bluuebunny/crossref_metadata_2025 huggingface dataset:
P-246. Candida auris Central Line Associated Blood Stream Infection Trends in Chicago Acute Care Hospitals, 2018-2023
Authors: Chundi Vaishali , Walblay Kelly , Zelencik Shane , Young Kim Do , Black Stephanie R
Published: January 2025

Background

The emergence of antifungal resistance and propensity of Candida auris to cause healthcare facility outbreaks and severe outcomes in patients has deemed it a target pathogen for public health mitigation efforts. Data sharing between the Chicago Department of Public Health (CDPH) and the National Healthcare Safety Network (NHSN) allows for the surveillance of central line associated blood stream infections (CLABSIs) in Chicago healthcare facilities. We reviewed the Candida species associated with CLABSIs to assess C. auris contribution to CLABSIs in Chicago over time.

Methods

Data was reported by 32 acute care hospitals (ACHs), including five long- term ACHs between July 1, 2018 and June 30, 2023. All but one ACH provided data for the entire reporting period. We examined trends of central line associated candidemia over time, specifically C. auris. A Fischer's exact test was calculated to determine if the proportion of C. auris significantly differed from 2019 to 2022. Patient demographics and outcomes were summarized for individuals with Candida species grown on culture.

Results

From July 1, 2018-June 30, 2023, 2,362 CLABSIs were reported of which 460 (19.5%) were associated with Candida species. The median age of patients with Candida CLABSIs was 60 years (IQR: 45-69 years), and over half (58.7%) of individuals were male. Among 160 patients who had a Candida associated CLABSI and cause of death data available, candidemia contributed to 18.8% of deaths. The contribution of C. auris to candidemia CLABSIs increased from 10.3% in 2019 to 19.4% in 2022 (p=.1353) and C. parapsilosis increased from 13.2% to 19.4%, while C. albicans declined from 32.4% to 24.3%, respectively (Table 1).

Conclusion

Candida species make up close to 20% of CLABSIs reported by Chicago ACHs during 2018-2023, with C. auris contributing to nearly one-fifth of them in 2022. While the growing proportion of CLABSIs associated with C. auris from 2019 to 2022 is not statistically significant, it has clinical significance, and demonstrates that healthcare facilities should emphasize critical assessment of need for central line placement and infection control interventions, such as hand hygiene and environmental cleaning, to prevent further spread of C. auris.

Disclosures

All Authors: No reported disclosures
P-257. Effectiveness of Pulsed-Xenon Ultraviolet Disinfection during Terminal Cleaning of Patient Rooms in the Intensive Care Unit on the Sustained Containment of Drug-resistant Acinetobacter baumannii
Authors: Morikane Keita , Yakuwa Jun , Nakane Masaki
Published: January 2025

Background

Environmental disinfection by ultraviolet (UV) has been shown to be effective in controlling transmission of multidrug-resistant organisms, and introduced into daily practices in addition to manual terminal cleaning in some hospitals in the US. However, its effectiveness outside the US healthcare setting is not well investigated. Moreover, its effectiveness to control gram-negative bacteria has not been well described.

Methods

This study was conducted in the intensive care unit (ICU) of Yamagata University Hospital, a 637-bed tertiary referral hospital. Sporadic transmission of two drug-resistant Acinetobacter baumannii (2DRA) began in late 2013. Despite intensified hand hygiene promotion and manual terminal cleaning, transmission of 2DRA continued. In January 2018, we added pulsed-xenon ultraviolet (PX-UV) disinfection for the terminal cleaning after every patient discharge. The study periods were defined as follows: the baseline period (August 2016 to January 2018, manual cleaning only) and the intervention period (February 2018 to December 2023, addition of PX-UV). All patients admitted in the ICU were regularly screened for 2DRA for the detection of possible acquisition of 2DRA throughout the study periods.

Results

The incidence of acquisition of 2DRA in the ICU significantly declined (4.45 per 1,000 patient days in the baseline period to 1.09 in the intervention period, relative risk (RR): 0.26, 95% confidence interval: 0.12-0.51). Cases in the intervention period were sporadic, and no cluster was found. In contrast, in non-ICU wards, where PX-UV disinfection was performed only after the discharge of patients known to be colonized or infected with 2DRA or other multidrug-resistant pathogens, possible transmission of 2DRA was observed several times.

Conclusion

Adding PX-UV after manual terminal cleaning was effective in controlling acquisition of 2DRA in the ICU patients. The effectiveness of PX-UV in controlling gram-negative MDROs in the non-US healthcare settings is suggested. In contrast, there was room for improvement in controlling of 2DRA in non-intervention wards.

Disclosures

All Authors: No reported disclosures
P-258. A Longitudinal Study on the Impact of Sink Interventions on Environmental Bioburden and Patient Infections within Two Intensive Care Units at an Academic Hospital
Authors: Gravagna Katie , Sickbert-Bennett Emily , Thompson Sharon , Warren Bobby G , Culbreth Cyndi , Schultz Kate , Alby Kevin , Barrett Aaron , Graves Amanda M , DiBiase Lauren , Fils-Aime Guerbine , Smith Becky A , Anderson Deverick J , Weber David J
Published: January 2025

Background

Patient room sinks are frequently identified as potential sources for hospital-associated infections (HAIs), but there are no clear recommendations for interventions to reduce sink-related pathogenic bioburden. We conducted one of the first longitudinal crossover trials to assess the impact of practical sink interventions in an academic hospital.Figure 1.Contamination levels in patient room sink p-trap and tap water between units over time.Black lines represent samples with CFU/mL above the limit of detection.

