bluuebunny/crossref_metadata_2025 huggingface dataset:
89. On-going impact of the SARS-CoV-2 pandemic on the evolution of carbapenemase-producing Enterobacterales in Ontario, Canada
Authors: Mozafarihashjin Mohammad , Jamal Alainna J , Kandel Christopher , Kohler Philipp , Mataseje Laura , Mulvey Michael , Allen Vanessa , Barker Kevin R , Baqi Mahin , Borgia Sergio , Coleman Brenda , Faheem Amna , Farooqi Lubna , Johnstone Jennie , Katz Kevin , Melano Roberto , Muller Matthew , Mubareka Samira , Patel Samir , Poutanen Susan , Richardson David , Li Angel , Zhong Zoe , McGeer Allison
Published: December 2022

Background

The spread of carbapenemase-producing Enterobacterales (CPE) is global threat. Numerous outbreaks of CPE have been reported during the COVID-19 pandemic. We describe the impact of of the SARS-CoV-2 pandemic on the emergence of CPE in south-central Ontario, Canada.

Incidence of clinical isolates of CPE and isolates with different CPE genes in Toronto/Peel region, 2017–2021.

The upper panel shows the incidence of patients with clinical isolates of CPE by year and quarter from q4 2007 to q1 2022. The lower panel shows the incidence of patients with clinical isolates with different carbapenemase genes by fiscal year during the same period.

Methods

TIBDN has performed population-based surveillance for CPE in Toronto/Peel region (pop 4.5M) from first identified isolate in 2007. All laboratories test/refer all carbapenem non-susceptible Enterobacterial isolates for identification of CPE. Hospital charts are reviewed and patients/physicians interviewed. Population data are obtained from Statistics Canada.

Results

From 10/2007 to 3/31/2022, 1367 persons colonized or infected with CPE were identified. Their median age was 68.7yrs (IQR 54–78yrs); 761 (56%) were male. 772 (56%) were colonized when first identified; 115 (8.4%) were bacteremic at identification or subsequently developed bacteremia. The most common organisms were E. coli (651, 48%), K. pneumoniae (436, 32%), Enterobacter spp. (146, 11%), Citrobacter spp (62, 5%); the most common genes were NDM±OXA-48 (722, 53%), OXA-48-like (341, 25%), KPC (225, 16%), VIM (44, 3%). The incidence of CPE infections increased steadily until 3/2020 then declined by 61% and remained stable until 3/2022 (Figure, upper panel). The decline was greater for E. coli (56% decrease), K. pneumoniae (62%) than for Enterobacter spp. (30%) and other species (19%). It occurred in all genes in 2020; however, KPC containing organisms increased again in 2021 (Figure, lower panel).

Conclusion

The advent of the COVID-19 pandemic was associated with an immediate, substantial decline in the incidence of patients with CPE in our population area. This decline occurred in both isolates with genes usually occurring in cases imported from other countries, and in those usually occurring in cases associated with transmission within Canadian hospitals. Decreased travel and enhanced infection prevention and control in hospitals may both have contributed to reductions in CPE during the pandemic.

Disclosures

All Authors: No reported disclosures.
90. Risk Factors for Community Colonization with Extended-Spectrum Cephalosporin-Resistant Enterobacterales (ESCrE) in Botswana An Antibiotic Resistance in Communities and Hospitals (ARCH) Study
Authors: Mannathoko Naledi , Mosepele Mosepele , Gross Robert , Smith Rachel Mann , Alby Kevin , Glaser Laurel , Richard-Greenblatt Melissa , Sharma Aditya , Jaskowiak-Barr Anne , Sewawa Kgotlaetsile , Cowden Laura , Reesey Emily , Otukile Dimpho , Cressman Leigh , Paganotti Giacomo , Mokomane Margaret , Lautenbach Ebbing
Published: December 2022

Background

The epidemiology of ESCrE in low- and middle-income countries (LMICs) is poorly described. While risk factors for ESCrE clinical infection have been studied, little is known of the epidemiology of ESCrE colonization. Identifying risk factors for ESCrE colonization specifically is nonetheless critical to inform antibiotic resistance reduction strategies.

Methods

This study was conducted in 6 clinics located in 3 districts in Botswana. In each clinic, we surveyed a random sample of outpatients. We also invited each enrolled clinic subject to refer up to 3 adults. Each adult clinic or community subject was also invited to refer their children. All subjects had rectal swabs collected which were inoculated onto chromogenic media for preliminary identification of ESCrE. Final identification and susceptibility testing were performed using MALDI-TOF MS and VITEK-2, respectively. Data were collected on demographics, comorbidities, antibiotic use, healthcare exposures, travel, and farm and animal contact. Subjects with ESCrE colonization (cases) were compared to non-colonized subjects (controls). Bivariable and multivariable analyses were conducted to identify risk factors for ESCrE colonization.

Results

Enrollment occurred from 1/15/20–9/4/20 and 2,000 subjects were enrolled. There were 959 (48.0%) clinic subjects, 477 (23.9%) adult community subjects, and 564 (28.2%) child community subjects. 725 (36.3%) subjects lived in the same household as another subject. The median (IQR) age was 30 (12–41) and 1,463 (73%) were female. There were 555 cases and 1,445 controls (i.e., 27.8% of subjects were ESCrE colonized). Unadjusted comparisons are noted in Table 1. Independent risk factors for ESCrE were younger age, hospital exposure, travel, and presence of an ESCrE colonized household member (Table 2).

