bluuebunny/crossref_metadata_2025 huggingface dataset:
Pneumonia panel results and antibiotic prescribing in COVID-19 patients in 2020 versus 2022
Authors: Hussain Aysha , Van Schooneveld Trevor , Bergman Scott , Miller Molly , Fey Paul D. , Stohs Erica
Published: September 2023

Background: Antibiotics are frequently prescribed in patients with COVID-19 infections to treat secondary bacterial pneumonia. The pneumonia panel (PNP) is a molecular diagnostic tool that rapidly detects 33 bacterial and viral targets. The utility of this panel in COVID-19 patients and how it may direct antibiotic use is unknown. We sought to understand the utilization of PNP in patients with COVID-19 pneumonia over time by comparing clinical parameters, microbiologic results, and antibiotic use between May–December 2020 and January–July 2022. Methods: We implemented the PNP in May 2020 with antimicrobial stewardship guidance, provider education, and order restriction to critical care and infectious disease clinicians. From February–July 2021 prescribers received regular structured antimicrobial stewardship feedback regarding PNP results; from August 2021 to January 2022, no antimicrobial stewardship feedback was provided; from February to July 2022, intermittent feedback was provided. We compared PNP and culture results from sputum or bronchoalveolar lavage samples and antibiotic use and modification within 24 hours of PNP result from patients with confirmed COVID-19 pneumonia between May–December 2020 and January–July 2022. Clinical data and antibiotic use were abstracted through chart review. We excluded patients who died within 72 hours of PNP, those who had concurrent nonpulmonary infections, and those whose COVID-19 test was >30 days prior. Results: We included 114 patients in 2020 and 71 patients in 2022. The overall median age was 61 years, 71% were male, and 66% were mechanically ventilated without statistical differences between the cohorts, including their comorbidities. Acute or worsening hypoxia remained the predominant indication for PNP (77% in 2020 vs 75% in 2022, NS). The median number of days between admission and PNP was 4 (IQR, 1–8) in 2020 versus 3 (IQR, 1–7), and the difference was not significant. PNP and culture results in Table 1 show that Staphylococcus aureus and Hemophilus influenzae were the pathogens most commonly identified. Table 2 describes empiric prescribing and modifications for commonly prescribed antibiotics. Prescribers used empiric cefepime and ceftriaxone more in 2020 and vancomycin more in the 2022 group; however, these were not statistically significant. Cefepime de-escalation was more common in 2022 (53% vs 28%; P = .03). Antibiotic modifications within 24 hours of PNP remained similar in 2020 vs 2022. Although vancomycin cessation was more common in 2020 (78%) versus 2022 (57%), the difference was not statistically significant. Conclusions: With ASP guidance, PNP may be a useful tool to stop or target antibiotics for secondary bacterial pneumonia in COVID-19 pneumonia. Early vancomycin cessation (prior to culture results) may be an enduring consequence of PNP implementation.

Disclosures: None
Using state claims data to explore first-line antibiotic prescribing for acute respiratory conditions—Minnesota, 2018–2019
Authors: Freitas Mari , Fell Ashley , Klammer Susan Gerbensky , Lynfield Ruth , Beaudoin Amanda
Published: September 2023

Background: Nationally, >30% of all outpatient antibiotics are unnecessary or inappropriate, and only 52% of outpatients with sinusitis, otitis media, or pharyngitis receive recommended first-line antibiotics. The Minnesota All Payer Claims Database (MN APCD) collects medical claims, pharmacy claims, and eligibility files from private and public healthcare payers. We analyzed claims to describe overall and firstline antibiotic prescribing for acute bronchitis, adult acute sinusitis, and pediatric patients. Results: We analyzed 3,502,013 respiratory events from 1,612,501 members. Acute bronchitis accounted for 179,723 events (5.1%), acute sinusitis accounted for 236,901 adult events (10%), and otitis media accounted for 232,226 pediatric events (19%). Also, 73,385 bronchitis diagnoses (~40%) had no associated antibiotic. Antibiotics were associated with 199,445 adult sinusitis events (84.2%), of which 89,386 (44.8%) were firstline antibiotics, and 190,962 pediatric otitis media events (82.2%), of which 126,859 (66.4%) were firstline antibiotics. Common antibiotic classes used when a firstline drug was not selected were macrolides (28.9%) and tetracyclines (26.8%) for adult acute sinusitis and cephalosporins (61.4%) and macrolides (30.6%) for pediatric otitis media. Compared to the least vulnerable quartile, the most vulnerable social vulnerability index (SVI) quartile had lower odds of receiving firstline antibiotics for adult acute sinusitis if antibiotics were prescribed (OR, 0.90; 95% CI, 0.87–0.94) and higher odds of receiving firstline antibiotics for pediatric otitis media if antibiotics were prescribed (OR, 1.16; 95% CI, 1.12–1.21). Conclusions: Improvement is needed in avoiding antibiotics for acute bronchitis and selecting firstline drugs for sinusitis and otitis media. Additional analyses adjusting for demographic, geographic, and prescriber factors are planned to better understand differences in prescribing appropriateness among Minnesotans.

