bluuebunny/crossref_metadata_2025 huggingface dataset:
P-120. Treatment of Acute Uncomplicated Diverticulitis among Hospitalized Patients: Clinical Practices and Outcomes
Authors: Tehaili Hussein , Shams Zainab , Malviya Meenal , Szpunar Susan M , Johnson Leonard B
Published: January 2025

Background

There are limited data comparing the outcomes of different antibiotic regimens for uncomplicated diverticulitis among hospitalized patients. We evaluated physician prescribing and outcomes based on discharge antibiotic regimens among hospitalized patients with acute uncomplicated diverticulitis.

Methods

We performed a retrospective chart review on adult patients at a tertiary care hospital between July 2018 and June 2023 diagnosed with acute uncomplicated diverticulitis. Uncomplicated diverticulitis was defined as patients without perforation, peritonitis, abscess, or strictures. We collected data on demographics, comorbid medical conditions, Charlson score, imaging findings and antibiotic treatment regimens as inpatient and outpatient. Ninety-day outcome measures included readmissions for relapse of diverticulitis, intervention for complications (operative or by interventional radiology) and episodes of Clostridioides difficile infection (CDI). Data were analyzed using Student’s t-test, the chi squared test, and the Mann-Whitney U test.

Results

Among 108 evaluable patients, 91.7% (99) received inpatient beta-lactam (BL) based therapies. Upon discharge, 44.4% (48) received fluoroquinolones (FQ) and 55.5 % (60) got BL based therapies. The groups were similar in demographics and clinical conditions; however, the median Charlson score was significantly higher in the BL group than the FQ group (1.0 (range 0-11) vs. 0.0 (range 0-7)), respectively. There were no differences in length of treatment as inpatient (3.3 days ±1.6 BL vs 3 days ± 1.3 FQ, p = 0.24) or outpatient (7.5 ± 4.6 BL vs. 7.0 ± 2.1 FQ, p = 0.51). Patients with a recurrence had a higher prevalence of rheumatologic disease than those without a recurrence, 28.6% vs. 9.6%, respectively, p=0.04), There was no significant difference in recurrence or readmission by outpatient regimen (57.1% BL vs 55.3% FQ, p = 0.9). There were two patients in the BL group who subsequently needed intervention and drainage on readmission and two episodes of CDI, one in each group.

Conclusion

In our study, there was no overall difference in 90-day outcomes for patients with acute uncomplicated diverticulitis who received FQ or BL therapy on discharge. Further studies should be performed to confirm this observation.

Disclosures

All Authors: No reported disclosures
P-157. Molecular epidemiology of carbapenemase genes among carbapenem-resistant Klebsiella pneumoniae (CR-Kp) from the Philippines: implications for surveillance and treatment
Authors: Maurice Salvana Edsel , Poblete Jonnel B , Francisco Christian , Geganzo Stessi , Luzentales Vivienne , Grace Hernaez Ma , dela Tonga Angelo , Perez Federico , Paterson David , Bonomo Robert A
Published: January 2025

Background

In the Philippines, the proportion of carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has doubled in the past decade and now exceeds 15%. However, the prevalence of different carbapenemase genes remains unknown. Unlike the United States and China where blaKPC predominates, blaOXA-48-like serine carbapenemases and metallo-β-lactamases (MBL) blaNDM, -IMP, and -VIM frequently occur among CR-Kp in the Asia-Pacific region. In order to better inform empiric treatment strategies and assist with infection prevention, we investigated the carbapenemases present in CR-Kp from the Philippine General Hospital (PGH), a 1,500-bed tertiary care national referral center in Manila, Philippines.Table 1.Carbapenemase genes detected with Xpert® Carba-R among carbapenem-resistant Klebsiella pneumoniae isolates from the Philippine General Hospital in Manila, Philippines.

Methods

CR-Kp from clinical samples were identified in the clinical microbiology laboratory at PGH using the VITEK® 2 platform (bioMerieux, USA). These isolates were collected and underwent rapid molecular testing with Xpert® Carba-R (Cepheid, USA) at the central laboratory of the Philippine National Institutes of Health. Molecular test results were typically available within 24 hours from the time of identification. These results were relayed to the treating physicians to guide clinical decision-making.

Results

A total of 81 CR-Kp isolates were collected from February to May 2024. Isolates were obtained from respiratory (n=44, 54.3%), blood (n=24, 29.6%), urine (n=9, 11.1%), and tissue/wound (n=4, 4.9%) samples. Table 1 summarizes the carbapenemase genes detected with Xpert® Carba-R among CR-Kp isolates from PGH, including multiple genes present in some samples.

Conclusion

Among CR-Kp from PGH, blaNDM was the predominant carbapenemase, followed by blaOXA-48-like and blaKPC genes. A third of the isolates co-harbored blaNDM and a serine carbapenemase, usually blaOXA-48-like. These findings suggest that there is molecular heterogeneity and likely plasmid spread among CR-Kp in the Philippines. These findings also underscore the importance of molecular surveillance programs that can rapidly characterize resistant strains, highlight the emergence of novel genotypes, and inform empiric and definitive therapy for CR-Kp.

Disclosures

Federico Perez, MD, MS, Merck: Grant/Research Support David Paterson, Infectious Diseases Physician, AMR Action Fund: Board Member|Aurobac: Advisor/Consultant|bioMerieux: Grant/Research Support|bioMerieux: Honoraria|CARB-X: Advisor/Consultant|Entasis: Expert Testimony|Menarini: Honoraria|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support|Shionogi: Honoraria
P-161. Assessing Antibiotic Usage Patterns, Knowledge Gaps, and Influencing Factors Among Poultry Producers, Veterinarians, and Farmers in Kerala, India
Authors: Kochuparambil Jose J
Published: January 2025

Background

Antibiotic resistance is a pressing global concern exacerbated by widespread antibiotic use in livestock farming. This study aims to assess antibiotic consumption patterns and knowledge gaps among poultry producers, veterinarians, and farmers in Kerala, India, crucial for implementing effective antimicrobial stewardship strategies.