Conclusion

ESCrE colonization was common and associated with several exposures. Our results suggest even modest healthcare exposure may be important in driving ESCrE. The strong link to household member ESCrE colonization highlights the potential role of household transmission or common exposure. These findings warrant further prospective studies and provide vital information to inform strategies to curb further emergence of ESCrE in LMICs.

Disclosures

All Authors: No reported disclosures.
790. Can Electronic Clinical Decision Support Systems Improve the Diagnosis of Urinary Tract Infections?: A Systematic Review and Meta-Analysis
Authors: Hojat Leila S , Saade Elie , Donskey Curtis , Deshpande Abhishek
Published: December 2022

Background

Urinary tract infection (UTI) is a commonly misdiagnosed infectious condition. Stewardship interventions which successfully reduce rates of asymptomatic bacteriuria treatment (ASB) are often labor intensive, and thus a systematic solution is desirable. In this study, our objective was to systematically review studies to evaluate the effect of implementing a clinical decision support system on the ordering of urine culture tests for the diagnosis of UTI across diverse clinical settings.

Methods

We conducted a comprehensive electronic search of 5 databases and manual reference list review for peer-reviewed articles published prior to July 2, 2021. Studies which described an intervention designed to reduce unnecessary or incorrect diagnosis of UTI through utilization of CDS were included. The primary outcome of interest was rate of urine culture tests ordered. Two investigators independently screened studies and extracted and compiled data.

Results

A total of 5,013 studies were screened, of which 14 met inclusion criteria for the systematic review (Table 1). The most common intervention was urinalysis with reflex to urine culture based on pre-specified urinalysis parameters, such as a threshold level of pyuria. All 9 studies with statistical comparisons reported a decreased urine culture rate post-intervention, 8 of which were statistically significant (Table 2). Overall, a 37% decrease in urine culture rate was detected after CDS implementation (Table 3). Several studies also reported improvements in antimicrobial-related measures such as days of therapy and guideline-concordant therapy. Catheter-associated urinary tract infection rate was decreased in 2 studies and unchanged in 1 study. A limited number of included studies reported no adverse outcomes including increased bloodstream infection and mortality rates.

Conclusion

Electronic clinical decision support systems appear to be effective in decreasing unnecessary urine culture tests and improving UTI diagnosis. Prospective studies are needed to evaluate the impact on antimicrobial prescribing, patient-relevant outcomes, and potential adverse effects.

Disclosures

Elie Saade, MD, MPH, Janssen: Advisor/Consultant Curtis Donskey, MD, Pfizer, Clorox, Ecolab, and Professional Disposables International: Grant/Research Support Abhishek Deshpande, MD, PhD, Clorox: Grant/Research Support|Merck & Co., Inc., Kenilworth, NJ, USA: Advisor/Consultant|Merck & Co., Inc., Kenilworth, NJ, USA: Stocks/Bonds|Seres Therapeutics: Grant/Research Support.
877. Synovial Fluid Testing Using the BioFire® Joint Infection (JI) Panel Potentially Decreases Time to Antibiotic Optimization for Acute Joint Infections
Authors: Whitt Benjamin , Kilic Abdullah , Palavecino Elizabeth , Beardsley James , Ohl Christopher , Stone Tyler , Taylor Alex D , Luther Vera
Published: December 2022

Background

Traditional synovial fluid culture for acute joint infection (AJI) is time-consuming, potentially delaying initiation of targeted antimicrobial therapy. The BioFire® Joint Infection (JI) panel, a multiplex PCR for synovial fluid, has been shown to have 90.2% sensitivity and 99.8% specificity for diagnosis of AJI. We sought to determine the potential impact of the JI panel on antimicrobial use for AJI at our institution.

Methods

Antimicrobial use was retrospectively reviewed in a cohort of adult inpatients who underwent synovial fluid culture and were diagnosed with septic arthritis or periprosthetic joint infection from Sept 2021-Apr 2022. Patients were excluded if there was an alternative source of infection or septic shock. Synovial fluid specimens were tested using the JI panel, and results were compared to those of traditional culture methods. Patients who were initially treated with broad-spectrum antimicrobials for AJI were included in a review of antimicrobial prescribing. Records were reviewed to determine the time at which a transition to targeted therapy was made when using culture. This was compared to the time at which panel results could be available and acted upon, in this study presumed to be 12 hours after culture collection.

Results

42 inpatients met study criteria for comparison of culture and JI panel results. The panel identified the organism that was grown in culture in 21 cases while detecting an organism in 5/16 culture-negative cases (table 1). In 5 cases, culture identified an organism not included on the JI panel. 29 patients met criteria for review of antimicrobial prescribing. Of these, therapy in 14/16 with positive cultures could have been changed earlier (table 2), resulting in an average reduction of time to targeted therapy of 57 hours (range 27–107 h, median 50.5 h) per patient. Targeted therapy could have occurred in 5/13 culture-negative cases.

Summary of comparison of culture and BJI panel results.

*Organisms identified by culture: Coagulase-negative staphylococci (n=4), Pasteurella multocida (n=1)

**Organisms detected by JI panel: Streptococcus pyogenes (n=2), Streptococcus agalactiae (n=1), Finegoldia magna (n=1), Enterobacter cloacae (n=1)

Proportion of patients eligible for a change in antimicrobial therapy.

Conclusion

Use of the JI panel could have prompted earlier optimized therapy in approximately two-thirds of patients. In 5 instances where cultures were negative, important AJI pathogens were identified. Another potential benefit includes reduced exposure to unnecessary broad-spectrum antimicrobials. Future study should evaluate the actual impact of the JI panel in practice.

