bluuebunny/crossref_metadata_2025 huggingface dataset:
P-298. Treatment of Carbapenem-Resistant Gram Negative Bacteremia based on Polymixin MIC
Authors: Menon Sruthi , Lavanya S , Anthur Nair Ajay , Babu Thomas , Murali A , Nair Krishna S
Published: January 2025

Background

Recent studies from India have noted increasing resistance against ceftazidime- avibactam in enterobacteriacea and non-fermenters and hence, polymixins are mainstay in the treatment of carbapenem-resistant gram negative (CRGN) infections. There is no susceptible breakpoint for polymixins in view of concerns with clinical outcome and therefore, guidelines recommend combination therapy. However, studies have failed to show the superiority of polymixin combination therapy over monotherapy. Invitro data shows ≥ 90% PK-PD target attainment for isolates with colistin MIC ≤ 0.5 mg/L, but lower success rates in isolates with higher MICs. Aim of the study is to evaluate if the choice of treatment of CRGN infections can be guided by polymixin MIC.

Methods

We retrospectively evaluated critically-ill patient with CRGN bacteremia with intermediate in vitro susceptibility to colistin (MIC ≤ 2 mg/L; as per CLSI) at a tertiary care hospital in India from January 2022- June 2023. Patients who received treatment for the CRGN bacteremia for <48 h were excluded. Based on polymixin MIC, patients were grouped into two study groups: those that received polymixin monotherapy and those that received polymixin in combination with another agent susceptible in vitro. Chi-square test was used for categorical data and student’s t-test for continuous data. Analysis was performed using SPSS v28 and statistical significance was defined as p < 0.05.

Results

Of the 114 patients with CRGN bacteremia, 64 (56%) had an MIC of ≤ 0.5 and 50 (44%) had MIC ≥ 1. There was no statistically significant difference in the ICU mortality between monotherapy and combination therapy arms (16% vs 15%; P = 0.9778) for polymixin MIC ≤ 0.5. However, when the MIC was ≥ 1, a higher mortality was observed in the polymixin monotherapy arm (82% vs 39%; P = 0.0029).

Conclusion

Isolates with MIC ≤ 0.5 can be treated with polymixin monotherapy alone while isolates with MIC ≥ 1 require a combination therapy of polymixin with another antibiotic suseptible invitro. However, this is a single centre retrospective study and further clinical trials are required to ascertain the feasibility of polymixin MIC guided treatment of CRGN infections.

Disclosures

All Authors: No reported disclosures
P-300. Antimicrobial Resistance Focus in French ICU: A national surveillance network analysis on Pseudomonas aeruginosa nosocomial infections
Authors: Bourge Xavier , Friggeri Arnaud , Lepape Alain , Prevot Claire , Machut Anais , Vacheron Charles-Hervé
Published: January 2025

Background

The aim of this study was to perform a comprehensive description on a cohort of Pseudomonas aeruginosa infected patients in ICU, comparing their characteristics between susceptible and resistant strains, to understand the impact of resistance on clinical decisions and to characterize patients at risk of MDR.

Site of infection of Pseudomonas aeruginosa

Methods

Adult patients hospitalized in France for at least 48 hours in ICU participating to REA-REZO surveillance between 2018 and 2021 were included in the data base used to create this cohort.

Resistance patterns of Pseudomonas aeruginosa

Results

4196 patients with nosocomial Pseudomonas aeruginosa infections were included in this cohort. Most infections were identified in patients with pneumonia, with a consistently high prevalence ranging from 71.5% to 74.5% depending on the year.

Among the Pseudomonas, 1734 (31.0%) were resistant to piperacillin/tazobactam, 1331 (23.8%) were resistant to ceftazidime, and 1191 (21.3%) were carbapenem resistant. A statistically significant difference (p< 0.001) in resistance patterns between the first and subsequent infections is seen, notably for resistance to carbapenems which rose markedly from initial to subsequent infections, from 16.3% to 27.8% (p< 0.001).

Regarding occurrence of resistant Pseudomonas strains, statistically significant differences in age distribution among the resistance groups are noted (p< 0.001), particularly evident in patients under 55, where 24.0% of those with dual resistance are under this age threshold, compared to 19.7% with no resistance. The SAPS II score was higher among resistant strains, as well as the duration in ICU stay, suggesting more challenging infections.

Description of the patient with Pseudomonas aeruginosa infections

Conclusion

These results reaffirm the critical challenge posed by resistant Pseudomonas in the ICU. It highlights the need for comprehensive antibiotic strategies that address the clinical, psychological, and economic dimensions of this issue.

Disclosures

Xavier Bourge, PharmD, MSD France: Employee Arnaud Friggeri, MD, MSD France: Advisor/Consultant Alain Lepape, MD, MSD France: Grant/Research Support Claire Prevot, n/a, MSD France: Employee Anais Machut, n/a, MSD France: Grant/Research Support Charles-Hervé Vacheron, MD, MSD France: Grant/Research Support
P-301. What Resistant Bacteria Are Lurking Outside Our Hospitals?
Authors: Yusuf Yasna , Awoyomi Olubosede , Wang Yongsheng , Bradbury Alison , Episcopia Briana , Abdallah Marie , Quale John
Published: January 2025

Background

Contamination of hospital environmental surfaces with resistant Enterobacterales and non-fermenting bacilli can facilitate nosocomial transmission. Little is known regarding the extent of contamination of environmental surfaces immediately outside the hospital setting.