Methods

A cross-sectional survey was conducted across Kerala, India, involving poultry producers, veterinarians, and farmers. Data were collected through structured interviews, focusing on antibiotic usage, knowledge, feeding practices, and biosecurity measures on poultry farms. Statistical analysis, including descriptive statistics, inferential tests, and regression analysis, was conducted to assess associations between variables and demographic factors.

Results

Among the participants, 37% of poultry producers were from urban areas, while 63% were from rural areas. The majority of veterinarians (65%) had over five years of experience in poultry farming. Tetracyclines, aminoglycosides, and cephalexin were the most commonly used antibiotics, with 35% of producers reporting their frequent use. Regression analysis revealed that farm size and educational level significantly influenced antibiotic usage patterns, with larger farms and producers with higher education levels more likely to use antibiotics regularly (p < 0.001). Despite high antibiotic usage, there were significant knowledge gaps among stakeholders regarding antibiotic resistance. Only 37% of farmers were aware of the link between antibiotic use and antimicrobial resistance. A significant association between knowledge of antibiotic resistance and age was observed, with older farmers demonstrating higher levels of awareness. 57% of farmers above the age of 50 were aware of antibiotic resistance compared to 23% of farmers below the age of 30 (χ² = 15.6, p < 0.001). Additionally, farmers who had attended training programs on antibiotic stewardship were significantly more knowledgeable about antimicrobial resistance compared to those who had not received training (p < 0.01).

Conclusion

The study highlights the need for targeted interventions to promote responsible antibiotic use and combat antimicrobial resistance.

Disclosures

All Authors: No reported disclosures
P-204. Contemporary Economic and Healthcare Burden Associated with Clostridiodes difficle Infections (CDI) in the United States
Authors: Thapaliya Dipendra , Krishnan Vidya , Hill Hannah
Published: January 2025

Background

Centers for Disease Control and Prevention (CDC) estimated that in 2017, there were 223,900 cases of CDI in hospitalized patients and 12,800 deaths in the United States. CDI is the most common health care-associated infection, and a leading cause of diarrhea in the hospitalized patients (Magill et. al., 2015). Incidence of Community-associated CDI is rising in recent years (Chitnis et. al., 2013; Gerding & Lessa 2015).

Methods

The National Inpatient Samples (NIS) datasets include de-identified patient-specific and hospital-specific information for hospitalized patients across the U.S. We utilized these datasets to study the economic and healthcare burden associated with CDI. Data were downloaded and SAS software was used for analyses. Continuous variables were summarized by means and standard deviations and compared using Student’s t-tests. Categorical variables were summarized by percentages and compared using Chi-squared or Fisher’s tests, as appropriate. Bivariate and multivariable logistic regression models were created to determine factors that are associated with the primary outcome.Table 1:Patient Characteristics

Results

A total of 10,806 cases of CDI were identified among in-patient samples of 1818,090 patients during 2017-2019 in 9 geographic regions across the United States. This constitutes 10% sample of the NIS dataset. Compared to 2017, significant increase in CDI was observed in 2018 and 2019 (12% vs 46 and 41% respectively). Of the patient population, mean age at admission was 66 years; white had the highest cases of CDI compared to any other race (p < 0.001). Majority of the CDI cases were observed in teaching hospitals compared to community hospitals (71% vs 9.3%; p=< 0.001). South Atlantic region had the highest CDI burden (20%) followed by East North Central region (18%). Large hospitals based on bed size observed significantly higher cases of CDI (51%, p = 0.017). Hospitalization charges was significantly higher among CDI patients (mean $ 109,798 vs $56,530; p = < 0.001).

Conclusion

These results highlight the significant disease morbidity and mortality as well as economic burden caused by CDI and warrants effective mitigation strategies to address the risk factors to minimize CDI.

Disclosures

All Authors: No reported disclosures
P-211. Implications of Skilled Nursing Facility Origin on Clostridioides difficile Infection Hospitalizations in the United States
Authors: Reveles Kelly , Strey Kelsey , Evans Cory T , Tillotson Glenn S
Published: January 2025

Background

Clostridioides difficile infection (CDI) occurs in nearly half a million Americans annually. Skilled nursing facility (SNF) residents are at increased CDI risk due to older age, underlying comorbidities, and frequent healthcare exposure. The study sought to describe the implications of CDI originating in SNFs, including CDI acuity, health outcomes, transitions of care, and economics.

Methods

This was a retrospective cohort study using the Premier Healthcare Database, which represents approximately one-quarter of United States healthcare systems. Older adult (65+ years) patients were included if they had an index, non-recurrent CDI hospitalization (ICD-10 code A04.72) between July 1, 2019 and December 31, 2022. Patient and CDI characteristics, health outcomes (inpatient mortality, hospital length of stay [LOS], readmission for recurrent CDI [rCDI]), and hospital costs were compared between patients admitted from a SNF compared to a non-SNF point of origin.