Disclosures

All Authors: No reported disclosures.
887. Race and ethnicity differences in hospital length of stay for children with acute osteomyelitis in the United States
Authors: Campbell Jeffrey , Shanahan Kristen H , Bartick Melissa , Ali Mohsin , Goldmann Donald , Shaikh Nadia , Allende-Richter Sophie H
Published: December 2022

Background

Changes in management of bone infections, particularly early transition to oral antibiotic therapy, have decreased length of stay (LOS) for children hospitalized with acute osteomyelitis. However, evaluation of differences in length of stay by race and ethnicity have been limited.

Methods

Using the Kids’ Inpatient Database, we conducted a cross-sectional study of children ages 0–20 years hospitalized in 2016 or 2019 with a primary or secondary diagnosis of acute osteomyelitis. Using survey-weighted negative binomial regression, we modeled length of study (LOS) by race and ethnicity, accounting for clinical and hospital characteristics and socioeconomic status. Secondary outcomes included predictors of LOS > 7 days (equivalent to LOS in the highest quartile), central venous catheter (CVC) placement, and time to debridement.

Results

We identified 2,388 patients discharged with acute osteomyelitis. Median LOS was 5 days (IQR 3–7). Black race (adjusted incidence rate ratio [aIRR] 1.15, 95%CI 1.05–1.27), Hispanic ethnicity (aIRR 1.11, 95% CI 1.02–1.21), and other race and ethnicity (aIRR 1.12, 95% CI 1.01–1.23) were associated with longer LOS, compared to White race (Figure 1). Additional factors associated with prolonged LOS were Medicaid/self-pay status (aIRR 1.14, 95% CI 1.07–1.21) and other insurance (aIRR 1.21, 95% CI 1.02–1.45), compared to private insurance; debridement procedure (aIRR 1.31, 95%CI 1.23–1.31); CVC placement (aIRR 1.41, 95% CI 1.31–1.51), and complex chronic condition (aIRR 1.21, 95% CI 1.11–1.33). The odds of Black children experiencing LOS > 7 days was 46% higher compared to White children (aOR 1.46, 95% CI 1.01–2.11; Figure 2). There were no differences by race and ethnicity on odds of CVC placement or time to debridement.

Model is adjusted for hospital location/teaching status, hospital region, year, debridement procedure, CVC placement, complex chronic condition, weekend admission, discharge quarter, hospital bed size, Zip code median income quartile.

Model is adjusted for hospital location/teaching status, hospital region, year, debridement procedure, CVC placement, complex chronic condition, weekend admission, discharge quarter, hospital bed size, Zip code median income quartile.

Conclusion

Black, Hispanic, and other race and ethnicity children with acute osteomyelitis experienced longer LOS than White children. Further research into mechanisms underlying these differences, including social determinants such as access to care or structural racism, may be important to improve care for children with osteomyelitis.

Disclosures

All Authors: No reported disclosures.
1164. Antibacterial Utilization for Febrile Illnesses and Laboratory-Confirmed Bloodstream Infections in Northern Tanzania
Authors: Moorthy Ganga S , Madut Deng , Kilonzo Kajiru G , Lwezaula Bingileki , Mbwasi Ronald , Mmbaga Blandina , Ngocho James , Saganda Wilbrod , Officer Clinical , Bonnewell John P , Carugati Manuela , Egger Joseph R , Hertz Julian , Maze Michael J , Maro Venance , Crump John A , Rubach Matthew
Published: December 2022

Background

Antimicrobial resistance is an important cause of morbidity and mortality globally; low- and middle-income countries (LMICs) face an especially high burden. Ineffective antimicrobial prescriptions and use of broad-spectrum agents contribute to resistance. We describe antibacterial prescribing patterns in patients with febrile illnesses and bloodstream infections (BSI) in northern Tanzania.

Methods

We compared data from two hospital-based prospective cohort studies, cohort 1 (2011-2014) and cohort 2 (2016-2019), both enrolled febrile pediatric and adult inpatients in Moshi, Tanzania. Aerobic blood culture was obtained in all patients and standard methods were used to determine isolate antimicrobial susceptibility. To describe management of febrile illness, we analyzed antibacterial drug prescription prior to and after enrollment. Broad-spectrum antibacterials were categorized using published frameworks. Treatments were categorized as discordant if a blood culture isolate was not susceptible to the patient’s antibacterial regimen. We performed descriptive statistics and logistic regression to understand predictors of receiving an antibacterial.

Results

In total, 2,176 febrile inpatients were enrolled. Antibacterials were administered to 430 (42.0%) and 501 (45.1%) patients prior to enrollment, and 930 (89.1%) and 1,060 (93.6%) during admission in cohorts 1 and 2, respectively. Infancy and duration of fever were associated with higher antibacterial prescribing prior to enrollment (Table 2). Broad-spectrum antibacterials were administered to 548 (52.5%) in cohort 1 and 682 (60.2%) in cohort 2. Laboratory-confirmed bacteremia was detected in 87 (4%) patients. Susceptibility results were available in 73 patients; of these, 41 (56.2%) received discordant antibacterials.

Conclusion

Antibacterials were commonly administered for febrile illness in outpatient and inpatient settings; over half of patients received broad-spectrum antibacterials. A high proportion of patients with culture-positive BSI were treated with ineffective antimicrobials. Improved laboratory diagnostics for febrile illness, antimicrobial stewardship interventions, context-specific clinical guidelines, and provider education may improve prescribing practices.