Disclosures: None
Retrospective data analysis of CLABSI rates at Baystate Medical Center during the COVID-19 pandemic
Authors: Satta Giovanni , Smith Kristin , Smith Jacob
Published: September 2023

Background: Central-line–associated bloodstream infections (CLABSIs) are an important public health issue. Recent data from the CDC have shown an increase in healthcare-associated infections (including CLABSI) during the COVID-19 pandemic. Therefore, the main aim of this project was to analyze the epidemiology of central-line–associated bloodstream infection during different periods at the Baystate Medical Center (Springfield, MA) before, during, and after COVID-19 peaks of infection. Methods: Two specific periods were considered during the year (quarter January–March and quarter July–September) to consider potential seasonal variations, and the incidence of CLABSI during those 2 quarters was analyzed for 4 different years: 2019 (prepandemic), 2020–2021 (intrapandemic), and 2022 (postpandemic). An analysis of the microbial pathogens causing line infections was also performed to investigate differences described by other authors. Results: In total, 97 CLABSI (all from different patients) were reported into the NHSN website during the 8 periods considered. The average age of the patients was 55 years, with a male:female ratio of 57%:43%, and 14 renal patients were on dialysis. The CLABSI rates ranged from a minimum of 1.11 in Q1 of 2020 (start of COVID) to a maximum of 2 in Q3 of 2021 (SARS-CoV-2 delta variant) (Table 1). A statistical comparison of the pre–COVID-19 period with the respective quarters during the pandemic years (2020, 2021, and 2022) did not show any significant differences (Table 2). In term of microbiological data, of the 97 patients with CLABSIs, most of the patients (n = 70) had only 1 pathogen isolated, 14 patients had 2 pathogens, and 3 patients had 3 pathogens, bringing the total number of bacteria cultured to 117. Candida spp and Enterococcus spp were the most frequently isolated pathogens at 19% and 13%, respectively (Fig. 1). There was no statistically significant difference between the pre–COVID-19 and intra–COVID-19 periods for Candida spp (rate ratio, 1.391; 95% CI, 0.5477–3.533; P = .48) or Enterococcus spp (rate ratio, 2.385; 95% CI, 0.8365–6.798; P = .09). Conclusions: The COVID-19 pandemic did not seem to have an impact on the local epidemiology at Baystate Medical Center in terms of CLABSI rates or type of pathogens causing infections, but the sample size taken into consideration may not have been powerful enough to detect statistical significance.

Note. This project was carried out as part of Dr Satta’s MPH requirements at UMass.

Disclosures: None
Novel strategies to reduce central-line–associated blood stream infection (CLABSI) events in the neonatal intensive care unit
Authors: Camelo Ingrid , Neshangi Srilatha , Thompson Amy
Published: September 2023

Background: We describe the components of an improved and easy-to-implement strategy to reduce CLABSI events in the NICU implemented during July–September 2021 in a tertiary-care healthcare center. These strategies were added to an existing institutional protocol created following CDC guidelines. Methods: During the previous timeframe of the implementation of new strategies, CDC insertion-related prevention measures [ie, hand hygiene, use of personal protective equipment (PPE), catheter size selection, standard chlorhexidine gluconate (CHG) antisepsis, maintenance related Curos disinfecting caps, and scrubbing the hub] were part of an existing protocol at our institution. We introduced the following key elements along with the previous ones: decrease length of umbilical vein catheter (UVC) utilization from 14 days to 5–7 days, change of dressing materials from BIOPATCH to 3M Tegaderm CHG chlorhexidine gluconate IV securement transparent dressing, enhanced compliance of an existing artificial nail policy, and restricted blood draw from central lines. Results: After optimization of the previous protocol through these additional strategies, we achieved a significant reduction in the NICU CLABSI rates from 12 CLABSI events between July 2020 and June 2021 to only 3 CLABSI events between July 2021 and June 2022. Conclusions: Revision of CLABSI bundle prevention protocols should be performed frequently to allow improvement opportunities to be added to diminish infection rates. The addition of simple and easy-to-implement key elements interventions to the existing CLABSI bundle had an important impact on the CLABSI rate at our institution.

Disclosures: None
The impact of a blood-culture diagnostic stewardship intervention on utilization rates and antimicrobial stewardship
Authors: Zhou Kelvin , Wang Melinda , Shay Sabra , Herlihy James , Siddique Muhammad Asim , Castillo Sergio Trevino , Lasco Todd , Barrett Miriam , Mohajer Mayar Al
Published: September 2023