Results

A total of 94,330 index CDI hospitalizations were included. Patients were predominantly female (58.4%), White race (81.6%), and treated in urban settings (86.5%). Only 5.3% (n=5,003) of CDI patients were admitted from a SNF; however, 28.4% (n=26,891) were discharged to a SNF. One-third (31.0%) of patients admitted from a non-healthcare location were discharged to a SNF. Patients admitted from a SNF were older (median age 79 vs. 76 years) and more likely to have a secondary CDI diagnosis (85.0% vs. 74.4%) and emergent admission (90.2% vs. 82.1%) compared to non-SNF patients. Patients admitted from SNFs were also more likely to experience poor CDI health outcomes, including higher inpatient mortality (12.8% vs. 8.2%), readmissions for rCDI (14.8% vs. 13.8%), median hospital costs ($17,728 vs. $14,832), and longer median hospital LOS (8 vs. 7 days) (p< 0.05 for all). Median costs were significantly higher for patients discharged to a SNF compared to a non-SNF location ($19,560 vs. $11,481).

Conclusion

Older, hospitalized CDI patients originating from SNFs disproportionately experience poor outcomes in health and financial burden. Over one-quarter of CDI patients were discharged to a SNF suggesting a major impact on physical function, quality of life, and associated risk.

Disclosures

Kelly Reveles, PharmD, PhD, AstraZeneca: Grant/Research Support|Ferring Pharmaceuticals: Advisor/Consultant
P-262. Hydrogen Peroxide Fogging: Feasibility and CLABSI Impact in a Pediatric Hematology/Oncology Unit
Authors: Bigham Michael T , Cirese Jill , Hord Jeffrey D , Williams Stephanie , Carr Beth A , Haydar Hanan , Pangonis Evelyn , Bair Tina
Published: January 2025

Background

Hospital acquired infections, including central line infections (CLABSIs), increase morbidity and mortality in immunocompromised patients. Environmental decontamination with HHP fogging reduces bacterial growth and bioburden in the hospital setting. The investigators sought to test the feasibility of an oncology unit-based hybrid hydrogen peroxide (HHP) fogging program and assess the impact on CLABSIs.

Methods

At a large Midwest freestanding children's hospital, this study evaluated the implementation of a HHP fogging program in a 20-room hematology/oncology inpatient unit and measured three endpoints:

1) the impact of fogging on aerobic colony counts (ACC) in a cohort of patient rooms cleaned using HHP Fogging (terminal clean + ultraviolet light + HHP fogging) compared to control rooms receiving standard cleaning (terminal clean + ultraviolet light);

2) the frequency, feasibility, and safety of fogging in a busy clinical unit; and

3) the important patient safety outcome, CLABSI rate, measured as rate per 1000 central line (CL) days of both mucosal-barrier infections (MBI) and non-MBI infections.

Results

The pre-/post-cleaning ACC measured in the control rooms resulted in no decrease in average ACC while the HHP fogging intervention rooms demonstrated a 99.9% decrease in ACC. The observed fogging interval for each room did not deviate significantly from plan [plan = 19 days versus actual = 18.2 days (SD±4.7)]; with fogging scheduled for 2 days per week and with no unplanned patient room changes. There were no safety events associated with fogging. There was 100% chemical and biologic indicators passage rate affirming successful fogging cycle completion. Baseline CLABSI rate was 2.8 per 1000 CL days (non-MBI=1.3 per 1000 CL days). Since fogging began, there has been only 1 CLABSI, yielding a rate of 0.9 per 1000 CL days (non-MBI=0 per 1000 CL days). Days between CLABSI events averaged 35.4 days at baseline and only 1 MBI event since implementation (103 days after previous event).

Conclusion

Hybrid hydrogen peroxide fogging is a safe, feasible, and effective method for reducing aerobic colony count in a busy hematology/oncology clinical unit and may reduce the CLABSI rate in an immunocompromised patient population.

Disclosures

Michael T. Bigham, MD, MBA, ForTec Medical: Advisor/Consultant
P-304. Vancomycin Resistant Enterococcus faecium Minimum Inhibitory Concentration Trends from 2019-2024: Have We Killed Daptomycin?
Authors: Arena Christen J , Mulbah Jessica L , Kenney Rachel M , Shallal Anita , Davis Susan L , Veve Michael
Published: January 2025

Background

Vancomycin resistant Enterococcus faecium (VRE) has been categorized as a bacterium with serious antibiotic resistance threats in the United States, where daptomycin (DAP) has been a drug of choice. In 2019, the Clinical and Laboratory Standard Institute M100S 29th edition revised DAP breakpoints for VRE to susceptible dose dependent with a minimum inhibitory concentration (MIC) of ≤ 4 mcg/mL. Higher MICs are associated with resistant mechanisms and increased microbiological failure is seen with MICs of 3-4 mcg/L. Linezolid (LZD) is an VRE treatment option that has favorable clinical outcomes and microbiological eradication with less emerging resistance, but LZD use can be controversial due to outdated dogma of using a bacteriostatic agent. The purpose of this study was to evaluate MIC trends for DAP and LZD in patients with VRE bloodstream infections (BSI) at a large academic medical center.

Bloodstream Infection VRE Comment within the Electronic Health Record: Current and Proposed

Methods

IRB-exempt, cross-sectional study of adult patients with VRE BSI and a healthcare encounter from 2019-2024 at a 5-hospital health-system in southeast Michigan. Patients were identified using Microsoft SQL Server queries based on microbiology results. The primary outcome was the proportion of patients with a DAP MIC > 1 mcg/mL with corresponding LZD MICs. Our health-system currently recommends DAP or LZD for VRE BSI until susceptibilities are available via blood culture comment (Figure 1).