Disclosures

Julian Hertz, MD, Roche Diagnostics: Grant/Research Support.
1167. Changing spectrum of aetiology of Acute Fever with Jaundice (Tropical Jaundice) in Adults presenting to Emergency Care--- A study from a Tertiary Care Hospital in North India
Authors: Suri Vikas , Singh Mandeep , Duseja Ajay , Biswal Manisha , Singh M P , Goyal Kapil , Mohindra Ritin , Singh Harpreet , Bhalla Ashish , Ratho R
Published: December 2022

Background

The spectrum of infections causing the above acute onset fever with jaundice has changed over the last few years from the conventional hepatotropic viruses to new emerging infections.

Methods

250 adult patients ≥ 14 years of age) with acute fever (body temperature > 101ᵒF of 14 days or less in duration) without any localized source of infection on initial clinical evaluation accompanied with jaundice (hyperbilirubinemia ≥ 1.5 mg/dl or elevation of ALT or AST ≥ three times upper limit) were enrolled.All these patients with fever and jaundice were evaluated on the basis of a standard proforma and were evaluated for malaria (peripheral smears/rapid diagnostic kits), scrub typhus( PCR /IgM ELISA), leptospirosis(IgM ELISA), enteric fever by blood cultures and dengue by dengue (NS1 antigen test and IgM ELISA), Hepatitis(IgM ELISA of EBV/HSV, IgM ELISA of HAV/HEV and HBsAg with IgM HBc ELISA if HBsAg positive)

Results

62.5 % were males and 37.5 % were females. The mean duration of fever before the presentation was 8.1 ± 2.58 days. 10 patients (4%) died, while 133 patients (96%) improved with treatment. Scrub typhus 57 (22.8%), Hepatitis E 33 (13.2%), malaria 9 (3.6%), dengue fever, enteric fever, hepatitis A and leptospirosis in 26 (10.4%), 6 (2.4%), 6 (2.4%) patients and 4 (1.6%) patient respectively were the prominent aetiology a patient presenting with fever and jaundice. Probable sepsis (Fulfilling SIRS criteria with a negative culture) accounted for 40(16%) patients. In 69(27.6%) cases no diagnosis could be made on serological testing Conjunctival suffusion (OR=23.17), respiratory crepitations (OR=5.17), thrombocytopenia (OR=1.14), normal INR (OR=0.29) were significant predictors of a diagnosis of scrub typhus in patients with fever and jaundice. Severe anaemia (Hb< 8), Hypoalbuminemia, severe thrombocytopenia (Platelet count < 50,000) and a near-normal INR at admission were predictors of a malarial vs a viral aetiology of Tropical jaundice. Co-infection with scrub typhus and malaria was seen in 6 patients (vivax-5 and falciparum-1) and viral hepatitis A & E was observed in 10 patients.

Conclusion

Neglected Tropical diseases like Scrub typhus infection is emerging as common aetiology of acute onset tropical jaundice in adults presenting to emergency services.

Disclosures

All Authors: No reported disclosures.
1171. Epidemiology of Old World Cutaneous Leishmaniasis among Members of the U.S. Military
Authors: Cebula Brenan R , Porter William D , Wortmann Glenn , Byrne William R , Polhemus Mark , Billick Kendall , Bernstein Wendy B , Hawkes Cliffton , Marovich Mary , Aronson Naomi E
Published: December 2022

Background

Cutaneous leishmaniasis (CL) is a threat to U.S. Military personnel as they deploy to endemic areas. As treatment may require evacuation, CL undermines operations. Elucidating the epidemiology of CL in this population is key for prevention.

Methods

We retrospectively reviewed data from a CL sodium stibogluconate treatment trial at Walter Reed Army Medical Center, Washington DC. 412 military members with parasitologically confirmed CL and deployment to Southwest Asia from May 2002 - August 2004 enrolled. Subjects’ CL lesions were counted and measured. 334 subjects completed a risk survey. Given no control group, we used number of CL lesions (NL), total lesion area (TLA), and lesion location as outcomes to assess CL risks. Non-parametric tests and logistic regression were used as appropriate.

Results

Permethrin treated bed net use was associated with lower NL (p = 0.000), TLA (p = 0.024), and odds of head/face lesion (OR 0.12, p = 0.047). Sleeping in a combat uniform was associated with lower TLA (p = 0.000) and odds of leg/foot lesion (OR 0.39, p = 0.023). Use of a permethrin treated uniform (p = 0.002) and N,N-diethyl-meta-toluamide (DEET) insect repellent at night (p = 0.046) were associated with lower NL. Noting unit members with similar lesions was associated with higher NL (p = 0.007) and odds of head/face lesion (OR 12.1, p = 0.019). National Guard status followed by Active Duty was associated with higher NL (p = 0.002) and TLA (p = 0.000) than Reserve. Sleeping in a building was associated with higher TLA (p = 0.008) and odds of arm lesion (OR 2.28, p = 0.016). Sleeping near animal burrows was associated with higher NL (p = 0.031). Sleeping on a cot (p = 0.006), certain ethnicities (p = 0.020) and certain military occupational specialties (p =0.038) were associated with higher TLA. Increasing age (p = 0.001) and years of service (p = 0.000) were positively correlated with TLA.

Conclusion

This is the largest group of U.S. Military members with CL reported and provides insight into risks for CL which will guide preventive efforts to reduce the burden of illness in this population.

The opinions and assertions expressed herein are those of the author(s) and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of Defense, or the U.S. Government.