Background: Blood cultures are often ordered when an infection is suspected; however, they have a low yield in most cases. The overuse of blood culture is associated with high contamination rates, resulting in excess diagnostics, unnecessary antibiotics, longer hospital stays, and higher hospital costs. We evaluated the safety of a multifaceted intervention, which encompassed education and blood-culture restriction, and its impact on blood-culture utilization and antibiotic use in adult intensive care unit (ICU) patients. Methods: The study was performed between October 2020 and October 2021 in the 12 general medicine and specialty ICUs of a quaternary academic care center. The intervention, implemented in April 2021, included providing education to ICU and infectious disease physicians based on an algorithm adapted from the Johns Hopkins DISTRIBUTE study in addition to restricting blood-culture ordering on these units to these providers. The month of April 2021 was excluded as a washout period. Study outcomes comprised blood-culture utilization, blood-culture positivity, days of therapy (DOT), and length of therapy (LOT), which were compared across the study periods using IRR or the Pearson χ2 test, as appropriate. In addition, 30-day mortality and 30-day ICU readmission were evaluated utilizing multiple COX regression models. Results: In total, 6,303 patients (2,087 MICU, 3,636 SICU, and 580 both) were included in the study, with a median age of 65 years (IQR, 21). Most participants were male (57.5%), with a median length of stay of 175 hours (IQR, 186). After the intervention, blood-culture utilization rates decreased from 15.4% to 12.4% (IRR 0.80, 95% CI, 0.76–0.85) (Fig. 1). There was no difference in blood-culture positivity between the preintervention period (11.05%) and the postintervention period (11.64%; P = .459). Days of therapy decreased from 1,180 to 1,130 per 1,000 patient days (IRR, 0.96; 95% CI, 0.95–0.98), and the length of therapy decreased from 602 to 579 per 1,000 patient days (IRR, 0.96; 95% CI, 0.94–0.99) (Fig. 2). There was no difference in 30-day mortality (P = .241) nor 30-day ICU readmission (P = .888) across the study periods after adjusting for potential confounders (Table 1). Conclusions: Our multifaceted intervention decreased blood-culture and antimicrobial utilization in the ICUs without significantly affecting the positivity rate, mortality, or readmission. This study suggests that educating providers on appropriate blood-culture use along with restriction could safely improve healthcare outcomes. Further studies are warranted to validate our results across various institutions and to evaluate the impact of blood-culture optimization in non-ICU patients.

Disclosures: None
Assessment of endotracheal aspirate culture appropriateness among adult ICU patients at an academic medical center
Authors: Chambers Michael , Humphries Romney , Harris Bryan , Talbot Tom
Published: September 2023

Background: Ventilator-associated pneumonia (VAP) is a significant cause of mortality in intensive care units (ICUs), but minimal research exists regarding the appropriateness of ordering endotracheal aspirate cultures (EACs). We evaluated the diagnostic utility of rationales given for EAC collection in ICUs at an academic medical center to assess potentially inappropriate EAC ordering. Methods: The study population comprised all adult patients admitted to an ICU in 2019 who underwent EAC collection. A random 10% sample from this population, stratified by ICU type, was selected. Clinical and diagnostic characteristics within 24 hours of EAC collection were identified by chart review. Clinical documentation was reviewed to identify ICU provider rationales for ordering EAC. Results: In total, 749 patients underwent EAC collection. Among them, 75 patients comprised the random sample, of whom 7 (9.3%) were excluded due to extubation before culture collection. Figure 1 shows patient distribution by ICU type. From these 68 patients, 105 EACs were collected. Of these, 41 (39%) were positive for potential pathogens, and 59 (56.2%) had explicit rationales for EAC collection, including fever (44.1%), hypoxia (18.6%), leukocytosis (16.9%), secretions (11.9%), shock (10.2%), and radiologic findings (8.5%). Also, 43.8% of EACs had no explicit rationale for collection. Table 1 shows sensitivities, specificities, positive likelihood ratios (LRs), and negative LRs for these rationales and related characteristics. Conclusions: EACs were commonly ordered without clear clinical indications. Of the noted rationales for EAC collections, most performed poorly at predicting positive cultures, which challenged common rationales for ordering EAC. This study could serve as a foundation for diagnostic stewardship interventions for EAC, potentially decreasing unnecessary cultures.

Disclosures: None
Longitudinal effects of direct observation of hand hygiene practices and monitoring of alcohol-based handrub consumption
Authors: Fujita Retsu , Yoshida Rika , Hori Satoshi
Published: September 2023

Background: In healthcare facilities, hand hygiene is important for infection control. The WHO recommends monitoring the consumption of alcohol-based handrub (ABHR) and direct observation of hand hygiene practices to ensure compliance with hand hygiene practices. Monitoring of ABHR is widely used, but direct observation is not widely performed, particularly in small facilities and non–acute-care facilities. We evaluated the effects of direct observation of hand hygiene practices and monitoring of ABHR consumption, with feedback to staff, on ABHR consumption and hand hygiene compliance. Methods: We conducted a prospective intervention study over a 4-year period. Monitoring of ABHR consumption and direct observation of hand hygiene practices, with periodic feedback to staff, was implemented in 17 facilities of varying types: 5 large-scale acute-care facilities, 6 middle-to-small-scale acute-care facilities, and 6 non–acute-care facilities. Statistics for ABHR consumption were calculated before and after the implementation of direct observation of hand hygiene practices, and the change in ABHR consumption was calculated. The paired t test was used to assess the statistical significance of changes. A generalized linear mixed model analysis was performed to assess factors associated with ABHR consumption. Results: The total observation time was 1,225 months (625 months before direct observation, 600 months after direct observation), and the average observation time per facility was 36.0 months (± 27.5). All facilities implemented ABHR consumption monitoring within 1 month of starting the study. However, the mean time required to implement direct observation of hand hygiene practices was 24.7 (±19.1) months. There was a significant increase in ABHR consumption in large and middle-to-small-scale acute-care facilities (P < .0001) after implementing the direct observation. However, there was not a significant increase for ABHR consumption in non–acute-care facilities (P = .14). Multivariable regression analysis showed that the hospital ward type, duration of ABHR consumption monitoring, and duration of direct observation of hand hygiene practices were independently associated with ABHR consumption. Conclusions: ABHR consumption increased in all facilities that implemented direct observation, but the change was not statistically significant in non–acute-care facilities. The generalized linear mixed model analysis showed significant associations between ABHR consumption and hospital ward type and time to monitoring of ABHR consumption and direct observation of hand hygiene practices. Direct observation of hand hygiene practices should be implemented more widely. The effect of intervention intensity should be evaluated in future studies.