Measured MICs of daptomycin and linezolid, 2019-2024

*Daptomycin MIC Breakpoints: Susceptible Dose Dependent = ≤ 4 mcg/mL, Resistant = ≥8 mcg/mL. Linezolid MIC Breakpoints: Susceptible = ≤4 mcg/mL, Intermediate = 4 mcg/L, Resistant ≥8 mcg/L

Results

555 LZD and 491 DAP unique MICs from VRE BSI were evaluated. Figure 2 represents the average MICs by month and year for DAP and LZD from 2019-2024. The majority of DAP MICs were measured at 2 (30%), 3 (56%), and 4 (18%) mcg/mL. DAP MIC50 and MIC90 values were calculated at 3 mcg/mL and 4 mcg/mL, respectively. 98.7% of LZD MICs were measured at ≤2 mcg/mL (Table 1). LZD MIC50 and MIC90 values were calculated at 2 mcg/mL.

Average daptomycin and linezolid MIC per month and year, 2019-2024

Conclusion

While the VRE MICs for DAP are increasing, LZD has remained stable over the past 5 years. A possible stewardship opportunity is to modify the health-system's current blood culture comment could suggest LZD as the VRE drug of choice and high-dose DAP as an alternative in patients until susceptibilities are available (Figure 1).

Disclosures

Rachel M. Kenney, PharmD, BCIDP, Medtronic Inc: Spouse is an employee, stockholder
P-305. Empirical Treatment with vancomycin-resistant enterococcus (VRE) Effective Antibiotics versus Glycopeptides: Impact on Survival Outcomes in VRE Bloodstream Infections
Authors: Hung Ou Tao , Chuang Yu-Chung , Wang Jann-Tay , Chen Yee-Chun , Chang Shan-Chwen
Published: January 2025

Background

Vancomycin-Resistant Enterococcus (VRE) is a predominant pathogen in nosocomial bacteremia (BSI) in Taiwan. Although glycopeptides are traditionally recommended for empiric treatment of suspected Gram-positive infections, this study evaluates whether empiric anti-VRE antibiotics improves survival compared to glycopeptides following definitive VRE treatment confirmed by blood culture.

Methods

This retrospective cohort study was conducted at the National Taiwan University Hospital and its branches from January 2010 to July 2023. It included patients aged 18 or older diagnosed with VRE BSI who received definitive treatment with linezolid or daptomycin (defined anti-VRE antibiotics). Patients were categorized into two groups based on the initial treatment received on the onset day of VRE BSI: empiric anti-VRE and empiric glycopeptide. The primary outcome was 28-day mortality.

Results

Of 2,067 VRE BSI episodes recorded, 138 met the inclusion criteria. The average age was 64.1 years, with a male majority of 64.5%. The overall mortality rate was 55.1%. The empiric anti-VRE group included 50 patients, while the empiric glycopeptide group comprised 88 patients. Time to definitive treatment was significantly shorter for the empiric anti-VRE group (0 days) compared to the empiric glycopeptide group (2.2 days; P < 0.001). Mortality was lower in the empiric anti-VRE group at 42% versus 62.5% in the empiric glycopeptide group (P = 0.02). Multivariable logistic regression showed empiric anti-VRE treatment as a significant predictor of lower mortality (adjusted odds ratio [aOR] = 0.38, 95% CI: 0.17–0.85; P < 0.05), independent of the Charlson comorbidity index (aOR = 1.23; P = 0.008), steroid use (aOR = 2.61; P = 0.03), and the Pitt bacteremia score (aOR = 1.43; P < 0.001).

Conclusion

Among patients who received definitive treatment for VRE, those treated with empiric anti-VRE demonstrated superior survival outcomes compared to those given empiric glycopeptides. This study underscores the importance of timely and appropriate antimicrobial therapy in managing VRE infections. While our data do not advocate for the universal use of empiric anti-VRE treatment, they suggest that such therapy should be considered when VRE infection is highly suspected to potentially improve outcomes.

Disclosures

All Authors: No reported disclosures
P-321. Risk Factors for Methicillin-Resistant Staphylococcus aureus Carriers in the Intensive Care Unit: A Single-Center, Retrospective Cohort Study in Japan
Authors: Yoshida Hisato , Nigo Masayuki , Iwasaki Hiromichi
Published: January 2025

Background

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common pathogens in the intensive care unit (ICU). Active surveillance cultures (ASCs) for MRSA often performed in ICUs may not be optimal in ICU settings with low prevalence of MRSA. This study aims to determine the risk factors of MRSA carriage in the ICU and develop a clinical predictive model to optimize the screening process.

Methods

All patients screened for MRSA by nasal ASC at the time of ICU admission between April 2015 and August 2022 were retrospectively included and divided into MRSA-positive and MRSA-negative groups. Patients’ characteristics were evaluated to determine the prevalence of MRSA and the risk factors. Cost analysis was conducted based on the risk factors identified by our analysis.

Results

Of the 3,927 ICU patients included, 133 (3.4%) were MRSA-positive. Multivariate analyses showed that risk factors for MRSA carriage were age ≥60 years (odds ratio [OR]: 1.60), history of hospitalization within a year (OR: 1.51), admission under departments dealing with skin and soft tissues (OR: 3.00), and ICD-10 codes classification I (OR: 3.44). Screening patients based on at least one of the risk factors exhibited high sensitivity (93.2%) to identifying MRSA carriage and could reduce ASC overall costs by 86.9%.

Conclusion

This study suggests that universal ASCs to detect MRSA may not be optimal in ICU settings with low prevalence of MRSA. Targeted screening based on risk factors may reduce the volume and cost of MRSA screening. Prospective studies are warranted to confirm these findings.