Disclosures

Naomi E. Aronson, M.D., Elsevier: Royalties as text editor, honoraria for chapter writing|UpToDate: royalties for writing chapters.
1186. Zika Virus Screening in Pregnancy in the Military Health System, 2012-2019
Authors: Wellington Trevor , Fraser Jamie , Kuo Huai-Ching , Hickey Patrick , Lindholm David A
Published: December 2022

Background

Zika virus (ZIKV) is an emerging arthropod-borne viral disease capable of causing fetal complications in pregnant patients exposed to the virus. Pregnant women are at risk of contracting ZIKV when they (or their partners) travel to areas with known transmission. Currently, asymptomatic prenatal screening for ZIKV is not routinely recommended, regardless of travel history, though rates of birth defects are similar between symptomatic and asymptomatic women. We sought to evaluate the rate of true positivity among pregnant patients coded for ZIKV in the Military Health System (MHS).

Methods

KAPOS (Deployment and Travel Health: Knowledge, Attitudes, Practices, and Outcomes Study) is a multi-cohort study evaluating the burden of travel-associated diseases in the MHS. The MHS Data Repository was searched for International Classification of Diseases (ICD)-10 codes for ZIKV infection in military beneficiaries receiving care during fiscal years 2012-2019. Subjects then underwent chart review for history of travel, diagnostic confirmation, pregnancy status, and pregnancy complications.

Results

230 unique subjects coded for ZIKV were identified. 124 subjects underwent chart review for diagnostic confirmation, of which 58 (47%) were pregnant. Of pregnant subjects captured for ZIKV, 41 (71%) were ruled out by laboratory evaluation, while 7 (12%) subjects were determined to have suspected, probable, or confirmed ZIKV. All subjects but one were asymptomatic. Travel locations associated with ZIKV in pregnancy were Puerto Rico (n=2), Guyana (n=2), and Brazil (n=1). Two subjects reported only partner travel to ZIKV regions (Cuba, Guyana). There were no documented cases of microcephaly, fetal loss, or preterm birth.

Conclusion

ZIKV infection in pregnancy can result in fetal malformations, though the role of laboratory screening in pregnant patients remains uncertain. While a majority of pregnant subjects coded for ZIKV were excluded by laboratory evaluation upon review, several cases of ZIKV were identified through screening, particularly in those with travel (or partner travel) to endemic regions. This study provides further insight into the importance of prenatal screening for ZIKV in pregnancy, particularly among those with personal and/or partner travel to endemic regions.

Disclosures

All Authors: No reported disclosures.
1198. Impact of Quaternary Ammonium Disinfectants on Transfer of viruses from Fomites to the Finger
Authors: Gerba Charles P
Published: December 2022

Background

Hard and soft surfaces (fomites) can play a role in the transmission of both enteric and respiratory viruses. Transmission can occur by touching of contaminated surfaces and bringing the hand to the either the mouth or nose or by re-aerosolization of the virus from the surface. In adults face touching occurs every 3 to 4 minutes. The amount of virus transfer which occurs depends on the nature of the surface, the virus and the degree and type of activity within a facility.

Methods

We conducted studies on the finger transfers of both a non-enveloped (MS-2 coliphages) and an enveloped virus (coronavirus 229E).

Results

The greatest degree of the non-enveloped virus occurred with acrylic plastic and stainless steel, while the greatest transfer of the enveloped virus occurred from porcelain. Transfer to the finger from surfaces of the coronavirus was reduced by treatment of surfaces with various commercially available quaternary ammonium disinfectants after 24 hours of application to the fomites by 37% to 99.9%. Using MS-2 coliphage as a tracer virus placed on a high touch fomite, we found that the use of quaternary ammonium containing disinfecting wipes in a long term care facility reduced the contamination of fomites by 80%.

Conclusion

The results indicate that spread of viruses in a facility and exposure via hand contact can be significantly reduced by disinfection of fomites.

Disclosures

Charles P. Gerba, PhD, Allied Biosciences: Grant/Research Support|Boeing: Grant/Research Support|Corning: Grant/Research Support|GOJO: Grant/Research Support|Rickett: Advisor/Consultant|Rickett: Grant/Research Support.
1199. Implementation of a Nasal Antiseptic Decolonization Program Reduces the Occurrence of Healthcare-Associated Infections in the Adult Intensive Care Unit Setting
Authors: Kreiling Stephanie , Watson Rachel , Perez Gabriela , Carr Adrienne , Wolfe Rachel
Published: December 2022

Background

Universal decolonization programs effectively reduce methicillin-resistant Staphylococcus aureus (MRSA) infections, bloodstream infections, and healthcare costs. However, universal decolonization programs that utilize mupirocin may promote antimicrobial resistance. Non-antibiotic interventions, such as nasal antiseptic decolonization, can contribute to the prevention of healthcare-associated infections (HAIs). A large hospital system sought to evaluate the impact of a universal nasal antiseptic program on HAIs in the adult intensive care unit (ICU) setting.

Methods

A nasal antisepsis decolonization quality improvement project (QIP) was implemented to reduce ICU HAIs by applying a 62% nasal antiseptic swab with emollients bilaterally to the nares every 12 hours for all adult ICU patients. The program was piloted across nine ICUs at three large hospitals from November 2021 to January 2022 and captured data from 12,404 patient days and 4,058 treatment days. Central line-associated blood stream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and MRSA bacteremia rates were compared a) between treated and non-treated patients during the QIP period and b) to rates during a three-month period prior to the QIP.

Results

The results of the pilot program indicated that patients who received treatment with the 62% nasal swab developed fewer HAIs than patients who did not receive the treatment. Two HAIs occurred in the treatment group (two CAUTIs) compared to 14 HAIs in the non-treatment group (three CAUTIs, nine CLABSIs, and two MRSA bacteremia). Figures 1 and 2 below demonstrate HAI rates in the non-treatment and the treatment groups. Figure 1Figure 2

Conclusion

Based on pilot results, the system approved implementation of a universal nasal antisepsis program using the 62% alcohol based nasal swab with emollients for expansion to all adult critical care units. Considerations for the future implementation of the program include broadening patient inclusion and performing ongoing HAI surveillance of treated and untreated patient groups.