Disclosures: None
Infection prevention and control perspective and practices among healthcare workers in Bangladesh: A multicenter cross section
Authors: Harun Md. Golam Dostogir , Sumon Shariful Amin , Rahman Aninda , Anwar Md Mahabub Ul , Islam Md. Saiful
Published: September 2023

Background: Infection prevention and control (IPC) is a critical feature of preventing the spread of healthcare-associated infections (HAIs) in hospitals. IPC practices are particularly important in resource-constrained and crowded hospital settings. The successful implementation of infection prevention measures depends on healthcare worker (HCW) knowledge of, attitude toward, and practice (KAP) of IPC. In this project, we assessed the KAP of HCWs and identified factors associated with IPC compliance at tertiary-care hospitals in Bangladesh. Methods: From September 2020 to January 2021, we conducted this hospital-based cross-sectional assessment at 11 tertiary-care hospitals. A semistructured questionnaire was used to conduct face-to-face interviews with physicians, nurses, and cleaning staff who were directly involved in patient care. Based on >75% of the total score, each KAP component was divided into adequate knowledge, favorable attitude, and safe practice. We performed descriptive analysis and multivariate logistic regression to determine the KAP score and associated factors influencing IPC compliance in hospital settings. Results: In total, 1,728 HCWs were interviewed; 76.8% of the participants had adequate knowledge on IPC and 54.6% reported safe practices. However, only 16.2% of HCWs had a favorable attitude toward IPC. Among the 3 HCW groups, nurses had the highest KAP scores (76.07±12.7) followed by physicians (69.8±16.2), and cleaning staff (34.4±27.3). Only 29.2% of HCWs reported having received IPC training, and they cited heavy workload as a barrier to IPC guideline adherence. HCWs having adequate knowledge showed 9 times higher odds of safe IPC practice (AOR, 9.36; 95% CI, 5.47–16.04). HCWs who had a favorable attitude toward IPC were 16 times as likely to perform safe practice toward IPC activities (AOR, 15.5; 95% CI, 10.27–23.42). Conclusions: Knowledge of safe practices and having a favorable attitude toward IPC are key components of a successful IPC program. Significant improvements are required among all levels of HCWs in Bangladesh tertiary-care hospitals, especially cleaning staff. Educational interventions to train on IPC guidelines, plus monitoring, could improve HCW safe practices.

Disclosures: None
Detecting fecal microbiota transplantation–associated infection transmission using shotgun metagenomic sequencing and clonality analysis
Authors: Briars Emma , Sater Mohamad , Billings Nicole , Herriott Ian , MacLeod Emily , Huntley Miriam
Published: September 2023

Background: Fecal microbiota transplantation (FMT) is a widely used modality for safe and effective treatment of recurrent Clostridium difficile infections, and FMT is being explored for the treatment of additional indications including gastrointestinal diseases and neurological disorders. Although microbiota-based therapies like FMT utilize rigorous donor screening procedures, these procedures are limited in resolution and scope, and there remains a risk of transmission of FMT-associated infectious agents from donor stool to a FMT recipient. Critically, these health concerns led the FDA to issue a 2019 safety alert for the transmission risks associated with FMT and to update its guidelines for screening and reporting. In a suspected transmission event, there is uncertainty around the source of infection; thus, methods are needed to rapidly determine whether a patient’s infection is linked to the donor stool product. Methods: Here, we developed a laboratory service sequencing and bioinformatics pipeline within our CLIA-certified laboratory for investigating suspected FMT infection transmission by measuring genomic relatedness. Our pipeline performs deep sequencing of a metagenomic sample, whole-genome sequencing (WGS) of an isolate derived from the implicated patient infection and determines the genomic relatedness between the 2 using a SNP-based analysis. The workflow was validated in silico with synthetic metagenomic samples spiked-in with WGS of clinically relevant isolate strains at varying abundance. Results: The sample and sequencing library preparation workflow was optimized across a panel of metagenomic and mock fecal microbiome samples demonstrating reproducible and reduced-bias sequencing of metagenomic samples. Our pipeline demonstrates high sensitivity and specificity for clonality calls when a spiked in isolate genome achieves 5× depth for >50% of the genome. We also demonstrated an interplay between abundance rate and sequencing depth for determining a clonality limit of detection. Conclusions: Taken together, our pipeline represents a new method that can support the clinical efforts of FMT and other microbiota-based therapies. References: US Food and Drug Administration. Important safety alert regarding use of fecal microbiota for transplantation and risk of serious adverse reactions due to transmission of multidrug-resistant organisms. Rockville, MD: Food and Drug Administration, 2019. DeFilipp Z, Bloom PP, Torres Soto M, et al. Drug-resistant E. coli bacteremia transmitted by fecal microbiota transplant. N Engl J Med 2019;381:2043–2050.

Financial support: This study was funded by Day Zero Diagnostics.