Methods

We conducted a 4-phase randomized crossover trial in a medical ICU (MICU) and burn ICU (BICU). Each phase was 8 weeks with a 2-week washout between phases: drain covers, point-of-use filters, both, or no intervention on patient room sinks by unit. Environmental samples from tap water, p-trap water, air, and swabs of the sink basin and adjacent surface were collected every 2 weeks from 5 patient room sinks per unit. Colony-forming units (CFU)/mL of non-tuberculous mycobacteria (NTM), carbapenem-resistant Enterobacterales (CRE), multidrug-resistant Enterobacterales (MDRE), and Stenotrophomonas maltophilia were calculated following MALDI-TOF speciation. Patient HAI results were also recorded.

Results

Without filters, 68.7% (68/99) of tap water samples were positive, compared to 2.2% (2/90) with filters (p< 0.05). P-trap samples were highly variable with high bioburden and no clear time trends at the room or unit level (Figure 1). Positive air and surface samples rarely occurred but were most common in the drain cover phase (12/135). Within rooms, environmental samples were primarily positive before patient clinical isolates of the same species (7/8). Tap water samples across both units were primarily positive for NTM (71/189) yet no study-room-associated NTM infections were identified.

Conclusion

We identified that sinks, particularly p-traps, present a consistent source of pathogenic bioburden with fluctuating populations yet rarely contributed to surface/air contamination with organisms of interest in ICU patient rooms. Neither intervention impacted p-trap colonization (CFU/mL). We found that point-of-use filters consistently and effectively removed NTM from tap water. Drain covers were not found to be a useful intervention for reducing surface bioburden. Future research on decolonizing pathogenic bacteria from patient room p-traps is needed.

Disclosures

Becky A. Smith, MD, UpToDate: royalties
P-272. Prevalence and Predictors of Multi-drug Resistant Organisms in Critically Ill Patients with Opioid Use Disorder and Infection: A Multicenter Retrospective Cohort Study
Authors: Rizwan M Zeeshan , Stevens Ryan W W , Akhtar Haris , Cunningham Julie , Cole Kristin , Gajic ognjen
Published: January 2025

Background

The opioid crisis and the increasing prevalence of multi-drug resistant organism (MDRO) infections pose a threat to public health. Opioid Use Disorder (OUD) patient are prone to MDRO colonization and infections, thus potentially leading to adverse outcomes during periods of critical illness. Understanding the prevalence and predictors of MDRO infections within this vulnerable population is critical to improving patient outcomes by optimizing interventions and treatment plans.

Methods

We conducted a retrospective, multicenter, cohort study to evaluate the prevalence of MDRO isolation among adults with OUD admitted to an intensive care unit (ICU) with an infection across four Mayo Clinic regions. Patients were classified to the MDRO cohort if an MDRO was isolated from standard cultures or rapid diagnostic testing within 48 hours of admission. We utilized descriptive statistics, univariate and multivariate least absolute shrinkage and selection operator (LASSO) regression analysis including random effect to account for site variability, to analyze demographic data, clinical characteristics, and outcomes.

Results

790 critically ill adult OUD patients with infection-related admission were included in the study cohort. The prevalence of MDRO isolation was 22.5% (n=178), with MRSA being the predominant isolated MDRO. In LASSO regression analyses, we identified homelessness (OR: 1.79, p = 0.022), no Medications for OUD (MOUD) treatment (OR: 1.56, p=0.023), and positive Hepatitis C Virus (HCV) status (OR: 2.19, p = 0.012) as significant predictors for isolation of an MDRO. Intravenous (IV) antibiotic use in the preceding 90 days was also positively associated (OR: 1.04 per 24 hours, p = 0.007), alongside mental health disorders (OR: 2.03, p < 0.001) and diabetes (OR: 1.54, p = 0.023).

Conclusion

The high prevalence of MDRO isolation in critically ill OUD patients with infection is associated with complex social and clinical factors.

Disclosures

All Authors: No reported disclosures
P-273. Risk Factors for 90-day Mortality Among Patients With Stenotrophomonas maltophilia Infection: A Retrospective Multicenter study
Authors: Al Qura'an Anood , Salazar Wilmer , Al khouri Zaid , Munshi Ruhul , Pichilingue Reto Patricia , Pinargote Paulette
Published: January 2025

Background

Stenotrophomonas maltophilia is a leading cause of mortality in critically ill and immunocompromised patients. This study aimed to characterize risk factors for mortality and evaluate if combination therapy or resistance patterns affect mortality in patients with S. maltophilia infections.

Methods

We conducted a retrospective, observational study at two academic medical centers in the United States including patients aged ≥ 18 years with positive S. maltophilia cultures between January 2019 and March 2024. Logistic regression analysis was performed to identify independent risk factors for 90-day mortality. A sub analysis for patients with pneumonia was performed. Standard of care was defined as monotherapy with trimethoprim-sulfamethoxazole (SXT) or levofloxacin.

Results

A total of 128 patients were included, median age was 66 years; 60.9% were male. 30- and 90-day mortality rates were 17.2% and 25%, respectively. The most common source of infection was pneumonia (52, 40.6%), which also had the highest mortality rates (32.7%, 46.2%) when compared to other sources of infection. Although non-survivors had higher rates of COPD (p=0.04), prior organ transplants (p=0.002), prior steroid use (p=0.03), and higher ICU admission rates (p< 0.001), they were not found to be independent risk factors for mortality.