Methods

Cultures of environmental surfaces surrounding hospitals in New York City were incubated at 37oC in MacConkey broth containing 4 mg/L ceftazidime and amphotericin B. Two sets of cultures were obtained: Group 1 cultures involved 42 high-touch surfaces within a two-block radius of each hospital that were cultured with rayon-tipped swabs. Group 2 cultures involved 5 surfaces of transportation centers near (n=8) and distant (n=8) from hospitals that were wiped with saline-saturated sterile gauze. Bacteria were identified using 16S ribosomal sequencing; β-lactamases were identified by PCR sequencing.

Results

In Group 1, the 336 swab cultures from surfaces around 8 hospitals yielded 66 cephalosporin-resistant bacteria, including 26 Brucella (Ochrobactrum) spp. and 12 Acinetobacter spp. One isolate of Brucella (Ochrobactrum) spp. was found to possess the carbapenemase OXA-24. Surfaces around 2 of the 8 hospitals accounted for 73% of the Brucella (Ochrobactrum) spp.

In Group 2, the 40 gauze cultures of transportation center surfaces near 8 hospitals yielded 38 bacteria. Of the 38 bacteria, 15 were Brucella (Ochrobactrum) spp. and 8 were Acinetobacter spp. In comparison, the 40 gauze cultures of 8 transportation center surfaces distant from hospitals yielded 33 isolates, including only 5 Brucella (Ochrobactrum) spp. (P=.03 compared to cultures near hospitals) and 6 Acinetobacter spp. No members of Enterobacterales were recovered in any of the Group 1 or Group 2 cultures.

Conclusion

Cephalosporin-resistant Enterobacterales were not recovered in any environmental cultures around hospitals. Both Brucella (Ochrobactrum) spp. and Acinetobacter spp. were frequently recovered; Brucella (Ochrobactrum) spp. appeared to be territorial and a reservoir for OXA-type carbapenemases.

Disclosures

All Authors: No reported disclosures
P-312. Elimination of barrier contact precautions for Vancomycin-Resistant Enterococcus (VRE)-colonized patients was not associated with the acquisition of VRE in a tertiary care center
Authors: Chanderraj Rishi , Kidder Ian , Dombecki Carey , Wasylyshyn Anastasia , Washer Laraine , Mills John , King Aaron , Woods Robert
Published: January 2025

Background

In April 2020, the University of Michigan discontinued barrier contact precautions for Vancomycin-Resistant Enterococcus (VRE) colonized patients while maintaining VRE surveillance. We conducted a retrospective cohort study to assess the impact of this policy change on the risk of VRE acquisition

Inclusion and Exclusion Criteria of the Cohort

Methods

We analyzed patients admitted between 1/2018 and 3/2021 who underwent weekly surveillance. The primary outcome was VRE-free survival; the main exposure was admission before or after the contact precaution policy. Demographics, Elixhauser comorbidity index, antibiotic and PPI exposure, and colonization pressure were incorporated as covariates in an extended Cox proportional hazard model of VRE-free survival. Time-varying covariates were accounted for and modeled using log-transformed time. Patients were censored at discharge or death.

VRE-free survival before and after change in contact precautions policy

Change in contact precaution policy was not associated with an increased hazard of VRE-acquisition in single variable analysis

Results

We identified 2,221 patients admitted before the policy change and 1,830 after, with 225 cases of VRE acquisition before and 196 cases after. No significant differences in age, demographics, antibiotic use, or PPI exposure were observed among VRE patients admitted before and after the policy change. However, VRE patients admitted before the policy change had more medical comorbidities (mean Elixhauser: 23.64 before, 20.77 after; p=0.008) and lower exposure to colonization pressure (mean VRE patient days: 13.4 before, 29.9 after; p=0.019).

In a multivariable extended Cox proportional hazard model, admission before or after the change in contact precaution policy showed no significant association with VRE-free survival (HR 0.81-1.1), or infection with VRE (HR 1.01, 95% CI 0.92-1.21). The most significant risk factors for VRE acquisition were vancomycin treatment (HR 1.60, 95% CI 1.25-2.03, p< 0.001) and PPI treatment (HR 1.43, 95% CI 1.15-1.77, p=0.001).

Multivariable cox-regression model of risk factors for VRE acquisition

There was no association between the change in contact precautions policy and risk of VRE acquisition

Conclusion

The policy change to eliminate isolation and barrier precaution requirements for VRE patients was associated with no detectible increase in the hazard of VRE acquisition. The most significant risk factors for VRE acquisition were vancomycin and PPI treatment. Our results suggest that appropriate use of PPI and antimicrobial stewardship may have a greater impact on preventing the spread and acquisition of VRE than barrier precautions.

Disclosures

Laraine Washer, MD, Ferring Pharmaceuticals: Advisor/Consultant
P-320. National Estimates of Rates and Resistance Trends of Enterococci Cases in the United States, 2012-2022
Authors: Maillis Alex , McCarthy Natalie , Lutgring Joseph D , Reddy Sujan , Wolford Hannah , Baggs James
Published: January 2025

Background

Enterococci are common causes of both community-onset (CO) and hospital-onset (HO) infections; vancomycin-resistant enterococci (VRE) are a serious threat. We sought to describe national estimates of Enterococcus faecalis and E. faecium rates and the proportion of cases that were vancomycin-resistant from 2012-2022

Methods

We identified a cohort of patients from the PINC AI and BD Research Insights databases with a clinical culture yielding an E. faecalis or E. faecium isolate with accompanying antimicrobial susceptibility testing (AST). Cultures obtained from rectal, perirectal or nasal swabs were excluded. E. faecalis or faecium isolates resistant to vancomycin were considered VRE. Isolates from patients with no culture yielding the same species and vancomycin AST phenotype in the previous 14 days were counted as an incident case. CO cultures were obtained ≤ day 3 of hospitalization; HO cultures were obtained ≥ day 4. We used a raking-procedure to determine weights for extrapolating the number of discharges included in our sample to match the national distribution of discharges, stratified by bed size, U.S. census division, urban/rural designation, and teaching status, for U.S. hospitals included in the American Hospital Association survey. Weighted rates were calculated over time as cases per 10,000 hospitalizations. The proportion of VRE (%R) was calculated as the rate of VRE cases divided by the rate of all cases of that species with an AST result.