Disclosures: None
Sex representation of editors, editorial boards, and authors of infectious diseases and healthcare epidemiology journals
Authors: Barajas-Ochoa Aldo , Ramirez-Trejo Manuel , Dash Aditee , Raybould Jillian , Bearman Gonzalo
Published: September 2023

Background: Academic publishing is not exempt from potential structural disparities. We assessed the sex representation among the editors and on editorial boards by their level of influence in the decision of a manuscript of the leading journals focused on infectious diseases and healthcare epidemiology. We also explored whether the sex of the first or last author correlates with the sex of the editors in a convenience sample of these journals. Methods: In a cross-sectional study, the 40 top infectious disease journals (Scimago Journal and Country Rank) and 4 healthcare epidemiology journals were selected. The names and positions of the editorial members were extracted from the journal’s website, and a decision-making level was assigned (ie, editor-in-chief as level 1, board members as level 3). Next, the first and corresponding authors’ names of all 2019 research articles published in a convenience sample of 15 of these journals were retrieved for the second aim. A digital gallery was used to assign one of the binary denominations of woman or man based on the probability that a name was culturally given to a woman or man. Differences were determined by χ2 and linear regression. Results: Overall, 2,416 names were retrieved from the editorial boards of 44 journals; 799 (33%) were assigned as women and 1,617 (67%) as men. The decision-making level showed 70 (3%) at the editor-in-chief level, 756 (31%) at the associate editor level, and 1,600 (66%) as editorial board members. The frequency distribution of assigned gender by decision-making level showed 21 (30%) women and 49 (70%) men at the editor-in-chief level; 263 (35%) women and 493 (65%) men at the associate editor level; 515 (32%) women and 1,075 (68%) men at the editorial board level. Some journals showed an even sex distribution, such as Clinical Infectious Disease or Microbiology Spectrum. However, others were significantly unbalanced. We retrieved 2,725 articles from the convenience sample of infectious disease–focused journals. Women were the first authors in 1,373 (50%) and the last authors in 974 (35%). Editorial board sex composition and sex of authors showed no significant correlation. Trends between infectious disease–focused and healthcare epidemiology–focused journals were similar. Conclusions: Although the data showed uneven sex representation on the editorial boards of infectious disease–focused and healthcare epidemiology–focused journals, there is no apparent vertical segregation or influence on publishing by sex. A generational transition seems to be occurring in editorship and authorship in the field.

Disclosures: None
A single-center experience with microbiologic surveillance of LivaNova 3T heater-cooler devices (HCDs)
Authors: Curry Scott , Alkabab Yosra , Nixon Danny , Dorman Susan , Salgado Cassandra
Published: September 2023

Background: The global outbreak of Mycobacterium chimaera infections associated with HCDs resulted in new maintenance recommendations. Since 2018, HCDs have been disinfected according to instructions for use (IFU), including twice-monthly bleach disinfection and monitoring hydrogen peroxide (H2O2) to maintain a minimum daily concentration of 100 ppm. In February 2020, the IFU added the recommendation to perform microbiologic surveillance of HCD tank water to ensure effectiveness of disinfection to levels of <1 colony forming unit per milliliter (CFU/mL) of nontuberculous mycobacterium (NTM). We report our experience with this microbiologic surveillance as well as that of culturing the HCD environment to investigate modes of transmission. Methods: In 2022, we began culturing tank water in 10 HCDs for NTM. For a subset of 6 HCDs, quantitative NTM culturing of tank water before and after bleach disinfection was done. After initial results indicated widespread-contamination of HCDs with M. chimaera, we performed fill water cultures from 5 sinks in 4 HCD maintenance rooms. We also conducted 20 two-hour NTM settle-plate cultures of a cardiac operating room (OR) at different sites both inside (n = 7) and outside (n = 3) the OR: 10 with the HCD (located outside the OR) turned off (controls) and 10 with HCD turned on (exposure). A paired t test was used to evaluate differences in mean recovery of NTM in tank water samples. Results: Cultures from 7 (70%) of 10 HCDs were positive, with a mean of 13.6 CFU/mL M. chimaera (Table 1). There was no significant difference between the 10 pairs of pre- and postdisinfection NTM cultures done according to the IFU from 6 HCDs: mean predisinfection cultures (15.5 CFU/mL) versus mean postdisinfection cultures (12 CFU/mL) (P = .90) (Table 2). For fill water, 1 of 7 sink samples in 1 of 4 rooms was positive for M. chimaera ( <1 CFU/mL) from a specimen from a fresh 0.2-µm filter that had been stored in the fill-sink splash zone. OR settle-plate cultures showed 0 (0%) of 10 control sites and 1 (10 %) of 10 exposure sites inside the OR positive for NTM, with a single CFU of M. avium–intracellulare complex. Conclusions: Our data cannot clearly refute either of 2 possible scenarios for HCD contamination: cross contamination during device maintenance versus at the point of manufacture. Despite the IFU guidance or disinfection being implemented, disinfection procedures failed to suppress NTM contamination, and tank water within most HCDs was contaminated with M. chimaera regardless of age or whether it was deep cleaned or upgraded with an aerosol containment device.