Disclosures

All Authors: No reported disclosures.
1203. Assessment of Infection Prevention and Control Programs in Acute Care Facilities in Central and South America
Authors: Quiros Rodolfo E , Rock Clare , Fabre Valeria
Published: December 2022

Background

Little is known about the development of Infection Prevention and Control (IPC) programs in Latin American hospitals despite alarming rates of multidrug resistant healthcare-associated infections (HAIs) in the region. The aim of this study was to identify gaps in implementation of hospital IPC programs in Latin America.

Methods

We conducted a cross-sectional survey using a self-assessment tool (Spanish version) adapted from the World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF) in March 2022. The survey was deployed to 40 hospitals in Panama, Guatemala, Ecuador, and Argentina through a regional research network. The instrument has 8 components (score 0-100), with 800 as maximum overall score. Facility IPC program implementation is categorized into four levels based on the final score: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Median scores, overall and by component, were calculated. Additionally, for each question, we estimated the proportion of hospitals that met criteria stratified by private and public hospitals.

Results

Thirty five hospitals (14 private and 21 public) completed the evaluation (88% response rate), 83% were academic, and 14% were < 110 bed-hospitals. Overall, 57% of hospitals fell in the “Advanced” category (percentile [p]10: 518; p 50 614; p90 744). The median score for each component is shown in the Figure. IPC education and training, and workload, staffing and bed occupancy had the lowest median scores (Figure). In general, public hospitals had lower scores than private hospitals (Figure). Most hospitals performed surveillance for HAIs and hand hygiene, although fewer monitored compliance with adherence to prevention bundles or communicate these data to front-line workers. Additional gaps were identified, principally between private and public hospitals (Table). Figure: Median score for individual IPCAF component for all hospitals, private and public heathcare facilities.

Conclusion

While most participating hospitals were considered “advanced” based on the IPCAF score, several gaps were identified, which differed between public and private hospitals. Insufficient IPC education and training, workload, staffing and bed occupancy, multimodal strategies and lack of leadership support may be barriers to effective IPC programs in the region.

Disclosures

All Authors: No reported disclosures.
1205. Does Perception of Cleanliness Matter? A Correlational Study Exploring Patient Perception of Cleanliness and HAC Score Performance
Authors: Stowe Caitlin
Published: December 2022

Background

One of the most common causes of healthcare associated infections (HAIs) is due to environmental contamination of surfaces in the patient care areas. Cleaning and disinfection of these surfaces has been shown to reduce the incidence of HAIs and contributes to the overall hospital cleanliness. Currently, hospital cleanliness is publicly reported through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey that is sent to all patients discharged from a healthcare facility. There is very limited research on if the perception of hospital cleanliness is related to the incidence of HAIs in a healthcare facility as defined by the facility's performance in the Healthcare Acquired Conditions (HAC) program.

Methods

A retrospective correlational study was performed to examine the relationship of patient perception of hospital cleanliness and the incidence of Clostridioides difficile (C. difficile) and Methicillin Resistant Staphylococcus aureus (MRSA) HAIs defined by the facility's HAC score. Multiple Center for Medicare and Medicaid Services (CMS) datasets were utilized for the study. There were approximately 2300 acute care facilities included that reported data on the patient perception of room cleanliness question, and either C. difficile or MRSA standardized infection ratio (SIR) for the time period of October 1, 2018 to September 30, 2019. Basic descriptive statistics and Spearman's correlational analyses were performed to analyze the relationships between the HAI HAC scores and the HCAHPS answer description to measure the potential association.

Results

The study found that as the percentage of patients who reported that their room was “always” clean increased, the hospital’s CDI or MRSA SIR decreased (r= -0.228,p= 0.00; r= -0.130,p= 0.00). The analysis also revealed that as the percentage of patients who reported their room was "never" clean increased, the facility's CDI or MRSA SIR increased (r= 0.180, p = 0.00; r=0.140, p= 0.00).

Conclusion

This study found that a hospital’s HCAHP performance on patient perception of cleanliness is related to their performance on certain HAIs as defined by performance on HAC scores. Further research is needed to determine if there are specific factors that influence patient perception of cleanliness.

Disclosures

Caitlin Stowe, MPH, CPH, CIC, CPHQ, VA-BC, ActivePure Medical: Employment|PDI Healthcare: Employment.
1206. Epidemiological interaction of MRSA, ESBL E.coli and C. difficile between ICU/Step-down Unit of University-affiliated Community Hospital and LTACs in Japan: Utility of Molecular Epidemiology Analysis by PCR-based ORF Typing (POT method)
Authors: Saito Hiroki , Kasai Fumimasa , Takakura Tomomi , Ohno Tatsuya , Hosoyama Akiko , Fujitani Shigeki
Published: December 2022

Background

Epidemiological interaction of drug resistant organisms between ICU and surrounding health facilities including LTACs have been of interest in the era of antimicrobial resistance (AMR) and aging society. In addition, conventional molecular epidemiology methods such as pulsed-field gel electrophoresis, and multilocus sequence typing are time-consuming and difficult to perform in a standard microbiology laboratory.