Disclosures

All Authors: No reported disclosures
P-396. Can ‘Handshake Stewardship’ Decrease Multi-Drug Resistant Healthcare-Associated Infections and All-Cause Mortality? - Insights from A South Indian Tertiary Hospital
Authors: Issac Aleena , Sreeraj V , Puthoor Deljo , Prathibha V K , Geethalakshmi V , Thomas Maridas Tom , Joseph Thomas , Mohan Gopika P , Johnson Mariya , Thomas Alga P , Santhosh Sneha , Lubaina P R
Published: January 2025

Background

Multi drug resistant Healthcare Associated Infections (MDR HAI) pose significant challenges for both patients and healthcare facilities, often stemming from inappropriate antibiotic usage. 'Handshake Stewardship' involves a proactive approach of auditing and providing feedback on antibiotic prescriptions to ensure their rationality, with discussions held confidentially with treating physicians. Endorsed by the Centers for Disease Control and Prevention and The Joint Commission, this method aims to engage clinicians in addressing clinical barriers to antimicrobial stewardship.

Methods

This study compares MDR HAI in the inpatients of two timelines, pre period May 2021 to April 2022 and post period May 2022 to April 2023. In the post period, the rationality of the antibiotic therapy is discussed with the clinician (in-person approach) by the Antimicrobial stewardship pharmacists within 24 hours of starting the monitored antibiotic. The clinician may or may not accept the interventions and the outcome was documented electronically. The primary outcome was the MDR HAI. Antimicrobial susceptibility testing was performed by the Clinical and Laboratory Standards Institute and ‘MDR’ was assigned as per the joint initiative document by the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC). HAI referred from the CDC’s National Healthcare Safety Network (NHSN) criteria. The secondary outcome was all-cause mortality. Descriptive cross-tabulations and chi-square tests (for all Categorical variables) were performed.

Results

83 HAIs in the pre phase period has 46 cases with MDR status in the culture report, whereas the post era reported 55 MDR status among 108 HAI cases. The post era has less percentage compared to the pre era with no statistical significance (p=0.319) (table -1). The MDR types depicted in table-2. It was found that all-cause mortality in MDR HAI showed no statistically significant difference (Pearson Chi-Square = 0.246) between pre and post phase.

Conclusion

'Handshake Stewardship' did not lead to a significant reduction in MDR HAIs or all-cause mortality during the study period, further long-term evaluations are warranted to assess its effectiveness comprehensively.

Disclosures

All Authors: No reported disclosures
P-399. Prevalence of gastrointestinal tract colonization by carbapenem-resistant Enterobacterales and vancomycin-resistant Enterococcus faecium in hematological patients at a referral hospital in Mexico City
Authors: Ramos Menchelli Ana Fernanda , González Lara María Fernanda , Guerra Bernardo Martínez , Fernández Oscar , Centeno Matus Edgar Daniel , Xancal Salvador Luis Fernando , Gómez Roberta Demichelis , Rodríguez Eucario León
Published: January 2025

Background

The prevalence of carbapenem-resistant enterobacteria (CRE) in patients with hematological neoplasias varies due to local epidemiology, antimicrobial prophylaxis and types of hematopoietic stem cell transplants (HSCT). Colonization by CRE is the main risk factor for infection, which carries a mortality up to 65%. This study evaluated CRE colonization in patients with acute leukemia (AL) and HSCT) within 28 days. Secondary goals included describing CRE bloodstream infections (BSI), colonization by Vancomycin-Resistant Enterococci (VRE), ESBL, and quinolone-resistant (QR) microorganisms, risk factors for CRE, and 28-day mortality.Table 1.Risk factors for CRE colonization among patients with acute leukemia and hematopoietic stem cell transplantRR: Relative risk, aHR: Adjusted hazard ratio, allo HSCT: Allogeneic hematopoietic stem cell transplant

Methods

This was a prospective cohort from March to October 2023 at a referral hospital in Mexico City. We included consenting adults with acute leukemia (AL) receiving induction chemotherapy and HSCT. Patients with prior 90-day CRE colonization or infection were excluded. Weekly stool screening, using the adapted CDC method, was performed throughout hospitalization, with a follow-up period of 28 days or until discharge or death. CRE were identified by MALDITOF-MS (Bruker), susceptibility testing done by Vitek2 (Biomérieux), using CDC breakpoints. Descriptive analysis was done for CRE colonization and mortality. A multivariate analysis for CRE colonization through logistic regression was done.

Results

Among 37 patients included, a CRE colonization prevalence of 21.8% was found, of which, 12.5% developed BSI compared to 3.5% of non-colonized individuals. Additionally, colonization rates for VRE, ESBL, and QR microorganisms were 5.4%, 35.1%, and 32.4%, respectively. Independent factors related to CRE colonization were older age and prior 6-month carbapenem use. 28-day mortality was 10.8%, with no differences between colonized and non-colonized groups. VRE colonization was significantly associated with VRE infection (p=0.04). CRE colonization resulted in increased 90-day mortality (50% vs. 10.3%, p=0.011).

Conclusion

The prevalence of CRE colonization in patients with AL or HSCT was 21.8%. It was associated with older age and prior carbapenem use and resulted in increased 90-day mortality. Colonization by ESBL and QR were frequent.

Disclosures

All Authors: No reported disclosures
P-400. Surgical Site Infections among Heart Transplant, Lung Transplant, and VAD Inserted Patients
Authors: Choudhury Bipasha , Smith Stephanie W , Buchanan-Chell Maureen
Published: January 2025

Background

Surgical site infections (SSI) after heart and lung transplantation and implantation of Ventricular Assist Devices (VAD) confer significant morbidity. Despite this, many sites do not perform routine surveillance of this population.