Disclosures: None
Polyclonal Burkholderia cepacia complex outbreak caused by contaminated chlorhexidine gluconate solution
Authors: Valdez Christel , Abad Cybele , Henson Karl Evans , Carascal Mark , Destura Raul
Published: September 2023

Background:Burkholderia cepacia complex is an opportunistic environmental pathogen that has been linked to nosocomial outbreaks. We describe an outbreak of bacteremia caused by Burkholderia cenocepacia from a contaminated chlorhexidine gluconate solution. Methods: The hospital infection control team carried out an outbreak investigation on February 21, 2021, when 3 adult hemodialysis patients developed B. cenocepacia bacteremia. Patient demographics and clinical profile were reviewed retrospectively. Potential sources of infection were identified, and environmental screening was performed in several units. Processes of catheter care in the hemodialysis unit were reviewed. Water samples from the hemodialysis unit, and samples of solutions used in patient care were sent for culture. Isolates from patients and from environmental samples were sent for 16S rRNA gene sequencing to determine genetic relatedness. Results: In total, 16 patients, 8 of whom were male, developed B. cenocepacia bacteremia during the investigated period. The median age was 68 years (range, 19–83), and 15 of 16 had at least 1 comorbidity. All patients used a central venous catheter (CVC) for hemodialysis, and 11 (70%) of these 16 were temporary. Chlorhexidine gluconate solution was routinely used as part of CVC care and 1 bottle was shared among 4 hemodialysis stations. On suspicion of contamination, all identified chlorhexidine bottles were recalled on February 26, 2021, and random samples from 15 opened and 19 unopened bottles were sent for culture from the following units: hemodialysis (n = 2), ICU (n = 14), wards (n = 6), and 4 each from transplant surgery, and delivery suites. O0f 34 sampled bottles, 17 grew B. cenocepacia: 8 opened and 9 unopened bottles. The Bayesian inference tree (Fig. 1) supports the hypothesis that patient samples and the samples from the chlorhexidine solutions were most probably related to each other based on the 16S rRNA sequences. However, the individual identities of the specific sample sequences could not be determined using the analyzed region of the gene, possibly due to low quality of the sequences received. No new cases of B. cenocepacia were identified after recall of the chlorhexidine solution, and the outbreak was deemed resolved on March 24, 2021. Conclusions: Medical solutions routinely used in patient care can cause outbreaks and should be suspected as a potential source of infection by infection control teams.

Disclosures: None
Outpatient parenteral antimicrobial therapy (OPAT) in a safety-net hospital: Opportunities for improvement
Authors: Bouzigard Rory , Arnold Mark , Player Jacob , Mang Norman , Lane Michael , Perl Trish , Castellino Laila
Published: September 2023

Background: Parkland Health is a 900-bed safety-net hospital that serves Dallas County, Texas. It has an OPAT program in which patients are managed via self-administration (S-OPAT), home-health/hemodialysis (H-OPAT), and skilled nursing facilities (SNF-OPAT). We evaluated the reasons for unscheduled emergency department (ED) visits by patients in these groups to identify strategies to decrease unexpected healthcare utilization and to improve safety. Methods: We performed a retrospective chart review of all adult patients discharged from Parkland Health on OPAT between April and June 2021. Demographic, medical, and healthcare utilization information, including the date and reason of first unscheduled ED visit after discharge, was collected utilizing a standardized instrument. The institutional review board approved this study. Results: In total, 184 patients were discharged with OPAT. Among them, 32% were female and 55% identified as Hispanic; 41% were non-English speakers, and 45% were treated for a musculoskeletal infection. Among all OPAT models of care, 43.4% were S-OPAT patients, 31.5% were H-OPAT patients, and 25% were SNF-OPAT patients (Table 1). The groups differed, and fewer African Americans received H-OPAT. Also, 45% were being treated for musculoskeletal infections and were more likely to be discharged with H- or SNF-OPAT. In addition, 41% were being treated for endovascular infections and 21.7% were being treated for genitourinary infections. The total length of stay in the hospital was longer for SNF-OPAT patients and shorter for S-OPAT patients (Table 2). Among 184 OPAT patients, 41 patients (22.2%) had an ED visit: 17.3% SNF-OPAT patients, 27.6% H-OPAT patients, and 21.3% S-OPAT patients (Table 2). ED visits were attributed to intravenous (IV) access–related problems (12 of 41, 29.0%), worsening of known infection (3 of 41, 7.3%), and abnormal blood test results (2 of 41, 4.9%). Also, 24 ED visits (58%) were not related to underlying infection or OPAT. However, when examined by the OPAT care model, 41% of ED visits among S-OPAT patients, 20% among H-OPAT visits, and 25% among SNF-OPAT visits were related to IV access issues. Among S-OPAT ED visits pertaining to IV access, 71% were for minor issues such as dressing changes or line occlusion or malfunction. Conclusions: One-fifth of OPAT patients had an unscheduled ED visit, of whom 20%–41% had issues with IV access. Many of these visits could be avoided with enhanced outreach to patients discharged with OPAT and improved ambulatory capabilities to provide standard services related to maintenance of IV access.