Risk factors for 90-day mortality include neutropenia (OR 12.237, p=0.047), polymicrobial infection (OR 7.93, p=0.009) and previous carbapenem use (OR 7.34, p=0.015). Enterobacterales and fungal infections were the most common co-infections.

Monotherapy (117, 91%), and resistance to STX or levofloxacin (4.69% and 10.9% respectively) were not risk factors for mortality (OR 0.9, p=0.9; OR 3.1, p=0.58). Interestingly, osteomyelitis was associated with reduced odds of 90-day mortality (OR 0.008, p=0.015). Independent risk factors for mortality in patients with pneumonia include prior carbapenem use (OR 6.54, p=0.029) and polymicrobial infection (OR 10.95, p=0.08).

Conclusion

S. maltophilia infection is associated with high mortality rates, particularly in patients with neutropenia, polymicrobial infection and prior carbapenem use. Although combination therapy or resistance to standard of care was not found to impact mortality, larger-scale studies are needed.

Disclosures

All Authors: No reported disclosures
P-290. Clinical and microbiological characteristics of patients infected with ceftazidime/avibactam-resistant Klebsiella pneumoniae carbapenemase-producing K. pneumoniae strains
Authors: Liu Szu-Yu , Chou Sheng-Hua , Chuang Chien , Ho Yu-Chien , Juan Chih-Han , Lin Yi-Tsung
Published: January 2025

Background

Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae with ceftazidime/avibactam (CZA) resistance emerged after the widely use of CZA. The most common resistance mechanism was mutations in blaKPC. We aimed to study the clinical and microbiological characteristics in patients infected with CZA-resistant KPC-producing K. pneumoniae, and focus on the comparison between the strains with or without KPC variants (wild-type KPC).

Methods

A retrospective study was conducted in Taipei Veterans General Hospital from February 2019 to July 2023. Hospitalized unique adult patients infected with CZA-resistant KPC-producing K. pneumoniae were included. Clinical characteristics and outcomes were collected, and genes encoding carbapenemases were detected by polymerase chain reaction followed by Sanger sequencing.

Results

A total of 44 cases with CZA-resistant KPC-producing K. pneumoniae infections were identified, and most of them were critically ill with the median APACHE II score 23.0 (IQR, 19.3-29.8). Pneumonia was the most common infection (n=18). Only 15 patients (34.1%) received appropriate treatment regimens, and tigecycline (n=8) and meropenem-based therapy (n=5) were the common regimens. Twenty-seven strains (61.4%) harbored KPC variants, and a total of 16 different types were identified. KPC-33 (n=10) was the most common, followed by KPC-35 (n=3). The overall 28-day mortality was similar between patients infected with and without KPC variants (22.2% vs 23.5%, p=1.000). A previous isolation of carbapenem-resistant K. pneumoniae and exposure to CZA were more common in KPC variants group compared with wild-type KPC group (92.6% vs 58.8%, p=0.017, 92.6% vs 41.2%, p< 0.001, respectively). KPC variants-producing strains also had a higher proportion of CZA MIC > 16 mg/L (85.2% vs 41.2%, p=0.002) and restored meropenem susceptibility (MIC≤ 4 mg/L) (70.4% vs 5.9%, p< 0.001) than that in wild-type KPC strain.

Conclusion

CZA-resistant KPC variants-producing K. pneumoniae has the tendency of restored meropenem susceptibility and higher level of CZA resistance compared with the wild type KPC-producing strain. The optimal therapy in these patients needs further study.

Disclosures

All Authors: No reported disclosures
P-294. The pathway to a decade of carbapenem-resistant Enterobacterales (CRE) : A 9-years experience in a teaching hospital in the Dominican Republic
Authors: Hernandez-Landa Ricardo Ernesto , Rojas-Fermin Rita A , Guzman-Marte Anel E , Peralta-Agramonte Katherine
Published: January 2025

Background

WHO warns about carbapenem-resistant Enterobacterales (CRE) and carbapenemase production, posing challenges in hospitals owing to treatment failure and rapid dissemination. In order to design adequate infection control and prevention strategies and local treatment guidelines, it is important to characterize the prevalence of these isolates. We aimed to assess the frequency of CRE and carbapenemase production in hospitalized patients between October 2015- March 2024.

Methods

A retrospective, descriptive and longitudinal study was conducted including all patients with positive CRE cultures, from January 2015 to March 2024, in a 289-bed tertiary hospital in the Dominican Republic. A database of susceptible and resistant Enterobacterales isolates was obtained, reviewing electronic records for culture origin, microorganisms, and carbapenemase production. Annual CRE rates were calculated including all hospitalized patients with Enterobacterales isolates.

Results

The CRE rate over a 9-years period was 1.7% (83/4843). A slight decrease was observed from years 2015 to 2017, followed by the lowest CRE rate in 2018 (0.2%). 2020 reported an increase of 160% in the CRE rate when compared to 2019, peaking at 3.5% in 2022. The most common microorganisms isolated were Klebsiella spp. (42.6%; 43/101) and Enterobacter cloacae complex (33,7%; 34/101) while the most common carbapenemase produced was KPC (39.4%; 39/99) followed by MBL (21.2%; 21/99). Urine cultures were the most common samples to isolate CRE, but a shift in the trend was observed in 2020, with blood cultures becoming the most common source of CRE. Sequencing of a small sample as part of a previous study reported the presence of KPC2 and KPC3.