Results

There were 810 unique acute care hospitals from 2012-2022. Weighted estimates resulted in 124,570 E. faecalis and 516,724 E. faecium incident cases nationally. Rates of CO and HO E. faecalis and E. faecium declined from 2012-2018 and increased from 2018-2021 (Figures 1-4). E. faecalis %R for vancomycin remained stable over the study period (CO: 4-5%, HO: 4-6%), while E. faecium %R declined over the study period from 67% to 57% among CO cases, and from 78% to 70% among HO cases.

Conclusion

Enterococci and VRE rates have increased recently while the proportion of resistant isolates has been stable for E. faecalis and falling for E. faecium. This suggests rate increases may be due to factors affecting all enterococci (e.g., host susceptibility or pathogen factors) rather than VRE specific factors (e.g., vancomycin exposure).

Disclosures

All Authors: No reported disclosures
P-323. Evaluation of WHO Five Moments Compliance Among Nursing, Paramedical Staff, and Emergency Medicine Technicians in a Tertiary Care Hospital in India: Expected vs. Actual
Authors: Sunny Alvin , Kochuparambil Jose J
Published: January 2025

Background

In tertiary care hospitals of a resource limited country like India, understanding hand hygiene (HH) compliance among nursing, paramedical staff, and emergency medical technicians according to the WHO Five Moments (5M) protocol is critical for improving infection control practices and patient outcomes.

Methods

Utilizing a pre-designed structured hand hygiene audit tool, this study conducted over 300 hours of direct HH observations between 2022 and 2022 at a tertiary care hospital in India. A total of 150 nursing staff, 60 paramedics, and 20 emergency medical technicians were included in the study cohort. Compliance with WHO 5M guidelines, including hand washing (50 seconds) and alcohol rub (25 seconds), was meticulously observed and recorded. Following the initial observation period, a targeted training program on the WHO Five Moments protocol was implemented for all healthcare professionals.

Results

A notable discrepancy between expected and actual compliance with HH protocols was evident among the observed healthcare professionals. Compliance varied across the groups: Among the 150 nursing staff, compliance rates were 55%; among the 60 paramedics, compliance rates were 40%; and among the 20 emergency medical technicians, compliance rates were 35%. Despite the established duration for HH procedures, all groups demonstrated suboptimal adherence to HH guidelines. Adherence to expected compliance increased the overall time per patient encounter by 5.5-11 minutes, highlighting the need for improved HH practices. Subsequent observations conducted six months after the training revealed a significant improvement in HH compliance rates across all groups: nursing staff demonstrated an increase to 81.3% paramedics to 68.3%, EMTs to 58.5%.

Conclusion

The study emphasizes the urgent need to address the gap between expected and actual HH compliance among healthcare professionals in Indian tertiary care hospitals. Enhanced educational interventions and reinforcement of HH practices are imperative to minimize the risk of healthcare-associated infections and improve patient safety outcomes.

Disclosures

All Authors: No reported disclosures
P-346. Candida auris: Colonization, Risk Factors and Antifungal Susceptibility at a Tertiary Healthcare Setting
Authors: Jonnalagadda Kirtana , Goel Ayush , Ajayababu Anuj , Xess Immaculata , Singh Gagandeep , Soneja Manish , Biswas Ashutosh
Published: January 2025

Background

Candida auris, a multidrug-resistant nosocomial pathogen, has emerged globally as a major threat to healthcare settings, and several hospital outbreaks continue to be reported. We attempted to study the risk factors associated with C. auris colonization and its antifungal susceptibility at a tertiary healthcare center.

1.Distribution of Candida auris isolates

Methods

A prospective observational study was conducted over 18 months. Patients were screened for Candida auris colonization by axillary, groin swabs, and urine cultures within 48 hours of admission. Patients with extended hospital stays, exhibiting clinical isolates positive for C. auris, were also included. Baseline characteristics and risk factors were assessed. In patients with positive C. auris isolates, samples from inanimate surfaces, hands of healthcare workers and patient care attendants were also screened for C. auris colonization. Antifungal susceptibility testing was done for all isolates.

Results

Ninety-nine patients (59% males) were included with a mean age of 43.1±18.06 years. There were 34 Candida auris isolates from 20 patients. Sixteen patients (80%) were colonized, and four (20%) had candidemia. Median duration of urinary catheterization (9 vs 3 days [p=0.01]) and prior antifungal exposure(p=0.04) were significant risk factors for C.auris colonization. Seventy-eight samples from bed rails, monitors, healthcare workers, and patient-care attendants showed no growth of C.auris. Antifungal susceptibility testing showed 87.5% and 37.5% of isolates were resistant to Fluconazole and Amphotericin B respectively, while all isolates were susceptible to Micafungin and Caspofungin.

Conclusion

Prior outbreaks of Candida auris at our medical ICU prompted the need for early identification, effective contact precautions, and decolonization to prevent fatal invasive infections. Patients with long-term urinary catheters in situ, prior exposure to antifungals, and prolonged hospital stay were found to be at risk for C.auris colonization, warranting further studies to implement routine screening in these high-risk groups.