Disclosures: None
Contact tracing using a real-time location system in a tertiary-care hospital in Singapore
Authors: Ng Guan Yee , Ong Biauw Chi
Published: September 2023

Background: Densely populated metropolitan cities like Singapore are susceptible to emerging infectious disease (EID) outbreaks. Singapore’s pandemic control measures include running biennial simulation exercises for all public hospitals on EID case management, in which a key assessment criterion is contact tracing. Current methods of contact tracing that involve retrospective review of the electronic medical record (EMR) are time-consuming and heavily manpower dependent, and they fail to capture a significant number of contacts. A real-time location system (RLTS) was accurate and effective in contact tracing. We compared the time taken to perform contact tracing and list of contacts identified for RTLS versus EMR, and we compared manpower and manpower hours required to perform contact tracing for RTLS versus EMR. Then we extrapolated the cost incurred by RTLS versus EMR. Methods: A prospective case study was conducted during a simulation exercise to determine and compare the list of contacts, time required, manpower required, and manpower hours required between RTLS and EMR. The costs of both methods were also compared. Results: RTLS identified almost 3 times more contacts than EMR (Fig. 2) with a 96.2% reduction in time taken, a 97.6% reduction in manpower, and a 97.5% reduction in manpower hours (Fig. 1). RTLS incurred significant equipment cost and therefore might require many contact-tracing episodes before providing economic benefit (Fig. 3). However, its speed and accuracy provided during contact tracing will allow the hospital to quickly isolate potentially exposed contacts, reducing the number of infected people during the spread of an infectious disease, particularly one like COVID-19. Conclusions: Albeit costly, RTLS is effective at contact tracing. RTLS has the potential to be the gold standard in contact-tracing methods of the future, particularly considering the current pandemic.

Disclosures: None
Understanding refugee and immigrant health literacy and beliefs toward antimicrobial resistance
Authors: Ladines-Lim Joseph , Scruggs Elizabeth , Adzemovic Tessa , Croxton Rachel , Romero Ron , Lukela Michael , Mehrotra Preeti , Patel Payal
Published: September 2023

Background: Antimicrobial resistance (AMR) is a global health threat, particularly in refugee populations, due to challenges posed by migration. Little guidance has been provided by public health agencies regarding antimicrobial stewardship specific to this demographic. Studies have primarily focused on encampment areas abroad. We sought to better understand health literacy and beliefs regarding AMR in local refugee and immigrant populations in southeastern Michigan. Methods: From November 1, 2022 to March 10, 2023, we distributed an anonymous questionnaire to adult patients at four primary care clinics in Southeastern Michigan and made it available online. The questionnaire collected demographic information and used 5-point Likert scale responses regarding antibiotic use in children with symptoms of respiratory infection. We binarized the questions and responses to determine whether respondents provided the preferred response and added these to create an overall health literacy score, then used simple linear and multivariable linear regression modeling to identify demographic variables independently associated with the health literacy score. Chi-squared and Mann-Whitney tests were also performed where appropriate. Results: Immigrants and refugees/asylum-seekers from low or middle-income countries (group A, n = 109) were compared to native-born Americans and immigrants from high-income countries (group B, n = 171) with participants from 40 countries (Figure 1). Age distribution did not differ between groups, while group B had generally longer duration of living in the United States (Figure 2). Differences were found in other demographic categories except female gender, with group B reporting higher income, educational levels, and English ability (Figure 3). Simple linear regression revealed that all demographic variables except age significantly correlated with responses (Figure 4). Multivariable linear regression showed that female gender, educational level, and age correlated with greater health literacy, while being in group A trended towards significance with respect to correlating with lesser health literacy (Figure 5). Conclusions: Immigrants and refugees/asylum-seekers from LMICs demonstrated beliefs suggesting deficits in knowledge of AMR compared to native-born Americans and those from high-income countries, independent of other potentially confounding demographic characteristics. Female gender, educational level, and age independently correlated with greater health literacy. These results could inform future patient-centered antimicrobial stewardship educational interventions in certain target populations such as immigrants and refugees/asylum-seekers in the United States.

Disclosures: None
Antimicrobial Stewardship in a Psychiatric Hospital: Opportunities for Improvement
Authors: Rozdilsky Melissa , Bryson-Cahn Chloe , Chan Jeannie , Jain Rupali , Lynch John , Martinez-Paz Natalia , Escobar Zahra Kassamali
Published: September 2023

Background: Western State Hospital (WSH) is an 800-bed, state-owned psychiatric hospital in Washington State which services individuals in 20 counties. WSH provides services and inpatient treatment to patients referred via behavioral health providers and/or the civil court system. Because many patients are admitted with serious, long-term illness, WSH also provides primary care and addresses infectious syndromes encountered in admitted patients. In January 2016, WSH officially began their antimicrobial stewardship program (ASP). In 2017 WSH joined the UW Center for Stewardship in Medicine (UW-CSiM) to grow and optimize their ASP. Methods: The lead pharmacist at WSH participated in weekly hour-long education and tele-mentoring sessions through the UW-CSiM program. Educational materials were adapted from UW-CSiM didactics and delivered to providers during regular meetings and grand rounds. Daily pharmacist led prospective audit with feedback was conducted. Antibiotic use data were collected and measured by days of therapy (DOT) per 1000-patient days from pharmacy dispensing records from 2015 to 2022. Results: From 1/1/15 to 12/31/22, there was a consistent trend of decreasing antibiotic consumption annually. In particular, antibiotic use decreased by over 65% ranging from 35-43 DOT per 1000 patient-days in 2015 to 9-11 DOT per 1000 patient-days in 2022 (Figure 1). This translates to approximately 1000 antibiotic days of therapy in 2015 and 200 days of antibiotic therapy in 2022. As of 2022, the two most common antibiotics used were cephalexin and sulfamethoxazole/trimethoprim Conclusion: Although treating infections is not a principal focus of a psychiatric hospital, patients receiving care in inpatient psychiatric facilities do experience common infections and receive antibiotics during their stay. At WSH, initiation of an antimicrobial stewardship program was associated with sustained decrease in total antibiotic DOT over 7 years. These data highlight the impact of tele-education and tele-mentoring in infectious diseases and antimicrobial stewardship as a path to build a successful antimicrobial stewardship even without formal infectious diseases training. Our single center experience at a large psychiatric hospital demonstrates the use of antimicrobials in these facilities and the opportunity for a large impact of an antimicrobial stewardship program in inpatient psychiatric facilities.

Disclosures: None.
Guide to assembling a successful K99/R00 application
Authors: Michaely Peter , Bielinski Suzette J. , Campbell Kenneth , D’Alessio Franco , Dean Delphine , Earley Yumei Feng , Paine Robert , Salama Guy , Peter Inga
Published: September 2023

The National Institutes of Health’s (NIH) K99/R00 Pathway to Independence Award offers promising postdoctoral researchers and clinician-scientists an opportunity to receive research support at both the mentored and the independent levels with the goal of facilitating a timely transition to a tenure-track faculty position. This transitional program has been generally successful, with most K99/R00 awardees successfully securing R01-equivalent funding by the end of the R00 period. However, often highly promising proposals fail because of poor grantsmanship. This overview provides guidance from the perspective of long-standing members of the National Heart, Lung, and Blood Institute’s Mentored Transition to Independence study section for the purpose of helping mentors and trainees regarding how best to assemble competitive K99/R00 applications.
Systemic Breaches of EU Environmental Law and Techniques of Judicial Engagement with Science: the Underused Potential of Infringement Proceedings
Authors: Eliantonio Mariolina
Published: September 2023

Environmental law has long been an area of concern in terms of correct implementation and enforcement. In this context, the Commission’s enforcement focus has been on “systemic” breaches of environmental law (that is, breaches that form part of a pattern of individual breaches that, taken together, because of their repeated or widespread nature, have a significant effect on the environment). Proving the existence of such breaches in environmental law presents a number of peculiar features, because of the scientifically–loaded questions which underlie environmental legislation. The aim of this article is to relate the established approach of the CJEU towards scientific uncertainty to the specific situation in which the Commission asserts that a breach of EU environmental law has a systemic nature. It will show that, while the CJEU has been sensitive to the systemic nature of the claims brought forward by the Commission by using some of the procedural tools at its disposal, its general reticence to engage with the substantive claims at stake might have the potential to reduce the effectiveness of the infringement proceedings as a tool to adequately pursue systemic breaches of EU environmental legislation.
The Systemic Criterion in the Use of Infringement Proceedings
Authors: Prete Luca
Published: September 2023

The aim of the present contribution is to assess how infringement proceedings under Articles 258 to 260 TFEU have dealt with ‘systemic’ breaches of EU law by the Member States’ authorities. It will be argue that two, or possibly three, strands of case-law appear to specifically concern systemic breaches of EU law.
RADIOCARBON CONCENTRATION IN SUB-ANNUAL TREE RINGS FROM POLAND AROUND 660 BCE
Authors: Rakowski Andrzej Z , Pawlyta Jacek , Miyahara Hiroko , Krąpiec Marek , Molnár Mihály , Wiktorowski Damian , Minami Masayo
Published: September 2023

The article presents results of measurements of radiocarbon (14C) concentration in sub-annual dendrochronologically dated tree rings of English oak (Quercus robur L.) from Grabie village near Kraków (southern Poland). Samples of early wood (EW) and late wood (LW) spanning the years 664–658 BCE. α-cellulose was extracted from each sample and their radiocarbon content was measured at the ATOMKI laboratory in Debrecen, Hungary. The EW and LW data confirm a prolonged increase in Δ14C values around 665–663 as was observed by Park et al. (2017), Rakowski et al. (2019), or Sakurai et al. (2020). In addition, we found that this event may consist of two relatively small events, as was proposed by Sakurai et al. (2020). Based on obtained in this and previous study data we estimate that the occurrence of the two events were between 665 and 664 BCE (Rakowski et al. 2019), and in late spring of 663 BCE (May–June, before beginning of LW formation).
Agency and the Arusha Declaration: Nyerere, NUTA, and Political Discourse in Tanzania, 1966–7
Authors: Bjerk Paul
Published: September 2023

Opening its general meeting on 27 December 1966, the state-sponsored National Union of Tanganyika Workers, known as NUTA, proposed a combative response to a presidential commission's investigation into mismanagement in the union. The union's general secretary also issued an azimio (resolution) that prefigured much of the socialist rhetoric and policy prescriptions that appeared a month later in Tanzanian president Julius Nyerere's Azimio la Arusha (Arusha Declaration) that refined his policy of African Socialism or Ujamaa. Although the NUTA azimio circulated widely and was submitted to the Arusha party meeting, it was excluded from both the record of that meeting and NUTA's own file of related material. This elision happened before its main author, NUTA general secretary Michael Kamaliza, was convicted of treason two years later. The suppression of NUTA's azimio offers a point of entry to investigate the diffuse agency of political rhetoric and the history of Nyerere's influential speech.