Conclusion

Despite being in a low resource country, infection prevention and control strategies have managed to limit the spread reported in other hospital settings in Latin America. The increase seen post pandemic emphasizes this importance. Although KPC is the most common carbapenemase type, NDM has been increasing, posing a major growing concern on treatment failure. Laboratory methods stand as a fundamental tool to understand the magnitude of dissemination, to elaborate clinical guidelines and improve diagnosis and patients outcomes.

Disclosures

Rita A. Rojas-Fermin, MD,FIDSA, Gilead: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria
P-295. Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemase (KPC)-Producing Organisms Treated with Ceftazidime/Avibactam: A Systematic Review and Meta-analysis
Authors: Munshi Ruhul , Salazar Wilmer , Taufiq Farah , Kauser Tanjina , Alam Mohammad , Pinargote Paulette
Published: January 2025

Background

Klebsiella pneumoniae carbapenemase (KPC)- producing organisms is a leading cause of mortality in hospitalized patients, potentially due to the emergence of resistance to novel antibiotics and limited treatment options. This meta-analysis aimed to elucidate the 30-day mortality rate and characterize risk factors associated with death in patients with KPC infections treated with ceftazidime-avibactam (CTZ-AVM).Figure 1:PRISMA flow diagram of studies selection

Methods

Our meta-analysis was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search terms used were “KPC” or “Klebsiella pneumoniae carbapenemase” in conjunction with “Avycaz” or “Ceftazidime/Avibactam”. Our analysis focused on mortality rate, risk factors, comorbidities, sites of infection, clinical outcomes, and treatment interventions. The primary endpoint was 30-day mortality.Figure 2:Mortality rate of ceftazidime-avibactam monotherapy

Results

Analysis of five observational studies with 1011 patients revealed an overall 30-day mortality rate of 33% (95% CI: 24%-44%). Mean duration of therapy was 14 days, 72% were male. Patients with comorbidities such as COPD (OR 1.54 [95% CI 1.04-2.29]), cerebrovascular accidents/dementia (OR 1.73 [95% CI 1.17-2.58]), hematologic malignancy (OR 2.01 [95% CI 1.24-3.25]), and neutropenia (OR 3.68 [95% CI 1.98-6.84]) exhibited significant higher mortality rates. Patients diagnosed with pneumonia were found to have a 77% increased risk of death (OR 1.77 [95% CI 1.15-2.72]), while septic shock effectively doubled the mortality risk (OR 2.22 [95% CI 1.82-2.70]). Monotherapy or combination therapy did not significantly influence the 30-day mortality rate.Figure 3:Mortality rate of ceftazidime-avibactam combination therapy

Conclusion

Our meta-analysis suggests that ceftazidime-avibactam monotherapy and combination therapy exhibit similar efficacy in terms of 30-day mortality in patients with infection by KPC-producing organisms. Mortality rates are impacted by different comorbidities, which need to be taken in consideration when managing these infections.

Disclosures

All Authors: No reported disclosures
P-297. Prospective Study on Microbiological Profile of Nosocomial Infections due to Gram negative lactose non-fermentative Bacteria in a Tertiary Care Hospital in South India
Authors: Radhakrishnan Sriram , Velmani Vaishnavi , Shailaja K , Dorairajan Sureshkumar
Published: January 2025

Background

Non-fermentative gram-negative bacteria (NFGNB) infections that are acquired in hospitals have particularly concerning characteristics; identifying these features can aid in prevention and improve the standard of care provided within hospital premises. This study aims to find out the nosocomial infections caused by NFGNB, its sensitivity pattern, length of culture reporting time, and patients with ICU stay.

Methods

A prospective observational study was conducted in a tertiary care hospital located in southern India during the 4 months of January-April 2024. Data were taken from the Department of Microbiology regarding the prevalence of NFGNB isolates from different culture samples and their sensitivity pattern. The number of MDR isolates throughout the four months, their susceptibility pattern, and the duration of culture reporting time for all NFGNB isolates were examined. Descriptive analysis was used to look at patient demographics, inpatient department, and ICU admission. Statistical analysis was done by Microsoft Excel.

Results

Total 72(18.6%) samples were recorded as NFGNB from 386 culture positive samples isolated from the Department of Microbiology. The most common isolate was Acinetobacter spp (38.8%) followed by Pseudomonas spp (27.7%). The mean of our study participants was found to be 55 years, with a male: female ratio 2:1. The General Medicine department showed maximum isolates i.e, 25% followed by Hepatology department i.e, 16.6%. Maximum NFGNB isolates are from Urine sample (33.3%) followed by Blood sample (27.8%). The mean time of culture reporting for NFGNB was 72 hours. Out of 72 NFGNB samples, 28(38.8%) were Multi-drug resistant isolates and 29(40.2%) required ICU admission.

Conclusion

NFGNB function as nosocomial pathogens, their startling resistance is a concern to epidemiology and medical care. These isolated pathogens have been manually reported for a considerable amount of time. Rapid culture identification methods would assist identify resistant diseases early and improve patient outcomes in low- and middle-income countries. Future studies should focus on implementation of approaches to reduce the incidence and resistance of nosocomial infections in LMICs.

