies to improve cancer screening rates.

Disclosures

Carlos Malvestutto, MD MPH, Gilead Sciences: Advisor/Consultant|Viiv Healhcare: Advisor/Consultant
P-442. Quantification of TTV in Saliva and Plasma of People Living With HIV
Authors: Gore Edmund , Groenewegen Hester , Lambeck Annechien , Niesters Bert , Bierman Wouter , Van Leer Buter Coretta
Published: January 2025

Background

Torque tenovirus (TTV) viral load in blood is now accepted as a marker of immunocompetence in immunocompromised patients such as transplantation recipients and people living with HIV (PLWH). TTV has been shown to predominantly infect T cells, which are vital for the control of TTV. In PLWH the level of TTV has been shown to correlate with the CD4 count. Recently, TTV has also been detected in saliva of PLWH. However, at this time it is not known if salivary TTV can be used as a non-invasive alternative to blood TTV, or as an alternative to a CD4 count. In this study, we explore the relationship between TTV in blood and in saliva with T cell subsets, including CD4+ T cells, to determine the clinical potential for this novel marker in PLWH.

Methods

80 PLWH visiting the outpatient clinic of our center were recruited. Inclusion criteria were age ≥ 18 years, use of combination antiretroviral therapy for ≥ 6 months and < 40 copies/mL in the last two viral load measurements. The CE-marked TTV R-Gene® kit (bioMérieux, Lyon, France) was used to detect and quantify TTV in plasma and saliva. Results are expressed in log copies/ml, with a cut off of 2.4 log copies. Absolute numbers of CD4+ T cells were measured using the MultiTest TruCount method (Becton Dickinson). HIV viral load was performed on EDTA plasma samples using the Abbott Real-Time HIV-1 assay.

Plasma TTV correlates with salivary TTV, R2 0.89, p<0.01.

Results

Individuals were predominantly male (86%), had a mean age of 51. The mean CD4+ count was 670 (447-844) and 25% had a low detectable HIV load (Table 1). TTV was detectable in 24% of plasma and 20% of saliva samples with an average of 3.86 log copies/ml and 4.01 log copies/ml respectively. Plasma TTV and saliva TTV correlate well (R2 0.89, p< 0.01) (figure 1). There is no relationship between plasma TTV (R2 0.004, p = 0.58), (figure 2) or saliva TTV and the CD4+ count (R2 0.004, p = 0.58) (figure 3).

Plasma TTV does not correlate with CD4 count, R2 0.004, p = 0.58.

Conclusion

Whilst neither salivary nor plasma levels of TTV correlate with the CD4 count of HIV patients in our study, salivary TTV correlates with TTV detected in blood. With the increasing interest in TTV in transplantation as a marker for immunosuppression, the fact that measurements of TTV can be performed on the saliva, preventing or reducing the need to draw blood from patients deserves further exploration.

Salivary TTV does not correlate with CD4 count, R2 0.004, p = 0.58.

Disclosures

All Authors: No reported disclosures
P-456. Reduction in the incidence of chronic hepatitis C, liver cancer, and related healthcare burden following the introduction of interferon-free direct-acting antiviral therapy in Japan: a national claims database study
Authors: Kanda Naoki , Yamashita Sinnpei , Hashimoto Hideki , Yoshimoto Hiromasa , Goda Kazuo , Mitsutakke Naohiro , Hatakeyama Shuji
Published: January 2025

Background

The World Health Organization aims to eliminate hepatitis C virus (HCV) infections by 2030. Interferon-free direct-acting antiviral (DAA) therapy, available in Japan since 2014, has demonstrated high hepatitis C cure rates and reduced hepatitis C-related hepatocellular carcinoma (HCC). However, DAA therapeutic efficacy on a national scale remains underexplored. In this study, we investigated national trends in HCV prevalence and complications, including liver cancer, during the era of interferon-free DAAs, with particular focus on the impact of coexisting human immunodeficiency virus (HIV) infection.

Methods

We used the National Database of Health Insurance Claims, covering >98% of the population in Japan, to extract claims data on patients with chronic hepatitis C between 2013 and 2022. We identified patients with chronic hepatitis C annually based on the presence of corresponding diagnostic codes and relevant tests (abdominal ultrasound or HCC tumor markers) within each fiscal year. Next, we analyzed the trends in the prevalence of chronic hepatitis C (stratified by HIV status), DAA therapy, HCC incidence and treatment, and healthcare costs.

Results

Between 2014 and 2022, 333,020 patients underwent interferon-free DAA therapy in Japan. The number of patients with chronic hepatitis C decreased from 690,336 in 2013 to 414,708 in 2022, representing a 40% prevalence reduction (95% confidence interval: 40%–40%). However, among people living with HIV (PLWH), we observed a 16% decline (10%–20%). Newly diagnosed HCC incidence among patients with chronic hepatitis C declined by 69% (68%–70%) over the 10 years. HCC treatment numbers also declined, with 50%, 80%, and 82% reductions in hepatectomies, radiofrequency ablation, and transarterial chemoembolization therapy, respectively. The total annual healthcare cost of HCV-infected individuals peaked in 2015 (1.1 trillion yen), coinciding with the widespread use of DAAs, and decreased to 65% of the 2013 expenses by 2022.

Conclusion

The introduction of DAAs significantly reduced the HCV infection-related healthcare burden in Japan. Extensive screening and treatment, particularly in PLWH, are crucial for successful HCV eradication.

Disclosures

All Authors: No reported disclosures
P-459. Length Of Hospital Stay, In-patient Mortality And Factors Associated With Mortality Among HIV-Cryptococcal Meningitis Patients Receiving Liposomal Amphotericin B At Tertiary Hospitals in Uganda
Authors: Namuju Olivie Carolyne , Kwizera Richard , Tugume Lillian , Boulware David R , Meya David
Published: January 2025

Background

Cryptococcal meningitis (CM) remains the second lethal opportunistic infection among People Living with HIV (PLWHIV) in sub-Saharan Africa. Currently, the patients are managed on single high-dose liposomal amphotericin B and flucytosine. However, there is no sufficient data on whether the new treatment regimen has an effect on reducing inpatient mortality and length of hospital stay in the real-world setting.

We aimed to investigate the proportion of inpatient mortality, length of hospital stay (LOS), and factors associated with mortality among patients with HIV-associated CM receiving liposomal amphotericin B-flucytosine regimen.

Methods

This was a cross-sectional study conducted to review medical records of patients admitted between December 2022 and May 2023 at 11 tertiary hospitals in Uganda. Medical records of 173 HIV-CM patients were reviewed. Univariate descriptive statistics were used to summarize the background characteristics. Modified Poisson regression was used to ascertain factors associated with mortality at bivariable and multivariable levels. Associations were presented through adjusted prevalence ratios with their 95% confidence intervals. Data were analyzed using STATA v15.

Results

Of the 173 patients’ medical records reviewed, 58.4% were males with a median age of 38 years (IQR= 30, 48) and over 55.5% were married. Patients with altered mental status (GCS< 15) were 40%. Overall, inpatient mortality for liposomal amphotericin B was 35.8% and this varied by health facility. The median LOS was 7 days (IQR = 3, 12). Factors associated with mortality were convulsion [APR, 1.86, 95%CI (1.21-2.86), p-value=0.005)], altered mental status [APR; 1.66, 95%CI (1.07-2.57), p-value=0.023], and a comorbid condition [APR, 2.26 95%CI (1.44-3.53), p-value=0.006]. Therapeutic lumbar punctures were significantly associated with reduced mortality [APR; 0.47, 95%CI (0.29-0.73), p-value=0.001].

Conclusion

Liposomal amphotericin B regimen has lower mortality than deoxycholate in the real-world setting. Patients on average spend more than a week in hospital. Male sex, convulsion, altered mental status, and comorbid conditions were independently associated with mortality. Therapeutic LPs significantly reduced inpatient mortality.

Disclosures

All Authors: No reported disclosures