Methods

Patients admitted to a university-affiliated community hospital in Japan was recruited if their cultures collected clinically during admission grew the following target pathogens: Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin Resistant Enterococci (VRE), ESBL Gram negative rods (GNR), carbapenem-resistant Enterobacteriaceae (CRE), multi-drug resistant Pseudomonas (MDRP) and Clostridioides difficile (C. diff). Their clinical information including admission to ICU/step-down unit vs regular wards and disposition was analyzed with chi-square test for binary outcomes.

For the isolates of MRSA, ESBL E. coli, and C. diff, further molecular epidemiology analysis was made, using PCR-based open-reading frame (ORF) Typing (POT method), a more resource-friendly and time-efficient technology originally developed in Japan.

Results

Among total 9639 hospital admissions in 2018-2019, the above-mentioned target pathogens grew from 233 patients (2.4%). There were 96 MRSA isolates (41.2%, out of 233), followed by 93 ESBL GNR (39.9%), 21 C. diff (9.0%), 13 CRE (5.6%), 10 MDRP (4.3%), and no VRE, respectively. Patients admitted to ICU/step-down unit were more likely to grow the target pathogens (117/1605 vs 116/7801, RR 4.90, 95% CI 3.81-6.30, p< 0.001), and to be discharged to LTACs than patients admitted to regular wards (70/113 vs 32/116, RR 2.17, 95% CI 1.56-3.02).

Molecular epidemiology analysis with POT method identified 5, 3 and 3 common strains across 20, 11, and 7 patients with MRSA, ESBL E.coli, C. diff, respectively.

Conclusion

The study suggests the pathogens of higher priority were more prevalent in ICU/step-down unit and that the discharge from ICU/step-down unit to LTACs could impact on further transmission in the surrounding region. POT method can be utilized for more efficient molecular epidemiology analysis in the era of AMR.

Disclosures

All Authors: No reported disclosures.
1215. Variation in Hand Hygiene Improvement After Implementation of an Electronic Hand Hygiene System During the COVID-19 Pandemic
Authors: Steinberg James P , Overton Elizabeth , Feistritzer Nancye , Love Kari L , Holdsworth Jill , Whitson` Margaret , Lewis Lorry , Lewis Lorry , Swann Julie , Jacob Jesse T
Published: December 2022

Background

Electronic hand hygiene (HH) monitoring systems have many potential advantages but there are limited data on wide-scale implementation of these systems. TableHand Hygiene Observations, Improvement in Adherence Rates and SIR Trends by Hospital

Methods

We deployed an electronic HH monitoring system in over 2,100 acute and critical care rooms across 9 hospitals in an academic health system. Badges with a Bluetooth beacon were issued to over 7,000 healthcare workers. Deployment began in early 2020 and was interrupted by the pandemic. The rollout of interventions to improve HH adherence was managed at the hospital level. Healthcare-associated infections (HAIs) were determined by the infection prevention team using standard CDC definitions. Hospital-level HH adherence rates were compared to a composite SIR including SIRs for CLABSI, CAUTI, hospital-onset MRSA bloodstream infections and hospital-onset Clostridiodes difficile infections.

Results

Between January 2020 and April 2022, there were over 36 million hand hygiene opportunities with an average of 19 observations per staffed room per day. Overall HH adherence improved from 46% to 60%, with significant variation by hospital (4 improving by >25% and 3 by < 5%). Hospitals whose implementation was most delayed showed the least improvement. Preliminary analysis found no relationship between hand hygiene improvement and the SIR composite aggregated by calendar year.

Conclusion

Despite the challenges of large-scale implementation of an electronic HH system during a pandemic, we demonstrated an overall improvement in HH adherence. The wide variation in improvement among hospitals was due to timing of implementation, variation in the dedicated hospital-specific project management resources and leadership engagement. In addition to technology, successful implementation of electronic HH systems requires dedicated resources and culture change. Pandemic-related staffing challenges, disruption of standard HAI prevention efforts and intensive device utilization confounded our ability to show a relationship between HH adherence and HAI rates.

Disclosures

All Authors: No reported disclosures.
1218. Genotypic Investigation of a Rotavirus Cluster at a Pediatric Hospital in 2022
Authors: Yoon Hee-won , Kitt Eimear , Smith Kenneth , Comar Courtney E , Harris Rebecca , Hopkins Amy , Jaimes Jose , Rustempasic Slavica Mijatovic , Gautam Rashi , Esona Mathew D , Handy Lori
Published: December 2022

Background

Rotavirus group A (RVA) was the most common cause of infectious gastroenteritis among young children before introduction of rotavirus vaccine in the United States in 2006. Following widespread vaccination, U.S. hospital acquired (HA) rotavirus cases are rare. We describe a cluster of rotavirus infections in a pediatric hospital with a genotype uncommon among U.S. children.

Methods

Patient cases of HA gastrointestinal (GI) illness were detected through hospital-wide microbiology surveillance, performed by Infection Prevention and Control (IPC) practitioners per state requirements. Cluster procedures were implemented on a unit when 3 cases were identified by symptoms and/or laboratory tests within 48 hours. Due to the current rarity of rotavirus clusters, the hospital partnered with Centers for Disease Control and Prevention (CDC) laboratories to sequence strains in addition to instituting local control measures. RVA strains were genotyped by using the genotype specific qRT-PCR assays for VP7 and VP4 genes. Next Generation Sequencing (NGS) was performed for RVA strain characterization on Illumina MiSeq. Genotypes for all 10 RVA were determined by NCBI’s BLASTN program.

Results

Epidemiologic surveillance identified a rotavirus cluster of 10 patients aged 10 months to 10 years old, of whom 50% had received rotavirus vaccine. Symptoms included emesis and diarrhea. Cases could not be attributed to vaccine related shedding. All patients had epidemiologic links by contiguous bed spaces or shared care teams. Sequencing was conclusive for 9 of the 10 stool samples to be a G9P[4] genotype, which is rarely detected amongst U.S. children. Local control measures of increased education and cleaning, isolation of positive patients in single rooms, use of soap and water instead of alcohol-based hand sanitizer on room exit, and furlough of symptomatic healthcare workers halted transmission.

Conclusion

Routine surveillance of HA GI illness identified a cluster; RVA strain genotyping and characterization identified unusual rotavirus genotype G9P[4] as the cause. Partnership between IPC practitioners and laboratorians with CDC demonstrated the need to enhance infection prevention measures to halt transmission and identified a rare rotavirus strain as the likely cause of the cluster.

Disclosures

Courtney E. Comar, PhD, Pfizer: Stocks/Bonds|Viatris: Stocks/Bonds.
1222. Summary of CDC consultations related to non-traditional medical therapies, 2016─2021
Authors: Beshearse Elizabeth , Perz Joe , Perkins Kiran M
Published: December 2022

Background

Non-traditional medical therapies, which include invasive or parenteral therapies for unapproved conditions, such as stem cell joint injections and certain cosmetic procedures may lack regulatory oversight and pose infectious risks to patients. We aimed to describe Centers for Disease Control and Prevention (CDC) consultations involving outbreaks or infection control lapses that involved non-traditional medical therapies to identify areas for prevention efforts.

Methods

We reviewed internal CDC records from January 1, 2016, through December 31, 2021, to identify consultations that involved investigations of disease transmission and infection control lapses involving non-traditional medical therapies in U.S. settings. We included consultations involving therapies and procedures such as facials, fillers, microneedling, intravenous hydration, vitamin infusions, platelet-rich plasma (PRP), and stem cell injections. We determined number of consultations and patients infected or exposed to infection control lapses, infection types, types of procedures implicated, pathogen of concern, and whether at-risk patients were notified.

Results

We identified 25 consultations that met inclusion criteria; 22 involved 65 infected patients and 3 involved infection control lapses without identified infections. Infection types included joint (n=8, 32%), skin and soft tissue (5, 20%), and bloodstream (3, 12%). The most common pathogens implicated included nontuberculous mycobacteria (3, 12%), hepatitis C virus (3, 12%), and several Enterobacterales (6, 24%). Therapies most frequently involved included PRP or stem cell joint injections (9, 36%), vitamin infusions/injections (4, 16%), and aesthetic treatments (6, 24%). Settings most commonly involved chiropractic clinics (3, 12%), pain clinics (3, 12%), medical spas (2, 8%), orthopedic clinics (2, 8%), and aesthetics clinics (2, 8%).

Conclusion

Lapses in infection control practices involving non-traditional medical therapies have the potential to place patients at significant risk of infection. Targeting infection control education and oversight to settings where these procedures commonly take place may help reduce patient risk.

Disclosures

All Authors: No reported disclosures.
1227. Candida Sternal Wound Infections After Cardiac Operations: Uncommon but Deadly
Authors: Seo Jung M , Louie Brian J , Phe Kady , Ghanta Ravi K , Trautner Barbara , Fukuta Yuriko
Published: December 2022

Background

Sternal wound infections (SWI) are a devastating complication of cardiac surgery. The majority of SWI are bacterial infections; however, Candida species are a less common cause and have not been well described. The purposes of this study were (1) to describe clinical characteristics, management and outcomes of Candida SWI and (2) to compare the risk factors and outcomes for Candida to bacterial SWI.

Methods

Our study reviewed medical records of 41 patients with Candida SWI after cardiac surgeries between 2013 - 2020 at our medical center, then compared them to 76 patients with bacterial SWI during the same timeframe via univariate analysis. We defined superficial SWI as positive culture isolates involving the skin or subcutaneous tissues, deep SWI as involving deep soft tissues or bone, and mediastinitis as involving the mediastinum.

Results

Of the 41 Candida SWI patients, relevant comorbidities included previous cardiac surgery (46.3%), heart failure (65.9%), and diabetes (58.5%). Candida SWI was diagnosed at an average of 123.6 days after cardiac surgery, with the majority being deep SWI (70.7%). Candida albicans was most common (70.7%). Bacterial co-infections were found in 53.7% (Table 1). Longer bypass and operative times for the initial cardiac surgery were found to be positively correlated to disease severity. Clinical cure rate after completion of antimicrobial treatment was 100% in superficial SWI, 72.4% in deep SWI and 25.0% in mediastinitis. Overall mortality was 29.3%: 25%, 24.1% and 50.0%, respectively. When compared to bacterial SWI, factors significantly associated with Candida SWI included: previous cardiac surgery (46.3% vs. 7.9%, odds ratio (OR): 5.9; 95% confidence interval (CI): 2.2-15.9), heart failure (65.9% vs. 11.8%, OR: 5.6; 95% CI: 2.4-12.9), and >48 hours of postoperative antibiotics (39.0% vs. 3.0%, OR: 9.9; 95% CI: 2.7-35.9). Mortality rates were higher with Candida than with bacterial infections (29.3% vs. 1.3%, OR: 22.2, 95% CI 2.8-177.2) (Table 2).

Conclusion

This study showed Candida SWI as a serious complication of extensive cardiac surgery with higher mortality rates. Prior history of cardiac surgery and heart failure, prolonged surgeries, and complicated postoperative course were significant risk factors for the development of Candida SWI.

Disclosures

Barbara Trautner, MD, PhD, Genetech: Advisor/Consultant.