Disclosures

All Authors: No reported disclosures
P-303. Mupirocin Resistance is Common in Tampa, Florida Staphylococcus aureus Clinical Isolates
Authors: Virgillio Ariana , Felton Emily , Becker Deanna , Lima Amorce , Silbert Suzane , Coughlin Emily , Shaw Lindsey , Kim Kami
Published: January 2025

Background

Mupirocin (Mup) is a topical drug used to decolonize carriers of Staphylococcus aureus (SA) to prevent later SA infection. A spot survey of SA isolates at Tampa General Hospital (TGH) revealed a prevalence in Mup resistance of ∼40%, leading to a change of decolonization protocol from mupirocin to povidone iodine in January 2020, just prior to the COVID pandemic. We determined the prevalence of Mup resistance in a random sampling of clinical isolates before and after change in decolonization protocol.

Methods

A total of 211 PreCOVID (before 2020) and 173 PostCOVID (after 2021) samples from various sources (blood, bone, eye, fluid, respiratory, urine, and wound) were tested with minimum inhibitory concentration for Mup resistance using literature values for susceptible, low resistance, and high resistance. Oxacillin sensitivity, to verify MRSA isolates, was tested in parallel. Results were analyzed via χ² for significance (p=0.05).

Results

Comparison of Mup resistance levels between the Pre- and PostCOVID time points showed no significant difference (p=0.460). PreCOVID: 71.1% susceptible, 8.1% low resistance, 20.9% high resistance. PostCOVID: 74.0% susceptible, 9.8% low resistance, and 16.2% high resistance. MRSA status correlated with Mup resistance in both Pre- (p< 0.001) and PostCOVID samples (p=0.001).

Blood vs Non-Blood samples differed in Mup resistance in the PreCOVID period (20.7% blood vs 34.1% non-blood, p=0.037), whereas samples in the PostCOVID period showed no significant difference in Mup resistance (22.8% blood vs 28.7% non-blood, p=0.375). Notably, 46.2% PreCOVID Respiratory were resistant to Mup (p=0.016). 26.3% PostCOVID Respiratory were resistant to Mup (p=0.651).

Conclusion

Change in decolonization protocol did not influence the overall prevalence of Mup resistance. Respiratory samples made up a significant proportion of the resistant samples in the PreCOVID time point, suggesting differences in prevalence of Mup resistance in different clinical sites. Further molecular epidemiological studies are needed to determine if specific sites of infection or specific patient groups are more likely to be colonized with Mup resistant SA isolates.

Disclosures

All Authors: No reported disclosures
P-319. Genetic shift of Methicillin-resistant Staphylococcus aureus isolated from bloodstream infections over 12 years at a tertiary care university hospital in Japan
Authors: Motomura Yuka , Miyazaki Motoyasu , Kamada Mitsuhiro , Satho Tomomitsu , Takata Tohru , Kashige Nobuhiro
Published: January 2025

Background

Limited reports exist on the long-term trends in genotypes of Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream isolates. Therefore, we aimed to investigate the longitudinal trends in genotypes of MRSA bloodstream isolates obtained from hospitalized patients during a 12-year study period from 2010 to 2021 at a tertiary care university hospital.

Methods

Over the 12-year period spanning from 2010 to 2021, we conducted a genetic investigation focusing on MRSA 245 strains isolated from the blood of hospitalized patients. The analysis involved the application of Staphylococcal Cassette Chromosome mec (SCCmec) typing, accessory gene regulator (agr) typing, PCR-based ORF Typing (POT), and Multi Locus Sequence Typing (MLST) to discern the genotypes of the MRSA bloodstream isolates. In this study, strains with the same POT type detected in two or more isolates were designated as epidemic clones, while strains without a common POT type were classified as sporadic clones.

Results

Until 2015, isolates with SCCmec II/agr II were prevalent, but from 2016 onwards, there was an increase in isolates with SCCmec IV/agr III. A total of 128 strains (52%) were identified as epidemic clone, while 117 strains (48%) were classified as sporadic clone. The detection rate of sporadic clone had significantly increased since 2016 (P < 0.05). The epidemic clone was classified into three clusters, with MRSA of CC1 being prominently detected after 2016.

Conclusion

This study found that the genotypes of MRSA bloodstream isolates underwent a shift from SCCmec II/agr II type to SCCmec IV/agr III type, particularly with a notable increase in MRSA of CC1, after the year 2016. There was a significant increase in the proportion of sporadic strains among the isolates, suggesting a diversification of genotypes.

Disclosures

All Authors: No reported disclosures
P-326. Where Does the Glove Fit? Examining the Effect of Hand Hygiene Timing on Healthcare Personnel Glove Contamination
Authors: Gettler Erin , Warren Bobby G , Fils-Aime Guerbine , Barrett Aaron , Graves Amanda M , Anderson Deverick J , Smith Becky A
Published: January 2025

Background

Guidelines recommend performing hand hygiene (HH) prior to donning non-sterile gloves, yet strong evidence is lacking and overall adherence is low. This study evaluated the impact of different HH and gloving strategies on glove contamination.