Disclosures

All Authors: No reported disclosures
P-350. Epidemiology of Candida auris isolated from blood cultures at a tertiary care facility in metro Detroit
Authors: Scipione Marco R , Zhao Jing , Jabbo Lavina , Salimnia Hossein , Chopra Teena
Published: January 2025

Background

Candida auris is a serious global health threat and the number of cases has increased recently. C. auris is often resistant to commonly used antifungals, making it difficult to treat. The objective of this study is to describe the epidemiology of C. auris isolated from blood cultures at a tertiary care facility in metro Detroit.

Methods

All C. auris isolates from blood cultures at the Detroit Medical Center from 8/1/2019 to 4/25/2024 were reviewed. Patient characteristics as well as microbiological characteristics were evaluated. There are no established susceptibility breakpoints for C. auris but the CDC has published tentative MIC breakpoints (mcg/mL) based on closely related Candida species and expert opinion.

Results

Thirty-eight patients had a positive blood culture with C. auris. The median age was 66 years (IQR 60-72). Length of stay was 37 days (IQR 22-62) and length of stay prior to positive blood culture was 25 days (IQR 11-43). Twenty-one (55%) patients had a C. auris isolation flag in the electronic medical record (EMR) prior to the positive blood culture. Only 31 patients had susceptibility testing done. All 31 isolates that were tested were resistant to fluconazole (MIC ≥ 32 mcg/mL) and all were susceptible to micafungin (MIC ≤ 2 mcg/mL). Thirty of 31 (97%) isolates were also susceptible to amphotericin B (MIC ≤ 1 mcg/mL). The antifungals with no published breakpoints had the following median MICs: voriconazole 2 mcg/mL (IQR 1-4); itraconazole 1 mcg/mL (IQR 1-1); isavuconazole 2 mcg/mL (IQR 1-2); posaconazole 0.25 mcg/mL (IQR 0.25-0.5); caspofungin 0.25 mcg/mL (IQR 0.15-0.5); anidulafungin 1 mcg/mL (0.5-1). The distribution of MICs for each agents are shown in figure 2 and figure 3.

Conclusion

Data are lacking to determine the most appropriate therapy for C. auris but based on local epidemiology, the use of an echinocandin as a first-line option for C. auris infections is appropriate.

Disclosures

All Authors: No reported disclosures
P-354. Clinical Utility of Tuberculosis Screening Tests After Tuberculosis Exposure at an Infusion Clinic
Authors: Li Aldon , Belleau Tawny , Faiad Graciela
Published: January 2025

Background

Tuberculin skin testing (PPD) and interferon gamma release assays (IGRA) facilitate screening of patients exposed to active tuberculosis (TB), but the clinical utility of TB screening tests in determining management of exposed high-risk patients is not well described. Because the sensitivity of TB screening tests is dependent on patient’s immunocompetency, further studies looking at the correlation between exposure, testing, and risk of progression to active TB in immunocompromised patients are needed. This study aims to describe TB testing and TB transmission among a large cohort of immunocompromised patients after a known TB exposure event.

Methods

Retrospective case series of patients who were exposed to TB as defined by CDC Guidelines, identified through contact tracing reports during exposure period April-July 2019. Local infection control protocol was to assess exposed patients with an IGRA initially, then place a PPD if IGRA was inconclusive.

Results

During the exposure period, an employee with direct patient care duties at an oncology infusion clinic developed active TB, exposing 443 patients. Of the 443 exposed patients, 57 either passed away prior to testing or declined testing. Of the 386 patients who underwent screening tests, 351 (91%), 23 (6%), and 12 (3%) were IGRA negative, positive, and indeterminate, respectively. Of the 12 IGRA indeterminate patients, 8 (67%) had a negative PPD, 2 (16%) refused PPD testing and a repeat IGRA turned negative, and 2 (16%) passed away without further testing. Of the 23 IGRA positive patients, latent TB infection (LTBI) treatment was given in 16 (70%) patients with 7 patients either declining therapy or passed away. None of the 443 patients developed active TB after a 5 year follow up.

Conclusion

The results of this study found no TB transmission occurred during a high-risk exposure event involving immunocompromised patients when protocol driven testing, treatment, and follow-up was completed. Although CDC publications report low sensitivities of IGRAs in immunocompromised patients, given the large number of exposed patients, serum testing was a practical choice for initial exposure testing and this study showed successful interventions when paired IGRA-PPD testing was used to risk stratify high-risk patients for LTBI therapy.

Disclosures

All Authors: No reported disclosures
P-362. Outbreak of neonatal sepsis in a maternity hospital in Kyrgyzstan, 2022-2023
Authors: Baibolotova Perizat , Nabirova Dilyara , Bekturova Lilya , Otorbaeva Dinara , kyzy Nasyat Kemelbek , Alymkulova Venera , Horth Roberta
Published: January 2025

Background

Sepsis is a leading cause of neonatal mortality and morbidity worldwide, notably in Kyrgyzstan. In January 2023, six neonatal sepsis deaths were reported within two weeks at a 157-bed maternity hospital, which usually has < 2 cases/month. We investigated to identify sources of infection and risk factors.Table 1.Factors associated with neonatal sepsis in a maternity hospital in Kyrgyzstan, 2022-2023*AOR- adjusted odds ration; ** CI- confidence interval; ***1. Healthy population (Reference group): Apgar scores at 1 and 5 min above 7; Unhealthy population: Apgar scores at 1 min below 7 and at 5 min below 7; Improved population: least one below 7

Methods

A concurrent case-control study included infants (< 28 days old) born at the hospital in January 2022-February 2023 and diagnosed with sepsis. Controls met same criteria and were born +/- 1 day from cases without sepsis. In February 2023, we collected rectal, nasopharyngeal, and high-touch environmental areas swabs in a single-day cross-sectional sample of hospitalized case-patients and mothers for culturing and MALDI-TOF. We used logistic regression to identify factors associated with sepsis.Figure 1.Two clusters of Acinetobacter baumannii detected among newborns with neonatal sepsis in a maternity hospital in Kyrgyzstan, 2022-2023