Considering the paucity of available data, this retrospective chart review evaluated the incidence, risk factors, associated microorganisms, and outcomes associated with surgical site infection by type of transplant received.

Methods

This review was conducted at a tertiary care hospital in Edmonton, Alberta. All patients who received a heart or lung transplant or VAD insertion between July 1, 2022, and December 31, 2023, that had at least 90 days of follow-up were included. Information collected included data on transplant/VAD insertion, age, sex, presence of SSI, microorganisms associated with infection, length of stay, and outcome. Other data collected included receipt of antibiotic prophylaxis, admission to hospital in the six months prior to transplant, and surgery in the six months prior to transplant.

Results

A total of 219 patients were included in the review (double lung transplant = 104, heart transplant = 38 and VAD insertion = 77)

SSI rate was found to be higher in the VAD insertion group (16%), compared to lung (12.5%) or heart transplant (7.8%) recipients. Post-transplant hospital stay was longer in lung transplant (17-131; median 55) and heart transplant recipients (81-115; median 112) who developed SSI, compared to their counterparts who did not develop SSI (12-197; median 32 and 13-120; median 20 respectively).

Coagulase-negative staphylococcus aureus was found to be the most common pathogen among all three groups of transplants that developed surgical site infections (SSIs). However, Cutibacterium acne was also frequently isolated in VAD recipients, while Yeast, E. fecalis and E. feceium were commonly found to be responsible for lung transplant SSIs.

Conclusion

Rates of SSI after heart and lung transplantation and VAD insertion are high and result in significant morbidity. The choice of antibiotic prophylaxis may need to be individualized in this patient population given prior antibiotic exposure, hospitalization, and risk of more resistant pathogens.

Disclosures

All Authors: No reported disclosures
P-417. Rectal Surveillance for Multi-drug Resistant Organisms colonisation Among High-Risk Patients Admitted in a Tertiary-Care Hospital in Greece
Authors: Protonotariou Efthymia , Tampakas Lampros , Meletis Georgios , Tychala Areti , Pontika Evagelia , Georgopoulou Ειrini , Bampi Konstantinia , Pantelidou Parthenopi , Trikoupis Petros , Sereni Zoe , Oikonomou Margarita , Katsanou Haroula , Mantzana Paraskevi , Metalllidis Simeon , Skoura Lemonia
Published: January 2025

Background

Antimicrobial Resistance (AMR) is a global urgent health threat that has escalated since the COVID-19 pandemic. Greece is a country with high rates of multi-drug resistant microorganisms (MDROs), including extended-sepctrum β-lactamases (ESBL), carbapenem-resistant Gram-negatives and vancomycin-resistant EnterococcI (VRE). In the present study rectal surveillance screening for the above mentioned MDROs was performed among high-risk patients admitted to our hospital.

Methods

High risk patients were defined as those previously hospitalized in our or other hospitals, those admitted from rehabilitation centers, oncology, and renal failure patients as well as patients that are already hospitalized in our hospital for more than 30 days. During the study period (Nov 2023 – Apr 2024), 425 patients were screened using Brilliance™ CRE Agar (Oxoid, UK) , Brillliance™ VRE Agar (Oxoid, UK) and CHROMID™ ESBL (bioMérieux, Marcy-l'Étoile, France). Carbapenem-resistant (CR) Enterobacterales and Pseudomonas aeruginosa were furtherly tested for carbapenemase production using the NG-Test CARBA 5 immunochromatographic assay (NG-Biotech, France). Isolates grown in the CHROMID™ ESBL plate were tested for ESBL production using ceftazidime and cefotaxime against ceftazidime/clavulanic acid and cefotaxime/clavulanic acid combinations.

Results

185 (43,52%) patients were positive and 240 (56,47%) were negative for the MDROs investigated. Detailed results are shown in Table 1. Among the patients found positive, 89 (48,1%) were from rehabilitation centers, 53 (28,64%) were previously hospitalized elsewhere and 30 (14,05%) were hospitalized in our hospital in previous months. CR Klebsiella pneumoniae (n=76), CR P. aeruginosa (n=56) and VRE (n=57) were the most common MDROs identified. Fourty-seven patients (25,4%) died, 116 (62,7%) showed improvement and the rest remained stable or moved to other facilities. Among the 240 negatives, 35 (14, 58%) died, 197 (82,08%) were improved and 8 (3,34%) remained stable.

Conclusion

Our results highlight the critical situation regarding the spread of MDR bacteria among hospitalised patients, especially the high-risk ones, showing the imperative need for strengthening the already existing infection control measures.

Disclosures

All Authors: No reported disclosures
P-419. The Epidemiology of Healthcare-associated Infections in Jordanian Hospitals before and after the COVID-19 Pandemic
Authors: Nasrat Salwa A , Alhawarat Mohammad , Gharaibeh Mohammad , Sayyouh Omar , Ramadan Mohamed , Said Mayar , Osman Tamer Saied
Published: January 2025

Background

The pandemic of COVID-19 resulted in an exceptional stress on the healthcare system. On the other hand, infection control measures were strengthened within the hospital settings. However, the effect on healthcare associated infections (HAIs) is still not clear, and data are still lacking. This study examines the rates of three HAIs [bloodstream infections (BSIs), Urinary tract infections (UTIs), and pneumonia] before the COVID-19 pandemics and compare them with corresponding rates after the pandemic.

Methods

HAI data were extracted from the national surveillance of HAIs conducted by the Ministry of Health in Jordan. Data for 18 ICUs in 3 tertiary care hospitals were extracted and analyzed for this objective. An active prospective surveillance of HAIs was implemented using US CDC NHSN case definitions. Pooled incidence rates of three HAIs during the pre-pandemic (July 2018–March 2020) and post-pandemic periods (June 2021–December 2023) were calculated and compared.