Methods

Healthcare personnel (HCP) were enrolled on inpatient units and then randomized into 3 arms: 1) standard practice of alcohol-based hand rub (AHBR) before gloving, 2) ABHR after gloving, or 3) direct gloving without HH. Study personnel first collected 1 control glove per HCP from the same glove box used after randomization. After donning, HCP gloves were aseptically removed and placed into sterile bags by study personnel (left, right, control). Inverted gloves were aseptically filled with 50 mL of neutralizing buffer, sealed, and agitated. Buffer was centrifuged at 3100 rpm for 15 minutes and decanted leaving only ∼3 mL of sample. Each homogenate was vortexed and plated onto routine media to assess for bioburden and epidemiologically important pathogens (EIP), including Staphylococcus aureus, Enterococcus species, and gram-negative bacteria. Gloves were visually inspected and tested for microperforations by the water inflation test. Rate of glove contamination and bioburden were compared.

Results

60 HCP across 8 inpatient units were enrolled. Control gloves obtained were frequently contaminated (48.3%). Compared to standard practice, neither HH after gloving nor direct gloving led to significant differences in glove contamination or bioburden (Table 1). In fact, HH after gloving trended toward lower bioburden on the gloves, but this result was not significant. Importantly, the application of ABHR to gloves did not compromise the integrity of the glove or result in microperforations. Gloves were relatively void of EIP.

Conclusion

In this exploratory analysis, HH after donning non-sterile gloves or direct gloving did not result in higher glove contamination. These techniques may represent safe alternative HH practices for HCP and circumvent some of the common barriers limiting HH compliance. Additional studies are needed.

Disclosures

Becky A. Smith, MD, UpToDate: royalties
P-328. Compliance of Hand Hygiene Practice among Health Care Workers in Tertiary Care Military Hospitals of Bangladesh
Authors: Md Abdullah Syed Abul Hassan , Harun Md Golam Dostogir , Amin Sumon Md Shariful , Jahan Ishrat , Ul Anwar Md Mahabub , Siddiquee Taufiq H
Published: January 2025

Background

Hospital-acquired infection is still a major cause of morbidity and mortality in hospitals. Healthcare workers’ (HCWs) hands become progressively colonized with potential pathogens during their patient care and act as a vehicle for transmission of microorganisms to other patients. Hand hygiene (HH) is undisputedly one of the most effective infection control measures. Military hospitals in Bangladesh are known for better compliance of health system practice. This study aimed to evaluate HH compliance and associated factors among HCWs in two tertiary level military hospitals in Bangladesh.Table 1HH practice of Physicans

Methods

We conducted non-participatory observations at 02 tertiary Combined Military hospitals (CMH) at Dhaka (1650 bedded) and Jashore (500 bedded) during Oct to Dec 2021. We used the WHO’s ‘5 moments of Hand Hygiene tools’ to record HH compliance among physicians, nurses and cleaning staff. We also performed semi-structured interviews to determine the key barriers to complying with HH.Table 2HH practice of Nurses

Results

We observed total 172 HH opportunities. The overall HH compliance was 30.9%, highest among physicians (34.5%), followed by Nurses (25.2%). Physicians’ performance (49%) on HH practice before touching a patient was higher than the nurses (46%) but poorer (44.5%) after touching the patient than same practice of nurses (58%). Study also observed that only 24% physicians and 18% nurses practiced HH Before and after handling patient file. Responded opined that workload, shortage of time, lack of facility, distance of hand washing station, inadequate supply were the key hand hygiene barriers with soap. Insufficient supply, skin reaction, cost of product, lack of knowledge appeared. Qualitative assessment revealed that Inadequate handwashing station at wards (distance), insufficient training & orientation for HCWs, irregular monitoring and audit and lack of enforcement of IPC guidelines were key challenges at both study sites.Table 3HH practice barrier with soap

Conclusion

HH compliance among HCWs of study hospital was short of standard for safe patient care. Periodical training and motivation, ensuring HH supplies and enforcement of IPC guideline is needed to improve the situation.Table 4HH practice barrier of sanitizer

Disclosures

All Authors: No reported disclosures
P-347. Investigating Risk Factors for Candida auris Bloodstream Infections: A Case-Control Study from Los Angeles County
Authors: Nguyen Jennifer , OYong Kelsey , Rubin Zachary A
Published: January 2025

Background

Candida auris (C. auris) has emerged as a significant pathogen due to its ability to cause bloodstream infections (BSIs) in highly vulnerable patient populations. Understanding the risk factors associated with C. auris BSIs is crucial for implementing targeted interventions to mitigate the burden of infection and ensure patient safety. In Los Angeles County (LAC), all C. auris cases are reportable to the Department of Public Health (DPH).

Methods

We conducted a case-control study to identify risk factors associated with C. auris BSIs. Using data reported to LAC from June 2019 to April 2024, cases included persons initially colonized with C. auris who subsequently developed confirmed C. auris BSI, while controls consisted of persons colonized with C. auris without C. auris identified from a clinical specimen site. C. auris cases and controls were identified via required laboratory and provider reporting of all positive C. auris tests. Data on various risk factors were collected from provider case reports that were completed on all C. auris-positive persons, excluding cases with missing risk factor data. We used logistic regression to estimate the adjusted odds ratios of a colonized case acquiring a C. auris BSI compared to only colonized persons, adjusting for age, sex, race/ethnicity, and healthcare facility where the positive specimen was collected.

Results

Of the 174 cases and 2,602 controls identified, increased odds of BSI were observed among patients with prior antifungal use (OR: 3.58, 95% CI: 1.12-11.41) and hemodialysis (OR: 2.33, 95% CI: 1.05-5.16). Other risk factors such as ventilator use, tracheostomy, central venous catheter presence, and wound presence showed no statistically significant associations.