Results

The study comprised 129 cases and 509 controls. More cases than controls weighed < 2500g at birth (52% vs 5%, p< 0.01), had anhydrous interval of ≥12 hours (43% vs 29%, p< 0.01), had Apgar scores of < 7 at 1 minute (83% vs 20%, p< 0.01), were more likely to receive both ventilation and an invasive device (98% vs 1%, p< 0.01) and to be admitted to the intensive-care unit (ICU) (82% vs 17%, p< 0.01) (Table 1). Sepsis was associated with birth weight of ≤2500g vs greater (adjusted odds ratio: 5.6; 95% confidence interval: [2.1-15.1]), infant blood transfusion vs no (9.9 [3.8-26.0]), use of ventilation and invasive device vs no (144 [28.8-729.7]), Apgar scores at 1 and 5 minutes < 7 vs greater (2.8 [1.0-7.8], urinary tract disease in mother vs not (3.5 [1.1-10.6]), and anhydrous interval ≥12 hours vs less (2.6 [1.2-5.5]). Acinetobacter baumannii resistant to cephalosporins, aminoglycosides, and fluoroquinolones was detected in 8/8 pharyngeal swabs from case-patients in two ICU rooms, forming two distinct clusters (Figure 1). Acinetobacter baumannii was not detected in environmental sampling, but the hospital had conducted deep cleaning shortly before the environmental team arrived.

Conclusion

Resistant Acinetobacter baumanni likely contributed to the outbreak. The hospital conducted environmental cleaning, replaced non-disposable instruments (cannulas, masks, tubes) and updated infection control practices. Neonatal sepsis cases dropped sharply to < 2/month by May 2023.

Disclosures

All Authors: No reported disclosures
P-366. Investigation of a Bacteremia Outbreak in Dialysis Patients Linked to Closed System Needleless Valve Connectors
Authors: De Souza Bruna , Oliveira Laryssa Aryadne , De Jesus Cinthia Carolini , Pereira Hoberdan , Couto Bráulio R G M
Published: January 2025

Background

Closed system needleless connectors are commonly used in central venous access for long-term intravenous treatments like chemotherapy or dialysis. This paper details an investigation into a sudden rise in bacteremia among dialysis patients.Figure 1Monthly Rate of Central Line-Associated Bacteremia (#Bacteremia per 1,000 Central Line-Days), February 2023 to March 2024.

Monthly Rate of Central Line-Associated Bacteremia (#Bacteremia per 1,000 Central Line-Days), February 2023 to March 2024.

Methods

Continuous surveillance of hospital-acquired infections (HAIs) in dialysis patients, as prescribed by Brazil's ANVISA. Monthly data analysis revealed an increase in the rate of central line-associated bacteremia in February 2024, which worsened in March (Fig. 1). To define the outbreak, we compared the incidence of bacteremia from the previous period (Feb/2023 to Jan/2024) to the current period (Feb-March/2024). Investigation of the outbreak commenced in February itself.Figure 2Comparative Analysis of Bacteremia Incidence: Previous Period (February 2023 to January 2024) vs. Current Period (February to March 2024).

Results

The outbreak was clearly defined, with the risk of bacteremia significantly doubling from February to March 2024 (Fig. 2), primarily caused by Staphylococcus species. After interviewing dialysis service professionals about changes in practices, we discovered that a new brand of closed-system valve connectors, purchased from China, began to be used on January 30, 2024. Tests and field evaluations revealed an accumulation of blood in the catheter hub, which could indeed have compromised the integrity of the accesses and facilitated bacterial growth (Fig. 3). The Infection Control and Hospital Epidemiology team suggested discontinuing the use of the device to assess whether there would be a decrease in the number of bacteremia cases. However, due to the high number of devices in stock, it continued to be used throughout the month of March, resulting in a further increase in infection cases. Due to the impact caused by the increase in bacteremia cases, the team decided to suspend the use of all valved devices after the first weeks of April. Consequently, after April 10th, the device was definitively discontinued in the department. The discontinuation of the device resulted in a decrease in the number of infections in April. By April 25th, the total number of bacteremia was 8 cases, of which 6 were reported between April 1st and 10th.Figure 3Tests and Field Evaluations Demonstrated Blood Accumulation in the Catheter Hub Using the New Brand of Closed-System Valved Connectors.

Conclusion

It was possible to link the use of the Chinese-made closed-system valved connector to an increase in the number of bacteremia cases, and its discontinuation resulted in a significant reduction in HAIs.

Disclosures

All Authors: No reported disclosures
P-372. Candida auris Outbreak in a Cardiothoracic Transplant Intensive Care Unit: Implications for Infection Prevention
Authors: Rathod Shardul N , Barajas Grace , Mitchell Brooks I , Malczynski Michael , Moore William Justin , Weslander Erin , Bertram Christie M , Sutton Sarah , Stosor Valentina , Qi Chao , Zembower Teresa , Bolon Maureen K
Published: January 2025

Background

Candida auris is a yeast that causes invasive infections such as bloodstream infections (BSIs); mortality rates for C. auris BSIs may be as high as 80%. Rates have been climbing in the U.S. Exposure to skilled nursing facilities (SNFs), long-term acute care hospitals (LTACHs), or inpatient rehabilitation facilities (IRFs) represents a known risk factor for C. auris. Our institution experienced a C. auris outbreak from September 2023 - January 2024.

Figure 1: C. auris Outbreak Epidemic Curve

Methods

C. auris cases in the outbreak were identified from clinical specimens and admission and weekly surveillance via polymerase chain reaction (PCR). Clinical characteristics were determined through chart review. A multidisciplinary team implemented infection prevention (IP) interventions to curb nosocomial spread.

Infection Prevention Interventions

Results

There were 20 cases of C. auris identified in our CTICU between July 2023 and January 2024 (Figure 1). Whole-genome sequencing and phylogenetic analysis based on pairwise single nucleotide polymorphism (WG-SNP) distance revealed two outbreak clusters.

Of the 20 patients, 13 (65%) were solid organ transplant/acute mechanical circulatory support patients and three (15%) had prior SNF, LTACH, or IRF exposure. Four (20%) patients had C. auris BSIs and seven (35%) patients died, including all patients with BSIs. The mean duration of antibiotic use in the four patients was 67 days.

IP interventions addressed potential vehicles of transmission including healthcare personnel hands, shared patient equipment, and the environment (Table 1).

Conclusion

Only 15% of patients had prior SNF/LTACH/IRF exposure; many were admitted from home and/or outside hospitals with risk factors including recent surgery and antimicrobial use. This suggests the epidemiology of C. auris may be changing, and it may be prudent to consider routine admission and weekly surveillance on inpatient units deemed high risk for C. auris. Effective IP interventions included interventional hand hygiene auditing, increased accountability and oversight for shared patient equipment, limiting the number of rounding providers in rooms, and auditing environmental cleaning. Sustaining these efforts is crucial to keep pace with an evolving C. auris landscape.

Disclosures

All Authors: No reported disclosures
P-380. Risk Factors and Clinical Outcomes of Breast Surgery Related Surgical Site Infections in Southeast Michigan
Authors: Malik Ambreen , Brar Simran , Shallal Anita , Suleyman Geehan
Published: January 2025

Background

Surgical site infections (SSI) after breast surgery are important healthcare-associated infections (HAI) that may delay initiation of chemotherapy for underlying malignancy, in addition to accruing substantial healthcare costs. The reported incidence of breast surgery-related SSI (BSSI) ranges from 0.8%-26% depending on underlying comorbidities. We aimed to describe risk factors and clinical outcomes associated with BSSIs in southeast Michigan.Table 1.Characteristics of patients with breast surgical site infections

Methods

Retrospective cross-sectional study of adult patients with BSSI at a six-hospital healthcare system. Patients who met the definition of BSSI (per National Healthcare Safety Network) from 2021 to 2023 were included. Charts were reviewed for demographics, comorbidities, risk factors, microbiological data, and clinical outcomes.Table 2:Microbiological data of breast surgical site infections

Results

A total of 146 patients were identified, of which 78 patients (53%) had clinical infection [Table 1]. Most of the patients were female (95%) and white (62%). Common comorbidities included obesity (36%), active breast cancer (55%), and diabetes mellitus (18%). Prior breast surgery (10%), chemotherapy within last 6 months (12%), and prior chest radiotherapy (9%) were less common. Mastectomy was the most common surgery (51%), often with lymph node dissection (46%), and many had artificial material placed (implant; 32% and tissue expanders; 18%). Only 88% of patients received peri-operative antibiotics, of which 72% received cefazolin. The most common microbes isolated were Staphylococcus aureus (24%), coagulase-negative Staphylococcus spp (23%), Streptococcus spp (19%) and Pseudomonas spp (19%). Most patients required repeat surgical intervention (81%), with hospitalization (59%) and removal of implants (45%). No patients died at 30 and 90 days after initial surgery.

Conclusion

In this large study, BSSI was often associated with artificial material implantation, and Staphylococcus aureus was a common pathogen. Most patients required repeat surgical intervention and removal of implants. Significant opportunities were observed with surgical infection prophylaxis.

Disclosures

All Authors: No reported disclosures
P-381. Enhancing Economic Outcomes by Strategic Investment in Orthopedic Surgical Infection Control
Authors: Bandeira Raquel , Bahia Filho José Américo , Luz Neto Vespasiano C , Messias Glauco , Mota Gabrielle R , Gontijo Thiago C , Colen Gabriel , Morganti Ana Carolina , Paula Ladeira Ana , Couto Bráulio R G M , Miranda Lívia , Messias Isabela , Messias Beatriz
Published: January 2025

Background

This study aims to assess the financial impact of investments in combating hospital-acquired infections, particularly surgical site infections (SSIs) in orthopedic procedures.Figure 1The infection prevention programs to prevent Surgical Site Infections (SSIs)

Methods

A retrospective cohort study from January 2019 to September 2023 included patients undergoing knee arthroplasty (KA), hip arthroplasty (HA), and open fracture reduction (OFR), defining SSI according to CDC criteria. Costs per SSI patient were retrieved from literature sources: $13,539.50 for hospital costs (LUNA et al., 2022) and $7,523.77 for direct treatment costs, adjusted for inflation (STARLING et al., 2022).Figure 2.Chart of Year-to-Year Surgical Site Infection Rates, Stratified by Type of Orthopedic Surgery

Chart of Year-to-Year Surgical Site Infection Rates, Stratified by Type of Orthopedic Surgery

Results

During the baseline period, January 2019 to to December 2022, 4,258 patients underwent orthopedic surgeries: HA (11%), KA (9%), OFR (80%). Of these, 2,439 were female (57%), 1,819 male (43%), mean and median age 51 years, standard deviation 21 years. 68 patients died in-hospital (1.6%), 239 diagnosed with SSI (5.6%). Postoperative infection increased mortality risk over twofold: without infection (1.5% mortality risk), with infection (3.8% mortality risk), relative risk 2.5, p-value=0.014. SSI was associated with prolonged hospitalization; average length of stay doubled with infection (18.2 days) compared to without (9 days), p-value: 0.001. Comparing infection risks from 2019-2022 (5.6%) to 2023 (1.4%) post-investment in infection control demonstrated a risk reduction. Relative risk (0.25) p-value < 0.001.Table 1.Annual Comparative Analysis of Surgical Site Infection Rates by Orthopedic Surgery Type