Results

During the study period, a total of 1642 HAIs were identified in 1624 patients for 302983 patient days. Male gender constituted 59.8% (412/689) among pre-pandemic patients compared to 61.6% (576/935) among post-pandemic patients (p value =0.4). Mean age of pre-pandemic patients was 44.68±1.12 years compared to 49.51± 0.88 years in the post-pandemic patients (p value =0.15). Specific HAI rates were significantly reduced after the pandemic compared to pre-pandemic period. Pooled pneumonia rate was reduced from 2.5/1000 patient-days to 1.4/1000 patient days (RR: 0.56; 95% CI, 0.47–0.67), UTI rate was reduced from 2.0/1000 patient days to 1.2/1000 patient days (RR: 0.59; 95% CI 0.49–0.71) and BSI rate from 2.6/1000 patient days to 2.6/1000 patient days to 2.0/1000 patient days (RR: 0.77; 95% CI 0.66–0.91). On the other hand, in hospital mortality rate for HAI patients significantly increased from 42.0% to 46.2% (p value =0.03).

Conclusion

Post COVID-19 period was associated with a significant reduction in HAI rates. This could be due to increased compliance of the healthcare workers with the standards of infection control. Sustaining HAIs surveillance and auditing of infection control practices are needed to monitor HAIs rates and alert for waning compliance with infection control practices.

Disclosures

All Authors: No reported disclosures
P-423. High Burden of Intestinal Colonization with Carbapenem-Resistant Organisms (CRO) at two Greek Intensive Care Units
Authors: Zarkotou Olympia , Louka Christina , Baziotis Georgios Alexandros , Roussou Anna , Charami Smaragdi , Vourli Sophia , Georgiou Panagiota Christina , Louka Styliani , Kousouli Elisavet , Mamali Vasiliki , Karakosta Polyxeni , Pournaras Spyros
Published: January 2025

Background

Screening for CRO intestinal colonization is part of the recommended interventions to limit their spread. We estimated the burden of carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) intestinal colonization at two Greek ICUs: Attikon University Hospital (AUH) and Tzaneio General Hospital of Piraeus (TGHP).

Methods

From October 2022, all ICU patients were screened for intestinal colonization by CRO; patients admitted post-surgery on a daily basis were excluded. The first isolate per patient was recorded as a colonization event, categorized as positive either at admission (< 3 days from ICU admission) or during ICU stay ( >=3 days). Admission prevalence rates per 100 admissions (APR) and incidence rates of ICU-acquired intestinal colonization per 1,000 patient-days (IR) were calculated. Rates from the 1st, 2nd and 3rd study semester were compared and incidence rate ratios were determined.

Results

APR and IR of ICU-acquired CRE, CRAB, and CRPA intestinal colonization are presented in Table 1. APR for CRO colonization remained stable, during the study period, with the exception of CRE at TGHP, which exhibited a significant increase (p=0.02). APR were significantly higher at TGHP for all 3 study periods apart from CRE in the first study semester (figure 1). IR of ICU-acquired CRE colonization were also significantly higher at TGHP, in all 3 semesters, possibly due to the higher colonization pressure (figure 2). The IR of ICU-acquired CRE and CRPA colonization remained essentially unchanged over the study period at each hospital. However, a significant reduction in the incidence density of ICU-acquired CRAB colonization was observed (figure 2).

Conclusion

Our study highlights the high burden of CRO colonization in Greek ICUs, which varies even across settings within the same region. CRE colonization presents the greater challenge, closely followed by CRAB, which however showed a significant reduction in ICU-acquired CRAB colonization during the last year. Active surveillance remains a crucial component of prevention bundles and can guide targeted prevention strategies.

Disclosures

All Authors: No reported disclosures
P-432. Understanding Weight Changes in HIV Patients on Integrase Strand Transfer Inhibitor-based Antiretroviral Therapy: Insights from Southern India
Authors: Siby Ashin , Biju Sanju , Paulson Shon
Published: January 2025

Background

As HIV infection continues to pose a significant public health challenge, especially in regions like Southern India, effective antiretroviral therapy (ART) remains pivotal for improving patient outcomes. Integrase Strand Transfer Inhibitors (INSTIs) have emerged as cornerstone agents in ART regimens, yet their specific impact on weight changes in HIV-infected individuals, particularly in Southern India, warrants comprehensive investigation due to limited existing data.

Methods

This retrospective study analyzed medical records of HIV-infected patients receiving care at healthcare facilities in Southern India. Patients who initiated INSTI-based antiretroviral therapy between April1, 2022, and December 31, 2023, were included in the analysis. Data on demographic characteristics, baseline weight, and weight measurements at follow-up visits were collected from electronic medical records. Statistical analysis, including descriptive statistics and paired t-tests, was conducted to assess changes in weight over time following initiation of INSTI-based therapy.

Results

The study included 84 patients diagnosed with HIV, predominantly HIV-1, with a male representation of 61% (n=51) and a median age of 36.3 years (range: 20–65 years). Common opportunistic infections observed were pulmonary tuberculosis, oral candidiasis, and herpes zoster. The primary antiretroviral therapy regimens were TDF+3TC+DTG or TDF+FTC+DTG. Following initiation of INSTI-based therapy, 69% of patients experienced weight gain, averaging 3.81 kg at 3 months, with 18.1% gaining over 4 kg. Median BMI increased from 23.82 kg/m² to 25.9 kg/m² at 8.5 months post-ART initiation. Among ART-naïve patients, 76% experienced weight gain, with 18.1% gaining 8.36 kg at 9 months. Gender and age did not show significant associations with weight gain. However, weight gain exhibited a positive correlation with time after INSTI initiation (r = +1), indicating an expected increase in weight per 0.1 months (F = 4.62, p = 0.032).

Conclusion

In conclusion, our findings underscore the significant weight gain associated with INSTI-based antiretroviral therapy among HIV-infected patients in Southern India, emphasizing the importance of monitoring and managing metabolic changes in clinical practice.

Disclosures

All Authors: No reported disclosures
P-435. Prevalence and Risk Factors for Toxoplasma gondii Seropositivity in a Geographically Defined Cohort of Persons with HIV in Southern Alberta, Canada
Authors: Rosen Charlotte , Gill M John , Fujiwara Esther , Krentz Hartmut , Kamaliddin Claire , Yuan Zhou Hong , McMillan Jacqueline M , Beckthold Brenda , Lang Raynell
Published: January 2025

Background

New evidence suggests Toxoplasma gondii infection may have inflammatory and neurocognitive effects. Among people with HIV (PWH) with immunosuppression, T. gondii infection can reactivate causing significant morbidity. We aimed to identify the prevalence and risk factors for T. gondii infection among a geographically defined cohort of PWH.Figure 1:The proportion of Toxoplasma seropositive and seronegative tests among people with HIV at Southern Alberta Clinic

Methods

The Southern Alberta Clinic (SAC) provides centralized HIV care to all PWH in southern Alberta. SAC is linked with a comprehensive database that collects T. gondii serology (IgG) on entry into the cohort. Using this database, we evaluated temporal trends and risk factors for T. gondii infection between January 1st, 1985 and January 6th, 2022. We used Poisson regression models with robust variance to estimate unadjusted and adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) for factors associated with T. gondii seropositivity (vs. seronegativity) among PWH.Figure 2:Toxoplasma seropositivity by country of birth among people with HIV at Southern Alberta Clinic from 1985-2022

Results

Among 4,424 PWH receiving care at SAC between 1985-2022, 3,696 (84%) were T. gondii IgG negative and 728 (16%) T. gondii IgG positive at cohort entry. Over time, the prevalence of T. gondii infection has been increasing (Figure 1). In adjusted analyses, T. gondii seropositivity was associated with older age >50 years (vs. < 30 years) at serology testing (aPR: 1.7 [95% CI 1.2-2.5]) and birth outside of North America (vs. birth within North America), Central/South America (aPR: 4.5 [95% CI 2.9-6.7]), Sub-Saharan Africa (aPR: 4.3 [95% CI 2.8-6.5]), and Middle East/Northern Africa (aPR: 3.6 [95% CI 2.0-6.4]) (Figure 2).

Conclusion

We found an increasing prevalence of T. gondii infection among our population of PWH over time likely associated with a greater proportion of our population being both born outside of North America and age >50 years. Identifying the prevalence and risk factors for T. gondii seropositivity is important for monitoring potential negative outcomes associated with T. gondii infection and risk stratification among PWH.

Disclosures

All Authors: No reported disclosures
P-444. Cerebral Small Vessel disease risk in people with HIV and substance use disorder
Authors: Ayoade Folusakin , Hernandez Salma , Tookes Hansel
Published: January 2025

Background

Cerebral small vessel disease (CSVD) is associated with an increased risk of stroke, dementia, and death. The risk of CSVD in people with HIV (PWH) is twice the general population but the CSVD risk in PWH with substance abuse is poorly defined. With national surveys showing approximately two-thirds of PWH admitting to using an illicit drug in their lifetime, the evaluation of CSVD risk in this population is needful.Table 1:Demographic and Clinical information of CSVD in PWH with substance use disorder (N=23)

Methods

We retrospectively analyzed brain magnetic resonance imaging (MRI) findings of PWH attending our ambulatory HIV needle exchange clinic. Brain MRIs done in the previous 5 years before study analysis were included. CSVD was determined by Cerebral small vessel disease score (0 to 4), assigning 1 point each for the following: (i) presence of lacunar infarct, (ii) microbleeds, (iii) prominent perivascular spaces, and (iv) white matter hyperintensities. The findings suggestive of CSVD such as age-related white matter changes and chronic microvascular ischemia were also included in the CSVD assessment. Substance use disorder (uncontrolled use of a substance despite harmful consequences) was determined to be present if this was included on the patient diagnosis list.Table 2:Cerebral Small Vessel disease Score in PWH with substance use disorder. 5 participants had a CSVD score of 0 but "age related white matter disease" on Brain MRI

Results

51 patients (PWH with substance use disorder) were included in the analysis. 23 participants out of this group had brain MRI imaging out of which 12 (52.2%) had CSVD. The mean age was 50 years. The demographic and clinical data of the cohort are shown in Table 1. The CSVD score ranged from 0 to 3 with an average score of 1. Table 2 illustrates the CSVD score of the cohort. 5 participants had a CSVD score of 0 but a brain MRI report of “age-related white matter changes”. The Pearson Correlation between age and CSVD score was 0.057 with a p-value of 0.86.

Conclusion

52% of PWH who use substance have CSVD on MRI brain imaging. This could translate to an increased risk of stroke, cognitive impairment, and death if not recognized early and aggressively addressed. CSVD score provides objective quantification of CSVD but age-related white matter changes, which are not captured on this score may be equally important especially as PWH continues to age. A systematic approach for screening for CSVD in PWH with substance use disorder is warranted to minimize the unfavorable outcomes associated with this cohort.

Disclosures

All Authors: No reported disclosures