Conclusion

Targeted infection prevention strategies are vital to mitigate C. auris BSI burden. Rigorous aseptic techniques during hemodialysis and judicious use of antifungal agents may reduce C. auris BSI risk. Although adjusted for in this analysis, specialized attention to infection control in healthcare facilities such as long-term acute care hospitals may be warranted, given their unique patient populations and care settings. Further investigation is warranted to identify additional strategies to mitigate C. auris BSI risk.

Disclosures

All Authors: No reported disclosures
P-368. Long-range Air Dispersal as An Important Source of Environmental Contamination in Candida auris Clustering: Possible Infection Control Implication
Authors: Fung Wing-Yu , Cheng Ryan Yiu-Fai , Yau Anthony Pak-Yuen , Lee Suet-Yi , Chan Ngan-Han , Wong Yuk-Shan , Cheng Naomi Hua-Yin , Wong Sally Cheuk-Ying , Lung David Christopher
Published: January 2025

Background

Long-range air dispersal of Candida auris has recently been described. Contact precautions alone may not be sufficient to target this mode of transmission. Hence, we study the factors affecting the extent of environmental contamination including air grilles in sporadic C. auris hospitalized patients, and in outbreak settings.

Study flow chart

Methods

Outbreaks and sporadic C. auris cases involving two local hospitals from March to October 2023 were retrospectively analysed. C. auris screening was performed for patients with defined risk factors or regular surveillance as per hospital policy. Environmental samples were taken from high-touch surfaces and air grilles from patients’ environment. Correlation between scale of C. auris clustering and extent of environmental contamination was analysed.

Outbreaks with positive environmental sampling

Results

A total of 170 new C. auris patients were identified, including 65 patients from nine outbreaks and 105 sporadic cases. Environmental screening was performed in eight outbreaks and 46 sporadic isolated cases (Fig 1). Environmental contamination rate of the outbreak group was significantly higher than the sporadic group (15.1% vs 2.5%, P< 0.05). Among outbreak groups, longer median duration of outbreak (34 [27-45] vs 7 [7-12] days, p< 0.05), and more patients’ involvement (9 [6-10] vs 5 [4-7], p=0.05) were associated with higher environmental contamination rate (Table 1). Ward contamination was more frequently detected in sporadic patients with longer duration of stay, though it was not statistically significant (30.8% vs 10%, p=0.09). Air grille samples had a significantly higher contamination rate than high-touch surfaces in both outbreak (41.4% vs 16.7%, p< 0.05) and isolated group (19.7% vs 6.7%, p< 0.05).

Outbreaks with negative environmental sampling

Conclusion

Prolonged and sizeable C. auris clustering was associated with more extensive environmental contamination, particularly air grilles. Long-range air dispersal, as evidenced by air grille contamination, is a possible risk factor for propagation in outbreaks. Contact precautions together with physical segregation to limit air dispersal is recommended. Decontamination of air grille is necessary to prevent further spread. The role of air grille surveillance as a surrogate marker of ward contamination is worthy of further investigation.

Disclosures

All Authors: No reported disclosures
P-402. A Seven-Year Analysis of CRAB and CRE Urinary Tract Infections in Tennessee
Authors: Patel Dipen , Mutamba Glodi , Taylor Jacquelyn , Harriott Melphine , Muleta Daniel
Published: January 2025

Background

Urinary tract infections (UTIs) are a prevalent health concern, affecting millions worldwide. The data collected through the Tennessee Multi-site Gram-negative Surveillance Initiative (MuGSI) was analyzed for a comparative study of UTIs caused by Carbapenem-Resistant A. baumannii complex (CRAB) and Carbapenem-Resistant Enterobacterales (CRE). We aimed to evaluate the demographics, prevalence, and clinical characteristics of patients with UTIs caused by CRAB and CRE.

Methods

Tennessee has participated in the Center for Disease Control and Prevention (CDC) Emerging Infections Program MuGSI project since 2014. An incident case is defined as the first CRE of E. coli, E. cloacae complex, Klebsiella species or CRAB per patient within 30 days. We analyzed CRE and CRAB incident cases of primary or recurrent UTIs reported to MuGSI during 2016–2022. Descriptive analysis and odds ratio were performed using SAS 9.4.

Results

From 2016–2022, 521 UTI cases were reported: 448 (86.0%) CRE and 73 (14.0%) CRAB. More males (64.4%) had CRAB infections (p< 0.0001); conversely, more females (68.5%) had CRE infections (p< 0.0001). The mean ages of patients with CRAB and CRE were 64 and 67 years, respectively. Incidence of CRAB was 8.6 in non-white and 3.3 in white per 100,000 population (p< 0.0001). CRE was associated with reduced odds (OR=0.17, p< 0.0001) of having indwelling catheters compared to CRAB. CRAB cases were 2.59 times more likely to be admitted to the intensive care unit (ICU) (p=0.0020). CRAB cases had higher odds of neurological conditions (OR=3.44, p< 0.0001), renal conditions (OR=2.27, p=0.0014), and diabetes (OR=1.67, p=0.0412). CRAB mortality was 6.9% compared to CRE at 2.0% (p=0.0178). Most CRAB and CRE cases were healthcare-associated infections (98.6% & 67.2%).