Conclusion

SSIs in orthopedic surgeries pose dual risks, increasing readmissions and impairing hospital performance. Investing in SSI reduction enhances patient care, safety, and yields significant financial returns. This study underscores the ROI of infection prevention, especially targeting orthopedic surgical infections. Preventing SSIs can yield monthly savings of $25,781.49 to $46,393.48Table 2.Reduction in Costs, Hospital Stay Duration, and Prevented Deaths Associated with Surgical Site Infections after Orthopedic Surgeries

Disclosures

All Authors: No reported disclosures
P-384. Cutting Through the Data: A Comparative Analysis of Surgical Site Infection Surveillance in Peripheral Vascular Bypass Surgery
Authors: Kim Young , Smith Becky A , Wood Brittain A , Padgette Polly W , Anderson Deverick J , Seidelman Jessica
Published: January 2025

Background

Different societies and organizations use different surgical site infection (SSI) definitions for surveillance. With multiple definitions in use, validation of surveillance findings becomes paramount, particularly for maintaining surgeon buy-in during data review and developing countermeasures. The goal of our study was to assess concordance between SSI diagnoses following peripheral vascular bypass (PVBY) surgery derived from review by a vascular surgeon (vascular) and those identified through SSI surveillance performed by the infection prevention (IP) team.

Methods

The IP team performs SSI surveillance using EPIC “Bugs” tool to identify potential SSIs from NHSN selected CPT codes. EPIC then identifies cultures within the infection window period and IP reviews the case to ensure it meets SSI criteria. Conversely, the vascular surgeon reviewed every PVBY CPT coded surgery to determine if an SSI occurred. The vascular review used the Southampton Scoring System. Both surveillance systems queried PVBY surgeries from 1/1/2018 to 12/31/2022 and used a 90-day surveillance period.

Results

Among the CPT codes used for surveillances, 569 PVBY surgeries and 133 SSIs (23.4%) were identified. Both surveillance systems picked up 484 cases (85.1%), IP noted 51 (9.0%) additional cases, and vascular found the remaining 34 (6.0%) cases. (Figure 1) Among the SSIs, both datasets detected 32 SSIs (24.1%), IP recognized 12 more SSIs (9.0%) and the vascular review designated the remaining 89 (66.9%) SSIs. (Figure 2) Of the 89 SSIs picked up by the vascular review, 5 SSI surgeries were not in the IP denominator. The other 84 SSIs were included in the IP denominator, but those were not denoted as SSIs. Among the 84, the majority (64, 76%) were Southampton scores of 2 or 3. (Figure 3) Of those 84, 51 (60.7%) did not have a culture taken.

Conclusion

The vascular SSI review identified 89 additional PVBY SSIs compared to the IP surveillance over the 5-year period. NHSN has limitations in PVBY SSI surveillance, particularly for superficial incisional SSIs. Although IP is not resourced to perform surveillance on every surgery, IP working with surgical teams to understand differences in surveillance can facilitate alignment needed to develop successful SSI prevention initiatives.

Disclosures

Becky A. Smith, MD, UpToDate: royalties Jessica Seidelman, MD, MPH, 3M: Expert Testimony
P-392. Use of Oral Tobramycin to Prevent Surgical Site Infections in the Setting of an Oral Neomycin Shortage for Patients Undergoing Colorectal Procedures: A Retrospective Chart Review
Authors: Radziszewski Skyler , Altar Melanie , Ondrush Nicole M , Patel Gopi , Adams-Sommer Victoria , Sadler Eleanor D , Santeusanio Andrew , Walits Emily , Lerner Polina
Published: January 2025

Background

Oral neomycin tablets have been the standard of care for gut decontamination to prevent surgical site infections (SSIs) in patients undergoing colorectal procedures. In August 2022, a shortage of oral neomycin tablets prompted the need for an alternative agent. Based on previously published data, intravenous tobramycin solution administered orally was selected at our institution. The objective was to compare rates of SSIs between oral neomycin and oral tobramycin in patients undergoing colorectal procedures.

Methods

A single-center, retrospective cohort study was conducted in adult patients at The Mount Sinai Hospital who received preoperative oral antibiotics for gut decontamination prior to colorectal procedures. Patients who received oral neomycin between November 2021 and April 2022 were compared to those who received oral tobramycin between November 2022 and April 2023. Patients who did not receive a companion antibiotic (erythromycin or metronidazole) were excluded. The primary outcome was incidence of SSI within 30 days following colorectal procedure. Secondary outcomes included return to operating room (OR), re-admission, and mortality within 30 days of procedure, post-operative length of stay, and incidence of C. difficile infection.

Results

A total of 119 patients were identified with oral gut decontamination regimens using neomycin (n = 63) and tobramycin (n = 56), who met study criteria. Baseline characteristics, including age, body mass index, and infection present at the time of surgery were similar between the two groups. The incidence of SSI was 3.2 per 100 procedures in the neomycin group and 3.6 per 100 procedures in the tobramycin group (p=1.00). There were no statistically significant differences in secondary outcomes including return to OR, readmission, incidence of C. difficile infection, or mortality within 30 days of the colorectal procedure. The median post-operative length of stay was 6 days in the neomycin group and 5 days in the tobramycin group (p=0.22).

Conclusion

Intravenous tobramycin solution administered orally was not associated with a higher rate of SSIs than standard of care for decontamination prior to colorectal procedures. These findings will contribute to the limited literature on this topic in the United States.

Disclosures

All Authors: No reported disclosures
P-398. External Validation of the Korean National Healthcare-Associated Infections Surveillance System (KONIS): A Surgical Site Infection Module Report
Authors: Kim Young Keun , Song Kyoung-Ho , Kim Su Hyun , Jeong Hye Ran , Shin Eunjeong , Song Jeongsuk , Park Sook-Kyung , Jang Sohee
Published: January 2025

Background

Validation of national surveillance data is necessary to identify methodological problems within the surveillance program, to help increase compliance and participation in the surveillance program, and to identify data quality issues.Table.Validation of the data of cholecystectomy, colectomy and spinal fusion from Korean National Healthcare-associated Infections Surveillance System (KONIS): A Surgical Site Infection Module Report

Methods

To determine the reliability and consistency of the application of surveillance definitions of the Korean Surgical Site Infections Surveillance System (KONIS-SSI), a validation study was conducted on data collected during the 4th quarter of 2022 for cholecystectomy, colectomy and spinal fusion. The 36,032 cholecystectomy of 162 hospitals, 11,819 colectomy of 60 hospitals and 14,949 spinal fusion of 57 hospitals were surveilled during 2022. Among them, a total of 2,508 operative procedures from 1,011 cholecystectomy of 27 hospitals, 702 colectomy of 20 hospitals and 795 spinal fusion of 20 hospitals were evaluated. Using the reviewers' classification of infection as the "gold standard", the sensitivity, specificity, positive and negative predictive value of the surveillance data were determined.

Results

The sensitivity, specificity, positive predictive value and negative predictive value for surgical site infections was 80.43%, 99.96%, 98.67% and 99.26%, respectively. The rate of disagreement was 99.24%. The rate of agreement of cholecystectomy, colectomy and spinal fusion was 99.70% (95% CI 99.13-99.90, 1,008/1,011), 98.43% (95% CI 97.22-99.12, 691/702) and 99.37% (95% CI 98.54-99.73, 90/795), respectively. The reasons of disagreement were a disagreement of surgeons, lack of medical records and system instablity of each hospital.

Conclusion

This study shows the necessity of continuous training and contact with surveillance personnel for maintaining data accuracy of surveillance data.

Disclosures

All Authors: No reported disclosures
P-436. Anal Pap Cytology for Anal Intraepithelial Neoplasia in Individuals under 45 Years of Age
Authors: Choudhuri Irada , Layden Alexander , Baran James , Faaborg Kevin B , McMahon Deborah , Ho Ken , Li Yijia
Published: January 2025

Background

Human Papilloma Virus (HPV)-related high-grade anal intraepithelial neoplasia (AIN) is the precursor of anal cancer. There are limited data identifying factors that influence AIN progression in adults eligible to HPV vaccines.Figure 1.Distribution of anal cytology and reference test results (n=488). (A) Anal cytology. (B) Reference testASCUS, atypical squamous cells of undetermined significance; LSIL, low grade squamous intraepithelial lesions; ASC-H, atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions; HSIL, high-grade squamous intraepithelial lesions; SCCIS, squamous cell carcinoma in situ.

Methods

This retrospective study includes individuals followed at University of Pittsburgh Anal Dysplasia Clinic from 2020-2024. Inclusion criteria were ages 18-45 years as of 2020, all sexes/genders, people with HIV (PWH) or without, and at least one anal cytology paired with pathology (reference standard) or high-resolution anoscopy (HRA) appearance (reference standard if pathology unavailable). We used Logistic regression to evaluate factors associated with high-grade squamous intraepithelial lesion (HSIL) or squamous cell carcinoma in situ (SCCIS) on reference tests (designated as ref-HSIL here). The University of Pittsburgh IRB approved this study.Table 1.Baseline demographics.

Results

We included 239 individuals, with median age 37 years, 16% female, and 95 (40%) received at least one dose of HPV vaccine at initial median age of 26 years (Table 1). Of 191 PWH, 93% were virologically suppressed, with median CD4 count 748 cells/µl at initial visits (2020 or after), and median nadir CD4 count 360 cells/µl. Distribution of cytology and reference tests (149 from pathology and 339 from HRA) was shown in Figure 1. Anal cytology had low-moderate sensitivity (55%) and specificity (82%), but an acceptable negative predictive value of 96% for ref-HSIL. In full cohort, risk factors for ref-HSIL were ASC-H (atypical squamous cells, cannot exclude HSIL) or HSIL on cytology (adjusted odds ratio [aOR] 6.19, P< 0.001). In PWH, nadir CD4 count <200 cells/µl (aOR 4.08, P=0.008) was associated with ref-HSIL while viral suppression tended to be protective (Table 2). Seven individuals with initial non-ref-HSIL progressed to ref-HSIL. Nadir CD4 < 100 cells/µl (aOR 25.0, P=0.010) and current smoking (aOR 6.2, P=0.095, Table 3) showed a trend in association with progression.Table 2.Factors associated with HSIL or SCCIS on reference tests in PWH.Table 3.Factors associated with progression to HSIL/SCCIS.

Conclusion

In this cohort of adults ≤45 years, cytologic ASC-H or HSIL predicts ref-HSIL. In PWH, low nadir CD4 count is a risk factor for ref-HSIL, while viral suppression is protective. Low nadir CD4 count is also a risk factor for AIN progression to ref-HIL. Our study helps prioritize target individuals who need HRA the most.

Disclosures

All Authors: No reported disclosures