Conclusion

The study marks the first multi-year evaluation of TN patients with CRE and CRAB UTIs. As expected, CRAB patients frequently needed ICU admission and were more likely to have indwelling catheters, neurological and renal conditions, and diabetes. This could be linked to ICU patient severity, but further studies are required to clarify. Additionally, significant race and sex gaps were noticed between CRAB and CRE-infected patients, prompting further investigation into these disparities.

Disclosures

All Authors: No reported disclosures
P-403. Incidence of Surgical Site Infections in Selected Tertiary Care Hospitals in Bangladesh: Findings From A Pilot Surveillance Project
Authors: Harun Md Golam Dostogir , Sumon Md Shariful Amin , Islam Md Saiful
Published: January 2025

Background

Surgical site infections (SSI) are the most frequent type of healthcare-associated infections (HAI) and SSIs have substantial healthcare ramifications. In Bangladesh, most hospitals lack surveillance systems for HAIs, including SSI. We conducted this SSI surveillance to assess the rate and determine measures of SSI burden in Bangladesh

Common Organisms for Surgical Site Infections in Bangladesh

Common Organisms for Surgical Site Infections in Bangladesh

Methods

From January to August 2021, we piloted SSI surveillance in four tertiary care hospitals. Participants included undergoing cesarean section (C-section) or abdominal surgery. We enrolled SSI cases if any infection occurred within 30 days of the surgery and contained the skin, subcutaneous tissue and/or deep soft tissue, in or on any part of the anatomy. We also collected data on symptoms, antibiotic consumption, diagnosis, and treatment

Results

We enrolled 1,760 patients, with a majority (75.7%) undergoing C-sections. Within 30 days of surgery, 33.2% (585) of patients developed SSI symptoms. Abdominal surgery patients had a higher rate of SSI (40.9%, 175/426) compared to C-section patients (30.7%, 410/1334). Most patients (90.9%, 532/585) acquired SSI symptoms during hospital stay. Two-thirds (66.4%) of patients were prescribed antibiotics on admission, and 70.1% were given surgical antibiotic prophylaxis. Rates of SSI did not differ between those who received antibiotics or not. The most frequently prescribed antibiotics were ceftriaxone 57.5%, on admission and the combination of ceftriaxone and metronidazole (84.1%) in postoperative patients. Only 10. 7% (63/585) of participants performed wound cultures, of which 76.2% (48/63) demonstrated growth. The most frequently reported organisms were Escherichia coli (37.2%), Staphylococcus aureus (30.2%), and Klebsiella pneumoniae (20.9%).

Conclusion

Further study of the factors contributing to this high incidence and timing for surgical antibiotic prophylaxis administration is needed. The high rate of antibiotic consumption also suggests a need for examination of whether appropriate treatment is being administered and/or if antibiotic prophylaxis is targeting the correct organisms. Additionally, strengthening IPC practices, establishing antimicrobial stewardship programs, and updating antibiotic guidelines could help prevent SSIs and AMR in Bangladeshi hospitals

Disclosures

All Authors: No reported disclosures
P-404. A nationwide survey of Infection Prevention and Control and High-level Disinfection and Sterilization practices in the Dominican Republic
Authors: Castillo Elianet , Rojas-Fermin Rita A , Reyes Yeison , Blanco Claudia , Villegas Antonio M , Mena Lora Alfredo J
Published: January 2025

Background

Healthcare-Associated Infections (HAI) cause significantly morbidity and mortality worldwide. Infection Prevention and Control Programs (IPC) have proven to be effective in reducing HAIs. In low- and middle-income countries, 15% of patients in acute care hospitals acquire a hospital acquired infection (HAI) compared to 7% in high-income countries. Strong IPC can reduce HAIs and the spread of antimicrobial resistance (AMR). We seek to characterize IPC capabilities and practices in the Dominican Republic (DR).

Figure 1: Population density of the Dominican Republic and geographic distrubution of hospitals surveyed

Methods

We performed an anonymous survey of infectious diseases (ID) specialists in acute care hospitals in the DR. A survey based on the CDC Infection Control Assessment and Response (ICAR) tool for general infection and control was distributed via professional society listervs between March 4 and April 24, 2024. Data was tabulated and descriptive statistics performed.

Figure 2: Components of Infection Prevention and Control programs in the Dominican Republic

Results

A total of 20 hospitals responded to our survey, representing 16 facilities in Santo Domingo, and one in Santiago, San Cristobal, La Romana, and San Pedro de Macoris respectively (Figure 1). Of the 20 facilities, 60% (12) reported having an IPC Program, 55% (11) had a dedicated multidisciplinary IPC committee, and 90% had access to an IPC expert such as an ID physician (Figure 2). Education to patients was provided in 58% of hospitals, 83% set policies and procedures based on national or international guidelines, 75% conduct annual risk assessments, and 50% utilize software for data reporting and extraction. All IPC programs reported access to the medical record. Fourteen centers reported data on high-level disinfection and sterilization (HLD), of which 50% had formal training for staff, 50% reported having HLD specific policies, 35.7% track devices for errors, and 28.5% have a reporting process for device-related infections to public health authorities.

Conclusion

Our survey provides an overview of the current landscape of IPC in the DR. While there has been significant progress in standardizing IPC practices, our findings indicate that nearly half of the surveyed hospitals do not have formal IPC programs. Notably, existing IPC programs often lack formal IPC committees, device tracking, data extraction, and infection reporting mechanisms. Addressing these gaps may help recude HAIs and curb AMR.

Disclosures

Rita A. Rojas-Fermin, MD,FIDSA, Gilead: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria